C7041 ' "','APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN OroLY
• *� BUILDING PROJECT IDENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 7041
y ADDRE935 N. Wolfe Road BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
NAME 5 l�R2 Y"1��y - - -- - _ - PLAN CHECK VALIDATION
. VALLCO ,PARK INC. DTV. ELECTRIC PERMIT FEE
PNONE`�'`"
NAMr°°`T°Rs _ OUTLETS-SWITCHES-RECEP 5.00/1.00
STOP-FIRE, INC' LIG,N°,433114 LIGHTING FIXTURES 5.00I1.00
IONTBACTOHs __ PPLIANCES-RESIDENTIAL 4.00
ADDRESS
470 E. Brokaw Rd.,H°NE 29303471 PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGNS• 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. v` 3.00
AARCH.OR
DDRESS ENG SPECIAL CIRCUIT ' 5,00 PERMIT VALIDATION
ZIP rrEMP.METER OR POLE INS. 15.00
APPLICANTS
ADDRESS
MOTORS SEE FEE SCH.
A
SERVICE CHANGE 10.00
0 0 o LICENSED CONTRACTORS DECLARATION
IC u u I hereby aifno that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
fey H 3 n (commencia,with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H m i Professions Code,and my license is in full force and effect.
i 0 m W Licenx Cla �LIc.Number F-1
Q H Da1c_ Conf ctor_L1-Lc ._` _
BUILDING PERMIT
at o i OWNER-BUILDER DECLARA'T'ION INFORMATION
w ; LL I hereby affirm that I am exempt from J17v_Contmclor's License MISC.— REFER TO ORD vALunnoN
oj Law lits the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 6.00 S/FT.
vi Code:Any City or county which requires a permit to construct,alter,
rta, Q Q Improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
a w0 , requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO �
w he is licensed purswmt to the provisions of life Contractor's Ui nse 0D�_
Law(Chapter 9(commencing with Section 7000)ofl)ivision 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE F/4-5--
S'Adle 111
f F. o
A. F pN the basis for the alleged exemption.Any violation ofoa cion malty STORIES TYPE CONSTR.
A. by any applicant lora permit cloth,,(heapplicam toacivil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than live hundred Aollan($500)J:
❑ 1,as owner of the property,or my employees with wagesas BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Seo. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
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 4.00 SO.FT FLOOR AREA TOTAL ACREAGE
. himself or through his own employees,provided that suchim ProvC-
meals are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have the burden of proving(hal he did not build or im- - RES IND CON PB OMer.
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20,00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sce, 7044,Business. LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. j
and P,obsslons Codc:'I'he Contractor's Ller.•nse Law does nut apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for suc11 projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA,2001t/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00
0"2 [)ate WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK 1:RS'CO`IPFN'SA'1'ION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate ofconsent to scll�msure. ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a cerlil'ied
copy lhercof(Scc.3800,Lab,;.).
Policy N.. Compony '
U O Certified c py is licreby furnished FIRE SPRINK ENERGY T-24'
z Z P,,cerfified ly fiIed i We Cuy p nn division.
O A an �+R'�t/I �L//-L(-:PYP-s P MISC.- REFER TO ORD. Y N❑ Y ❑ ' N❑
CrN CIiR'1'117CA'I'Ii OF GXEM111'1'ION PROMj'� KIiRS- ' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.0 C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O 11 his section need not be completed if the permit is for one TOTAL v[:] NE) ✓O . rv❑
Z hundred dollms(S 100)or less.)
U O I certify that in the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,1 shall not',uploy any person in any manner so as to
UW beconm subject to the Workers'Compensation Laws of California.
y Dula ApplicantBUILDING L S
} to NO'T'ICE'1'0 APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 4.00 0
F Z_ emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK q o_3provisions of the Labor Code, you must forthwith comply with - FEE
U such I n visions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 3.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10XWC.EM.) 5.00 SEISMIC FEE a�
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of ole work for which this permit is issued(Sec. MICROFILM
3097,Civ,CA HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
. information is correct. I agree to Comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 4.00
hereby authorise representatives of this city to enter upon the BOILER-COMP(over 100,0008TU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
1 Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00
gA oflhis permit. MECH.CONT. LIC.NO. MECH.
TOTAL � 03
SigriTOTAL
store of Appli• t/Coritrador DVC
INSPECTOR COPY '