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♦
THIS APPLICATION IS A VALIO PERMIT WHEN PROPERLY FILLEO OUT, SIGNED, AND MACHINE VALIDATED IN THE SPACE PROVIDED.
PERMISSION IS THEREFORE GRANTED TO DO THE WORK INDICATED IN ACCORDANCE WITH ALL APPUCABLE ORDINANCES; LAWS AND
REGULATIONS.
. PERMIT IS SUBJECT TO ALL APPLICABLE SECTI �NS OF SANTA CLARA COUNTY ORDINANCE CODE.
THIS PERM {T SHAL! EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF WORK IS NOT COMMENCEO WlTHIN 60 DAYS.
"REFUNO : WHERE NO PORTION �F THF WORK OR COIVSTRUCTION COVERED BY THIS PERMIT HAS BEEN COMMENCEO BEF�RE THE EX-
PIRATION DAtE HEREOF, REQUESTS FOR REFUNDS MUST BE MAOE IN WRITING TO 7HE DIRECTOR OF THE BUILDING INSPEC71i�N DIVISION
' �N �R B£FORE SEVENTY-FIVE (75 ) DAYS FROM THE DATE �F ISSUANCE OF THIS PERMIT."
GRADE LINES AS SHOWN ON DRAWING ACCOMPANYING THIS APPLICATION ARE ASSUMED TO BE GORRECT. IF ACTUAL GRADE LINES
ARE N07 THE SAME AS SHOWN , REVISED pRAWINGS SHOWING CORRECT GRADE LINES, CUTS AND FfLLS, TOGETWER WITW COMPIETE
DETAILS OF RETAINING WALLS ANO WALL FOOTINGS REQUIRED, MUSI� B� RESUBMITTED TO THIS DlVISION FOR APPROVAL.
' � tNSPECTOR MUST BE GIVEN 24 HOURS• NaTICE FOR EACH INSPECTION .
IN CONFORMITY WtTH THE PROVISIONS OF SECTION 7031 .5 OF 1'HE BUSINESS AND PROFESSIOiVS CODE AND SECTION 3800 OF THE
:.: � : : e� ; ` LASOR CODE 4F tHE STATE OF CAIIFORNIA; `APPLICANT SHALL FILE WITH THE BUILDiNG INSPECTOR 7HE CERTIFICATES DESIGNATED ! N
( 1 ) AND ( 2 ) BELOW AND/OR SHALL INDICATE ITEM ( 3 ), (4 }, ( S ) OR ( b } WHICHEVER IS APPLICABLE.
( 1 ) CERTIFICATE OF CONSENT OF SELF-INSUREO ISSUED BY THE DIRECTOR OF IfVDUSTRIAL RELATIONS. ,
; ' ( 2 � CERTIFICATE (�R EXACT DU?LICATE COPY ) OF WORKMEIV 'S COMPENSATION INSURANCE ISSUED BY AN ADMITTEO INSURER.
( 3 ) 7HE COST OF THE WORK TO BE PERFORMED IS $ 100 OR LESS.
(4 ) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SF�ALL �VOT EMPLOY ANY PERSON IN
ANY MANNER S� AS TO BECOME SUBJECT TO THE WORKMEN `S COMPENSATION LAWS OF CALIFORfVIA.
( 5 ) I CERTIFY THAT 7HE APPLICANT IS LICENSED UNDER THE PROVISION� OF CHAPTER 9 ( C�NUyIENCING • AT SKTION 7000) OF
DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE ANb SAIO APPLICANT S CALIFORNIA STATE CONTRACI'OR S LICENSE NO.
CLASS IS IN FULL FORCE AND EFFECT.
� b � MPE CON RACTOR 'S LICENS�E LAW ( ST�A E BASIS OR EAXE�VIPTION . �ROVISI �NS OF SECTION 7040 THROUGH SECTION 7053 OF
�
. APPLICANT S
SlGNATURE PHONE
APPI ICANT'S
ADDRESS ZIP CODE
AGENT'S
SIGNATURE
DECLARATION OF �ONSTRU=TIQN LENDER
PURSUANT TO SECTION 1193 OF THE CODE Of CIVIL PROCEDURES. AN APPIICANT IS REQUIRED TO
INDICATE TNE FOLLOWiNG.
1 } NAME OF CONSTRUCTION LENpER BRANCFi OfiSIGNA71pN
ADDRESS ZIP CODE
2) THERE IS NO CQNSTRUCTION tENDER.
