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12362P1► OFFICE COPY �11 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPE.RTINO PF.R.MITNU .MSER 1236.2 INSPECTION DIVISION JOB INSPECTION RECORD „ ERMITEXPIRATIQN i 0356 ,. < s- , ; JOB ADDRESS U IT# LOT# — • PERMIT EXPIRES IF WORK OWNER TOR IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. 1 C N DA INSPECTOR 1 SPECTION RECORD FOUNDATI _q ���al / "— , l Co�� rSl.+i�V UFER PREGUNITE - 'j— y-j� aU X%V* 'W V4,(( PERMIT vnuonnory /�E"D .""AATE ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED c(s"['..�L7-,I,yL.�.e, bT �o wie -'r ev✓ evOrkPLUMBING UNDERGROUND/SLAB � S�l,\�\ .i0. C9J OXt4pTW \ELECTRICAL MECHANICAL - F'}- _ tC / 8�yt B D E ECT. PLG. M CH. El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED y -/ f _ 8'% �S/ /?L{4 Kouy b,�y BUI DING . `Js� TION I FORMATION WOOD FLOOR L JrLN '$/FT. PLUMBING pfj Q/ •••�/l Ltd / �Y-j7 i1A{ /i%LAy..e..;.RM MECHANICAL' ELECTRICAL - N a 9 /z/'� y,�, / . AV PERMIT To /N7 ids FRAMING -///, 5"a& INSULATION Y-L7g� t -d W..e,- CD�p ) 3etil-Flt.• CiaTv�-Pf�1+Ac ick sroRles TYPE corvsrR, qip OUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF 'O,'� S/� SO. FT. FLOOR AREA TOTAL ACFEAGE DIAPHRAGM 'BUILDING USE ' RES IND CON PB One, cl 0 El 0 El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST t`n.>\� /y� r TRACT No. PARCEL No. MECHANICAL ELECTRICAL-- FINALS DATE INSP. ACC.OATE ACC. FILE NO. FRAMING SAN * I.- INSULATION � PLUMBING ZONING ENG. SITE NO. GAS • MECHANICAL- FIRE SPRINK "F] ENERGY T 2 "o COVER NO WORK UNTIL ABOVE HAS BEEN SIGN HEATING LATH -INTERIOR ELECTRICAL FLOOD ZONE ° ❑ NE] . A.L.0C. Y ❑ NQ LATH -EXTERIOR FIRE DEPT. - SHEETROCK' GPtAQE FEE SUMMARY SHEAR INTERIOR B U I LDIN BUILDING r ;moi` ' L SHEAR EXTERIOR �TEMPOR RY APPROVALS' FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE Y``( OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ' I MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0. PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL — SEE PERMIT -FOR EXPIRATION DATE — CONST. TAX IMPORTANT! TOTAL PLEASE READ REVERSE SIDE BEFORE ' CALLING FOR FINAL INSPECTION. OFFICE COPY 4ftLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY I BUILDING PROJECT IDENTIFICATION' APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 1 Z36Z SUILDIW' ADDRESS^ S OWNER' "AME le A10/ ,PHONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION G Q �T 167 / / �� s6s 9y CONTR T 's / If,00/1.00 UTLETS-SWITCHES-RECEP 10 :r e CLIC. No. L DATE OF APPLICATION LIGHTING FIXTURES 10.00/1.00 CONTRACT ADDRESS ,j proNE�/ 3% -Q APPLIANCES • RESIDENTIAL 4.00 PANELS 10,06 ARCHITE oRCT/PD / S - ENGINEER / pp Lc, No PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. N0. ' SIGNS TRANS. 3.00 ARCHNO SPECIAL CIRCUIT 5,06 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 S S ZIP I 1 ppucarvrs� ADD R s / MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 C DATE U 19pIBBDAN/LE E LICENSEDCONTRACTORSRsTONfTO 1 hereby affimthat II am licensed der pro s 9 r I., (commencing with Section 7000) of Division 3 of the Business and Professions Code, arqrmy license is in full force' ( License Ca LeNumb n e f t BLDG. I ELECT. 00 PLG. MECH. 13 11Dale Contractor BUILDING PERMIT f irg - NERUBUI LDER DECLARA ON I hereby affirm that I am exempt from the Contractor's License Law forth¢ followmgreason.(Sec. 7031.5, Business and Professions Code: Any cityorcounly which requires a permit to construct, oiler, improve, demolish, or repair any strucl are, prior to 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 Law(Chapter 9(commencingwith Section 7000) of Division 3 ofth¢ Business and Professions Code) or that he is exempt therefrom and INFORMATION MISC. - REFER TO ORD VAqLUAT�IOs�Ns /��O W� PERMIT ISSUANCE 10.00 .ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of5ection 7031.$ 1 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN -WATER IEA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (See. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve= mems are not intended or offered for sale. If, however, the building F IXTUR ES - PER TRAP 5.00 SD. FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6.00 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- prove for purpose of sale.). C O I, as owner of the properly, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE REB IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIALWASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. , contracts for such projects with a conlractods) licensed pursuant to the Contractor's License Law. SEWERSANITAR V -STORM EA. 200ft/10.00 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 ACL. DATE ACC. FILE N0, WATER TREATING EQUIP. 