6509 (4) Vi APPLICANT TO FILL IN INFO ATION WITHIN RED LINES'.='USE;BALL POINT PEN ONLY
BUILDING PROJECTADENTIFIC N sI PERMIT NUMBER
BUILDINGAPPLICATION & PE IT
A20045 Stevens. Creek.'Bldg.#2 IstF DDRESS BUILDING=ECECTRICAC-PLUMBING-MECHANICAL 6509
. COINEDs Fre erick';Petri, George - - - PLAN CHECK VALIDATION
NAMTY. ELECTRIC PERMIT FEE
Somps, .Frank Bilbacl poo(/ I,S)948-78
NAMECONTcroRs 'S,�Rr� L2gz � UTCETS;,SWITCHE&-RECEP .5.00/7.00
NAME
,+ .LIGHTI
uc.No. NG FIXTURES •5.00/7.00
. .
AfA55Ss Cj^3a3ATLsoK ✓e•/+,��yLv'r� �,�,�.
PPLIANCES'-RESIDENTIAL 4.00
Yn RvUrvE•
TW'�`JY LO PANELS ^ 5.00 - -' TATE OF APPLICATION
- ARCRrtECT - SIGNS" 't ., 6.00. PLAN CHECK FEE P.C.N0.
(ENGINEER r
k
Ra Rooe ,
y _ LIC.No. i SIGNS,.TRANS.. �,
AARC On DDRESS ENC :r SPECIALCIRCUIT *io6,00 • PERMIT VALIDATION
• zm4 EMP.tMER OR ETPO IN_S. 15.00 '
" APPUCANTS MOTORS . SEE F CH.
ADDRESS 1303 Lick .Ave'.
'Sprig Electric _ SERVICE CHANGE
00 . LICI: SIA)CONTRACTORS DECLARATION-
Ni
< U U I hereby uffirm'thut I•am licensed under provisions of Chapter 9 r - - ISSUANCE DATE
H G N (commencing with Section 7000)of Division 3 of the Business and RLOG. ELECT. - PLG. MECH.
r w z. I'rolcssions C(itL:.Ii UI my license iv in full fnl�(��d7,.gl'B.I. t ,• t „ •''� I n. ❑
} O -.., License Class - Lic.Number ❑ ❑
o
Date_7=1_78$-Contrucho_$pLlg-r
w H o
E - - , PERMIT
¢ o n - - OWN(It BfIILDI:R UPIO
CLARAT N- MISC + • RTO ORD INFO MATION
w 3 r -I.her`by all nn th
11n1 I am exempt from e C l tot's Luen L - vALUAT I OIN - $I FT.
F .. o j: L w I.,the I'ollowl g eaatim m
(Sec 7031 5.Business aI d Professions 77F_ -MFT pERSSUANCE 6.00 Ib UU
� yw Code.Any city or county which m9uiresa permit m construct,alter, - " '• '
EE Q,Q LO improve,detnu]Nh' n r pair any stmd,loc,poor to IR Issuance also, ELEC.CONTE V LIC NO
it
T ¢ requires the applicant for such permit to Ole a smgneil statement that TOTAL PERMIT T0.
n w m he is licensed pursuant to the provisions W the Contractors L'ecnseT71
i Law(Chapder 9(cummencingw•ith Sectwmm7000)of Dmvmslon3'ofthe.
BCL(-�
usiness and Professions Code)or that he is exempt therefrom and; QTY. PLUMBING PERMIT FEE +
the basis for the alleged exemption.Any violation of Section 7031.5, ".� STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivilpenally' „ALTER-DRAIN&VENT-WATER (EA.) 4.00
01 not amore than'five hundred dollars(S5000.)
- _
'❑ I,as owner of the property,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,strueture is not ,•
in ended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Cndc The Contractor',License Luw does not applyfo un owner ol, - "
Properly who builds or improves thereon,and who does such work. FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA -TOTAL ACREAGE
himself or l hrougt his,..it employees,provided that Sueh mmproL _ GAS-EAI SYSTEM-11NC.40UTLETS 4.00
I • mends are not intended or offered for sale IL however,the holding s .m
•
or Improvemmml is sold within one year of completion,the owner. - GAS-EA:SYSTEM-OVER 4(EA.) . 1:00 - RUILDI G USE
builder will have the burden of proving Our he Jtd not hold or am,'
Prove lar purpose of,ac.). - INDUSTRIAL WASTE INTER_. 20.00 •RES IND •' N Pa Omer
❑ I,as owner of Ole property,am exclusively contracting with - ❑ ❑_ ❑ ❑
l ivansed contractors o construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 . ASSESSOR P RCEL'NO..
