6256 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE DALL POINT PEN ONLY
BUILDING PROJECT I DENT]FI ION PERMIT NUMBER
�( LI:JNG - APPLICATION & PERMIT 6256
/\ Aiuip " `21710 Stevens Creek Blvd.Blvd. ILDING -ELECTRICAL-PLUMBING-MECHANICAL
r08-1 '�) v Yi.-, y?+tfy i~`•*': PLAN CHECK VALIDATION
z�ELECTRIC PERMIT s tB!
P cli !Pt',r-
AcrORs/ _ UTLETS-SWITCHES-RECEP 5.00/1.00
` V LI LIGHTING FIXTURES 5.00/1.00
/ A r ACTOR _ _ PPLIANCES-RESIDENTIAL_246 4.00
er
PANELS S.00 DATE OF APPLICATION
ORCR 2CT SIGNS 6,00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.NO. SIGNS TRANS. 3.00
ADDRESS emG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH. J'
noon Ess
SERVICE CHANGE 10.00
00 LICENSED CONTRACTORS DECLARATION
u I hereby it than I am licensed under provisions of Cho r 9 ISSUANCE DATE
N I-commencing win Srclio ]0001 of Divismn 3 of h and
BLDG. ELECT. PLG. MECH.
Professions Ca rent ice nae is in full lore` J
z o - License C'Ims Lie Num he ❑ ❑ ❑
y I_Dw I1ale�/7. Ctmraelt
'..BUILDING PERMIT,',
s ¢ W'NFR-BUILDER DECLARATION ..
D a U .` ,.INFORMATION"
X
S sc r- 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LLOj Law for the followingreason.ISec.7031.5.Business and Professions PERMIT ISSUANCE VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter, 6.00
ac a¢ 2O imprrve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. _ ELEC.
nuD a, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m" he 1 licensed pursuant to the provisions of the Contractor's License
r• i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe " r:
z a Heinen and Professions Code)or that Ire is exempt therefrom and GTy.zi PLUMBING PERMIT -a,PEE's
I is the had,,for the alleged exemption.Any violation of Section 7031 S "t "'Y STORIES TYPE CONSTR.
n _ by any applicant far a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WA, (EA.) 4.00
of not more than live hundred dollars f 45001.1'.
EDI,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.CROUP RES.UNITS
their sale compensation,.,I]do the work,and the structure is not
• intended or offered for sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does null apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 $D.FT.FLOOR AREA TOTAL ACREAGE
Il imset or through his own employees,provlJ
zeJ that such improve-
alsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INCA OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA) 1.00 BUILDING USE
builder will have the burden of proving that lie did not build or im- RES IND CON PB Omer
20.00
prove for purpose of sale.). INDUSTRIAL WASTE INTER.
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the prnjecl(Ser. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:Tile 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
contracts for such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCELNO.
the Connetor,License Law.
❑ 1 amcwere'(toner Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Owner Dalt T.WATER SYSTEM PAIn4.00 ACC.DATE ACC.FILE NO.
WORK 1.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby Afiorn that I have a curtf. ate of consent to self-insure. s, I�.. 4 ZONING ENG.SITE NO.
or a cerin kale r Wor ,La Compe Ion In a certified
c e 0,Lab.C.l. �i
company AAI!Di&M44Ne_
L erW led co"is hereby furors cd. FIRE SPRINK ENERGY T 24
Z z ❑ Certified copy is riled with the city inspection division. MISC.- CU9REFER TO ORD.
O Applicant Y❑ N❑ Y ❑ N❑
CC T CE R TI FICATF-OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.D.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL o 1 phis _ lion need not be completed if the permit is for o y� TOTAL �� Y❑ N❑ Y ❑ N❑
Z) Z n red dollars IS t 00)or less.) - J2hT:b*r.34. ti 's �.ris*19•t`a '4a {,.P'ys (� •,C•`
U O 1 certify that in the performance of the work for which this per. MECNANICaL PERMITy `.��.a4 HE W RE4. /tRYF
LL I- nil issued, I shall not employ any person in any manner sn as to L. .j- S f, , .4ay +r .,hP N ee4�j: '
U hecmme subject to the Workers'Compensation Lawsof California. BUILDING
0. Dam Applicant ALTER OR ADD TO MECH. 4.00
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex.
Z comfort,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Cute, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10AOO11F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 5.00 $EISM44i
I hereby affirm that there 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 HEATI NG UN IT(OV ER 100,000 B.T.U.P.50
Lender's Adores ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county PLUMBING 0
ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 STU)SEE FEE SCH. MECHANICAL
above mentioned properly for inspection purposes.
(W' t/C.nl
indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupdies,judgments, costs and expenses which CONST.TAX
mayIe against said City in consequence of the PERMIT ISSUANCE 3.00
gran / MECH.CONT. LIC.NO. MECH. v� OTALTOTALf--
Si mctor gate
OFFICE COPY