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11624 POST THIS CARD NEAR-FRONT OF BUILDING PFNMIT NUMBER ' �. .. CITY OF CUPERTINO 11624 INSPECTION DIVISION 1 JOB INSPECTION RECORD JA 'ei /(/�/V/ PERMIT EXPIRATION JOB ADDR ESS /�J �LUNIT# LOT# " +�k RMIT EXPIRES IF WORK owNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU= FOUNDATION - ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION} PERMIT VALIDATION- 1' PREGUNITE - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB P/7,(�. PLUMBING - /aLo ELECTRICAL • ISSUANCE DATE - MECHANICAL - BLDG. ELEcr. P MEc I. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING ERMIT WOOD FLOOR INFORM TION'.. VALUATION_ $/FT. PLUMBING ' - MECHANICAL PERMIT TO ' " ELECTRICAL FRAMING �� ��_ ✓G" STORIES TYPE CONSTR. INSULATION OCCGROUPRES.UNITS . PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FT.FLOOR AgEA TOTAL ACREAGE Ills ROOF DIAPHRAGM BUILDING USE �� Nd •� . _ fr�'�rf-� y(!A / , �� HES IND CON PB, 00e• APPLY NO ROOFING UNTIL ABOVE HAS B IGNED / ❑ ❑ ❑ 0 0 ASSESSORS PARCEL NO, ROUGH PLUMBING ' THACT NO PARCEL NO, GAS TEST MECHANICAL ELECTRICAL FINALSS l DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN * ZONING - ENG.SITE NO. " INSULATION - PLUMBING GAS FIRE SPRINK ENERGY T30 MECHANICAL v ❑ N� Y ❑ N� COVERNOWORKUNTILABOVE-HASBEENSIGNED` HEATING , LATH-INTERIOR ELECTRICAL FLOGO ZONE A,L.U.C. LATH-EXTERIOR FIRE DEPT. 0 NE] y IN SHEETROCK GRADE - FEE SUMMARY SHEAR INTERIOR - - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS - . BUILDING FIREWALLS ELECTRIC PLAN.CHECK GAS ` FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEENiSfIGNEO OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST.TAX., IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ��, PERMIT NUMB11624 ER 'BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT ADO "n_ v, // O ? Sc.. e--h � ,B BUILDING -ELECTRICAL-PLUMBING-MECHANICAL , OWNER'S / I PLAN CHECK VALIDATION " ME //j)-��O TY. ELECTRIC PERMIT FEE pgCRT IIJT PHONE C NTRACTOR'S NAME _ /�� '•�,� UTLETS'-SWITCHES•RECEP 10.00/1.00 E` W• J-/y�Llc.rvo �p LIGHTING FIXTURES 10.00/1.00 CONTRACTOR' PPLIANCES-RESIDENTIAL 4.00 PRESS ( X Z NE ��J,J PANELS 10.00 DATE OF APPLICATION 'AR cmTECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No, SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 n APPLICANTS MOTORS SEE FEE SCH. ADDRESS `✓� SERVICE CHANGE 20.00 ^11ta yjLLO w 00 LICENSED CONTRACTORS DECLARATION < uu I hereby affirm that I am licensed under provisions of Chapter 9 ISSILIAeft N < (commencing with Section 7000)of Division 3 of the Business and BLDG. L T. PLG. MECH. r m z Professions Code d my license is in full fores,apd • c. i o w- License Lic.Numb om \ ❑ ❑ ❑ ❑ o w r Date _a�_ContractmW Q L, J BUILDING PERMIT u: ¢w u OWNER-BUILDER DECLARATION INFORMATION w1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION SIFT. F a- O a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 r Code:Any city or county which requires a permit to construct,alter, 2 ¢ ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.NO. TEL EC.. i w m LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License `i Law(Chapter9(commencing with Section 7000)of Division 3 ofthe F i o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE f31G ¢ f � the basis for the alleged exemption.Any violation ofSection 7031.5 TORIES TYPE CONSTR. by any applicant for u permit subjects the applicant Ica civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not marc than five hundred dollars(5500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 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 improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or int RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of Ile property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date .WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. .WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a Certificate of Consent to self-insure, ZONING or a certificate of Workers'Compensation insurance,or a certified ENG.SITE N0. copy ther Lab.C.). e �of�S Policy Nq'KT!• s mpany.SNEP-1Yx1/1L- H O H' Certif, dcopy is hereby nished. FIRE SPRINK ENERGY T49 Z Z ®Cert'i c Is filed ijjty pI c'I inspection division. MISC.- REFER TO ORD. Y❑ N❑ y ❑ No O Applicant a Fy CERTIFICATEPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.O.C. W W > GOMPE EXEMPTION FROM WORKERS'NSAI'ION INSURANCE. PLG.CONTR. LIC,NO. PLG. d O (This section.need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ =) Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I. mit is issued,I shall not employ any person in any manner so as to U become subject to the Workeri Compensation Laws of California. O w BUILDING a y Date Applicant ALTER OR ADD TO MECH. 5.00 } N NOTICE TO APPLICANT: If,after making this Certificate sa Ex- emption, .x- pmvision you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK such pons of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10,OOD C.F.M) 4.00 CONSTRUCTION.LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,CWC.