5655 - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT _ 5655
ADDRESS
OA7S-/Do239 t,8g BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER' IN l». •�LQ,xA v.: A: PLAN CHECK VALIDATION
. NAME sG.J��T C>W QTy.a '• 'ELECTRIC PERMIT -'?., r Ey F�EE''l
CDM RAcrDR
NAME UTLETS-SWITCHES-RECEP 5.00/1.00
LOC.NO. LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGNS 6 PLAN CHECK FEE P.C.NO.
Ofl
NGINEE
C=1 Llc.No. bQ SIGNS TRANS. 3.00
ARCH,OR ENG, ^ / // shc��,� SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDRESS Of �L G 6
5;_ ZIP /$/ EMP.METER OR POLE INS. 15.00
APPLICANT'S 13 Q-7 S yy� p`.1r S.-a. ir MOTORS SEE FEE SCH.
ADDRESS J ✓ -
_dL '94,( SERVICE CHANGE 10.00
o Ie-i
Foo LICIiN$EU CONTRACTORS DECLARATION
v I hereby affirm Thal I am licensed under provisions of Chapter 9 ISSUANCE DATE
w G aar (commencing with Section 7000)of Division 3 of the Business and BLD ELECT. PLG. MECH.
F w z Professions Code,and my license is in full force and offset. El E] ❑
z o w- Li¢nsr Class Lic.Number
o z, � )rtn Contractor
. J U •I 7
-t J. WIUDING PERMIT
a o d
OWNER-BUILDER DECLARATION MISC.- REFER TOO -"'• NFORMATyION
w3 r I hereby affirm that 1 am exempt from the Contractor's License InJ/ALUATION S/FT.
al u• o a Law I..the following reason.(Sce,703 1.5,Businessand Professions PERMIT ISSUANCE 6.
Code;Any city or county which requires a permit to construct,alter, 4310(
2M ¢¢ 20 improve,demolish,or lepair any slraeare,prior to its issuance,also FLED.CONTR. LIC.NO. ELEC. ,
K O u requires the applicant for such permit to rile a signed statement that TOTAL PERMIT TO
n w he is licensed pursuant to the provisions of the Contractor's License
r z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of he a," '' Condos. (8 units)
Business and professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
F eo the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN SO VENT-WATER (EA.) 4.00
of not more Illan five handled dollars(5500)): •
Z 5 N. Hr..
❑ Las owner of the properly,or my employees with wagesasBACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sole Compensation,will do the work,and the structure is vol
intended or offered lot sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 R-1 8
Code:The Contractor's License Law dols not apply to an owner of
• property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 so.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mems are not intended oroffered for,cdc.If,however,the building GAS-EA.SYSTEM-111NC.40UTLETS 4.00 14,000
or improvement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or ice- RES IND CON PB Omer
prove for purpose of sale). INDUSTRIAL WASTE INTER. 20.00
as owner of lite property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
YlEnvd cuotractors to comtoact'the project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 269-2-2
contracts for such projects with a ccRLUR mP,)fiec,owd pursuant to
SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ lam exempt ander Sec.-- ,B.&P.C.for tlnis WATER HEATER W/VENT 4.00 7575lessen
Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that 1 have a certificate of Consent to alt'-insure. ZONING ENG.SITE NO.
or a cirtilican of Workers'Compensation Insurance,or a certil'ieA
copy thereof(See.3800.Lab.C). S3
Policy No. Company
OfJ CertiECJ copy is hereby lltnishrd. FIRE SPRINK ENERGY T-74
Z Z ❑ Certified copy is fled with we city inspection division. MISC.- REFER TO ORD. y❑ N❑ Y❑ N[]0
Applicant
FPERMIT ISSUANCE 6.00 FLOOD ZONE A.L.uc.
IY - CERTl14CA'1'li OI°EXEMPTION FROM WORKERS'
Lu > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y❑ N❑
CL 0 ('Phis action need not he completed if lite permit is for one TOTAL
:D Z hundred d01lars($100)or less'.)
