13754 (4) I.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
1+
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER
App
ADORES LOT #49 PLAN 1BR544 Evening 13754
lisSpring Court BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S 415 PLAN CHECK VALIDATION
NgM�REGORY GROUP, INC• O7Y. ELECTRIC PERMIT FEE
GNE 595-2100
croRs
RARE $ OUTLETS-SWITCHES-RECEP 10.00/1.00 86.00
NAMF
Same ,c....B-430097 IqLIGHTING FIXTURES 10.00/1.00 18.0
C
ADDRE s crDRs 220--Twin Dolphin Dr. PPLIANCES-RESIDENTIAL 4.00
.ONTRA
RWC, CA. 94065 4151.0.E 595-2100 PANELSto.oa I DATE OF APPLICATION
aRCHIT FCT • PLAN CHECK FEE P.C.NO.
ENGINEER ARAM BASSENIAN, AIA PANELS (OVER 200 AMP( 20.00
& ASSOCIATES uc.ND. SIGNS TRANS. 3.00
ARD..OR ENG. PERMIT VALIDATION
AooREss 39910 WRsteE�y Place #196 SPECIAL CIRCUIT 5.00
\
APPLICANTNew sor BC . Zia EMP.METER OR POLE INS. 20.00
ADDRESS 220-C Twin Dolphin Dr. 6 MOTORS SEE FEE SCH. 6.00 `�I�ID
RWC CA. 94065 SERVICE CHANGE 20.00 K �"
W W o LICENSED CONTRACTORS DECLARATION DEC 3 01987
a v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLD MECH.
D i Professions Code,and my license is in full force and effect.
o i H
J Do License Class_B Lia Numbc
F n H ase Contractor
>< BUILDING PERMIT
or ce w 4 OWNER-BUILDER DEC ATION INFORMATION
F
;LL N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
au v, Law for the following reason, 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION g/FT.
Code:Any city or county which requires permit to construct,alter, 10.00 QQ
Qp improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. •p 97 a o00•DD
O u requires the applicant for such permit to file a signed statement that TOTAL
A w w he is licensed pursuant to the provisions of the Contractors LicensePERMIT TO
H z > Law(Chapter 9(commencing with Section 7000)of Division 3 of the S2Ca kIz-
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
. w the basis for the alleged exemption.Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty STORIES TYPE CONSTR.
of not more than five hundred dollars(S500)J: ALTER-DRAIN&VENT-WATER (EA.) 5.00 ) f N
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not Oce.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 �- 3
Code:The Contractor's License Law does not apply to an owner of
properly who builds improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through hisis own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00
or trnprovement is sold within one year of completion,the owner 6-0
-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
prove for 1,as ownerose
of the
INDUSTRIAL WASTE INTER. 30.00 RES lO CON O Dr❑ber
❑ I,as owner of she property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply / p
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3 N G- 9',3
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO,
❑ I am exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00 Cr GJ' f�
Owner Date On
WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance.or a certified ZONING ENG.SITE NO.
Policy No.
copy thereof(Sec.3800,Lab.C.L United Pacific O
Company
O ❑ Certified copy is hereby(urn,,Ie FIRE SPRINK ENERGY T 2C
Z Z f� Certified c s ed wit city inspection division.
F O A WCant MISC.- REFER TO ORD. Y ❑ N[:] I Y❑ NEI
rn CERTIFIC TEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
LOU COMPENSATION INSURANCE PLG.CONTR, LIC.No. PLG
IL O (This section need not be completed if the permit is for one TOTAL Y❑ N Y ❑ N❑
Z hundred dollars($100)or less
C..1 O 1 certify that in the performance of the work for which this per- QTY. MECHANICALjM
IT FEE
FEE SUMMARY
W H mit is issued,I shall not employ any person in any manner so as to
O L) become subject to the Workers'Compensation Laws of California.
y Date APPlicant ALTER OR ADD TO ME5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate or Ex- 424.00
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE 275.60
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO r_FJVU 4.00i6o nnCONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVE =C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
she performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). Sacramento S&L HEATING UNIT 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address �,�, -1-04 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have readtNh+iaptl that the above VENTILATION FAN (SINGLE) 4.00 142
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00 92.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU(SEE FEE SCH.
•1 above-mentioned property for inspection purposes. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of I MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX ZB2•66
may in any way accrue against said City in consequence of the 10.00
granting Of this permit MECH.CONT. LIC.NO. MEC..
TOTA` TOTAL
Signa.e o 1 and/Conlracmr Dal 51 .00 $ 1 ,434.07
OFFICE COPT