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8346 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS S ,) J p BUILDING—ELECTRICAL—PLUMBING—MECHANICAL tP OWN 5 PLAN CHECK VALIDATION NAME O..J � �y,F.r�+- DIiY`� p QTY. ELECTRIC PERMIT FEE LA P PHONE NAME Ac oR OUTLETS-SWITCHES-RECEP 10.00/1.00 _ ua No. lrr ADDRESS LIGHTING FIXTURES 10.00/1.00 ooa�cAPPLIANCES-RESIDENTIAL 4.00 Ao REssS oR E HONE PANELS 10.00 DATE OF APPLICATION ORPANELSPANELS (OVER 200 AMP) 20.00 ?LAN CHECK FEE ENGINEER Lac.No. SIGNS TRANS. 3.00 ARC OR ENG. � 1 ^^L C, y PERMIT VALIDATION ARC OR la T�E , l-I, SPECIAL CIRCUIT 5.00 zIP Cj) ', EMP. METER OR POLE INS. 20.00 APPLI DORE as rs ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 00 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 < u I herchy affirm that I am licensed under PRrvtsious of Chapter 9 ISSUANCE DATE w G n BLDG. ELECT. PLG. MECH. (rnnvnrnUng with Section 7000)of Division 3 of the Business and HozProfessions Code,and my license is in full force and effect. ❑ ❑ ❑ z o m — Liccnsc Class V Lit.Numbcr ` so o w r w Dun' Contractor T ar f BUILDING P MIT T ¢o i u OWNER-BUILDER DIiCL,1 RATION INFORM ION w3 LL m 1 hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD uo¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. HN y,� Code:Any cityorcounty which requires a permit to construct.alter, ' ELEC.CONTR. LIC.NO. ¢ Q Q o improve,demolish,or repair any structure,prior to its issuance,also ELEC. LL requires the applicant for such permit to lite a signal statement that TOTAL PERMIT TO A. w m w Ile is licensed pursuant to the provisions of the Contractor's License Fz > Law(Chapter 9(Commencing with Section 7000)of Division 3 ofthe ¢ o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ r S the basis for the alleged exemption.Any violation of Section 7031.5 5 RIE E CONSTR. n 3 — by any applicant for u Pcrmit subjects the applicant loo civil penalty of oot more than five hundred dollar,(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for Sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:Tire Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work 40r< FIXTURES-PER TRAP /5 sa.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees.provided that such improve- f _ mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owne builder will have the burden of proving that he did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB other ❑ 1,as owner of the property,am exclusively'contracting with . . ❑ ❑ ❑ ❑ ❑ liconxd contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCE L NO. and 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 a contractions)licensed pursuant to ISEWER-SANITARY-STORM EA.200ft/1 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I:un exempt under See,—,B.&P.C.for this WATERHEATER W/VENTiG reason 7 Owner [),in WATER SYSTEM 5.00 PCC.DATE ACC.FILE NO. WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm (hat 1 have a certificate of consent to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C.). Policy No. fiflvgY hexo­ - J. O CICetlifted o y is hereby f mis . FIRE SPRINK ENERGY IF 24 Z Z JQ Certified copy is filed with the city inspection division. O Applicant .. - MISC.I REFER TO ORD. Y❑ N❑ Y ❑ N❑ ~ va R PERMIT ISSUANCE 1 = — CISk'I'IIICA MPFNSATION INSU AOM WORKIiRS' PL000 ZONE AL.U.c. W � COMPENSATICIN INSURANCE PLG.CONTR. LIC.rv0. PLG, CL D Illus section need not be tontpletetl if the permit Ls for one IS G TOTAL Y❑ At Y ❑ NE]D Z bund reddollurs($1001or les.) U O 1 certify that in the performmce of the work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY W l— mit is issued,1 shall not employ any person in try Intu ncr so as to Ow became subject to the Workers''Compeismion Laws of California. a Dmc Applicant 13UILDING >_ GO NO'I'ICI' TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 f— ? cmption,you should become subject to the Workers'Compensation APPLIANCE 5.00 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=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GF.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the perbormance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name �y b�j}y .cj �- HEATING UNIT 100,000 B.T.U.)9.50 Lenders Address ELECTRIC I certify thm l have read this application and Smte tha'Ih'c e6bbe VENTILATION FAN (SINGLE) 4.00 inl'om,ation is correct 1 agree to comply with all city and county PLUMBING ordinances and state laws Dilating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby au0mdre representatives of this city enter upon the above-mentioned properly for inspection purposes BOILER-COMP(Over 100,000 BTUI SEE FEE SCH. MECHANICAL cv, (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the grantingoflhis permit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL 6D 1.94..4 nu o Ap Ircanl/C nlmclor Date INSPECTOR COPY '