8631 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
.amtAPPLICATION & PERMIT
(ADDflEDING55 �87I� LOT 22 8631
PLAN 4 BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
OR PLAN CHECK VALIDATION
NAME, DeAnza Group, A California OTY. ELECTRIC PERMIT FEE
vsloNE1-1,81
io
cns
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
The
Alden LIC.-o 465640 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR -RESIDENTIAL 4.00
ADDRESS
411 Borel Ave,Ste. 410 APPLIANCES
San Mateo Ca.9440 ZHo,415/571-14111 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER 1deron-NakamuraIC.NO C013712 SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT N
ADDRESS 2070 Business Ctr. #220 SPECIALCIRCUIT 5.00 '�
Irvine, Ca. z,,92715 EMP.METER OR POLE INS. 20.00
APPLICANTS 411 Borel Ave, See. 4lO MOTORS SEE FEE SCH. JUL 2 y
ADDRESS 1gR5 SSan Mateo. Ca. 94402 ERVICE CHANGE 20.00 /nt
. o 0 o LICENSED CON'I'RACTCIRS DECLARATION TEMP.POLE 30.00 4/fy Of C ....{{
¢u u I hereby affirm that I am licensed.under provisions of Chapter 9 ISSUary CE OAeEf/n0
wQ w (commencing with Section 7000)of Uirisiun 3 of the Basin ss and BLD ELECT. PLG. MECH.
F y z Professions Code,and my license m in full face - e L ❑ ❑ O
zo - License C s Lic.Nuntber
Z,w t Dutc Contractor
s BUILDING PERMIT
¢ c ¢ 4 OWNER-BUILDEk UEOLA RA 'ON
a o o ° MISC.- REFER TO ORD' INFORMATION
1 hereby a(Ilrm that I mn exempt from Ole Contractor's License
LLoa Law for the following reason/Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
VALUATION
Code'.Any city or county which requires a permit to construct,alter,
¢ re 4 O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NQ ELEC. / �� S/FT.
- ¢ requires the applicant for such permit to file a signed statement that TOTAL PERM( TO
whe is licensed pursuant to the provisions of lira Contractors License
Uzi
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthc
4 Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
s i o
¢ H o the basis pli the aBcgcdermnpubje Any he applicant
of Section 7031.5 STORIES TYPE CONSTR.
n ; m by my more tha firm permit subpar, 5500).licum wucivil penally ALTER-DRAIN 5.00
of nal more than five hundred dollars(5500).): z V
❑ E as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered far sale (Sec. 7044, Brininess and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 114,
Code:The Contractor's License Law does not apply to an owner at
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 5O.FT.FLOOR AREA T64FAL ACREAGE
himself re through his own employees,provided that such offered for provided
that r.such
building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200
builder will have the burden of proving that h - . - . .
e did not build or am- BUIL ING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON PB Oar
❑ 1,as owner of the property,am exclusively contracting with m❑ ❑ ❑ ❑
licensed contractors lu construct the project(Sec 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO-
und Professions Code:The Contractor's License Law does not apply
to an..net of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractoRs)licensed pursuant to
Ore Contractor's License Law, SEWER-SANITARY-STORM EA.2001ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sea ,li.&P.C.lin this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSA'IION DECLARA'I'ION WATER TREATING EQUIP. 5.00
I hereby affirm (hat I haven certificate of consent to sell-insure,
or a certificate of Workers'Compensation Esumnca,or v erfifiN 1 t l /� ZONING ENG.SITE NO,
copy thereof(Sec.3800,Lim I.
Policy No I
O ❑ Curti fun FIRE SPRINK ENERGY T 24
Z Z Lyy Certified copy L itl lire City inspection division. MISC.- REFER TO ORD.
O Applicant V❑ N❑ V ❑ N❑
jr y CERTIFICA'1'EOFE ':NIFI'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u,D.
L �_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL o 1'I'his section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
D Z hundred dollars 1$100)or less.)
U O 1 certify that in the performance of lire work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
L I- mit is issued,I shall not employ any peon in any manner so as to
O w become subject to the Workers'Compensation Laws of California. Q
a Dmc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING !D�
} W NOTICE 'TO APPLICANT: If,after making this Certificate of Ex- eJ
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the 3097 performance of me work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Larder's Name Rnnk Of ARPriCa, P.O.
