15137 (4) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON PERMITNUMBER
aaILOING APPLICATION & PERMIT 15137
AOORESS'�'�666 PAALM SPRING COURT
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
NAME Greor Group n�I❑fl1' R QTY PLAN CHECK V A L(DAT ION
Ahmans8n 6eV. Pi2g'595-2100 ELECTRIC PERMIT FEE
• CONTRgCTOP$ '
NAU"regory Group, Inc. B-430097 OUTLETS-SWITCHES-RECEP 10.00/1.00
LiC.NO, LIGHTING FIXTURES 10.00/1.00
gpNTRAcroR's` - Wln 0 p In r. PPLIANCES-RESIDENTIAL 4.00
94065 415�9-2100 PANELS
10.00 DATE OF APPLICATION
""`HITELT Aram Bassenian, AIA &
OR,A PANELS (OVER 200 AMP( 20.00 PLAN CHECK FEE P.C..NO.
ARCO sociates LQ;„$395 SIGNS TRANS.
3.00
ARCO On n' Oop31 Gha Dr• PERMIT VALIDATION
q°DRE�anta Ana H� E�_ //10 SPECIAL CIRCUIT s.00
5 S. ZIP�27D7 EMP.METER OR POLE INS. 20,00
APPLICANT'S
ADDRESS 220-C Twin Dolphi WC MOTORS SEE FEE SCH. ?14-'e
SERVICE CHANGE 20.00
102 LICENSED CONTRACTORS DECLARATION
ri W I hereby affirm than 1 am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business,md ISSUANCE DATE
H H 2 Professions Code,unrA my limns¢is'in lull fmc•'n fleet. • (J ^ BLDG. ELEECCT. IP LAG. MEECCIR.
z o T - License Class D Co.
Number I^� 1�1 t6L 11�t
,��_w Dale oUactor_ T{ ,�(
Q Y Ct Ali UI
R 0 w OWNER-BUILDER UILDBR DECLARATION Y Cupertino BUILDING PERMIT
R
;a H I hereby affrm than 1 an esempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
H LL o j Law for the following reason.ISec.703 LS,Business and Professions PERMIT ISSUANCE VALUATION $/FT.
2w>� Code:Any cityorcounty which requires a permit to construct,alter, 10.00
O improve,demolish,Ur repair any s[rucmre,prior f0 its issuance,also ELEC.CONTR. L¢.N0. ELEC. 185,865
n w m S, requires the applicant for such permit to file a signed statement that TOTAL
he is licensed pursuant to the provisions of the Connrnctoi s License PERMIT TO
HZQLaw(Chapter 9(commancing with Section 7000)ofDivision 3ofdtc SFDU
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
I m the basis for the alleged exemption.Any violation of Section 7031.5
U, ;_ by any applicant fora Permit subjects the applicant[oucivil penaltyML
- STORIES TYPE CONSTR.
of not more than five hundred dolWrs tS500)1: AINSt VENT-WATER (EA.) 5.00 2 SNHR
eaz owner of the propertyor my employees with wages asW PROTECT.DEVICE 4.00their sole compensation,will do the work.and the structure is notOCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044. Business and ProfessionsOOR,ROOF,AREA,COND. 5.00Code:The Contractors License Law does not apply to an owner ofR-3property who builds or improves thereonand who does such work -PER TRAP '00himself or through his own employees,provided that such improve- $a.FT.FLOOR AREA TOTAL ACREAGE
mems are not intended or offered for SaleI L however,the buildingSTEM-1 INC.4 OUTLETS 6.00 2917
or improvement is sold within one year of completion. the owner-
builder will have the burden of proving that he did not build or im- YSTEM-OVER 4 (EA.1 2.00 Bw LOING_USE
Prove for purpose off the . INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON PB Omer
❑ L as owner M the property,he exclusively contracting with Icy ❑ ❑ ❑ ❑
licensed contraz[od to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 1�•
and n owner ns property
The Contractors improves
Law does not apply ASSESSORS PARCEL NO.
co an owner of property who builds tr improves nsedon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 / 9
contracts for such pmjl:cns with a contruc[od sl Iicenaed pursuant no tl 6- -�l LD-)
the Contractor's License Law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
❑ ]am exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00 8098
Owner Uwe WATER SYSTEM 5.00
ACC.DATE ACC.F LLE NO.
WORK RS'CO.NPEM1'SAiION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affrm [list I have a certificate of consent to self-insure.
or a certificate of Workvs'Compensation Insurance,or a certified 20NING ENG.SITE N0.
copy[hereof(Sec.3800,Comp Pth iced PaC1f1C_
Policy N rt Co hereby
1 I
O � Certified copy is hereby furnished.
Z 2 OC Cert ified copy 1 lh [he Lily inspection division. FIRESPRINK ENERGY T.24
� O
Applicant - � MISC.- REFER TO ORD. YF] NE] Y (] N[]
= D CERTIFICATE OF EXEh1 PTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.D.
IU > COMPENSATION INSURANCE PLG.CONTR.
Q. Cl LIG NO. PLG.
Z (This seam[ need not be completed if Ne.permit is for enc TOTAL Y❑ N1 Y No
UO hundred icl,tdollurt(51001 pe less.(
I is issued,
that h the performance pens work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
0 U mit is issued,I shall not employ any person in any manner so is to
Datebcso' a subject n0 the Wlicant Compensation Laws of California.
y DOL ICANI: I ALTER OR ADD TO MECH. BUILDING
} w NOTICE TO APPLICANT: If,after making this workers'
Compensation
mpe of iEx-on 5.00 940.5
Z aovisio,you Should become subject m the Workers'CComply w ith APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you must forthwith Comply with FEE 15.5
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY MCONT, LIC.
NDLING UNIT(OVER 10=CF.M.16.00 SEISMIC FEE
I hereby affirm that 0®re is r construction lending agency forUST HOOD(WITH DUCT) 5.00 13.
the Perlormance of the work mr which this Penni[is issued(Sec.
3097,r'sNa . e urit / Pac- 'C ING UNIT(T0100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Addie m-_ ING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC 70.3
I certify Than l h4 erect Nn application and state that the aboveILATION FAN (SINGLE) 4.00
into
is correct 1 agree to comply with all city and countyPLUMBING 70•3
• oNirnmeas and cute laws relating m building construction, and -COIVP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes, R-COMP (Over 100.000 BTUI SEE FEESCH. MECHANICAL
(We) agree to save, indemnify and keep brimless Nc City of - REFER TO ORD. 0.3
Cupertino against liabilities,judgments, costs and expenses which
may in any way accrue against said City in onseyuenee of WeIT ISSUANCE 10,00 CONST.TAX
ranting of this permit _ /_ /f LIC.NO. MECH.
' TOTALSignatureofAppl¢ant/ [tractor amTOTAL s
OFFICE COPY