5944 APPLICANT'TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
r' BUILDING PROJECT IDENTIFICATION- - _ PER IT NUMBER
RDILrING ' ': APPLICATION & PERMIT' : . . f+ p
N ADDRESS. 8 aT wooer ti 15944
..r
^\.,,' r•",eN r ryrV I� • F1 BUYILD-'I^iNsaGro"B-aaEaLECTRICAL-PLUMBINwG
-MECHANICAL41'5o y\ OwNEP'S I wNs
PLAN CHEC 'VALIDATION
NAME
"SELECTRIC PERMIT "* "b�. '4FEE
PHorve xaTM� �3
CONTRACTOR S UTLETS-SWITCHES-RECEP 5.00/100 d 3
ucrmo. LIGHTING FIXTURES 5.00/1.00 `f7�/
` 1 'rorvTRACTona - ° - APPLIANCES-RESIDENTIAL
PANELS S.UD DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
on VAArlp '4p.. "
GI YTI� X1 1 SIGNS 6.00
ENNEER .�
1•fO'f1+ , Lic.NO.. A•AG11- SIGNS TRANS. 3.00.
ARCH.OR ENG. PERMIT VALIDATION
ADOR�}s CA ai IAM .SPECIAL CIRCUIT 5.00
b�J• nP EMP.METER OR POLE INS. 15.00 _
APPLIANT'S - MOTORS SEE FEE SCH:
I - AooREss
SERVICE CHANGE 10.00
Oaci VVVY/�J
O
02 ' LICENSED CONTRACTORS DECLARATION
a u,� 1 hereby affirm that I am licensed under provisions of Chapter 9 `- ' " ISSUANCE DATE
N G T ,(commencing with Scelion 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
rmz ilpml"sirns Code,. d ylicenseisinfull fore nQ fegl. fifo n4 ^v tnrfinn -
z o m License Class Lic:Number _r.�{s"� • �I '�' j
4 y r m Dulc Cnnlrnctor J((fi5_
.n
m Q IS a - OWNER-BUILDER DECLARATION- BUIL,°OING?µERM1T
- o.d u r INFOfiMATION
X g LL w I hereby affirm Ihat 1 ern exempt from the Contractor's License MISC.,- REFER TO ORD
u O¢ Law for the following reasoirfSec.7031.5,Business and Professions , f7VALIJATION $/FT.
PERMIT ISSUANCE Colc:Any cityorcounty which requires a permit to construct,alter, B'�ac ¢ ¢ o improve,demolish;or repair any structure;prior to its issuance,also ELEC.CONTR. LIC.NO.O ELEC.i w m LL requires flit applicant for such permd 10 file a signed T[alement that TOTAL �/ PERMIT To
he is licensed pursuant to the provisions ot the Contractor's License
"h "4
s- zQ BHome.Law and (commencing with Section is exemfttheron3of(he I
Ez o 'Business and Professions Code)or Ilmt he is exempt therefrom and Q�,� PLUMBING�p.�P� ERMIT FEE
Kf ce the basis for the alleged exemption Anyviolation of Section 70315' j$Rl,% „xx�%}vs; q'M `M kit e .'1°r..'s, a STORIES TYPE CONSTR.
u 3 _ by any applicantfor a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4,00
- of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00
their sole`compensation,.will do the work,and the structure is not OCG GROUP RES.UNITS
intended or offered for sale(Sec. 7044;Business and Professions - DRAINS-FLOOR,ROOF;AREA,COND. 4.00
Code:The Contractor's License Law does not apply'to an owner of
properly who builds or improvesthereon,and with does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.if,however,the building'/ GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement Is sold within one year of Completion the owner- GAS-EA.SYSTEM-OVER 4 IEA.1 1.00 - -
1, bu id r will have the burden of proving that he did not build or im-- BUILDING USE
pros for purpose of sale.).; ' -„ RES IND CON PB Other
❑ I as.to nor Of the,property irn exclusively'contracting with• INDUSTRIAL WASTE INTER.' 20.00 ❑ E / 13 El ❑
licensed cmitracton to construct the proje2l ISec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Commetor'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
contracts for such pr jects with a Conl ectm(s)licensed pursuant'to
the Co.!Rut 0'S License Law. SEWER-SAN ITARY-STORM„EA.12QOft/5.00 TRACT NO. PARCEL NO.
