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13284 (3) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATIO PERMIT NUMBER u,,,L ,NG 8- APPLICATION & PERMIT ���� AUIL IN An q ' s- '�fIS '.PYP.. ILDING - ELECTRICAL-PLUMBING -MECHANICAL " MAR'S PLAN CHECK VALIDATION NAME DTV. ELECTRIC PERMIT FEE �..C�,JCirnN/O \" • HNMTR TORS 3A OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 RONTRACTORS PPLIANCES-RESIDENTIAL 4.00 AO9 Ess � L6�X a PrNNE PANELS 10.00 DATE OF APPLICATION ARC TECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR SIGNS TRANS. 3.00 Ic' aoDfleSS RR. Enc, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zip TEMP.METER OR POLE INS. 20.00 APP ICA TS MOTORS SEE FEE SCH. L'�i- J_• . 11 SERVICE CHANGE 2000. �,'L'4f \I`I T woo LICENSED CONRACITIRS DECLARAfION ���' 11 •� IJJ.) < u U, I hereby atino that I ant lieenxd under provisions of Chulmer 9 ISSUANCE DATE P. femnmencin,with Section 7000)of Division 3 of the Bminesa and Q 6 E�.�'�T PLG. MECR. r N i I'ruressiom Coda,reed O 0t en>e•is in full ILrs'�T z y mOy¢mW wu License Class LicTrial =s lon.Nmnb4J•,/�(L��t/ylarf -'"- BUILDING PERMIT Dine �O�� OWNER-BUILDER LHCL(A ❑ .INFORMATION Es. 0 n t- I hereby allunt (hut 1 ant exempt Ilam the Contractor's License MISC. - REFER TO ORD ,a 3 VALUATION 5/FT. F U0< Law for the folluwingreawn.(See 7031.5,Busawssaudl'mlessiooa PERMIT ISSUANCE 10.00 r/ Code:Any city or county which requires permit loconurucl,al(er, to its ISsaan CC,slur ELEC.CONTR. LIC.N0. r, _ ¢ ¢ QO ihnprovc,damolish,or repair auy Stnmprc,Prior ELEC. requires the applicant For seen permit to the a signed swoopent(hal TOTAL PERMIT TO >< S he is licensed pursuant to the pnoroon>of the Con«uator',Licenso _ w 'i Law(Chapter Y(commencing with Section 70000of Division 3 of the r < Business and Professions Code)or What he is exempt Therello ll and CITY. PLUMBING PERMIT FEE Q F o the basisfor lire alleged excngniohr.Any violation of Section 703 t,5 STORIES TYPE CONSTR. n ;m by any applicant fm a pernot subjects the npplicann Ina civil ponally ALTER-DRAIN& VENT-WATER (EA.) 5.00 afoot more than five hundred dollars($500E): ❑ I,as Owner of Elie property,or my croldoyce,will wagro as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP HES.UNITS (heir sole compensation,will do the work,unit Tho Mruclora o nut intended Or offered for sale ISac. 7044, Brainos and ['lot..i Tin, DRAINS-FLOOR,ROOF,AREA,CONE). 5.00 Code:l'he Contractor's License Law does not apply to an owner ul property who builds or improves thereon,and who does such &Urk F IXTURES-PER TRAP 5.00 SO,FT FLOOR AREA TOTAL ACREAGE himself or Through his own employees,provided that such intpro e meI u are non intended or offered for sale.It,however,the budding GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or intpmsenetu is sold within one year ul enhnple%iun. The owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving%lint he did not build or int- RES IND CON PB Conti, prove for PEOPose of sale.). INDUSTRIAL WASTE INTER. 30.00 ID 1, 11 El 11 1:1 ID1,as owner of the property,aln exclusively contracting wish licensed convucmrs In construct the prujec((Sec. 7044,Ih,lncss LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Profession,Code:The Con(u¢mrS License Law dues no(apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such pru)ee(s with a connaaorw licensed pursuant To SEW ER-SANITARY-STORM EA.2001[/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. Cl I ant exempt under Sac.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason - Ow'nej H-J�-pla_eF_""7 Date WATER SYSTEM 5.00 ASC.DATE ACC.FILE NO. ORKERS•C MPENSAI'[ON DECLARA"I'ION WATER TREATING EQUIP. 5.00 I hereby atfnn nwi I hn,e a cinific.v of co.uEnt to.rlhi....... ZONING ENG.SITE NO. or a certificate•of W'orkcri Coupmnsa murunee,or a"'iilied wpy Thereof ISee 3tl0UL , adC'. Policy No. 00 LACE). f- O ❑ Certllled coyy i)hfSAI fpppished. FIRE SPRINK ENERGY T 24 ❑ Cert i�.l,aPqIt 0 dt rtupenion division. MISC.