8608 A,PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
\ PERMIT NUMBER
-- BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
ADDRESS 1/Y//J fy LOT 5 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL !/`•J!•
OW PLAN CHECK VALIDATION
NAME DeAnza Group, A Californi XITY. ELECTRIC PERMIT FEE
ON
E' NA.E CONTRACTORS
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
The Alden CoMpAny Llc LIGHTING FIXTURES 10.00/1.00
TRA
CONCTOR'$
ADDRESS 411 Borel Ave, Ste. 410 APPLIANCES-RESIDENTIAL 4.00
C
PHON PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 Y!
ENGINEER
' UC.6013712 SIGNS TRANS. 3.00
ADDRESS ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
2070 Business Ctr. X220
Irvine. Ca. zip EMP.METER OR POLE INS. 20.00 p�y�
ADDRESS Ts 411 Borel Ave, Ste. 410 MOTORS SEEFEESCH. PLY'
. San Mateo- Cn. 94402 SERVICE CHANGE 20.00 'JUL 2 9.1985
o o LICENSI'D CONTRACTORS DECLARATION TEMP.POLE 30.00
a O w I hemby affirm that I am licensed under provisions of Chapter 9 n3.1 ISSUANCE DATE
r y a N (connalmcing with Section 7000)of Division 3 of the Business and BL tl .`a ECECT.q PL'@f h}ECH.
w z Professions Code,and my license is in full force and c feet. ❑ ❑ S❑
z O m- License Class B Lie.Number
o w Date / Contractor
�7� T83 --4� BUILDING PERMIT
¢ ¢ a OWNER-BUILDPR DECLARATIO,
a o d u INFORMATION
w g I- I hereby al'Turn that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
uoo Law for the Billowing reason..(Sec.7031.5,Businesxand Professions pERMIT ISSUANCE 10.00 VALUATION $/FT.
� - v, Code:Any city orcounty which requires a permit to construct, Her,
K , 4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
A m¢ requires the applicant for such permit to file a signed slalemenl that TOTAL PERMITTO
or he is licensed pursuant to the provisions of the Contractor's License
F z rt Law(Chapter 9(commencing`^'ith Section 7000)of Diviston 3 ofthe
I i O Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ I- m the basis Nor the alleged exemption.Any violation of Section 7031.5 STORIE TYPE CONSTR.
La
Ate - by any applicant to,a permit subjects the applicant a civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more that five hundred dollars(5500).1:
❑ I,as owner of the properly,or my Tndoyvcx with wa,vs as II
BACKFLOW PROTECT.DEVICE 4.00 OCC.GROUP R s.UNI
their sole compensation,will do the work,and the structure 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
t property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SVSTEM-11NC.4OUTLETS 6.00
or improvenm it is sold within one year of completion, - . .) 2.00 the owner- GAS EASYSTEM-OVER 4 (EA
builder will have the burden ol'proving that he did not build or an- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 RE 'IND CON PB Odl
.
- ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
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 does not apply
to an owner of property 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
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I ant exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
mason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that I have a certificate ofcunsent to WIf-insum,
or a certificate of Workers'Compensation Insurance,or a certified y' ZONING ENG.SITE NO.
r copy thereof(Sec.3800,Lnb.C.). �i f /• ��i1+'' .
1'olicY No._p dltllnY-T M-Cw.....+..... . ...
Q ❑ Certillc w yt re for t d. `•`•"'Ya�•J ' FIRE SPRINK ENERGY T-24
Z Z ❑y Cert fid opY s d d wi tl Othe city inspection division.
O Ap cant MISC- REFER TO ORD. Y ❑ N❑ Y❑ N❑
N chR'I-IFICATEOF I;%E11PT�1 WORKERS' PERM IT ISSUANCE 10.00 FLOODZONE A.L.U.C.
W > COMPENSATION'(NSURANCE PLG.CONTR. LIC.NO. PLG.
0 (This scc(mar need not he completed if thC:]e permit is for ane TOTAL Y N❑ Y E] IN
hundred dollar,IS 100)or Ies0
U O 1 certify that in the ped7mnance of me work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mil is issued,I shall not employ any person in any manner so as to
U w become subject to the Workers'Compensation Laws of California.
CL Date Applicam ALTER OR ADD TO MECH. 5.00 BUILDINGSoo, 5z
} 0 NOTICE TO APPLICANT. If,after making this Certificate of Ex-
Z eniption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be doomed revoked. AIR HANDLING UNIT(TO 1OXMC.F.M.) 4.00 FEE
CONSTRUCTION L1iNDINC AGENCY AIR HANDLING UNIT(OVER 10.01MC.F.M.) 6.00 SEISMIC FEE
I 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,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name- Bout. elf Ampri-- D n
HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
-BOR 1"BEEi Poi"o Alto-6a-
I certify that l leave read this appla,ion andst (pb ql bovc VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all cd'y a3 county PLUMBING
ordinances and state laws relating to building construction, and 130ILER-COKIP(3H.P.or 100,000B.T.U.) 6.00
hereby authorize representatives of this City to enter upon the BOILER-COMP(Over imocif BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino eg inst liabilitres,judgments, costs and expenses'which PERMIT ISSUANCE 10.00 CONST.TAX ` i
may m a accru against said City in consequence of the
granitng tl IcrGo- MECH,CONT. LIC.NO. MECH.
TOTAL TOTAL G
Signature Apl icant Contractor Ua[e
INSPECTOR COPY
POST THIS CARD NEAR FRONT
CITY OF CUPERTINO
INSPECTION DIVISIONb
c r
JOB INSPECTION
j%j j}'
JOB ADDRESS I(/ JU/ `r
OWNER CONTRACTORiQua
OF BUILDING
RECORD
r UNIT# LOT#
60.
I PFRMITNU64BER
t
MIT EXPIRATION
PERPERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
AST CALLED INSPECTIDN.
INSPECTION— DATE INSPECTOR l SPECTION RECORD
FOUNpA710N
UFER
3 F -
PREGUNITE PERMIT V IDATIDN
palgrSSAA'oNCE DATE 185
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Ire.—//_ y-- }
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
BLED) E T. PLG. ECR_
I%
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI DING PIERIVIIYINFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
FRAMING
INSULATIONL z
STORIES TYPE CONSTR.
V/
OCC GROUP RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNSIV
ROOF
SO. FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES / IND CON PB Other
El( Q El El ElASSESSORSAPPLYNOROOFINGUNTILABOVEHASBEENSIGNED
PARCEL NO.
ROUGH
PLUMBING
GAS TEST
TRACT NO. PARCEL N0.
MECHANICAL O
ELECTRICAL __5 _ FINALS DAO INSP.
ACC. DATE ACC. FILE NO_
FRAMING SAN #
ZONING ENG. SITE NO.
INSULATION PLUMBING. -
S GAS
FIRE SPRINK
v N
ENERGY T•2a
Y I--] I--]
MEC ICA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HE TI
FLOOD ZONE
Y NEI
A.L.U.C-
YI] N
LATH—INTERIOR ELPCTRKAL
LATH--EXTERIOR FI PT.
SHEETROCK GRADE a -gjG' FEE SUMMARY
SHEAR INTERIOR BUILDING
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS ^
FIREWALLS IV ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEE f / NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY
OCCUPANCY OF BUILDING ISNOTPERMITTEDUNTILBUILDINGFINAL ISSIGNEDBYBUILDING INSPECTOR. MICROFILM
Lu
ARRANGE FOR INSPECTION BY PHONING 252-4505,
F— ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
SEE PERMIT FOR EXPIRATION DATE —
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT?
PLEASE READ REVERSE SIDE BEFORE ml
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY