4954QPPXICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION
-
APPLICATION & PERMIT
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
PERMIT NUMBER
4954
4 T
BUILDING
10201 Torre Avenue, 2nd Floor
A102 _ Suite oo
OWNER '$ 415)
NAME /
Lincoln Property Co.,,,,, 571-2200
_
OTY. V ELECTRIC PERMIT FEE
PLAN CH KVALIDATION
DATE OF APPLICATION
CONTRACTOR
NAME
NAME
WIICI LIG, No.. 377579
OUTLETS - SWITCHES -RECEP 5.00/1.00
LIGHTING FIXTURES 5.00/1.00
CONTRACTORS Menlo Park (415)
A DR 55 j�(I� "-^
�0 1 Hamilton Ct. PHONE
APPLIANCES - RESIDENTIAL 4.00
PANELS 5.00
ARCHITECTSIGNS
OR
ENGINEER WIICI '- 377579
LIC. NO.
6.00
PLANCHECK FEE P.C, NO.
SIGNS TRANS. 3.00
AITCH -OR ENG. Menlo ParkSPECIAL
ADDRESS ^.
1011 Hamilton Ct. 9402
CIRCUIT '5.00
PERMIT VALIDATION
EMP. METER OR POLE INS. 15.00
APPLICANTS
ADDRESS - -c
W1 ICI Address _
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
s' LICENSED CON TRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
ISSUANCE DATE
(commencing with Section 7000) of Division 3 of the Business and
Professions Coderm1Bny li,cer is in Wfull for"1`ff7'9
Licmisc Cl'Iss LicNumbcr �JJ 77
Dum en"vo"i -I -IC -1
BLDG,
ELECT. I
El
PLG. MECH.
Ei
- -El
BUILDING PERMIT
7W
OWNER -BUILDER DECLARA IION
I hereby At i... that I am exempt from the Contractor's License
Law for the following reason. (See. 703 1.5, BUsinessand provisionspERMIT
Code Any city Or. Counly which req hires a perm ii no construct,Ulier.
improve, demolish, or repair any Structure, prior 10 its issuance, also
requires the applicant for Such permit to file a signed statement drat
he is licensed pursuant to the provisions of,the Contractor's License
Law (Chapter 9fcommencing with Section 70001 of Division3 of the
thno ass and Professions Code) I), that he b exempt therefrom and
_-INFORMATION
MISC. - REFER TO ORD
��"20�QQTION
2 .90 SF
S/FT,'
ISSUANCE 6.00
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL
PE MIT TO
/A/7
,
CITY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
the basis for the alleged exempt ion. A ny violation of Section 7031.5
by any applicant Or permit subjects the applicant o a civil penalty
of not more than live hundred dollars (5500).):
ALTER -DRAIN& VENT -WATER (EA.) 4.00
❑ 1, as owner of the property, or my employees with wages as
(heir sole compensation. will do the work, and The structure is nut
BACK F LOW PROTECT. DEVICE 2.00
OCG GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 4.00
intended or offered for sale (Sec. 7044- BaII1Ivss and Professions
-
Code: 'I lie Contractor's License I,Uw does not apply to an owner of
property who hands or improves thereon, and who docs such work
FIXTURES - PER TRAP 4.00
SO. FT, FLOOR AREA
TOTAL ACREAGE
himself or through his own employees, pr aided that such improve-
ments are not intended or offered for sale. If. however. the holding
GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement is sold within One year of completion, lite owner-
builder will have lire burden of,roving that he did not build or im-
,mveforpurpo,wof.,ale),
❑ I, as owner of the properly, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 1.00
BUILDING USE
RES IND CDN PB Ome,
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 20.00
LAWN SPRINKLERS - 1 INC 5 V.B. -5.00
,
LAWN SPR INKLERS - OV ER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
licensed contractors to construct the project (See. 7044, Business
and ['To hessions Code: 'I'he Contractor's License Law does not apply
to an owner of property who builds orintpro,es Ihereon, and who
controls for such projects with u contoNtarls) li cescd pursuant To
the Contractor's License Low.
