8627 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENT[F I CATION PERMIT NUMBER
aDl°las LOT 29 APPLICATION & PERMIT ��
PLAN 4 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
�. ER
NAME PeAnza Croup, a California QTY, ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
Ltd. Partnership PHGNE415 571-1 81
NOMEHAcioHs OUTLETS-SWITCHES-RECEP 10.00/1.00'
The Alden Company LIC.No. 465640 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
ADDRESS 411 Borel Ave,Ste.410 APPLIANCES-RESIDENTIAL 4.00
ADDRESS
San Mateo Ca.94402 PHONE415/571-1 81 PANELS 10.00 DATE OF APPLICATION
OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINE
alderon-NakamuralG.ND. C013712 SIGNS TRANS. 3.00
ARCH OR ENG. PERMIT VALIDATION
ARCHER 2070 Business Ctr. X220 SPECIAL CIRCUIT 5.00 A
Irvine Ca. z92715 Tp EMP. METER OR POLE INS. 20.00 q U
APPLICANT 411 Borel Ave,Ste.410 MOTORS SEE FEE SCH. JUL
San aMateo Ca. 94402 SERVICE CHANGE 20.00 2 91985
w o O LICENSED CONTRACTORS DECLARATIONTEMP.POLE 30.00 CI Of CUd1ef 100
Fi w I hereby off rm that I am licensed under proveji ss of Chapter 9 I SUANCE AT
(commancilyg jvji ly��t 1pn 7000)of Division 3 6j 1 s antl BLD ! ELECT. PLG. MECH.
H w z Pro@scions I license is in lull fume u 'cr.
S, o w - License Class �__-I.ic.Number_
9 m Ore Conrucmr
a IS E J
¢ ¢ a OWNER-BUILDER DECLARATI BUILDING PERMIT
X
;A H. I hereby a, Rr than I am exempt from the Contractor License
ca - MISC.- REFER TO ORD INFORMATION
HLLOj Law fur the following l'cason.lSec.7031.5,11usinessand Professions PERMIT ISSUANCE ALUATION $/FT.
Cade:Any city or counly which rcyuires a perm it to construct.alter, 10.00
¢ a¢ o improve,demolish,nr repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /
ca w m¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /J7�
Business and Professions Code)or that he is exempt thcrefrnm and DTV. PLUMBING PERMIT FEE (/
w ~ m the hasis for the alleged exemption.Any violation o'Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civilpenalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500p.):
❑ 1,as owner of the property,or my ennployees with wages as BACK FLOW PROTECT. DEVICE 4.00 oCC.GROUP RES.UNITS
their sole compensation,will do the work,and the stnci.m is not
intended or offered'for sale(Sec:7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:1'lie 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 5.00 $ .FT. ooR AREA To aLacHEAGE
• himself re through his own employers,provided If,h ev such improve-
mentsarenotimendrdorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or.improvement is sold within tine year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.1 2.00
builder will have the harden of proving that he did not build or int- BUILDING USE
prove for purpose ofsele.l. INDUSTRIAL WASTE INTER. 30.00 IND CON PB Other
❑ 1,as tiwner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct tiro 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 nor apply /
to un owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projects with a contractor(s)licensed prusuant to SEWER-SANITARY-STORM EA.200ft 110.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under SSS.-.B.&P.C,for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 -ACe.DATE ACC.FILE NO.
WORK Ii RS'COM PI7NSA1 ION DECLARA'i'[ON WATER TREATING EQUIP. 5:00
I hereby affirm that I have"certificate of consent to self-insure.
ora certific.FC916447-mina ry Arldtyn, C=Vd ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
PAY,No.
0 ❑ Certified copy is rr by tonnesd FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy 'e h 't Iirhe city inspection division.
FO Applicant _ MISC.- REFER TO ORD. v ❑ NE] Y ❑ NE]
in CP.RTIFICA"r1SF IiMPTION FROM WORKERS' PERMIT ISSUANCE -10.00 FLOODZONE AT.uc.
LU > COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG.
