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8628 .APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -any; BU I LDING PROJECT I DE TIFICATION PERMIT NUMBER APPLICATION & PERMIT _ fly -`LOT 31 ��Q r BUILDING-ELECTRICAL-PLUMBING -MECHANICAL UU CJ OWN ti PLAN CHECK VALIDATION ""MEGx6Up' A California CITY. ELECTRIC PERMIT FEE • ` r /, _ PRONE croRs NAME1 Al UTLETS-SWITCHES-RECEP 10.00/1.00 NOME LIC.-o 465640 LIGHTING FIXTURES 10.00/1.00 ' CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADDRESS 411 Sorel Ave,Ste. 410 Ran MArilin. MOry PANELS 10,00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.0Q PLAN CHECK FEE P.C.NO. OR ENGINr a, anarI luimtJya__,� SIGNS TRANS. 3.00 ARCH OR ENG. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION ADDRESS2070 Business Ctr. $220 X M zip EMP.METER OR POLE INS. 20.00 APPucANr'S MOTORS SEE FEE SCH. Ad? 411 Borel Ave, Ste. 410 San Mattel Ca. 94402 SERVICE CHANGE 20.00 woo LICENSED CONIRACTORS DECLARATION TEMP.POLE 30.00 I - � (Y/Q� au I hereby affirm that I am licensed under provisions of Chapter 9 IS$UANC .ATE 'F- atw (commencing with Section 7000)of Division 3 of the Business and a e G. ELECT. PLG. MECH. 0 O i Professions Code.and my license is in full Race and f LL ❑ ❑ ❑ 2 O H - License Class Lit.Number - O w r Date"' 'BUILDING PERMIT 0 i OWNER-BUILDIiR DECLA RA 1 INFORMATION F I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD yq LUATION $/FT. F u O j Law for the following reason.(Sea 7031.5.Business and Professions PERMIT ISSUANCE 10.00 o Code:Any city or Comely which requires permuct,it to constralle,, /5 tt ¢ G 0 improve,demolish.or repair any structure,prior to its issuance,also ELEG CONTR. LIC.NO. ELEC. t alO a, reunion;the applicant to,such permit m file it signed Statement that TOTAL 6 wes LL he is licensed pursuant to the provisions of the Contractors License PERMIT TO Hzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe - a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE O the basis for alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a3� by any applicant for a permit subjects the applicant Toa civil penally ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(55001.Y. ❑ I,as owner of the property,or my Cmpbyccs with wa,,,asggCK FLOW PROTECTDEVICE 4.00 OC GROUP RES.UNITS sole compensation,will do the work,and the structure N nut . intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT. LOORAREA T AL ACREAGE himself or through his own employees,provided that such on prove. ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 ILDING USE builder will hove the burden of proving that he did not build or hit- row for purpose ol'sale')' INDUSTRIAL WASTE INTER. 30.00 E IND DON Pa Other ❑ I,as owner of the property,am exclusively contracting with El ❑ El 1:1 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 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 contractods)licensed pursuant to SEWER-SAN EA.200ft110.00 the Contractors License Law. TRACT NO. PARCEL NO. O I am exempt lender Sec.-,B&P,C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. • WORK ERS'COM PENSATION DECLARATION' WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. co py thereof(Sec.3800,Lab.C.). C '� Policy NO ga z ❑ Ccrtit s 'twit spe `n`^"Y��� FIRE SPRINK ENERGY T-20 z O ApOp-¢etNficd c file with the city inspection division, MISC.- REFER TO ORD. v ❑ N❑ v ❑ N❑ dB�+rAP ~ m PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. JU CIiR1'I FICCO a EXEMPTION PROM WOR KIiKS' W � COMPF.NSA'1'ION INSURANCIi PLG.comTR, LIC.No. PLG. CL0CL 0 (This section need not be complcicd if the permit is for one TOTAL Y F] N❑ Y❑ N hundred dollars IS 100)or less J U O I certify that in the performance of the work For which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers Compensation Laws of California. d Dine-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT: If after making this Certificate of Ex- 2 eruption,you should become subject to tlm Workers'Conlpenwtion APPLIANCE 5.00 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 10MOC.F.M.1 4.00 CONSTRUCTION LENDING AGENCY . AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that (here 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 3097,Ci,CA HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Bank of A-ertnn D A Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that have read this application and �thc above VENTILATION FAN (SINGLE) 4.00 • 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.