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8378
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT lDENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OW /-. 8378 Eaa PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE JPHONE coMEaA roar OUTLETS-SWITCHES-RECEP 70.00/7.00 LIc.N LIGHTING FIXTURES 10,00/1.00 CONTRACTORS DRAPPLIANCES-RESIDENTIAL 4.00 Ess 1_7 I 'O� PANELS 10,00 DATE OF APPLICATION on n PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P,C.NO. ENGINEER L.C.NO. SIGNS TRANS. 3.00 A Ress ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPucnrvrs MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 °a j.= TEMP.POLE 30.00 Hoo LICENSED CON DECLARATION a U u I hereby of firm that 1 am licensed under provisions of Chapter 9 lsi6r niSSUANC6DATE y A w (commencing with Section 7000)of Division 3 of the Business and BL G: 'ELECT. 'PCC. MECH. H o z Professions Co and my license is in full force and effect. ❑ o El ❑ z o�, - License Cla Lia Number mr Date Contractor a m s BUILDING PERMIT ¢ ¢o i o OWNER-BUILDER DECLARATION INFORMATION w 3 LL H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION $/FT, HUOJ Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 Code',Any city or county which ie9uire.s a Permit in construct,alter, or ¢ ¢ 2 improve,demolish,or repair any structure,prior it)its issuance,also ELEC.CONTR. LIC.NO. ELEC. C a requires the applicant for such permit to file a signed statement that TOTAL PE IT TO a w m he is licensed pursuant to the provisions of the Contractor's License i Law(Chapter 9(commencing with Section 7000)o1'Division 3 ofthe At io 1lusiners and Professions Code)or than he iscxempt therefrom and QTY. PLUMBING PERMIT FEE`, aC'U�l ¢ Hp tilebasis for the alleged exemption.Any violation of Section 7031.5 STORIES /'TYPE CONSTR. is, by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES,UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044. Business and Profession% DRAINS-FLOOR,ROOF,AREA,CONDE 5.00 Code:The Contractor's License Law docs nut apply to an owner of property who builds or improves thereon.and who does such work FIXTURES-PER TRAP 5.00 SO.ET FLOOR AREA TOTAL ACREAGE . himself or through his own employees,provided that such improve- menlsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00 or improvement is sold within one yeit of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have lire burden of proving that he did not build or int- BUILDING USE prove for Purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 .RES IND PB Omer O 1,as owner of the property,ant exclusively contracting with C1Elc ry ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC'5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law doe not apply In an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 t - contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00 Ole Contractors License Law. TRACT NO. PARCEL NO. ❑ I amexempt under See ,B.&P.C.for this WATER HEATER W/VENT 6.00 musol�i� Owner - time WATER SYSTEM5.00 � � ACC.GATE ACC.FILE NO. W'ORKERS'COMPENSATIONDECLARATION WATER TREATING EQUIP. 5.00 1 Irereby a10rm that I have a cer ificme of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec 3800,Lal,CJf i Policy No. `Cm 0 ❑ Cert ified copy is hereby' 'arm icit FIRE SPRINK 'ENERGY T 24 .Z Z ❑ Cecil led copy is fled Ps rh the city inspection division. MISC.- REFER TO ORD. O Applicant lY !_L+_ A .A�Smc ' Y ❑ N❑ Y ❑ N❑ lbwCB R'1'11'IG\TIi OF II"'�•CE%1TIPTION PROM WORKERS• PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU 5; COMPENSATION INSURANCE PLG-CONTR. LIC.NO. dPLG. V❑ N❑ V C] NNE]-0 tThis section need not be completed if the permit is for one TOTAL ::) Z hundred dollars($100)or less.) U O 1 cartify ❑till in the peH'ommnce of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1-(Er mit is issued,1 shall not employ any person in any manner so m to U U become subject to the Worker Compensation Laws of California. W Date Applicant ALTER OR ADO TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT': If,after making this Certificate of Ex- H Z rotation,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions 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 AIRHANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE