11556 (3) APPLICANT TO FILLWIIS dRMA-MON WT`fHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BNrIGING APPLICATION & PERMIT
M195
r, (RF
BUILDING — ELECTRICAL—PLUMBING —MECHANICAL 11556
...EH,s J--�RC
NAME
PLAN CHECK VALIDATION
l �/ OTY. ELECTRIC PERMIT FEE
+� ' PHONE-
.,.„• NAMEnAciDRs OUTLETS-SWITCHES-RECEP 10.00/1.00
LpD uC.No. LIGHTING FIXTURES 10.00/1.00
Waveless logs SANTA CLARA PPLIANCES-RESIDENTIAL 4.00
1 ALDO AVE, PHONE PANELS 10.00 DATE OF APPLICATION
IRmicTEci
OR
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.No. SIGNS TRANS. 3.00
moo ess ENa SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH. i�f-,,, �•��I j�
ADDRESS p�",� r' !(��� v
1 ALDO AVENUE, SANTA CLARA, CA SERVICE CHANGE 20.00
omzpl C'''
0 o LICEN'ShD CONTRACTORS DECLUtA'I'ION [III i t : lI. I.:}Il
or u G 1 hereby infirm that I mu 1lcanu'I muter pntvi+ions III Chain, 9
2 w ISSUANCE DATE
r ¢ n Uomntrn ting with Senium]000)IT Division 3 of the Bu,inus unJ I .yyp)(y„I Uyy;Cj, PL❑G. MECH.
r0i 1'rofrssioncC �I/flm��tr�rnse is in lull lUrpt}ogh, I. h;I'L1LJ��I II' €1rLLkf{U
o z_0 Lieensr C s _-'{/sL4S,1_Lie Nunlher.JL_O60 u yr
Gabel� Con frac for
¢ se , '' BUILDING PERMIT.
¢ ¢ Xit. OWN'EK-BUILDER UEC'LARA I']ON INFORMATION
H I hefeby infirm that I am rxrngsl Iron iho Conuxcuu',L,V1,1 MISC.— REFER%ELEC.
w o ¢ Law for the fullo viog newn.(Sec.7031.5,BusincssanJ Professiune VALUATION $TFT.
n�, � Code:Any city or county which reyuiresaperntit,ocons,ruct,ul°'q
PERMIT ISSUANCE
S x 4 O improve,denuslish,or Iepuir any ffr¢Yurr,prior to i,inrLmC.•,also ELIC.CONTR. LIC.NO.0 IS requires the applicant for such permit to fila a signed aatrntn.l Ihul PERMIT'TO
awmhe is IicenseJ puduum Ia Thr provisions of the CoatrtnurS Limue 1^> Law(Chafe,9(commencing with Sect ion 7000)o fDi,,,.u3.Ilhe I lf-�,1Business and Professions Codd or that he is c%cimu thrrorum;mt QTY. PLUMBING PERMITI I 1IS r m the basis 1or the alleged exemption.Any vonslion III'Section 7031.5 STORIES TYPECONBTR.
i by any applicant fur a pertnit subire,the ahplic:um lou JIL of mol more Dun rise hundred dole,(SS001.1: ALTER-DRAIN & VENT-WATER (Eas owner of the property',or Iuy rnlployees with wal:cs:u their sale mblb,nsalmn,will do the work,and Be,trucmrc,Int BACK FLOW PROTECT. DEVICEOCC.GROUP RES.UNITS
intended lir uttered for sale (See 7044, Iitumess and Piole,iutu DRAINS-FLOOR,ROOF,AR EA,CON
Code:The Contra,,.,', License L,Iw Aur,Int apply to an owner uI
pr.peny whobuilds or un proves ihmeun,and who docs sudl'w L,k FIXTURES-PER TRAP 5,001 So.n'.FLOOH ARCA LOIAL ACHPAGB
himself or through his own empluyccs,pnnided that such itupruslr
mems are not imend.•A or offrn•A for sale.if,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
+`,�.' or iniprowmmu is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
Builder will have the burden of pnn'ing that he did not build or ill, BUILDING USE
p,.ve for puqusu'of,ale.). RES IND CON PB Omer
❑ I,as owner of the property',am excbob,l, ,on actin,with INDUSTRIAL WASTE INTER. 30,00
licensed contract., to euutruct the pinjen(See. 7044,Iiluincvs LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code Thr C.nlracl.r',Lia•I,c Law dor,nal apply
to an owner of property wino builds OI Intpmves thereon.and who LAWN SPR INKLERS-OVER 5 (EA.) 1.00
Contracts lot welt proi,cle with a contract.rUi lica'rocd instant 1.
