29021APPLICANT -TO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
CITY OP CUPERTINO BUILDING F.LF.CTRICAI. PERMITNO. 29021 O O Z1
1
BUILUING DIVISION APPLICATIONIPERMIT PLUMBING - MF,CHANICAI. L
HIUD.DmG PRO furl n1RNTiVICA7ION
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ARCHIT!? T/F. INEER: LIC NO:
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CONTACT PHONE:
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❑ Consultant Fees Paid by Applicant (Initial)
BUILDING PERMIT INFO
RI,DG E PI MB MECH
omil ❑
LICE SED CONTRACTORS DECLLAARGAnON
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
"Z with Section 7000) of Division 3 aflhe Business and Professions Code. and my license is
00 infullforceandeffect., .p,
�FUZ�'j License Class 1� Lic.Y )Z
NQ� Dmc Comractm B
a' ARCHITECTS DECLARATION
O Z O Z I onderssand my plans shell he used as public records
Q'PY ELECTRIC PERMIT
FEE
JOB DESCRIPTION
RESIDENTIAL:
❑SFDWL ❑KITCHENREMODEL-
❑ADDITION El PLUMBING RE -PIPE
❑MULTI -UNIT ❑STRUCTURAL
MODIFICATION
11 INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
❑ BATH REMODEUREPAIR 0 DEMOLITION
❑ OTHER
PERMIT ISSUANCE
AI'PLIANCFS-RI'SIDFNf1AL
PANE'
UP TP2 PS
P �.F'. W
2�
y {ay Q
Sea 0.0
a1 W
W�
C(commencing
0. �toL
{s,
pLIQ
jj0. r'1❑❑++
Y6
f13..
Licensed Professional
OWNER -BUILDER DECLARATION
I herchy affirm that 1 em exempt from the Cartoonists License Law for the
following reason. (Sevin, 7031.5. Business and Professions Gde: Any cit, ",county
which rcquim a Mrmit to cnnstrvct, aper, improve, demolish, nr mpair any swcwm
prior to its issuance, also requires the applicant for such permit o file o signed statement
that he is licemedpuaoanno the p ... mnmofthe Comracmf's License Law(Chape,9
with Nation 70p0) of Division 3 ofthe Business and Professions Code)or
that he is exempt themfrom and the basis for the alleged exemption. Any violation M
Section 7031.5 by any applicant for a Prot, subjems lhenpplicam to a civil penalty of
not... than five hundred dollms($50m.
F] 1, as owner of the property, or my employees with wages an their sole compensation,
will do he work,end Nestrvcmre is oat intended oroffered for sale (Sec. 704,1, Business
and Pfufessinns Cede: The Cnntmctm's License Law dies not apply m an owner of
property who builds m improves thereon, and who does such work himself or NrougM1
his awn employees. Provided that such improvements am not intended or nHered for
.sale. IL however, the building or improvement is sold within one year ofcompedonthe
rovarr-hailder will have the burden of proving that he did not hm" or improve fm par -
pose of sole.).
Fl I, as owner of the Property, am exclusively contracting with licensed contractors m
construct the project (See. 7016, Business end Professions CadcJ To, Contmctola Li.
rise Law does not apply to an owner of property who builds or impoves Ncrenn. and
who contracts for such projects with a connamods) licensed pursuant to the Contracmrs
License
License Low,
se exempt under Sec. P C far this reason
201-I PS
VE PS
SIG . LECT L
SPECIAL CI IT
TEMP. METER OR
COMMERCIAL
❑ NEW BLDG/ADDITION El DEMOLITION
NAST ❑FOODSERVICE
-Put PR0 E/MrE�NTQ
❑OTHER
V � �
POWER DEVICPS
SWIMMING POOL ELECTRIC
U'[LETS - SWITCHES -FIXTURES
NEW RESIDENTIAL ELEC SQ FT.
SQ. FT. I'LWR AREA
✓ �, 1;,`
NOV 21 1995
ESQ, FT
TOTAL:
QTY. I. RING PERMIT FEF.
PERMIT ISSUA
ALTER -DRAIN&VENT -WATER LEA)
q
1
OZ
Z 0
f -s
1[7a-sik4
LLI
Q
UO
i1n t+
Q V
(1i
L VJ
6 Date
fns VALUATION
W� %'��"W it tap j�� IIV�
let' WORKER'S COMI'PNSATION ITEC ARATION
I hereby affirm anderpcnally nl'pe'jury one of efollowing de armions:
}]lhavcand will ..lot inu Ceadden enfCn ovau sdf-insure for Wa er's Cumpem
smion, as provided for by Section 37M M the La r Code, for the pert, man. of the
w k for which Nis permit is issued
have and will maintain Worker's Comps ation Insurance, u seat by Section
7 of Ne Labor Code, fonhc performanc flhe work for which this pe it is issued.
My Workcis Calnpens:IllolllaMLmOeeca er and Policy moun are:
Carrier. Policy No.:
CERTIFICATE OF EM ION 0 O 2R,'
COM . SATION INSUR N
(This section need not campleredl0 ,one died dollars ($IIXI)
.,less)
tern Natio NrN mann 1 which spamitisissoedlshall
nil employ any person in ony runner sr' esnb' t mNe Workers'Cmnpen-
smion Laws of Calif.,
A IICW ie. Da
BACK FLOW i'ROTE . DEVICE
DRAINS- it,RO IiA, COND,
STORIES
OCC. GROUP
TYPE CONSTRUC ION
APN
P KTUR . - PF.R' 1'
GAS -FA. SY 1 -II OIITL S
GAS -EA. SYSTEM` QRS( )
GREASRIINDUSTRL WASTE RCEPTOR
BULDINGD ISION FEES
t
GREASE?3'RAP
PLANCHECK FEF r
SEWI?R-SANITARY-STORM EA. 21N1 FT.