I hereby aff'irnt that there is a construction lending agency lot EXHAUST HOOD (WITH DUCT) 5.00 s .the performance of the work for which this permit is issued(Sec. _ MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Namc� �+ HEATING UNIT 100,0008.T.U.)9.50 Lrndeh Address ELECTRIC I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and cowtly PLUMBING ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 her,C y: uthorize representatives inspection Cit to enter upon the BOILER-COMP (Owr 100,000 BTU)SEE FEE SCH. MECHANICAL abovo a tinned properly for inspection Purposes. (We a L� Is save indemnify and keep hanNe s the City rf MISC.- REFER TO ORD. Cupertii a aiiist liabilities,judgments, costs and cx penses which PERMIT ISSUANCE 10.00 CONST.TAX y in ny way accrue against said City 'n consequence of the -. g a f t s P MECH.CONT. LIC.NO. MECH. '/✓_, OTAL TOTAL V % btu n p �n[/Cnnt[uct enc - INSPECTOR COPY !1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT?EN ONLY BU I LDING PROJECT IDENTIFICATION PERMIT UMBER But, IN[, APPLICATION & PERMIT ADD ESS" g � � + . BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 3 7 8 ER'S { PLAN CHECK VALIDATION NiME R F QTY. b x ,.;, ELECT RMI Tai? PHONE LCONTRACTOROUTLETS-SWITCHES-RECEP 10.00/100 LIGHTING FIXTURES 10.00/1.00�! PPLIANCES--RESIDENTIAL 4.00 ,1HON / PANELS 10.00 DATE OF APPLICATION OR - - PANELS (OVER 200 AMP)) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER + Un.No. 'SIGNS TRANS. 3.00 ARCH.OR ENG. + ADDRESS SPECIALCIRCUIT 5,00 PERMIT.VALIDATION - _ ZIP EMP.METER OR POLE INS. 20.00 - hp h c� APPLICANT 5, MOTORS ' - SEE FEE SCH. APR !.+ F+ SERVICE CHANGE 20.00 2It1(l0 woo LICENSEll CONTRACTORS DECLARATION TEMP.POLE 30.00 •cfty,Of Cap a 0I hereby affirm that 1 am licensed under provisions of Chapter 9 - y a y (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE H y 2 Profession and an,license is in full f e an C(feCf BLDG. ELECT. PLG. MECH. Zo i m'D License Class LE.Numbe - :❑ ❑ F O H m r w Date Contractor ac SE OWNER-BUILDER DECLARATION '' , JBUILDINGjPERMIT# ��;�;: X ;LL�' I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD 3, 'Ik INF„QRIIAATION�F , '„ ,. LL O¢ Law for the following reason.(Sec.703 t.5,Business and Professions - VALUATION - - PERMIT ISSUANCE 10.00 S/Fr. f H i POST :7H'IS CARE :•1ltEAR FRONT OF`BUILD.ING .. VE IT NUMBER CITY OF CUPERTI :ND ` INSPECTION DIVISION* UO J06 INSPECTION RECORD V PE'fM1T iEXPIRAT1ON JOB AQDRI UMF7 T# PERMIT EXPIRE$IF WOR flWIVfiR _ _:' cTOn. IS''NOT STA�RTSO WNW . {N ECTION DA E 'INSPECTO INSPECTION RECORd ISO OAYB OE PERMIT IS8U-- FOUNDATION - - - -- ANCE OR 1E0 DAY$.FROM,• LIFER LABTCALtEDCN8P6CTtON. PREGUNfTE - - - FE_.RMrvvu/oAT •,� POUR Nb CONCRETE UNTIL ABOVE NAS BEEN 51MI) a LINDERVROUND:/SLAS APR. N 219 5 PLUMBING - ;ELECTRIirAL : ECMANICAL - -_ - - � �. ,© ', �•.. Q I.. �-y: NET DONbT U8'FLOOR'UNTILABGVEHASBEENSIGNEfl I-DIN TION -� -INFORMATION WOOD FLOOR YALUA SmT. MECHANICAL ELECTRICAL - - - - - - - - .. 'FRAMING _ . : .-- a • CON . - BTOFFI - INSULATION cl ROUP: E. NITE' PLACE NO SWBPLOOR UNTIL ABOVE HAS BEEN SIGNED '. � _ - _ eQ.YT:PLCDR AiIEA TOTAL ACReAtl � �. ROOF . , DIAPHRAGM - - _ - — IL IN - REE IND CGN APPLY NO ROOFING UNTIL'AB VE HAS BEEN SIGNED ❑ Ariee . ROUGIi PLUMBING_ GAS TEST - : _ .TRACT. ARCELN - MECHANICAL . ELECTRICAL _ FINALS A" INSP.• ACC.GATE ACC:FILE FRAM�INQ - SAN.4F —_ 20NING EN(i.8'ME WO. iINSULATION. , "PLUMBING _ MECHANICAL FuiE¢PRINK' ENERGY T 2a COVER 1@:NN111 UNTIL ABOVE HAS BE€N SIUNED HEATING Y❑' Y❑ N[] - k11TW—UNTERIOR E'LECCFiICAfc i . PLoomzoNE - A.uue. LAT -EX'i'ER1DR- , FIRL.DEPT. L v[] W❑ v� 'FEESUMMA�iY SMEETROCK -. .r GRADE '. - SHEAR INTE IOR _ 8U1I:AI N(3 sHEaR EXTERIOR ' .. TEMPORARY APPROVALS 81LI!DING `� .'�PIRE,SNALLS ELECTRIC: - _ V, PLAN CHECK--, NOTAK08PLAMIklfNTILANbt1EHA89 •- SIGNED OCCUPANCY _ SEISMICFEE a 1. OCCUPANCY OF BUILDING 18 WtP€RMITCED:UNTI'l.'BUILDING FINNL.IfI5FGNEO BY SUILDING9NSP C'1'OR. MICROFILM ARRANGE FOR'INSPECTION BY PHONING 252.4!%% ELEcrF1Ic iw- -.ONE WORKING DAY BEFORE REO U1RED INSPECTION. , PLUMBING 'PLEASE GIVE JOB ADDRESS WHEN PHONING. —SEE PERMIT FOR EXPIRATION BATH MECHANICAL .CONST.TAX- IMPURTANT! PLEASE READAEVElRSE SIDE BEFORE TOTAL dALL.INO FOR FINAL INSPECTION I : " gFFICECQPY - - •