14056 z
`" T TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUG PROJECT I DENTI FI CATI ON PERMIT NUMBER
APPLICATION & PERMIT
'r w Y�-•.'7GL
/ l.�I IIx P sG 14 > BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 14056
DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
. rolorG1 -,/3i?'1 51OUTLETS-SWITCHES-RECEP 10.0011.00 8, y 4
Lli/J S-j. ' �.. Q trl1 LIC.NO :l LIGHTING FIXTURES 10.00/1.00
r CONNTRATOR's APPLIANCES-RESIDENTIAL 4.00
// ✓/ (f� �r - PHONE 3�AG�/L.'(�- PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE Y.C.NO.
OR G� PANELS (OVER 200 AMP) 20.00
ENGINEER 'ACV/ _ ;
LIC.No. - Z SIGNS TRANS. 3.00
��•al ADDRESS NG. PERMIT VALIOAI ION
lllrrr //�� Aa1S.G� SPECIAL CIRCUIT 5.00
N /� 0.;; (i���pL2bti'!(('ii " zIP ' r<'y EMP.METER OR POLE INS. 20.00
ADDRESS rs �.. MOTORS SEE FEE SCH. ,
ADDRESS C C'( Trre,�
SERVICE CHANGE 20.00 CGL
Q o LICENSIiD CONTRACTORS DECLARATION �/-zS /
a/z U 1 hereby'uG'irm Ih'.H I wn licensed mWYI pnn'isimlS til Chupler`I ISSUANCE DATE
n¢ n lconunenaing wish Sea ion 7000)of Disisioo 3 of the Business and ❑LUG. ELECT. PLG. MECH.
/ Profesonn'S CDJr, nyyyy license is in full Iory�altkl�kcf •3 ❑ O El
zo i m o License Class- Lic.NWllher -
H W Date/e'�-'�f(vConlranor r(
¢ y E _II ,l Ci'.
¢ ¢w¢ OWNER-BUILDER D17C'LAKA'TION �.C. BUILDING PERMIT.
'xu o o I hereby MISC.- REFER TO ORD INFORMATION
y affirm that I am eumpt Iron the Cunlrucmr's License
703 VALUATION F LL O j Code y ity oriounty which
r. uires$perilin mcon construct,alter, PERMIT ISSUANCE 10.0011 $/FT.
Code:Any city or toms,y which requires a peon it to cons)ante aheqf
in a ¢ o improve,demolish,or repair pry structure,prior to itsissuance,also ELLC.CONTR. LIG NO. ELEC.
nG¢ requires the applicant for such permit to Glc a signed statement that TOTAL
w 2 he is licensed pursuant to the provisions of the Contractors License PERMIT TO
H 2 i Law(Chapter 9(commencing with Section 7000)o1'Division 3 of the
f 4 o Business and Professiuns Code)or that he is exernpt lherelronn and QTY. PLUMBING PERMITW4.000CC.
'C/I,�a7iY,�b
¢ r $ the basis for tire alleged excnlptian.Any violation of Seclion 703 L$ RIES TYPE CONSTR.
i ; � by any applicant for a permit subjects the applicanno a coilpenully gLTER-DRAIN& VENT-WATER (EA.)of mol Ionic than five hundred dollar(5500).):
❑ 1,as owner of Bre progeny',or my employees with wages as BACK FLOW PROTECT. DEVICE GROUP BEs.UNITS
Ellett sok compensaliun,will do the work,and the structure a not
intended or offered for sale (Sec. 7044, Businns and Profession' DRAINS-FLOOR,ROOF,AREA,CONCode:The Contractors License Law does not apply Rs an owner ofproperty with builds ur improves thereon,and who docs such work FIXTURES-PER TRAP LooH AREA TDrAL ACREAGE
himsell'or through his own employees,provided Ihal such ilprove-
mems are not intended oroffeed lir wleIf.Iluwuveq the building GAS-EA.SYSTEM-1 INC.4 OUTLET
or improvement is Sold within one year of completion, the owner-
builder will have the burden of proving Ilia,he did riot build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
Prove for purpose of or RES IND CON PB Omar
❑ I,os..net of the property,all exclusively contracting with INDUSTRIAL WASTE INTER. 30.00El
licensed contractors W construct the project(See'. 7044,IRulpns LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Canlraclors License Low dues not apply
to an owner of properly who builds of impruves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant In
the Commctnr's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam ex4mp,under SC,,_,EE&p.C.for this
reasonWATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACG F14E NO,
W'ORKERS'COMPENSA'f ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby allinn that I have a certificate ul cannot to sell:ir.ure.
or a certificate of Workers'Compensation Insurance,or o cenilied ZONING ENG,SITE NO.
copy thereat(Sec.3800,Lab.C.).
Policy Na Company
0 0 Certified Copy is heraby furnished.
Z z Piecenil op Iv file i11 B It pecliun dim,her. FIRESPRINK ENERGY T.24
� O plicam '� V' IMISC.- REFER TO ORD. [:] � ❑ C]
V N V N
it m CERTIFICA'I'1i 01:FXMPfION 17RONI WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A,L.U.C.
LU COMI'l'NSA-'60N INSURANCE PLG,CONTR. LIC.NO. PLG,
D_ O (This section need mol he conUslcle,l if the Porti is for one TOTAL Y❑ N Y E] N
:) Z hundred A011urs(S 100)o r less.)
U O 1 Cerny that in the Perfurinmlcc of the work fur which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,I shalt not nnplDy any Pmum in any Inannuer su a to
U become subject to the Workeri Compensmion Laws of California. W
a>_
Dam Applicant BUILDING
>_ W NOTICE 'f0 APPLICANT': If,after In'akin,this Cerlilieude of Ec ALTER OR ADD TO MECH. 5.00
I- Z eruption,you should become subject to lire Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency forEXHAUST HOOD IWITH DUCT) 5.00
the petliHlnance of the work for which this puonil is issued(Sea MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
inlonna[iun is I:nrrcal. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6,00 PLUMBING
ordinances and state laws relating to building wnstruclion, an
hereby authorise repose motives of this city Ill solar upon the BOI LER•COMP (Ove,100,000 BTU)SEE FEE SCH. MECHANICAL
hereby
property for inspe r this
pu city
in
(We) agree to save, indenmify and keep harmless the Cily of MISC.- REFER TO ORD.
Cupertino against liabilities,j.udgrocRis, Costs and enpnnes which CONST.TAX
mily-'In' ny way accrue, against said City in cornequence of IIIe PERMIT ISSUANCE 10.00
arcing c�thls pe MECH.CONT. LIC.NO. MECR.
ora•of AVVhCanl Contmnur 6a re TOTAL
COPY