C7042 APPLICANT TO FILL IN.INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON IT NUMBER
BUILDING APPLICATION & PERMIT O��
ADDRESS
BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
DwNERs . _ +_ .-. _ -. KvauOAnoN
NAME _ OTY. ELECTRIC PERMIT FEE
SNEAKERS OF NO. CALIFORIDIA
NAME croRs APHO +UTLETS-SWITCHES-RECEP 5.00/1.00
NAME
STOP-FIRE INC Uc.No4331 LIGHTING FIXTURES 5.00/1.00
CONTRACTORS -" "`PPLIANCEB-RESIDENTIAL 4.00
4477 E. Brokaw Rdy..293-3473 _ _BANEUS,_ 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
LIC,NO SIGNS TRANS. 3.00
ARCO.OR ENG. PERMIT VALIDATION
ArDRES$ SPECIAL CIRCUIT - 5.00 f
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS /
SERVICE CHANGE 10.00
D o o LICENSED CON'I'RACfORS DECLARATION
v u I hereby from that I ton licensed under provisions of Chapler 9 ISSUANCE DATE
v, a u (commenting with Section 7000)of Division 3 of the Business anJ BLDG. ELECT. PLG. MECH.
H m z 1'mtessirnsC99 d rn ety.q In full Port-
zLiccnsDuW um be ❑ ❑ ❑ ❑
9 w- 11a1c Contractor l^- ••'" _ - ,
a Y s BUILDING PERMIT
w ¢ OWNIi R-RUILUIiR UECLARANPIONy 'TY _ INFORMATION
A 0dMISC., REFER TOORD
w 3 r 1 hereby affirm that I am exempt from the-Comraclur's License VALUATION $/FT.
F u m J Law lin Ihefollowing reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 6.00
Code:Any city or county which mquiresa permit to construct.alter.
2 rt }¢ 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /
D Z requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E
m he is licensed pursuant to the provisions of the Contractor's License _
I> Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE I� 1
St F_o the basis for the alleged exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR.
IN
by any applicant fora permitsubjects the applicant oacivil penally ALTER-DRAIN&VENT-WATER (EA.) 4.00 of not more than five hundred dollars(8500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensalion,will do the work,and the structure is not
intended car offered for sale (SCC. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner.of 1 7 1
property-wAo builds or improves thereon.and who does such work .i FIXTURES-PER(TRAP 4,, 1 ` 41.00 so.Rr.FLOOR AREa TOTALACREAGE
himself through his own employees,provided that such improve-
mmntsure renot intended oroffend for sale.If,howeveq the building GAS-EA.SYSTEM-1INC.4OUTLETS 4.00
or improvement is sold 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 an
for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON vB Dater
❑ I,as owner of the property,am exclusively contracting with ❑ E] E] ❑ ❑ ,
licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL N0.
.>� and Proo isions Code:"Che Contractor's License Law does not apply
u)an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a Contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ Iamexemplunder5ec. ,BAP.C.for this WATER HEATER W/VENT 4.00
/ reason
Owner Date WATER SYSTEM 4.00 ACC.DATE ACG FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby atOrm thin I have a cenificale of consent to set Ginsuro' ZONING ENG.SITE NO.
or it certificate of Worker,'Compensation Insuran e,or a certified
Copy Ihureot(S" 3800,La,C.).
Policy No, C'onlpany
O Cl Ce,lifiedc py iv hcrchy furq-ishcd. FIRE SPRINK ENERGY T-24
Z Z q Certified, )p fitd-.efthit, pcni n division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O A cent V N V N
ir rn CIiFIT 1E[CA'I'I>OP UXIiNPI'ION FROM W 1:RS' PERMIT ISSUANCE 6-00 FLOOD ZONE A.L.u.c.
LU > COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. Y❑ N❑ V❑ N❑
CL O 1'rhis section need not he completed if the permit is for one TOTAL
2 hundred dollars(SI00)or less.)
U O 1 certify that in the performance of the work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
U hcmmcsobject to the Worked Compensation Laws of Califb,niu.
O,to Date Applicant BUILDING
0- ALTER OR ADD TO MECH. 4-00
}Yrn NO CE TO APPLICANT; H. its,making this Certificate of Fs-
F Z mnprior.you shoved become subject To the Workers'Compcnsat un APPLIANCE 4.00 PLAN CHECK
provisions of tire Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10A00C.F.M.) 3.00
CONS'1'RUCI'ION LENDING AGENCY
AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE �."'
1 oru
hereby aff rn that there is a cnstction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the perrirnance of the work for which this permil is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
LaWcr's Address HEATING UNIT(OVER 100,000 B.T.U.17.50 ELECTRIC
I Certify that I have read this application and state that lite above VENTILATION FAN.(SINGLE) 3.00
information is correct, 1 agree to comply with all city and bounly PLUMBING
ordinances and slate laws relating In building construction, and BOILER-713(H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over l00,OD0 BTU)SEE FEE SCR. MECHANICAL
abovcntentioncd properly for inspection pyymows.
(WC) agree to rove, indemnify anJ k2p harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgm.ms,te.111 and expenses which CONST.TAX
may is any way accrue again t said City in consequence f the PERMIT ISSUANCE 3.00
gmntin of this permit. MECH.CONT. LIC.NO. MECH.
G TOTAL TOTAL
Signal re of Appr and/C I actor I lc
INSPECTOR COPY