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address . . I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building Construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize 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 m save, indemnify and keep harmless the City of MISC.- REFER TO ORD. C Ftino against liabilities, Idgments, rosts and expenses which CONST.TAX ay p any way accrue eg est said Cit in consequence of the PERMIT ISSUANCE 10.00 anti gof[h�spermit. I e� MECH.CONT. LIQ NO. MECH. TOTAL ♦��yf�f���CpQ� TOTAL' / Signature of Apphcan/Contractorignature of /Contractor )etc . .._... OFFICE COPY 'N. r. ~r HOSKINS ENGINEERS INC. FILE 509 SOUTH BASCOM AVENUE SAN JOSE. CALIFORNIA 9512B �GC � (408) 97 9 -7800 r DJuly 17 , 1986 AUG ( 986 BLDG. INSPECTION DEPARTMENT CITY OF CUPERTINO Dwayne Serrano I... W. Kaye Company Post: Office Box 427 Sranta C].ara , California 95052 in accordance`with your request,�I_ have_ examined . tile dlua.am roof. beam at Johnsons Cuiier.L.i,no ,Fl.ower_s , ,10285 DeAn•r.e Bayll,.__1` in Cupertino, -California on July-']:S ; :1:9t3G. The Purpose c f. the visit was to determine the extent: of damage due to the recent fire at this .Location . further. , the examinat:i.on was limited to the glulam beam as it is my undersL-andi.ng based on discussions with you that the remainder of the roof: structure was going to be replaced . The glul.am measured 6-3/4 inches wide by 24 . 00 inches deep. The beam spans 45 . 0 feet : The contributing area to the subject beam is 17 . 25 feet in width . The beam was slightly charred approximately ].7 feet from . the rear support . Only one side of the beam was affected . The bottom side of the beam was unaffected. The charting was scraped with a knife to determine its thickness . At the worst point, the charring was approximately 1/16 inch in thickness . This represents an approximate one percent reduction in the structural capacity of: the beam. Further, the maximum charring did occur at the point of maximum stresses . Therefore , it is my opinion that it is not necessary to replace this beam. further, it is my judgement that this beam may remain in place and should perform adequately for its intended purpose . If you have any questions regarding the above, please do not hesitate to contact me . Yours truly, ?J. Walter Hoskins , President JWH/mdh APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY " BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT n�� TDDRESS L BUILDING- ELECTRICAL-PLUMBING-MECHANICAL 4.30 • O ER'sIas PLAN CHECK VALIDATION NAME /.rte OTY. ELECTRIC PERMIT FEE \,/ PHONE ONT ACTOWS w NAME / UTLETS-SWITCHES-RECEP 10.00/1.00 Q {y C.No. IGHTING FIXTURES' 10.00/1.00 a CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 COORESSNTRAC PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER OC.NO. SIGNS TRANS. 3.00 ARCH.OR ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS IIP EMP.METER OR POLE INS. 20.00 Ato seMOTORS ' S CH. DORE5a SERVICE CHANGE J 20. 0 ( of w o o LICENSf:D CONTRACTORS DIiCLARATION u U I hereby affirm that I am licensed under provisions of Chapter 9 Q ISSUANCE DATE r 4 e- (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. ry i Professions Code,and my license is in full force and effect. z ❑ ❑ El m License Class Lic.Number Q N O Contractor Q y f j Date BUILDING PERMIT IF w u OWNER-BUILDER DECLARATION INFORMATION E: 3 uA.r I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD Fun Law forthe following reason. 7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. v, Code:Any city or county which requires a permit construct,alter, d Q Q at 0 Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. yLIC.NO. ELEC. .y `_T i E o u requires the applicant for such permit to file a signed statement that N 6Z f�4i, TOTAL CJ U PERMIT TO w $ he is licensed pursuant to the provisions of the Contractor's License � 7 Hzi Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe / a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE E x o STORIES TYPE CONSTR. Tic I-$ the basis for the alleged exemption.Any violation of Section 7031.5 e. by any applicant for a permit subjects the applicant loo civil penalty gLTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 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 improves thereon,and who does such work FIXTURES-PER TRAP 5.00 -Co.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve. meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES INC CON PB OMer prove for purpose of sale.). INDUSTRIAL WASTE I NTE R. 30.00 ❑ d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 -ASSESSORS PARCEL NO. and n owner of Code:The Contractor's License Law does not apply to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor)sl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec. - ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-Insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,nr a certified copy the ( e 3 00,Lab.C.)