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6177 APPLICANT TO FILL-IN IN MATION WITHIN RED LINES - USE ACL POINT PEN-ONLY •BUI LDI NG PROJECT I DENTI FI ION - PERMIT NUMBER BUILDING APPLICATION & PTRMIT •' ADDRESS • N 6177 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OW [R'S � ` PLAN CHECK VALIDATION DTV. ELECTLRIC PpERMIT „ FEE - [ FHONE kt "W L:/lt�Mk•AST "fT.`M IC .A CONTRACTORS � UTLETS-SWITCHES-RECEP 5.00/1.00 C4`� R.0.�47��• lie ND.3Ip�0,5r/ LIGHTING FIXTURES . 5.00/1.00 - CONTRACTORav0 ^ PPLIANCES-RESIDENTIAL 4.00 A/pO ES W�r PHON13 PANELS 5.00 DATE OF APPLICATION ARRCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.NO, SIGNS TRANS. ,3.00 ARCW OR ADDRESS ENG. SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 15.00 ADDRESS -s - MOTORS, SEE FEE SCH. APPLICA SERVICE CHANGE 10.00 FOO LICIiNSGD CON]RACTORS DECLARATION , w 'f hereby affirm that I mn licensed under pravisicnsof Chapter9 N a N (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE BLDG. ELECT. ,PLG. MECH. r H z Professions CoAuu��ee��d my license is in full fore ' 1' ❑ ❑ ❑ 2 O-w - Licemu Clgs Lic:Number - o m �.w Date_(1- Contractor. ¢ se¢'a OWNER-6OILDER DECLARATION "BU_ILDING�PpERM1T- °'° MISC.- REFER TO ORD # .r URMA,Ty'ION E ; ,+ w I hun:hy aftinn that I am exempt from Ili Conlmctor's License u O< Law for Ilse following reason.(Sec.7031.5,Iiusinessand Professions VALUATION E/FT. F - PERMIT ISSUANCE 6.00 Fy�2 Code:Any molishor rounty pair any reqstructure, ermittoconstruct, uance,ll,so �sfA ¢ rt a O Improve,demolish.or repair any sticture,print to its issuance,nt also ELEC.CONTfl, LIC.NO. ka0 ELEC. LLLVVV ° u Requires itic the applicant for such permit to file a signed statement that TOTAL AKm he is license)pursuant to life provisions z i umsof the Contractor's PERMITTO La. withScctnon 7000)ofDmislon3ofthL "A '-' 1 s 4 o Business and Pmfesnons Code)or that he is exempt therefrom and DTV{ ' '� �PLUMBING'P•ERMIT ;FEE 01 the basis for the alleged ex in,ption Any vnoletion of Sect ion 7031 5 "'"„ ^!1 n'owK„� d. ug- b any applicant lora permit subjects thea applicant to a civil enall TC STORIES TYPE CONSTR. v r o ni v j pv pen.", ALTER=DRAIN&VENT-WATER IEA.) 4.00 of not more than five hundred dollars(E500).1: ❑ 1,as owner of the Property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2,00 DCC.GROUP RES.UNITS their Sulc EDm pensation,will do the work,and the Structure is not intended ur.offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 4.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves Duman,and who docs such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided That such improve. nonts are not intended or of fired for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 4.00 or improvement is sold within one year of completion,the owner builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. RES IND CON PB Dinar ❑ I,as owner of fire property, - 20.00 p tr Kenn rojectiv Se . 7044, ins with licensed contractors to construe( Ow project(Sec. 7044,Business11 El 11 0 El LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORSPARCEL NO. and Professions Code:The Contractor's License Law does not apply 4,[ to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3 contracts for such projects with a Lunlrucfor(s)licensed pursuant to the Commuter's License Law, SEWER-SANITARY-STORM EA.200ft/6.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,BAP.C.Rullus WATER HEATER W/VENT 4.00 mason Owner Date - WATER SYSTEM 4.00ACC.GATE 'ACC.FILE NO. WORKERS'COMPIiNSA'1'ION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm 0mL1 have a certificate ofconsual Io self-insum. or a certificate of Workers'Compensalion Insurance,or u certified ZONING ENG.SITE NO. copy thereof(Sec.3800,ta y.NALF 4eg77W / Policy No. Company_u is CSO?��/T Q ❑ Ce! m copy is heron u isheI ^ FIRE SPR INK ENERGY T-24 Z-Z ❑ Cer ific c py is 'le w 1 he city it peclion division. _ " H OI"' Applicant MISC.