2180 (2) I APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
2 P RM N M ER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT 2180 auaolNc
ADDRESS
r
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
NER's - - - _ - PLAN CHECK VALIDATION
NAME
Y DTV. ELECTRIC PERMIT FEE
P...
NAME AcroHs - UTLETS-SWITCHES,RECEP 5.00/1.00
$, 51`Sruc.No. �p0 LIGHTING FIXTURES 5.00/1.00
ADDREADTOR's PPLIANCES-RESIDENTIAL 4.00 -
ADDREEs Qom/ ��(�/�
PNONE rJ'-T W10 PANELS 5.00 DATE OF APPLICATION
A C ITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRAN 3.00
ARC H.RESS ENG, Sp L IR IT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR INS. 15.00 7
Ar'S
ADDRESS NT MOT SEE FEE SCH. Z_ '
SERVICE CHANG 10.00
'02 LICENSED CONTRACTORS DECLARATION _ "
'eu U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N e wy°��/' (commencing with Section 70001-of Division 3 of the Business and BLDG -ELECT. PLG. MECH,
r D �A Professions Co je I n license is in full force nd of a 1. ❑ `1 ❑
oi to G License Class Lie.Numb- u ,�'
F m J Uofe_i ���Z�e�Contract r
BUILDING PERMIT
rz wu OWNER-BUILDER DECLARATION - INFORMATION
w �+o r I hereby affirm that Iam exempt from the Contractor's License MISC.- REFER TO ORD FLLw Law for the followingreason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 6.00 VALUATION S/FT.
Code:Any city or county which requirese permit to Construct,nL,alter,
QS ¢p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEC.
O M requires lire applicant for such permit to file a signed statement that TOTAL PERMIT TO
e w as or he is licensed pursuant to the provisions of the Contractor's License
FZ >
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
a Business and Professions Code)Or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M . the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a; by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN VENT.-WATER IEA.) q,00
of not more than five hundred dollars($500).):
❑ 1,as owner of the,propmty,,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions 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 docs such work FIXTURES-PER TRAP 4.00 $o.FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered for sale,If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1,00 BUILDING USE
builder will have the burden of proving that he did not build or im. RES IND CON Pa Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ 1,as..net of the property,am exclusively contracting with ❑ ❑ ❑ ❑- ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS.1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Convactur's License Law does not apply _
to an owner'of property who builds or improves thercun,and who LAWN SPRINKLERS'-OVER 5(EA.) 1.00
contracts for such projects with•n contructor(s)licensel pursuant to
the Contractor's License Law,' SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec,-,B.&P.C.for this WATER HEATER W/VENT 4.00 -
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
'-WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that 1 have a certificate of consent to self-insure. ZONING
or a certificate of Workers'Compensation Insurance,ora certified ENG.SITE N0:
copy there 1 ec 3 00,Lab.C.). . -
PolicyNo ompany„i-le Al N,� -
O ❑ Ccrlifiedcapyisherebyf nished. FIRESPRINK ENERGY T 24
Z Z ❑ 'Certif isle t fit C Pcoon dlv"ema. REFER TO ORD
O APPIicy=ys.. MISC- . Y C] N❑ Y ❑ N❑
� y CERTIFICATEOF i KFMPT FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.UC.
LU > COMPE SATION INSURANCE PLG.CONTR. LIC.NO, PLG.
C o This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ - N❑
D Z hundred dollars IS 100)or less.)
V O 1 certify that in the performance of the work for which this per DTV. MECHANICAL PERMIT FEE FEE SUMMARY
ly 1- mit is issued,I shall not employ any person in any marine'
so as to
U become subject to the Workeri Compensation Laws of California.
y Dmc Applicant ALTER OR ADD TO MECH. ' 4.00 ;6 BUILDING
} rA NOTICE TO APPLICANT: IL after making this Cen l'icme of Ex-
f- Z emption,you should become subject to the Workers'Compensaliun APPLIANCE 4.00 PLAN CHECK
provisions of lire Labor Code, you most forthwith comply with FEE
V such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10MC.F.M.) 3,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 5.00 SEISMIC,FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ-C.). , 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 state that(lie above VENTILATION FAN (SINGLE) 3.00
0 information is correct.I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILE8-COMP(3H.P.or100,000B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 7
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless (he City of MISC.- - REFER TO ORD.
Cuperto against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 0� CONST.TAX
may 'inn any way accrue against sold City in Consequence of the
m 0f thispermit MECH.CONT. UG NO. MECH,
TOTAL op TOTAL
nature of AppT ant nUa for Date
OFFICE COPY
Citm of Cupertino
10300 Torre Ave March 21, 1983
(408) 252-4505
Ext: 228,229
Thermal Design Systems
441: Aldq la.::a: '':1:•I.
Santa Clara, Ca.
Gentlemen:
After reviewing our files, we find that permit no. 2180
• issued on 7-19-89 for merhnniral
has exceeded the maximum alloted time of 180 days since:
® 1. ) Permit was issued. (Copy sent to Four Phase)
2. ) Last called inspection.
Options for renewal are listed under Sect. 303(d) 1979 Uniform
Building Code. (enclosed)
In order to close our files, your cooperation would be appreciated.
CITY OF CUPERTINO
"John usto
Building Official
JB:JJ
•