�.rt ,� Policy N Company O ❑ XRrhrICATE isI byf gtsheJ. FIRE BPRINK ENERGY RP9 Z Z ❑ y fl J h the cit spwtion division. MISC.- REFER TO ORD. O AppliY❑ N❑ Y ❑ N❑ H rnPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. 1 017 EXEMPTION FROM WORKERS' LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. y❑ N❑ v ❑ N[_]1 O (This section need not be completed if the permit is for one TOTAL ::) Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- CITYMECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as m O W hecome subject to(he Workers''Compensation Laws of Califonsia' BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 >_ tail NOTICE TO APPLICANT: If,after making this Certificate of Ex- )... Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1010000EM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097;CIv.C.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC (3 Lender's Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county BOILER-CONT(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,00OBTU)SEE FEE SDH. MECHANICAL above-mentioned arty for inspection purposes. (We) agreesa i damnify a harmless the City of MISC.- REFER TO ORD. Cupertino incl 1` i' es,jud ants c is and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in y KV a ago' said in consequence of the an' t i MECH.CONT, LIC.NO. MECH. TOTAL TOTAL gn lureof Appmant/Co tr or Date OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LOING PROJECT I DENTIFICATI ON - PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRES ,s 5 09640 BUILDING-ELECTRICAL-PLUMBING ECHANICA i rOWrvER'B PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE L _rP_ID PHONE CONTRACTOR'S NAIME /' a UTLETS-SWITCHES-RECEP 10.00/1.00 m.No. 37 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ' MC) p �' // Q LLZ-A ZNE '3 PANELS 10.00 DATE OF APPLICATION A CIOTECT PLAN CHECK FEE P.C.NO. OR - 1 PANELS (OVER 200 AMP) 20.00 ENGINEER N uc.No. SIGNS TRANS. 3.00 ARCH.OR RESS ENG SPECIALCIRCUIT Fj,QQ PERMIT VALIDATION ZIP MEMP.METER OR POLE INS. 20.00 n Avvucnr rvs MOTORS SEE FEE SCH. AO RCA / `- SERVICE CHANGE 20.00 ,�/n woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 /!ol"k" a u U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE vHi<w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. Hoz Professions Cod�(pn y cense is in full fore n f ct o i L o License Class L /� Lic.Number ❑ ❑ ❑ Date Contractor y f i BUILDING PERMIT 2 w a OWNER-BUILDER UF:C ATION INFORMATION:-- woaU MISC.- REFER TO ORD g u H I hereby affirm that I am exempt fro the ConUaclor's License VALUATION S/FT, w u O a Law for the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 W0 Code:Any city orcounty which mquiresu permit to construct,alter, Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. in DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w S m he is licensed pursuant to the provisions of the Contractor's License A^ /� Fa, Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthe 114 (..�" , 14 O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE rc H the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES - TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(8500).1: ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 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 improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE gh•' mems are not ownemployees,for Sale.If,ho ever,hat the improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 mems are not intended or offered for sale.If,however,the budding "nou or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose ofsale.). RES IND CON PB Omar I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sea 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed Pursuant to SEWER-SANITARY-STORM EA.200fU10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec,-,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm(hat I have a certificate of consent roself-insure, ZONING ENG.SITE NO. or a ce ificat of Workers'Compe Insurance, r u certified copy @'y� C.Irfoiny r��r cLaIC olic a Company J) liGed copy is he ab FIRE BPRINK ENERGY TQ4 Z Z ❑ Cert d copy is Glc wi he city, inspection division. MISC.- REFER TO ORD. O Applicun Y ❑ N❑ V❑ N❑ ~ H PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. CC CE FIC OM OP I ATIO TINS FROM WORKERS' WCOAIPF:NSATION INSURANCE PLO.CONTR. LIC.NO. PLG. CL a (This section need not be completed if the permit is for one TOTAL V❑ N❑ Y❑ N❑ D Z hundred dollars IS 100)or lass.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mil is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. 