7282 .. _ . . T' aJ•; rFer. ..,.,..,. *-"' 'rr'1F'N::^-• .u'. .,,.y„-..,r - .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE�BALL POINT PEN ON
BUI LDI NG PROJECT I DENTI FICATION •^ PERMIT NUMBER-
ao'tieess / APPLICATION &'PERMIT
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 7282
OWNER'5 A U PLAN CHECK VALIDATION
"AME ' ' bPANELS
LECTRIC PERMIT FEE '
/ r Ptj 57705
NonTRACTOR s,j. r a- WITCHES:RECEP 5.00/100 A,._ ,
IXTURES 5'00/100
GONTaAir OR s �- - 9�5' -RESIDENTIAL 400
A/�p�ESS '
PHONE,3��Z t 5:00 DATE OF APPLICATION
i - --. O.
ARCH ECi .PLAN CHECK FEE ':, +-P CnN
OR . :✓'/ '' .'n.ENGINEEEE� S. 3.00
ARCH ORIENG,Yi •- $PEOIAL CIRCUIT - 5,00 PERMIT VALIDATION
f t A�ogEbF�.��
t. 5/Dy zIP EMP METER OR POLE INS. 1500 /
t AVPucA vi- MOTORS ,,'rte / SEE FEE$CH
✓ :p /r�oR o q;.F.t s trx v, rrK._.': sy w x.,
� „ W, j :.{ t .c. L fs, _,SERVICE CHANGE 1000 (_�
1 0 0 0 LICENSED CON"FRACCORS DECLARATION A Ar
vlM t,�,A n'hherehy alta rm that l a,licensed under provisions of Chapter - ISBUANCE GATE
' (cu nmencing wlh'Scotion 7000):of Division.3'Of thL Business and ,L - BLOG.r ELECT. PLG. MECH.
H
H Zi.{ I roflssons Cod,,,and my licensL is ni'fall'fomgg a�nU fCL Flo
Z o - License Class '.� Li Number Y// / o ;n ❑_.- .®, - ❑
0 z H w IJJte Contractor' '
a m � .. BUILDING PERMIT
Q ix w a ` OWN[R- DIiCLARATION - . INFORMATION
o A '- MISC REFER TO ORD
K
; N I hv,by JfE i that 1 am exempt from rlhc G'essa tors License VALUATION $/FT.
F LL o a' IJ f earl c'4illo mg easun.(Sc 7031 S Busi sand'Pmfcss ons 'r PERMIT ISSUANCE "6.00 ''�
(. d :Any*city or w ty which a Im,sail permit to construct,alta
ir rt c p i
prove,d,mol II o repair tructura prior to its issuenc',also ;E;LFC TR LIC-NO ( ELEC. !S,
• .'
D ¢, ryires[hc applicant fo[suchpe mi t+fileasignW statementihal �� , TOTAL PERMIT TO
w c, lie 's licensed pursuant to the provisions of the Contractor's License
r• z i Law{Chapter 9(commencing wthSection 7000)o f Division 3ofthe
4 Baines. and Professions Core)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
I o the basis for th,alleged excmpllan.Any violation of Section 7031.$ STORIES TYPE CONSTR.
by any applicant for it permit subjeHs,theupplihiinl ton civil penalty
ALTER-DRAIN&VENT-WATER (EA.).4.00
of not more lhsn five hundred dollars(3500).1:.
❑ Ia as owner of the property,or�my.employees with wages as BACKFLOW PROTECT:-'DEICE 2.00 OCC.GROUP RES.UNITS
thesole compensation,will do the work,and the structure is not _
intended or offered for sale (See 7044, Business and Professions DRAINS-FLOOR ROOFpAREA,CQND. 4.00
. Cod the Contractors License Law docs not apply to an own, s f y�
1oprty whosbldso improv theron and who does such work d FIXTURESrPER TRAP F `f ,w4OO SG FTFLOOn AREA TOTAL ACREAGE
himself or through his own employees,provided that such imp * -
`.r+. mentsare:hute
t�inndd-;,T.tfeted for saleylfho eve 9 �
re build ng' x_GAS=6ATSYSTEM 31NC:'A@LiTLETS�.400 ..*�• 7a gt.---.--- .
