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09800 APPLICANT TO FILL IN INFOF TION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT Nume eaILDINGPROJECTIDENTIFICAT APPLRoILU ICATION & PEF01 ADD BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OyVOO ' OWNER'S �( PLAN CHECK VALIDATION jNAME 1/1'/ QTY. ELECT RIC PERMIT FEE 6F �. V 1✓�� PHONE 73YTY ` /// N,NT AcroR's � �If(� UTLETS-SWITCHES-RECEP 10.00/1.00ME /'3 /'f0 3 uc.NO. LIGHTING FIXTURES 10.00/1.00 ADDRESsroas APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER LIC i No. SIGNS TRANS. - 3.00 ARCH ass ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION' t PPziP EMP.METER OR POLE INS. 20.00 F1Al APPLICANTS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 11 N U 1(?p 0 0 o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 H c u E, I hereby affirm that I am licensed under provisions of Chapter 9DwTE yz a S (commencing with Section 7000)of Division 3 of the Business and. 4 L CLIZCT. PLG. MECH. H i Profession,Code,and or,license is in full force u..d effect. z o w - License Class Lic.Number , El 11 1:1 4 w ­ w Datc Contractor a m s WILDING PERMIT ¢ se 4 OWNER-It UILDER DECLARATION ¢ w v INFORMATION wa I I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD u O j Law for tie following rcason.(Sec.7031.5,B.,iness and Professions VALUATION $/FT. - PERMIT ISSUANCE 10.00 ' Code:Any city or county which requiresapernot t oconstrect,alter, 3 {tom en ¢ >4 improve,demolish,or repair any structure;prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. u D u requires On applicant for such permitj�i file a signed statement that _ t. .� TOTAL X m he is licensed pursuant to the provisi ns of the Contractor's License r r /- PERMIT TO ea Law(Chapter 9(commencing with Section 7000)of Division 3 of the .LF..T - 4 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE / /rte �'L ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES .TYPE CONSTR. aim by any applicant for a permit subjects the applicant to a cavil penalty ALTER-DRAIN -WATER IEA.) 5.00 ' of not more than five hundred dollars($5001.): ❑ Las owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 O c.GROUP RES.UNITS Omar sole compensation,will do the work,and the stmclure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 .tS Code The Contractor's License Law docs not apply loan owner of x;Kl -/ property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 ser�^Frp.FLOOR AREA rorgL ACREAGE himself re through his own employees,provided that such improves - - ' s:! / �7 me improv Rod meet is w thinoffered onefor year If,however,thebuildingowner GAS-EA.SYSTEM-1 INC.4OUTLETS 8.00 or improvement is sold within one you of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.1 2.00 builder will have the burden of proving that he did not build or in.- BUILDING ON USE EES IND CON PR Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 �I,as owner of the property,am exclusively contracting with -. DI RS P licens d contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. _ 8.00 ASSESSORS PA EL- O. ' and Professions Code:The Contractor's License Law does not apply 1, to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 3 a _/� - Q/ - 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 �/ rcason /k owner Date WATER SYSTEM 5.00 ACC.GATE ACC FILE NO, WORK ERS'COMPENSATIONDECLARATION - WATER TREATING EQUIP. 