0 i Date Applicant ALTER OR ADD TO ME 4�. Ist 5.00 'BUILDING } m NOTICE TO APPLICANT: If,after making this Certificate of Iix- ? emption,you should become subject to(he Workers'Compensation APPLIANCE PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE I hereby affirm that thereisis a construction lending agency for EXHAUST HOOD(WITH'DUCT) 5.00 the performance of tlnG w*r far which This permit is issued ISec. MICROFILM the performance NF/(j(� _ HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT IOVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address .1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and 130ILER-COMP(3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP i0ser 100,000 BTU)SEE FEE SCH, MECHANICAL (!" above-mentioned property for inspection purposes. '(We) agree (o 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 against said City in consequence of the PERMIT ISSUANCE 10.00 grant of[his permit. MECH.CONT. LIC.NO. MECH. -� TOTAL/((,�^/m TOTAL Si re o App cont/Contractor Date OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER aDILDING • APPLICATION & PERMIT 11872 AOORE`S `/�- f1I� IDS S. .1V11w E Aw-zA- Uui b. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S _ PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE Ll.{}ILIQ PHONE CONTRACTORS NAME UTLETS-SWITCHES-RECEP 10.00/1.00 1AmBla 'uc.NO.lO 63 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS 01 PPLIANCES-RESIDENTIAL 4.00 �•j �QfWI 1 11 444hoNE -6?, PANELS 10.00 DATE OF APPLICATION ARCHITECT - - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.NO. SIGNS TRANS. 3.00 AENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESSDDRESS ZIP TEMP.METER OR POLE INS. 20.00 ADDRESS r$ MOTORS SEE FEE SCH. lI ) SERVICE CHANGE � 20.00 D o O LICENSED' CONTRACTORS DECLARATION /�3l• it to I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE Na i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F m 4^L Professions Code tg license is in full r' ebf t ❑ 2 o w`- Licens Ce los_ b0 Lie,Numhc ❑ O r D Date- Contractor 3 BUILDING PERMIT ¢ a w ¢ OWNER-BUILDER DECL RA 1 - o A " MISC. REFER TO ORD INFORMATION w3 LL y I hereby affirm that 1 am exempt from the Contractor's License .- VALUATION $)FT. LL o ¢ Law for the following reason(Sec.7031.5,Business andd Pr Professions PERMIT ISSUANCE 10.00 � - Code:Any cityorecunty which requires a permit to construct,alter, Q W Q 0 Improve,dem011sh,or repair any structure,prior to Its Issuance,also ELEC.CONTE. LIC.NO. ELEC. w -O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO a w m he is licensed pursuant to the provisions of the Contractor's License flL p rzr Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe ( eP/ - ¢ Business and Professions Code)or that he is exempt therefrom and QTY'. PLUMBING PERMIT FEE It t$ the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR. i3 by any applicant for a permit objects the applicant as civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(5500).1: ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does nut apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 mems are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did net build or in,. GAS IND CON Pe Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply - to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec..,BAP.C.I'or this WATER HEATER(W7tV.ENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE No. WORKHRS'COMPENSATION DECLARATION WATER TREATINi COUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified - o themof(See 3800,Lab.C.). fs^nRY l+t1U Policy No. Company h-'}sl All C ` Q ❑ Certified ropy is hereby furnished. Y FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. O / Applicant MISC- REFER TO ORD. Y❑ rv❑ Y NEI = W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 Q FLOOD ZONE A.L.U.C. LU COMPENSATION COMPENSATION INSURANCE. , PLG.CONTR. LIC.No. PLG. / 1 Q (This section need not be completed if the permit is for one TOTAL (O Y C] N❑ Y❑ N❑ Z) Z hundred dolhrs($1000orlass) U O 1 certify that in the pa,fommm •of the wor for wRch this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ' y pe so i ny manner sit as to U beco sub' to Workers'C pe all .o alifo ia. y Date�� Ph' :Dt < ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTI TO APPLICANT: IL a m i Lhi ,Ertl ice 'x- F Z emplion,you should became subject to the WOr IS penswimt APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forlhwi comply with' FEE U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10A0DC.F.M,) 6.00 SEISMIC FEE 1 hereby affirm that (here is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have read this application and stale that the above VENTILATION FAN.(SINGLE) 4.00 information is correct. I agree to comply with all city and county - PLUMBING aNinace ns and state laws relating to building construction, and BOILER MPOH.RoF100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 1D0,DO0 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. ( ) agree to save, indemnify and keep harmless the City or MISC. REFER TO ORD. Cap- ino against li ililies,jlYlgmenls,costs anJ expenses which CONST.TAX may atApplic,UVContra wa a true against said City in consequence of the PERMIT ISSUANCE 10.00 grant gois 1MECH.CONT. LIF NO. MECH. ��� �� � TOTALTOTAL Sig rDate . OFFICE COPY