- REFER TO ORD. p Applicant- rC- r Y ❑ "❑ Y ❑ N❑ C6RI'II'ICA'I'I'.OMI'I'I( 'ROM%IORKERSS. PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W 7 COMPON SLI RANCIi I'LG.CONI R. LIC.NO. PLC. CL O TThis section need Ito% ba 'til it the pe nail i, for on, TOTAL Y ❑ N❑ Y ❑ N❑ D Z hundred Jolla..(1100)or lea.) U O 1 cenity that in the performance pf the work for which This Per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issuEd.I Oall not employ any person in wry nmnner so as to Ow become subject to the Workeri Coni,n,aTion Laws of Caliiontia. BUILDING y Dale-Applicant ALTER OR ADD TO MECH. 5.00 } w N'01'ICE TO APPLICANT: If,alter making this Cmou,nn n1 Ex- H Z ehnption,YOU should beCURIC subjeCl TU Ere Workeri Co npensadom APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, You must forthwith comply with FEE U such provisions.,(his permit shall be deemed revoked AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00 CONSTRUC"1'ION LENDING AGENCY AIR HANDLING UNIT(OVER IOMC.F.M.) 6.00 SEISMIC FEE I hereby affirm that There is 3 construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 The performance of the work which This permit is inucd(See MICROFILM 3097,Cn.C.). �d�� HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nome ///! HEATING ON IT ER 100,000 B.T.U.)9.50 Lender's N,un-- ELECTRIC j)I I certify that lnas.'read this appli:ation and slate OUR the above VENTILATION FAN (SINGLE) 4.00 nfonnxton is correct, I agree To comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING uodirances and state laws Eluting m building construction, and hereby vn G.Rvaa representatives e,nous city to enter upon Rhe BOILER-COMP (Ova, 100,000 BTU)SEE FEE SCH. MECHANICAL herebUbO,vmautiomiz Preprese or vex TEE jun pu,Pos.'s, (We) agree to > , mdl n lily and kca'p h:undes tho City or MISC.- REFER TO ORD. Cupertino gmm liabilities,juelgntanu. est, mW vxptni",which CONST.TAX may in n s. aeeru n• l�l Cilyin mnaoyuena, of Eh.• PERMIT ISSUANCE 10.00 gran a a pc ni MECH.CONT. LIG NO. MECTI, TOTAL TOTAL Sig anter TIL\pplium..nm actor/ )am ,r.I:ECL'COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LOINS PROJECT I DENTI FICAT]0 PERMIT NUMBER ADIL ADDRESS B-- _ APPLICATION & PERMIT AD ¢Ss -�20196 TEC.r�s �� ((, ILDING - ELECTRICAL-PLUMBING-MECHANICAL 13284 E '5 PLAN CHECK VALIDATION rvAME ) lt�e / QTY. ELECTRIC PERMIT FEE COPTS o 42 / OUTLETS-SWITCHES-RECEP 10.00/1.00nC i/% LI � L ' LIGHTING FIXTURES 10.00/1.00 (JUNTIFACROIRS I PPLIANCES-'RESIDENTIAL 4.00 AO E55. //E y OL , 1H.NE PANELS 10.00 DATE OF APPLICATION ARC TELT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR E E IAJ SIGNS TRANS. 3.00 1 Hc' NCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 711 EMP.METER OR POLE INS. 20.00 ADDRESSTS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 ��'l�/ \ISI r o o LICENSED CONTRACTORS UIiCLA KATION <u U 1 hereby affirm that I am Ii imuJ under provisions of(-Luque,9 ISSUANCE DATE NA a (Cnnllllamerrl• will,Section 70001 0l'Diriaion 3 of the Busin.ss end Q m b y EL�i PLG. MECH. r y z I'refessionI Ccd, d u nu is in full tbr' 1: t il' ')U;�'�;�7�/ry 2 o m - Licenw CIL,, p�v Lie.Number. L.41 ❑ ❑ w Date ContruLRu- �� ¢ - s q]�-' BUILDING PERMIT ¢ m ¢ a ONT'E ILI{UILIIER DECLd RA'I'10 ✓ ¢a, u - INFORMATION W ;d o I hereby Affirm that I un,exenulu Iron) the cuutraam't t.rcme MISC.- REFER TO ORD .o J Law for the following,anon.(Sec.7031.5,Business and]'lure...on' PERMIT ISSUANCE 10.00 �) ' VALUATION S/FT. Fm>E CoJe'.Any city or county which R'9lllresa,crint tocc druCt.ahar, - ¢ 6 Q O hnprove,.demoiill,or repair unY'>t metun.Prio,to il%issu�nce,also ELEC.GDNTR. LIC.N0. ELEC. y m 6 requires the aP pli"m for fuel,permit to tide B signed aWetrent that TOTAL /i PERMIT TO u w he is licensed pursuant to the provi,cuns of the CORRO''lef%Licuse _ r 2 r Law(Chapter Y(cummencingwilh SccRul 7000)uf Division 3 of the a' Business and I'rul'cvions CoJe)or D,ai he ie oxnnpl thcretNan:Ind OTY. PLUMBING PERMIT FEE ¢ o the basis for the alleged exemption.Any violation of Section 7031.5 S'FOHIES TYPE CONSTR. ate - by any applicant for a permit utuelh the applicanno a cisil'anally ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than the hundred dollar,ISSOOI.I: ❑ 1,as owner of the property,or my empdnyee%with »ayes as BACK FLOW PROTECT. DEVICE 4.00 m their sole copmu etion,will Jo the work.and the vinctu ,% re not GOC.GROUP HES.UNITS intended or offered for sale (Be,. 