5.00 WORKF-RS'COMPENSATION DECLARATION '/ 1 hereby affirm that I have a certificate of consent tgs�lf-insurgr. or a certificate of Workers' Compey�anon In e, q/rAGl rtifi�il copy thereof(Sec. 3800, r/e't4ala ' Policy No. Company ZONING ENG. SITE NO. FIRE SPRINK v ❑ No ENERGY T-24 Y ❑ N❑ ❑�Q¢rllfied cD is lt¢reb furnished. B' c:r: t� c y is fde with ci t)�/}�' PccIi_cIiO division. Applicant / _�6M MISC. REFER TO ORD. CER FICA LOFT M R w KERS' OA PERMIT ISSUANCE 10.00 I FLOOD ZONE A.L.U.C. PLG. CONTR, LIC. NO. rLG. COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y N ❑ C]❑ Y N ❑ hundred dollars IS 100) or less) I certify that in the performance of the work for which this per, mit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. Date ApplicantALTER OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ,3 fG�� eftV OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- _ APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.NL) 4.00 PLAN CHECK FEE emption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (OVER 10MC.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY 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. 3097, Civ.C.) t MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC I 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 ordinances and slate laws relating to building construclion, and PLUMBING BOILER -CORM (3 H. P.or100,000B.T.U.) 6.00 801 LER-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. (We) ire to save, indent���gyl�fy and keep harmless the City of Cuperl' o a 'nst Babili 'fs, {rilgments, costs and expense which may i 1 y Secy a nst said City in cons quen of the granti 1 f l CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Signiobbre licant/Con ractor Dat OFFICE COPY t AA)LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDINO PROJECT I DENTIFI T APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 12059 aO ADORE DRE'op OWNER'S - 'PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE NON BS 3 / UTLETS-SWITCHES-RECEP 10.00/1.00 IGHTING FIXTURES 10.00/1.00 j/ A,- - foN, R' RESS A E55 PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION R TECT p 2 No. (/dam PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR NG. ADDRESS 6.00 SPECIAL CIRCUIT S PERMIT VALIDATION TION/`�/ TEMP. METER OR POLE INS. 20.00 ZIP O APPLICANTS ADDRESS��( MOTORS 'SEE FEE SCH. SERVIC HA G 20.00 . LICENSIA CONTRACTORS DECLARATION'PAID I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, }wense is in full for License Class V Lia Number DJI Om octo ISSUANCE DATE r) QS r BLDG. ❑ ELECT. PLG. MECH. ❑ ❑ y;, t ^' BUILDING PERMIT INFORMATION O NER-B DER DE L RAT1 N I hereby affirm that I am exempt from the Co tractor'sOssions Law for the fallowing reason. (Sec. 7031.5; Business and Pro Code: Any city or county which requires a permit to construct, alter, Improve, demolish, Of repair any structure, prior t0 its Issuance. also requires the applicant for such permit to file a signed statement that he is licensed pursuant 1O the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and Q MISC. - R PER TO.ORD - VALUATION $/FT. PERMIT ISSUANCE 10.00 /0 - E CONTR. N0. ELEC OTY. PLUILING PERMIT -.----- FEE' - PERMIT TO STORIES TYPE CONSTR. the basis for tile alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant too civil penalty' of not more than five hundred dollars (55000.): ALTER -DRAIN -WATER IEA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, GOND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to anowner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsare not intended oroffered for sale, If, however, ole building FIXTURES - PER TRAP 5,00 SO, FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the Nowner- builder will have the burden of proving at h e did not build or im- prove for purpose of sale.). CI 1. as owner of the property, am exclusively contracting with - . . GAS • EA. SYSTEM OVER 4 (EA.) 200 BUILDING USE RES IND CON PB Omar 13 El ❑ El1. INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who ILAWN SPRINKLERS- 1 INC 6 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts l'orsuch projectswith a contractors) licensed psysuant to .the Contractor's License Law. - SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. Cl. I am exempt under Sec.., B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Dam WATER SYSTEM - 5.00 ACC.DATE ACC. FILE NO. �j7 WATER TREATING EQUIP, 5.00 1V6.ORATION 1 hereby affirm that I have a certificate ofemosent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE N0. copy