7129 (3) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
It. BUILDING APPLICATION & PERMIT 7129
ADDRESS
IV U BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
O ER'5 PLAN CHECK VALIDATION
•
NAE QTY. ELECTRIC PERMIT FEE`i /.4' PrPZ. PHONE
'CONTRACTORS UTLETS-SWITCHES-RECEP 5.00/1.00
NAME // �
Q SS 1L- uc.Na Q LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S IV PC I" APPLIANCES-RESIDENTIAL 4.00
ADDRESS /�,//
y3o i�ALI91 .d PHONE WIP PANELS 5.00 All, DATE OF APPLICATION
ARCRITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
On
ENGINEER - '
Llc.rvo. SIGNS TRANS. 3.00
A
Do Ess ENG, SPECIAL CIRCUIT 5.00 / PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00
nooeess TS �J MOTORS SEE FEE SCH. ,S
..-2z
-To F41^ A l 4! SERVICE CHANG 10.00 i
r o o LICENSED CONI'RACIORS DECLARATION
ISIG v 1 harchy all that I am licensd under provisions of Chapter 9 ISSUANCE DATE
H a n (co mmenei,,with Section 7000)of Division 3 of lire Business and BL ELE PLG. MECH.
F w z I'role"imis Codc,up'�nny li,row is in lull fore.' ul'k' �� ❑ ❑
z O y 1-iccnsc Class_ Lic.Numbs 7
Q y T w Date /�'1 )��>'r Contractor r
ars va -C�-OBUILDING PERMIT
w a WNli R-BDILDER DECI�Rfd'ISC& K�/SP INFORMATION
a o o O REFER TO ORD
is1 hereby ffinmthut I vat exempt (non We Contractor's License MISC.-
3 u y° P VALUATION $/FT.
F LL O j Law for the lisllowillg reason.(Sec.7031.5.Business and I'rofesslons PERMIT ISSUANCE 6.00
Code:Any city or county which reyuiresa permit to construct,alter,
2 ¢ A Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. Q/Q /
LL feQlllrl`S IIIC apphCJllt IVr NLII permit IV OIc J flgnL'd SlalCnlenl LIIaI TOTAL CO / PERMIT TO
A w m he is licensed purslane to the provisions of the Contractor's License (J•• �I rx/
F z i
Law(Chapter 9(commencing with Section 7000)of Division3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE -
r a the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TyPFyFONSTR.
aim by any applicant fort a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
((/�a//.r/C.
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2,00 OCC.GROUP RES.UNITS
their Vale compensation,will do the work,and the structure Is not
intended or cheroot for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The COntmcmr's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SD.FT.FLOOR AREA TOTALACREAGE
• himself or through his own employees.provided that such improve-
mentsare net intended oroffered for Sale.if,however,the budding GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
or Improvement Is wild within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
ti,. prove for purpose of sale.). RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 ❑ E:] ❑ ❑ ❑
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PAHCEL NO.
and Professions Code:The Contractors License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
controatmeto , pmiccLwitllacontrsctorlsl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Contractor[h pow Law.
Cl I am exempt under See. .HAKC,for this WATER HEATER W/VENT 4.00
ml,in
owner Date WATER SYSTEM 4.00 ACQDATE ACC,FILE NO.
WORKIiRS'COMPENSA'1'ION DECLARATION WATER TREATING EQUIP. 4.00
I hereby aN'iun that I have a certilicme of consent to set Ginsure, ZONING
or a certificate of Worker:Compcnsmioa Imo ratios,or a certified ENG.SITE NO.
j copy thereof(Sec.3800,L..RC.l. L Ax -
Policy No. C'onlpar, C
Q ❑ Certiliedcopykimm mishcd. // FIRE SPRINK ENERGY T 24
z tlfied o .itf with the it Kpe111 4ctiml division.
_ ZO App c py i ` MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
Fy PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u.C.
LU > CIi R'I'II4CA PE SAISIION INS PROM WORKERS'
W COMPIiNSAI'ION INSURANCE PLG.CONTR. LIC.N0. PLG. '
� Z fl'his uclum Cecil of be <omplcl,d if the firomt is for one TOTAL Y E] NE] Y E) NEI
hundred dollars(S 100)or IcsJ
U O 1 certify that in the performance of the work for which this Per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL F mit is issued, I Strait not employ any person in any mannerus as to
U become subject to lite Workers'Compensation Laws of California.
O w BUILDING /( /
a Dmc Applicant ALTER OR ADD TO MECH. 4.00 Iv
} W NO110E you
APPLIShould become
: If,after making this r,'Compe sa Ex-
H Z_ Or scion,you should become sohjem m 0m W forthwith
Compensation APPLIANCE 4.00 PLAN CHECK
provisions io the Labor Codc, you must forthwith emnply with FEE -
U'
_%,f such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000QF.M.) 3.00
CONST'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE f
1 hereby afinn thal there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work fa which this permit is issued(Sec. MICROFILM
3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Achim
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
I orRity that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
. information is correct. I agree to comply with all city and county BOILER-ODMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction, and
Imruby authorise representatives of this city to Core, .,on the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mcntioncd property for Do,wi,tion purposes.
(We) agree to save, indenmify and keep harmless the City Of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
accrue against aid City in consequence of the
grantip o th' ermil. � ^ � r MECH.CONT. LIQ NO. T0TAAL TOTAL
�6'/tore of Appl ci at/Co tor•~ Date a
INSPECTOR COPY