8621a APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION &PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
862
aunolNG
ADDRESS IWO LOT 12
190 bll� Ir. PLAN 1
owN
NAME DeAnza Group, A California
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
PHONE
CONTRACTORS
NAME
UTLETS-SWITCHES-RECEP 10.00/1.00
The Alden C(Mpany LIC.No 465640
LIGHTING FIXTURES 10.00/1.00
DR's
AD
ADDRESSRESS 411 Borel Ave,Bte. 410
PPLIANCES- RESIDENTIAL 4.00
PANELS 19.00
San Mattrin- HON
DATE OF APPLICATION
OARCHITECTPANELS
ENGINEER
Ic. NO
OVER 200 AMP) 20.09
PLAN CHECK FEE P.C. NO.
r1
SIGNS TRANS. 3.00 �
ARCH. OR ENG.
ADDRESS 2070 Business Cir. #220
Irvine. Ca. vP 92715
SPECIAL CIRCUIT 5.00 'v
PERMIT VALIDATION
®
TARY
/
JUL 2 91985
�! a ��s��
CI1J530AN A.TE•rn
B D ELECT. PLG. MECH.
El ❑ 1:1License
EMP. METER OR POLE INS. 'F 20.00
ADDRESS 411 Borel te. 410
ADDRESS Ave,,
San Mateo. Ca. 94402
MOTORS' SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONI' RACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Busine and
Professions Code, and my license is in full force and eff cl.
Clyysss Lie Number
TEMP. POLE 30.00
Date_]./35YRI Contractor
,
BUILDING PERMIT
INFORMATION
OWNER -Bl DficLARnT
I hereby collo that I so exempt from the u Contrainessacor'e License
Law for the following reason.(Sec.uires a•Businessand Professions
Code: Any city or county which requiresa permit to construct, aticq
MISC.- REFER TO ORD
PERMIT ISSUANCE 10.00
VALUATION
SIFT.
ELEC. CONTR. LIC. NO. ELEC.
TOTAL 't�
improve, demolish, or repair any structure, prior to its issuance. also
requires the applicant for such permit to Ills a signed statement that
he is licmised pursuant to the provisions of the Contractors License
PER MIT TO
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant too civil penalty
of not more than five hundred dollars(S500)J:
STOR
TVP CONSTR.
ALTER -DRAIN & VENT -WATER (EA.) 5.00
❑ 1, as owner or the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK F LOW PROTECT. DEV ICE 4.00
tree. GROUP
RES.UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
FIXTURES - PER TRAP 5.0950.
GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00
property who builds or improves thereon, and who does such work
himself or through his own employees. provided that such improve-
mentsarenotintended or offered for sale. If, however, the building
FT. FL R AREA
TOTA ACREAGE
or improvement is sold within one year of completion 'the owner.
builder will have the burden of proving that h e did not build or im-
Prove for purpose ofsaic,l
❑ 1, as owner of the property, am exclusively contracting with
- .
GAS - EA. SYSTEM OVER 4 (EA.) 2.00
B ILDING USE
RES IND CON PB Ocher
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
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 - 1 INC 5 V.8. 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for such projects with a contraetods) licensed pursuant to
the Contractor's License law.
SEWER -SANITARY -STORM EA. 200/t/10.00
TRACT NO.
PARCEL NO.
❑ 1air exempt under Sec.-, If&P.C. for this
reason
WATER HEATER W/VENT 6.00
Owner Date
�ACC.DA
WORKERS'COMPENSATION DECLARATION
WATER SYSTEM 5.00
E
ACG FILE NO.
WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self -insure,
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
..-_
copy (hereof (Sec. 3800, Lab.C.).
Policy No. t y
❑ Ccrti 1 c Y 6.fui11T1ESrG'DIDp'an
C1q Certified copy d w the city inspection division.
Ap cant
I i % J I I
FIRE SPRINK
Y ❑ N❑
ENERGY TZ4
v ❑ N❑
MISC. REFER TO ORD.
CIiRTI PICATIi F 1 XIiMPT1ON FROM WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
COMPENSWION INSURANCE
[ This section need mot be completed if the permit is for one
Y N
[-]❑
'Y N
[:]❑
PLG. CONTR. LIC. NO.
TLG OTAL
hundred dollars (S 100) or les.)