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino agat t a litics,j gments, costs and expenses which CONST.TAX may in any w c e ag nh said City in Consequence of the PERMIT ISSUANCE 10.00 granting Of Ilii a rlti MECH.CONT. LIC.NO. MECH. 5/11 /As TOTAL TOTAL Signature of AppllOam/Con ,, Date INSPECTOR COPY twr APPLICANT TO FILL-IN INFORMATION WITHIN RED LINES -- USE BALL POINT PEN ONLY IL t U StU LDI NG PROJECT I D I FICATION PERMIT NUMBEA eeUOLOI11G LOT 31 APPLICATION & PERMIT r.DREss PLAN'2 BUILDING - ELECTRICAL- PLUMBING - MECHANICAL8628 OWNE_ - -- - PLAN CHECK VALIDATION NAMEDe'Anza, :Group, •A- California QTY. ELECTRIC PERMIT FEE Ltd. Partnershz_ . PHONE 415/571-1481 CONTRACTOR'S = NAME OUTLETS -SWITCHES - RECEP 10,00/1.00 The Alden Company tIC.NO. 465640 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S 411 Borel Ave Ste. 410 APPLIANCES- RESIDENTIAL 4.00 ' AOOREss San -Mateo, Ca.94402HONf+15/571-14 1 PANELS 10.00 DATE OF APPLICATION ARCHITECT _ PANELS {OVER 200 AMP) 20.00 PLAN CHECK FEE P.C,NO. O_ ENGIN alder-onTNaka a IC.NO. C013712 SIGNS TRANS_ 3.00 AARCH. ORDDRESS ENG. '2070 Business Ctr. #220 SPECIALCIRCUIT 5.00 PERMIT VALIDATION Irvine, Ca. zip 92715 EMP. METER OR POLE INS. 20.00 FAIT) ADDRESSTs 411 Borel Ave, Ste. 410 IMOTORS SEE FEE SCH, 1G , Q ` l. Sari Mateo, Ca. 94402 SERVICE CHANGE 20.00 ct:- <_ LICENSED CONTRACTORS DECLARATION TEMP. POLE 30,00 1 hereby affirm that 1 am licensed under provisions of Chapter 9A ... ISSUAN DATE commencing with Section 7000) of Division 3 of the Business and PLG. MECH. Professions Codc, d my license is in full force toLicenfeC1PssLic. Number Date JJ Contractor OWNER -BUILDER DECLARAT BUILDINGTERMIT MISC. - REFER TO ORD INFORMATION 1 hereby affirm that I am exempt from the Contractor's License VALUATION $(FT. Law for the following reason. (Sec., 7031.5, Businessand Professions PERMIT ISSUANCE 10.00 Code: Any city or county which requiresa permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also ELEC. CONTR. LIC. NO. ELEC. ! CJ (J requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO S! he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of Section 7031.5 STORIES TYPE C TR. by any applicant for a permit subjects the applicant to a civil penalty ALTER -DRAIN &VENT -WATER (EA.) 5.D0ofnotmorethanfivehundreddollars (5500).): p 1, as owner of the property, or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 osc G DUP RA=s. UNITStheirsolecompensation, will do the work, and the structure is not r`[1 intended or offered for sale (Sec. 7044, Business and Professions DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work F IXTUR ES - PER TRAP 5.00 Sa FT. F OR AREA TOTALACREAGE himself or through his own employees, provided that such improve- GAS - EA. SYSTEM -1 l NC. 4 OUTLETS 6,00meritsarenotintendedorofferedforsale. If, however, the building or improvement is sold within one year of completion, the owner- GAS EA. SYSTEM -OVER 4 {EA.} 2.00builderwillhavetheburdenofprovingthathedidnotbuildorim- 'BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 IND CON PB Other I, as owner of the property, am 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 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 contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT N0. PARCEL NO. 1 am exempt Under Sec. BAP.C. for this WATER HEATER W/VENT 6.00 rcason Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORKERS' COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self -insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.C.). S,9PolicyNo. - Cerli to co s ere furmshe . FIRE SPRINK ENERGY T-74 EX Certified c p i le with the city inspcct[on division. MISC. - REFER TO ORD. Applicant Y N Y N CERTIFICATE F EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE PLG. CONTR. LIC. NO. PLG. YN Y N This seclirin need not be completed if the permit is for one TOTAL hundred dollars ($ 100) or less.) 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY mit is issued, I shall nor employ any person in any manner so as to became subject to the Workers' Compensation Laws of California. BUILDINGDateApplicantALTERORADDTOMECH. 5.00 NOTICE TO APPLICANT: ]f, after making [his Certificate of Ex- emption, you should become subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT (TO 10j000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT (OVER 10i000C.RM.) 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 3097,Civ.C.). Bank of America P.O. HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name H EATI NG UNIT (OVER 100,000 B.T.U.)9.50Lender's Address ELECTRIC I certify that I have read this application and ,e Mai the above VENTILATION FAN (SINGLE) 4,00 information is correct. I agree to comply 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 hereby authorize representatives of this city to enter upon the BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICALabove-mentioned property for inspection purposes. We) agree to ve indemnify and keep harmless the City of MISC. - REFER TO ORD - Cupertino agai t a lilies, ' gments, costs and expenses which PERMIT ISSUANCE 10.00 CONST- TAX may in any a ag st said City in consequence of the granting of lhi MECH. CONT. LIC, NO, MECH, 5/31/85 TOTAL TOTAL ddI Signature of Applicari /Contrac or Date OFFICE COPYOFFICE COPY