APPIICANT'S SIGNATURB DATE
�
' ITEM EACH h0. FEES THIS SPACE fOA INSPECTOR'S USE ,
APPLICATION FOR PiUMBING PERMIT ISSUANCE FEE z.so z.�o
SANTA CLARA COUNTY ENVIRONMENTAL MANAGEMENT AGBhCY SURVEY FEE 1 HR./ f10 MSN. io.oa
8ilILDiNG IHSPECTION QiVISlON �
70 W. HEDD�NG ST., SAN JOSE, CA 95110 • TEL. 294-Z351 Eoch plumbinp llxtvr�, trap, t�t ot lirtvros oe ono 1 .70
Irop. inctudlrp wof�r. droinaqa pipir+p ond
buk flow proTONion theretor
� ADDRESS
Eoch buil0ing scwor or troilor pork sowor � 5.50
� SiREEtNiliA6iR `� Q [� , ��� •
+++��ea s� ti� i � .oa
vosrorFicEldrrl 2/ /JC7
pATE Of g� G Mn Np, WORK i0 O[ @a�h wotet hootot ond/or venl 1 .70
/1ii11[ATIOH F OS EfERfNCE �E OY l� � �+O � VnRT1A! OK (SIGf1ATURF) . W►Tf
�, r�LI
�f � � � CONTRAQOt • �
USE Oi S7AUCRlRt M! Of tMlRGVF.�ttNT Eoth yas vOnt 1 .70
QfAM� RFSIOENGE 0 dUILO QREN{ODtI QREiAI�I HER / � � ROi16HOit (SIGNATURE} OAIE
$'d��fR Each gcs piping �yafvm of ono to fivo ouNets i .70 .
SQ. Fi. NO. Of NO. Of
SIIf i/1Mtl1ES STOIUIS
� !' FINAL OR {SIGHATURf) MTf
Eoch gas piping sysfcm o! aix or more. ps /'i v
�J ou�lot .3 �7
f , r
ftAM[ CF OVYN [R � PMON£ � � .
Fath repoir or irutollotion o! wata�, D � D Efit �pufnd a � EI� on ti1� Y[S OAtt F4E� �
soii, wau�, ond v�M syst�m '�/ �/� S.SO �
MAILMIG AobI1tSS � nP �
OX 70ISSUE PERNIIT DATE Of ISSVE
��TM � Eoch indus7ria) wosf• pra•Ire01men1 inte►ceplot, PEWA11 NO. DAfE
ineluding i!s trap ond ven1, e:cepling � � ^�,�"�
hilth�n fypo ptooso intorcoptore tuncfioaine
_� m fixture tropf 1 .10
CONTAALiOR THIS APP�ICATION IS A VALID P�RMIT
n�ss IIC. NO. PHOH� TO INSTAII PLUMBING WORK AND/ OR FIXTUNES AS LI57E0,
EotF� roinwat�r aynfems _ pot droln ] .40 AT THE JOB ADORESS IiV01CATE0 HEREON , ONLY WHEN
PROPERIY INITIALED AND MACHINE VALIDATED IIV THE
SPACE PROv10�� BEIOw.
AODAESS Alforolion or ropoly d water p;p3np or wator � •70
Im m�torr+�lfy witA M� P�ovliloro of Sation 70.1 � .5 d �h� WsieNS ond P�d�s+lon� Cod� instaHolion froafinp equipmenl. R�qvnA fw nlunds or od�wfm�n� in I�n paid m��l D� mad� b M� Ouiidinp 011i�ial in
ond S�dion �aao � ,h. �eeer Ced� M M� f1ef� o� Galilor+�:o. applicoat �fiall HI� wlrh tM
Bu:tdinp Insp�etor 11� uHillcoU�. d�sipnot�d In II ) ond 1�) 0.lew and/w ft�oll inOknla Inm wrifinp in co�to•monu wiM opplica0l� Naiw�(�) d �h� Soeto qoro Couny Ordiaonu God�.
(9). �4}. (S) a (6) wdricMw�. i� ayplicosb.
(1) GrNlkof� d Con�nt d SNt•Inwr� nw�d br tM Dinc*or d Mdusrtial It�loflons.
�a) 4rlilicot� (or .:on au�ko�• covrl d wo*n�sn's Coa�.roo�io� ��wonu h�wd �
°" °dO1���d �"""�' Altorofion w ropai� d droinope or vont pipinp 1 .70
Q (�} ih� taft d �M r+ork 10 b� p�rlwm�d is if00 or I�w. SUB TOTAL
�m 1 urlitp Mot in th� p��ormona o! t!N wak lor wAi�A Iris p�imil Is luu�d
tl�or I sAdl na* �nplay a� p�nen In onr eronn�r w w fo baom� �ubjM
a tt�• w«f.»e'� Co�y.nw�en ►a.a d Co�c�anio. Each lown aprinkf�r syst�m on oay ono m�1er. 4.20 CPi Adj. ± %
Q (S} � �ily qw� th� opprmn� b IicsroM und�r Ih� pmvii3aa d Owpt�r 9 indudi�sy botk 11ow prWection dovic�s th�r�fwe
(wnvn�ncinp of S�eior 7000) ef aivision � d tf� Bwia�» ond Mof�wlons
[oM, an0 �aid ' rodory lluns�.
Na. tiaa�tllaotlon i� in tuil torc� ond ��.d. Otho� Adj . D
� (S1 AAallwm i� �a�ap� fran {5) und�r t1N oA?fimbb prov{fiom o! VocVUm brpokers Or back }low protaclive davitaf
S�di 70s0 �hraph 7039 � troeta '� liana� I.ow. (Sta� bo�;� on fonb. vot7. etc.. or ior iMtellolion o� �n• •
ta OI�. '
qtiut�NYS � d. . prot�eted plumbiag fixture+ TOTAL FEES
SIGNATU1li _ /�/ onQ to five 4,40
CON ION LENDEN $EE 119 ,�,p, orer fivo , Oo[h oddilionol �� TNIS S�ACE i011 MALHiN1 VALIAwTIOW ONLY
NMAE: Swimrning poob. Privoto 11 .OG � � J7 6 �� � ' � �i � p • • � ww 8 � -; :'Y 1 (�
.. ,. 7 �
„���s: - - -
publit ��-GO
t7HXNOwN: �� SU8 TOTAi ��� �
� � FpRldBQ•1!!7
' /. ,,.�
� TH15 S*ACE �OII INS►ECTO�'S 11fE
ITEM EACN NO. fEfS
APPLICATION �OR ELECTRICAL PERMIT 1$SUANCE FEE � . � �.�o z. ao
SAN7A CLARA COUNYY ENVIRGNlYlENTAt MANAGFJIAENT AGENGY ptRMtt FEE
BU�LC1tVG Ii�iSPECTION DINISlOrI Ne,. .�i. ora �us�. ' si .so v.* � � w. ��•
70 W. HEDa1NG ST.. SAh JOSE. CA 95110 • TEL. 299-�351 }�^�h "���y ^�' � � ^'°�orfrodio"
�sMdinp hw ua;•s. tha�d.
Al1 oth�n a+ uaif bosif r 1 .50
liahd I i
ADflRESS TEMPORARY POLE , 3.90
L1GHT OUTlETS � 1 •10 (MtNiMUM FEE) 4.20
STREET NU � /�����`j U1j RECEPTACLES �
SWITCHES I ovar 10 ,Zp �,
roST OffICE (p �d IIGHT FIXTURES 1 •10 (MlNIMUM FEE} 2,40
W1TE Of 6UIlp1 E NO. WORIt TO bt OVER 10 � •ZD �o-
� 11rPLiGI1TtOM FORCR R �NLE �NE � �`„�Q�d�� HEATER (PE8 KW) � .�Q MRTlA! O% (S�GNAtUA[� OAT[
� � 3 '� OONTRARO�I
RANGE /OVEN/ DRYER/ WATER HEATER 1 . 10
USE Of STIIU U t ME OF IMAROYEMiHT
QFAMiIYYFSIDEN[E Q Oi11lD QREJAODEI 011[rAlk MER PANFL/ PANEL BOARD/ SWITCHBOARD �• 10 RDUGHOK (SlGNATURE) DATE
��^ FIRE OAMAGE INSPECTIOti � 1 .OQ
SQ. FT. NO. OF NO. Of
Si2E FMUUts STORIES SENViCE CHANGE �•��
_—^ SURVEY • 1 HR (f10) MIN. 10.00 +(� V fINAIOK (SIGNAiURE� �1E
� ✓� .
� � TEMA08ARY METER SET 4.40
` NMA[ OF OWtlill �• �__� PM = �d MOVFD IN HOUSE (MlNIMIIM i11AC} 11 .00
MOTORS • 1 / 2 HP OR LESS ,bp E��Irpvir�d a Q t�11anH�• YEf CATEFII[D �
MAIIINGApD�fSS �� Z�a 1 / � TO 2 HF 1 . 10
� ? TO 5 HP 1 .70 OK TO SSUE PFRMIi CwTi OF ISSUE
� S TO 1 S HP 2.26 �� PERAUt Np. S OY owTE
�TM 4'� � 15 70 45 HA 3.30 � �� �� � Z� � � '�
YS TO SO HA 4.10
coNi.�noA SO TO 100 MP 8.ea THIS AP�I.tCAT10N IS A VALIp PERMIT
ClASS ll[. No. ►NOr+E OVER 100 HP � � •� TO INSTALL ELECTRiCAI WORK AN�/OR FIXTURES AS LiSTEO,
' AT THE !08 AQDRESS INDICATED HEREpN, ONLY WHEN
P80PERLY IN{TIAtBO AND MACHINE VALIDAT�b IN THE
rruwsFOwNEas • � / � icvA oA �ESS .ao SPACE PROVIDED BELOW.
�oaACSS 1 / 2 TO Z KVA l . � o
In cp�ormity w+M IM yrovitions o1 SMion 7ptl .i d th� businas ond Wd�uiom Cod� 4 TO S KVA 1 .70
und S�pion �L00 0! tA� loDy Cod� 01 M� Stat� of Colianio. opWicant sAOl1 fi1� r.�+h n� 5 TO 15 NVA Z.20 R�qwat� Iw nlunds or ed�uaun�nu in Np pold mus! E� mod� ro It� Bulld3np OH{cial in
Bui3dinp Imp�cror tl» anif7cel�s. dalpnol�0 in (Ij aad {2) p�lovr ondla shofl indico» it�m writi� fn aonlormo�cr ai�A oppliceDl� wcNon(�) d M+a Sanro Gora �ounqr Ordinor�u Ced�.