U O 1 certify that in lite performance ol.the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,1 shall out employ any person in any manner so as to e
U become yto)" to the Workers Compensation Lows of Califo iu. BUILDING
O w N01 7/�3 ICAN a„ r ALTER OR ADD TO MECH. 4.00 1,260.$0
} ran NOl'IC:7 AI"LICAN'f: If,after making this Cerl ificate or
hs
♦- Z cmpton,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U Snell provisions or this putout shall he deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMICFEE 30.17
1 hereby affirm that there is a construction lending agency far EXHAUST HOOD(WITH DUCT) 2.00
the perRmnanec or the work for which this=it is issued(Sec. MICROFILM
3097,Civ.C.) h HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name MtI� HEATING UNIT(OVER 100,000B.T.U.)7.50 ELECTRIC
( Lender's Address SA it 1
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00
• information is correct. I agree to comply with all city and countyBOILER-pOMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and slate laws orbiting to building construction, and
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100.000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. -
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue agains said ity in consequence of the PERMIT ISSUANCE 3.00
nli f this p i MECH.CONT.' UC.NO. MECH.
G TOTAL TOTAL 1,290.67
Signature ol'Applicant/Contractor le .
OFFICE COPY
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
DATE S - 19 E of BLDG. PERMIT NO. S
t /n1 / ,�1
THE BLDG, LOCATED AT /6 'Y 1 '7 U a-r�G-� Nn
0
OWNED BY �..-r.ti. � �-r-�- �/ie-✓J .
v
HAS BEEN (CO`MP�EDI FOR USE AS D• u
(ALTERED)
I �
BUILDING INSPECTOR
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE 1
CITY OF CUPERTINO +{
f J� 7 e � 3
To P'Z � I,
You are hereby a�u'thhooriizzed to Connect electrical s-ervice/for
ice'..+•—
'OwnerorTenant �p—
At /G' ;;7 -7
No
11 No.of Wires Size of Wires Size of Switch
Motor Load Phase
` •_ Voltage 9 I
Heating Load K.W. Vohage
/ ( Light—1;0 Service Reconnect
No.of Meters l(I\ Henl 120 Three Wlre More Service
power ee Phase Move Meter jj
No.of Add.Meters I
Q•
ELECTRICAL INSPECTOR t
� I
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
s _
To
G You ore hereby authorized to Connect electrical service for
'Owner or Tena at
At
v'
No.of Wires Size of Wires Size of Switch
Motor Load _ Voltage Phase
Heating Load K.W. Voltage
/c Lghi I10_New Service �i Reconnect
No.of Meters Heat ]20 Three Wire More Service
No.of Add.Meters Power. (A Three Ph.,e- Move Mere,
ELECTRICAL INSPECTOR
V
ELECTRIC SERVICE NOTICE OFFICE COPY 1
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
L 19
To /s/ '`iI C_
You are hereby authorized to Connect electrical service for
'Owner ar Tenant � ri
C'�c"c�� —
v
No.of Wires Size of Wires Size of Switch J
o i
Motor Load Voltage Phase
Heating Load K.W. Voltage
( Light—]10—.New Service Reconnect
No.of Meters l(1\ Hear I20 Three Wire More Service
No.of Add.Meters Power \//�Three
ePhasee Move Meter
Q• ELECTRICAL INSPECTOR
U
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO �7
19
To
d You are hereby authorized to Connects elleccttri_calalpl service for
'Owner ar Tenant
No.of Wires Size of Wires Size of Switch
Motor Load*-- Voltage Phase
Heating Load K.W. Voltages
Light 110 New Service _ Reconnect
No.of Meters Heat 120Three Wlre More Service
No.of Add. Meters Powerfhire Phase Move Meter
&• ELECTRICAL INSPECTOR
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO 7
19
a
To
You are hereby awhonzed to Connnnje�ctt electrical service for /7
'Owner or Tenant p^ #- 7
t At
i Size of Wires Size of Switch
No.of Wires
b Motor Load'y Voltage— Phase
K.W. Voltage
Heating Load /
( Light
I10—New Service `i/L_ Reconnect
No.of Meters /
(l11 Ippihree Wire More Service
Heat
__ hr a Phase Move Meter
No.of Add.Meters Power
Ow ELECTRICAL INSPECTOR /,
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTORS NOTICE
c CITY OF CUPERTINO
tF To f 7 19
You are hereby authorized to Connect electrical service far
'Owner or Tenant ``/ pu{zw` �p /y' ,�j ®� -'7
AI •/�� 3 J� K J r-`--t'4-�ilJ e All l V/./'�•'o`-S /
9 No.of Wires v
� Size of Wires —_Size of Switch
Motor Land
Voltage Phase
Hearing Load_
K.W. Voltage
No of Meters L'9hr I IO�New Service
Reconnect
Hear I40�Three Whe
No.of Add.Meters More Service
QPowe. Three Phase
Move Meter
M
ELECTRICAL INSPECTOR
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
To O F r 5"— 7 sPI—
You are hereby authorized ra Connect electrical service far
'Owner or tenant 11.