Still Professions code:'The Contractor's License Law does not apply '
Io in owner of property who builds or improves thereon,and who _ LAWN SPRINKLERS-OV ER 5(EA.) 1.00 .,.
contracts for such projects with a contracmons)licensed pursuant to
the Cdntractur's License Law. SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT NO, PARCEL NO.
"❑ I
on exempt under See. '-,ILAP.C.for IN, WATER HEATER W/VENT 4.00 ' '
rcasan
Owner Rate WATER'SYSTEM 4.00 ACC.GATE ACC.FILE NO. ,
WORK I iRS'COM PENISATION RRCLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers' ompensation Insurance,or a ce7til'icd
` {;I�? b �°'I Citation Insurail�
i pt y
O' ❑ Certil' copy is niched. FIRESPRINK ENERGY T-74
ZZ .`{I,Carl 'i• if
'ty � ' cati�n,division. MISC.= . ' REFER TO "
O Applicant_. _ - V❑ N❑' V ❑o N❑ -
W CER'I'I FICA' i P Ex MM ON FRO I ORKERS' - PERMIT-,ISSUANCE " - 6.00 FLOODZONE A.L.U.C.
W > C( PdxSAT'DON INSII2A - A. PLG.CONTE. - LIC.NO. PLG.
C O (This section reed'net be permit is For one - ` T
completed if,the pOTAL Y❑ 'N❑ Y ❑' NE]
Z) .hundred dollars(S100)or less.I T -
U O ,I certify that in the pr:dormance.uf ile..,it for which this per- GTY.' .MECHANICAL PERMIT - FEE FEE SUMMARY
IL I- mil is issued,I shall not employ any person in any manner sn as to .
U become subject to tBC Workers Compensation Laws of Caliionda,
0 y Date Applicant' .. ALTER ORiADD TO MECH. •4,00 BUILDING
} to NOTICE TO APPLICANT': If,after making this Certificate of Ex,
F Z caption,you should become subject tit the Workers'Compensation 'APPLIANCE 4.00 PLAN CHECK
REvisions
provisions
of me Labor Code, you must forthwith comply with FEE
U
'Dell or this permit shall be deenmed revoked. AIR HANDLING UNIT(TO 10,000C.F.ruL) 3.00
CONS'IRUCI'IONLENDINCACENCY AIR HANDLING UNIT(OVER 10p00 C.FM.) 5.00 SEISMIC.FEE
I hereby affirm that there is'a coriatruction lending agency for EXHAUST HOOD(WITH DUCT) ' 2.00
the p,if arnmoace of the work to,which (his permit is issued(Sea MICROFILM? '
3097,Civ.C.). �1'me C - HEATING UNIT(TO 100,000 B.T.U.) X4.00 •- '
Lender's Add 18�,gr&&enT2r-Pta Z3�: HEATI NG UN IT(OV ERA 00,000 B.T.U.)7.50 -
Lender'slxamcss ELECTRIC 61-.00
Icertify flim l have read thisaplib"fion and state that theabove VENTILATION FAN (SINGLE) 3.00 •'
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building consvuaion, and BOILER-CONT(3 H.P.Ti 100,000 B.T.U.) 4.00
hereby authorise representatives of this city to enter upon the
above-mentioned property for inspect ion purposes. BOILER-COMP(Over 100,000 BTU(SEE FEE SCR. MECHANICAL
(We) agree to save, indemnify and kcgp.harmlcss the City of MISC.- ',REFER TO ORD, '
II' Cupertino agajns idailities,,judgments; costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX '
may ananytrue against said City in consequence of the
gratin of t er iL - MECH,CONT. LIC.NO. MECH. '
7-! - TOTAL. ITOTAL
III'. 'Signa are of ppli nt/Conlrac Date -
' OFFICE COPY