Loading...
6854 (2) CIAM ©s . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIFICATION� a PERMIT NUMBER BUILDING ♦ ` Y APPLICATION & PERMIT ADDRESS BUILDING - ELECTRICAL-PLUMBING-ME-MECHANICAL 685 4 OYINER's OTYPLAN CHECK VALIDATION NAME 4GIO . ELECTRIC PERMIT FEE • PHONE CWERACTORs UTLETS-SWITCHES-RECEP 5.00/1.00 �RA(lAE /IOILA/I E' aW UC.NO. tie LIGHTING FIXTURES 5.00/1.00 CONTRACTORS Rs ADDRESS APPLIANCES-RESIDENTIAL 4.00 J,a6 r7 �( q� PHOrvE t/ - S PANELS 5.00 GATE OF APPLICATION RCHITECT 0-/-1A)5/'�>✓ SIGNS 6.00 PLAN CHECK FEE P.C.NO. OR 5/t, ENGINEER - uc.No. SIGNS TRANS. 3.00 ARCH.Ess ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 15.00 AANT ADDRESS MOTORS SEE FEE SCH. DRESS Ess y SERVICE CHANGE 10.00 Y o o LICENSED CONFRACTORS J-"TRACTORS DECLARATION / ' E7 ¢ u 1 herchy affirm that I am licensed under provisions of Chaplet 9 ISSUANCE DATE wa N (cotmnencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F o z Professions Code,a ..y license is in full force and f c'r ❑ ❑ �.S ❑ a o�, - Liccnsc Class Lic.Numher 11f-TJX g Ilatc '9 r Contractor ¢ Ys BUILDING PERMIT ¢ ¢ ¢ < OWNER.BUILDER DECLARATION INFORMATION E: 3 LL r I hereby afro..Olaf I um exempt from Ole Contractors License MISC.- REFER TO ORD LL o a 1-sew for lire following mason.(Sec.7031.5,Businessand Professions pERM1T ISSUANCE VALUATION S/FT. � - Code:Anycity orcounty which requiresa permit to construct alter, 6.00 IS ¢ Q Q improve,demolish,or repair any structure,prior t0 its issuance,also ELEC.CONTR. LIC.NO. ELEC. O ¢ requires the applicant lin such permit 10 filen ira signed l...tcut that TOTAL PERMIT TO w " hu is licenucd pursuant to the provisions of the Contractor's License A Hza Law(Chapter 9(commencing with Section 70000of Division 3 ofthe �L'J Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. La3°2 by any applicant for a permit subjects lire applicant ton civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 ol'riot nmm than five hundred dollars(5500).1: ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP' PES.UNITS their sole compensation,will on the work,and the structure is not intended or offered for sale(Sec 7044, Business and ProfessionsJ;L DRAINS-FLOOR ROOF,AR EA,COND, 4.00 - Code:'I'he Contractor's License Low does not apply to an owner of ' property who builds or improves thereon,and who does such work FIXT - ER TRAP 4.00 sD.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- Gents are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00 or Improvement is sold within one year of completion,the owner. GAS EA.SYSTEM.OVER 4 IEA.) 1.00 BUILDING USE builder will h;ve the burden of proving but he did not huild or im- d RES IND CON PB Other prove for purpose ofsale.). INDU TRIAL WASTE INTER. 20.00 ❑ I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the Project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 }ASSESSORS PARCEL NO. anti Professions Code:'I'lie Contructor.'s Listow Law does not apply ,( x 10 un owner of properly who builds or improvus thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant tot the Contractor's license Law. SEWER-SANITARY-STORM EA.200ft/8.00 P& TRACT NO. PARCEL NO. ❑ lam sempt under Sec ,B.&P.C.for this WATER HEATER W/VENT 4.00 reason Owner Uute WATER SYSTEM 4.00 ACCDATE ,ACC.FILE NO. WORK ERS'CQMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I It.,,a trtificutc of....cut to Self-insure. or u certifcute of Workcri Cumpwlsation Insurance,or a certified ZONING ENG.SITE NO. thereof(Sec.3800,Labf,I Policy No. Company A)(-7 J O ❑ Cerfilied copy is hereby furnished. FIRESPRINK ENERGYT"P4 Z Z ❑ CerlifieIqrpyfiled with the t nspcction division. MISC.- REFER TO ORD. 0 Applicant_/=__e6�ss61Uk� l Y ❑ N❑ Y ❑ IN Cc: (((U PERMIT ISSUANCE 6.00 FLOOD ZONE •A.L.U.C. (r ] CER'I'I1'ICA'I E OI'IiXEMPI'ION FROM WORKERS' LL COMPENSATION INSURANCE P CONT LIC.N0. PLG. (� CL ❑ (I[its section need not be coniplmed if the nit is for one TOTAL�QI Y❑ N❑ Y ❑ N❑ Z htmdred doll...(S 100)or less.) U O I certify that in the performance of work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shalt not employ person in any manner so as to U become subject to Ole Worke ora pensalion Laws of California. CL Date Appll ALTER OR ADD TO MECH. 4.00 BUILDING } m NOI'WE TO APPLI I. If, its,making this Cenific,tc of Ex- ♦- ? emption,you sl o become subject In the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions of a Labor Code, you must forthwith comply with FEE U such provi ns or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00 CONSTRUCI'IdN LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE I hereby affirm that there 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.CJ, HEATING UNIT(TO 100,000 B.T.U.) 4.00 ,1 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC Lenders Address I certify that I have mad this application and state that the above VENTILATION FAN (SINGLE) 3.00 rTU information is correct. 1 agree 10 comply with all city and county PLUMBING l ordinances and state laws relating IT building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 4.00 hereby authorize representative,torics of this city to enter upon theaboveBOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL hereby araioncd properly fative,or of It Purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00 grant Oft ispe,mil. MECH.CONT. LIC.NO. MECH. rOTAL TOTAL Signature of Apph nt/Contractor c - .: l INSPECTOR COPY