13382 (3) APPLIC. =ILL IN INFORMiA T iON Vi CHIN RED LINES - Ut;E E.ALL POINT PEN ONLY
BUI LDI N.,,,,JECT I DENTI FICATION APPLICATION & PERMIT PERMIT NUMBER
i YAt RES
0Sc
1A�J,ness ILALsn`jSJ DYls�s LO?^�
P`r z LBBUILDING -ELECTRICAL-PLUMBING -MECHANICAL 13082
OWNER'S c-0.�c S",/ �-- __7___ - PLAN CHECK VALIDATION
NAME C7^'
1( QTY. ELECTRIC PERMIT E .'.FEE,., 8�
PHONE
CONTRACTOR'S
.- NAME 334685 OUTLETS-SWITCHMSEE
1.00 O y�
(.+s•I sLG �'✓ LIC.NO. - LIGHTING FIXTUR1.00 - /0 3
CONTRACTOR'S pp !/O
_. AoonEss t�[sfGF�tUe�. Bl,) �(w9 "pj - APPLIANCES-RESI4.00
-��GC' f�flrV O PHONE PANELS0.00 DATE OF APPLICATION
ARCHITECT �+ yf. 14L PLAN CHECK FEE P.C.NO.
�( OR CI .rL C T PANELS (OVER 200 AMP) 0.00
ENGINEER E
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG (4./ `I
V
ADDRESS
7]- I U pYIKYGr'V 06iVJ2 - L�. SPECIAL CIRCUITS.QQ ERMIT VALIDATION
/\ { C zIP I51�'/ EMP.METER OR P0.00
APPLICANT'S M I•', n /1
APPLICA 1 9 � MOTORS CH.SERVICE CHANGE0.00Bf 1
--00 0
/
F°O LICENSED CON'I'ItACT01 5 UG('LAI1A'I'ION of Cu 1/f/
au u I hereby..fliers that 1 ,m licen.d Once.......ku ns of Chaplet 1) I-' [[
2 w ISSUANCE DATE
a d (somnlencing with Secs ion 700e i of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
10
F y i Professions Code,onJ my license is in full fume:yOJ r Icph�
z ° m License Class_ Con Number�J-YY.jjlj fit Ind
L r w Date ;f Contractor f`Q,_[,,.J.G,.L l/T. LM
a Ca ertinu
¢_ m w u O Nlai-BUILDER DECLARATION Clty Of /r',;;, BUILDING PERMIT
° MISC.- REFER TO ORD INFORMATION.
X ; y 1 hereby,flan that 1 am exempt from Be,Cmmmnor's License
u O a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT,
- PERMIT ISSUANCE 10.00 .U'�
Code: e,Benny or Countypair any rcquiresature permit priot 0 construct,,also ,IL-
a ¢ a o improve,Demolish,or repair any structure.prior to its issuance,also ELEC.CONTH. LIC.NO. ELEC ] /✓ �
d W m LL 1-pone,the appfic,nt or,.ch lienal to IIIe Y i gnud,ime III a nt that /,f/�,`IJ / 2� 'TOTAL /9L� PIiHMIT TO
he is licensed Pursuant to Be provisions of the Contractor's License C\V,w` -M1]
rz > Law(Chapter 9(commencing Willi Section 7000)of Division 3 of the
Business and Professions Code)or Ihu1 he is exempt Ihrrclrom and OTV:'- "': PLUMBING PERMIT r ,. :1,FEE U
¢ Nm the busts for the alleged exemption.Any violation of Section 7031.5 :'1 - +-'s STORIES TYPE CONSTR.