(�). (q, (S� ar (b) whicAwN. 7s opplicobl�• 15 TO 4S N VA 3.30
(1} GAilkos� ot Cem�M d S�M•iiuurW luwd br th� Oir�Nw o1 Induatriof RNations. 43 TO SO KVA 4.40
(�} an at�dmit�dn wnrf duylicot� wpy3 d Werk�n i [o�p�e+otim 4auronp Iswod by .
50 TO 100 KVA 8.80
� Q (�} Tt,� cm� ol +M work ro b� p�rlo��n.d Is 1100 a I�ss. OVER 100 KVA 11 •00 SUB �OTAL
t�) 1 cxtilp tAOt in �M pMfa�+enu d tA� wak Iw whltA tl+h p�rm!! is isw�d
Mvt 1 fAell nd anplor mr p�non �n onr nqnn�r so w �o O�can� wbt�c* S1GN5 �•�a CP! Ad' ± %
Ip IM Wakn»n's Cany��qo�ip� Lars d ColHana. �•
Q IS) I erfify MW Ih� opplitant it lium�d unGr tA� p►a�fslom d C�PtK 0 SIGN TAANSFORMERS ' .00
(comm�MlnQ U S�ction 7009) a1 d+v;tion 8 d th� 8wla�u an0 hol�saiom
Cod�, on0 �old opplicnnl's Colilornlo Stah Cont�oc�af lianH•
µo, os�ilieation is ia lutl Iaa ond dt�ct- FESTOON lIGH11NG • 100 LANIPS OR 1E55 2.20 Olh�r Adi.
. Q I6) �ppl:oon� i� �l�a�At Iraa (!) obo.+ wid�r ro� opp�imsl� pro•iaian d 101 TO Z00 lAlJlPS 3.30 // D
fai • ion.��A 70 3 0� Casuotbr'� t� law. (E►ata OVER 400 LAMPS 4.40 `r•
A�PIiCANT'S � �: � ✓ , �s' ,�'�� SPEC1At CIRLUITS � 2.40 TOTAL FEES
SIONA1UitE �
CONSTR QIOtII[NOER ' (SEE IIV3 C. . P. TRAILER SPACES 1 . 10 � .� t � � 4 y EPf33MCF �ORMACHIttt VAtj�/�T1�pT� , ,, .� 2y�t ���
{7 p o w D
N�E, � ELECTRiC WELOER (PER KVA) .60 • �
Apmtess: MERCURY VAPO(i LAMP 1 .10
UHKNOWN: BY: SUS TOTAL •
� � �QpH►79-1 /77 . . '
' 1TEM EACM NO. FEES TMis SPACE io�t INSPEC�OiI's usE �
APPLICATION FOR PLUMBlNG PERMlT ISSUANLE FFE z.zo �. s.zo
D�T. OF PUSLIC WORi(S SANTA ClARA COUNTY SURVEY FEE 1 HR./ SIO MIN. I0.00 •
BUILDING INSPECTION DIViS10N • ' �
1555 BERGER DRIV� SAN JOSE, CA. 95112 TEL. 299•2$S1 Eoth plumbing lixture, trop, set o! �ixtures on ono � .�o % , `
frop. iaclvding water. draiooga pipieg and A � �O • �
j bock flow p�otoction lhorolor � l '
1•� •
� ADDRESS
I Eoeh buildiny tovwr o+ troil�r pask a�w�r 5.50
StItfETNU7NaER �Y S Od / � /� f� � VD •
I Movod in hovso II . QO
�csr c:F�cc �urn 1 ~' 1 �
I DATi OF WORiC TO BF
APP���i1O„ tU1L01tIG �tRl+NT NO. ppNE EY EaCh vrat�r heote� ond/ or ven! ( .70
fOf CR053 IIliE1t[NCE OWHFIt
PAR�IAI p1( (SfGNATURE) DATE
• QNTRACTOR
USE OF STRIICTUAi TYAE Or IMPROVEMENT Each 0�� yQ�� 1 .70
Q FAM1lY RtSIDINCE Q 6vllp �}�El1tODE1 QRFPAIt OOTNER
ROUGH OX (S�GNATilqF) DATE
�T►�E� Eoch yos pipinq �yilam of ona to five oull�ta 1 .70 O
SQ. FT. Na. OF NQ. OF � 1� �
Slif FAMlL1ES STOitilS �
I ����L��� Eoch pos pipin� iytiam o! tix or moro. por FtNAI OK (SK3HAiUtFI DAiE
//�� /'y bDd ovl1�! .�0
I NMA! Of OWNfR V i+ R.VON �GI O �Yi �HGNE '
( EacA ropoir w iostatlalion of woter. Elll �puir�d a �+a EII on fi3• YES DATE fIIED �
AH►I1INGAOOi1E3S 5d ,� � I�t r wil, waslo, ond vcnf syatvm s,sp
� Ox TO ISSUE PEWNT OAtE Oi RSYi
• OTM � � ' Eoch induthiol vaito pro•fraotm�nf inlercepfa. P�� ��j� 1 CAT U, / ��
includinp ib trap and vont. oxcoptin9 � v ��! �
G ���� kitchon lyp� graaso intortoptors lundion�ng
i CONTRACTOA • as fixturo tioPs 1J0
THIS APPtICA710N IS A VAtID PERMIT
an►ss uc. No. �� TQ INSTAIL PLUMBlNG WORK AND/ OR FIXTURES AS LIS7F0,
Q ��3 � � �f E«h roinwotor �num� _ p�r droin 4.20 AT THE JOB ADDRESS lNDICATED HBREON , ONLY WHEN
- PRO?ERLY INITIAlED AND MACHINH VALIDATED IN THE
A���s � v� / D S �, /i•�� SPACE PROVIDffD B�LOW.
