10246 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BU L•DI NG PROJECT I DENTI FICATI ON PERMITNUMBER
BWL0,NG APPLICATION & PERMIT 10246
- woeTjt&&.. 20650. Valley Green Drive BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
oNNCEOtn's PLAN CHECK VALIDATION
NAME
Sobrato. Developmentq OTV. ELECTRIC PERMIT FEE
J ONE
NOMERAcroRs UTLETS-SWITCHES-RECEP 10.00/1.00
Aire Sheet Metal, I&c„D. . :271'264 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR ORa 'P P.O. BOX _APPLIANCES-RESIDENTIAL 4.00
Redwood City, CA. 94A§ 364-8081 , PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) \„� 20.08 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.NO. ISIGNS TRANS. ' 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 n
ADDRem Ts P.O.. BOX $629. MOTORS SEE FEE SCH. -�
Redwood City, CA. 94063 SERVICE CHANGE 20.00
, 00 LICENSED CONTRACTORS DECLARATION TEMP,POLE 30.00
a i w I hereby affirm that I am licenYd under provisions of Chapter 9 ISSUANCE DATE
us¢ H (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r w z Professions Code,and my license is in full force and effect. I�
i Om- License Class -CZC` Lo.Number_27_U6.4-
- ❑ ❑ ❑ I'FI
O H DagXp.,4/CA� 9n�ContractorM&Chan _
l.ea . '•"y
¢ Y J -8z
or ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
E o t U INFORMATION
K ; LL_ I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
iO LL 0 ¢ Law for the following mason.(Sec.7031.5,Businessand Professions VALUATION S/FT.
_ PERMIT ISSUANCE 10.00
� w0 � Code:Any city or county which requiraapermutoconstruct,alter,
tE ¢ ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.NO. ELEC.
Da,requites the applicant for such permit to file a signed statement that TOTAL
E
he is licensed pursuant to the provisions of the Comoiclor's License PERMIT TO
r• z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom anJQTY. PLUMBING PERMIT FEE
lei o
¢ I the basis for the alleged exemption.Any violation of Scclion 7031.5 STORIES TYPE CONSTR.
ca by any applicant for a permit subjects the applicant to a Civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500)J:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compenmtinn,will do the work,and the structure is not
tended or offend for sale (Sec. 7064, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5A0
Calc The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employers,provided that such'in
Piave-
m
merits are not intended or offered for sale.11,however. e holding GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
RES IND CON PB Order
prove for purpose ell the.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ d as owner of the property,and exclusively contracting with
licensed contractors to The
the project(Sec. 7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The who
buildsContractor's improv Law Joel not apply
- to contracts
owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 6(EA.) 1.00
the Cont for such projects with a contractors)licensed pursuant to
the 1amcexe pt under
Sec. SEWER-SANITARY-STORM EA.2001t110.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
mason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM .5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a cenifwate of consent to self-ho...c. ZONING or a certificate of Workers' /CompensalioPP Insurance,yl certified ENG.SITE NO.
copy thereof(Sec.3800,Lah,C.).�` 7/' GUi
Policy,No. Company 1!= �h1T/,01 it/
Q ❑,/Certified copy is hereby o
furnished. A FIRE SPRINK ENERGY Te
Z 2 'p, Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Applicant Y N V N
CC CERTtr-ICATEOEEXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.UD.
LLI > CONIPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CLa (This section need not be completed if the permit is for one TOTAL Y[3NE] Y ❑ N[3
U O hundred dollars IS 100)or less I
I certify that in the Performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.I shall not employ any person in any manner so as to
O w become subject to the Worker Compensation Laws of Califomu.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
at
} w NOTICE TO APPLICANT: If,after making this Certifice 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 u¢h provisions or this permit shall he deemed revoked. AIR HANDLING UNIT TO 10 F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT OiF.M.1 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) Q " 5.D0
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 1 B.T.U.) 00
Lender's Name none
Lender's Address HEATI NG UNIT IOV 100,0 .50 ELECTRIC
I certify that I have read this application and slate that the above VENg-COW
N FAN IS 4.00
infornmtion is correct. I'agree to comply with all city and county PLUMBING
l\ ordinances and stale laws relating to building construction. and BOIL (3 H.P.or 1T)0,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOIP (OYer 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned propertyfor impaction purposes.
(We) agree to save, indemnify and keep hunnl the City of MISREFER TO ORD. -
Cupertinoagainst liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
grunting of this permit. MECH.CONT. ,LIC.NO. MECH.
or ` TOTAL
..{- Signature of Applicant/Contractor ate -'1', . jpp/ / oD
OFFICE COPY