SEWER -SANITARY -STORM EA.200ft/8.00
TRACT NO
PARCEL NO.
❑ I am exempt under Sc,.-, If &P,C. for this
WATER HEATER W/VENT 4.00
reason
[)ate Owner
WATER SYSTEM - 4.00
ACC.DATE
ACC. FILE NO.
WATER TREATING EQUIP. 4.00
VC RKERS'COMPENSATION DECLARATION
1 lemby affirm that I have a certificate of Consent to sell' -insure
or u ccrtif irate of Workers' Comp cation Insurance, ser v certified
ZONING
ENG. SITE NO:
copy themof(Sec. 3800. Lab.C.
rahey Na. nr gr4ndem. Co.
❑ Ce le c(11' b nus
❑ Ce ti I, T my t with the' city hspecuon division.
Applicant
Nsi �
iRT'IFI 'Ii.OF EXEMP IOfjF ,(WORKERS'
'
FIRE SPRINK
V ❑ N1❑
ENERGY T 24
V ❑ N❑
MISC. - REFER TO ORD.
PERMIT ISSUANCE 6.00
FLOOD20NE
A.L.u.C,
PLG CONTR. LIC. NO.
PLG.
TOTAL
-. COMPENSA'1'10N DRI\NCIi
fI'hi seCllon��nn�ed not be Completed if the pcnnit is for one
hundmc I 1IS10010r1ess.)
I certify that in the perfomwnce of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
' V ❑ N❑
V ❑ N❑,
CITY. s MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
.�(%
became subject to the Workers' Compensation Laws of California.
Date 1 Applicant
NO'I'ICI , TO AI)PLICANT: If, after making this Certificate of I:,-
/ ALTER OR ADD TO MECH. 4.00
APPLIANCE 4-00
PLAN CHECK
in tom you should become subject no the Workers' Contpensatiimt
provisions of the Labor Code, you must forthwilh comply wills
such provisions or Otis permit shall be deemed revoked
FEE
AIR HANDLING UNIT (TO 1000OCF.M.) 3.00
AIR HANDLING UNIT(OVER IQ0WC.EM.15.00
SEISMIC FEE
� �6
CONSTRUCTION LENDING, AGpNCY
1 heneby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 2.00
the ,fu nion,, of lite work for which this lie nnit is issued (Sec
3ood, Cis c.). FBS Mortgage Co.
Lender's Name '-- -
MICROFILM
- HEATING UNIT (TO 100,000 B.T.U.) 4.00
- HEATING UNIT (OVER 100,000 B.T.U.P.50
ELECTRIC
Lender's Address 7'i(1To-=�ya_y�d Aya,vO.._S_�f (}OQ-
I certify that I rp�qyiy�If I gppQpliculion and state that the abo t,
nl'orinalion [s corr�islf. f3�retM complywilh :III city old county
ord,, s and slate laws relining to building construction, and
cauthori4e
VENTILATION FAN (SINGLE) 3.00
PLUMBING
BOILER- COMP (3 H. P. or 100,0008.T. U.) 4.00
BOILER -COMP (Over 100,000 STU) SEE FEE SCH.
MECHANICAL
hereby representatives of this city to enter upon the
above mentioned property to inspection purposes.
(We) agree to save. i unify and keep harmless the Cit' of
4.1 MISC. - �!'• `4ki REFER TO ORD.
Culiertiu against Ii. , judgments, costs and expenses which
Ipny in nn .c against sunCity in eunsequcnm of the
CONST. TAX
PERMIT ISSUANCE 3.00.
MECH.CONT. LIC. NO.
MECH.
I 'aLin• r the fl II
s
,It/CIr
TOTAL
TOTAL
gna to 011T A acto oat
1 / 1, `J . INSPECTION COPY