Lender's Address JJeX__18O__pis_1_0 _ HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application andROO the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING _
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Ove.100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentions .rope-for inwechon purposes.
(We) agree love, indem ify sad keep binuless the City of MISC.- REFER TO ORD.
Cupertino ag�Ay 'abi ties,j gments, costs and expenses which s CONST.TAX
may in anyeci said City in consequence of the PERMIT ISSUANCE 10.00greatingoftnit. ��\�/A� MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL �o
Signature of Applicant/'ontractor Date Q
INSPECTOR COPY
I
POST THIS CARD NEAR FRONT
CITY OF C U PE
INSPECTION DIVISION
JOB INSPECTION
B C Zk l;rLf byJOADRESS'1 f
OWNER . CONTRACTOR
OF BUILDING
RT I - * NU `
f
RECORD
UNIT$ LOT#
i ((J.
PERMIT NUMBER
631
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
1S NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION DATE INSPECTOR INSPECTION RECORD
FOUNDATiON.J S(,,\r
LIFER
PREGUNITE
PERMIT VALIDATION
29 9 ,S$
City IS9UAt9 EA)AT-e
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLA
PLUMBING
ELECTRICAL
MECHANICAL oGf I ELECT. a MECH,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
5$=-bFRAMINGr
INSULATION
TORIES TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF Jy1
I
SO. FT FLOOR AREA
J
TOTAL ACREAGE
DIAPHRAGM
5, S Z
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
BUILDING USE
IND CON PB Other
El El ElNASSESSORSPARCELNO
ROUGH
PLUMBING ,
GAS TEST
TRACT NO, PARCEL Na.
MECHANICAL
ELECTRICAL FINALS DATE INSP,
ACC. DATE ACC. FILE NO.
FRAMING SAN #
TONING ENG.SITENO.
INSULATION PLUMBING/b`(, ,
GAS
FIRE SPRINK
YE:]' N
ENERGY T-24
Y No
MECHANICAL 7-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLDOO ZONE
Y N
A. L.U.C.
Yo No
LATH-INTERIOR ELECTRICAL r 6
LATH-EXTERIOR FIRE DEPT.
SHEETROCK _ 2,g-W GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
BUILDING
SHEAR EXTERIOR TEMPORAR APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEE JNOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDOCCUPANCY
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
uj
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!
PLEASE READ REVERSE SIDE: BEFORE
CALLING FOR FINAL INSPECTION.
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
TOTAL
OFFICE COPY
O
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F-' 00vZ
LLJ W
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APPLICANT TO FILL IN INFORMATION WITHIN RFD LINES - USE BALL POINT PEN ONLY
BUNG PROJECT IDENTIFICATION
APPLICATION &PERMIT
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
PERMITNUMBER
ILDING .r OT 22
ADD R 586311tpj 4
NAME DeAln_zia Group, A California
Ltd. Partnership PHGNE 415/571--1
QTY. ELECTRIC PERMIT FEE
81
ALAN CHECK VALIDATION
DATE OF APPLICATION
CONTRACTOR'S
NAME NAME
The Alden Company LIC. NO. 465640
UTLETS-SWITCHES-RECEP 10.0011.00
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S 411 Borel Ave Ste. 410ADDRESS
r
Ave,Ste.
Mateo, Ca.94402-NoN415/571-14
PPLIANCES-RESIDENTIAL 4.00
1 1PANELS 10.0
ARCHITECT
ORENGINE
alderon-Nakamuralc. No. C013712
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO.
P
SIGNS TRANS. 3.00
ARCH. OR ENG, 2070Business Ctr. #220ADDRESS
Zrvinei Ca. zIP92715
SPECIAL CIRCUIT 5,00 PAW VALIDATION
Lff [[ff u5 1,985
City of uAerfrnQ
ISSUANCE PATE
EMP. METER OR POLE INS. 20.00
ADDRESST$
411 Borel Ave, Ste. 410
San Mateo, Ca. 94402
MOTORS SEE FEE SCH.
