8623 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DE TIFICATION PERMIT NUMBER
l
BUILDING
�gaSCJ APPLICATION & PERMIT
)nti LOT BUILDING-ELECTRICAL-PLUMBING-MECHANICAL8623
Dw PLAN CHECK VALIDATION
NAME YaAnza Group, a California CITY. ELECTRIC PERMIT FEE
Ltd. Partnership PHDNE415/571-1
NOMERAcrORs OUTLETS-SWITCHES-RECEP 10.00/1.00
The Alden Comi)anV LIC.NO. 465640 LIGHTING FIXTURES 10.00/1.00
ADDRESS
CONTRACTOR
411 Borel Ave,Ste.410 APPLIANCES-RESIDENTIAL 4.00
San Mateo Ca.94402 PHONE415 571-1 81 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINE
Calderon-NakamuraD.NO. C013712 SIGNS TRANS. 3;00
ARCH.ORENO. PERMIT VALIDATION
i ADDRESS 2070 Business Ctr. 0220 SPECIAL CIRCUIT 5.00
Irvine Ca. z92715 TEMP.METER OR POLE INS. 20.00 )
APPLICANT'S t^✓
ADDRESS MOTORS SEE FEE SCH.
411 Borel Ave Ste.410 SERVICE CHANGE 20.00
0 0 o San MdtZ&D:perehifR9440DLCLARATION TEMP.POLE 30.00
a u 1 hereby affirm that I am licensed under provisions of Chapter 9 1
G w (commencing with Section 7000)of Division 3 of the uslness and ISSUANCE DATE
F m z Professions Code,and my license is in ftill force a 1 't BLD ELECT. PLG. MECH.❑ ❑ ❑
2 O In - License Cl Li,Llc.Number
o � r ° IJate_>./.-�.L/2S� Contractor
¢ a, to¢ OWNfi R-BUILUHR DECLARATION
BUILDING PERMIT
` O a. ° MISC.- REFER TO ORD INFORMATION
se 3 N 1 hereby attire that I ant except from the Contractor's License
u O j Law for the following•reason.(Sea 7031.5,Business and Professions VALUATION $)FT.
- g PERMIT ISSUANCE 10.00
Code:Any city or county which requiresa permit toconstreLaiteq
rtQ ° inflame,demolish,or repair any structure,prior to its issuance.also ELEC.CONTR, LIC.NO. ELEC.
° u requires the applicant for such permit to the a signs(]oamment that TOTAL
n w m w he is licensed pursuant to the provisions of the Convector's oft se E M T
M 2 a•
Law(Chapter 9(commencing with Section 7000)of Division3 of the
4 ° Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ F $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIET TYPECONSTR.
A. by any applicant for a permit subjects lire applicant to a civil Hendry ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500)J:
❑ Las owner at the property,or my employees with refs net BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP S.UNITS
hirer sole compensation,will property,
the work,and the sl He fare is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractur's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOA AREA TOTAL ACREAGE
• himself or through his own employees,provided that such int prove.
merits are not intended or uttered for sale.If,however,the budding GAS-EA.SYSTEM-I IINC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burdemof proving that he did not build or in GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUfLDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RE5 IND CON PB Omer
Cl . .
1,as owner of the property,am exclusively contracting with El El 1:1 El
contractors to Construct the project(Sec.7044,ltusmv,, LAWN SPRINKLERS-1 INC 5 .00 ASSESSOR SPARCELNO.
and Professions Code:ThContractors License ContractLicense Law docs not apply V.B..
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)liccowd pursuant to
tire Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL NO.
❑ lam exempt under Sec.-,B&P.C.liter this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 C . A ACC,FILE NO.
WORK Ii RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
y 1 hereby affirm that I have a certificate of consent to self-insure.