I� �T Attorotion w r�Aoir o! water piDie9 or watcr 1 .70
le oonlormiy wltb tM provl�lons d SM1en 7G11 .5 d th� Busin�ss ond Prdwions Gwh iiuloUolion frvoting �qVipmenl,
and S�d7oe �t00 0� t1» lobor Cod� d tM Stol� cf Colitemio. opyllcaet sholl 1i1� wifA Ih� 14quari lar tafuno� a odi��nfs In INa
iuitdin In fh� prtilfwt��. dwi nat�d in I� � ? b�low ond/or �Aell Indicol� iMm poid mw! b� rnad� to th� Wiidinq OMiciaf In
p W� 9 � � ) rrritfnp In wnlw�nonn wlr� ayplimbl� a�cfion(�E d �h� Sonro Cloro Cow�ry Oidiaoau Cod�.
(� , Is�. !s} w le� wnia�.wr, �� epoikae�..
� (1 � Grtpicot� o� Co�wnf W S�lt•imund isw�d by M� DirWOr of I�dwtAol R�forlon�, /
� t? GrfilieoN (a ��ed duplitat� topy) d Wakemn's Campentatioe I�ronp i�au�d br
ea odmNt�d Irounr. D
Altorollon or rapair ot droinogo or vent piping i ,70 { � , �^ O � �
Q (7) ih� cp10� �� �+o�k fo b� pNfwn»d b 3100 er Nu. � � � 2 5UB TOIAL
i
O S�� I aHily Maf 7n M� p�rformenn W fh� .rerk for wl�id� Nis p�nnit i� I�su�d A � Y � ` �(� � � �
Ma7 1 shail nW �r�ylay unY Y�+wn fn a�r mona�r w w fo b�com� wb��et �.
to �T� wakm�n's Ga�p�roo�lon taws d Gotilanio. Eath lown � rinklor s tom on on ono motor. �.ZO � �j CPI Ad . f %
� (S� 1 artilp tAW M� oaaucom is lian�d und�r Ih� provisiaro d Cf+opt�r 9 Includlnq bak flow pfotoelion d@YiCai thofa}at� � �
(opnm�ndnq at S�d1on 7000} of d�visiaa 3 W Ih� OwlrHSS and hd�s�lons /�
Cod�. � spl�pp�imnY� Co13lania Stal� Cu�trodor'� liu�a�. Le�/ �
Mo. � 3 Clouiliwrlaa i� In tvll iora end �HM. � C; OtAet Ad�.
I O (e) Aypstcanl is •.�n�p1 tram (s} opw. „nd�r rl» appsiceW pwr�abiu of Vocuum br�ok�n w bock tlow proracffvo dov;qs
Swio� JotO +1�rovpa 7oss a a� eantroax'� tic«u. taw. (S+o+� boY� on fonks. vote. �tc.. w for inatollotton on ua-
fa �um 1on.
� nr►uCANr: p�Wocf•d plvmbinp fixturn
StGn�iu�E ons �o five q.Zp TOV1l FEES
COMSilU1C'110N IENLfR (SEE 1143 GC.P.) or�t }iv�. �OCh odditiOnal .�0 TkIS SPACE i0� �AtHtHE VAl10AT10N ONt�
N��: Swimrnlnp pools. privofa 11 .00
' AOORFSS:
ur+xHOwH: er:
��b�� �.�� - 7b � 4 0 �, b • P • 23866 G� — A 12.4
sue ioTn� �► , .
m� � eaer�. •
' Tt1�5 SfAC[ FOR INSiEC701t'S USE
ITEM EACIi NO. FEES
' APP�ICATION FOR FLECTRICAL PERMIT
• DEPT. OF PUSLIC WORKS SANTA CLARA COUNTY ISSUANLE FEE z.�o �,�o
PiR1Nl EE
BUILDING INSPECTIQN OIVISION N„,, ,s�ai. o,wT��:�p�. si .sov� � aaw. �+.
