8757 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT,,PEN ONLY #84-322
I BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS
20�'GG'D Lazane0 DT. BUILDING"ELECTRICAL-PLUMBING-MECHANIC L / 8757
OWrvER'B PLAN CHECK VALIDATION
NAME Apple Computer QTY. °` ELECTRIC PERMIT FEE
PHONE
CONTRACTOR NAME Guardian UTLETS-SWITCHES-RECEP 10.00/1.00
uC.No. LIGHTING FIXTURES 10.00/1.00
ADDH FEcroR'S y50 N. Ren95t0rff-G. PPLIANCES-RESIDENTIAL 4.00
ADDRESS
At. View A. 94043 PHONE 961-7161 PANELS 10.00 )DATE OF APPLICATION
ARCHITECT- PANELS (OVER 200 AMP) ZO.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER .
LIC.rvo. ' SIGNS TRANS. 3.00
ARCH,°ss ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zip TEMP.METER OR POLE INS. 20.00
APPLICANT
ADDRESS MOTORS SEE FEE SCH,
IUUj�ffJ
' SERVICE CHANGE - 20.00
w O o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 '�^❑10��/
< U I hereby affirm that I am licensed under provisions of Chapter 9 P'ATNCE DA(((TE
yaw (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
F o z 'rofessions Code,. d icense is in full force and effect J a 09 ❑
Z,o License Clas' Lie.Number p > -
o w C j. Date- - - Contractor--M522
A, a s BUILDING PERMIT..
¢ ¢ w¢ OWNER-BUILDER DECLARATION - TION
0T- MISC: REFERTOORDCitV
W 3 LL I hereby uffirin that I and exempt lion,the Contractor's License - VALUATION $/FT.
_F oL Law for the following reason. 703 t.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which reyuiresa permit to construct.alter, 1(y DDD
Qa,Q O Improve,demolish,Or repair any structure,prior t0 ns Issuance.also ELEC.CONTR. LIC.NO. ELEC. - r
o u requires the applicant for such permit to file a signed statement that TOTAL PERMIT.TO
w w he is licensed pursuant to the provisions of the Contractor's License
F z a
Law(Chapter 9(commencing with Section 7000)of Division 3ofthe Fire Sprinklers
E D Business 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 1 STORIES TYPE CONSTR.
o36e , by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA:) 5.00
of not more than five hundred dollars($500R.)
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCG GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building - GAS EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
O I,as owner of the property,um exclusively contmclLlg will, ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-.OVER 5 IEA.1 1.00
contracts for such projects with a eontructous)licensed pursuant to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt under Ser.-,B&P,C.for this WATER HEATER W/VENT 6.00 '
reason
Owner Date WATER SYSTEM 5.00 ,
ACC.DATE ACG FILE NO.
WORKERS'COMPENSATION DECLARATION - WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent toself-insure, ZONING ENG.SITE N0.
_ or a certificate of Workers'Compp;;µµssyyr pp In�++(y.�1,,JJ�� ,,QQr o e•r{y�f}�d
copy thereofisec.3800,Lab.C.).V j6j-ULU1UO- 1$
;PolicyNo. Company-L-y{.t�_ .f--I�u�fa-I-
O ❑ Cerliliedcopyishereby(umisl --" �� "'- FIRE SPRINK ENERGY T-24
z Z )0 Certified copy is fled with the city inspection division. ,
O Applicant - MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
'
CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c.
i
'W > COMPENSATION INSURANC17 PLG.CONTR. LIC.NO. PLG.
a This section need not be completed if the Permit is for one TOTAL Y El ❑ Y❑' N❑
Z hundred dollars($100)0r less.)
U O 1 certify.that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL-H mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
O Do Dare l Applicant p BUILDING 104.50
0. pp ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: 1f,after making this Certificate of Ex-
F Z emptl0n,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply withFEE 67.93
U such provisions or this permit shall be deemed revoktd. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE ,98
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have:read this application and state that the above VENTILATION FAN (SINGLE) 4.00
( information is correct. I agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COIVP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(WB) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses whichCONST.TAX
may in any way ace a against said City in consequence of The PERMIT ISSUANCE 10.00
gran' g of this r I. MECH,CONT. LIC.NO. MECH.
` 6-6-85 TOTAL TOTAL 173.41
g re A li nl ntractor -Date -
i OFFICE COPY
r