7009 A4PPLICAN:rJTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT 1 DENTI FICATI ON PERMIT NUMBER
E aDI'mm,
APPLICATION & PERMIT
ADDRESS
21267• Stevens Creek Blvd. BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 700.9
OIVNER'S •/ PLAN CHECK VALIDATION
NAME. Alamo Computer Cpqer QTY. ELECTRIC PERMIT FEE
NAMERACTans UTLETS-SWITCHES-RECEP 5.00/1.00
ACTION FIRE CONTROL I.C.ND. 325155 LIGHTING FIXTURES 5MI1.00
ADDRESS
S OR's
< PPLIANCES-RESIDENTIAL 4.00
41075 Railroad AvP_ vHONE PANELS 5.00 DATE OF APPLICATION
nt CA 94538 SIGNS 6.00 PLAN CHECK FEE P.C.NO,
N
LIC.NO. SIGNS TRANS. 3.00
AARCH.OR DDRESS ENG. SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION
i ZIP EMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH. /f
ADDRESS
SERVICE CHANGE 10.00
0 0 o LICENSED CONTRACTORS DECLARATION I /
Q u I I Imrehy affirm fiwt I am licensed under provisions of Chapter 9 ISSUANCE DATE
h a U
(cowith Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r w z Professions Co arI license is in full lure p �I ❑ ❑ ❑ ❑
z o m - 1, Rumba
D N = CI . C:aorraelor�
a mF BUILDING PERMIT
Ie a re a OWNER-BUILDER DECLARATION INFORMATION
A oa " MISC.- REFER TO ORD
w LL r 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION SIFT,
I- LL o a Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 6.00
Code:Any city or county which requires o permit ro construct,aIle,
a1 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELF C.V 1T260.A. 00
- o ¢ tributes the applicant for such Permit to idea xiyned sOnemmnt that TOTAL -
LL PERMIT TO
w m he is licensed pursuant to the with provisions of 00 )ire Contractor's's 3 ofthe 7
z > Law(Chapter 9(mmons Co,10 or that
is exempt theref o and FIRE SPRINKLER$
Business and Professions Codcl or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
e. the any
aper tte lora
exec sc ion.is the
applicant
of5ec ivil cnally STORIES TYPE COrvsTR-
a ;°-a by any upPlicam fora permit subjects the applicant luacivil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not atom than five hundred dollars(S500)J:
❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
I their sell,compensation,will do the work,add the unarnu,is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
_ Code:The Contractors License Law does not apply to an owner of
property who builds or improves"thereon,and who docs such work FIXTURES-PER TRAP 4.00 so.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improvn-
musts are not intended or offered for sale.It.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion.lire 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-
o
proveforpurposeofsal¢.L INDUSTRIAL�WASTE INTER. 20.00
RES IND CON PB Dner
EDI,as owner of the pmpery,ant exclusively contracting with E] E] ❑ E] ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
_ wad 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
mr
conters fusuch projects with a contractor(s)licensed pursuant to
the Cntr:tntnr's LiecusC Law. SEWER-SANITARY-STORM EA.20011/8.00 TRACT NO. PARCEL NO.
iI ❑ I:u I exentpi under Sec. ,B.&P.C.I..cis WATER HEATER W/VENT 4.00
reason
OwOcr Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hcrcby al'lion that I have it certificate at consent to ecll-iusure, ZONING ENG.SITE NO.
or a certificate.of Workers'Compensation Insurance.or u certified
cops'thereol(Sec.3800,Lab.C.).
I'oliry No. Company
O PJl Certified copy is hmeby famished. FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is'd, wlh the city'inspection division. MISC.- REFER TO ORD.
Q J\ppicanr d _.�> SEG Y❑ N❑ Y ❑ N❑
� N CER_TD'IC'A'TF OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLC.
CL CL 0 IT his section need not be completed if the permit is for one TOTAL v[:] N❑ Y ❑ rv❑
hundred dollars 0100)or less.)
U O 1 certily that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
it LL U mil is issued,I shall not employ any person in any manner w as m
become subject to the Workers'Compensation Laws of California.
a Dam Applicant ALTER OR ADD TO MECH. 4-00 BUILDING 22.00
NO]ICE TO APPLICANT': If,after making this Certificate of Ex-
♦- ? cngnion,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
Provisions of file Labor Code, You ..it Rnlhwair comply with FEE 14.30
U sneh provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Op00C.F.M.) 3.00
CONSTRUCT"ION LENDING AGENCY AIR HANDLING UNIT(OVER IOSMCF.M.) 5.00 SEISMIC FEE 50
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
m 'the performance of Tho work lin which this peunir is issued(Sec. MICROFILM
s 3097,Civ,C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
,Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lendeh Address ELECTRIC
i I certify that I have read this application and stale that fire above VENTILATION FAN (SINGLE) 3.00
intormalion is correct. I agree to comply with all city and County BOILER-COMP(3 H.P.or 100,000 B.T.U.1 4.00 PLUMBING -
ordinances and slate laws relating to building const rc.tcn, and
hereby authorise representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless tte City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against said City in consequence of the
granting ofthis permit. MECH.CONT. LIC.NO. MECH.
d. TOTAL TOTAL 36.80
\Signature of Apolicant/ onlracloi rz'�N A' - _
INSPECTOR COPY