The URL can be used to link to this page

10298 APPLICANT TO FILL IN INFC&ATION WITHIN RED LINES - USE BALL POINT PEN ONLY • _"BU I LDING PROJECT lDENT]FICATION PERMIT NUMBER BULUING APPLICATION & PE T ADDRESS BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 10298 OWNER PLAN CHECK VALIDATION ��' NAME 1 TV. ELECTRIC PERMIT FEE / Q ( PHONE /JO �14 / NAMERACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00 h /o LIC.No, LIGHTING FIXTURES 10.00/1.00 AOCRESs Rs APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRESS ErvG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP ITEMP.METER OR POLE INS. 20.00 do . APPLICANT S ADDRESS MOTORS SEE FEE SCH. �y SERVICE CHANGE 20.00 wicz Foo LICENSED CONTRACTORS DECLARATION TEMP.POLE , 30.00 a U U I hereby affirm that l am licensed under provisions of Chapter 9 ISSUANCE DATE H G N (commrneirg with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. n- w z Professions Code,and my license is in full force and effect. ❑ 1:1 ❑ ❑ Z, O w - License Class Lie.Nmnber 0 O v, F w Date Cunlructor h Ma w< BUILDING PERMIT OWNER-BUILDER DECLARATION Cope" w ;u w I hereby affirm m mcmr's that I aexempt from the CootLicense MISC.- REFER TO ORD INFORMATION u. O¢ Law for the following reason.(Sec.7031.5.Businessand Professions VALUATION $/FT. H - PERMIT ISSUANCE 10.00 Code:Any city or county which structure, u tore permit to construct,alter, 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. _ LIC.NO. ELEC. a 9 O ¢ requires the applicant for such permit in file signed statement that TOTAL �J Q w m LL Ire is licensed pursuant to the Provisions of the Contractor's License PERMIT TO F z a Law(Chapter 9(commencing with Section 700()of Division 3 ofthe i D Business and Professions Code)or that lie is exempt therefrom and GTY. PLUMBING PERMIT FEE �E 4 R F m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES' TYPE CONSTR. i 3 .- by any applicant fora permit subjects the applicant tuacivilpenalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the Property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 ACG GROUP RES.UNITS their sole compensation,will do the work,and tine structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00 Code:The Conlmclor's Licensc Law docs'not apply to con owner of Property who builds or improves thereon,and who dors such work FIXTURES-PER TRAP 5.00 so.IT.FLOCH AREA TOTALACREAGE ® himself or through his own employees,provided that such improve- immix are nut intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,tireowner- GA$-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose ofsale.). RES IND CON PB Omer th ' INDUSTRIAL WASTE INTER. 30.00 El El El 1-1 13 ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See 7044,Bminess LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code: The Contractor's License Law docs urd apply to an owner of property who builds or improves thereto,and who LAWN SPRINKLERS-OVER 5 IEA,) 1.00 contracts for such projects with a contractors)beensed Pursuant to the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this reason WATER WATER HEATER W/VENT 6.00 Osvner_yp5_7 Dmc - WATER SYSTEM 5.00 ACG OATS ACC.FILE NO. WORK ERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby ulfirnn that I have a ertiliaate of consent m selbinsum, or a certificate of Workers'Compensation Insurance,or it certified ZONING ENG.SITE NO. copy thereof(Sec,3800,Lab.C.). Policy No. Company Q ❑ Certified copy Is hereby furnished. FIRE SPRINK ENERGY TY4 Z Z O Certified copy is filed with the city inspection division. p: O Applicant MISC. - REFER TO ORD. YE] N F] Y EJ NC] CrN CF-RI'IFICA'1'17 OP EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00FLOOD ZONE A.L.u.c. W > (70 41;NSA'IION INSURANCE: PLG.CONTR. LIC.NO. PLG. CL Z ('Phis section need not be completed if the permit is for one TOTAL Y❑ N Y [] N hundred dollars IS 100)or Its,) U G 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY UL I- mit is issued. I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. ED Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE'1'0 APPLICANT: If,after making this Certificate of Ex- Z emptier,you should become subject to the Workco'Com,tRoRion APPLIANCE 5.00 PLAN CHECK pro000 visions 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 IQOOOC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 30 • Qt) I certify that I have read this upplicotiun and state Ih:n the above VENTILATION FAN (SINGLE) 4.00 i naatiou is correct. I agree to comply with all city and county BOILER- H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and nate laws relating to building construction, and hereby mentioned representatives ec this city es ewer upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above hereby authorize property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertinopgainst liabilities,judgments, costs and ex perces which CONST.TAX may in ny way accruggsaid City in conscyuence of the PERMIT ISSUANCE 10.00 gr:mii tf Ihi,,crotif MECH.CONT. LIC.NO. MECH. A»..Hw � �.- 3'��7; TOTAL TOTAL 9igTaure of Applicant/Catc OFFICE COPY