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5652'�PPLIC4NT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY •- • O' Z_z P 0 CC - LU > ao Z) Z Uo LL U O w CSo . F ? +, BUILDING PROJECT IDENTIFICATION ,APPLICATION&PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 5652 BUILDING e` AooREss r' dale -/o.za n PLAN CHECK VALIDATION art A CAL a A QTV. ELECTRIC PERMIT FEE NAN NAcroRs NAME UTLETS- SWITCHES -RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 LIC. NO. CON OTRADRRAc7oR's ADRESS PPLIANCES- RESIDENTIAL 4.00 PANELS 5.00 PHONE DATE OF APPLICATION ARCHITECT OR ENGINEERC� 1� �` �-G4��,J\/`sec. No./ / W SIGNS 6.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH, OR ENG. 12/ / aSLI�A FEES A -Al' Cpe nv F f SPECIAL CIRCUIT• 5.00 PERMIT VALIDATION �� PAI / %/ L I B]M� G. I DATE EMP. METER OR POLE INS. 15.00 ApPU Ess 13o'7 S _y,gwr Sur`l'L 0Zo A bORE ss S u c L MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 LIffi'mr tUCONTRACTORSDECLARATION 'I her. affirm That I am licensed undo pruvisions or Chapter 9 (commencing with Section 700of Division 3 of the Business and ei Professions Code, and my license e is in full force and el feet. Class Lie Number BLDG. � tYLjJ1M C ELECT. W10 PLO. MECH. El ElLicense I)um Contractor By I LDIN-G PERMIS�.T; ' iNFORMAT1( Y oWNERBUILDER DECLARATION e Contractor's License I hereby affirm that I am exempt from tire Law for (he following reaSrn. (Sec. 7031.5. Businessand Professions Code: Any city orcounty which requiresa permit loconMOWL alter, improve, demolish, or repair any structure, prior In its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Lov,(Chapter 9(commencing with Section 7000) of Division 3 of lire Business and profession, Code) or that he is exempt therefrom and the basis for (he alleged exemption. Any violation of5ection 7031.5 MISC .- REFER TO ORD VALUATION 431s000 - PERMIT ISSUANCE 6.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMITTO Condos. (8 units) QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN& VENT -WATER (EA.) 4.00 by any applicant for a permit subjects the applicant toa civil penally of not more than five hundred dollars ($500)J: 2 5 N. Fir. ❑ I, as owner of life properly, or city employees with wages as their Sale compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who holds or improves thereon, and who does such work BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP R=1 RES. UNITS 8 DRAINS -FLOOR, ROOF, AREA, GONG. 4.00 FIXTURES - PER TRAP 4.00 SO, FT. FLOOR AREA TOTAL ACREAGE himselfor through his own cmployces, provided that such improve. menu are not intended ornlr.0 for sale. ll', however, the building 14,000 , GAS - EA. SYSTEM - I INC. 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 p uve for purpose of sale.). ��p" I, as owner of the property. San exclusively contracting with IR' 'L contractors to construct the project (Sec. 7044, Business and Pmfessinns Code:'I he Contractor's License Law does not apply to an owner of properly who builds or improves (hereon, and who GAS - EA. SYSTEM -OVER 4 (EA.) 1.00 RES IND BUILDING OCON USEPB Other a-1 6J ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 LAWN SPRINKLERS -OVER 5 (EA.) 1,00 ASSESSORS PARCEL NO. 269-2-2 contracts for such projects with a comracter(s) licensed pursuant to life Comractor's License Law. " SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 4.00 ❑ lam exempt under See .B.&P.C. for this 7575 easonr go rre cane Hate -16 _�'!� WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. IWATER TREATING EQUIP. 