CL 1'1'his section need not be completed if the permit is for one TOTAL Y❑ N❑
CL 0Z v❑ N❑
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of rhe work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
U. U mit is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California
a Due Applicant BUILDING
} W NOl'ICI: TO APPLICAN this"f: If,after making s CcUiticam of Ex- ALTER OR ADD TO MECH. 5.00
Z_ emprion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.Ii X4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm th the c is a oh traction)Irndi"yy��ag• cy for EXHAUST HOOD (WITH DUCT) 5.00
the perfonnanec of ,fp h ®0a.pcgo sGss�l.(Sec. MICROFILM
30nder's .am OR 1tl ,Y810 A10'Se�. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name 44 UUUUZ
Lender's Address HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that l have read this application and sure that the above VENTILATION FAN (SINGLE) 4.00
ordinances n coram.I agree ti 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 lar eves of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby
menrioneJ property forinsp of
this
purposes.
(We) agree to save, i d-unify and keep hurniless the Cfty of MISC.- REFER TO ORD.
Cupertino against Imb'i s judge nts, costs and expenses which
;Win any way ac amst id City in cunsc51113r1181g
PERMIT ISSUANCE 10.00 CONST.TAX' �.
g(dBting of this per MECH.CONT. LIC.NO. MCH. -- -
TOTAL TOTAL 6
Signatureof Applicant/Con .,for Dare
INSPECTOR COPY
ELECTRICAL r,,-I-( FINALS DATE INSP.
FRAMING t'Z-I SAN #
INSULATION PLUMBING 1 _ J
f
ZONING ENG. SITE .NO.
POST THIS CARD NEAR FRONT OF BUILDING
Ya; CITY OF CUPERTINO' 7
INSPECTION DIVISION
JOB INSPECTION R D. •
JOB ADDR [JNr T#
OWNER CONTRACTORIS
F RMIT'NUMBER
RS2,
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
PE ATION
JLIL 2 9 1985
City of Cupenlao
ISSUANCE DATE
INSPECTION 4L D INSPECTOR INSPECTION RECORD
FOUNDATION~
lsUFER
PREGUNITE
HEATING ,
HSPOURNOCONCRETEUNTILABOVE BEEN SIGNED
A.L. D,C.
Y LJ N
UNDERGROUND/SLAB
PLUMBING
LATH --EXTERIOR
ELECTRICAL v
MECHANICAL
GRADE
BL / ELECT.. PLG MEC.
BUILDING b
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILING P RMIT
IN ORM TION
WOOD FLOOR VALUATION
x.;:,
SIFT.
PLUMBING
PLAN CHECK
FEE
MECHANICAL
ELECTRICAL
GAS
FRAMING
INSULATION
STORIES TYPE 'C STR.
OCCUPANCY -OF BUILDING IS NOT PERMITTED UNTIL 8UILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
OCC, GROUP RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SQ, FT FLOOR AREA
f i;
r J
TOTAL ACREAGE
DIAPHRAGM tr `7.
f ,Ap-
BUILDING USE
RES IND CON PR Other
El El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDEl
ROUGH
ASSESSORS PARCEL NO.
PLUMBING - j`'"
GAS TEST
TRACT NO, PARCEL NO,
MECHANICAL 2 y
ACC. DATE ACC, FILE NO.
ELECTRICAL r,,-I-( FINALS DATE INSP.
FRAMING t'Z-I SAN #
INSULATION PLUMBING 1 _ J
f
ZONING ENG. SITE .NO.
Imo-
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
f -SEE PERMIT FOR EXPIRATION DATE-
MECHANICAL
S( IMPORTANT!
CONST. TAX !
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. r` t J
OFFICE COPY
GAS
FIRE SPA INK
Y NE]
ENERGY T•24
Y NF
MECHANICAL /
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,
FLoOD ZONE'
Y "
A.L. D,C.
Y LJ N
LATH -INTERIOR ELECTRICAL i1`6
LATH --EXTERIOR FIRE DEPT.
SHEETROCK 1` GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING b
BUILDING
SHEAR EXTERIOR p_ TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEE f .4NO.TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY
OCCUPANCY -OF BUILDING IS NOT PERMITTED UNTIL 8UILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505 ELECTRIC
Imo-
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
f -SEE PERMIT FOR EXPIRATION DATE-
MECHANICAL
S( IMPORTANT!
CONST. TAX !
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. r` t J
OFFICE COPY