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8358
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BU I LD ING PROJECT I DENTIFIC PERMIT NUMBER 'BUILDING APPLICATION & PEOT ADDRESS XIUILDING —ELECTRICAL—PLUMBING—MECHANICAL 8358 OWNER' J PLAN CHECK VALIDATION NAME JJE ✓/''[L�fS/� CITY. ELECTRIC PERMIT FEE f • PHONE NAME - I` Co RADTon5 (r 0UTL ETS-SWITCHES-RECEP 1Q,QO/1.00 Llc.No. LIGHTING FIXTURES 10.00/1.00 f-ONTRACTOmS PPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 AARCH OR DDRESS ENG SPECIALCIRCUIT 5,00 PERMIT VALIDATION ZIP fTEMP.METER OR POLE INS. =0 ADDRESS TS MOTORS j SEE FEE SCH. j SERVICE CHANGE 20.00 �, ^ a — _ _ _ a. 00 o O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 ��(//d T < U U I hereby affirm that 1 am licensed under provisions of Chapar 9 ISSUANCE DATE ' r vHi at vo (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H n z Professions Code,and my license is in full force and effect. Z o v,— License Class Lie.Number ow o Dmc Contractor T T� r E -a '^ BUILDING PERMIT ¢ ce w ¢ OWNER-BUILDER DECLARATION I I INFORMATION oAe' MISC.— REFER TO ORD w 3 u I hereby affirm that I am exempt from the Contractor's License G VALUATION $/FT. .. o ¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE] 7,OIQB (:ode:Any city or county which requiresa permit toconstrocLalber, R m ¢ improve,demolish,or repair any structure,prior 10 its issuance,also ELEC.CONTR. LIC.NO. /p? f� ✓—t/ ELEC. 0 K retinues the applicant for SOCA permit it)f0v a signed statement that TOTAL /O z �� PERMIT TO wa he is licensed pursuant to the provisions of the Contractors License _ rzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe e ¢ Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE ¢ e the basis for the alleged exemption.Any violation of Section 7031.5 STORIES OAST dam by any applicant for a permit subjects the applicant toacivil penalty gLTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).1: 3 N ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 lJ OCC.GROUP RES.UNITS their sole compensation,wiH do the work,and the structure Is not ! intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 a Code:The Contractor's License Law does not apply to an owner of G(�I1 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP yyr SO.FT.FLOOR AREA TOTAL ACREAGE Smmots ahimself or through his own employees,provided that such improve. _ rc not in tended or offered Im sale.If,however,the building GAS-EA.SYSTEM-1INE.40UTLETS 6QQ a Ud ,/ or improvement is sold within one year of completion, the owner- T 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 purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe On., ❑ I,as owner of the 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 Conlrclor's License Law does net apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 �3�_� �� the Contractor's License Law. SEWER-SANITARY-STORM contracts for such uch pensees with a commmmgsl licensed Panamintto SEEY EA.200ft/10.00 TRACT NO. PARCEL NO. / p reasonl am exempt under Sec--- .&P.C.for this WATER HEATER W/VENT 6.00 v Owner Date WATER SYSTEM 4,C AC/C.DATE ACC.FILE NO. WVKERW KERS'COMPEN 'PION DECLARATION WATER TREATING EQUIP. 5.00 S��OMPEN I hereby affirm that I have a certificate of consent to selGinsure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,1-ab.0). Policy No. Con.pany O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T 24 Z 2 ❑ Cerlified copy is filed with the city inspection division. REFER TO ORD MISC.- R . O Applicant Y❑ NO Y ❑ N❑ CC CC ? CLRIIPICATI O\EXENIP INSURAONCFORKERS' PLG.COERMIT ISSUANCE PLG NO. PLGFLOOD ZONE A.L.U.C. COI'v CL Z ('this section need not be completed if the permit is for one TOTAL Q � Y El NE] Y El -1:1N hundred dollars(81 00)of less.) U O 1 certily that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY pc,,.,,I— mit is issued,1 Shall not employ any perain any manner so as to m O become subject to the Workers'Compensation Lows of Califomia. Q.W Doc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Sa 3 l• } to NOTICE TO APPLICANT: If,after making this Certificate of Ex. Z eruption,you should become subject to the Workers'Compensation APPLIANCE5. PLAN CHECK provisions of the Labor Code, you must forthwith comply wish FEE U such provisions or this permit Shall he deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 1 CONSTRUCTION LENDING Acer:cY AIR HANDLING UNIT(OVER 10,000GEM.) 6.00 SEISMIC FEE � 6 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCthe T) - 3097 performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 810 MICROFILM 1 Le ender's nder's Name Addrem HEATINGUNIT(OVER100,000B.T.U.)9.50 ELECTRIC Lss 1 ccelity that 1 have read this application and nate that the above VENTILATION FAN (SINGLE) 4.00 'nfonndtimm i correct, I agree to comply with all city and county PLUMBING ;la• ordinances and sate laws relating m building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 ' 76) hereby authorize representatives of this city to enter upon the BOILER-COMPOver100,000 BTU)SEE FEE SCH. MECHANICAL above mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.-e REFER TO ORD. - Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX lam+ may in any way accrue against said City in consequence of the PERMIT ISSUANCE 0 tit granting of this permit MECH.CONT. LIC.NO, MECH. TOTAL � 6 ire TOTAL igna roof Applican ontrac 4 Date INSPECTOR COPY