9139 IA' TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
i BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BarLDING APPLICATION & PERMIT 9139
ADDREs19925 Stevens Creek Blvd Lnks
DING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
•
Technicillngy
NAMEOUTLETSAc ONE
Rs -SWITCHES-RECEP 10.00/1.00
A. A LIC.No. LIGHTING FIXTURES 101.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
k(. 669$ owENs D¢
PHONE 4A,3. y I PANELS 10.0qDATE OF APPLICATION:
OORRCNrtEC PANELS (OVER 200 AMP) r. 20.00' PLAN CHECK FEE P,C.NO.
ENGINEER'
uc.NO. SIGNS TRANS. 3.00
ADD Ess ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
A + MOTORS SEE FEE SCH.
ADDRESS DREss I
j SERVICE CHANGE 20.00
oaz
FOO LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y w (amunmwing with Suction 7000)of Division 3 ol'the Business and
¢ n BLDG. ELECT. PLG. MECH.
D z Professions Code,and my license is in full force and effect.
z O as - Liecas Chtss_G...bt__Lia Niunbur
O z H )ale Commaor-FgrsQ� _
a r ii BUILDING PERMIT
¢ Ie w ¢OWNF-R-BUILDER DECLARATION
o
ao a U INFORMATION
X
S:Ic 1 hereby atfirnt that I am exempt from the Contractor's License MISC.- REFER TO ORD•
u O 4 Law for lite following reason.(Sec.7031.5,Businessland Professions VALUATION $/FT.
H - PERMIT ISSUANCE 10.00
Code Any my or county which reyuiresa permit to construct,alteq ' 400
¢ rt a 0O improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. l
O LL requires the applicant for such permit to file a signed statement that TOTAL
a w w m he is licensed pursuant to the provisions of the Contractors License PERMIT TO IIetB
r- >
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
io Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Salon System
¢ H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
Ate - by any applicant for a permit subjects the applicant it,.civil penaly ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S5001J: "
❑ 1,as owner Of the property,or myemployers with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and Om sl incline Is not
intended or offered for sale (Sec. 7044, Business and Profrssians DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code.rfile Contractor's License Law dors not apply to an owner,of
properly who builds on improves thereon,aril who floes such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such int Prove- -
meats are not intended or offered for sale.If.however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with . . ❑ ❑ ❑ ❑ El
licensed contractors To construct the project(See.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(EA.) 1.00
contracts for Such projects with a contractnn(s)licensed pursuant t0
the Contractor's License Law. (I' SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I and exempt under Sec,-,BAP.C.for tins WATER HEATER W/VENT 6.00
rcasan
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
j .
wok KCRS'COMPF;rvSATION DECLARATION WATER TREATING EQUIP. 5.00
'�• I heroby affirm that I have a certificate of consent to self-insum,
or a certificate of Workers'Compenmfion Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). -
policy N,gtic),Fq_Company�ycr..xgAlR�EIgEJ}Al -
Certiiedc copy is
fwitht FIRE SPRINK ENERGY T-24
Z Z Certified copy is file) with the city inspection division. MISC.- REFER TO ORD.
�` Applitanl V N V N
Cr w CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
iLa ('Phis section need not be completed if the permit is for One rOTAL Y N Y N�
:XZ, hundred dollars IS 100)or less.)
U O`x'" 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. U roil is issued,.) shallr
not employ any person in any murmur se.as to
O W become subject to the Workers'Compensation Laws'of California.
IS.
Late N Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 68.550
,} to NOTICE TO APPLICANT. If,after making this Certificate Of E.-
F. Z_ rntption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions at mis permit shall be dcuamd revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
44.53
v
CONSTRUCTION LENDING AGI?NCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE -56
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -
thc 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
Lumber's Address
HEATING UNIT(OVER 100,000 B.T.U.)9.50
' Lender's Name ELECTRIC
1 certify that I have read this application and state Otat the aboveVENTILATION FAN (SINGLE) 4.00 +
information is correct. I agree m comply with all city and con'y PLUMBING
ordinances and statelaws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize'representatives ol',this city to enter upon the
abovo-nentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We);agree to save, indemnify 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 cunsmluence of the
granting of this penult. MECH.CONT. LIC.NO. MECH. ,
TOTAL TOTAL 113.59
)
,Signa r u Ap cant/ ontractor I at
INSPECTOR COPY