n ; byanyapplicant farapermit subjects the applicant WaCBLI penally
of nm more than five hundred dollars($500).1: ALTER-DRAIN (E
A.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 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. 5,00
Code: The Contractor's License Law does not apply to in owner of
property who builds or improves thereon,vid Who does Such work FIXTURES-PER TRAP 5.00 ss= -CO.PT.FLOOR AREA Toigt AeaegeE
himself Or through his own employees,providedthat such improve
ments are not intended oroffercd forsale.Il',however,the building GAS-EA.SYSTEM-1INE.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM OVER 4 (EA.)Builder will have the burden of proving that h . - . 2.00 e did not build or int- BUILDING USE
prove Las
ownerose
of sale.)' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PD oma,
❑ 1 as owner of the property,he exclusively contracting with ❑ ❑ 11 El ❑
add Pro coionLCod to The
the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESS ORS PARCEL NO.
add Professions Cole:The Contractor's License Law does not apply ..
to an owner of property who builds or improves thereon,and who - LAWN SPRINKLER .:,Qy, 5 IEA.) 1.00
contracts for such projects with a contractods)licensed Pursuant to _
in,Contractor's License Law. SEWER-SANITARY- T RM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ hum exempt under See,.,B.&P.C.Bur Ibis WATER HEATER W(V ENT 6.00 �p
reason
Owner .. ..- .. . .....
'vote WATER SYSTE .• n 5.00 ,�, - ACC.DATE ACC.FILE NO.
WORK E RS'COEM PENSATION DECLARATION WATER TREATING E I s(t)(IU 5,00
I hereby uffinn tial I have a certificate of consent In all'-imure, -•
r a cert ifncute of Workers'Compensation Imumntt•,or a certified ZONING ENG,SITE NO.
'copy thereof(Sec3800,Lab.C.)
.. ['� J
OI1CYNo,9I61Qj Company -,HGA_RrENJ Now6t4-
0 Cl Certified copy is hereby furnished.
Z 2 ❑ Certified copy is fled WERE-the city inspeclion divisionFIRE SPRINK ENERGY T44
PO Applicant MISC.- REFER TO ORD.I YE] N❑ Y ❑ NE]
CC W CI:RTIFICATE OI7 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LUQ COMPENSATION INSURANCE PLG.coNTH. LIC. 0. PLG. '1 / (/1+
0 to (This section need not be completed if the permit is I'or one Geis,\G 6 TOTAL�qtp Y 13 No Y 13 N E3
O hundred Jullnrs 0100)or less.) 1,,,.-,
I cerlily that in she performance of the work for which this per. OTY. i' }',. MECHANICAL PERMIT., +' ) FEE SUMMARY
LL P- mit is issued,I shall not employ any person in any Banner so as to . ,') - --FEE, '
0 W become subject IO the Workers'Compensation Laws ol'California.
M NOTICE TO APPLICANT: If,after makingthis Certificate of Ex- ALTER OR ADD TO'M C s'
} 0. Date Applicant h 11"5 5.00 BUILDING
I- - emption,you should become subject to the Worken'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must lorthwith comply will,
(J such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT,ITO l0,0Q0C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNI TIO E 10000 C.F.M.) 6.00 SEISMIC FEE 421 7
1 hereby affirm. Has fwB, is a construction leading agency I'or EXHAUST HOOD (WITH D Q (f!UC .00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 11DO •0 B.T.U.) 8.00
Lender's Nameer
Lenders Address H EATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC ,3
( certify that)have read this application and slate lam theabove q I VENTILATION FAN ISINGLE) 4,00
inforI ation is correct. I agree to comply with all city and county
Endimnces and slate laws relating to building comtructmo, and BOILER-COMP
H.P.or 100000 B.T.U.) 6.0 PLUMBING d P6
'�._.' hereby authorize representatives of Ibis city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and p nless the Cil,of MISC.- REFER TO ORD.
Cupertino against liabilities,jullgmel costs Ind expenses which d „ CONST.TAX G G
may in any w' 'ccrue agaipu " J City in emisequame of the PERMIT ISSUANCE 10.00
gmntin• th' pe n' 2/ MECH.CONT, LIC.NO. MECH.
4)CB,_ 3 e /� TOTAL �1p TOTAL f�
Signalu a of Appliean l/Con Hector Dale C'/ICUsK x'$"(�7 6 9
I