8614 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDINGADDRESS
rift/// APPLICATION & PERMIT 8614��
.AooREss /f/7r/{�y , LOT 19
Dee PLAN 4 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OW 'SI PLAN CHECK VALIDATION
NAME DeAnea Group, A California OTV. ELECTRIC PERMIT FEE
.\ - PHONE
rCi°r",aERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
The Alden rmpany LIC.No 465640LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4,00
ADDRESS 411 Borel Ave,Ste. 410
Ran MAtian, HD PANELS 10.00 DATE OF APPLICATION
OR PANELS
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
Ic.No. r011712 SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS '2070 Busiriese Ctr. 0220 SPECIAL CIRCUIT 5.00 p�
Tryinare. Ca- Ins EMP. METER OR POLE INS. 20.00 PAW
APPLICANTS MOTORS SEE FEE SCH. JUL 2 9
ADDRESS 411 Borel Ave, Ste. 410
qan Mnrphn, CA- 94402 SERVICE CHANGE 20.00 1985
w ¢ TEMP.POLE 30.00
'00 LICENSIiU CONTRACTORS DECLARATION pity of Cuae
Q u w I hereby affirm that I am licensed under provisions of Chapter 9 U l ISOBUANCq 0-A`rE
(commencing with Section 7000)of Division 3 of the Busine and
u�i a w B ELECT. PLG. MECH.
H H z Professions Code,and my license is in full force an of ect.
2 o w - Licenx Clas Lic.Number
9 y A w Licca. d.7SOu_Contractor
a x f BUILDING PERMIT
¢ ¢ ce a OWNER-BUIL DFiR Df:CL IRA
e_ O a U INFORMATION
is 3 LL w 1 hereby affirm that 1 am exenmt frmm the Cnnt actor's License MISC.- REFER TO ORD
o a Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION :5/FT.
rLL Code:Any cityorcounty whichmquiresapermittoconstruct,ager,
re ¢ Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
avc
w m¢ requires the applicant for such permit to file a signed statement that TOTAL P TO
he is licensed pursuant to the provisions of the Contractors License
r z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
i o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ F m the basis for the alleged exemption.Any violation of Section 7031.5 STORMS, TYPE CONSTR.
a3 _ by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN IEA.) 5.00
of not more than five hundred dollars($500).): �..
❑ I,as owner at the property,or my employees with wageset BACK FLOW PROTECT. DEVICE 4.00 oCC.GROUP HES.UNITS
their sole compensation,will Jo the work,and the st ruclurc is not
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
properly who builds or improves Ihereon,:rad who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
• himself or through his we employees,provided that such imt!rove-
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 IEA.) 2.00
builder will have the burden of proving that he did not build or inn- DING USE
prove for purpose ol'sale.). 5 IND CON PB Omer
❑ I,as owner of the property,an,exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code: fire Contractor's License Law does not apply
to an owner of property who builds or improves there.....and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 d,
contracts for such projects with it contractor(s)licensed pursumtl 1,
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO.
O lam exempt under See. ,B.&I'.C.I'ur this WATER HEATER W/VENT 6.00
reason
Owner Datc WATER SYSTEM 5.00 ACC.DATY ACC.FILE NO.
WORKS RS'COMPENSATION UECLARA9'ION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ol'cnnsad to.self-insuo, ZONING ENG.SITE NO.
or a certificate of Workers Compensation Insurance,or a cerifed
copy Iheredf(Scc 3800,Lab.C.).
Policy No- q t y t
❑ N
O ❑ ceniS1
Certified o i f J tit u l ) I n division, FIRE SPRINK ENERGY T-24
Z Z LY PY
Hu y al ec io ❑ ❑
O An cam MISC.- REFER TO ORD. Y Y ❑ N
fr In CERTIPICAI'li - iSIPTION'PROM WORKERS• PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPI!NSA7'ION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This ,-error, need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
::� Z hundred drilla..(8100)or less.)
CJ 0 I certify that in the performance of the work fnr which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 0 mit is issuedI shall not employ any person in any ma Calif so to
O
become subject
ct m the Workers'Conmensst ion Laws of California.Oc Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Ssrn
} 0 NOTICE TO APPLICANT: H.aper....king this Certificate of Ex-
Z_ 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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTR UCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)DDOC.F.M.) 6.00 SEISMIC FEE
1 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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's nJdress_Bo ±ro�Pal-ai �.8_ HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that have read lhisapplication and r+ theabme4BOI
NTILATION FAN (SINGLE) 4.00
• information is correct. I agree to comply with all city and county' PLUMBING
ordinances and state laws relating m building consvuclirin, andILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
II authorize representatives of this city to enter upon theLER-COMP IOver 100P008TU15EE FEE SCH. MECHANICAL
above-mentioned property for inspection purpoxs.(We) agree to ave indemnify and keep harmless the City ofSC-- REFER TO ORD.
Cupertino aIt t is litres,j gments, costs and expenses which CONST.TAX
may in any y cc ue agar it said City in consequence of the PERMIT ISSUANCE 10.00
granting oft p ni. MECH.CONT. LIC.NO. MECH.
S/3t /aa OTAL TOTAL
Signature of A ph a t/ ontra rUute `f
INSPECTOR COPY