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C7217 �1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING BUILDING PROJECT IDENTIFICATION 1 PERMIT NUMBER BmLomG APPLICATION & PERMIT ADDRESS �7 . L ..7217 Ci,T. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNERS PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE (L. PNDNE CONTRACTOR ryUTLETS-SWITCHES-RECEP 5.00/1.00 A ✓ O c°.4c GcX S LIC NO LIGHTING FIXTURES 5.00/1.00 CONTRADDRECONTRACTOR /��•�-,� APPLIANCES-RESIDENTIAL 4.00 ADORE / L / q G i3�CTPHONE `� /7% PANELS` 5.00 DATE OF APPLICATION OR T _ SIGNS \ 6.00 PLAN CHECK FEE P.C.N0. OR ENGINEER LTL.NO. �1 t SIGNS TRANS. _ 3.00 ARCH.OR ENG. / PERMIT VALIDATION ADDRESS 11 SPECIAL CIRCUIT 5.00 ZIP EMP:METER OR POLE INS. 15.00 /'1x/5 ADDAPPIalCESS MOTORS SEE FEE SCH. ��((���/jj)) ADDRESS SERVICE CHANGE n 10.00 ¢ _ w o o LICENSED CONTRACTORS DECLARATION a u v I hereby infirm that I am licensed under provisions of Chapter 9 `' r ISSUANCE DATE ve rt y (cuci an,crng will,Seclinn 7000)of Division 3 of Thu Business and BLDG. ELECT. PLG. MECH. r N z I'rnl'cssionx Co �and,lBy''ensc is in full fo mr c' •1' 9 z O mlas Lic.Nmain ber 1 © z ❑x Q m F w Du(c Contractor a >< BUILDING PERMIT ¢ ¢ w a OWN FR-11 UI LDER DECLARATION INFORMATION X o d w I hereby allirm that I am exempt from the Contractor's License MISC.- REFER TO ORD 3 u y p VALUATION $/FT. Hu Oj Law for the following reason, 70JL5,Business Professions PERMIT ISSUANCE 6.00 Code:Any city or county which requires a permit toconstruct,alley, S(/ Qu,Q Q Improve,demolish,or repair any structure,prior In Its Issuance,also ELEC.CONTE. LIC.N0. ELEC. Q / - D u requires the applicant for such proud to Ile a signed statement that TOTAL OSD, PERMIT TO n w m ha is licensed pursuant to the pros Rossi ons of the Contractor's License - H z i Law(Clmpter 9(commensing with Sec(ion 7000)of Division 3 of the (r L 4 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE A, ¢ H o The basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a, _ _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN'Bt.V ENT-WATER (EA.) 4.00 of not more than five hundred dollars($5000: ❑ h as owner of the property,or Pry employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is or intended or offered for sale (Seo 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Contractor's License Law does notapply to an Owner of properly who hands or improves thereon,and who does such work FIXTURES,PER TRAP 4.00 sa FT FLOOR AREA TOTAL ACREAGE h iniself or through his own employees,provided that such improve- -, meats are"or intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 , or improvement is sold within one year of completion,the owner- GAS-E' .SVSTEM-OVER 4 IEA.) 1.00 BUILDING USE builder will have the burden of proving that he did no(build or im- ,ov,let purpose of salc.L INDUSTRIAL WASTE INTER. s - 20.00 RES IND CON PB Other ❑ 1,as owner of tine property,am exclusively contracting with ❑ ❑ ❑ - ❑ ❑ licensed contractors to construct be project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and I'mfessions Code:'ibe COntracOH'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 Lmnmets for such projects with a contractod s)licrewd prGUtHH to the Contractor License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. f ❑ Iamexennptunder Sec. ,B.&P.C.for this WATER HEATER W/VENT 4,00 reason owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WURKIi 'C PENSAIIONDECLARATION WATER TREATING EQUIP. 4.00 Ihereby alfr the ave a cerlifnea(eefcoment to wit-insure, it or a eel iftcate ,f rkeri Compensation Insurance,or a certified ✓ ZONING ENG.SITE N0. py lhcrco( c 3800,1:n.CJ. / y N •Con any O JJ- CL and�opY is I c11 f�crtisl FIRE SPRINK ENERGY T-24 Z 2 /� CC L co-y f wlM 'tlr division. 0 Applican 1 MISC.- REFER TO ORD. v❑ N❑ v❑ N❑ Fy PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.0 c. CERI'IFICA'rt:OF EXEMPTION FROM WORKERS' l - Lu f - COMPENSAT ION INSURANCE PLG.CONTR. LIC.NO. PLG. / / { ❑ CL 0 ('Phis section need not be completed if the permit is for one TOTAL �6. v❑ NEI v❑ N hu ndred dollars IS 100)or le..) V 0 1 certify that in the performance of the work far which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL•U. mit is issued.I shall not employ any person in any nnanner so as to became subject m the Workers'Compensation Laws of California. � n 'Dale Applicant ALTER OR ADD TO MECH. 4.00 BUILDING } W NOTICE'IO APPLICANT': If,after making this Certificate of-E.- eruption, f E.- ? eruption,you should become subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK provisions of (he Labor Code, you most forthwith comply will, FEE U such provisioriv or this lmnnit shall he deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M,) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOOOC.F.M.) 5.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00 the performance of the work for which this permit is issued(See. MICROFILM ) 3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lcadnr'e Nxnm ' 1 Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC I certify thatIhave reatl- ui,3pplicalr..andslamthattheabove VENTILATION FAN (SINGLE) 3.00 Y / Th,...ratio" is cotrcct. I agr c (o comply witlu all city and county M,PLUMBING ,nlinances aqA�slate lows elating to,building construction, and BOILER-COMP(3,H.P:or100,000B.T.U.) 4.00 hereby a iryorlre repress tatives of this city to enter upon the BOILER-COMP (over 100,000 BTU)SEE FEE SCH. r MECHANICAL above- n one pro y for iospectlon purposes. (Wr An ve, indemnify ' nd keep harmless the City of MISC.- REFER TO ORD. Cupertino .unst liabily't ics,judg nts, costs.,,itexpenses which CONST.TAX may any�wuy ace is against aid Cit yin consequence of the PERMIT ISSUANCE 3.00 gr g of this pe %. MECH.CONT. LIC.NO. - MECH. 1 �.e TOAL i TOTAL ,�� � St nOlUre o AppliL f/Contfactor '- Dale j N INSPECTOR COPY