18660APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING -'MECHANICAL
PERMIT NUMBER
I 18660 � � bn O
BUILDINNR%L5G
A K)O`frn� i)
OWNER'S
NAifW G1_ �,{., /� C'�
l(.-.� 1 PHONE JVD
DTV. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
L 4� If "
.i
AN 271993
J)I DATEOF APPLICATIONI
CONTRACTORS
NAME f 1
con& ionrd it Lie. No.
UTLETS-SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR s
ADDRESSDRESS
AL 1
1loL�'-ICJ U\,I"V) PQ. PHONE IL�\
[APPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT
OR
ENGINEER
LIC. No.
PANELS (OVER 200 AMP) 20,00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ENG.
ADDRESS
SPECIALCIRCUIT . 5.00
PERMIT VA LOCATION
TEMP. METER OR POLE INS. 20.00
ZIP
APPLICANTS
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
fXjV" �v
LICENSED CON'T'RACTORS DECLARATION
0, 0 ^ Q /\, A r 1)
I hereby affirm that I am licensed under provisions of Chap 9
(commenting with Section 7000) of Division 3 it the Business and
Professions Coda, u ul�v license is in full Cor • � rid a tett
License license
Number _
Date�J�l__��_-L Cantrador
'Ar T-
ISSUANCE DATE
BLDG.
❑
ELECT.
❑
PLG. MECH.
❑
- ,� ��
BUILDING PERMIT
OWNER -BUILDER UECLA RATION
I hereby affirm that I am exempt from Thu Contractors Li rise
Law for the Wllowing reason. (Sec. 7031.5. Ousiness and Pnlles.I
Code: Any city or county which reyuiresa permit tocomtrucL alter,
improve, demolish, or repair any 9Rmtmre, prior to its issuaoee, also
requires the applicant for such permit to file a signed statement that
he is licensed pursumll to the provisions of the Contractor's License
INFORMATION
- EFER TO ORD
PERMIT'ISSUAN E 10.00
VALUATION
S/FT.
ELEC. CONTR. LIC. NO.
CLEC.
TOTAL
PERMITTO
GTY. PLUMBING PERMIT FEE
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he a exempt therefrom and
STORIES
TYPE CONSTR.
the basis (nr the alleged exemption. Any violation of Section 7031.5
1
by any applicant for a permit subjects the applicant toa civil penalty
of not more than five hundred dollars ($5001.)'.
ALTER-DRAIN-WATER(EA.) 5.00
❑ 1, as owner of the properly, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK F LOW PROTECT. DEV ICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044. Business and Professions
Code: The Contractors License Law does not apply to an owner of
properly who builds or improves thereon, and who does such work
FIXTURES - PER TRAP 5.00
50. FT. FLOOR AREA
TOTAL ACREAGE
himself or through his own employees, provided that such improve-
mentsarenolinlendedorofferedforsale. If, however, the building
GAS-EA.SYSTEM-I1NC.4OUTLETS 6.00
or Improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
Prove for purpose pf sole.).
.I, as owner of the property, me exclusively contracting with
licensed contmetors to conatrud life project (Sec. 7044, Basin.,
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
GAS- EA. SYSTEM - OVER 4 (EA.) 2,00
BUILDING USE
RES IND CON PB Other
❑ El 13 El 1:1❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
contracts for such projects with a contractions) licensed pursuant to
the Contractors License L.W.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
❑ I am exempt under Sec.-, B &P.C. for this
reason
owner Dam
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WORK ERS'COM PF-NSA'IION DECLARATION
WATER TREATING EQUIP. 5.00
I hereby alhoor that I have a cerliticate of consent to sell -insure,
or a certificate of Workers' Compensation Insurance. Dr a certified
copy lhercol'I 38 0 IbC.I
Policy NO(w�Y d4 NC�111 any_J ")TUI rl1
ZONING
ENG, SITE NO.
O Certified copy is hereby bmin,101.
FIRE SPRINK
ENERGY T-24
f Certi ]uit ix tiled (y�L' 11 El• c'L its e -tion division.
Applicants A�11 J _
Y❑ N❑
Y❑ N❑
MISC.- REFER TO ORD.
Cli CA'I IS OP EXEMPT' NFROM WORKERS' -
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
PLG.CONTR. LIC. NO.PLG.
TOTAL
COh11IFNSA'1'ION INSURANCE
Ilhis section need mol be complelN if the Permit is for one
Y ❑ N❑
Y'❑ N❑
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars IS 100) or hr,0
I certify that in the performance of the work for which this per-
mil is issued, I shall not employ any person in any manner so as to
heconm subject to the Workers Colnpensalioa Lows of Caluornia.
Dale Applicant
ALTER OR ADD TO MECH. 5.00
NOTICE '10 APPLICANT: If, after making this Certificate of Ex-
empt on, you should become Subject to the Workers' Compensation
APPLIANCE 5.00
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit 111.11 be dccmcd -evoked
AIR HANDLING UNIT (TO 10)000CF.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.F.M.)6.00
FELECTRIC
CONSTRUCTION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 5.00
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
HEATING UNIT IT 100,000 B.T.U.) 8.00 1
HEATI NG UNIT IOVER 100,000 B.T.U.)9.50
Lender's Name
Lender's Address
VENTILATION FAN (SINGLE) 4.00
PLUMBING
I certify that I have read this application and nate that the above
information is correct. I agree to comply with all city and unlmy
ordinances and state laws relating to building conatn¢tinn, and
BOILER- WMP I3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP IOve- 100,000 BTU) SEE FEE SCH.
MECHANICAL �7
hereby authorize representatives (it this city to enter upon the
above-mentioned property for inspection pugmse%
MISC. - REFER TO ORD.
/
CONST. TAX
(We) agree to save, indemnify and keep harmless the City of
upertino against liabilities, judgments, costs .,-
C expenses which
may t ny ay accrue//%'��!!N•'Lnst ud City In wnsequencc of the ran Yof- ispen
PERMIT ISSUANCE 10.00
MECH. CONT. LIC. NO.
-
MECH.
TCJ J
TOTAL
��.y
lSgmamre of Applicant/ motor Date
OFFICE COPY