2584 •' CAVY Or CUPERTINO INSr1:CTIO1! RECORD (Office Copy)
2497 - -- -�B].vd._...—.Q�a�•Z .-.?s F/:
PI:Pd1I'r NO. SANITARY DIST. 140. LOT NO. ADDRESS
Int: Remodel Four Phase 295-0900 Ex. 2097
PROJECT 01-INER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buil dine -/-Pa Date Insp.
Electrical 9 /-per Power Pole
I'Iumhinr /o-y-A2 Underground
?lcchanical P,oul;h Wiring _Z Z
Temp. Cas/Elect. Flans
Solar Ceiling
Ptre Sprinkler Fixtures Int/Ext
u Sign Motors
Grounding
Flisc.
Temp. Power _
Other
FINAL I14SPECTIONS Not Approved
Date Insp.
Fle PLUMBING
Electric _ Date Insp.
Plumb in , Backflow
?lechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
• Plnnnin Solar 'Rough
Fire Dept. , c- .A Ilater & Insulation _
Health Dept. ?Iain Drain
Building R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification 11ECIIANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Hembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Crease Duct & hood
Tiedowns One (lour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
Ilalls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Ilallboards Int 1?xt.
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• ' - PERMIT NUMBER
r1 euiLpBUILDING PROJECT lDENTIFICATION APPLICATION & PERMITING /�J
•^' AD E
7se 2437
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
WNE 'S PLAN CHECK VALIDATION
A � QTY. ELECTRIC PERMIT FEE
vHON
CGNTn ACTORS
NAE UTLETS-SWITCHES-RECEP• 5:00/1.00
b S Lic.No, LIGHTING FIXTURES 5.00/1.00
o RESS Tons K2oj] PPLIANCES-RESIDENTIAL 4.00
REaS �-r
PHONE 5SZ-04 U O PANELS - 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
' I.C.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIALCIRCUIT 5.06 PERMIT VALIDATION
ADDRESS
ZIP TEMP. METER OR POLE INS. - 15.00 n
Ars MOTORS SEE FEE SCH.
ADDRESSDDRESS ' III
SERVICE CHANGE 10.00
w o o LICENSED CONTRACTORS DECLARATION
U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
vii a m (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H y z Professions Code,and my license is in full fora and effect. ❑ ❑ ❑
z o w- License Class Lic.Number__ v
o to H o Dam Contractor
a y m � - BUILDING PERMIT
¢ a w¢ OWNER-BUILDER DECLARATION INFORMATION
oA " MISC.- REFER TO ORD
X 3 H I hereby collo that I so exempt from the Contractors License VALUATION SIFT.. .
Hu04 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE - 6.00
Code:Any cityorcounty which requires a permit to construct,alter,
SC to
Q improve,demolish,or repair any Struct Ore,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. QO
D LL requires the applicant for such permit to file II signed statement that TOTAL PERMIT TO
K
$ he is licensed pursuant to the provisions of the Contractor's License
Fi > Business
w(Chand Processions Cngwith Section is7000)
exempt theron3of the
¢ ¢ Business and he alleged exempt or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE SR
F $ the basis for the alleged exemption.subjects
Any applicant
of Section malty STORIES TYPE CONSTR.
by any applicant fora ivehumeddceclsthe 500).Lcam toacivil penalty ALTER-DRAIN& VENT-WATER (EA:) 4.00 �/
of not more than five hundred dollars(my em1: P VVV
❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEV ICE 2.00 =,GROUP RES.UNITS
intendele r offered
for
will(S the work,and the structure is not
intended or offerod for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The orLicense Law does not apply to an owner of
property whh builds builds or improves thereon,and who Rocs such work FIXTURES-PER TRAP 4.00 50.FT.FL�O.O�RL AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- 3e�
mentsare not intended or.ffened forode.If,however,the building GAS-EA.SYSTEM-1 OVER
4.00
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 ,or build or im- RES IND CO)K PB Ocher
prove for purpose'of sale.). INDUSTRIAL WASTE INTER. 20.00 tll'1�/
❑ I,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. 5.00 ASSESSORS PARCEL NO.
and Professions Coope The Contractor's License Law doesnot apply
to an owner of property who builds improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 V/
contracts for such projects with a contractions)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exec t under Sec. ,B,&P:fi,fo }tr
r io.
reason p _ ,U �Y WATER HEATER W/VENT - 4.00
Date - O Own'rA WATER SYSTEM 4.00 TCC.DATE ACC.FILE NO,
WORKERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP, 4.00 �-
I hereby affirm that I have a cenificateofconsent to self-insure' ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lxb.0).
