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11723 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PI RMIT NUMB ED INSPECTION DIVISION 11723 . JOB INSPECTION RECORD v PERMIT EXPIRATION JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR / IS NOT STARTED WITHIN INSEE TION DATE INSPECTOR SPECTIO RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _y -Yb ANCE OR 180 DAYS FROM �-.- LAST CALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION .QF•FN.I.I 1 POUR NO CONCRETE UNTIL ABOVE WAS BEEN SIGNED " UNDERGROUND /SLAB , . PLUMBING ELECTRICAL IS$UAry.CEDATE BLDG. ELECT MECHMECHANICAL a . ❑ 1 2s ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION $IFT. PLUMBING 1-.2247 MECHANICAL Y b 87 / ELECTRICAL PERMIT TO FRAMING INSULATION - STORIES TYPE CONSTR, OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 3 _ - ROOF SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM I BUILDING USE HES IND CON PB Oln., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 0 0 0 0 ASSESSORS PARCEL NO. ROUGH a� //- - PLUMBING GAS TEST S Up TRACT NO. PARCEL NO. MECHANICAL 3_/d3.,E ELECTRICAL q�,7 FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING -!{J SAN # ZONING ENG.SITE NO. INSULATION ��� PLUMBING All GAS MECHANICAL 3 FIRE SPRINK ENERGY T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIG EO HEATING Y ❑ NE) Y E] "0 FLOOD ZONE A.L.U.C. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Yo N❑ SHEETROCK I GRADE FEE SUMMARY SHEAR INTERIOR / BUILDING u SHEAR EXTERIOR �— -g'j TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX 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 BUIXDI NG PROJECT IDENTIFICATION PERMIT NUMBER t,JILDING APPLICATION & PERMIT �DDNEss -75 /f BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 11723 OWNER'S PLAN CHEC VALIDATION "A CITY. ELECTRIC PERMIT FEE CONTRACTORS "AMOUTLETS-SWITCHES-RECEP 10.00/1.00 atil_ EIC.No, P3 LIGHTING FIXTURES 10.00/1.00 ADcroRs ORC APPLIANCES,RESIDENTIAL 4.00 /Y CONTRAS4 �� PROnE Q PANELS 10.00 DATE OF APPLICATION CHI E AR C'T PLAN CHECK FEE OR PANELS (OVER 200 AMP) 20.00 -q■ ENGINEER ( '.nN. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDgTION AooR SPECIAL CIRCUIT 5.00 3b E zIP /5� EMP.METER OR POLE INS. 20.00 APPLI ANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 l.0'Iw wo o LICENSI: CONTRACTORS DECLARATION /L 4W a i w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE n G ec ELECT. PLG.(commencing with Section 7000)of Division 3 of the Business and BLD MECH. H w i Professions Code,a my license is in zO o t full fore t !2 - Licesc C Lia Number mbate Contractor ❑ ❑ ❑ a y 2 -, BUILDING PERMIT ¢ ¢ OWNER-BUILDER DECLARATION K o a INFORMATION w g 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD t+ VALUATION S/FT. o J law for the following reason(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requiresa permit to construct,alter, SS ¢ Improve,demolish,or¢pair any structure,prior to Its issuance,also ELEC.CONTE. LIC.NO. ELEC. i aO u requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TO w9 m he is licensed pursuant to the provisions of the Contractor's License17 H z aLaw.(Chapter 9(commencing with Section 7000)of Division 3 ofthc 4 n Business and Profssions Code)or that he isexempl therefrom and CITY. PLUMBING PERMIT FEE ¢ Hp the has is for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE GONSTR. by soy applicant lura permitsubjects $5GOd.licum toacivil p:nalty ALTER-DRAIN of not mom than flue hundred dollars(SS employees f� ❑ Las owner at the property,or my employees with re is Hos BACK FLOW PROTECT.DEVICE 4.00 then sole compensation.will Jo the work,and the structure is not OCC.GROUP RES UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREACONO. 5.00 1 Code:The Contractor's License Use does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 6.00 ser.pPr.FL TARFA TOTAL ACREAGE himselfornot hrough ownemployees,for sale. if,ed that however, the improve- GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 �7s me its are not intended or offered for sok.IL mpleveq the building or improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4 (EA) 2.00 builder will have the burden of proving that he did not build or no, - . - . BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 IND CON PB Omer ❑ 1.d as owner of the property,ons exclusively . 704Utdliu with ❑ ❑ ❑ ❑ licensed contractors : comtroct the project(Sec. 7044,of apply LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 56-7- contracts ASSESSORS PARCEL NO. toProfessions Code:The Contractor's improv Law docs not apply J (-7- ��^O� to tr owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER$(EA.) 1.00 J commns forsu LicenecLwithacontmctorts)lipnsed pursuant to SEWER-SAN ITARV-STORM EA.200ft/10.00 the Contractor's License Lew. AC NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&PC.for this WATER HEATER W/VENT 6.00 rcawn Owner Date WATER SYSTEM 5.00 AC ATE ACC.FILE NO. WORK I!RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsem to self-insure, or a certificate of Workers Compensation IInV,a4 a certilied ZONING ENG.SITE NO. copy thereof(Sec 3600,Lb.C.I. _ �3 Policy No. Com perry 0 ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T$4 Z Z ❑ Cert ificd c filed mesh the cis epec Otior division. Applicant btu MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ NN[]~ N �� PERMIT ISSUANCE 10.00 LU - CIiRTI PICCOMP F SAI ION FROM WORKERS' FLOOD ZONE A.L.U.C. W �_ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. 