5668 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN"ONLY ---BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDINGAPPLICATION & PERMIT
ADORES „� s BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 56 '6,/fie
8
2083 Stevens Creek Blvd. '
OWNER'S PLAN CHECK VALIDATION
r NAME QTY. ELECTRIC PERMIT FEE
• J. Volkmann & Assoc.
ncraRs
NA.E UTLETS-SWITCHES-RECEP 5.00/1.00 \
NAME
Peninsula Air Cond.lTAq. 436343 LIGHTING FIXTURES 5.00/1.00
CONTRACTORS
oo Ess TORS 415-389-18? PPLIANCES-RESIDENTIAL. 4.00
1690 TacWa E PANELS 5.00 DATE OF APPLICATION.
ARCHITECT KOow SIGNS B.00 PLAN CHECK FEE PX.NO.
OR
1 ENGINEER
LIC.No. SIGNS TRANS. 3.00
! A...Ess Ervc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
' ZIP rrEMP.METER OR POLE INS. 15.00 r
APPLICANT'S MOTORS SEE FEE SCH. /
AuuREss z� R
T SERVICE CHANGE 10.00cia
o o LICENSED CON'T'RACTORS DECLARATION
a v�. 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
ak, NQ trot (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
w z Ism lrssum,Cod,,a iY nsc is in full force an f c
o o Licen s Lie Number
a Ir ❑ ❑ ❑
Psw Dale Contactor
• E m f'.a - �. y., BUILDING PERMIT-
M¢ a w a-• t OWNER-BUILLER DECLARATION INFORMATION
f`a oa UT ' -_ M&.- REFER TO ORD
aa 3 r 1 hereby affirm that I am exempt from the Cons.nd Po License -
.. oaLawlor the following remora.f5cc.7071.5.ellsinessand Professions PERMIT ISSUANCE vnwnnoN $/FT.
_ 6.00
QQ 0/ Cole:Any city or county which rcyuires a permit to construct alter,
improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIQ NO. ELEC.
D R requires the applicant for such permit to IIIe a Signed Statemeltt that TOTAL PERMIT TO
a w mhe is licensed pursuant to the provisions of the Contractor's License
Fzi