( it.ey
At /G' z .3 s9�, V
No.of Wires J
Size of Wires —Size of Switch
Motor Load
Voltage -- Phase
Hearing Load—�_ K,W,
Voltage\/
No.of Meters ( tight I l0—New Service /` {
�— L(11 Reconnect 1
Hear "0_�Three Wire
No.of Add.Meters More Service
Power ee P
hrhase
Move Meter
ELECTRICAL INSPECTOR
i
OFFICE COPY i
ELECTRIC SERVICE NOTICE i
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO 19
To U . /� . �- C. �
y You are hereby authorized to Connect electrical service for
'Owner or Tenant
r At U
•
No.of Wires Size of Wires Size of Switch
e
Motor Load �
Voltage Phase
Voltage
Heating Load K.W. /f�/
Light
110_�New Service Reconnea
No.of Meters Heat
12pThree Wire More Service
No.of Add.Meters Power
T ee Phase Move Meter
ELECTRICAL INSPECTOR
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO �]
r J / 19
4
To � e
,f You are hereby authh.,iii,ed to Connect electrical service forr//-�
'Owner or Tenant (n�
16 ') 3 S' 1?-/0 9 .lJ
At
Size of Wires Size of Switch
No.of Wires
Motor Load
Voltage --KWPhase
. , Voltage
Heating Load \`
He110_—New Service �` Reconnect
/ ll rhervice
_
N0.04 Meters °, More S1201[hree Wire
7let,Phase Move Meter
No.of Add.Meters Power
�•
ELECTRICAL INSPECTOR �/
BUILDING INSPECTOR'S.OFFICE
sids.Dept.
CITY OF CUPERTINO otr«Cory
❑ Backflow Device Sanitary Permit No.
Sewer Connection Plumbing Permit Na. ��ss
'O Plumbing Final' 'Lot No.
Owner or Tenant + ��'�� -- ��•: ". '-R="`
At 45F Z 5•y d/.r s. i 1•yJn . r
Tract '
Date Connected c. /�� — �" ' 19,V�lDateFinal) S,',/j 19`4- •
PLUMBING INSPECTOR
I
BUILDING-INSPECTOR'S OFFICE •
• Bldg.Dept.
CITY OF CUPERTINO OIHn Copy
❑ Backflow Device : Sanitary Permit No.
D�Sewer Connection Plumbing Permit No. •�G � .
.21r Plumbing Final Lot No. �
�.
Owner or Tenant [�/./�� .n+' `-:�_ .• ^) '.. .: /a . :+ .
_
At //1 7.44 K!a JiY •w /A• r ��
Tract
Date Connected 19 �spate Final
o" '
PLUMBING.INSPE TOR'
�I. BUILDING•INSPECTOR'S OFFICE:... Bidg:DeP,.
CITY OF CUPERTINO Office Copy
Backflow Device
Sanitary Permit No:
❑ , ,
/ •• PlumbingPermit No. 42., S-r
D Sewer Connection
0 "Ry '!
•Qr Plumbing Final. '• : Lot No: .. .�
Owner or Tenant -�*"'�e; �ft.'""F�/� • 'n -
Tract
19 ��• DateF.inal
Date Connected
Oo • PLUMBINGINSPECTOR
�I BUILDING INSPECTOR.'S OFFICE' B1dg.Dept.
CITY OF CUPERTINO Office COPY
❑ Backflow Device
Sanitary Permit No. 1/4 31
r
Plumbing Permit No. G.SS
� 'Sewer Connection �. � .
/ Lof No. �� 7
w❑ Plumbing Final. ,• . rJ
r:
Owner or Tenant - .
At—
Tract
Date Connected 1.9� 'Date.Final
PLUMBING INSPECTOR
w
it BUILDING INSPECTOR'S OFFICE Bldg.Dept.
office Copy
CITY OF CU
PERTINO
❑ Backflow Device , Sanitary Permit No.