1 ❑ ('This section wed not be completed if The permit its for one TOTAL Y❑ N❑ Y ❑ N❑ Z) Z hundred dollars(S 100)or Icv.) U O 1 Certify that in the performance of the work for which[his per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued, I shall not employ any person in any manner so a m 0 W t>Lcomc subject to tlm Workers'Compensation Laws of CalioOliu. a Date-Applicant BUILDING >_ 0NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 F ? emption,you should become subject to she Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the labor Code, you muss forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=0C.P.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNrr(OVER 10=C.F.M.) 6.00 SEISMIC FEE 3 I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 she performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT ITO 100,ODO B.T.U.) 8.00 Lender's Add H EATING UN IT(OV ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that)have read thisapplication and slate that theabove VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. BOILER-COMP (Osar 100,000 BTU(SEE FE£SCH. MECHANICAL (We) agrce to save, indemnify and keep lmo,l¢s the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs a m expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the grant' ¢permit. MECH.CONT. LIG II MECH. p � 0 TOTAL TOTAL 0 Signature of Applicant/Contractor a OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUIlsDINGPROJEPT,IDENTIFICATI APPLICATION & PERMIT PERMIT NUMBER ^°I`°IN° 12 714 noon - ^ /L BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER' II PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE vnoNE • con Tons NAM UTLETS-SWITCHES-RECEP 10.00/1.00 f LIC.NO:' _ LIGHTING FIXTURES 10.00/1.00 CONT CTORs [APPLIANCES-RESIDENTIAL 4.00 Ao PHONE PANELS 10.00 DATE OF APPLICATION ARCHrtECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCHE 6RR END' SPECIAL CIRCUIT 5.010 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 A. ss APP AN MOTORS SEE FEE SCH. E 63 SERVICE CHANGE 20.00 w o o LICE N SBU CONTRACTORS DECLARAT ON ¢v I here y affirm that I am licensed under provisions of Chapter 9 ISSUANCE DAT wwi 'ion 70001 of Uivisian 3 of the Busines and BLDG. ELECT. L MECH. z (cimmicimbKH o z Professions Cod,, y li.nse is in full fu z E3 ❑ ❑ o"� - Lieenu CI Lie.Number 2 y H o Dute Contractor _ a x J BUILDING PEIRMIT ¢ ¢ wa WNER-BUILDER DECLARATION O d u INFORMATION w ;LL N I hereby affirm that I am exempt from the Commetor's License MISC.- REFER TO ORD u_p g law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. Code Any city or county which requlresa permit to constrI altcq 2 a ¢ 0 improve,demolish,or repair an structure,prior ELEC.CONTR. LIG NQ ELEC. p p y r qr to its issuance,also to o u requires the applicant for such Permit to file a signed statement that TOTAL PER T w $ he is licensed pursuant to the provisions of the Contractor's Limnsa H z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the 4 o Business and Professions,Cale)or that he isaxempt therefrom and CITU. PLUMBING PERMIT FEE ¢ H the basis for the alleged exemption.Any violation of Section 7031.5 I TYP NSTR. by any applicant for.permit xubjeds the applicant mo civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollen(SS00).1: ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP 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,AR EA,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 a FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provide)thuf such improm GAS-EA.SYSTEM-I OUTLETS 6.00 ments are not intended or offered for sale If,however,the building jr 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 of sale.). INDUSTRIAL WASTE INTER. 30.00 NilIND CON PB Omar ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044, Busimee, LAWN SPRINKLERS-1 INC 5 V.B. 6.00 and Professions Code:The Contractors License Law does not apply ASSESSORS PARCEL NO. to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such Projects with a cantractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO, PARCEL NO. O 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'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a Certificate ofconsent to self-insurc.' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Scc.3800,Lah.CA Policy No. Company O ❑ CertiNed copy is hereby furnished. FIRE SPRINK ENERGY TN Z Z ❑ Certified copy ie Blcd with the city inspection diviilnn. O Applicant MISC.- REFER TO ORD, YE] NE] vC:] NQ ~ ver PERMIT ISSUANCE 10.00 � - CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD-ZONE A.L.U.C. LUQ COMPENSAT10NINSURANCE PLG.CONTR. LIC.NO. PLG. Y� N� VE] N CL CI (Thu section need not be completed if the Permit is for one TOTAL Z hundred dollars($100)or less.( U O I certify that In the perfurrom ee of thv-orkbfwhicKlhis per. OTY MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ Per n i manner so as to beton s t m the Workers' P• tion of Tomia, a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } N NOT C APPLICANT: I!, t r ma ng u Ceniflcate of Ex F ? emption,you should become ' feel to he Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor C you ost forthwith comply with FEE U such provisions or this permit shall be cemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10MC.