C8757 r
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
r BU LDI NG PROJECT I DENTI FICATI ON , PERMIT NUMBER
ADEAPPLICATION & PERMIT 8757
ODRSS
OREss
20605 Lazaneo Dr. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME Apple Computer vHorvE OTY. ELECTRIC PERMIT FEE
,�.
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
-/ NAME Guardian
nklerSI '] LIC.No. LIGHTING FIXTURES 10.00/1.00
Spg1\ nODRESS 950 . Rengstorff-G. APPLIANCES-RESIDENTIAL 4.00
PHONE .7161 PANELS 10.00 DATE OF APPLICATION
MF
A 1 EcViaw PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
t,• t ARCH,OR END
. PERMIT VALIDATION
#.
ADDRESS �' '4 SPECIAL CIRCUIT 5.ZIP 'Y T EMP.METER OR POLE INS. 20.00
Ct APPLICANTS ..MOTORS SEE FEE SCH. k
ADDRESS CSERVICE CHANGE 20.00' Jwoo. LICENSED CONT RACPORS DECLARATION TEMP.POLE 30.00 ��/��•�
< O w I hereby affirm thinil am licensed under provisions of Chapter 9 ISSUANCE DATE
� p•,N < N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
(3 •r.w Z Profexiions Code,and my license is in full form and effect, _
4z o m-/ License GWgs Lia Number - ❑ ❑ ❑ ❑
I D O� Ddte=-P Contractor
-2 522 ,BUILDING PERMIT �x
¢ ¢;� OWNER-BUII-DLR DEC (ION - r INFORMATION -1
~
I hereby affirm that I:am exempt from the ContmTtor.'s Licpse Aa MISC - +v- REFER TO ORD
o j Law for the follo winreason.(Sec 7031 5,Busmes,5hA Professions 't A..-r4.-. ...••-- VALUATION 5/FT
g PERMIT ISSUANCE" 10.00 -.�orc.+s twc.arc-rr;a,.w
Code:proe,y city lish county whiny structure permit o its issuance,
alsoer, L
¢ ¢ Q o Improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.N0. ELEC. •1Y.000
O ¢ requires the applicant for such permit to filet signed statement that TOTAL •• PERMIT TO
he is licensed purstanl to the provisions tf the Contractor's License
aLaw(Chapter 9(co ur enemgwithSection7000)o1Divsiot3oftlte Fire S rinklers
Business and Profession{Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE p
¢ F o the basis for'I he alleged exemption.An y'viola t ion of Sect ion 7031.5 STORIES TYPE CONSTR.
> i9 by any applicant for a PCmtit subjects the applicant toa civil penalty'
I of not more than five IiAdred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
hIC u ❑ I,as owner of the property,or my employees With wages as BACK FLOW PROTECTDEVICE 400
6N' their sole compensation,will do the work,and the structure ie not . . OCC.GROUP RES.UNITS
�n intended or offered Or 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 tivough his own employees,provided that such improve-
• Gents are not intended or offered for sale.If,however,the building iGAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year -r of completion,the owner- GAS EA.SYSTEM-OVER 4 IEA.( 2.00
`4 t builder will have the burden of proving that he did not build or an- BUILDING USE
Prove fat purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PE, oma.
t ❑ 1,as owner of the property,am exclusively.contracting with ❑ ❑ ❑ ❑ ❑
f. licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
I 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 contractor(s)licensed pursuant Io SEWER-SANITARY-STORM EA.200ftI10.00
the Contractors License Law. TRACT NO. PARCEL NO.
�). ❑ lent exenrpl under See. ,B.&P.C.fur this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
� ACC.GATE ACC.FILE NO.
i WORK ERS'CONIPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconstnt to self-insure.
is or a certificate of Workers'Compensation Insurance,or a cetified ZONING i ENG.SITE NO.
mpv tlltrenr(seC.3goo.Lan.c.)wC161_02010. 0-015
cPlicopyy Nn. Company fbEPtj�hTUt031-
Q ❑ Certified copy is hereby fortis ; FIRE SPRINK ENERGY T 24
y; Z 2 ,A(l
y1{]3 Certified copy' is fled with the city inspection division. MISC.- REFER TO ORD. v ❑
O� rlicant N❑. Y ❑ N❑.
'nY'~ r '0 ' PERMIT ISSUANCE" 10.00
LU
f-IiR'I'll'ICATEO-NXATIN INS fROMWOR61iRS' FLOOD ZONE A.L.U.C.
W COM11PIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
•? Z IThie section need not be completed the permit is for one TOTAL Y❑ N❑ Y El N❑
hotdo.]dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL. H
LL. mit is issued.I shall not ernploy any person in any manner so as to "'tee
w
become subject to the Workurs'CompeBmtion Laws of California.
OBUILDING
b, n Date Applicant ALTER OR•ADD TO MECH. 5.00 104.50
AN } 0 NOTICE '1'O APPLICANT': If,after making this Certificate of 1!x-
Z emotion,you should buamne subject to the Workers'Compensation APPLIANCE'l, 5.00 PLAN CHECK
provisions of the Labor Code, you must I'orlhwith comply with
- < U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 - FEE 67.93
_
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE .98
1 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,Ci,C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
/-• information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00
hereby( authorize representatives of this city to enter upon the :,BOILER-COMP Over 100,000BTU)SEE FEESCH. MECHANICAL
above-intank red property for inspection purposes.
(We) agree to save, indetnnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, cosh and expenses which CONST.TAX
I. may in any way, accrue against said City in consequence of the PERMIT ISSUANCE 10.00
gran ing ofthis rrtt A- MECH.CONT. LIC.NO, MECH.
85 TOTAL TOTAL O
tat u�y A li I 1 frit 'or Date 173.41
INSPECTOR COPY
I ¢ •