6504 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
ADR . APPLICATION & PERMIT 50
ADDDRESSESS b
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 6
OWNER'S PLAN CHECK VALIDATION
NAME Frederick Petri, George ' QTY. ELECTRIC PERMIT FEE
Som B Frank BilbaopHck15)948-78 2-
CONTRACTORS 9UTLETS-SWITCHES-RECEP 5.00/1.00
NAME
Sprig Electric LID.No2 LIGHTING FIXTURES 5.00/1.00
GONTRACTORS --1 APPLIANCES-RESIDENTIAL 4.00
ADDRESS
1303 Lick Avenue P 14108 Z PANELS 5.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
oil SIGNS 6.00
i ENGINEER
Ray
8 Rooker c.NO. SIGNS TRANS. 3.00
r nooeess E.G. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP
EMP.METER OR POLE INS. 15.00
1 Ar$ MOTORS SEE FEE SCR. (�•W-A��
�I
ADDRESS
w
1303 Lick A eenue SERVICE CHANGE 10.00
ro o LICENSGU CONTRACI ORS DECLARATION �/J
<U u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w Hemon ereing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH.
i I'rs(uSim"Coda'nd,���}}}yyy ImenV,is in full fnrc-u d c
o z m hi<ens�I u%((j'-'lu�p1y'e hie.Number c�
Dale /�19 Contractor
a Y sBUILDING PERMIT
o: rt er ¢ OWNER-B 111LD1iR DECLARATION - INFORMATION
0AU MISC.- REFER TO ORD
X3: u y- I hereby a lire thin 1 nm exempt (tort the Conlmelois Lice¢e VALUATION 5/FT.
H u o a Law for the following rcawa(Sec.70315,Business aced Professions 1 PERMIT ISSUANCE 6.00 6.00
Cade:Any city or county which requires permit to Construct,alter,
¢ 2 Q improve,demolish,or repair any structure,prior to its iouance,also ELEC.CONTR. LIC.NO. ELEC.
- R a: requires the aPplicmnl for such permit to Ilea signed statement that TOTAL PERMIT TO
w ro hLL
e is licensed pursuant to the provisions of the Comrmtor's License
F z i Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthc r.-G
¢ Ilusiness and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢F Oo Ihu basis(or the alleged exemplion.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any eppllcanl for a permit suhjacts the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 4.00
Of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.uNlrs
their Sell,compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and P,ofesirnls DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does nor apply to an owner of
property who builds or improves thereon.and who does such work F IXTUR ES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself ortlirough his own employees,provided that such improve-
mmmlslfrC nut intended orofferi,d for sale.Il;however,the build ing GAS-EA.SYSTEM-11 NC.4 OUTLETS 4.00
ur'.lnpm'vcmcn l is sold within one year Of completion,the owner-
I • builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
IT der RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑
❑ I•as owner rs the property,he exclusively contracting with
all(]professions
contractors od to construct the project ISeC. 7044,Rosiness LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
to n,o Tessio ns property Contractor's improv s th Aeon not apply
_ to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contractsfor such projects with a contractors)Iicenved pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
U"Holo exempt under Sec. ,BAP.,ho this WATER HEATER W/VENT' 4.00
Owner _ _
wnter Uun' WATER SYSTEM 4.00 ACC.DATE ACO.FILE NO.
I, WORK ERS'COMPENSA""PION DECLARATIONWATER TREATING EQUIP. 4.00
/ 1 hereby alEnn Ihat I have
a certificate of ou,t rt to sell'-insum,
Iorv certificate of Worker ZONING Compensation Insurance,or a certified ENG.SITE NO.
�I copp itierco(1Scicf.3C8m00,Lab J. -
.�, OOu�TJVO up' ,y Han IneuTeltc
r Idle copy l'h h cents u• _ FIRESPRINK ENERGY T-2a
Z 2 `CcHil' Ip li TI D c'Y inspection Jjvisimr. MISC.- REFER TO ORD.
.y ' ❑ Applicant VE] NE YF .NE]
~ w I{ PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.0 C.
- t CEk'I'IIICATIi F .XIiA11"I'ION FROM O KIi RS'
LU 5; •III COM SATI(1 N I NSURANCE PLG.CONTH. LIC.NO. PLG.
CL ❑ I,his section need not be completed if the permit is for one TOTAL Y[:] N[D Y C:] NE]
� 2 hundred dollar,IS 100)or less.)
00
,I certify that in the.performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- '1 its issued. 1 'hull not employ any person in any mmmerso as to
he me subject to the Workers'Compensation Laws of California.
U lu nattl AI licant BUILDING
I p ALTER OR ADD TO MECH. 4.00
} h rNOTICE TO APPLICANT: If,after making Lis Certificate of I.s-
F Z / emp0on,you should become subject to the Workers CORIpensation APPLIANCE 4.00 PLAN CHECK
-/ provisions of the Labor Code, you must Rottiwilh comply wllll FEE
U % such provmuc,or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10MC.F.M.) 3.00
�/ f ti- CONSTR(ICI'IONLENDINCACI:NCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
Iherl,bo affirm mal mare i, a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
/J Ihu 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
Lender's Nxme ma8a--S-• HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I
VENT ATION FAN SINGLE 3.00
I certily)thal 1 have read Ibis application and state that the above VE L (SINGLE)
inlormer idm is Correct. I agree to comply with all city and county PLUMBING
ordinancai 'and slate laws relating to building construction, and BOILFA-COMP13 H.P.or 100,000 B.T.U.1 4.00
I caul1s{ire represevatives of this city to enter upon Linc BOILER-COMP IOWn 100,000 BTUI SEE FEE SCH. MECHANICAL
n above-me 11Tonal printery for inspection purposes.
(WC) vgnro Ifo vve. dernin y and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against tiales,judgments, costs and expenses which CONST.TAX
may in any way, a u against said City in consequence of the PERMIT ISSUANCE 3.00
granting of thispur Il MECH,CONT. LIC.NO. MECH.
TOTAL TOTAL
Signattl Gof Apnf an Contac or Date
'a l �;• l $'1 INSPECTOR COPY
1