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8425 t) /APPLICANT TO FILL IN INFORMATIbN VVI'THIN RED LINES - USE BALL POINT PEN ONLY _•% PERMIT NUMBER BUILDING PROJECT IDENTIFICATION'q%`• =BUIL CATION & PERMIT ,BUILDINGDRESS / ,� 8425 nADN.=7 W f / ' TRICA L-PLUMBING-MECHANICAL l{ / �\ I / d -•M UUU LL2 VVV :.... �' t., .1f1fV1 , 1 NAME � - - �� PLAN CHECK VALIDATION • CITY. ELECTRIC PERMIT FEE ',PHONE , .NnMeRA R OUTLE_TS-SWTC IHES-RECEP 10.00/1.00 L-C.NO. LIGHTING FIXTURES 10.00/1.00 ADDRESS 20823 Stevens Crk Blvd PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10252 20-7 .00 DATE OF APPLICATION OR TCupertine PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.O.NO. ENGINEER LIC.NO.C009175 SIGNS TRANS. 3.00 npORiss SPECIAL CIRCUIT S.QQ PERMIT VALIDATION 18008 Skypark Cr. #200 PAID lryzIP _ EMP.METER OR POLE INS. 20.00 q ADDRESS 2082.3 Stevens Crk Blvd MOTORS SEE FEE SCH. AUG 2 0 1985 u SERVICE CHANGE 20.00 0'¢ z rC2G. Cupertino CA 95014 TEMP.POLE 30.00 ,-02 LICENSED CONTRACTORS DECLARATION City of Cupertipp v I hereby affirm that I am licensed under.provisions of Chapter 9 ISSUANCE ATE '1 w G w (commencing with Section 7000)of Division 3 of the Business and OLD ELECT. PLG. MECH. ­ w.z Professions Code,and my license is in full force and effect. i ❑ ❑ ❑ z o m - License Class Lic.Nunlbeg 0 y Parc �jb-/S Contractor f3'd' ¢ m s C. BUILDING PERMIT (I: II: w 4 OWNER-NUILDF:R DECLARATION INFORMATION X 3 LL H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION $/FT: ¢ Law for the following reason.(Sea 7031.5,Business and Pru fesstons PERMIT ISSUANCE 10.00 H m Code:Any city or county which requiresa permit to construct,alter, ¢ ¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. o u requires the applicant for such permit to file a signed statement that TOTAL ERMIT TO E: m m he is lice used pursuant to the provisions of the Contractors License r z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the / Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ¢ r© the basis for the alleged exemption.Any violation of Section 7031.5 - STORIE Y 0 d ;� by any applicant for a permit subjects tie applicant loacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(5500).7: ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP R .UNITS I their sole compensation,will do lire work,and the structure is not intended or offered for sale (Sec. 701 Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:'The Contractor's License Law does not apply to an owner of properly who builds Or uuprmoe thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO T. CD RARE TO ALACREAGE Mewl(or through his own employees,provided that such in.prose- .cuts are not intended or uttered for sale.Il:Bowever,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,tie owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or owner, BUILDING USE , ems prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other El 1,as owner of the property,am exclusively contracting with El El ❑ ❑ licensed.contractor, to construct the project(Sec. 7044 Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO and lrlfessions Code 1'he Contractor:license Le d not apply s to m t wner of property who builds or improves Iand who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to IIh' the COnlmctor's License law. I SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under See,-,B.AP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5 1 q p ACC.FILE NO. WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to sell-insure, Z NING: ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified ✓ copy thereof(Sec 3800,Lab CA ' `1 PolicyN `\ O 1( Cc IiL 12 y�lC R. FIRE SPRINK ENERGY T 24 Z.Z" ( Certified copy is filed with the city inspection division. OApplicant MISC.- REFER TO ORD. Y E3 NVi Y ❑ NF] Bj�S-OCtf� rTQO-11-1 PERMITISSUANCE 10.00 OC - CERT'IFICA'TIi01'EXEMPTION FROM WORKERS' I FLOOD ZONE A.L.U.0 W 1 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. I d Y N V N0 O (This section need not be completed if the pennil is for one TOTAL D Z hundred dollars(8100)or less] U O 1 certify that in the performance of the work for which this per- DTY. MECHANICAL PERMIT FEE FEE SUMMARY U_ F- mil is issued,I shall not employ any Re nun in any manner so as to Ow er become subject to the WorkCompensation Laws of California. BUILDING Ed Dale-Applicant ALTER OR ADD TO MECH. 5.00 rto .NOIICI: TO APPLICANT': If,after making this Certificate of Ex- pZ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK ' Provisions of the L'uhar Code, you must forthwith comply with ••'�" such pnivizi us ur this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE I CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE FaeatiY L I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 1st 30• ,Cw.Cance of thMICROFILM Elie work for which this permit is issue)(See.J. HEATING UNIT(TO 100,000 B.T.U.) 8.00 I\ ,fv Lenders Name Lenders Address, HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and stale that the above VENTILATION-FAN (SINGLE) 4.00 "1 information is correct. I agree to comply with all city and county BOILER-COW 1P (H.P.or 100,0008.T.U.) 6.00 PLUMBING \.�. ordinances and state laws relating to building construction, and hereby authorize representatives of this city to Inter upon Ihe. BOILER-COMP I❑ver 100,000 BTU)SEE FEE SCH. MECHANICAL C above-nterfikmcd property for inspection purposes. 1 (We) agree to save, indenutiry and keep harmless the City of MISC.- REFER TO ORD. ' Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the r gramm,of this permit. MECH.CONT, LIC.NO. MECH. r DTA, TOTAL I pp met Contra actor U `t• ,y A� _ INSPECTOR COPY