6509 (3) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FIC.. . JN PERMIT NUMBER
BUILDING APPLICATION & PEh1v11T 65 0 9
ADDRESS
20045 Stevens Creek Bldg.��2 1stOREss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NAMERa Fre erick Petri, George X
PLAN CHECK VALIDATION
• Somps, Frank Bilbao PNCC( 15)948-78 CONTRACTOR S
;.
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
*. -Tr
LIC.No. LIGHTING FIXTURES 5.00/1.00
CONTRACTORS
AppREas /3Q3 /CKIq✓e `✓ APPLIANCES-RESIDENTIAL 4.00
4/ 4 Cn C^n Ant nnin Re1�E�g � PANELS 5.00 DATE OF APPLICATION
OPRCHrtECT SIGNS 6.00 PLAN CHECK FEE .C.NO.
ENGINEER Ray Rooker
UC NO SIGNS TRANS. 3.00
ADDDRRE°ss ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR PO IN 6.00
APPLICANT'S
ADDRESS 1303 Lick Ave. Morons ECH.
l� v
Sprig Electric Lng-mg-gl ,;ILSERVICE CHANGE 0.00
(
I Woo LICENSED CONTRACTORS DECLARATION "� �O/ S
<u Fox UUVGI 11111.
U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a < i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F y i Professions CQt4:,1.01 my license is in full 102"(M-I. ❑ ❑ ❑
zw o License Class_ Lic.Number jul. i985
w
Date 7-17-$- Contractor prj
i s¢ OWNER-BUILDER DECLARATION co of GUP
i ;' r 1 hereby affirm that I am exempt from the Contractor's License MISC.- OFIRR TO ORD '^
u O¢ Law JOT the followingPERMIT ISSUANCE VALUATION
reason.(Sec.7031.5,Business and Professions S/FT.
mar Code,Any city or county which requires a permit to construct,alter, 6.00
u ¢ ¢ 00 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
L m LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
i w he is licensed pursuant to the provisions of the Contractor's License -
zi Law(Chapter9(commencingwi(h Slction7000)ofDivision3oftheE
P ¢ o Business and Professions Code)or(hat he is exempt therefrom end try
the basis for the alleged exemption.Any violation ofSection 703 L5 +, ;, " yy➢`„ :fn STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant penalty
of not more than five hundred dollars(1500).): ALTER-DRAIN&VENT-WATER (EA.) 4.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2,00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES,UNITS
intended or offered for sale (SVC. 7044. Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,GOND. 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 FIXTURES-PER TRAP 4.00• gD,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenetintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00 -I
OF improvement is sold within one year of completion,the owner-
builder .will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDI G USE
prove for purpose of sale.). RES INN PB Omer
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 1-1 01
licensed contractors to Construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 5.00 ASSESSOR PARCEL NO.
A 13
and Professions Code:The Contractor's License Law does not apply V.B.
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with a contractoos)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/6.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C,for this
reason WATER HEATER W/VENT 4.00
Owner Date WATER SYSTEM 4.00
ACC.DATE Ace FILE No.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
[op bl` 98% ')Citation Insuranc
Poli n p y
O ❑ Cenifed copy is DIM hed.
FIRE SPRINK ENERGY T-24
P2 AppCert i y it fly elYion division.
licant - MISC.- REFER TO ORD. Y❑ N❑ Y C] NE
fLy
CERTIFH,AJ 3 FEXEMPTION FRO ORKF-RS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
Lu C F.NSATION INSURA PLG.CONTR. LIC.NO. PLG.
1 O (This section need not be completed if the permit is for one TOTAL Y[3 NE] Y N�
Z hundred dollars 1$100)or less.) 11 4da rM s -rte, y;e +,• 1 �y
C.7 O 1 certify that in the performance of the work fur which this per �Er
, �
LL 1- mit is issued,I shell not employ any person in any manner so es to tJ ry -�
Q
W become sulnect to the Workers'Compensation Laws of Calimmia.
CL Date Applicant ALTER,OR ADD TO MECH. 4.00 BUILDING
} rn NOTICE TO APPLICANT: If,after making this Certificate of Es-
F. Z empDon,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
Provisions of the labor Code, you must forthwith Comply with
U such PIDVomm or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING LINT(OVER 10p00C.F.M.) 5.00 SEISMIC FEE
1 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.1. B JF p£ Ij a HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Namt 44 agEreni er ,�5 HEATING UNIT 100,000B-T.U.)7.50 ELECTRIC
Lenders Address 61.00
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
• information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-CObP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP over 100,000 BTUI SEE FEE SCH. MECHANICAL
hereby Dth.riF Property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino again 'abilities,judgments,costs and expenses which
may in any true against said Ciiy in consequence of the PERMIT ISSUANCE 3.00 CONST.TAX
man[in oft cr MECH.CONT. LIC.NO. MECH.
TOTAL
Signa ure of Ppb nati-ontracpf Date
OFFICE COPY