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4571APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALLPOINT PEN ONLY BUILDING PROJECT lDENTIFICATION APPLICATION & PERMIT UI LDING - ELECTRICA L- PLUMBING -MECHANICAL PERMIT NUMBER e A �� J BUILDINGr{ AooREss 70 f�7eo LA2e, OWNER'SPLAN NAM / % PHONE r0 -• OTY. ELECTRIC PERMIT FEE CHECK VALIDATION ' DATE OF APPLICATION ' corarRAcrORs (CICS ti?QF tj� uc. No. 9%8-"7& UTLETS-SWITCHES -RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 corvTRacrOR'r ReY/PHONE. 1-L 6'51 xo) APPLIANCES- RESIDENTIAL 4.00 PANELS 5.00 ARRCHITECT ENGINEER uc, No, SIGNS 6.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESOR ENOS - SPECIALCIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 15.00 ZIP A ADOR E DRESS ss MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 LIC17NSED CONTRACTORS DECLARATION 1 (�� ��� 9DR I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 orfythe Business and Professions`od nit en Lies in full fora (- License lass Lie. Numb / Date Contrac[or �f ItY/J ISSUANCE DATE BLDG. ELECT. ❑ PLG. MECH. ❑ ❑ BUILDING PERMIT MATION OWNER -BUILDER DECLARATION I hereby affirm that rum exempt from the Contractor's License Law for nilia ity Director wliichec.7tiresa Business and Professions 1 oconsuanLalter, improve, demolish, or repair any structure, prior n its issuance. also Cprosc. ycityor cooralmir ny Structurep prior Ser vires Ilse applicant for such permit to filen rigout actor's of that License hu is licensed pursuanten the provisions of the 7000) of Law fChand Professionsand nCode) or Sectionnisevemf Dtherelronanc li,a bass and Professions Code) or that he is exempt Ihcrc MISC.- REFER TO ORD VALUAT N �/ O (Vy1i7 $/FT. PERMIT ISSUANCE ELEC. CONTR. LIC. N0. - ii, EC. . TOTAL PERM o Ci6? �ES •l`�I OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. n 70 the basis for fhc alleged exemption. Any violation of Secl ion 7031.5 by any applicant for a permit subjects the applicant On civil penalty of not more than five hundred dollars (5500).1: A' M6,0. rf� ALTER -DRAIN -WATER (EA.) 4.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS . M /.�/ S DRAINS -FLOOR, ROOF, AREA,COND. 4.00 Code: 'The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedorofferedforsale.If, however, the building FIXTURES - PER TRAP 4.00 s0. FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SVSTEM-l1NC.40UTLETS 4.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that. that he did not build or im- prove for purpose ofsale.). ' ❑ 1, as owner of the property, am exclusively contracting with . GAS - EASYSTEM -OVER 4 (EA.) 1.00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 20.00 licensed contractors 10 construct the project (Sec. 7044, Business Unit Professions Code: The Contractors License Law does. not UPPly to an owner of properly who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ISEWER-SANITARY-STORM EA. 200ft/8.00 TRACT NO, PARCEL NO. ❑ I um exempt under Sac.-, B.&P.C. for this reason WATER HEATER W/VENT 4,00 Date _ Owner WATER SYSTEM 4.00 ACC.DATE ACC. FILE NO. WATER TREATING EQUIP. 4.00 WORK ERS'COMPENSATION DECLARATION T hereby affirm that I have a certificate of consent to self -insure, or a cartificate of Workers Compensation Insurance. or a certified ZONING ENG. SITE NO. copy thercof(Sce. 3800, Lab.C.).� �= n21Lt Policy No. Company 1 ❑ Certilie opy is hereby furnished. ❑ Ce r Le pY S Ele tha city my action division. Applican - FIRE SPRINK v ❑ N❑ ENERGY T 24 v ❑ N❑ MISC. - REFER TO ORD. CI7RII F-ICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD zorvE A.Cu.c. COMPIiNSAT'ION INSURANCE: IThis'secti(n need not be completed if the permit is for enc v ❑ N ❑ v ❑ N ❑ PLG. CONTR. LIC. NO, PLG. TOTAL hundred dollars IS 100) or less I ' I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING fZ hCC011lC subject to the Workers' Compensat inn Laws of Calltornia. Date Applicant NOTICE TO APPLICANT: If, after making this Cerlil'ic:ne of Ex- ALTER OR ADD TO MECH. 4.00 APPLIANCE 4.00 PLAN CHECK FEE emption, you should become subject to the Workers'Contpensatiun provisions of the Labor Code, you must forthwilh comply with such provisions or this permit shall be deenied revoked. AIR HANDLING UNIT (TO 10,000C.F.M.) 3.00 AIRHANDLING UNIT(OVER 10=C.F.M.15.00 SEISMIC FEE xS 71 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2,00 De performance of the work for which this permit is issued (Sec. 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)7.50 ELECTRIC I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING 130ILER-COMP(3H.P.or100,000B.T.U.) 4,00 BOILER -COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon (h° abovrmentinned property for inspection purposes. e) ugrt save, indemnify and keep h;unulcss the City of Cupertino again "' s, judgments, costs and expenses which )nay In at ey nett u6 inat said City in consequence of the MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 3.00 gral fail perp I. _3 _� MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Si eat are ol'Apph hart/Contractor Dee OFFICE COPY IF ' DICK'S ROOPNG �O November 7, 1983 cr CupertinoBuilding Uept.i. - 1 •�'•.!�I. i� `o i �.� , Re: Mr. and Mrs. Bor'nNOV T 1983- 'e i! 7970..Woodlark way ; BCDO.rINSPECTI0N;0EPARTMEK Cupertino, Ca. o' ' CITY 'OF I CUPERTINQ" ' '� •. ,;,� is •i i. r Dear Sirs/ Madams: 0 d' As of today we have replaced all the sheating.,tioard that, `O were cracked or broken.cc !••� I; Sincerely, %q'.il•, Rick Pisano I' _ Lr) President ' O o RP/jct , it COIF I i'