SERVICE CHANGE 20:00
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9
commencing with Section 7000) of Division 3 of the Busigrz and
Professions Code, d my license is in fun force
License Cay Lic. Number
Date // Contractor
OWNER -BUILDER DECL.ARA 0
hereby affirm that 1 am exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5, Business and Professions
Code: Any city county which requitespermit to construct, alter,
or repair any structure, prior to its issuance, alsoimprove, demolish,
requires the applicant for such permit to file a signed statement that
he is licenseddpursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 oft he
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
byany
otmoretha riforve hundred
dollars
5500).
he licanttoacivilpenalty
of not more than five hundred dollars (5500).):
I, as owner of the property, or my employees with wages as
their sale compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors License Law does not apply to an owner of
P'P'who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve
meets are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.).
1, as owner of the property, am exclusively contracting with
He r"contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
contracts for such projects with a contractor(s) licensed pursuant to
the Contractor's License Law.
13m exempt Under Sec. B.&P.C. for this
reason
TEMP. POLE 30.00
BLD ELECT.
E]
PLG.
1:1
MECH.
BUILDING PERMIT
INFORMATION
MISC. -- REFER TO ORD
VALUATION SIFT.
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIc, NO, ELEC.
TOTAL PERMIT TO
4G')fr'
r'
jJ/
J,(//,`_
QTY. PLUMBING PERMIT FEE
STORIES
r-
TYPE CONSTR.
lVrALTER -DRAIN & VENT -WATER (EA.) 5.00
BACK FLOW PROTECT. DEVICE 4.00 OCC UP
J/Q/
RES. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00
FIXTURES -PER TRAP 5.00 SG. FT. FLOOR AREA
l
U
TOTAL ACREAGE
GAS - EA. SYSTEM - 1 l NC.4 OUTLETS 6.00
GAS - EA. SYSTEM OVER 4 {EA) 200 BUILDING USE
R S IND CON PB Other
ASSESSORS PARCEL NO.
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS 1 INC 5 V.B. 6:00
LAWN SPR INKLERS - OV ER 5 (EA.) 1.00
SEWER -SAN EA. 200ft/10,00 TRACT NO. PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Date
WORK ERTCOMPENSATION DECLARATION
1 hereby affirm that [ have a certificate of consent to selfinsure.
Or a certificate of Workers' Compensation Insurance, or a certified
copy thcrcof (Sec. 3800 ].
Policy No.
nt ;r,mpanCeilecopyisburnla
C}{ Certified Copy I t th city inspection division.
Applicant _
CERTIFICATE OF E EMPTION FROM WORKERS'
COMPENSATION INSURANCE
This sectidn need not be completed if the permit is for one
hundred dollars (S 100) or less.)
I certify that in the performance of the work for which this per-
mit is Issued, I shall not employ any person in any manner so as I
become subject to the Workers Compensation Laws of California.
Date ApplicantALTER
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
performance of the work for which this permit is issued (Sec. the
3097 C
Lender's Name Bank of America P.O.
WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO.
WATER TR AT1NG EQUIP, 5.00
ZONING ENG. SITE NO.
FIRE SPRtNK
Y N
ENERGY T-24
Y N MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00 FLOOOZONE
Y N
A.L.U.C,
Y NO.
PLG.CONTR. LIC. NO. PLG,
TOTAL
QTy. MECHANICAL PERMIT FEE FEE SUMMARY
BUILDING gQORADDTOMECH500
APPLIANCE 5.00 PLAN CHECK
FEEAIRHANDLINGUNIT (TO 110MC.F.M.) 4.00
AIR HANDLING UNIT(OVER10MC.F.M.) 6.00 SEISMIC FEE
r
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
EATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRICLcndcr'sAddrcss
1 certify that I have read this application andMINA he above
information is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city 10 enter upon the
above -mention prop y for inspection purposes.
We) agree ve indem fy and keep harmless the City of
Cupertino aga t iabi hies, J gments, costs and expenses which
may in any y cc said City in consequence of the
granting of th p it. ,1/A
5/31/85
VENTILATION FAN (SINGLE) 4.00
PLUMBINGBOILER-COMP(3 H. P. or 100,000 B.T.U.) 6.00
BOI LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL
MISC. - REFER TO ORD.
CONST. TAXPERMITISSUANCE10.00
MECH. CONT. LIC. NO. MECH.
TOTAL
TOTAL
Signature Signature of Applicant ontractor Date
OFFICE COPY