Loading...
3317 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN BUILDING PROJECTd DENTI FICATION NUMBER - BUILDING - 'APPLICATION &I PERMIT e� �'] ADDRESS J 1 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OwNER'E K - PLAN CHECK VALIDATION OTY. ELECTRIC PERMIT FEE-_ (• ©J_LJA V PHONE e S , .. CONTRACTORS 'OUTLETS-SWITCHES-RECEP' 5.00/1.00 NAME y uc.No. - LIGHTING FIXTURES . '5.00/1.00 CONTRACTOR'S APPLIANCES,RESIDENTIAL 4.00 ADDRESS PHONE PANELS - 5.00 DAT E OF APPLICATION ARCHITECT - PLAN CHECK FEE P.C.NO. OR SIGNS - 6.00 ENGINEEn uc.No. SIGNS TRANS.- - 3.00 ARCH OR ADDRESS ENG. SPECIAL CIRCUIT .5.00 PERMIT VALIDATION ZIP• TEMP.METER OR POLE INS. 15.00 APPOCANTS MOTORS SEE FEE SCH. ADDRESS.! SERVICE CHANGE PAILJ10.00 .t0 o LICENSED CONTRACTORS DECLARA'T'ION 1 /�-�4 a u I hereby affirm that I am licensed under prcoisimis of Chapter'] - - ISSUANCE DATE - - m rt h (commencing with Section 7000)of Division of the Business and BLDG. ELECT. PLG. -MELH. F N z Professions Code,and my license is in full force and effect. _ 9 O y.— Licanse Class - Li,.Number „ w Date - - CDntract., I O . upe mo -/ ❑ f�— ❑ ' 0 .a x E .. - - T — BUILDING PERMIT rc w a „ OWNFR-tl UILDFiR UECLA RATION .o A.o INFORMATION wtB n r 1 hereby affirm that I am exempt from the Contractor's license MISC. RERE TO ORD u O a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION _ 4. - . PERMIT ISSUANCE 6.00 - Codc:Any city or county which oiluires a permit to construct,alter, ELEC.CONTR. LIC.NO. a o improve,Demolish,or repair any structure,prior to its issuance,also ELEC. /Q fY. n w m u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO he is licensed pursuant m the•provisions of the Contractor's License _ . r z r' .Law(Chapter 9(eommencingwith Section 7000)of Division 3 of the ,��F(,�'T• z o Business and Professions Code)or that be is exempt Iherefnmt and QTY. PLUMBING PERMIT FEE - X t-$ the basis for the alleged exemption.Any violation of Section 7031.5 - _ STORIES TYPE CONSTR. by any applicant for o permit subjects theapplicant Ric civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 of not more than five hundred dollars(S500)J: - ❑ I,as owner of the property,or my employees with wages as - BACK FLOW PROTECT. DEVICE 2.00 .OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offend for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4,00 Code:'rhe Contractors License Law does not apply to on owner of ' property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 So,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such inipiove- meaismenolIntendedorofferedforsulc.IL howceci,the huilding GAS-EA.SVSTEM-.11NC.4OUTLETS 4,00 ' i+ for improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1,00 - BUILDING USE builder will have the burden of proving that Ite did nm build or int- RES IND CON PB Om 'move fur"'n"aw of sale.). _ INDUSTRIAL WASTE INTER.' .20.00 e ❑ 1,as owner of the property,u p exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. . 5.00 ASSESSORS PARCEL NO. - and Professions Code:The Contractor's License Law GM,not apply to an owner of property who builds or impnrves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.). 1.00 , contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ' - SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO: ❑. I am exempt under Sec. ,B.&P.C.forthis WATER HEATER W/VENT - 4,00 V reason . /\ Date �/ �_ML tEns Uwocr WATER SYSTEM 4.00 ACC.DATE .ACC.FILE NO. • WORKERS'COMPENSAFION OIiCLALA A'I'ION " WATER TREATING EQUIP., 4.00 I hereby affirm that 1 have a certificate of consent to seliNnsure, - ZONING ENG.SITE NO. or a certificate of Workers Compensation Insurance,or a certified rol+y thercnf(See 3800,Lah.CJ. Policy No. Company O ❑.Certifiedcrpy is hereby famished. FIRE SPRINK ENERGY T 24 z Z ❑ Certified copy is fled with the city inspection division. MISC- REFER TO ORD. ' O,. Applicant a Y ❑ N Y ❑ N❑ ~ �+ PERMIT ISSUANCE 6.0.0 jr CIi R'fIFICATE ENEATI N INS FROM WOR.ERS' FLOOD ZONE A.LLLC. W � COMPENSATION INSURANCE .. PLG.CONTR. LIC.No. PLG.- - CL a (This section need not be comp cled if Ili' permit oJor.ora• ITOTALr L• Y❑ 'N❑ Y ❑ N❑ D Z hundred dollars(5100)orIes-)' ' ,U O 1 certify that in the performance of the work for which this per- - FEE SUMMARY LL P mit is issued,I shall not employ any person in any mannor so us to QTY. MECHANICAL PERMIT FEE O W - become subject to the Workers'Compensation Laws of California. y Date - APPlicuni ALTER OR ADD TO MECH. 4.00 BUILDING >_ W NO]ICE '1'0 APPLICANT: If,efmr making this Cort ificatc of Ex- H Z emption,you should become subject to the Workers'Compcmutiun- APPLIANCE 14.00 PLAN CHECK provisions of the Labor Code, yet, most forthwith comply with FEE U such provisions of this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10=C.F.M.) .3.00 j CONSTROC'I'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10)M0C.F.M.) 5.00 SEISMIC FEE , I hereby affirm that Umre is a construction lending agency.for EXHAUST HOOD (WITH DUCT) 2.00 the performance of the work for which this permit is issued(Sec. MICROFILM - 3097,Civ.C.). - - HEATING UNIT(TO 100,000 B.T.U'.) 4.00 Lender's Name HEATING UNIT(OVER 100,000 B.T,U.)7.50 ChoLeader's Address ELECTRIC (� .i I certify that 1 have read thisimplication and stale that flit above VENTILATION FAN (SINGLE) 3.00 infmnnation is correct. I agree to comply with all city and county PLUMBING ordinances and slate laws relating to building construction, and BOILER-.COMP(3 H.P.or 100,000 B,T.U.) 4.00 - hereby authorize representatives of on city es enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL " above-mentioned properly representatives of (Lis p urposes. - (We) agree lD save, indemnity and keep hanmluss'dIC City of MISC.= REFER TO ORD. CONST.TAX Cupertino against y liabilities,just said s, costs and expenses f he - ' may in any way accrue against said City in consequence of the PERMIT ISSUANCE • 3.00 granting of this permit. MECH.CONT. LIC.NO. MECH. . rorAL- TOTAL Signature of p licant/ConUacl r Dame OFFICE COPY