17485 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY iW
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING 1860 APPLICATION & PERMIT �0 �o A
ADDRESS 4 O OC 5
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
101-23 N. Wolfp. Road
OWNER'S PLAN CHECK VALIDATION
NAME
CITY. ELECTRIC PERMIT FEE
Nickles & Dimes PRONE
CONTRACTOR
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Cal-Air Inc. LIC.NO 137195 LIGHTING FIXTURES 10.00/1,00
OONTRACTOR'S San )Jbse APPLIANCES-RESIDENTIAL 4.00
ADDRESS
1775 . 1st St PHONE947-0155 PANELS 10.00 DATE OF APPLICATION
RDRfTacT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO,
O
OP
E NGINEEP
LIC.No. SIGNS TRANS. 3.00
ARC DDDDRESS END. - SPECIAL CIRCUIT 5.00 P MIT A
zIP EMP.METER OR POLE INS. 20.00 P
ADDRESS
MOTORS SEE FEE SCH.
1775 S . 1st St San Jose SERVICE CHANGE 20.00
MAK 1 s 1990
It,O LICENSED CONTRACTORS DECLARATION
a I hereby affordthat I am licensed under provisions mf Chapter 9 nft
w a i (commencing with Suction 7000)of Division 3 of the Business and BLDG. CT. PLG. C .
r w z Professions Cod;,�V J t�vJI sc u in full I'or' .�µ{t t ❑ ' ❑ ❑
l o w License a�lla�s �4 r��l� Lie Number_ O
H w DatcJ�.2J_7_S�Contmctora. - 1L
a Y Ems, BUILDING PERMIT
S: wOWNER-BUILDER DECLARATION INFORMATION
w3:LL, 1 hereby affirm Thal 1 an exempt from the Contractor's License MISC.- REFER TO ORD
u O¢, Law for the following reason. 7031.5,Businessand Professions pERMIT'ISSUANCE 10.00 VALUATION S/FT.
� - Code:Any city or county which requiresapermit toconouicl,altar, -
Q2improve,deowlish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO I
a w m he is licensed pursuant to the provisions of the Contractor's License
sa Law(Chapter 9(counuencingwilh Section 7000)of Division 3 critic
a
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ ro the basis for the alleged exemption.Any violation ofSeclion 7031.5 STORIES TYPE CONSTR.
u ;m by any applicant for a permit subjects(he applicant to a civil penally 5wmALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more out Five hundred dollars($500D.);
O I,as owner of the property,Or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law Joel not all 1y to an owner of -
property who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5,00 50,FT,FLOOR AREA TOTAL ACREAGE
himself re though his own employees.Provided ev such improve- -
himsearenorintendedorofferedforsate ILhoweverthe building GAS-EA.SYSTEM-1 INC.40UTLETS 6.00
improvement is sold within ane year of completion, the owner GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden orproving that he did not build or im- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 11 as owner of file property,am c'elusively con lmcling with ❑ ❑ ❑ ❑ ❑
Mlicenxd c;mramnrs to construct the project(Sec. 7044, Bus ncss LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL No,
Mand Professions Cade:The Contmctor�License Luw docs not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
T`� contracts for such projects with a contruclons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
(�m
LN
the Cantruclor's License Law.W ❑ lam exempt under Sec. .B.&P.C..for this WATER HEATER W/VENT 6.00
f` •�, reason
owner Date WATER SYSTEM 5.00
ACC.DATE ACC,FILE NO.
\.
WORK ERS'COMPIiNSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm)hut I have a certificate of consent to self-insure, ZONING
it n re,lifi,rte of Workers'Compensnlion Insurance,nr u certified ENG.SITE N0.
copy thercof(St4:.3900,Lab.C.'Libert Mu
Policy No. Company y
❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z Cl Certif py 81eJ til the city inspection Division. MISC.- REFER TO ORD.
F O APPlic�a { a�J�I�1/1 r-/1 q n Y ❑ N❑ Y ❑ N❑
�+ to "CF R77112-r ti1iN W-Q67 PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
_ COMP1iNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. V❑ N❑ Y ❑ N❑
�d O (This section Decd not be completed if the permit is for one TOTAL
2 hundred doH...S100)or less.)
U O 1 certify that in the perfor*11""il,work ' r which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
null Is issued,I hull not emprson in n nanuc soas oUbccoi�yp�gi�h�qj'csrii aonDate1Cl{1 y4 - ALTER OR ADD TO MECH. _5760N NO111fCCCIII{{{`I TTT-CANT: Iking t i. Ccrtdicmc of li
F 2 mnplion,you should become subject❑i the work"' CompcnsuY i APPLIANCE 5.00 PLAN CHECK
provisions Of the Labor Code, you must forthwith comply wit FEE
U such provisions or this permit shall be deemed revoked D AIR HANDLING UNIT(TO 10=C.F.M.)- . 0
CONS'IRUM[ON LLNDING AGIiNCI' AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby 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. MICROFILM
3007,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 9.00'
Lender'sName HEATI NG UNIT(OVER 1
Lender's Address 00,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and stale that file above VENTILATION FAN (SINGLE) --488
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL /
above-mentioned property for inspection purposes.
(We agree to suvu, enmify and keep harmless the City of MISC.- REFER TO ORD.
Cup no against liub' ties judg mils, coils and expenses which CONST.TAX
a any way acc a ag just iJ Cit' in conseyuenc of t c PERMIT ISSUANCE 10.00
f g�p1 fOIhill••u``f�'rQ1]�i. CH.CONT, LIC.NO. MECTOTAL
Signature o(Appicanl/Contractor Dale Cal-Air 137195
OFFICE COPY