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C8344 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER aDILDI.G APPLICATION & PERMIT OORE55 /�-2J�7 &-00 83-44 q alf �' J5 (aC � &-00BUILDING - ELECTRICAL-PLUMBING-MECHANICAL I-� - Jtl OWNER'S ' NAME ,.,f-�n PLAN CHECK VALIDATION r . l/A��O1(J E� HO�CLf`'��� QTY. ELECTRIC PERMIT FEE ) 1 /�� 0 "'I/p,ACTO N PHONE l Oi J^U�� /��'� NAMERncTORs UTLETS-SWITCHES-RECEP 10.00/-1.00 NO' K/UOGV Luc.NO, LIGHTING FIXTURES 10.00/1.00 ADDRESS oRs PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. °" UPrI�� F ITSGH PANELS (OVER 200 AMP) 20.00 ENGINEER 74Z ISIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 948 GA94(o7 ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT MOTORS 4 SEE FEE SCH. ADDRESS V U0 [104A-#J f�/�!•�70.1`� T S��EEK (TIIb TEMP.POLE 20.00 n /` /,/� <i woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 �O L- r a v I hereby-affirm that I am licensed under provisions o(Chapter 9 ISSUANCE DATE H< m (commencing with Section 7000)Of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F D z Professions Code,and my license is in full force and effect. © ❑ ❑ 'oi w 0 License Class Lia Number w F Date Contractor ¢ Y f J ¢ -a OWNER-BUILDER DECLARATION BUILDING PERMIT INFORMATION XI hereby affirm that I am exempt from the Contractor - REFER TO ORD 's License MISC. 4 .. o¢ Law for the following reason.(Sec.7031.5.Business and Professions VAWATION $/FT. ac g PERMIT ISSUANCE 10.00 ,A� Code:Any city or county whichrequiresa permit toconstruct•alter, T�) ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 171J M O I, requires the applicant for such permit to file a signed statement that - TOTAL " PERMIT TO a n ea y he is licensed pursuant to the provisions of the Contractor's License ^ ca Law(Chapter 9(commencingwith Section 7000)of DMsion3 oldie /VT 7Ce�/"/ e` ¢ Business and Professions Code)or that he isexempt therefrom and QTV. PLUMBING PERMIT FEE U �.- the basis for the alleged exemption.An iQuo B p }'violation tInacl ion malty STORIES TYPE CONSTR. 3 by any applicant for a permit subjects the applicant Ina civil penalty of not more than five hundred dollars(5500)-)_ ALTER-DRAIN& VENT-WATER (EA.) 5.00 � ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 ocC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -- Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE • himself re through his own employees.for Provided that such improve- mean are not intended or offered for sale.If,however.the building GAS-EA.$VSTEM-I INC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ..pO I as owner of the property,am exclusively contracting with 0 D 0 El El IieeRsed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Profesiuns Code:The Contractor's Lie, nsc Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 i contracts for such projects with a contractoq s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for Ulis reason WATER HEATER W/VENT 6.00 i Owner � � WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. OIC1C IiR1�^eEM :15,441 DECLARATION WATER TREATING EQUIP. 5.00 I ereby affirm that I have a certificate of consent to sell-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY TR4� z 2 ❑ Certified copy is file) with the city inspection division. MISC.- REFER TO ORD. O Applicant Yo NE] V [:) NE] CC: y CERTIFICATEOF EXCMPTION I7ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. __LU COh1PF.N8AT10N INSURANCE: PLG CONTR. LIC.No. PLG CL Z (This sectidn need not be completed,if the permit is for one TOTAL Y E] N� .Y ❑ N� hundred dollar,IS 100)or less.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY _ LL F mit is issued,1 shall not employ any person in any manner so as to U0 LU become subject to the Workers'Compensation Laws of California. O_ Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING _q r, IJ-6>_ rn NOTICE TO APPLICANT: If,after making Illi,Certificate of Ex- I.- 2 emption,you should become subject to the Workeri Compensalion APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with FEE U such Provisions or this Permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE sa. I hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). H EATI N G UN IT(TO 100,000 B.T.U.) 8.00 Lender's m aNe HEATING UNIT(OVER 100,000 B.T.U.)Lcndcr's ... ELECTRIC _ I certify that I have read this application and state that[lie above VENTILATION FAN (SINGLE) 4.00 information is state 1 s agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING hereby thoraces and state laws atives to building cuolruc tion, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL alTcve-mentioned property for inspection purposes. (We) agree to save; Indemnify and keep humdcss the City Of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX nmy in any way accrue against said City in consequence of the n my of[his pcnniL• MECH.CONT. LIG.N0. MECH. igndttlre n(App twat/Contractor D t TOTAL rs 0