Loading...
P10238 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY 5171 LDI NO PROJECT I DEN71 FIC TiON PENMiT Niri iW' ruituac, APPLICATION & PERMIT AOGRE ♦6NI�J►� .F' .� vi•44"4 BUILDING-- ELECTRICA PLUMBING-•MECHANICAL 10238 N sraaA O'�GEIMr " � PLAN CHECK VALtUATION C / s itt.I r(RIC Aiir FOG ' OUTLETS•SN�k7CNE$-R,r.C1:P 10 00/O4TTtyn� t & 1.00 LIGHTING FWTURES 10.00M.00 rONTRACi�jr PPLIANCES•RESIDENTIAL 4.00 AfnMES. ��]t� no 17.7 L It I- PANELS 10.00 DAT}OF APPLICATION OR PANELS ANELS(OVER 200 AMP) X00 ' E661NE4.R `,/g[�N1} �r--T 4rC.N0� SIGNS TRANS. 3.00 Anon€OR la$E SPECIAL CIRCUIT 5.00 PERMIT VA AIA Zip EMP.METER OR POLE INS. 20.00 A►vue % s MOTORS y !p SEE' H. 7 ioc ADORE R� ,,.,. ,�!_ is t "� SER_VICF CHANGE 20,00 TEMP.POLE oo y CItV ot c o CENSED NTRACTORS DECLARATION . }� < 151 hereby affirm that I am licensed under provisions of Chapter 9 ISSUAkCE DATE a (commencing with Section 7004)cf Division 3 of the Business and ELDG. ELFECI Pf 0 MECN Professions Code,a'1 my I,ceuse is 1, toil 1n f F o License Class...4 W Lic.Num -� Q L f wr W_ Date- f4-01iR,�,l0,�.,.,.C'onittict J i OWNER-BUILDER DECLAR TION i hereby affirm that s am exempt from the Contractor's Licensa MISC. Y.OLU- __. ATION Ltlw for the following resson.(Sec.7031.5,Busin-mv and Professions PERMIT ISSUANCE 10,00 0 Jv Code Any city or courtly which rcwuires a Perm it to co _(n>ct,atter, }"Q r< improve,demolish,er repair any structure,prior to its issuance,also ELEC.CONTA, LIC.NO ELEC.,,/,,) D requires the applicant for such permit to file,a signed statement that TOTAPEHMI $h he is licensed pursuant to the provisions of the Conttacior's License ----- ��a _ *R Law(Chapter 9(commencing with Section 7WOofDwision3oflhe ��1/ ar7tztj'dv./�eY"�a4e Business and professions Cade)or that he is exempt therefrom and MUM"FGRMIT •-•-s-TWUl--- T PE CON it z the basis for the alleyred exemption.Any violation of Section 7031.15 by any applicant for a - I s�� Y PP permit subjects theappliant toacivilptnalty ALTER GRAIN& VENT-WATER (EA.) :,.00 of not more than five hundred dollars($500).); ❑ 1.as owner of the progeny,or my employees with wages as BACI:FL OW PROTECT.DEV IDE _ 4.00U AEs.UNIT their We compensation,wi' 'le work.and the xtructurt isnot � intended or affered for sal:,oec. 7044, Business and frofossions GRAINS-FLOOR,ROOF,AREA CONO. 5.00 Code:The Contractor's License Law does not rpply to an owrur of - property wtro builds or improves thereon;and who does such work FIXTURES-PER TRAP 5.G0 ip,FT.FL00i AREA TL7 FAL ACREAGE himself or through his own employees,provided that such improve• mints ate not to tended or offered for sale.If,however,the building IGAS-CA.SYSTEM 1 INC.4 O LETS 8.00 or improvement is sold within one year`of completion,the ownrr• ONm GAS EASYSTEM•OVE (EA.) 200 U L tN auEE builder will have the burden of proving Ills:he did not build or im• . , . ME IND COAL P8 prove for purpose of sale). INDUSTRIAL WASTE IN CO e 0 1,as owner of the property.am exclusively conlractintt with w licensed wntraetots to eonsituet the project(Scc. 7044,Business LAWN SPRINKLER 1 INC.5 V.S. 600 ALSSEUORS PARCEL N and Professions Cotte The Conirelor's License Law does not apply -- -- ------ to an owner of property who builds or improves thereon,and who LAWN SPRINKL S•OVER 5(EA.) 1.00 contr4clsfor stiol1projeclswith a,ontraclons)lrxnsedpursuant to 5lWER•SANiT RYSTORMEA.204ft1)O.CO the Contractot's License Law; _ _ T AU NO. PARE L zi I am exvmp-under Sec _a ,B AKC.for this WATER HE ER W/VENT 8.00 ' reason.._,�...,._�-..._:�-._..._.....,___-_� -.�� _•._.._�. -..,— _ Owner., .... ..__....4-- — 'Date -- -- WATER VqTEM 5.00 Acc.DATE At,e.FILE NO. WURKIRS'COMPENSATION DLCI.ARA1ION WATE 1`REATING EQUIP. _6.00 1 hereby alffrin trial i have a certificate of consent to setf•insure. ONING ENC(.siTE NO, or a certificate of Workers'Compensation(nsurm ice,or a certifted copy!hereof(Sec 1800,1 ah C. Policy No Q 0 C:ertifted copy is hereby fume ed. -7—IRE THINK ENERGY T•24 Z O Appli'14C'ertilieds�if py Iw the c I` a pe. C]iviston. M13C: REFER TO ORO. y N� 10 No IX C'FR11 Alf 01'EXEMPTION FROM WORKERS' PtRM17 ISSUANCEt0.D0i 6Loon zoNE A.L.u.c. ill COMPENSATION INSURANCE PLO.CON)A LIC:NO AL YCJ N[] vN❑ (This section need not ht completed if the permit Is lot one TOT aT hundred dollars IS 100)at less.) certify that in the perfs.rmance of the work for which this per- * iNANICAL I P" U. ►- int is issued,I shall not employ any person in any manner so as io . U become subject to the workers'C ompensation Laws of Cahfarnia. ©us Date__. Applicant .. BUILDING db ...... --- _-_.._... _ ALTER OR ADD TO M 5.00 _ } t0$ NOTICE TO APPLICANT. if,after making this Ceninwate or - - - .3 emptio.l.you should become subject to the Wmken'Cumpensatiun APPLIANCE _ 6.00 PLAN CHECK provisior's of the Labor Code, you trust forthwith ccuipiy with - —�- FEE r� such provisions or this permitshall he deemed revoked AIR HANDLING UNIT,(19 1qeQA,11^ 4.(Y) CONSTRUCTION LENDINC,AGLN(7Y AIRk4tN6LwaUN 1 C.F.M.) 5.00 SEISMIC FEE I hereby affirms that there is at culvstruchon Ivnduvg agency for EXHAUST HOOD(WITtj(WITH 5.00 the pefamrancc of thew rk far which this permit is issued f"Scc- MICROFILM 3097,Civ C't. HEATING UNIT IT . .U,) $.) Londe/'s Name._2 Lender's Addmss_ .__ _ _ HEATING UNIT(OVER 100,000 B,T.1,139.5a ELECTRIC �Q 1 certify t:,at I haveread this apphcalu.nand state that Itlecti)ve VENTILATION FAN(SINGLE) 4,00 information is correct 1 agree to comply with all city and county PLUMBING_ r . ordmoncea and state taws relating to building v'onstrucium.. and BOILER t (3 H.P,or 100,000 B.T,U,) 8.00 - btrcby authorim representatives of this city to enter upon the 601 LER-COMP(Over 100,WO STU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (WO agree to save. mur;nnify and keep hamilvss the City of MlSC. REFER TO ORD. Cupertino against liabilities,judgments,costs and expenses which �- T CONST.TAX may in any way accrue r`minst slid 0ty in cotmquenc e of the PERMIT ISSUANCE IQ. _ gts f this porrn RCsi CONT. - LIC,NO, MECH, TOTAL atu of pp,c,nttC.ontractoa - OFFICE CC.