L or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO,
copy tIH,mo]��Sc-�c.��Ig �I.X1y .). � Hn �Q
1'olicY No._j!Q9,� P bdY mean
„ O Q. CeII2,ed cop is h Cby fur fished. FIRE SPRINK ENERGY 20
Z Z , f2l Certified co s w h the city inspection division. y❑ N❑ Y ❑ N❑
FO Applicant MISC.- REFER TO ORD.
y CFRTIFICATE P I'M MELON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE: PLG.CONTE. LIC.NO. PLG.
CL O (This section are(] not be completed if the permit is for one TOTAL Y❑ N❑ Y F]IT
::) 2 h admd dollars($100)or less I
U O I certify that in the performance of the work for which this per. CITY, MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit Is issued.I shall not employ any person in any manner so as to
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become subject to the Workeri Compensation Laws of California.
U'Itc Applicant ALTER OR ADD TO MECH. BUILDING
. 5.00 {�!�
]} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- V T
2 e...POST,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
U
provisions of the Labor Code, you must forthwith comply with FEE,ash provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=471F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11C.RM.) 6.00 SEISMIC FEE /0 Od'
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the P,nimpancC of the work Icor which this permit is Laucd(See. MICROFILM
3097,Civ.CJ. HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lenaer%Name Bank.af America.P.O.
Lenders Address U bX100, HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that have read this application and state that the abuse VENTILATION FAN (SINGLE) 4.00info -
.� ordinances a aolate 11 agree to comply with all city and county BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and slate laws relating to building construction, and
hereby authorize representatives of this city w enter upon the BOILER-COMP (OVer 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned pr perly forinspect ion purposes.
(We) agree to a ' Aemnify and keep harmless the City,of MISC.- REFER TO ORD.
Cupertino agates I' iii es,jut cols, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any w.4am agains said City in consequence of the 'T
granting of this 1 a MECH.CONT. LIC.NO. MECH.
Y
5/31/85 [TOTAL TOTAL �>Q� Oa'
Signature of Applicant/ ontractor Date
INSPECTOR COPY
POST THIS CARD NEAR FRONT OF BUILDING
PFR i11T IJIIAARFR `
CITY OF CUPERTINO -
w
INSPECTION DIVISION
1
JOB INSPECTION RECORD
JOB ADDRESS U t A LOT#
OWNER &NTRACTOR 7
8623
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
184 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION EfATE I CTOR _ IN_ PF_ CTION RECORD
FOUNDATION,
LIFER
PREGUNITE JZ -7 %`o ovT
PERMIT VALIDATION
nISSUANCE DATE
D IELWIlI 0 PLG. MEC
POUR NO CONCRETE UNTIL ABOVE HAS—BEEIN SIGNED
UNDERGROUND/,SLAB
PLUMBING
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
r ` BUI DING qERMIT
IN roRMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
N` MECHANICAL
ELECTRICAL
P RMI7 TO
IrYFTSTORIR, FRAMING
INSULATION
DCC. GROUP RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF V' -V
SG. FT'F40LOOR AREA
J
TOTALACREAGE
DIAPHRAGM Q_ BijLLDING USE
E IND CON PB Other
li
ASSESSORS PARCEL NO.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING
GAS TEST.
MECHANICAL //O/
TRACT NO. PARCEL NO
ELECTRICAL - 3 FINALS DATE INSP.
ACC. DATE ACC, FILE NO
FRAMING Q, SAN 7/3&,G
ZONING ENG. SITE NO.
INSULATION _ r PLUMBING y
GAS
FIRE SPRINK
r N
ENERGY T•24
v N
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE
Y N
w_L.u.c.
Y NEI
LATH—INTERIOR ELECTRICAL D'ndi7
FIRE DEPT.
SHEETROCK GRADE r/ FEE SUMMARY
SHEAR INTERIOR — - BUILDING 6 BUILDING
I _ SHEAR EXTERIOR f0 -;L TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEEEE
SEISMIC FEE rNOTAPEOR'PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252-4505,
Lu
WORKING DAY BEFORE REQUIRED INSPECTION.
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
SFE PERMIT FOR EXPIRATION DATE -
MICROFILM
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
I M POR TANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION-
TOTAL
e' 4
OFFICE COPY