Policy No. Company
O ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T 24
z Z Cl Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
0 Applicant N❑ Y N❑
~ va PERMIT ISSUANCE 6.00 FLOOD ZONE
Lu - CIiRTI F-ICCOMPE I ATIOTINS FROM WORKERS'
UJ 1 COMPIiNSATION INSURANCE PLG.CONTR, u0.No. PLG.
d O
(This action need not be completed if the permit is for one TOTAL V❑ V�LJ
0 Z hundred dollars($100)or less) '
O O 1 certity that in the performance of the work for which this Per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any manner co as to
U become subject to the Workers Com ensation Laws of California. a
O w p BUILDING
Date-Applicant ALTER OR ADD TO MECH. 4.00 �Q
} N NOTICE TO APPLICANT: If,after making this Certificate nlEx-
)... ? emplion,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK Oto
provisions of the Labor Code, you must forthwith comply with FEE t
V 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 10=C.F.M.) 5.00 ' SEISMIC FEE
1 hereby 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: HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Ci,C.). '
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)T50 ELECTRIC
Lander's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct, I agree no comply with all city and county PLUMBING
onlimnas and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,0006.T.U.1 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 STU)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 umd expense+which - CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00
p bill III, r MECH.CONT, LIC.NO. MECH.
.L7 - �Z TOTPL TOTAL 5
Signature of Applicant/Contractor Date '
OFFICE,COPY
CENTRAL FIRE PROTECTION DISTRICT
• ', 3071 DRIFTWOOD DRIVE
SAN JOSE, CA. 95128
SERVICE SINCE 1947 408-3784010
(Date)
TO: C c1P&-7e_'77-
FROM: Fire Prevention Division �1Gef� 02
SUBJECT: '%� Sv� /d 7 O u �! /J ffNs a R c ✓.o .
For.your information, run card, pre-fire plans, etc., the
changes have been made in your first-in response area: � 7-y3
V We have inspectedthe above subject facility for conformance with
the minimum requirementsyf-iJ .C., U.F.C., Title 19, C.A.C. Fire
clearance is hereby ( "`
Add this occupancy to your company inspection program. .
A new dwelling at:
. � Fire protection water supplied by:
A new commercial occupancy at: :
The building is _ is not _ is.partially _ sprinklered.
There are on-site hydrants. '
A new hydrant at:
A new hydrant in your second-call area, located at:
A Medeco (lock box) (padlock) (electric gate switch) has been`
installed at the above subject address.
INIT. Added to Run Card by B/C SHIFT
JAfA
B:jg/7-81 C
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -,USE BALL POINT PEN ONLY
PERMI NU
BU I LDING PROJECT IDENTIFICATION ' APPLICATION & PERMIT A
SuaOwc r L`
ADDRESS f
46 loovl,Die-A U FlaorL BUILDING'—ELECTRICAL—PLUMBING -MECHANICAL
WNER's /V �Z�3`' PLAN CHECK VALIDATION
NAME I 'c p,
-N =SA .rHONEZSS'OPI nO CITY. ELECTRIC PERMIT FEE
-dollh Foy NAMCONTRACTOR', OUTLETS-SWITCHES-RECEP 5.00/1.00
LIC.NO. LIGHTING FIXTURES 5.00/1.00
CONTRACTOR
ADDRESS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 5.00DATE OF APPLICATION
ARCHITECT SIGNS- 600 PLAN CHECK FEE P.C.NO,
OR
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
AARC"DDREOR SS ENG. SPECIAL CIRCUIT � 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS.., . 15.00
AMOTORS SEE FEE SCH. '
ADDDRESSDRESS
SERVICE CHANGE 10.00
w
00 LICENSED CONTRACTORS DECLARATION T
a L,y I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w a w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
.H O z Professions Code,and my license is in full force and effect ❑. ❑
' 0. — License Class Lie.Number
2 z Date Contractor
¢ y s BUILDING PERMIT
¢ ¢ w OWNER-BUILDER DECLARATION .. r
MISC.— REFER TO ORD INFORMATION
Z
5 a.y I hereby affirm that I am exempt from the Contractor's License VALUATION - $/FT.
