16000 (3) ; :
AA P.;tCANT TO FILL NININFORMATION WITHIN RED LINES- USE BALL POINT-PEN-ONLY'
v.. BUI LDING PROJECT I DENT(FICATION - - -PERMIT NUMBER
aDILDING • APPLICATION & PERMITp
ADDRESS
I•, 'RESULTS .WAY
' BUILDING -ELECTRICAL—PLUMBING,-.MECHANICAL
OWNERS
NAME . t i PLAN CHECK VALIDATION
• y QTY. ELECTRIC PERMIT- FFE
MEASUR'EX PRGNE /
NOMERAcroR's OUTLETS-SWITCHES-RECEP 16.00/1'00 i
cal-Air,-, Inc. Lt. No, 137195 r LIGHTING FIXTURES, 10.00/1.00
CONTRACTORS 'APPLIANCES-RESIDENTIAL'' " 4-.00
• ADDRESS
T775%S. 1st St ' PHGNE,947=.0155 PANELS 10.o0
GATE OF APPLICATION
' ARCHITECT + PLAN CHECK FEE P.CdNO.
OR , PANELS (OVER 200:AMP) 20.00
ErvcirvEER: " ' uc.ND: •- SIGNS TRANS." - 3.00
ARCH.OR ENG. 'PERMIT VALIDATION .r
ADDRESS - _ SPECIAL'CIRCUIT s 5.00
-ZIP EMP.METER OR POLE INS. ' 2000
APPLICANT s
� - MOTORS SEE FEE SCH.
ADDRESS ,, E ,'
1775 S.., 1St St.. San Jose SERVICE CHANGE,;' ' 2000
oo _ LICENSED CON I RACTORS DECLARATION _ y,
a u I hereby af0 m that am licensed underprovisions of Chapter 9 JOB #1739 s 'ISSUANCE DATE
a w (commencing with Section 7000)of Division 3 of the Busivess and 'u
rn Q n - G.,- ^ELECT. PLG MECH., '
H o z Pro(esslons Code�InA' _Vy�rT�Is h lull to e.{ e f __= _ -
z o H a License I �/ .V-�Lm Number- .7 BLDG. PERMIT- 1705$ --El', ` � . .❑'- ®'
9 Z H'O - Date�I_(�Contracvir_ MAK �-t
'¢ ¢ w Q OWNER-BUILDER DECLARATION ,", CI VII ,BUILDING PERMIT 1
w ; , y I,hereby'affiml that 1 am exempt from'
the Contractors License MISC.— - _ REFER TO ORD INFORMATION
I.aw for ihel follow119net _'I'lleo.7031.5,mis 'ss and Professions 'PERMIT ISSUANCE Y. • 10.00 -?VALUAnoN $/FL :
Cotle Any city or wuntywhich r",7031
eq mresa perms ttoc nslnc4alteq -
¢ ¢¢ 0 un prove delilolish n repair any struUure,prior to its Issuance,also ELEC.CONTE. LIC.-NO-
EIEC
O ¢ requires the applicant for such permit to file a sig led statement that - - TOTAL
n w m a- he is licensed pursuant hi the provisions of the Contractor's License _ PERMIT TO -
.H' i
Law(Chapter 9(commencingwith Section 7000)ofDivision 3 oldie - 'I + ,
io Business and Professions Code)or that Ile is exempt therefrom and QTY. - PLUMBING PERMIT•, FEE i �c EU-
¢ the basis for lire alleged exemption Any violation Df Section 7031.5 w : ";,. +-STORIES - TYPE CONSTR.
