Loading...
C8153 APPLICANT TO FILLIN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY f' PERMITNUMBER BUILDING PROJE�� vNTI FICATION iT / aDILDiNG APPLICAil r4y i & PERMIT,"" - ADDRESS - _ � BUILDING- ELECTRICAL-PLUMBING-MECHANI(AL8153 OWNER' PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE -� r G P rvE - C _ NAME RAcroR's UTLETS-SWITCHES-PECED 10.00/1.00 ^� LIC.NO. LIGHTING FIXTURES 10.00/1.00 nooeess TORS S; C151aC PPLIANCES-RESIDENTIAL 4.00 - �: `n Kr PHONELI- ,,, C- PANELS 10.00 DATE OF APPLICATION ARCHI Ec PLAN CHECK FEE P.C.NO. on PANELS (OVER 200 AMP) 20.00 ENGINEER C uc.No. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5.00 PER MIT VALIDATION :s,C-) )P to In , IP Cly ,. ( EMP. METER OR POLE INS. 2000. APPLIENT'S �yV ADDRESS MOTORS SEE FEE SCH. o c, n% „C SERVICE CHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 a u I hereby affirm that I am licensed under provisions of Chapter 9 [[aa ¢ wA x ,p; ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H N i Professions C9dc�and my license is in full foyer: of est. W 2 0 m License Class Lic.Number - *S S I ©._ 1-7-` El, � w H Date -�1 1 55; Contractor Q y ' . ¢ ¢ wa OWNER-BUILDER DECLARATION BUILDING PERMIT a O' DMISC.- REFER TO ORD INFORMATION w g u_ 1 hereby affirm that I am exempt from the Contractor's License u. 0 j Law for the following reason.(Sec.70J Ls.Business and Professions VALUATION $/FT. ? - PERMIT ISSUANCE 10.00 _ /��eu0 Code:Any city or county which requires a permit to construct atleq ¢ ¢ ¢ D improve,demolish,or repair any structure,print to its issuance,also ELEC.CONTR. LIF NO. ELEC. y m a requires the applicant lot such permit to file a signed statement that TOTAL / CV PERMIT TO a w he is licensed pursuant to the provisions of the Contractor's License Hii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe rE Q Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE n / (E mthe basis for the alleged exemption.Any violation cf Section 703 L$ STORIES- TYPE CONSTR. a 3 .- by any applicant for a permit subjects the applicam toacivil penalty a- (EA.) 5.00 of not more than five hundred dollars(SS00).): '/ ,/ ❑ I,as owner of the property,or my employee,with wages as - BACK FLOW PROTECT.DEVICE 4.00 o GROUP RES.U hT their sole compensation,will do the work,and the sl rectum Is not intended or offered lit sale (Sec. 7044, Business and professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 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 5.00 ix 4X se.FT.FLOOR AREA TOTALACREAGE himself re through his own employees,provided that such improve-building ., , Zrovemenotntis sold mthinonferede year o It.compleveq the budding GAS-EA.SVS EM-11NC.40UTLETS 6.00 or builder will have is sold within one year of completion.the owner builder will have the burden of proving that he did not build or Ino- iGAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose ofsaleJ. RES IND CON 'PS Other ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑, ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0. and Professions Code:The Contractor's License Law does not apply to an owner of Property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) ' 1.00 contracts for such projects with a contractor(s)licensed pursuant to rte Contracttr's License Law, SEWER-SANITARY-STORM EA.200ft/10-00 -- TRACT NO. PARCEL NO. ❑ l am exempt under Sec.-,BAP.C.lin this ' WATER HEATER W/VENT 6.00 q reason - S/ l r�/ 3 Owner Date WATER SYSTEM 5_00 e,[ ACC.DATE ACC FILE NO. WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00 - I hereby affirm that I have a certifieme of consent to sell-insure. or a certificate of Workers'Compensation Insurance.or a certified ZONING ENG.SITE NO. copy thereof(Sea.3800,Lab.C.L _ 1! Policy No. Company I s" I- C; h . O ❑ Cor(ificdcopy is hcrcby(untoEdA FIRE SPRINK ENERGY T 24 z Z VCertified copy is filed with rte city inspection division: MISC.- REFER TO ORD. irO Applicant 11` (e E-+ Y ❑ N EJY E) NE] W . CER'I'I FICAT'Ii 01'EXEMPTION FROM WORK FRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > CO!,iPENSA'1'ION INSURANCE - PLG.CONTR. / LIC.NO. PLO. J ❑ ❑ ❑ ❑ CL Z (This section need not be completed if the permit is for one '�^ - TOTAL V N V N hundred dollars IS 100)or less.) U _O 1 certify that in the perforoiancc of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shill nut employ any Person in any manner so:u to .- U become subject to the Workeri Compensation Laws of Calil'orniu. 0".a Date Ajtplicam ALTER OR ADD TO MECH. 5.00 BUILDING SS } w NOTICE TO APPLICANT: If,alter making(his Certificate of Ex- - ♦- ? enhption,you should become subject to the Workers'Compensation APPLIANCE �' 5.00 PLAN CHECK , provisions of the Labor Code, you must lorthwith comply with FEE U such provisions or this permit shall be decreed revoked. AIR HANDLING UNIT(TO 10=CF.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10MC.F.M.) 6.00 SEISMIC FEE I herehy'affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. r/ MICROFILM 3097 Civ.C.).wI ^'O^ / HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lenders Nume r'+1 �• K r�e T"� Lender's AJdresst 6 -r x HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC rti C I information that I have read this application and all c that the above VENTILATION FAN (SINGLE) 4.00 /) - ordinances n correct 1 agree to comply with all oily and county PLUMBING ordinances eori state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 7(J hereby authorize representatives inspection this city es enter upon the BOILER-COMP'IOver 100,000 BTU)SEE FEE SCH. MECHANICAL 3r d5. above-mentioned property for inspection purposes. (we) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 U _� CONST.TAX �` /ju may in any way accrue against Said City in consttluence of the 7 grunting of thio permit: MECH.CONT. LIG NO. MECH. _ 2 TOTAL 7�` TOTAL a a e'of Ap h nt Contractor Datc INSPECTOR COPY I