1555 BERGFR DRIVE SAN JOSF, CA. 9511 � T�L. �99-2351 ��m��Y ��YC�YtHf101 a ,�;aa�+��
�cnMinp two �fori��. tMr�d.
All oth�n on unit boila � 1 .50
Ihf�d Mlow.
ADDRESS TEMPORARY POLE �.30
IIGHT OUTlSTS 1 • 10 (MINlMUM FEE) 4.20 � '
STp[ET N3JM9FR
� 6 � � � � v � RECE4'TACLES D � O
SWITCMES ovot 10 ,2p �, Q
rost oiFlce uTr) r� � S� T/T LIGMT FIMUBES 1-10 (MINlNWM FEE) 7•40 O • a
DwrE W eurlowG P�n NO. w � = OVER 10 .70 �o. � � �
AlKIUTION f0ltCR055 R�ERENCE �Nf �
pyy�fp HEATER (PER KW} .�p �I1tT1At Oi( (SI6NATiJ11ly DArE
TM��� RANGE /OVEN/ DRYER/ WATER HFATER 1 .10 � ,�+ r
US[ O� StRUCTU1tE TYA[ Of IMatOYiJMENT .
Q FAMILY RESIDFNCE 0 6L11D �pE+�oau ORIPApt QOTHER PANEL/ PANFI BOARD/ SWITCFIBOARD �• � � RDilGN OX (fIGNATUAE) 1 DATE
QOiHfR FIRE DAMAGf INSPECTION 11 .00 • '
SQ. iT. NO. Of NO. Of
S�it F.utltl[E Q STOAIFS / SERVICE CMANC�E 3.30 � � �
r SURVEY • 1 HR {510) MIN. 10.00 FINAt Ox (StGNATU11i) oAtE
,Q n /� ��7�+� '� ���� � N TEMPORARY METER SET 4.40 '
HAMi OF OWNEII G� ,S J� �� � ��G /� �•T I d^� �'MON� � "�J• MOVED IN HOUSE (MINIMUM j11 .00) 11 ,00
MOTOAS • 1 / � HP QR 1E55 • .60 E1�lrpuir�d f'�� ^o EIRm131� Y[S OATEHlfO NO
MIIILINGAODtESS � (� � � N ��' 1 / Z TO 2 NP 1 . 10
2 TO S HP 1 .70 OK TO 13SUi PEIIMIT OATQ Oi ISSU�
C' � / ,y v 15 0, 45NHA 3.Sa �E Ny�_, �2���' IS J ED 8Y oAT � �
an ��
. �S TO SO HY 4.40 ' ' .
coHn�cro� ' � �r� � �}�/�-�l so To i oo Mv e.eo THIS APPLICATION lS A VALID PERM3T
cuss -• UG. NO. YilOT/E ovea ioa Ha � � •� TO INSTAII ELECTRICAL WORK AND/OR FqCTURES AS LISTED,
C � � � D �3�t, ,��� O � � AT THE 108 ADDRESS INdiCATEO NEREON. ONLY WHF.�1
�) /� a / TMNSFOAMfRS - 1 / 4 KVA OR LESS .60 SPPACE PROVIO�BELOW. D MACHlNE VALIDATEO IN TH�
ADO�tESS IIO�•� / // /r� U� L � S (J"'/� T� S 1 / Z TO Z KVA 1 . 10
In wnlorrnU�r ..i1r n+� prwhiom d S�ction l091 .S d M� Owinas ond hdwbn� tod� � TO 5 KVA 1 .70
ond SKtlon �L00 0l ttu laDw Cod� W iM Stot� oi Colitomia. appllmnt �!w!i lil� vAth M� 5 TO 1S KVA Z.ZO II�W�sb Iw r�lw�da a adjrslrn�nla In INa poid niwt h� mod� ro u+. w�wt� ari�ioi M
l�iidinp leup�ctw 1M a�titieW��. d�siynaNd In (1 ) ond {7) O�lew ar+d/or tAall ind'ecoN it�n� wr�+lnp In m�+fartanu wltt� appliooW� t�ctien(�) d M� ianto dora Counry OrEine�u Gad�.