Or 31
Plumbing Permit No.
O' Sewer Connection _
Lot No. Rt'�. ' '
M"Plumbing Final. •• • - a
IOwner or Tenant - •
At
Trdct
19
Dote Connected �l 19 X yDate Final—
PLUMBING INSPECTOR
:I OM
I •
BUILDING INSPECTOR'S OFFICE '. Bldg.Dept.
CITY OF CUPERTINO office Copy
• ❑ Backflow Device Sanitary Permit No. //4-5- 31
❑' Sewer Connection Plumbing Permit No. 574'5'�
Lot No.
7
. .
Plumbing Firial -
Owner or Tenant ti �� R+' /��' 't. `a►
Tract .
Date Connected Aa 19L!ZDate Final �� 1945
4
+ PLUMBING INSPECTOR
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
S— '7 )q�_S BLDG. PERMIT NO. G
DATE p 7�pd�f
THE BLDG, LOCATED AT �n��-2y--7
i OWNED BY p
(COMPLETEDI' ,S� D u
HAS BEEN IAbTEREDI' FOR USE AS
(
i
r'
I
_0-
BUILDING INSPECTOR
d
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO S ,`�,
DATE —7 . I9 r BLDG. PERMIT NO.
I'(n�
THE BLDG. LOCATED AT
j OWNED BY
I HAS BEEN (COMPLETED) FOR USE AS S FP U
(ALTERED)
{r
1
1
1, p.
BUILDING INSPECTOR
I '
I, CERTIFICATE OF COMPLETION
. BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
DATE — 19'f5 BLDG.��PPERMITNO.. �'S�'o�p 7
THE BLDG. LOCATED AT-
-7- 1:,
T O 1 3S dDQ^^— , ^ o
5
$ OWNED BY ^"`- /
HAS BEEN (C MPL ETE DL FOR USE AS 5: F. b. L4
1 (ALTERED)
i
i
,
t OM
S
BUILDING INSPECTOR
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
S- 19 �� BLDG. PERMIT NO.— S-6 SSf
DATE
THE BLDG. LOCATED AT
OWNED BY
v
HAS BEEN (CQMF FOR USE AS 1A .
(Aff FRED)
i
i
pM
c
BUILDING INSPECTOR
i
CERTIFICATE OF COMPLETION
{ BUILDING INSPECTOR'S OFFICE
I! CITY OF CUPERTINO
DATE s- 7 19=. BLDG. PERMIT NO. pp S6 � S
RW,"
THE BLDG. LOCATED AT v
OWNED BY
ICOMPLET DI S- . F. l> LA-
N l .
HAS BEEN FOR USE AS
AL'T REDI,.
If
iDUI v NG INSPECTOR
11. �.. 46,
( BUILDING INSPECTOR'S OFFICE .' :'` Bldg:Dept. f.
J CITY'OFCUPERTINO Of6cacoPv
O
Sanitary Permit No.
Backflow Device
J ,
Plumbing Permit No. .7 '
ElSewer Connection
�-. ..
/�Lot NO.
� Plumbing
Owner or Tenant ^ �
y At
Tract
/A /..� 19 :r°�•Dote Final "%S-- • 19,�� `
Dot'eConnected --
1 �� PLUMBING INSPECTOR
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
CITYOFCUPERTINO
19 O �� BLDG. PERMIT NO.
DATE
, THE BLDG. LOCATED AT
OWNED BY
(�COMS LEE" FOR USE AS
y HAS BEEN AL'TEREDI
1
BUILDING INSPECTOR
i II
l CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
1
DATE s^ . 19-EZ BLDG. PERMIT NO.
boa
j THE BLDG. LOCATED AT 37
i
OWNED BY
HAS BEEN (LOMP FOR USE AS LA '
(ALTERED)
i
t
i OM
BUILDING INSPECTOR
BUILDING INSPECTOR'S OFFICE
{f Bldg.Dept.
CITY OF CUPERTINO office Copy
❑ Backflow Device Sanitary Permit No. //-•'M I
Sewer Connection ' . Plumbing Permit No.
t -
O'Plumbing FinalLot No. res. -7
Or
Owner or Tenant ��•'++c- �f'.• 12A
At
Tract
Dote Connected ifs 19y'✓'Date Final 19•
t i•
:t� e•
O° "
PLUMBING INSPECTOR