8601 PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDINGPROJECT IDENTIFICATION PERMIT NUMBER
-DILDING APPLICATION & PERMIT
ADO" s LOT('11i
!* pl�a/c+ I BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
( Nnme eAREB Group, A Californi TY,
ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
Ltd. Partnershi PHONE 415 1-
.4811
NAMERAcroas UTLETS-SWITCHES-RECEP 10.00/1.00
The Alden Com an uc.NO. 465640 LIGHTING FIXTURES 10.00/1.00
CONTRAACTOR'S
ADDRESS 411 Borel Ave,Ste. 410 APPLIANCES-RESIDENTIAL 4.00
San Mateo Ca.94402ONE415 571-1 PANELS 10.00 DATE OF APPLICATION
x AC"ITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.0.N0.
OR
NGINEE
RCalderon-Nakamuaa.No. C013712 SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS 2070 Business Ctr. $220 SPECIAL CIRCUIT 5.00
r
Irvine Ca. ➢P 92711; EMP.METER OR POLE INS. 20.00
APPLICANTS 411 Borel Ave, Ste. 410 MOTORS SEE FEE SCH. �'ll� ,
ADDRESS
San Mateo Ca: 94402 SERVICE CHANGE 20.00 JUL
o o LICENSED CONTRACTORS DECLARA'PION TEMP.POLE 30.00 I 2 9 1985
cin I hereby affirm Hurl Item licensed under pixotimus of Chapter 9 ISSUANCE DATE
Nay (Commencing wit
rction]000)of Division J of the Business and 0 .0 1�€QTc P��LR� MECH.
rwz Professions Cade,a my license is" full forcead e ❑ PW�O. ❑
o 0 m I-icense Clad�sS Lie Nwnber
0 m F J DmcCmvractor
a x s BUILDING PERMIT
¢ ¢ a OWN73R-HUILUF;R UECLARA'1'10,
C d U INFORMATION
a, LL I hereby collo that I all exempt from tire Contractors License
ns MISC.- REFER TO ORD
s- 04 Law for the following mason.(Sec.7031.5.Business Professions PERMIT ISSUANCE VALUATION $/FT.
Code:Any city or county which requirese permit to construct alter, 0.00
QQ ¢ 0 Improve,deI110I1Sh,Of Rpillr 8my 51lnCIprC.prior 10 IIS ISSndmfe.8IS0 ELEC.CONTR. LIC.NO. ELEC.
w- 0 , requires the applicant for such permit to file a signed statement that TOTAL ` p RMIT TO
he is licerlsed ansamll to the provisions of the Contractor's License R.
rzi LuwlChuplcrl(comnm.tem,with Section TOODof Division 3ofthe
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
f i o
¢ I- o the basis for tile alleged exemption.Any violation of Section 703 LS STORIES TYPE CONSTR.
n ; m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than Iis hundred dollars($500).)'.
❑ I,as owner of he property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Dcc.GROUP RES.UNITS
sole compensation,will do the work,and tire structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds Or improves thereon,llnd who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOT VACREAGE
® hinself or through his own employees,provided t mt such improve- Y
norms are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion.ole owner-
UI
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 t JG USE
prove for purpose Of sale.). INDUSTRIAL WASTE INTER. 3000 RS IND CON PB 011ier
❑ I,as owner of the property,am exclusively contracting with . ❑ 0 0 ❑
licensed contractors 10 mtr
nsud 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 properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorfs)licensed pursuant to SEWER-SANITARY-STORM EA.200ftI10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. .B.&P.C.WrHMS WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
C .DAT ACC FILE N0.
WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Hhereof(Ses.3800,Lab.CJ.
Policy No.
-11M044F y SfEn_�i �/
❑ Certified copy is 1, y nude / / FIRE SPRINK ENERGY L24
Z_ Z ❑XCerl it led copy ix�//rl d ith lie city Inspection division. MISC.- REFER TO ORD.
Applicant )K Y[] N� Y � NF]
PERMIT ISSUANCE 10.00
CC C17F 1*11:1 TE(1 E I h1 ION PROM WORKERS' FLOOD ZONE A.L.U.C.
LL > COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG.
0 Clhis Section need nal be completed if the permit is I'or one TOTAL Y❑ N❑ Y [] N❑
Z handled dollars(S100)or less.)
U 0 1 certify that in the pertomanice of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall nut employ any on,,..in any manner so as to
U ED become subject to the Workers'Compeasution Laws of California.
ail
Ua e Applicant ` BUILDING
>_ tNOTICE TO APPLICANT: ALTER OR ADD TO MECH. 5.00 NT: If,after making this Certificate of Ex- �
f" Z enlption,you should become subject to the Workent Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you OIUSH forthwith con0dy with FEE
U such provisions or this permit Shall be deemed revoked AIR HANDLING UNIT(TO I0=C.F.M,) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING t0,000C.EM.16.00 SEISMIC FEE S"
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
ahr p,oformance Of the work for which this permit is issued(Sec. MICROFILM
3097,Co,C.). HEATING UNIT(TO 100,000 B.T.U.) B.00
Lender's Name Bank Of HEATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address P.O. ELECTRIC
I certify that l have read this application and a a the above VENTILATION FAN (SINGLE) 4.00
. int'onnation is correct 1 agree to conmly with all city and county PLUMBING
ordinances and state laws relating In building Construction, and BOILER-OOMP(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 SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) -gree to save, Indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against 1',b'I ties,j dgments, costs Old expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any wa c ue agai sH said City in consequence of tire
granting of this r i MECH.CONT, LIG NO. MECH.
5 31 SS TOTAL TOTAL
Signalurr of Ap on roc Uatc
INSPECTOR COPY