17665 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT I DENTI FICATION PERMIT NUMBER .
BUILDING APPLICATION & PERMIT t
ADDRESS 17665
10500 Rid eVleW Court BUILDING- ELECTRICAL-PLUMBING-MECHANICAL I
OWNER'S PLAN CHECK VALIDATION
NAME (408) QTY. ELECTRIC PERMIT FEE
Digital PHONE 252-638
croRs
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Marelich Mechar iUc„ l 519464 ILIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS p (415)
200 Jennings St. PHONE _5500 PANELS 10.00 DATE OF APPLICATION
RCHrtECr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
O
OR
ENGINEER George Green
g LIC.NO, SIGNS TRANS. • 3.00
AARC"
DDRESS ENG. CA. SPECIAL CIRCUIT. 5.00 PERMIT VALIDATION
221 E. Hacienda Cam bell zIP95008 TEMP. METER OR POLE INS. 20.00 S ^cQ
APPLI C ANT's MOTORS SEE FEE SCH.
ADDR Ess
200 Jennings St. S.F. CA 94121-SERVICE CHANGE 12AID 20.00 ����('(V
'02 LICENSED CON"TRACTORS DFCLA RATION
1[ u" 1 hereby affirm that 1 con licensed under provisions of Chapter 9 ISSUANCE DATE
4 4 w (commencing with Scclion 7000)of Division 3 of the Business aad BLDG. ELECT. PLG. MECH.
oi Professions Code,and my license is in full force and effect. ❑ ❑ ❑
z o w - License Class Lic.Number _L p�e�s�no
9 - Date Contractor Q[NE�16
a y f � C� BUILDING PERMIT
IS ¢w 4 OWNIi R-BUILDER DECLARA'110N INFORMATION
o A " REFER TO ORD
E
g u r 1 hereby affirm that I am exempt 1'rmn [he Contrucmr i License MI$C.- VALUATION
r LL o a Law for the following reason.(Sec.7031.5.eusinesx and I'rofcssims PERMIT ISSUANCE 10.00
Code:Any city or county which requires u pennit to const rucl,tI teo
IS
at¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. EL
EC. 2 a 000 a 000
O LL requires the applicant for such pmol it to lila a signed Statement llml TOTAL PERMIT TO
w$ he is licensed pursuant Io the provisions of the Contractor's License q.
HiQ Law(Chapmr 9 lcommencing with Sectiun7000)of Division 3 fthe
Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ F D the basis for the alleged exemption.Any violation of Section 703LS STORIES TYPE CONSTR.
n ;� by any applicant for a permll subjects the applicant o a civil penalty ALTER-DRAIN -WATER IEA.) 500
of not more m .
an live hundred dollars 2 Concrete
❑ I,as owner of the property,or in, employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OGG,GROUP RES.UNITS
intended or offered lot sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code The Contractor's License Law docs not apply to an owner o1'
properly who builds or improves thereon.and who does such work FIXTURES-PER TRAP 5.00 SQ,FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such insprove-
msoleats are not intended or offered for e.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 319304
or improvement is sold within one year of completion,the owner-roGAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
an ldee will have the burden of pving that Ice did not build or im-
prove for Purposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND cory PB orae.
❑ I,as owner of the property,con exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. .
and Professions Code:The Contractor's Licasc Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ftI10.00 TRACT NO. PARCEL NO.
❑ lam exempt umdcr Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owncr Dam WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK IiRS'CONIPI:NSA IION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sel Ginsure; - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,lir a certified
copy lhereof(Sec.3800,Lsb.C.l.� / D��/'
Policy No. Company h L]
0 ❑ Ccrtiticd copy is here by luJffnisI d. FIRE SPRINK ENERGY T"24
Z Z 15i cc Cor is Iled�lh /Jra cily�nspection division. misc.- REFER TO ORD. ❑ ❑ ❑ ❑
O RippTllCant V N Y N
CL h C17R'FIFICA'1'17017Ii XI;MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPFNSA'PION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O
(I IRS section need mol be completed if the pennit is for one TOTAL Y❑ N❑ Y ❑ N❑
0 Z hundred dollars IS 100)or less)
0 O 1 certifyit at in the performance of the work for which tills per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
M
LL 1- mis issued,I shall riot employ any person in any punitive so as to
0 W become subject to the Workers'Cmnpensatinn Laws of Call.. la.
Date Applicant ALTER OR ADD TO MECH. 5.00 9.00 BUILDING
} y NOTICE"TO APPLICANT: ll',after making this Certificate of Es-
F. Z caption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith cuun ly with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10OW C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY 8 AIR HANDLING UNIT(OVER IQOWC.F.M.) 6.00 88.00 SEISMIC FEE
I hereby affirm that Iherc is a construction lending agency lot EXHAUST HOOD (WITH DUCT) 5.00 '
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name -
Under',Address HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I Certify that l have read this application and state that the above 2 VENTILATION FAN (SINGLE) 4.00 9.00
1.0
information is correct. I agree to compty with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
herehy authorize representatives of this city to enter Inion the 1 BOILER-COMP lover 100,000 BTU(SEE FEE$CH. 123.00 MECHANICAL
above-mentioned properly for inspection purposes. to
(We) agree to save, indemnify and keep harmless the City P 10 MISC.- Pumps REFER TO ORD. 65.00
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way neer against said City in consequence of the PERMIT ISSUANCE 10.00 Da
con
oft hisp rn MECH.CONT. LIC.NO. MECH. 0 0
�- Zc3-8 % TOTAL TOTAL D�.DD
Signature of Applicant/Conlmctor Dam Marelich Mechanical X3.94-6A-
OFFICE COPY