7035 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LD ING PROJECT I DENTIFICATI ON - PERMIT NUMBER
9GLLGING APPLICATION & PERMIT 7035
ADDRESS /� A p
1060 BLANEY ITV C�11 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S ' PLAN CHECK VALIDATION
NAME PEALMl SOLA $ABLE CRUX CITY. �}t ELECTRIC PERMIT FEE
� JCONTRACTORS PHONE `�'S F F /
.(
.NAME ��/p pe,/ ecvvsT, WC, UTLETS-SWITCHES-RECEP 5.00/1.00 (o d1�
LIC.No, LIGHTING FIXTURES 5.00/1.00 , V
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS VANO��e yk7A,�i �.1. �{501I L
3�/Cj PHONE Oy PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLANCHECKFEE P.C.NO.
OR W9a0r-_6L COLLA AI S
ENGINEER
' tic.No. SIGNS TRANS. 3.00
�ARCH,OR ADDRESS ENG. ) SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
1345 VAl" - WA STz"1_ l2 EMP.METER OR POLE INS. 15.00
APPucANr's MOTORS SEE FEE SCH.
^.
ADDRESS G AWV,6 SERVICE CHANGE 10.00
/1S
C o LICENSED CONT RACI'ORS DECLARATION '
Q o u I hereby atfirtn that Inn, licensed under provisions of Chapter 9 ISSUANCE DATE
(Com n.mein,with SCellall 7000)of Division 3 of the Rome,and BLDG. ELECT. PLG. MECH.
z F.N i Pn.fcssions Codd.:uul Itry license is in full force and effect. ❑ ❑ ❑
o m - License Class Lie.Number
-
0 z F o Contractor
BUILDING PERMIT
tc w a OWNER-BUILDER DECLARATION INFORMATION
A o a REFER TO OR
w3 r I hereby al❑nn thus I am exempt from the Contmemr's License MISC.-
h. ¢Oj Law lot the following reason.lSec.7031.5.Rusinessand Professions PERMIT ISSUANCE VALUATION 5/FT.
Code:Any City or county which requires a permit to construct,.Iter, 6.00 .t...0
<o improve.demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.' V v v •1
a w m, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
z ic
a Law(Chapter R(Commencing with Section 7000)of Division 3 ofthe
4 o Rusiness and P,,nC.suns Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
I o the hasis for Elie alleged esemptmn.Any violation of Section 7031.5 STORIES TYPE CONSTR.
be any any applicant for a permit subjectsthe applicant toacivilpenalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not more than live hundred dollars(5500).)'.
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their safe contpensmion,will do the work,and the Structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
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 4.00 SO.FT,FLOOR AREA TOTAL ACREAGE
•• himself or Ihrauµh bis own employees,provided that such impowc-
cnuare not intendedoroffcred for sale,If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 4.00
or improvement is old within ,an year of con...letion,tire,owner- GAS-EASYSTEM-OVER 4 IEA) 100 BUILDING USE
builder will have,the burden of proving(flat he did not build or int- . . .
RES IND CON PB 0 ber
prove for purpose of soleal. INDUSTRIAL WASTE INTER. 20.00
L) I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licen.md emtrumors In 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 docs not apply
to un owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractons)Iiccowd ponu.»t to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ Iain exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 4,00
on
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COM PIiNSA'I'ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby altinn that I have a certificate ofermsent or self-insure. ZONING ENG.SITE N0.
or a Ccuiticate of Workers'Compensation Insurance,or a certified
/ copy thereof(Sec.3800,Lab.C.L
�F PolicyFo. Company �
0 .
O Cetlilled appy is henhp forms d.. - LS _� ffQ_Z ] FIRE SPR INK ENERGY T-24
Z Z Cl Cent ,I opy is lilt wi:41 th• city inspection division. MISC.- REFER TO ORD.
O' Applicant J/,JT(eyes !! / V❑ N❑ V ❑ .N❑
L CER'fll'ICA'I'1i(lF IL\Ie NPI'ION'FROM WORKERS' PERMIT ISSUANCE 6.00 i d FLOOD ZONE A.L.u.C.
DJ > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O 11 lie, section nred out be completed if the pan...I is for one TOTAL �� Y❑ N❑ Y❑ N❑
Z hundred dollar,IS 100)or less.)
U O 1 Certify that in tlt, pe,fiolu ncC of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I srd[not employ any person in any....ne,so as to
U become subject to toe Win kers'Compensation Laws of California.
O U1 Date A, lic:o.I BUILDING CSO
a 1 p ALTER OR ADD TO MECH. 4.00
} w NOTICE '1'0 APPLICANT': 11,alter making this Certificate of Ex-
Z cnption,you shuhdd beconc"A'a't to Oe Workcrs'Compcnsatmn APPLIANCE 4.00 PLAN CHECK
provisions of the L.huf Code, you must forthwith comply with FEE
U such provisions of this permit shall bm declined revoked. AIR HANDLING UNIT(TO 10WOC.F.M.) 3.00
CONS I RUCI'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE X70
I hereby aH'Inn that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work far which this permit is issued(Sea. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 4.00
[.Carter's N.n'c HEATING UNIT(OV ER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
PLUMBING
. information is correct. I agree to comply with all'cip and county
BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
ordinances and state laws relating to building construction, anJ
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over IWOOOBTU1SEEFEESCH. MECHANICAL
above-mentioned property for inspection purpo . -
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments• costs Sc'and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against Said City in consequence of the
grant ing of Pis permit, MECH.CONT. LIC.NO. MECH.
OTA[. TOTAL F3 a 6
r Signal r want/Contrxc e
INSPECTOR COPY