by anysapplleant for a peno't subjects the applicant to a civil penalty . - y -.'ar
of not more than five hundred dollars($500).): ALTER-DRAIN,&VENT-WATER (EA.) '5.00 -1 '",f
❑ I,as owner.[,the property,or my employees with.wages,as .DEVICE 4 00 '
' their sole con
stricture FLOW PROTECT
pensation,will do.[Ile work,and the s
ue[ure Is not eOCC.GROUP, DREG UNITS
iiia nded or offered for sale.(9ec. 7044, Business and.Professions DRAINS-FLOOR,ROOF,AREA,COND." 5.00 "
Code The Contractor's License Law does not apply to an owner of _
property Who builds or improv s the eon an,who does such work FIXTURES-PER TRAP 5.00 + SO FT FLOOR AREA - TOTAL ACREAGE
himself or through his own employees,provided that such Inlprove-
mvntaam ,otintendedorofferedf W,If,however,the budding GAS-EA.SYSTEM-VINC.4 OUTLETS 600 I'' 4 �'
or improvement is sofd•wilhin othe
p e year of completion a iter GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have th burden of pr Ing that ho.did not build or im -. �-BOILOING uBE
ro
pve forpurp L.1 sale)'. ' .: HE ,IND CON'., ,PB Oth
❑ I as owner of the pioperm ty,eesebsi ly contracting' ilh. INDUSTRIAL WASTE INTER. 30 00 - O
licensed,contractorsto construct the,project(See. 7044,Business ' LAWN SPRINKLERS-1INC 5.V:B. - 6.00 ah r ,q&&Essoab PARCELNO y '
a
and Professions Code:The Conttuctm s License Lu does not apply
hI an owner i 1 property who builds or improves then.on,and who , LAWN SPRINKLERS-OVER 5 (EA.) 1 00 T
Q the Co is for such L cense L with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10 00-
the 1anictors License LAW. -` i* TRACT NO PARCEL NO
I am exempt under Sec: ,B.&P.G 1'or this -
-�, - ti - WATER HEATER W/VENT- 600 -
S
Owi er Date- WATER SYSTEM' • 5 00 1 ACC.DATE AccFaE No
WORKERS comrErvsnTl0N DECLARATION - WATER TREATING EQUIP., 500 ".
hereby affirint t1 at 1 have e certificate of consent to self-insure, I
- '
Or a certificate of Workers Co npeosetion lism,re,or a ecrtdied t ZONING ,ENG SITE NO.
copy there.4s"6 9800 Lob C)'
Policy No Corapanv TJ hPrty -Mntna _
(Y10 ❑ Certified copy shereby furnished - .d�' FIRE SPRINK ENERGVT24
❑ C mired B li pI lyinspection division. -r
Z Appl cant -EXIT ll - ; MISC - REFER'TO ORD - ' v � NO 1 v❑: ND
� � ACZ-161-VL78 /V-U 7
to PERMIT ISSUANCE 1000 s
• � 'CERTIFICATE OI'EXI:MI'1I(1N FROM WORKERS. - ^>FL000 ZONE l,ALU.C. ';
LU > COMPENSATION INSURANCE PLG.CONTR. : LIC.NO. "PLG. Vd`d-
d ,lThis section need not be completed if Ihc'perm it is for nnc ' TOTAL Q,- N❑ "'V�❑-..NO'
� Z- hundred Aollars(SI00)or lC',I - -
` U O I reify that in lire performance-of lire work for which this per. QTY. MECHANICAL PERMIT' FEES - d -' FEE SUMMARY ,
EL mit is issued,I shall not employ any person m any ndnncrso as to
O W become subject to the Workers'Coimpeneution Laws of Califorria. _
Dale- Applicantn- (BUILDING
}'m NOTICE TO APPLICANT': If,after making this Certificate of Bx- ALTER OR ADD TO MECH. '5 00
F 2 edlption,yin should become subject to the Workers'Compensation - APPLIANCE '5.00 TPLANCHECK
_ provisions of,the Labor Code, you must forthwith comply with - `' - a y�• -•
V such provisions or this permit shall he deemed rcvokul. �' AIR HANDLING UNIT(TO 1Q000C.F..M.) 4.00 - 1 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.16.00 " SEISMIC FEE',-„ "' r _ i .
_ I hereby me of lir ihere.is a which
thi,p it is agency for i•- EXHAUST HOOD(WITH DUCT) " 5.00
I the peKv.C.).e of tiro work f r hick this p my is issued(Sea. MICROFILM
3097,Civ.C.). - ! HEATING UNIT(TO t00,000,B.T.U.) 8.00 '
Lender's Name HEATING UNIT(OVER 100,000_B.T.U_.)9.50
• Lenders Address •ELECTRIC - -
Iceitifythatl-have read this uppliaLLicn and`stutc that the above VENTILATION FAN (SINGLE) 4.0
information is cornet I agree to comply with all oily and county - PLUMBING
'
ordinances and state las relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby eutiona representatives ec this city to enter upon the BOILER-COMP (Ovar 100,000 BTU)SEE FEE SCH. MECHANICAL
about-mentioned property for vesp of
purposes.
(We) agreAimmmni efy and keep harmless the City of MISC.- REFER TO ORD. _ -
up 'no agts, 'udgmonls, costs odd capers. hichmayanye'ag Inst sa I Cfty in consegi•nee o the PERMIT ISSUANCE 1000f/ ( MECH.CONT LICNO., MEC1 9� AZ� DTA �I TOTAL
Signature of Applicant/Contract ; Date Cal Air Inc.. 137195 M
OFFICE COPY
H