(�))). (4F. (S1 a (b) ��wr, is opPlimb��. 15 TO QS K V A 3.30
( t) Gn�fico+� ot toni�n� ot s�tr•lawr.a tuuw by fh� Dir�aor o! ad�n�nol n.lmian. 23 TO SO NVA 4.40
(7� Grtillcot� (w �xac� duplicat� eo�) d Worknwe'� Canp�niolion Insuronn ir�a�d by
� an admir�d laeur�r. 50 TO 100 KVA B.80 C' �. � '�
OVER 100 KVA I1 .00
Q (�f Th� caf o! tfw work to b� PNfam�d b {100 a I�p. ��i SUB ?OTAL
Ol+1 I artNy tlwf 1n th� p�Aarreoncs d tM wwk for wAiM Mi� Owmio it iuuW � �! � �
Mot 1 shotl no! �ntploy ony p�non In aey moena w of lo b�carn� wb��al SIGNS 3.30
ro ro. wo:wn.n'� Go�np.eaarion �awa d eourornw. �C � .�j � CPI Ad�. ± 7i
� {5) 1 pA:tr thot p�� appliwM It liu�u�d und�r IM prwisioru d CAop��r 9 SIGN TRANSFORMERS .60 7 � � �
(conw��ndnp af S�uion 70001 d divislon 7 d Ib� Butin�tt and Prd�tsioru n � ��i
Ced�. ad soid. �pliwn!'f COlilpnio StW� CoMrotfa�'� Ua�m�. 1 .
No. �' 1 - qa»ifimelon b in IWl lores a�d �tt«e. fESTOON UGHi1NG • 100 LAMPS OR lESS 2.10 � L Oth�r Adj.
Q (0) ApqlcoM i� ��u++P� han (S) oben undu M� oppliwbl� provislona ef 101 TO 400 LAMPS 7.30
Sutlee 7W0 dsrouph 7033 d �A� Conuodo►'� Uans� �ar. (Sta� bosSs OVER 400 LANL�S t.40 d
fp�j�x��n w
AYKKANT'S Ei/�� .�,y. SPEGAL dNCUiTS 2.40 TOTAL FEES �
SlGNA1NRf �f� : •
aDNSTRUCTtON tENOi� SEE 119� C.GP. TRAIIER SPA�ES 1 . 10 TNtS E�ACf FOxAtALNIN� VAl1011TION OM� •
NMAF: ELECTRIC WELDER (PER KVA) .60
�o�=ss; MERLUttYVAPORLAMP � . , � A�lG• 2� � 4 0 � s � P • 238b6 �} -�- A �1.1 :
uNxNpwN: 6v: SUB TOTAI
, �
� � ►ORAA 79�3/1� �"�
• ITEM EACH NO. F E THf3 SPACE FOA INSVlC�OR'S Y3E
� APPLICATION FOR MECHANICAL 'PERMlT �ssu�c� FEE s
� DEPT. OF P�JBLIC WORKS SANTA CLARA COUNTY SURVEY FEE 1 HR./ S1D M�N. lO.OD -�^�
r� "7"'�/.. ��.Q QOk/'SOd� e
� (' BUiLDING INSPECTION D�VISION (IIS10110f30n Or �e�aat�on ot oa�ti :
t� �orae•air w grwiMtype furn«e or 4urn�t, �
' 1SS5 BERGEi! DRIVE S/1N JOSE, CA. 9511 'l TEL. 299•ZS� � ;rxludinp duds oed v�nts onoch�d to ooch ,�J
apaisaMe, �� �o o�a �nci�d�� foo,000 a.r.u.': a.ao rGcSr�l h � ��� ��
' or.. � oo,000 e.r.u.•. s.so
ADDRESS Domeslit hrpo incinerolot 5 .50
� � ��i/ � f� _ / Comm�rcial or ind�afriol type In�inerotor T2.00
SiRtii NW�t6ER � v Flaor furnaco includinp vanl 4,40
J� �J/'' Su a oT a �j0�f ♦ �.40 ¢ � 0 `
rQSf OfFIC[ {[IT� �I/ / � '
pATi Of 6iJIt01i1G VEIUMIT NO. w �K O 6F
AiPl1UT10N O Ff 0.[NGE Nt IY (Of fAplOCOmant o!) OppllOn[Q von! inftnllad PARTIAL O� (SIONATUAE) DATi
'/� /4 ,w � �i NiR a►d no! inctud�d in on opplionce p�rmlt 7 .40
V O CONTRAC►Ox
Yff Oi iT�t 11E ME OF 17NROVEM[H7 Ropoir o!, alforalion d, or oddition to eoth �OYGH OK (SI6NATUIIi) a►tE
iAMIIY �ESIDFNCE p 6U�LD �FMOOEt O�PAIR dOTNFR haotitfg appliOrit�. r�frig�rorion unir, '
HtII corrdort cooliny �nif. obsorptien un3t,
p, �T, Ha. oi No. Os or �oeh eornfort haotinp, cooting. abiorption,
y�Z� FMA1UES /1 . S70AIts �f or woporotiw cooling �y�t�re. ieclud3nq
CJ (r� imtallafion o! conlrolf 4.4a fINAIOR (SIGNAtiJllF) ���
Instoli0tion a relototion o! eoth boiler or
MMII OF OWNFR � rHON comprassor:
To Ond including 3 hy. l.40 EI11 r�quk�d 1N� a EIN en lib Y[S DATF FIlEO �
� � Ovor 3 hp to ond including 15 hp . 6.30
MAIlINGAOCNlSS Z, S � ziP Q ovor IS hp lo ond intludiay 30 hp. 11 .00
1 Ovor 90 hp ond ietivdiny 50 hp. 1A.50 ON i0 tSSUL PiRM1T OAiQ Gs ISSUF
Qr obsaption q�1om — To and �E�M�T NO.� ` � � �� O
including 100.000 B.t.U .'a 4.40 v �
� ��� Ov�r 100,000 to ond iacludiog 500.004 . 8.30 �
� Ov�r 500,060 fo ond intludiop 1 .000,600 I1 .00
CONTRARO�t Ov�+ 1 .000.000 to ond Includinp 1 ,75Q,000 16.50
{rafriy�rotion compr�ssor ovar so np or , THIS APPLICATION IS A VALID FERMIT
Cu►ss u�• N PH�� ob�ption sys�om over 1 ,7i0,000 B.T.U .'i ��•so TO INS�ALL MECHANICAL WORK AND/ OR fIXTURES A5 LiSTED,
AT THF J08 ADORESS INDICATED HEREON, ONLY WHEN
Air•Aaed�iny vnit ro o„d �nduding lo,000 e.1.en. PROPERLY IN1ilALED AIV� MACHINE VALIDATED IN THE
inclvdiny ducli ottah�d lhorato 3.30 SPACE PROVIDED BELOW.