4.00 WORKERS'COMPENSATION DECLARATION 1 heeby alfirnf that I have a certificate of consent to scl4insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lah.CJ. ZONING ENG. SITE NO. S8AJ �5 P.hey No. Company ❑ CerlihCdcopyisherebyfmoishcd. ❑ Certified copy is filed with the city inspection division. - FIRESPRINK y ❑ N❑ ENERGY T-24 Y ❑ NC]Applicant MISC. - REFER TO ORD. PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. CERTIFICA'I'E OF EXEMPTION FROM WORKERS' PLG.CONTR. uc..NO. PLG. TOTAL COMPENSATION INSURANCE (This Section need not he completed if the permit is For one y❑ N❑ Y❑ N❑ ' hundred dollars (S 100) nr less.) 1 certify that in the performance of the work for which this per- nit is issued. I shall not employ any person in any dramrer so es Ise QTY. MECHANICAL PERMIT . FEE FE E?SMARiYr UM�s''3 He come sppbject to the Workeri Compensation Laws of California. Datc_jI'l l : r-Applicant NOTI' 7 A Pt.ICANT: If, a ter making this Certificate of I x. coalition, you should become subject to the Workers' Compensation provisions of the tabor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING 1.260.50 ALTER OR ADD TO MECH. 4.00 APPLIANCE 4.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 3.00 AIRHANDLING UNIT(OVER 10=CF.M.) 5.00 SEISMIC FEE 30.17 CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM 1 hereby affirm that there is a construction lending agency for the performance of the work for which Ihis permit is issued (Sec. 3097, Civ.C.).,� �Mfll.' s�4 HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATING UNIT (OVER 100,000 B.T.U.)7.50 ELECTRIC Lender's Nanic Lender's Addresses .3,�0I saL r , I certify, (hat l have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER -COMP (3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives Of this city to enter upon the above -mentioned property for inspection purposes. ' MISC. - REFER TO ORD. CONST. TAX (We) agree to Ni indemnify and keep harmless the City I Cupertino against liabilities, judgments, costs and expenses which may in any way accrue agui nsl aIJ Cty in consequence of the PERMIT ISSUANCE 3.00 MECH. CONT. L L. NO. MECH. TOTAL TOTAL 1,290.67 P fn us "a" //JJ g // Signature of Appllicinnt/Contractor De(e OFFICE COPY CITY OF CUPERTINO INSPECTION RECORT) (OFFICE COPY) f�on�% PERMiT NO. ADDRESS �� PROJELa _TUWNbff ISSUED re DATE INSPECTIONSFINAL DATE Gas • .. � ; sue: BUILDING DATE Pad Certification INSP. oun ation v re- unite a- eam Uziderfloor Girders Floor Steel Tiedowns Diaphrams o eismec Bracing Walls -Panels rame at _ 'WrNailboardsnt xt. irewa s terms _ Net rove Is kcf-^ w.0 ()T 6-Ft— 5-7—YN 1 U <P R-c-Ca�Nb- v-' l (-(ea�C T _Z'(-�Y 4'v . ELECTRICAL Power Pole DATE IINSP.' PUMING Backflow DATE '. • u IVZ n- 1 '' 1 rA I LL DATE UnderFloor S.M. INSP. Ducts & Insulation /a-/ - Fire ers ire ace cease Duct 4 mood_ e Hour Shatt Condensate Drain m ment Anchorage Flues r Other of rove BUILDING . ti.. . (4zlllVIAQ - dNTr U-146r <lw l ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO / q DATE ' 19BLDG. PERMIT NO.D �Z- I', :THE BLDG. LOCATED AT ` / lJaXj hI- OWI`=EDBY ��� ' HAS BEEN I MPLET FOR USE AS —/� o� N O ALTERED) I; BUILDILGINSPECTOR CERTIFICATE OF COMPLETION r 3 BUILDING INSPECTOR'S OFFICE CITY �O. FCUPERTINO DATE �— . j qx3, -FCBLDG. PERMIT NO. THE BLDG. LOCATED AT 11 O%! 1 ie I I I Q n WAS BEEN 'J�• •, USE AS � I CERTIFICATE OF COMPLETION �r)�.3 BUILDING INSPECTOR'S OFFICE [ / CITY OF CUPERTINO DATE 7 — 19-4YI7 BLDG. PERMIT NO. .THE BLDG. LOCATED AT__LL�_2�ZF,�� OWNED BY 4 U 1' HAS BEEN QMP_LETE OR USE AS C-D 14 �� O (ALTERED) CERTIFICATE OF COMPLETION BUILDING'INSPECTOR'S OFFICE CITY OF CUPERTINO /! DATE, 19.. i BLDG. PERMIT NO, :THE BLDG. LOCATED AT Z 0 Z 2n i (e ui p n OWNED BY 1 (/ U/ VI c HAS BEEN ( MPLETED� OR USE AS (ALTERED) ���� l CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO / DATE —7 , I q--Ffr BLDG. PERMIT NO. THE BLDG. LOCATED AT0 _42,A 1A d N-P OWNED BY HAS BEEN IAL ETEDI FOR USE AS L' O 1 n i OM DUICUINU INSPECTOR CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO j DATE �— 19� BLDG, PERMIT NO.