6525 (4) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTI FICATION APPLICATION & PERMIT PERMIT NUMBER
ADDRESS Suite 206 6525
nmaREss BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
20045 Stevens Creek Blvd
OWNER'$ { - 4r. PLAN CHECK VALIDATION
NAME Frederick Petri, George ' -w::� v _ `
4=1
'ELEGTRIC;PE d B`
So
Frank Bilbao P(6l5)948-784 ' •- 'i�a?; 52 #A5 g� sr' 22
NAMECONTEncroes 6 - UTLETS-SWITCHES-RECEP 5.00/1.00
Sprig Electriam.ND. 296728-CIO LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
1303 Lick AVE PHONE 298-3134 PANELS 5.00 DATE OF APPLICATION
OORRCHrtECT SIGNS 6,00 PLAN CHECK FEE P.C.NO.
ENGINEER
Ray Rooker LIC.NO. SIGNS TRANS. 3.00
nnoeeOR sS ENE. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00
APPLICANT Sf
MOTORS SEE FEE SCH.
ADDRESS ( �("L`• r
1303 Lick Avenue S.J. 9511C SERVICE CHANGE 10.00
o¢ ZI
Foo LIC ENSED CONT RAM ORS DECLARATION
a u I hereby acorn that 1 am licensed under Provisions of Chapter 9 ISSUANCE DATE
N Z ta Icommenemg with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
N i 1'm(essions Code,and my licensn is is full force and effect. O ❑ ❑ ❑
zo,., License Clam_- Lia Number
0 Z F w Dalc_-. _ Contractor
BUIL.01 ERM
a o a a OWNER-BUILDER DISC1.nRA nor.' ,'-�/�.-.,',{yr}g4'INFORMATION ?
I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
o J I,aw for the following reason.(Sac.7031.5.Businessand Professions PERMIT ISSUANCE VALUATION §/FT.
Code:Any city or county which requires a permit to construct.alter,
6.00 -
C2 Q O Itttprove,demolish,or repair any struc Wre.prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. ftp
wO¢ requires the applicant lm such permit to file asigned statement that 5' rl Electric 2967280 67TAL �YTfVV PERMIT TO
m h Is licensed pursuant us flue provisions of the Contractor's License
-i Lw(Chapter 9(commencing wthS t' 7000)ofDivision3ofthe
I -- s asa< 5'-n- t a[
z o Bu iness and prm'cseions Code)o that h exempt therefrom d IQTV! pf$,faP':PLUMBING PERMIT "wwrrd's 1�I
$XFEL t
¢ F a the basis for the alleged exemption.Any violation of Section 7071$ �-;tot .R*n .•.pir�',..,,?h v';y+(,1� rF+t STORIES TYPE CONSTR.
ibyanyapplicant for a permit subjects the applicant to a civil penalty
ofnot more Iran five hundred dollars(S5001.): ALTER-DRAIN&VENT-WATER (EA.) 4.00
I'1 1,as owner of the property.or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00GCC.GROUP RES.UNITS
hit ode compensation,will do the work,and the woelure is notLncnded or offered for sale(Scc. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner ofproperty who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00SG.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mems are not intended or offered for sale.If.however.the building GAS-EA,SYSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Orion
for purpose of sale.). INDUSTRIAL WASTE INTER. 2p-00
❑ I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ 0 ❑
licensed contractors to construe( the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:T'he 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 fur such projects with a contractors)licensed pursuant to
I lac Contractor's License Law. SEWER-SANITARY-STORM EA.200108.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.Cor this WATER HEATER W/VENT 4.00
reason
Owner - Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certiftcale of consent to self-insure. ZONING ENG.SITE N0.
or a cerfilicate of Workers'Compensation Insurance,or a certified
coy Pt5635 ° mP�Y Citation Insuranc
O ❑ CerRlied D yis herchy famished ("' FIRESPRINK ENERGY T 24
_Z Z IX Cer d py is filed with I cit / ctiu iv'ioa MISC.- REFER TO ORD.
D Applicant_ I /LCs Y C) N E] Y [] No
~ va PERMIT ISSUANCE 6.00
� - CIi R'I'IIICA'f F,O NI A iION INS FROMNCE . ERS' FLOOD ZONE A.L.u.C.
W COMPENSATION INSURANCE PLG.cONia. LIC.rv0. PLC. YE] N❑ Y E] N�
� Z 1 I his section need not be completed if the permit is for an TOTAL
hundred dollars($100)or less.) :ken
U O I certily that in the performance of the work for which this per-
LL
er IL 1- nail Is issued,1 hall not employ any person in anymanner
Q w home subject to the Workeri Compensation laws of Califomaa.
D_ Dam ApplicantALTER OR ADD TO MECH. 4.00 BUILDING
>_ N NO'T'ICE TO APPLICANT: IL after making this Certificate of Ex-
F 2 emption.you should become subject to(he Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=41F.M) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVEA 1O=C.EM) 5.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the 3097.Performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
Lender's Name +nYa�k-Qfr,f'M1 1;;141...., e
Lender's NamAides ��11z -Y-�'-" HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC 0!!-
I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00
information is correct. 1 agree to comply with all city and county BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP Iowr 100,000 BTUI SEE FEE SCM. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to Stve, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, Costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue ag LRst said City in eonseque a the
ting this permit MECH.CONT. LIC.N0. MECH. c
TOTAL
n
.real Applica 1/Contractor Dfit, s�:.'$•`31:`.a--. a
OFFICE COPY