AODRfSS
NOTE: Thii 1�� �holl not opply to an oir•handling
Im m�lwmNy wifh pN prorlflons ol S�dion 7071 .� oi th� Ousin�q ona Pralwions Cod• vnit which is o pottiot� at o teclory oswr++bled Rpu�sl� Ip nlund� p edjuffnrnb (n 1�s pald must b� mod� tp M� Euildinq ONitk! in
� md S�dton �t00 d Ir� labw Cod• d rh. S�m• d ColBwnlo. o�pttwe� �Aof1 lil� w�t1+ sM aPplio�c�. wr+dwt <oolin unit. ovo rotiva
aiu�na �,,,awo. u�. o..+a�r.s, dMJpna��d in (1� ond (2) b�lwr m�d/or Yatl Indicot� i�m 0 A� w►►tinp �n aoe�lo+mona wlfA opplitobN Netlon(�) d Ih� Smilo Ctata Couefy O�i�onu Cod�.
i �z)• N1. (s) � (`) ��►• i� ay�1mLl�. tooler or obsofptioe vnif lor whidf o p�rmil is
1) GrtitiooN d �ena�nf of s�lldmw�d iaswd b� tT� Oi��eta el Indwnlef 141miena. �oquirod elsowl�oro.
2) Gttiliwh (ar �xod d�pfitoq tepr) d Wukrt�a's ComA�rnation Mnatona iawd Or
on admlttsa Iniunr. Air-haadliny unit ows 10.000 c.l.m. S.SO /�
� � �/
QR�) 1� wat d +t+� wak �o e� p.Aarnwd 'a 3100 er I�s�. Evoporativ� aoo}ar otbar thon pwtabl� typ� 3.�0 SU8 TOfAL � ��'�
i �«) t arlil�r thol ia 11� �elormsne� d IA� v.pk tor wldd� thls p�nnif if inu�d
rhot I d�afl �wt �p1q ar�r pMOn M wy� moan�r w m to buom� sub�M Von! ton oonnocted !o o �1np1� duct 2.40
, to th� Wcrkm�n'a Wmy�motien lan d WNanio. Ven1ilnlion syft�rp whith is net a parlion d CPI Adj. ± %
O (5) � c«r1y rAo� a+� opp��m�+r i� �ia�wd �ndK +�• vrovi�lom d Ctwp+•r v �yy heotinp or oir wadifioniny systetn
(comr+»ndny ot S�ctia+ T000) � dldtlon 9 d t�r eu�lmu oed hWmlons outAorisod b o rrnit . 3.30
Cod�. ond w1d OppliwM'a Cuti(unla Srot� Cenaodar'� Uanu. p=h�� Ad�.
No. Qoss{Ilwlion ia l� fufllora md �HM. Inttallofion a! fach hoad which i� wrvod by
� Q (6) Appfioont is �x�myt fram (3) abow vr�0a tl� opp�iwL�� Worisions d mecho+�lco1 oxhousl, intluding dud� for hood. 3.3a
�aw �as� o� �h. neaw•, tia�a. ta... (Sro�. emu
� �� � Appliot�e ar pioco ot �quiprn�nf r+o! dosssd in
�mrc�wrs -��� othor pppii0nce wfoqorios, or for which eo TOTAL FEES
� S�pHATURE othor t�� is lisled. 3.30
iHli SPAGF FOR MA[NiNt VAIICATIpN ONLY
CONSMUCT14H LENDSR (SEE 1193 C.C.P.)
_�_, vent 3.30
NAMf:
E� ��om �f ���,� 050�. 3.30 ' G -76 • 3 G � 2 6 H P � � 38 b 6 (►,) �-- A b. C
t AOD�ES�1-'
• SU8 TOTAL
ua�wowr+: o+r: •
' m� row� e�en,