6990 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT 1 DENTI FICATI ON - PERMIT NUMBER
a0ILDING, m t APPLICATION & PERMIT
ADDRESS. Calpran lenC�)L - 6990
20300 Stevens Creek Blvd. BUILDING ELECTRICAL-PLUMBING-MECHANICAL
OwrvER'S /L-ro).,FinO City Genres c �' `+ PLAN CHECK VALIDATION
NAME ltes
A�3ciaes B QTY.c k ,ELECTRIC PER
EEE'..
PHONE #
CONTRACTORS
NAME. 32 UTLETS-SWITCHES-RECEP 5.00/1.00
NAME.
Pim Electric,Inc. LIGNO. 323080 35 LIGHTING FIXTURES 5.00/1.00
ADDRESS oR'S P.O.BOX PPLIANCES-RESIDENTIAL 4.00
CONTRACTOR
, Ca.94501 ' PHONE 522-5335 PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS' 6.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRRiSS ENG, SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00
APPLICANTS P.O.BOX MOTORS ESCH.
ADOREss
Alameda, Cal.94501 SERVICE CHANGE 1
02 LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE///DATE
H <w (commencing with Section 7000)of Division 3 of the Business and I BLDG. ELECT. PLG. MECH.-
F y z
Professions�Co( . 1 y license is in full ons,3rLr fgb Y f,�1
Zo
OL
w ,License �5_Lic.NumbeP93l1U:ef.•-Int.• ❑ IIS ❑
Doc Contractor r
a m ' '. BUILDING PERMIT
a, ¢ w OWNER-BUILDER DECLARATION a,P -
MISC.- REFER TO ORD !L� `INFORMATION 7
w 3 LL H 1 hereby affirm that I am exempt from the Contractor's License Q
S reason,(Sec.7031.5,Business.nd Professions VALUATION
F ¢ o a how I'nr the following PERMIT ISSUANCE 6.0
S/FT.
Code:Any city or county which requires a permit to construct,alter,
¢ ¢ improve,demolish,Ar repairany structure,prior to its Issuance,also ELEC.CONTR, LIC.NO. ELEC.
rc w m¢ ¢aryirca the applicant for such permit m file..signed statement that Pim Elec.Inc. 323080 TOTAL PERMIT TO
lie is licensed pursuant to the provisions of the Contractors License
F z a Law(Chapter 9(commencing with Section 7000)ofDivision 3 of tire ,
i o Il I ihess and Profession,Code)or that Ire is exempt therefrom and OTY, PLUMBING PERMIT FEE'
¢ H m Ilio basis for the alleged exemption.Any violation of Section 7031.5 - - STORIES TYPE CONSTR.
e_ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(55000.):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00
their sole compensation,will do the work,and the structure is not OCC.CROUP .RES.UNITS
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:"f he 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 - 4.00
• himself or through his own employees,provided that Such improve. SO.FT.FLOOR AREA TOTAL ACREAGE
merits are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
or improvement is sold within one year of eolipletion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.)
builder will have the burden of proving that he did not build or im- 1.00 BUILDING USE
.prove for purpose of sale.). - INDUSTRIAL WASTE INTER. RES IND CON pe Cohen
m
❑ I,as owner of file property,aexclusively contracting with 20'00 ❑ ❑ ❑ ❑ Ellicensed coniraetnrs 1. construct the project(Sec.71044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
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(EA.) 1.00
contacls for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM,EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec..,K&P.C.lot this WATER HEATER W/VENT'
• reason 4.00
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate ofconsen[to self-insure,
r a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO,
copy Ihcre�,f,{.Gr>UgqC.l. per„. -
Policy Not0.••�0 {fin(NfaAYY +`+zY a1 Ins.
O ❑ Cerified copy is hereby furnished, FIRE SPRINK ENERGY T 24
($ .r, O rip .{vr bledyw�th ih�.•,.Yay inspection division. MIS -- REFER TO ORD.
Z 0 Applicant 1111_bler._4L 10.11114.. p•. Y❑ N❑ Y ❑ N❑
CC W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE" PLG.CONTR. LIC.NO. PLG,
IL Z, (This section need not be completed if thE]e permit is for one TOTAL Y NEIY❑ N❑
hr.. Anllan($100)or less,) _
U O 1 certify that in the performance of the work for which this per `` n " x .,`;FEE SUMMARY r_
LL F mit Is Issued,I shall not employ any person in any manner so as to CITY: MECHANICAL'PERMIT +'< %*:.,FEE+,. a ...#as..el,
O W become subject fo Ole Workers Compensation Caws of California. ,
Date Applicam ALTER OR ADD TO MECH. 4.00 BUILDING
} N NOTICE;TO APPLICANT: If,after making this Certificate of Ex.
. ? emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
Provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. 'AIR HANDLING UNIT(TO 10=11F.M.) 3.00
CONSTRUMONLENDINGAGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
-1 hereby affirm that [here is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name U
Lender's Name HEATING UNIT(OVER 100,000 B.T. .P.50 ELECTRIC
27
Icertify that)have read this applicalion and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county PLUMBING
• ordinances and stare laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00
hemby'aithorize representatives of this city to enter upon the BOILER-COMP (Ovar 100,000 BTU)SEE FEE SCH. MECHANICAL
.hove-mentioned propurty for' ion purposes.
(We) agree to Save, ind oily a d keep harmless the City of MISC.- REFER TO ORD.
Cupert no ag''nSt IiabiliY ,judge rts, costs and expenses which CONST.TAX
may, any against id Cily in consequence of the PERMIT ISSUANCE - 3.00
gm gof this er MECH.CONT. LIG NO. MECH.
TOTAL TOTAL ,
gnstore of Appl t/C rac[or Date
OFFICE COPY