�"�� THE BLDG. LOCATED AT�6��C) ,{ a lI A -p /)�-- OWNED BY �j HAS BEEN OM PLETED�I OR USE AS 14, Q42 fAtT R I I BUILDING INSPECTOR'S OFFICE Bldg, Dept. CITY OF CUPERTINO ottmecoPy O Backflow Device R] Sewer Connection ❑r Plumbing Final Sanitary Permit -No. Plumbing Permit No.Lot,NS�r / o 3 V Owner or Tenant .c-rJ it /% 0, At 14 a Tract Date Connected 19 19-EL/Date Final PLUMBING INSPECTOR - CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OFF CUPERTINO DATE -+ 199 r BLDG. PERMIT NO. ! THE BLDG. LOCATED AT 4 Kt /l.P�Ijp 1— OWNED -BY HAS BEEN I �MPLETEDI OR USE AS n (AALrEREDI o� CERTIFICATE OF COMPLETION D r3 BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE_, 19-2f BLDG. PERMIT NO. THE BLDG. LOCATED AT �/T L 2 7 I OWNED BY.. Li/ lil C�p 1&7-f �"/f,�• HAS BEEN �OMP FOR USE AS r" (1 �A c�/J �1-ACT RE I i BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO Bldg. Dept. Offc ! ❑ Backflow Device ;❑O. Sewer Connection Plumbing Final Owner or Tenant t�— ¢e opy Sanitary Permit No. --/ Plumbing Permit /No. Lot,No 3 Date Connected li> 19r/ Date Final 19 ,F'{'� ©r PLUMBING INSPECTOR I BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO Bldg. Dept. Office Copy I ❑ Backflow Device Sanitary Permit No. //S- .y ❑v Sewer Connection `. Plumbing Permit. No. S� S Rl Plumbing Final Lot No �. I Owner or Tena nt r^t u At L I Tract I Date Connected I qeLV— Date Final 0/��='%j3 " I OM PLUMBINSTOR BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO Bldg. Dept. Office Copy ❑ Backflow Device Sanitary Permit No. ❑� Sewer Connection Plumbing Permit No. errm tNo. /R' Plumbing Final Lot No �. i Owner or Tenant -4. -7en��cat-i.� y I n Date Connected 19-,T Date Final 3 19 J-' p„ I PLUMBING INSPECTOR I BUILDING INSPECTOR'S OFFICE � CITY OF CUPERTINO Bldg, Dept. Office Copy ❑ Backflow Device Sanitary Permit No. I t ❑✓ Sewer Connection Plumbing Permit No. SG „ Plumbing Final 6PI4 3 ,�.�' M) / Owner or Tenant � .1.�-x© j 1 r r At ioaay/,,,Ca ,.1/� I Tract ! Date Connected // - /- 19A`/ Date Final i�1-��lq,j�s•- PLUMBING 5PECTINSPECTOR I BUILDING INSPECTOR'S OFFICE I CITY OF CUPERTINO Bldg, Dept. Office Copy I ❑ Backflow Device - Sanitary Permit No. I 31Sewer Connection Plumbing Permit nNno. u I ! d Plumbing Final Lot No. 3 Owner or Tenant a.1 T i Date Connected /r _ /- 19SyDoteFinal Q/i I OM PLUMBING INSPECTOR BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO Bldg. Dept. ❑ Backflow Device Sewer Connection ❑` Plumbing Final Owner or Tenant Office Copy Sanitary Permit No. //fry/ Plumbing Permit No. t'ot No. 3 Date Connected iG /— lq A°� Dote Final a l7� 19�'sl" OM 'LU� SPECTOR BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO Bldg. Dept. Office Copy ❑ Backflow Device Sanitary Permit No. f S\ Sewer Connection Plumbing Permit No. 5,7 Plumbing Final 9 -3 — Cot No. J Owner or Tenant At Tract Date Connected lQ / 1 q,W Date Final—/ 7' ' J 1 — I q ys PLUMBING INSPECTOR , ELECTRIC SERVICE NOTICE BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO OFFICE COPY 19 �) To l You are hereby authorized to Connect electrical service for No. of Wires Size of Wires Size of Switch Motor Load Voltage Phase Heating Load K.W. Voltage ll9ht 110_New Service / Reconnect INO. of Meters / Heat 120_TThree Wire More Service No. 04 Add. Meters Power � ' Three Phase Move Meter ELECTRICAL INSPECTOR ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO / To You are hereby authorized to Connect electrical service for Owner