5.00 ' I Ruch,Siff.... that I have a certificate of consent to sell-insure. or a certificate of Workers'Cmnpensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.CJ. Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. FIRE - REFER TO ORD. O Applicant Y ❑ NE] Yo NE] M CERTIFICATIi OF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LUC. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Z (TCL his section need not he con.pleted d the permit is for one, TOTAL Y❑ N❑ Y N hundred dollars IS 100)or Iess.l -) EI O 1 certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- fait is issued,I shall not employ any person in any manner so as to O w hecome subject to the Workers'Compensation Laws of California. Q. Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } V, NOTICE TO APPLICANT. If, Her making this Certificate of Ex- Z_ emption,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 CONST RUCTION LENDING AFE:NCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE O I hereby offann 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,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 IsnJcr's Name keeyC'p HEATING UN IT 100,000 B.T.U.)9.50 Lender's Addres +�- �! q 7ELECTRIC I certify that l"FW dthis ,J;Atom and xmtgj�JVdbovc 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-001 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon die BOILER-COMP (Over 100,000 BTU(SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep hannlesa the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which may in any way accrue against said City in conscyucnce of the PERMIT ISSUANCE 10.00 CONST.TAX ant I' is pc mi MECH.CONT. LIC.NO. MECH. _ _o TOTAL TOTAL 66, 0 Signatureof Applicant/Contractor Uat c OFFICE COPY (if*N-, CK T-4VD YrG - `�-9--�6 tw�c� �1r (ua G�z,c�rV P74 4 A-4 -/a �" �T mss, r- y'` =�r WCxs �j//n4/�s-ti 3�c� ���- jd?`�. --�'ors6-otrfet:t �1'� wiuy �1-� �,,�eJ`�,�✓ `r�/ldC V7 / 27..r��.3/" r�L� G��� /41^SN,a�..r�r j v.—, f5 y.-`v, Sd✓ l2� t.C7�1 PZ9 VJ7' }2��k �? v �, rs �v Z Ffb 3 4- L�--Cd-�Ct�T� (\T• 1�T1� W ez r s� 7o �o 2Y,-A qr4 FLS LNrA T 'r 57 7e 12�1��8& F1�vuM6 4 v YVtecu �s+t� POST THIS C D NEAR FRONT OF BUILDING PERMIT NUMBER CIT , OF CUPERTINO )z ., INSPECTION DIVISION JOB INSPECTION RECORD'_ .PERMIT EXPIRATION . .� �Y/Z/'I �.I 'A / .. p'r.. Is[JOB ADDR ESS UNIT# _LOT# PERMIT EXPIRES IF WORK NBc I JI nntCONTRACTOR .IS NOT STARTED WITHIN INSPECTION. DATE INSPECTOR" ._ NSP CTI N RECORD 160 DAYS OF PERMIT ISSU;,._ FOUNDATION ,!J ,� ;ANCE;OR,180 DAYS FROM 1 UFER /Tp nrl•eu.� / X LAST CALLED INSPECTION. PREGUNITE I-s '�S 4 P l '4 'T PERMIT VALIDATION Fo� �f1 was 'Ta 10 G.I olLw �X'/l/O POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .2-7$6 KtR-K w6.Cl 00, wLvy "ll � UNDERGROUND /SLAB - �� � 1 II v✓e1T 31.4 1` PLUMBING Y37�7f/ uF Pv 'af4f,7[o 3 ELECTRICAL r �I� y, cvz -14 ."fo Z .ISSUANCE GATE ME HANCALL G. ELECT. P MECH. r . s'14 L 6)C w\ " /67GrY V. ball i TAIi t (oA� ✓11) Wurw\ IN DO NOT POUR FLOOR UNTIL ABOVE3HAS:BE SIGNED -t' u' 6a r' zV, ` Sc 1,• I. BUILDING PERMIT -WOOD FLOOR - 2yY- ."I INFORMATION,`;... " _�' VALUATION $LFT. PLUMBING p �-�L WQ •E,/, TO - _ MECHANICAL '2Y-g 6'13 L,e-Kl L ELECTRICAL �, "� (5.' '(cG-L� 6C,W v RM!igo • � �.: FRAMING J- :-VA X(C to w..$�wl `a b(aX 5 RIES INSULATION TYPE CONSTR. .