7044, Business and Ihol.•mimisDRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply to an uwucr of Property who builds or improves thereon,and who does such work FIXTUR ES- PER TRAP 5.00 so.FT.FLOUR AREA TOTAL ACHEAGE • himself or through his own employees,IN, provided Bur such impurvr GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 nnnts I o not intended or addend ler sale.If,howevcq the building or improvement is sold within one year of completion, the owner- GAS-EASYSTEM-OVER 4 IEA ) 2.00 BUILDING USE builder will have the burden of proving that hu did not build or in . (EA. I[ RES IND CNG PB Omar prove for purpose of sale.). I NDUSTR IA L WASTE I LATER. 30.00 Cl 1, 1:1 E] El El ❑ I,as owner Or the property.ant eXCILINoely contracting with licensed contractors to container tine project(Sea 7044,&sine%t LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'I It,Contractor's Licersc Law due,not appay to un owner of proporly who builds or improves lhemon.wWwho LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such pout,,s with a can Vacronel Iicen.r-J purso-an!Ie rile Contra,biC,License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,R.&ItC.rile rbi, WATER HEATER W/VENT 6.00 Ow"Liv f�Z}�g�.g--�`'F.�- - - Dale WATER SYSTEM 5.00 O� J V� � / ACC.DATE ACC.FILE NO. OIL KI:ItS'ANHT NSA'1'ION UECLARKIION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a cerlitieate of eoment to W1-im,u«, or a certificate of Wo,kcri 0nu e'IM1.I neumnee,or a ce'lil led ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). / Policy No- 0 o0 O Crnillcd m y Impi>Lcd. FIR[SPRINK ENERGY T39 z Z ❑ Certilxt�yyPgJ II ut ,nspcnnm Jivition.O Applicant- MISCREFER TO ORD. v ❑ N� v ❑ N❑PERMIT ISSUANCE 10.00 D: - CEKTIFICKRi I'I '12(1h1 WUI<KIiItS• FLOOOZONE A.L.U.C. CL 0 W CONI' NL SURANCIi PLG.CONI H. LIC.NO. PLG. V� NEI Y❑ N[]CL 2 f shit section need not be cmn"Ided it the Ile'r,lIH is for One TOTAL hundred dollars 1 S 1 UGI or Iesa.l U O I eenify that in the perfoHn acts of the work for which thi+per OTY. MECHANICAL PERMIT FEE FEE SUMMARY IL F mit is issued.I dull nut nnpluy any person in any manner w us m 0 Ubecontesubject to thW' e orkeri Cmns pe, .Nion Laws of CaHl'umia. LEI a Dal`' ApP n,.uB _ ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE 1'0 APPLICANT': If,altar nuking lhia len inwaln of k,- ? nnpliun,you should become suhic,I m the Workcri C.....pe„sa iuu APPLIANCE 5.00 PLAN CHECK provisions ode she Labor Code, you must forthwith cumpdy will FEE U Inch provisions or this permit shall be devilled revoked. AIR HANDLING UNIT(TO IOSMC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby ulfinn !hal then is a corouuctiun lending agvnq fur EXHAUST HOOD'(WITH DUCT) 5.00 the perform once DI tln wad o which this penult is imucd(Sec MICROFILM 3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nae,e Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC wl I certify final I have read this applicaion and flute that the above VENTILATION FAN (SINGLE) 4.00 infonnalion Is correct 1 agree to comply with all otY and cuunly PLUMBING Rating ordinances and state laws m building cemnuCtion, unit BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authurive representative% of this city to enter upon the ubuva•-memioned property 1'ar ilupvetiun u,xR,1, BOILER-COMP (O Var 100,000 RTU)SEE FEE BCH. MECHANICAL q (We) agree t0 tale, Indenmify stud k,,,, 1,unolc,s Um Ci,y of MISC.- REFER TO ORD. Cupertino ugaiN babilitict,judgment a, ens ,no cx Pcmcs xl,ich CONST.TAX may m an w ac-to• I 'na a, Cn lin eun'.""Nce of the PERMIT ISSUANCE 10.00 gfan pr III /yyll// MECH.CONT'. LIC.NO, MECH, i f = �j TOTAL TOTAL Sib atureoL\PPlicun!' louclur j ,7177 COPY