or Tenant-rA--•' """-'�"-�' ��""t��"""�" No. of Wires. Motor Load _ Heating Load Size of Wires Voltage K. W. Size of Switch light I10New Service ^ Reconnect No. of Meters Heot 120Three Wire More Service No. of AddMeters Power � three Ph/ ose Move Meter Q• ELECTRICAL INSPECTOR (\�) + U -- � ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTORS NOTICE CITY OF CUPERTINO / - - 'F� 19 S -� is ,') f It', You are hereby authorized to Connect electrical service //for / , lb l—I Owner or Tenant q 1 No. of Wires _ Motor Load _ Heating Load Size of Wires m of Switch Voltage Light 110_New 5ervice —1- --`— / 140� Three Wire More Servlo No. of Meters Heal Three Phase Move Meter No, 04 Add. Meters Power OP M ELECTRICAL INSPECTOR OFFICE COPY ELEC TRDINSPECTORING IC SERVIICE NOTICE BUILCITY OF CUPERTINO / y — % 19 �1 To 7 You are hereby authorized to Connect electrical service for T/M ^ Owner or Tenant --- A® ,z.E. 1 rr No. of Wires— Size of Wires�� Size of Switch Phase — Motor Load Voltage— Volrage_— L ci — K. W. Hearing oa 110 5erWoe Reconnect Light _New More Service 1 20_Thre, Wire No. of Meters Heat Move Meter (Three Phase Power No. of Add. Meters raj t /i ©� ELECTRICAL INSPECTOR /' ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE i CITY OF CUPERTINO 19 To , You are hereby authorized to Connect electrical service for Owner or Tenant At li No. of Wires Size of Wires Size of Switch Motor Load Voltage Phase Heating Load K. Light I10—New Service u Reconnect No. of Meters / Heat 120 Three Wire More Service Power Three Phase Move Meter ' No. 04 Add. Meters _ Qr M ELECTRICAL INSPECTOR v ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO y 7 19 To You are hereby authorized to Connect electrical service for No. of Wires Size of Wires Size of Switch Motor Load Voltage Phase i Heating Load K. ((( Light I10 _—New Service 'r Reconnect � No. of Meters / Heat 120--Three Wire More Service Three Phase Move Meter No. of Add. Meters Power. ww ELECTRICAL INSPECTOR ELECTRIC SERVICE NOTICE �--- BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO To Ydu are herebby� authorized to Connect electrical service for Owner ar Tenant No. of Wires, Motor Load _ Size !of Wire! OFFICE COPY / J- 19 t-7 )— of Switch Heating Load K. W. Voltage Light—] 10 —New Service Reconnect No. of Meters Heat 120Three Wire More Service No. of Add. Meters Power Three Phase Move Meter (2). ELECTRICAL INSPECTOR ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO To _ You are hereby authorized to Connect electrical service for 1 No. of Wires. Motor Load _ Size of Wires Size of Switch Heating Load K. W. voltage v No. of Meters / Light Heat I10New Service ^ Reconnect Wire More Service I20__Three No. of Add. Meters ©M Power ELECTRICAL INSPECTOR T(\hrre�e Phase Move Meter. ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO 19 •�) To You are hereby Lthorized to Connect electrical service for Owner or Tenant Y I n 9 At / No. of Wires Size of Wires Size of Switch Motor Load Voltage Phase Heating Load K.W. Voltage \' Light 110 _New Servi ce K Reconnect No. of Meters (l\/ Heot i 20__Three Wire More Service No. of Add. Meters Power Three Phase Move Mete, �� " Qv w ELECTRICAL INSPECTOR ' •' ' .� — — - --- — _- _ OFFICE COPY ELECTRIC SERVICE NOTICE BUILDING SPECTOS TICS OF CUPEERTINO p 19 �p .- / l o t tiereby autht Yuu are horized to Connect electrical service for M Owner or Tenant , , At Size of WiresS,zeof Switch �--� No. of Wires Phase Voltage-� Motor Load Voltage Heating Load --� K. W. X 110� New Service Reconnect I ( Llght I40_—Three Wire More Service No. of Meters Heat Move Meter 11 Power /\ Three Phase No. of Add. Meters /; (, v _ 1 1 ]0 i N Ate^ � ©" ELECTRICAL INSPECTOR ✓� `