The URL can be used to link to this page

18245V ¢Z Foo QUV N2w Qa o z w F m r M y E J ¢¢a: 0 W V w 3 A ~ H u O ¢ E 0 ¢ ¢ o O AwaW va E Z IS I 40 6 1- H@ O Z2 FN CC- W > d 0 D Z UO U_ U Ow } n (0. I�• APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION&PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL - PERMIT NUMBER is 18245 BUILDING aoc �:'f/IFDV /V • �� • OWNER'S NAME V� 1 C0 t PHONE OTV. ELECTRIC PERMIT FEECONT PLAN CHECK VALIDATION -10 h� NAME croRs NAME UTLETS-SWITCHES -RECEP 10.00/1.00 L�--f � TIC No. pI'O LIGHTING FIXTURES 10.00/1.00 ^1 "j y7/ y� (�/✓f�/ CONTRACTORS ADDRESS PPLIANCES-RESIDENTIAL 4.00 PANELS 10.00 ''1 2& , !� � 1 `T L_19 -E-N PHO 69- 00 DATE OF APPLICATION ARCHITECT � �•-• `•_w 0. ENGINEER LIC. No. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ISIGNS TRANS. 3.00 ADDRESH EN4& • / SPECIALCIRC UIT 5,00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 • zlv ' ADDRESSrs 464 4 aooress �yi •' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSI!D CON'T'RACTORS DECLARATION 1 hereby affirm Il,at I am licensed under provisions of Chapter') ISSUANCE DATE (commencing will, Section 7000) of Division 3.f tllc Business and Professions Code, and my license is in full force and effect. -- BLDG. ELECT PLG. MECH. AUG License Class Lic. Nwnher Date Contranur BUILDING PERMIT OWNER -BUILDER DECLARATION 1 hereby affirm Thal 1 am exempt from the Contractor's License Law for the following reason. (See. 7031.5, Business and Professions Code'. Any city or county which requires. permit to construct, al ter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such revisit to file a signed actor's i that liere ui licensed pursuant to the provisions of the Contractor's staor's License INFORMATION MISC.- D VALUATION ,'/y/1A /tit�Jl� (XJ(`�) $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERM( ' OTY. PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that his is exempt therefrom and STORIES TVPECONSTR- the basis for the alleged exennpllon. Any violation of Section 7031.5 byanyapplicantforapem,it subjects the applicant ton civil penalty of not more than five hundred dollars (5500).): ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their sola compersalion, will da the work, Intl Dtv structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 intended or offered for sale (Sec 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly w110 builds or improves thereon. and who does such work FIXTURES -PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve mems are not intended or nl7cHed for sole. If, however. the building GAS - EA. SYSTEM -1INC. 4 OUTLETS 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 am- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND ON B .,he, ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. licensed a ntmcto,s In construct the project (Sec 7044, Businacs and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves there.., and who contracts for such projects with a contractorls) licensed pursuant to lite Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ l anis exempt under Sc,.-, BAP.C. for lits reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORK 17 RS'COM 1117 NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of confirm to sell' -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Site. 3800, Lab CA Policy No. Company FIRESPRINK ENERGY T-24 ❑ Cutlificd ropy is hcmby lnrnished. ❑ Certified copy is filed with the city inspection division. Applicant Y ❑ N❑ V ❑ N❑ MISC.- REFER TO ORD. CIIRTIFICA'I'1: OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. UC. NO. PLG . TOTAL C'UMPENSA60N INSORANCIi on (This section need not be completed if the slit is for e hundred dollars IS 100) or less.) QAJ l.� I certify that in the performance of the work for which this per- It is issued, I hull nese en,p toy any parson in any manner, so as t. bccbje�ci t, m Work a rs' �,I penin ' IT Luw/f f Culil'on8a. 1)alc7-LL=3JApplicane _C.Kd• �-�.f"r• i K I_�- NOTItI. TO APPLICANT': If, after maklnx 11115 Cerl lflrate Of Ex- Y [:]N❑ Y ElN❑ OTV MECHANICAL PERMIT FEE FEE SUMMARY BUILDING `t G 11 ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE emption, you should become subject to the Workeri Compens:dim, provisions of the Labor Cale, you into forthwith comply will, such prnvisiuns on fills permit ba11 be deemed revoked. AIR HANDLING UNIT (TO 10,000OF.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM -�• 1 herehy affirm that there is a construction lending agency for the performance of the work for which this perms{{ i.a issued (Sec. 30Y7, Civ.0.). LNJIJGe Ai �FJQ �{&rw Lender's Name HEATING UNIT ITO 100,000 B.T.U.) 8.00 H EATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lender. nddress-I_'1� .1.5-�� I certify that I hove read mis.pplwal.... and stem lhm lna above information is correct. 1 agree to comply with all oily and county ordinances and Stam laws relating to build taxconstruction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for iisoce on purposes. MISC. - REFER TO ORD. (We) agree to save, infirm nify and keep harmless the Cily of upertino against liabilities, it gments, costs and expenses whirl, Jam in any way accrue uxai -t said Ciry in consequence of unit CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL,rj m h 'n it. - /J. J Sig pIii,Ynf1C6nIr'aZ orw Date OFFICE COPY