❑ Ihm exempt unoer.Scc. '•,B.&P.C.for this
reason T WATER HEATER W/VEN 'r""'' 4.00
Owner - ,Date WATER SYSTEM 1 4.00
t M1C ACG GATE ACC.FILE NO.
.WORKERS'COMPE.NSATION DECLARATION WATER TREATING.EQUIP! /'+ 4.00
1 hereby affirm (hit I,have acertificate ofconeent toself-insure, _
or a certificate of Workeri Compensation'Insurance,.or a Certified - nnY{1911 ZONING ENG.SITE NO-
copy TherWW))��`9$py 3. D,Lab C.) 'ILV UY •ors' -
Pnlicy N®LFJ'26y` JompanyI -
❑ Ceruucd copy is hereby form lied -
Z Z ❑ Cer[Cip{_�By„ioi� �Itlh,fir 'ty inspection'division - FIRESPRINK ENERGYT-24
Applicant_ /GW2-C C'f� - MISC:- REFER TO ORD, YEs[ v1 No
rnPERMIT•ISSUANCE
Cr - CIi R'fIFICA'I'EOh F.XIiMI'TION FROM WORKIiRSt. � � 6.00 FLOOD ZONE A.L.u.C.
LU > COMPENSATION INSURANCI PLG.CONTR. - LIC.NO.' PLG.
ll D 1['hi' tendo need no[ he completed.if the p it I.s'Ior one TOTAL Y NE] V F] N[]
� Z hundred dollar,($100)or less.) a
V O I ecoid that in the performance of the work for which this er waat. x'w �'ee * '.'+: •a"%+ aaolso,i''sRF
}
.LL y- p employ y person in any manner so as to xOTYf?kAaa ak'a sMECHANICAL PERMIT + atw PER k$�'� EE6 SUM ARMY
F mil is issued,I shall not em Io m
aw become subject to the Workers',Compensation Laws of California. % '-' "w x n^u TKM . . +°^"- '" n.'.
Date -Applicant 'ALTER OR ADD TOMECH. 4.00 BUILDING
il d' 9d. W
-• } taNOTICE 'TO'APPLICANT: If,after making this Certificate id Ek-
F ? eruption,you.should become subject togthe Workers'Counpensation' APPLIANCE - 4.00 PLAN CHECK
provisions of'the,Labor Code, you must forthwith comply with, r, FEE
CJ such provisions or this permit shall be deemed revoked: AIR HANDLING UNIT(TOf10,000C-F,M.) 3.00
- . CONSTRUCTION LENDING AGEN(!Y - AIR HANDLING UNIT(OVER I0,OODQEM.)15.00 SEISMIC FEE 3 �s
I hereby affirm that then is a eonstructiod lending agency for EXHAUST HOOD MITH.DLICT) 2.00
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Cic.C.). .,• - t^ - HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER.100,000 B.T.U.17.50 ELECTRIC �•43 d;
L nders Name
- -- -
i-- Icertify that lhave read&sapplicathonandsWtcthat the above VENTILATION FAN (SINGLE) 3.00
i f nances n correct 1 agree to comp)y ildh ull,eity and cranny BOILER-COMP(3 H.P.or 100,000 B.T.U.) 400 PLUMBING 3 :
ordinances and state laws relating to pbuddth construction, and r
/ ercinspection ey authorize representatives of U.-Cuterupon the
IShBOILER-COMP (Over 100,000,BTU)SEE FEE SCH. MECHANICAL 60
above mentioned property for p purprp oses .1
(We) agree to save, indemnify end keep harmless the City of MISC.- y REFER TO ORD'.
Cupertno against liabilities,judghnents, costs'and'expenses which py CONST.TAX
may m any way accrue against said Chty.,in consequence of the PERMIT ISSUANCE 3.00
g'r,aInlyhn7/&ofthis permit. ' MECH.CONT. r LIG NO.
MECH
iigmdu TOTAL
/r(J TO
e• OFFICE COPY