7147 APPLICANT TO•FILL IN INFORMATION_ WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
:t
ADDRESS 714
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
15'i OPINE.St PLAN CHECK VALIDATION
"AME
NAMELECTRIC PERMIT FEE
. PHONE
' ° 1 LETS-SWITCHES-RECEP 5.00/1.00
RE LIGHTING FIXTURES 5.00/1.00
A
ro E "YORs LIANCES-RESIDENTIAL 4.00
i
• P NELS 5.00 DATE OF APPLICATION
A Cm EC SIGNS 6,00 PLAN CHECK FEE P.C.NO,
O
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS END,
SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
]IP EMP.METER OR POLE INS. 15.00
ASMOTORS SEE FEE SCH, l/\Ulfl1�f
r
ADDRESS
SERVICE CHANGE 10.00 H000 LICGNSIiD CONTRACTORS DECLARATION E7�'00
Q U u I hereby affirm that I a0 licensed under provisions of Chapter 9 ISSUANCE DATE
y ¢ m (colmomnang with Scctinn 7000)of Division 3 of the Itusinen and BLDG. ELECT. PLG. MECH.
r=y Z Professions Code,and my license is in full fore f tCII . ❑ E ❑ ❑
Z O m- Limn Clan Lic.Number
9'Z H o IJuW Contmclor
Z
x s BUILDING PERMIT
Lu OWN. - DGR UGCLARATIO, INFORMATION
X �' N I hereby affirm that 1 am exempt from the Contractors License MISC.- REFER TO ORD
H a. 0 4 Law fur the following reason.(Sec.7031.5,Business and l'rofussions PERMIT ISSUANCE 6.00 vnwnTloN $/FT.
Code:Any city or counly which reyuiresa permit to construct.alter,
2 Q.p improve,den'alish,or.Tepdir any struclure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
&SIY req uines the appI La nl for such pc rmiI la Iile a signed u l cm ent Ihut TOTAL PERMITTO
a w mF" he is licensed pursrmnt to the provisions of the Contractor's License
F z;i•
Law(Chapter 9(commencing with Section 7000)of Division 3 of the L$
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i3 !2 by any applicant for a permit subjects lire applicant to a civil penally ALTER-DRAIN& VENT-WATER (EA.) 4.00
of nod Dore than five hundred dollars(S500).):
<, ❑ I,as than
of the property,OF my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole coorpensalion,will do the work,and the st macre is not
intended or offered for sale fSee. 7044. Business and Irofessions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
,p Code:: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himselfor through his own employees.provided that such improve-
ments are not intended or offered for sale.IC however.lire building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
or inlpravemenl is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
i builder will have Ole burden of proving that he did not build or int
prove for purpose of sale.). INDUSTRIALWASTE INTER. 20.00 RE5 IND CON PB anter
O I,as owner of the property,am exclusively contracting with E] E] ❑ E] ❑
licersod conlfmclors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
Code I ply
to frowner ns property Contractor's 1-seers.Law doesnotapply '
to frowner ofpropertywho builds orimproves
ensed p,and who LAWN SPRINKLERS-OVER 5IEA.1 1.00
contracts for such projects with a contrnclor(s)licensed pursuant to
the Coiarnc0n's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL No.
❑ tum exempt under See. ,B.dl'.C.for this WATER HEATER W/VENT 4.00
noon
UJA
O"'oar nam WATER SYSTEM 4.00 Acc.DATE ACC.FILE No.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affront flout l have a Lrtiticulc of consent u, elf-insure, ZONING ENG.SITE NO.
nr A e ca e of Werke a'pe �!'on ra
D unce r f a c c
I'
' e b .
I a
Q C 11 is hereby urnishu FIRE SPRINK ENERGY T24
,z ClCertifie is -led wi I dhI 'sly 'ns c i n divii n.
p Applicant I JitTMISC.- REFERTOORD6.00, ❑ N❑ Y ❑ No
ED PERMIT ISSUANCE L0o0
~
G1iR'I'I I ATE OPfiXGh1PTION FROM WORKERS' 1 ZONE A.L.UF.
eW COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG,
` IffL0 11 his section need not be completed if the permit is for one TOTAL ❑ N❑ Y ❑ N❑
Z hundred dolhus(S100)or less.)
U O 1 certify that in the performance of❑m work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall nor croduy any person in any manr...so as to
0•
U beconc s,Ibjccl to the Worker�Compensation Laws.f California.a Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
>- N NOTICES TO APPLICAN'C IC after making this Certificate of Ex-
F,.Z cmPtiun,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
f. pmvisiuns of the Lnbor Code, you nm¢I forthwith cool Ply with FEE
smelt provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=1C.F.1%) 3.00
y°
CON$TRUCCION LENDING AGENCY AIR HANDLING UNITIOVER 10=C.F.M.15.00 SEISMIC FEE
tt I hereby aflinm that them is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
7p the pertmurance,of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ) HEATING UNIT(TO 100,000 B.T.U.) 4.00
Leader's Isfinne
Address Addr
Lender's HEATING UNIT(OVER 100,000 B.T.U.17.50
ELECTRIC
I certify than 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
nl'onnarion is correct.1 agree to comply with all city and county -COMPI3 H.P.or 100,0008.T.U.) 4.00 PLUMBING
ances 'f
. ordinand state laws relating to building construction. and BOILER
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
aboveanentionet property for inspection purposes. -
Yp,'�,;, (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
'^J7 Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against said City in"; f
gr lung of this er itH.CONT. LIC.NO. MECH.rh O
TOTAL TOTAL
S' f C8 IrACIOr
,a, INSPECTOR COPY '