- REFER TO ORD. Y❑ NEI V ❑ NE] PERMIT ISSUANCE 6.00 N CIi IFICA'PP F EX . PITON PROM WORKf:RS' FLOOD ZONE AL.u.C. W - CO PENSA ONINSURANCE PLG.CONTE. ❑C.NO. PLG, . IL a . (This section nee,l not be completed if the permit is for one TOTAL Y 0 NY N� :3 Z hundred dollars IS 100)or less.) y., - U O I certify that m the performance of the work for which this per. OTVe'' MECHANICALPERMIT FEE k*d,' _;i,FL,EE SUMMARY W F mil rs Issued,1 shall noLenlploy any person in any manner so as to k $I„N�"r � xyr ,f y , Q W become subject to the Workeri Compensation Laws ofCal - + y Date Applicant -' ALTER OR ADD TO MECH. . 4.00 BUILDING Od >_ m NOTICE'TO APPLICANT: If,after making this Certificate of rix. ' F 2 ¢option,you should became subject to the Workers'Conmensatiun APPLIANCE, 4.00_ PLAN CHECK - provisions of the Labor Cod, you nwst forthwith comply with FEE + U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER INWC.F.M.) 5.00 SEISMIC FEE - /�Irzl Thereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name Lender's Address HEATI NG UN IT(OVER.100,000 B.T.U.)7.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 information is correct. I agree to comply with all city and county PLUMBING onlinunces and slate laws relating'to building consfmction; and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 hereby aulhuri c represerunwes of this city to enter upon.lhe above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City'of MISC.- REFER TO ORD. . Cup Ino against liabilities,.judgments, costs and expenses which CONST.TAX -q m i any way a m asainsad I said City in consequence of,th}' PERMIT ISSUANCE - 3.00 v$�� gr n[' gof this per sic MECH.CONT. LIC.NO. MECH TOTAL , T `-ems 4„ O 1 AI: ' n 5 atum ofA tictmctor Date •+NT', '',"n ' OFFICE COPY , " TTY OF CUPERTINO INSPEi.TION RECOR,$ i (OFFICE COPY) - l77 /03 96PERMIT M. ADDRESS .ocs,�— PERMIT ISSUED DATE "ELECTRICAL DATE INSP. I il3in� — --- Electrical Plumbing "Power Pole mcnanical r un Te— as ec u irin S- Y— o ar Walls ire prin c ere1G^1 bign fixtures Int/Ext motors -- Misc. Grounding e Power Wer — FINAL INSPECTIONS DATE INSP, Not rove Gas .Y - - y zs �S o K Electric um - a "PLUMBING DATE INSP. .�fec�anic -P-PS' � � o ar Backflow ��o r un ia�- �mrtloor annin Partialoug Fire t. uo1Fi o -lete �eat t_, ar on u ater *& Insulation - er R/ot/5Drain Gas 77s .Other BUILDING DATE INSP. Not rove Pad Certifications - Foim anon Ips e o DATE INSP. blab--me ran i_ Underfloor S.M. a � Ducts nsu ation Under teeoor it ers ire D�—ers F - FToor tem Fireplace -- 'rie s grease Duch, oo �Dia�hrams One our a t Se'iWalsmec racin ensate ain _ s f �j cal �� _ �u ent An orage _� e. F ues Comb. Air Eatf l ter - WaT''j53 r n Ext. 5- of prove -- -- rewaL�16 '— eE rove ��J— r 4 CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE' �- 19 BLDG. PERMIT NO. y 7 i THE BLDG. LOCATED AT,�n � l ii CF- j,CE !� OWNED BY Ef u "I'i Q1 n 14 / / I. HAS BEEI��OMPLETEDI FOR USE AS Z r- b ALTS ED) 1 I ©M I BUILDING INSPECTOR I it BUIL'DIN.G INSPECTOR'S OFFICE Bldg.Depc CITY OF CUPERTINO Office Copy �\ Backflow Device Sanitary Permit No. [�7 Sewer Connection - - Plumbing Permit No. /1© Plumbing Final Lot No. �f Owner or Tenant At t ' Tract ' Date Connected <% —I)--r'a, 19-P—C—Date Final / "' - T9• ' rPLUMBIN�CTOR i i OFFICE tor9 CITY OF CUPERTINO COPY GAS SERVICE NOTICE 119 To I You are hereby authorized to connect the GAS service for Owner or Tenant At New Service bb"J No. of Meters Reconnect No. of Add. Meters Move Service Move Mete r PLUMBING INSPECTOR ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO �• 19 To i"V � E You are hereby authorized too Connect electrical service for 'Owner or Tenant —"""'c'S Cr•<►�^r"' I1 Ik No.of Wires Size of Wires Size of Switch 1 X Motor Load Voltage Phase Heating Load K.W. Voltage / Light I10New Service Reconnect No.of Meters Heat-120— Three Wve More Service i No.of Add.Meters Power /�• Thre Phase Move Meter Il OO • ELECTRICAL INSPECTOR ELECTRIC SERVICE NOTICE P� T -OFFICE i 1 BUILDING INSPECTOR'S NOTICE `! CITY OF CUPERTINO C' { cr To Z 19 �T You ore hereby authorized to Connect electrical service for ( ' 1/l/ }y 4r N Owner or Tenant_ +_' At / r) 9 A &k•P 1A r L,/(4 1 No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase I Heating Load K.W. Voltage t _ Light—]10_New Service Reconnect No.of Meters ' C Heat—]20—Three Wire More Si No,of Add. Meters Power. Three Phase/ Move Meter Jt 0� ELECTRICAL INSPECTOR` 42An • � �- �- III �f