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HomeMy WebLinkAbout8335 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER BUILDINGAPPLICATION & PERMIT �� ADDRESS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL Ow PLAN CHECK VALIDATION X NAME QTY. ELECTRIC PERMIT FEE lox ,L orvB - NAMEACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 y 1 C (0C-AL.(0N5TQuc.No, TD LIGHTING FIXTURES 10.00/1.00 ADDRESS TOR'S A-Tp6R PPLIANCES-RESIDENTIAL 4.00 JaNUJ PHONE _ PANELS 10.00 DATE OF APPLICATION ORORCHrtECT PANELS (OVER 200 AMP) 20.00 7`7 LAN CHECK FEE P.C.NO. : I ENGINEER LIC,No. I1,r SIGNS TRANS. 3.00 ADDRESS Nc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APPLICANT'SMOTORS SEE FEE SCH.ADDRESS caiV7 s SERVICE CHANGE 20.00 j /L/,( 0o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 / t/ a U U I hemby aft m [hut I am licensed under provisions of Chapter 9 ISSUANCE DATE N < i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH. H z Professions Code,and mry license is in full force and effect. z o H -� License Class �, Lie.Number ® ©� 'Date Contractor a 'T . (LTA�n'�.c-s�p.ac BUILDING PERMIT ' wa OWNER-BUILDER DECLrwrroN"' o A MISC.- REFER TO ORD INFORMATION g n H I hereby affirm that 1 um exempt from the Contractor's License VALUATION $/FT. .. 0 4 Law l'or the following naso...(Sec,7031.5.Iiusincssand Professions PERMIT ISSUANCE 10.00 � W Code:Any city orcounty which requires a permit toconslruct,alteq ?y ab0 rea, Q 2 Improve,demolish,Or repair any Structure.prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC, ''11 j J •il / O LL requires the applicant for such permit to file a signed Statement that TOTAL OL,J PERMIT TO n ' 041. he is licensed pursuant to the provisions of the Contractor's License i Law(Chapter 9(comaevcingwtth Sema..7000)of Division 3of0te F o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE r"�:./�7a 0 .the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. A. by any applicant for a permit subjects the applicant toll civil penalty ALTER-DRAIN -WATER (EA.) $,00 / of not more than five hundred dollars($500),): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC,GROUP RES.UNITS their Sole compensation;will do the work,and the structure is not intended or offered I'nr sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE • mems are not hrough ownemployees,for Sale. If.ed that however. the improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 mems are not intended or offered for sale.If.however,the building or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove will have the burden of proving that he did not build or ism- RES IND CON PB Omer prove 1, purposea.,owner of sale.). INDUSTRIAL WASTE INTER. 30.00 ® 0 0 0 0 ❑ d ua owner of the property,ire exclusively . 0contracting,BI with licensed contractors to construct the project(Sec. 7044,cut apply LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to owner of property who builds or improves thereon.sua who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contractsonract su License L with a contracmds)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the OMtlmctorS LiCenSe law. TRACT NO. PARCEL NO. t ❑ Iuntexemptmder Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason ! Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKERS'CO:MPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to sch-insure. ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(See.3800,Lab C.). / Policy No. Com pant$ O ❑ Certified co py is hereby l riishe . �4� � RESPRINK ENERGY R24 Z Z ❑ Certifi'd mp is filed with the ' y inspection division. 1-- Ode Applicant L MISC.- REFER TO ORD. 4_Y N� v NF.RTI FIC 'Ill UP IEXF.NIPTION PROMW :RS' PERMIT ISSUANCE 10.00FLOOD ZONEA.L.U.C.dLU .OMPFNSATION INSURANCE PLG.CONTR. LIC.NO. PL .0- a (This Section need not he completed if the permit is for ane TTALY 'N v N❑ hundred dollars IS 100)or less.) ``CJ O 1 certify that in the performance of the work for which this per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY - ,LL F mil is issued, I shall not employ any person in any manner so as to ;'�• U become subject to the Workers'Compensation Laws of California,` 0 a Dufo ApplicantBUILDING } 0NOTICE 10 APPLICANT''. if,after making this Cerfif eine of Ex- ALTER OR ADD TO MECH. 5_00 �a.Q ♦- Z emptim,you Should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK - Ilevisions 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 1S EISMIC FEE e.2 I hereby affirm That there: is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 . the performance of lire work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT (TO 100,0008.T.U.) 8.00 Lender's Name HEATING UN IT 100,000 B.T.U.)9.50 Lenders Address ELECTRIC a I certify that I hove rcuJ this application and state that the above VENTILATION FAN_(SINGLE) 4.00 infor cation is correct. I agree to comply with all city and county ' PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.R.Lr 100,000 B.T.U.) 6.00 hereby awhw-U, erpresentahvcs .1 this City to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL (fU above-mentioned property For inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and cxpcnxs which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE I-Gao granting of this Bruits. MECH.CONT. LIC.NO. MECH. TOTAL .7 U1J TOTAL e .2 s gnalure onlraclor Date � INSPECTOR COPY ' ' I