Loading...
C6272 ti ARPLICANT TO FILL IN INFOR TION WITHIN RED LINES - US! BP POINT PEN ONLY BU LD1 NG PROJECT IDENTI FICAT - - • - PeRrglr NUMBER 7 EWU)ING APPLICATION & PERMIT (/�// ADDRESS L 07 7/ BUILDING- ELECTRICAL-PLUMBING-MECHANICAL W R PLAN CHECK VA\\\(DATION 1' NAME �� ; w QTY. ELECTRIC PERMIT FEE �9( �'7 y PHONE CONTRACTOR UTLETS-SWITCHES-RECEP 5.00/1.00 NAME 11C.NO. `+ LIGHTING FIXTURES 5.00/1.00 b ANTRACT Rs PPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 5.00 DATE OF APPLICATION A HI c SIGNS 6.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.90 r( ADDRESS ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 15.00 APPLICANTS MOTORS SEE FEE SCH. Q ADDRESS J SERVICE CHANGE 10.00 / woo .LICGN51iU CONTRACTORS DECLARATION ��' I hereby affirm That I am licensed under provisions of Chapter 9 ISSUANCEGATE hG n (commemmng with Section 7000)of Division 3 0(the Business and BLDG_ ELECT. PLG. MECH. H �_Z Professions Code,and my license is in full forec'and It O ❑ ❑ a, 0 R.- License Class Li,.Number a m t w Da1e.�..^�1' Cantractor_ - `BUILDING PERMIT,. 2 w OWNER-BUILDER DECLA�' [�ON INFORMATIONw 3 LLw I hereby allinn (hat I am exempt from ntractor S I.icenxe MISC.- REFER TO ORD u_ O j Law for the following reason.(ties.7031.5,Business and Professions PERMIT ISSUANCE �B /VALUATION $/FT. r _ 6.00 J � Code:Any city mcounty which requires apermit to construct. ELEC.CONTR. . LIC.NO. Iz c Q 0 improve,demolish,or repair any structure,prior to Its issuance,also ELEC. on O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO A w m LL he is licensed pursomit to the provisions of the Contractor's License H z i Law.(Chapter 9(commencingwith Section 7000)of Division 3 o(the a IiusiR.S and 11(Chapter Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE MI the basis for the alleged exemption.Any violation ofleetion 7031.5 STORIE ateT by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00 S of not more than five hundred do110rS(5500).): C, I.as owner cf the property.or my employees with wages as v their sole compensmion,will do the work,and the structure is nut BACK FLOW PROTECT. DEV ICE 2.00 OCC.GROUP RES.UNITS intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:'The Contractor's License Law does not apply ID an owner of property who builds or improves thereon,and who does such work _ FIXTURES-PER TRAP 4.00 SD,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- 1 mems are not intended or offered for Sale.if,however, he building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00 or imps vement is sold willow one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.1 1.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Other prove for purposcnt sale.). INDUSTRIAL WASTE ntINTER. 20AO ❑ ❑ ❑ ❑ ❑ U Las owner of the property,am exclusively cometing with licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply �/r to an owner of property who builds or impmvas thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 3 h(� TJ 3 the CA sl'orsuchpnnjvI.mwith acontraulorfsl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. the Cactsfooril.icele I-u w. ❑ lam exempt under Sec.-,IL&P.C.for this WATER HEATER W/VENT 4.00 L I reason (V 0/�U Owner Date WATER SYSTEM 4.00 ACC.OATE ACC,FILE NO. WORKERS'COMPENSA'I ION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have a cerlificate ofconsenl to sell-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified \.. copy thereof(Sec.1800.Lab.C.l,n - �r �/1 N C �. Policy Nn. Company_L�Q_G_Z _��L O ❑ Ccs is cupyi,hcrchyI Risked. FIRE SPRINK ENERGY T24 Z 0/` Apnlicae ific copy is I'Ic �ILu inspection Aivisinn. MISC.- REFER TO ORD. ❑ ❑ ❑ V N V N cc N CP 11'ICATIi P lihll'I'ION PROM WORKIi R$' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. W >_ COMPIi ll(1N INSURANCI! PLG.CONTR. LIC.No. PLG. C' B (I hi, ,,ctitin nccJ toil he c.nniloted it (ha permit is fur nm, TOTAL V❑ N❑ V❑ N❑ Z) Z hu.Wred Jolla..($100)or less.) U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL H mil is issued.I shall not employ any person in any manner so as to U become subject to the Workers Compensation Laws of Calitornia. O ED Date A,, ( ant BUILDING L 01V P'c ALTER OR ADD TO MECH. 4.00 Q } w NOTICE 'f0 APPLICANT: IL after making this Certificate of Ex- Z enption,you should becon,csuhjcct to the Workers Cmnpensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE C..) such provisions or this permit shall be deemed revoked. 1.!2 AIR HANDLING UNIT(TO 10SMC.F.M0 3.00 1 CONS'I'RUCTION LENDING AGENCY T AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE ./ I hereby all'ino that there is u construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 */ the performance of the work for which this permit is issued(Sec. MICROFILM Y 3097.Civ.CL HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name HEATING UNIT(O VER 100,000 B.T.U.P.50 ELECTRIC Lender's Address I codify that l have read tbisapplicarion and state that the above VENTILATION FAN (SINGLE) 3.00 inlnrinpt ion is wrreet. I agree to comply with all city cool county PLUMBING . nininces and stale laws relating to building construction, and BOILER-t COMP(3H.P.or100,000B.T.U.) 4.00 hereby authorize 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, indenmify and keep (armless the City of MISC.- REFER TO ORD. 6(. Cupertino against llaj,ditics,judgnl cuts, outsand expense,which CONST.TAX ma f I any way ace a against said City in consequence of the PERMIT ISSUANCE 3.00 a / ' gr oth of this RCnnl, • MECH.CONT. LIC.NO. MECH. / TOTAL TOTAL Sig lure.1 Apylic=omfoatnn INSPECTOR COPY