' or improvement is sold ohm one year I completion,the owner GAS-EA.SYSTEM-OVER 4 IEA 1 ,1 00 "1. tr-c,.,BUILDING USE k +
builder will have the burden of p o mg,that he did not build or thr -. ¢
prove for purpose of sale/. - _ INDUSTRIAL WASTE INTER N" O,�pWJ E:] a �_OQr
❑ I as owner of the property,am exclusively contracting with 20.00 .pr'"
licensed-contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC'S V[B: 5.00 ASSESSORS PARCEL NO.
and Pro fcssions Code:I lie Contract'or's License Law does not apply
'to an owner o1property who builds on improves thereon,and who LAWN SPRINKLERS-'OV ER 5(EA:) 1.00 .(
contracts for such projects with a Wafiactmis)licensed pursuant to
lifeContractor'sLicenseLaw. - SEWER-SANITARY-STORM EA.2OOR/B.00 - TRACT NO, PARCEL NO.
❑ I am exempt order Sec. ,B.&P:C.Cor the, WATER HEATER W/VENT. 4.00 - t,
reason
Owner Date' - WATER SYSTEM. 4.00 ' , ACC.DATE ACC.F IL ENO. .
WORK ERS'COMPENSA I ION DECLARATION, WATER TREATING EQUIP. 4.00 -
I h v.by,xffirm that I have.acul li IE''afcom m tc IYmsuc 's ZONING
ova orlil vats of Workers'Compensation Ensu e � td ted .ENG.SITE NO.
copy lhof(S 1800 LJb.C)
_ I of y No '- • _Company
_
O ElCrtdiedcopy -lmrebyfumislled. - - + FIRE SPRINK, "ENERGY T-24
is_fi ' the city�sp�s.tion divisor - -
�&fC tfeil, n - MISC REFER TO;ORD.
Z
O -. /Cppl' ant /Yy1. mFr�I^c� .. . ,.., Y❑ N❑ - V ❑ No
� Ni., c CEk'1'IFICATl OF EXEMPTION FkOM WORKItNs ' PERMIT ISSUANCE 6.00 FLOOD ZONE AL.UC.
W >
COMPENSATION INSURANCE PLG.CONTR LIC.NO. PLy G.
TOTAL ' N V N
CL O- (I I - section need not b, o npl ted if the Petit s for oa v' El NEI
2;.; hmarruftesilefi,dkic,IS 1(10)or less.) . ' ' �...,.
J C.) 26 1'I cera Ty that in the:perfofmance of ihework'M('ur coif W°Ihrs pe #' s -"+x 'wDY �' it, it a FEE S6IMMARV
LL I- mitris issuedso
, 1 shall act employ any pern in any manner sous to OTV: 4 .—MECHANICAL PERMIT FEE
U. Necome subject to life Workers'Compensation Laws of California.
O w.. Date Applicant BUILDING
tL•., - ALTER OR ADD TO MECH. 4.00
} to NOTICE FO APPLICANT: If;aftear making this Certificate of Ex-
r2 'L pton,'you should bcwme sobject 1n6 Workers Compenselirm APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U �% 'such provisions or this permit shall be deemed revoked AIR HANDLING'UNIT(TO
CONSTRUC110N LENDING AGENCY AIR HANDLING UNIT(OVER 10=1 .F.M.).5.00 SEISMIC FEE --
1 hcieby,afG t th a t there rs a emote action lending agency for EXHAUST HOOD(WITH DUCT) 2.00
performance of the work lor.whurl this.pnit is issued(Sec MICROFILM -
3097,CIvC) _ HEATING.UNIT-(TO 100,000 B.T.U.) 400
' Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)750
,ELECTRIC
-
�
Lender's Address �. ✓'
1 rrtify*tl,at l hocead thisapplication and stat that the above VENTILATION FAN (SINGLE) " ' 3.00
information k correct 1 agree
to
comply with all city and county - PLUMBING
ordinances and state laws relatng to'building constructor and BOILER-COMP(3,H.P.or 100,000 B.T.U.) 4.00 . '
h r by aullool Rep....matives of this city'to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
.hove-mentioned property far inspcchin parPoses.
(We) agree to save, indemnify anJ'.keep i ex, the City of MISC.- REFER TO ORD.
Cupertino against abil judgments, ros d expenses which CONST.TAX
may in any way against said C' conseluc-ca of the PERMIT ISSUANCE -s:-.r _ 3.00
granting of L MECH.CONT. LIC.NO. '- MECH.
j S ;'i ... TOTAL . TOTAL
Signature of iranlCntNt!lor„ t Doe
INSPECTOR COPY \