8609 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATION - PERMIT NUMBER
BUILDING ` 3 / LOT 4 BUILDING APPLICATION
EE ELECTRICAL-PLUUMB PLUMBING MECHANICAL
PLAN 1 8609
NAME
DeAnza Group, A Californi PLAN CHECK VALIDATION
NAME PE TY. ELECTRIC PERMIT FEE
Ltd. Partner PHON
NOAMERACTOns UTLETS-SWITCHES-RECEP 10.00/1.00
The Alden CompanyUc.4f65640 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
AONTRASDRESS411 Borel Ave, Ste. 410 APPLIANCES-RESIDENTIAL 4.00
" C
San Mateo Ca.94402FHD"415 S PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 ^'� PLAN CHECKFEE P.C.NO.
ENGIGN�+Ee ^1
END -Nakamura LIc.C�13]12 SIGNS TRANS. 3.00
` ADR, PERMIT VALIDATION
ADDSSRENG.
Irvine,2Ca0 Bus Teens Ctrz P 9221 SPECIAL
METIER OR POLE INS. 20.00
92 is SAID
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS 411 Bozel Ave, Ste. 410 �JUL 91985
San Mateo Ca. 94402 SERVICE CHANGE 20.00
w o O LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
¢ uZ 1 hereby firm that I am licensed under provisions of Cha ter9 -
rtC(� of Cne
no
ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and 0 D ELECT. PLG. MECH.
H w i Professions Code,and my license is in full fine f et. ❑ ❑ ❑
z o m- License Class R Lie.Number
Q w o Late_3/.31/-85--Contfactor
m s --� � BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATI N
o a D MISC- REFER TO ORD INFORMATION
X 5 LL 1- 1 hereby affirm thin 1 am exempt from the Contractor's License n
LLoa Law lot the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE - 10.00 VALUATION
Code:Any city or county which requimca perrail tocoretrucLalter,
¢ Q o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO. ELEG. l'/ ,
ca itDLL
requires the applicant for such permit t0 file a signed statement that TOTAL PERMIT TO
n w m m he is licensed pursuant to the provisions of the Contractor's License
r z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
i D Business and Prolessions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE nA
¢ r p the basis for the alleged exemption.Any violation of Section 7031.5 -STORIES TYPE CONSTR.
to by any applicant for a permit subjects the applicant toa civil penalty' ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollar,(S500).): 01-2,1
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GRDUP E .UNITS
sole compensation,will do the work,and the structure is not
inm nded or offered for sale (Scc. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:'Fhe Contractors 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 SO.FT.PIA R AREA TOTAL ACREAGE
.
himselfofthroughhis ownemployees,fors, le.If.ed thatsuchimprove- GAS EA.SYSTEM-1 INC.4 OUTLETS 6.00
ncuts are not intended or offered for sale If,however,the building
or improvement is sold withinnuc year of completion, . - .) 2.00 the owner- GAS-EASYSTEM OVER 4 (EA
builder will have the burrden en of proving thus he did not buil)or im- - BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 R IND DON Pa Omar
❑ L as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑
licensed corttmc tors to construct the project(Sec. 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 r ASSESSORS PARCEL NO.
and Professions Code:The Contractor's o License Law does not apply
toan trowner ofpropertywho b ui ldvtrimprovesnsed;R,andwho LAWN SPRINKLERS-OVER 5(EA.) 1.00
Conthe Contractor's
for ctor's License
ets Lwith ucontracmns)licenced pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's l-ittnse Law. TRACT NO. PARCEL N0.
❑ 1 am exempt under Sec. .B.&P.C.lin this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ,DA E ACC.FILE NO,
WORK B RS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of Consent to sell-insure, ' ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,,LlaaRCA
Policy No. (�T�ny' Ili�,.l. -
O ❑ Certihe el y Is ler h lar d. den-Bompany
FIRE SPRINK ENERGY T@<
Z 2 CCertified ) ¢ filet wi I the city inspection division.
O Ap cant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ No
CC m CERTIFICATE:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE: PLG.CONTE. LIC.NO., PLG.
D 1'I 'his section need not he completed if the permit is for one TOTAL v El ❑ v❑ NEI:
hundred dollars(S 100)or less.(
U O 1 certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 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.
UJ Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} to NO'T'ICE:TO APPLICANT: If,after making this Certificate of-E.--
F Z anption,you should become subject to the Worker:Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the L.bor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed.revoked. AIR HANDLING UNIT TO 10,000GF.M.) 4.00
CONST RUCTION L17NDING AGENCY AIRHANDLING UNIT(OVER I0=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is u construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this Permit is issued(See. MICROFILM
3097,CivC.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lendds Name�Rank of Amo-F 60...«�O.aF D_��-o_r
Lenders Address HEATING UNIT(0
100,000 B.T.U.)9.50 ELECTRIC
$OX-1'B�O11 a'r0i--s - Ca.
I Certify that I Ilavc read this upphcation and slot 363 le above VENTILATION FAN (SINGLE) 4.00
• information is correct. 1 agree to comply with a city ant county PLUMBING
ordinances and state laws relating to building construction, and BOILER-OOMFc H.P.or 100,000 B.T.U.) 6.00
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.'
(We) u"ret save, indmnnil'y and keep harmless the City of MISC.- REFER TO ORD.
Cupertino ag I. bilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any ecrue �ainst said City in consequence of the
granting O( S nit. MECH.CONT. LIC.NO. MECH.
yl� g/at/R5 TOTAL TOTAL
Signature of ppi ant/ on ur Datc
INSPECTOR COPY