the Contractor's License Low. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT No, PARCEL NO.
❑ 1 am uccnB+t under Sec.—.11&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.OATF. ACC.FILE NO.
WORK Ii RS'CONIPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cenilicme of C.IIIIIII t.a'If"inv.r,
or a certificate of Workers'Cnmpen,oull Insurance,.r a certilie l ZONING ENG.SITE NO.
Copy themy 1 A•' ig00 Ltb.Y.Lr,QC.—LAA'IPs
Policy'No.}���L{{,,�L,,11 r 1,pan —P
0 ❑ CetlRn�ST�1SYremby l unticbed' FIRE SPR INK ENERGY L]4
Z Z X Certified copy is filed with the city insponiun division.
F" O Applicant MISC.- REFER TO ORD. Y ❑ N Y ❑ N[]
!2 CLR'RFICA'I'F OF I:XI'MFI'[ON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE AL.U.C.
LU ('ONIIII-MAiION INSUIIANCI' PLG.CONTR. LIC,NO. PLG.
d o This section need not be completed it file permit i, tot am TOTAL Y❑ NE] Y ❑ NCD
Z hundred dolls,IS 110)or less.)
U O 1 certify that in ,he perfutuRo,OI the work for which this Per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL P- ,tit i+issued,I ,hull not employ any Faun in an,nrwuer+.u,t.
0 W bacotne subject to the WOlkeri Cutnpen+atwG Laws of Call'ontI,
OL Ua,e Applin nt ALTER OR ADD TO MECH. 5.00 BUILDING
} rn NO"f ICE 'y0 A I'I'I.ICA N'1''. If,ager It,kin,Ih i,CYn i Beat,I E,
I•— Z emptian,you should 1).•cmnc subjrn to the Wod.cri Cuntprnsetim, APPLIANCE 5.00 PLAN CHECK
U
pro
visions of the Lobar Code, you into, Lrihwi,ll comply .,li FEE such provisions or this permit stall be deemed revoked AIR HANDLING UNIT(TO 10) 00C.F.M.) 4.00
CONSTRUCRON LENDING AGENCY AIR HANDLING UNIT(OVER IQO(3OO.EM.) 6.00 SEISMIC FEE
I hereby a0inn that ,here is a cm,mteliun lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is i,acd(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 8.00
L,nder's Nante
Lender's Address HEATING UNIT IOV ER 100,000 B.T.U.M50 ELECTRIC
I certify that 1 have read this application and state that the abuvv VENTILATION FAN (SINGLE) it
information a menet. I ,agree to comply with all city and cuua(y BOILER-COMP13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
,finances and cute laws ,eluting to bili Wing Construction,chum, one
ereby anti.n,n• representatives .f this city w cn n'r upon Om BOILER-COMP IOvur 100,000 BTU)SEE FEE SCM. MECHANICAL
abova-InemimmJ pmpersy 1'ur inspoaiun Purposes.
(Nee) agree ,D save, indemnify and krrp luribi-I the CID 01 MISC.- REFER TO ORD.
C'uper,ino against liabilities,llWgnn'n,, nn, wui rapensos wllicll CONST.TAX
Illay in any way accrue against Said City' in conwqueIRV of ,h.• PERMIT ISSUANCE 10.00
granting of this pvnnlL MC:CH.CONI. L h.IJg^� MECH.
dt /T8 DIAL 1S.00 TOTAL
Signal.Ie.f Apphcall1lCml,ru. I D Ir _ THERMAL DESIGN SYSTEMS i-,
I-uF!CE COPY