1 certify that in the performance of the work for which this per-
mit is issued, 1 shall not employ any person in any manner so as to
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
-
become subject to the workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, alter making this Certificate of Ex.
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
FEE
,,notion , you should hecnme subject to the Workeri Compensation
provisions of the Labor Code, you must hollovah comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 100MCF.M.) 4.00
AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
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.
3097, Civ C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address_B05C 18 ••iza-
I certify that l have read this application and a(�theabove
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
PLUMBING
BOILER-COMP(3 H.P. or 100,0008.T.U.) 6.00
hereby authorise representatives of this city to enter upon the
abovrmentloned property I'or inspection purposes,
BOILER -COMP (Over 100,000 BTU) BEE FEE SCH.
MECHANICAL
(We) agreegill, 'ode" fy and keep IT rr as the City of
MISC. - REFER TO ORD.
Cupertino aaties,'u P 6j gments,costs and expenses which
may in any n a egad 't said Citin' consequnce of the
granting of thi:
.AX
PERMIT ISSUANCE 10.00 t
MECH. CONT. LIG NO.
MECH.
TA
TOTAL TOTAL
/-
SignatureofApplicant/ ontmctor Dutc15
INSPECTOR COPY
POST THIS CARD NEAR FRONT OF BUILDING
4 CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
vxmMJOBADDRESSA00NN T LOT#
OWNER CONTRACTOR a.
PERMIT ER
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSP CTION D INSPECTOR INSPECTION RECOR
FOUNDATION Ie )M
UFER
PREGUNITE
PERMIT IQiN
lJUL + iss§
city of Cu C JZ'IQ,7
ISSUANCE DATE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICALT
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI DI G ERMIT
INFORMATION
WOOD FLOOR 1. VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL
QIFRAMING
P AhI1T TO
STORIES-* TYPE-CONSTR.
INSULATION
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO. FT FLOOR AREA TOTAL'ACREAGE
DIAPHRAGM 6 -(Ir$
l l —BUILOlNG USE
RES IND CON PB Other
El El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO,
ROUGH
PLUMBING L,
GAS TEST
TRACT NO. PARCEL NO
MECHANICAL
ELECTRICAL b . g.r FINALS DATE INSP.
ACC DATE ACC FILE NO
FRAMING SAN #
ZONING ENG SITE NO.
1NSULATION PLUMBING
GAS y -f, FIRE SPRINK
Y N
ENERGY T-24
Y [:j N
MECHANICAL l
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE
Y N[J
A.L.U.C.
Y I] NC]
LATH --INTERIOR ELECTRICAL i
LATH -EXTERIOR FIRE DEPT.
SHEETROCK [ GRADE FEE SUMMARY
SHEAR INTERIOR - BUILDING
BUILDING
SHEAR EXTERIOR TEMPORARY APPROV-XI SNIf
FIREWALLS ELECTRIC PLAN CHECK
FEEEE
SEISMIC FEENOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDIOCCUPANCY
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
MICROFILM
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
TOTAL
OFFICE COPY
O
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P yCC -
W
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F-
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P QPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LD1 NG PROJECT I DENTI FICATION-
APPLICATION & PERMIT -
BUILDING - ELECTRICAL - -PLUMBING - MECHANICAL
PERMIT NUMBER
8621
BiALDING
ADDRE 'I O LOT 12
Y
s
DeAnza Group, A CaliforniaNAME
Ltd. PartnershipPHONE 415/571-1
QTY. ELECTRIC PERMIT FEE
81
PLAN CHECK VALIDATION
CONTRACTOR'S OUTLETS -NAME SWITCHES - RECEP 10.0011.00
LIGHTING FIXTURES 10.0011.00TheAldenCompanyLir-No. 465640
DATE OF APPLICATION
rOADDRESS OR'S 411 Borel Ave,Ste. 410
San Mateo, Ca.94402HON415/571-14
PPLIANCES- RESIDENTIAL 4.00
1 PANELS 10.00
ARCHITECTPANELSOR
ENGIOEValderon-Nakamura,c.w. C013712
OVER 200 AMP) 20,00 PLANCHECK FEE P.C.NO.
SIGNS TRANS. 3.00
AENG, `2070 Business Ctr. #220ADDRESSDDRESS
Irvine, Ca. ZIP 92715
SPECIALCIRCUIT '5,00 PERMIT VALIDATION
RAV 1lR/• V
JULn p291985
nn + U(iy Q Sbj;