�-IF{sdb r4 yra. W'iPa� ILLI . lar Ir o y w� J I.Gac�irCQ4 OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL^ABOVE,HSIGNED'. ROOF BEEN SIGNEof yG-BG a - ROOF DIAPHRAGM O ar'-rW _ 18 WING US 1 -►'y IND CONOtl,er APPLY NO ROOFING UNTIL.ABOVE HAS BEE SIGNED µ Y-..` .w d°, '6-/.�-'/,(� - El D - E:l ' SSESSORS PA EL O.. ROUGM, - 5� $C c�Gaaw/Mn�n .°s.3/7, ' _a 1r . PLUMBING .j �-3T-S� P./.e�'-�� R/-s.�-y( ..'.,/q-1 .i-- GAS TEST ARCEL NO. CAL(0 pa � ACC.OATE ACC.FILE NO. ELECTRICAL - FINALS - ,. ;��CiATE �. INSP. _" FRAMING o-Ny I c _e SAN # INSULATION PLUMBING I� )� ZONING ENG.SITE NO. GAS . .. .. ii' .._... FIRESPRINR ENERGY7j20, MECHANICAL .Ia, )pj IM(9 COVER O W K UNTIL ABOVE HAS BEE SIGNED HEATING Y "� Y �• "Q " LATH-INTERIOR ELECTRICAL _ FLOOD ZONE A.L.U.D. LATH-EXT E�i10 �' L v ELECTRICY❑ :NEI Yo N� SHEETROCK FIRE DEPT. GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - SHEAR EXTERIOR TEMPORARY APPROVAi:,o BUILDING FIREWALLS ELECTRIC ' r --� �. C_ PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEENSIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ~O� ONE WORKING DAY BEFORE 'REQUI-RED INSPECTION. PLUMBING ' PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE.— MECHANICAL IMPORTANT! CONST.TAX PLEASE READ%REVERSE SIDE BEFORE I .TOTALP ' CALLING FOR FINAL INSPECITION.._ I' : ' OFFICE COPY ('L cCLV 7-17'6 NoYrj 0V73,,cle woLL , VArr-- T5,,//1 wd �iv4421 $rhTR&cK $ Roo.Ms o. S.7Jz �-1z-�6 ir-�vtur�<•- y"��, C�.�-r ,�-w�Tk,�s- �ti2:ar,..,gJz .ti�.w u-.,rLL. ��' . Mme,/ .Kd r-,t S� w (l� �t o ►� weaT 7a s�uac r�D J� Ile 7-29-f b T�SuL 1 slrgea wp6� 2 "PfL. fo. d sis/ v.,ys. r Lr 2RZh t ! !3 tri . ! U R/lu P� pvtr�hE+� , —ll•�6—lsrf�• :�7. �/a-�1 � ir-dr � s,�P2 �� /2�s. . . ' Li T'L F Yr vvrZ$ , 5hf4oCK C Air (r[ -YG a f- 3a,1 (=G�1. 2s�/•'cA'/yr ,t// ..,. CzJvtiiT5 f/�aw.c 1,7-J�� 2,1-14 97`' Frt �TslnNJIre�r��� nfi oN'—� ewi c (» �a�Lw S � � ✓ `1rh EF�s. �kJ 1faYJ<JT ELECTRIC SERVICE NOTICE P.G.B E.COPY BUILDING INSPECTORS NOTICE CITY OF CUPERTINO i • 9 TO 1 You are hereby authorized to Connect electncol service for 'Owner or Tenon, No.of Wires Size of Wires Size of Switch flt� Motor Load VOltage Phase Heating Load K.W. Voltage Light-]JO.New Service Reconnect No.of Meters / Heot I 20__Three Wire More Service Na,of Add.Meters Power Thr Phase Move Meter Qr w ELECTRICAL INSPECTOR a Cupertino Sanitary Distrix Copy BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO � ® Sanitary Permit No. `�— E ❑ Backflow Device e Plumbing Permit No. ❑ Sewer Connection LL Loi No. —� ❑ Plumbing Finol Owner or Tenant o At Traci '^ '9—g_Date Fln r�19 Date Connected LUMBING INSPECTOR OM ELECTRIC SERVICE NOTICE P.G.B E.COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO To You are hereby authorized to Connect electrical ser/vice for Owner or Tenant At /6 �r�-5 No.of Wires Size of Wires Size of Swirch Motor Load Voltage Phase Heat'mg Load K.W. Voltage Ligh, I10New Service_f- Reconnect No.of Meters Hear 170 Three W;re More Service_ No.of Add.Meters Power Three Phase Move Meter ©° ELECTRICAL INSPECTOR CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE — Z�-( 19k—!�— BLDG. PERMIT NO. THE BLDG. LOCATED/AAT OWNED BY ® = HAS BEEN (COMPLETED) / € FOR USE AS P (ALTERED( Om a � ao li O � BUING INSPECTOR P.G.&E. CITY OF CUPERTINO COPY GAS SERVICE NOTICE t / /0 E `o u_ To You are hereby authorized to connect the GAS service for V""5: fOV/ L �f Owner or Tenant. At ( � r ® - New Service t� ° No. of Meters Reconnect No. of Add. Meters Move Sgrvice` �MM0 eter PLUMBING INSPECTOR