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a colntruction 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.). a HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UN IT(OVER 100,000 B.T.U.M9 Lender's Add ELECTRIC 0 1 certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 information is corcet.1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COM I3 H.P.or 100,000 B.T.U.) 6.00 hereby authorise representatives of this city to enter upon the BOILER-COMP (Ove.100,0130 BTU)SEE FEE SCH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep Ilumlless the City of MISC.- REFER TO ORD. Cupertino asl Iiab ' ,ilijudgments, costs and expenus which CONST.TAX may any ay ince Inst said City in MIT gee the PERMIT ISSUANCE 10.00 gran of 0NMI ` MECH.CONT. LIC.NO. MECH. / TOTAL TOTAL S' lureo pplicanl/Contractor D. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LVDI NG PROJPiQT I DENTI FIC TION LG PERMIT NUMBER g,ILP,NG APPLICATION & PERMIT Ab0R BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 11266 OWNS 's PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE PHONE ' H°MER °R UTLETS_M IX 10.00/1.00 �C.No. LIGHTING FIXTURES 10.00/1.00 °ONtR ' APPLIANCES-RESIDENTIAL 4.00 DDR PRION 2L PANELS 10.00 DATE OF APPLICATION OR ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEEP.C.NO. ENGINEER LIC,NO SIGNS TRANS. 3.00 nooR'Ess ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP. METER OR POLE INS. 20.00 APP "T' MOTORS SEE FEE SCH. Ao ' ✓^ SERVICE CHANGE 20.00 ' ` w 0 9 LICENSED CONTRACTO S DECLARATION Q u u I hereby affirm that I am licensed under provisions Of Chapter 9 ISSUANCE DATE so z i (commencing with Section 7000)of Division 3 of the Business J ¢ BLDG. ELECT. PLG. MECH. H D z Profession Cott ,Inn rouse is in full fore z D"�/- Licen lass ❑Lic.Number ❑ ❑ 0 z Date Contractor a Y W OW' ER-BUILDER DECLARABUILDING PERMIT ¢ ¢ ¢ T O u, u INFORMATION wd H I hereby affirm that I am exempt from the Comre w's Licensc MISC.- REFER TO ORD u o g law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 1000 vnLunTlary g/FT. rya+ Code:Any city or county which reyuimsa Permit to construct,alter, i is 4 00 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 0, requires the applicant for such Permit t0 file a signed statement that TOTALvs RMIT TO' EL he is licensed pursuant to the provisions of the Contractor's License M'£C✓C,('�/ H ¢i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe - ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ = 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. A , by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ I,es owner of the properly,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. 7144, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5,00 SG.FT.PLIOOR AREA TOTAL ACREAGE himself or through his own employees,provided that wch improve GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 ments 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 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- prove for purpose of sale.). INDUSTRIAL WASTE INTER. Op,DO RES IND CON PB Our. ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPR INKLERS- 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 contractorts)licensed pursuant to SEWER-SAN V-STORM EA.200fi/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATER WIVENT 6.00 reawn Ow Datc WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO. 1 RKE S' f EN A N DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to set&insure. ora certificate of Workeri Compensmio Insane ... I ZONING ENG.SITE NO. ropy thereof(See.3800,LaRC-). Policy No. Company av O Cl Certified copy is rcby FIRE SPRINK ENERGY T.24Z Z ❑ Certified 0 inspection divisio . FO Applicant the MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ CE EOEEXE PTION r-ROM WORKER ' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C. LU > COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG. d O (This section meed not be completed if the permit is for one TOTAL Y❑ N❑ V❑ N❑ 2 hundred dollars(S 100)or less.) U O 1 certify that in the Performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,1 shall not employ any persue in any manner so as to OW become subject to the Workers'Compensation Laws of Califomia. a Date ApplicantBUILDING >_ m NOTICE TO APPLICANT: If,arta,making this CenificuEZtc of EALTER OR ADD TO MECH. 5.00 F jZ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with 7FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10p00C.F.M,) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,00017-EM.) 6.00 ISMIC 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 thk permit is Psued(Sec. HEATING UNIT(TO 100Rat ROFILM 3097,Civ,C.). ,000 B.T.U.) 6.00 Lender's Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 EL TRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is rorlecL I agree to comply with ell city and county PLUMBING ordinances and state laws relating to building construction, and, BOILER-COMP(3 H.P.or 100,000 B.T.U.1 6.00 p hereby authorize representatives of this city to ewer upon the BOILER-COMP (Over 100,1X10 BTU)SEE FEE SCH. MECHANICAL hereby actio riz property for coon purposes. (We) aWee to save, ind Rif and keep harmless the City'of MISC.- REFER TO ORD. Cupertino against li jud encs, costs end expenses which NST.TAX may i way again said City in wnse9ucnce of the PERMIT ISSUANCE 10.00 Ingo h6 it n MEC CANT. LIC.NO. MECH. / TOTAL TOTAL urCof P tic [ ontrac[o Uate o OFFICE Y