2078 (2) APPLICANT TO FILL IN INFORMATION WITHIN,RED LINES — USE BALI_ POINT PEN ONLY
-' PERMIT UMBER
.� BUILDING PROJECT [DENT]FICATION
auILDiNG APPLICATION & PERMIT '078
o-•14+ ScaL�ZxC—
vz ADDRESS ,,p r
1 d.Y.►-��L BUILDING—ELECTRICAL—PLUMBING_MECHANICA
Ovel ` PLAN CHECK VALIDATION
t NAME •{ � OTV. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S
p OUTLETS-SWITCHES-RECEP 5.00/1.00
Z�Il4 s Se_RV, LIC.O."I LIGHTING FIXTURES 5.00/1.00 '
CONTRACTOR'S ,y� .` APPLIANCES-RESIDENTIAL 4.00
ADDRESS \_ n. d���'py� r����/�
L1L.1�{C..�22 fA• (lItbl PHON 6'1 :11,040 PANELS S.00 PATE OF A PPLICATION
ARC HITECir SIGNS 6.00 PLAN CHECK FEE P,C.NO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ADDRESS sea. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
.ZIP TEMP.METER OR POLE INS. 15.00
AMOTORS SEE FEE SCH.
ADDDRESSDRESS
SERVICE CHANGE - - 10.00 rANIE 00oLICF:NSIiD CONT R,\CI'OI1S DECLARATIONPI hereby affirm that 1 am licensed under provisions of Chapter) IE
ma N ICOmmencing with Section 70001 of Division 3 Of the Business and -- B�G. ELEO A PLO. MECH.
F y i Professions Co 11 a license is N full f0 ca J e f c 1AFE `1
z o o — License C a s Lic.Number`s_I N 7�_q_ c u
9 w L w Dale Contractors pp
BE S,
w OWNER-BUILDER DECLARATION CIYy OF' MAT ONIT
E:
3LL H 1 hereby affirm that 1 am exempt from the Contractors License MISC.— REFER TO ORD
u.
H'LL Law for the followingreason.(Sec.7031.5,Bosincesand Professions PERMIT ISSUANCE 6.00 VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter. ��J 1
to Q improve,demolish,Or repair any structure,prior In its issuance,also ELEC.CONTR. LIC.NO. ELEC. J
to
E Or LL requires the applicant for such penuit m file m signed statement that TOTAL
e. w he is licensed pursuant to the provisions Of life Contractor's License PERMIT TO
H z 1 Law(Chapter 9(commencing with Section 7000)of Division 3 of the ,
4 D Business and Professions Code) cr that he isexempt therefrom and DTV. PLUMBING PERMIT FEE
at F o the basis for the alleged exemption.Any violation of Section 7031.5 x STORIES TYPE CONSTR,
u ; m by any applicant for a permit subjects the applicant to a civil penalty .
Of gLTER-DRAIN&'VENT-WATER (EA.) \ C gOksZ
not more than five hundred dollars(4500).1', �. 1
❑ I,as owner of till properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 p�ggp ,yNr
their sole compensation,will do the work,and the structure is not C:J u &7E 3
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 4.00
Code:The Contractor's License Law does not apply to an owner of i^/GG
property who builds or improves thereon;and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himselfor through his own employees.Provided that such improve.. 02 y S T� �•L;i('
meats ore not Intended oroffered for efts.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
or improvement is sold within One year Of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have Ilse burden of proving that he did not build or im-
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 4000 RES IND CON Pa Omer
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct Ilse Profen(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
full Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with it contractorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCEL NO.
❑ l am exempt under See.—,B&P.C.for this WATER HEATER W/VENT 4.00
nelson
Date ' OwI,e, WATER SYSTEM 4.00 ACC.OATE ACG FILE NO.
WORKBRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of consent 10 sel Ginsure, ZONING ENG.SITE N0.
or a certificate of Workers Compensation Insurance,or a cerliticJ
copy lherepf,(S�cQ3A�00 Lab.Y.l. EAR.
Policy No I n
O ❑ Certified copy is herebyfurnisled. FIRE SPRINK ENERGY T-24
Z zO `J�Certi ' d c y Is filed with fee city inspection division. MISC.- REFER TO ORD. v •, N N
A hcant ❑ ❑ Y\❑ ❑
= N CERTIFICATE OF FXEMI"1'ION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIG.NO. - I.G.
CL 0 (Ibis section need not be completed it (lie permit is for Ona TOTAL Y❑ N❑ Y E] N❑
D Z hundred dollars IS 100)Or less.)
U O 1 certify that in the performance of the work for which tills per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as t0
O W become subject to the Workers'Compensation Laws of California. I -O J-0
Date Applicant BUILDING
St. ALTER OR ADD TO MECH. 4.00
N NOl'ICIi TO AI'1'1-(CAN"f: If,idler making this Certificate of Ex-
Fz emplion,you should becomesubject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0MC.RM.) 5.00 SEISMIC FEE a`a
I hereby affirm that there is a construction funding agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance Of the work I'm which this permit is issued(Sec. MICROFILM
3097,Cie C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that l have read this application and sLate lhft the above VENTILATION FAN (SINGLE) 3,00
• inlbnnalion,is correct. I agree to comply with all city and county PLUMBING
ordinances and slate laws relating Io building construction, and BOILER-COMP I3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this 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 keep harmless the City oC MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against said City in consequence of tile
gr' lingo hispernll, MECH.CONT. LIC.NO. MECH.
/ it q orAL TOTAL 3� dm
/� Signa are of pideurl/Co ONIet., Cl �-
'� OFFIC@ COPY -
• Cites of Cuperti»o
10300 Torre Avenue P.O. Box 580
Cupertino, California 95014 Cupertino,California 95015
Telephone: (408) 252-4505
DEPARTMENTOF PLANNING AND DEVELOPMENT
February 1, 1984
Mr. Lee King
10741 Santa Lucia Road
Cupertino, California 95014
Subject: Roofing Permit No. 2078 - 10741. Santa Lucia Road
Dear Mr. King:
In accordance with the subject roofing permit No. 2078, the Building
Division inspected the final installation of the roof to ordinance
requirements and found said installation to be consistent therewith.
• The subjective area of quality workmanship is not a code requirement,
therefore, the building inspectors do not exercise judgment in those
matters.
I hope this information will be helpful to you.
Sincerely,
CITY OF CUPERTINO
James H. Sisk
Building Official
JHS:pc
•