thereof (Sec. 3800, Lab.C.). Policy No. Co from, FIRE SPRINK Y N ❑ ENERGY T$4 - v N ❑ ❑ ❑ Certified Co by i d. Cer -Alklicant is the c' ins on division. MISC. - REFER TO ORD. CE IFICATEOFF 'MPTION' WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPEN TION IN ANCIL (This section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N ❑ hundred dollars (S 100) or less.) 1 certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compenmlion Laws of California. Date ApplicantALTER NOTICE. TO APPLICANT: If, after making this Certificate of IN. QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 FEE AIR HANDLING UNIT (OVER 10p00CEM.) 6.00 SEISMIC FEE .CONSTRUCTION LENDING AGENCY I hereby affirm that tlu�Wq a construction lending agency for the performance of the why s pernsit is issued (Sec. 3097, Civ.C.). %.� EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,0008.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Irfo Lender's No Lender's Address I 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 ordinances and state laws relating to building construction, and PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 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 save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may ' an ay rue a I said City in onNuance of the PERMIT ISSUANCE 10.00 gra it. is it. MECH. CONT. LIC. NO. MECH. TDTAL - TOTAL SidnaturesufAliplicAt/ t t Date 3 19,�ISE COPY �J W O Z_z P 2-14 jr LU _ ao Uo LL U Oa } So F- E A I.* ARPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LD1 NO PROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING- ELECTRICAL- PLUMBING - MECHANICAL PERMIT NumBER- 12529 RDILpINC / os ADDRESS e A..2AVb. OWNER'S PLAN CHECK VALIDATION NAME 1 A•e- PHONE QTY. ELECTRIC PERMIT FEE CONTRACTOR's - NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 P1Cc.H' LIC. NO. DATE OF APPLICATION' CONTH ADORE Sam rdc� ,. AOORE55 R (( qq ' / " / u• 7A _V 11L PRONE�c� p/0/ APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 AflcwrecT OR ENGINEER Llc. No. PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADD Ess etc. SPECIAL CIRCUIT 6.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP APPLICA ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 _ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3.f the Business and Professions Codg�an m license is in full fur a f,( rpt. License Class_ - Lic. Number_ +S b._ - BLOC. ❑ ELECT. ❑ PLG. MECH, Tr ❑ Dale - Contractor TLOL"` ' BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirns that 1 am exempt from the Contractor's License Law l'orthe ityfollowing reason. (h requires a Business hocnd Professions Code: Any city or county which requiresa permit locanstrucl, alter, improve, demolish, or repair any structure, prior to 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 Law (Chapter 9 Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and INFORMATION MISC. - REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO ' ,F _ , L C � � QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollars (5500).): ALTER -DRAIN -WATER (EA.) 5.00 O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 Oce. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds of 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 meals are not intended or offered for sale. If, however. the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 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- prove for purpose ofsale.). ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. licensed contractors to construct the project (See. 7044, Business and Professions Code: The Contractor's License Law does out 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 conlmctods) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200tt/10.00 TRACT NO. PARCEL NO. ❑ tont exempt under Sec. ,e.&P.C. for this reason WATER HEATER W/VENT. 6.00 .Owner Data WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thenuf(Sec. 3800, Lab.C,). `) yl. M ' Policy No. CmuPaay- 1i:4k Y ❑ Certified copy is hereby furnished ]( Certified copy is filed Ih f -it in etion division. Applicant . RTI FICA 'li l- EMPTI PROM WORKERS' FIRE SPRINK y ❑ N❑ ENERGY T-24 y ❑ N❑ MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 FLOOD'ZONE A.L.U.C. PLG.CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N❑ Y ❑ N❑ Y MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per. mit is issued, 1 shall not employ any person in any manner so as to BUILDING become subject to the Workers' Compensation laws of California. Date ApplicantALTER NOTICE TO APPLICANT: If, after making this Certificate of Ex- OR ADD TN%P 5.00 ZO APPLIANCE 5.