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C 8402 (5) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER AURIEN SS AOGRAPPLICATION & PERMIT 8402 A �3 O tot BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME / OTV. i ELECTRIC PERMIT FEE �/ . CONTRACTORS NAME ` UTLETS-SWITCHES-RECEP 10.00/1.00 �" �� LIc.No 9f" LIGHTING FIXTURES 10.00/1.00 nooness'oR's 'APPLIANCES-RESIDENTIAL 4.00 QQQ 6 Ora "20N-_1s-"/-46 PANELS 10.00 DATE OF APPLICATION OR ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER, LIC.No. SIGNS TRANS. 3.00 ApOREES No SPECIAL CIRCUIT 6,00 PERMIT VALIDATION zIP a EMP.METER OR POLE INS. 20.00 APPucaers ' aooREss MOTORS SEE FEE SCH. ' (9 C9 © 0 SERVICE CHANGE 20.00 02 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30,00 < °u I hereby affirm that�I am licensed under previsions of Chapter 9 vHi 2 w ISSUANCE GATE ¢n (commencing with Section 7000)of Division 3 of the Business and a ELECT. PL EC HA w i Professions Co}}�{II.�•,a�nJ��Qy�JI'cense is in full fore a fe Z imo License Cless l.4---V-L Con Number F H r J Dale lfe�/.p=c(j=Contractor- OD L,, a_ w¢ OWNER-BUILDER DECLARATION 'I_ BUILDING PERMIS* °n ° MISC.- - REFER TO ORD ,INFORMATIONt`: X ; h 1 hereby affirm.that I am exempt from the Contractor's License u O¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. y w PERMIT ISSUANCE 10.00 > Code:Any cityorcounty which requires a permit to construct.alter, /)/\ QQ ¢ � Improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTE. LIC.NO. ELEC. �/-to 0 - °a heQ is licensed the dapplicant for SOCK provisions to(Ile a Signed actor's Li enst TOTAL 20 PERMIT TO a w S re is licensed pursuant to the provisions of the Contractors License Hii Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the - �O 4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ir H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant(ora pemrit subjects the applicant to a civil penalty of not more than five hundred dollars(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5,00 ❑ 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 OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP' 5.00 SO,FT,FLOOR AREA TOTAL ACREAGE himself ments re through his own employees,provided that such improve- orunprovemenotnntendedwithinoffered onafor sale, year If.however,t the owner. GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 bu improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or int BUILDING USE prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 RES IND CON PB Other ❑ 1.d as owner rs the property,he exclusively, 7044, ins with � � � � C] 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 who buildsContractor's License Law does not apply to tr owner of property who builds t r improves used oath who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts actor's h License with a contra<lorlsl licensed pursuant m the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec,.,B,&P,C,for this reason WATER HEATER W/VENT 6.00 , Owner Date WATER SYSTEM 5,00 ACC.DATE ACC,FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 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. copy thereof(Sec.3800,Lab.CJ. Policy No. Conrpan O ❑ Certified copy ishereby l'urnishe �Qe2 f' // FIRE SPRINK ENERGYTY4 Z Z, ❑ Certified py s 3-IttLLwill the coy ms ctmu division. H' O Applicam ���+-�/ X h 9 /.�e .�rCONTR, REFER TO ORD, v � N� y ❑ NE] � y CERTIFICATF:017 EXEMPTION FROM ORKF.RS' NCE 10.00 FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE LIC.NO. PLG. d O (This section need I be completed if the permit is for oneTOTA V N� V❑ IN D Z hundred dollars($100)nates,) U O I certify that in Om performance of the work(or which Ibis per• ANICAL PERMIT FEE FEE SUMMARY LL 0- 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 MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of F Z emptinn.you should become subject to the Workers'Compensation I APPLIANCE 5.00 PLAN CHECK r provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 113=11F.M.) 4.00 v CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEE I - D 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,Civ.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 I certify that 1 have read rhes application and Mate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 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 construnion, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH.1 MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. _ Cupertino against liabililies,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 grand p(lhis penniL MECH.CONT, LIC.NO. MECH. TOT / TOTAL P Signature of p an[/Comractor Date OFFICE COPY