F LL 0 ¢ Law for the following reason.(Sea 7031.5,Business and Professions PERMIT ISSUANCE 6.00
,n0J Code:Any city or county whichregairesu permit toconstruct,alter-
c ¢Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
D¢ requires the applicant for such permit l0 file a signed statement that TDTAL PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
HiQLaw Chapter 9(commencing with Section 7000)of Division3 of the PL UN�/.U(r vC Mt'
szo
Business and Professions Code)or that he is exempt therefrom and 'CITY. PLUMBING PERMIT FEE
¢'H m0 thebasisthe alota exemption,subjects
ubjetstheaplica o toacti0n malty STORIES TYPE CONSTR.
i3 � by any applicant l'oru permit subjects the applicant toa civil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not more than five hundred dollars(S500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 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. 4.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employe,,•provided that such improve- .
'ments are not intended or offered for sole.If,however,lire building IGAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
or improvement is Sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA.I 1.00 BUILDING USE
builder will have the burden of proving that h - .e did not build or im- RES IND CON PB 'Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ Las owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct 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( O
Contracts for such projects with a contractor(s)licensed pursuant to
the Contractors License Law, SEWER-SANITARY,STORM EA,2661 .00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec. B.,4P.C.for this WATER HEATER W/VENT 4
re.
son
Date Owe I WATER SYSTEM 4. ACC.DATE ACC.FILE NO.
WORKF:RS'COSIPENSATION DFCLA RA WATER TREATING EQUIP
I hereby affirm that I have a certilicale of consent to self.n sL e, -
or a certificate of Workc,v Compensation Insuruncc,nr a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,LAC.).
Policy No. Company
O ❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ v ❑ N❑
N CE RTI FICATE:OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. fy
1 O fThR section need not be completed if the permit is tiu'one TOTAL Q Y ElN❑ v C] C:)
:) Z' hundred dollars IS 100)0r less.)
U O I certify that in the performance of the work for which this per CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued, I shall not employ any person in any manner s0 as to
U become subject to the Workers'Compensation Laws of California.
O W -
Date—Applicant BUILDING
'} tail NOTICE TO APPLICANT: If,after making this Certificate of Ex- ' ALTER OR ADD TO MECH. 4.00
F Z cur ion,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 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000C-F.M.) 3.00
MBZ
CONSTRUCTION LENDING AGENCY L AIR HANDLING UNIT 1 C. .00 SEISMIC FEE
1 hereby 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 .SJ.in(�L00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 OO
. information is correct. I agree to comply with all city and county PLUMBING
ILER-COMP.(3 H.P.Or 100,000 B.T.U.) 4,00
ordinances and state laws relating to building construction, and BO /o
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 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 core against said City in consequence of the PERMIT ISSUANCE 3.00
In of thi tie �j MECH.CONT. - - LIC.N0, MECH.
/O _ ( ��
TOTAL fIL TOTAL a 7 4TH
Y gnaturco Applican 'ontractor Date /
OFFICE COPY
•, Citm of Cuperti"a
10300 Torre Ave March 21, 1983
(408) 252-4505
Ext: 228,229
Four Phase Systems
C/O Ron Olivas
10700 N. De Anza Blvd.
Cupertino, Ca. 95014
Dear Mr. Olives:
After reviewing our files, we find that permit no. 2437'& 2SA4
issued on 9-1-B2 & 1,0=4-B2 for Tntarinr remnAal
has exceeded the maximum alloted time of 180 days since:
1. ) Permit was issued.
�x 2. ) Last called inspection.
Options for renewal are listed under Sect. 303(d) 1979 Uniform
Building Code. (enclosed)
In order to close our files, your cooperation would be appreciated.
CITY OF CUPERTINO
John Busto,
Building Official
JB:jj
I •