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING ' T 10 .M.1 4.00 FEE AIR HANDLING UNIT IOVERIO .) 6.00 r SEISMIC FEE CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOO 5.00 the performance of the work for which this permit is issued (Sec. 3097, Civ.0.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEAT] NO UN IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address I 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 eounry ordinances and state laws relating to building construction, and PLUMBING BOILER -COMP I3 H. P. or 100,000 B.T.U.1 6.00 BOILER -COMP (Over 100,000BTU1 SEE FEE SCH. MECHANICAL 0 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue, against said City in Consequence of the MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MEC,H+.�CSONT. LIC. �NjO/ �% TOTAL (%�O �O lw� DIO c/� G I -e TOTAL grant im((pfthis permit. /z -7 St st//tome ffAA.l icanl/Contractor f Dote OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHII RED LINES - USE BALL POINT PEN ONLY BU LDJ NG PROJECT I DENTI FICATI ON APPLICATION & PERMIT BUI LDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER BUILDIN ADDRES 1 355 N. DeAnza Blvd.12552 OWNER'S NAME Apple Computer PHONE OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTOR'SOUTLETS NAME - SWITCHES -RECEP 10.00/1.00 JILIGHTING FIXTURES 10.00/1.00 Ber ie Plumbing COuc.No. 17633 ADDRESS 'J'70 Haven Ave. (415) AGGRESS }j APPLIANCES - RESIDENTIAL 4.00 IPANELS 10.00 Redw Off City CA PHONE '168-9494 DATE OF APPLICATION ARCHITECT on ENGINEER uc, NO, PANELS(OVER 200 AMP). 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS.3.00 A0CH OR ENG. GRESS SOO SPECIAL CIRCUIT . PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP APPLICANT'S ADORE55 MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 • LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (Commencing with Section 7000) of Division 3 of the Business and Professions Coda aedeny license is in full fore llt ffyf}, License Class 1. 3300 Lic. Number 11 OO, -SS VV..3S Date Contractor BLDG, ❑ ELECT. ❑ PLG. MECH, ❑ ' BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5, Business and Professions INFORMATION MISC. - REFER TO ORD VALUATION S/FT. PERMIT ISSUANCE 10.00 Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure, prior to 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 ELEC. CONTR. LIC. NO. ELEC. TOTAL �'x PERMIT TO QTY. - PLUMBING PERMIT FEE Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 b , STORIES TYPE CONSTR. ALTER -DRAIN -WATER (EA.) 5.00 by any applicant for a permit subjects the applicant loo civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for Sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS 2 DRAINS -FLOOR, ROOF, AREA, COND. 5.00 10.00 Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who does such work 6 FIXTURES - PER TRAP 5.00 60, FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such mimprove- mes are not intended or offered for sale. If, however, the building GAS - EA. SYSTEM - 1 INCA OUTLETS 6.00 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- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE 'RES IND CON PB Omar ❑ ❑ ❑ ❑ ❑ INDUSTR IAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 " LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER-SANITARY-%XEA. 200f1/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec,-, BAP.C. for this reason 2 WATER HEATER W 6.00 12.00 Owner Date WATERSYST 5.00 ACC. DATE ACC. FILE NO. WORKERS'COMPENSATION D17CLARATION WATER TR EA�ik 5.00 " 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy theOiQW L F.r pmnRlrind Policy __-I Certified copy is hereby furnished. Certified cop Is filed with the ity iI spemion division. Applicant FIRE SPRINK Y C]N ❑ ENERGY T-24 Y C]N[]{L MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FRO 1 WORKERS' PERMIT ISSUANCE 10.00 10.00 FLOOD ZONE A.L.U.C. PLG.CONTR. LIC. NO. ., TOTAL 62.00 COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y❑ No, Y❑ N❑ OTYMECHANICAL PERMIT FEE FEE SUMMARY hundred dollars(5100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workeri Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10MC.F.M.) 4.00 AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 VELECTRIC CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ. EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN ISINGLE) 4.00 PLUMBING / - BOILER -71M 6.00 ,H.P.or100,000B.T.U.) BOILER -COMP (Over 100,000 BTU) SEE FEE SCI-. MECHANICAL - hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO, MECH. ' TOTAL TOTAL granting Of[ Is permit. t -$ Signature of Applicant/Contractor Dale OFFICE COPY