8625 s
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
art BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
" D,Do,ss APPLICATION & PERMIT
j./UIg /� L4( POT28 -ELECTRICAL-PLUMBING-ME
MECHANICAL8625
OW ' BUILDING
S
PLAN CHECK VALIDATION
NAME DeAnza Group, a California QTY. ELECTRIC PERMIT FEE '
PHONE
NAMERA TOR's UTLETS-SWITCHES-RECEP 10.00/1.00
gin pany LIC.No. LIGHTING FIXTURES 10.00/1.00
r,ONrrRAc7oas PPLIANCES-RESIDENTIAL 4.00
ADDRESa 411 Sorel Ave,Ste.410
PHONE _ PANELS 10.00 DATE OF APPLICATION
OR
CHI ECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER
Ic.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
2070 Business Ctr. 4220
z,97715EMP.METER OR POLE INS. 20.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 2000
o o ..San D1gtf61J W.*IR94(G2MCLARATION TEMP.POLE 30.00
< v w 1 hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
vi a m BLDG ELECT. PLG. MECH.
r z Professions Cole,and my license is in full(rocs and ((e 1. ❑ ❑ ❑
.o 0 A W Liccnse Class Lm.Number
H m ti Dute SST Contactor
a x s J BUILDING PERMIT
E o 6 U OWNER-BUILDER DECLA RA I INFORMATION
wg; H. 1 hereby affirm that 1 and exempt flora the Contractor's License MISC.- REFER TO ORD
u. o ¢ Law for the followin•reason.(Sec.7031.5,11usines,vand Professions ALUATION /FT.
_ < s PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter, 8
2 ¢¢ 0 improve,demolish,or repair any structurc,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a requires till'applicant for such permit to file a signed statement that TOTAL PERMIT T O
d w w he is licensed purvuunl to the provisions of'the Contractor's License
za
Law(Chapter 9(commencingwith Section 7000)of Division 3 of the
i D Business and Professions Code)or That he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORMS T CONSTR.
a. 5_; by any more
fora permit subjects tile applicant loacivil penally ALTER-DRAIN -WATER (EA.) 5.00
of nut mare thus five hundred dollars(my em):
❑ I,as owner of the property,or my employees withwupes as BACK F LOW PROTECT.DEV ICE 4.00 C.OCGROUP S.UNIT
their sole compensation,will do the work,and the structure is not
intended or offered for sale(See. 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 F IXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
S himselfor through his own employees,provided that such inn prove-
meats are not in tended or offered for sale.If.however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the herd,.of proving that he did not build or im- a ILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 IND CON Pe Omer
. .
❑ I,as owner of the property,am exclusively contracting with El ❑ ❑ El
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 docs not apply
to an owner of properly 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 SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
I. ❑ I am exempt under Sec. ,B.&PC.for this WATER HEATER W/VENT 6.00
reason /
e.
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKF.RS'CONIPI:NSATION DItCLARA'1'ION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sdf-insure.
or a certificate of Workers'Compensation Insurance,or a cerlified ZONING ENG.SITE NO.
copy thereof(Sec.3800,LabC . �. - -'
Policy No. e_!_!e��e..
❑ Cerlil'ie e ys tem r IS s e YFIRE SPRINK ENERGY 7424
Z Z CD[Cenificd copy is f d
08'j...a ci inspuclion d'rvisirn. MISC- REFER TO ORD.
O Applicant V❑ NEI Y ❑ N[]
H_ PERMIT ISSUANCE 10.00
=`y- CERTIFICATEOF IiXEh1 PTION FROM WORKERS' FLOOD ZONE A.L.U.c.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. v� N� v � NEI 0 (This section need not be completed if the permit is for one TOTAL
handled dollar,(S I00)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT' FEE FEE SUMMARY
DIL 1- mit is issued,I shall not enmloy any person in any tomm"ss as to
U become subject to the Workers'Compensation Laws of Califnrtl ice.
U a Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ Us NOTICE 'f0 APPLICANT: If,after making this Certificate of fix-
? emption,you should become subject to Om Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of tile 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.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE QO
1 heahy aflirm 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(See. MICROFILM
3097,Civ.CJ. I HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Addreis mr - n n ELECTRIC
I certify that I have read Ibis application and sate I a m a Ove VENTILATION FAN (SINGLE) 4.00
. inove-mentioned properly for inspection purposes.formation is correct.I agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-CDMP(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$DN. MECHANICAL
ab
(We) agree to save, in Emnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino againWfic , , costs and expenses which pERM1T ISSUANCE 10.00CONST.TAXmay in any waCity in consequence of the granting of this MECH.CONT. LIC.NO. MECH.
5 31 85 TOTAL TOTAL 6Signature ofApDate �U,Z O
INSPECTOR COPY