ENERGYFEE
WATIiR HEATER WNENTMLECTR
GRADING
AN ol
OAPo the Worker' tar mukin II'sC sm, mifthelalourCa you should
NOTICE subject
become suhjcm m the Worker's mpensmi sof Ne Lutror CnJe, you must
ns
farthwithcomplywithsublonsi.'n orlhisp nilshmlbedecmedrovoked
CONSTRU IONI DINGAGENCY
I hereby affmn that there is a was ction lending agency for the performance of
the work for which this recruit is issu ce. 3097, Civ. C.)
Lender's Name
Lender's Address
WATER SYSTTiM/IRI?A71NG
-
WATIiR SERVICE
Receipt is
NEW RESIDENTIAL PLMB. SQ. FT.
_
O"
TOTAL:
aFLE
1 certify and 1 have read this application end scam that the above im,...0 ion is
conecL lagree medmply wird ell city std caunry arJinanen wJ mom laws relntingm
building construction, and hereby authorize representatives of this city to enterupon the alnve-mentioned property for inspection purposes.PF,RMIT
agree m save, indemnify and keep harmless the City of Cupertino against
liabilities,judgments, cosh and expenses which may in any way a.mcngainat avid City
in curouqueea of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOU CEREGULATIONS. �Isr
QTY. MECHANICAL PERMIT
ISSUANCE(We)
ALTER OR ADD TO MECH.
^ t
PLUMBIN FEE `.
AIR HANDLI NO UNIT (TO 1010(0 CFM)
MECHANI AI. FEE
AIR HANDLING UNIT (OVER IL" CFM)
CONSTRII f10NTAX
Signature of Appiicam/Commear Dam
MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Sudety
Code, Semkm 255320)?
❑Yes �No
Will the alicant or future building
pp g.cupam use cyuipmcm or Devices which
r
mt Aeznrdnus aicontnddrords as defined by the Ray Arca Air Quality Management
UsnnT
❑Yes IVNo
I have read the hazardous materialsAIR
rtquiremenu under Chapter 6.95 of the Cali.ISSUANCE
finnia health & Smdy Cale, Sections 25505, 25533 and 25536.1 understand that if the
1,uilding does not currently have a tenant, that it is my responsibility to notify the oxupom
of the inquiemems which must be met prior to issuance of a Certificate of (kcupancy.
EJ(HAUST HOOD(W/DUC'D
HOI151NG MI ATION FEE
HEATING UNIT LTD IOLOW BTU)
,
HEATING UNIT (OVER 100,000 BTU)
PAID I
Date Re \ipt N
VENTILATION PAN (SINGLE RESID)
-
BAILER -COMP (3HPOR 100,00(IBTU)
TAE:
BOILER -COMP (OVER 100,000 BTU)
CONDITIONER
DATE
ISSUED BY;
NEW RISIDEIST1AL MECH. SQ, FT.
Owner or authonzed agent Date71
TOTAL:
OFFICE' .7 1 , ' . i 1 ,
I
0
Ci
1 FA:O. INSPECTION
I FINAL BLDG.
7 77 1 V
W= F AAV WJ I L --V W, k
m
st
Lim
on
Plot ,plan plant Md Lped(icbuon 4d herewnti
ESTIMAIED.VALUE OF IMPROYEMENi3
2
A4
JOhn R;
PjIBrj: McClellan Rd.
6
PMbNE 2ss- .174
ADDRESS
q
q
PHONE
STATE LICENSE
BUIlDINO INSPECTION RECORD
FLOOR STER
BOND BEAMS
ATM
1 FA:O. INSPECTION
I FINAL BLDG.
7 77 1 V
W= F AAV WJ I L --V W, k
m
,
FO 1) NlAlION
-7
FLOOR STEEL
BOND REAMS
FIREWALLS
VE BRAtT_
LANDSCAPING
FINAL RG.
TliEOWNS
Misc.
•
BUILDING DEPARTMENT
Certificate 0 Occupancy
No. ..177 .........
THIS IS TO CERTIFY that the (description of building or structure).
MULTI TENANT #4 (SHELL)
------------- •-----..........• • •----•.... _...... •---..._------------................... •...... _ _... -• -•----............. _..............----••.....
VALLCO PARK
-----------------------------------------••--
----------• ---------. •--•-• •------• •----- • -•----------•--• •-------•--------------•----------------------------------•------•-------------. -.
Erectedon Lot No ----- ---------------•---------------------- Block No. ---------- --------••-------•-------- •-----------••----
Addition shed Fire Zone ii
Street No. __ 19310 Pruneridge Ave. Occ. Group F-2
Owner ...__.. Vallco Park Use Zone __._.'._(Planned Industrial Park)
-------•• -••--- .......... .........................................
Frank L. Hope .. Associates
Architect-----------------------••-•------...----..._...._....--- •--------------------••----•-•----•--•-••---..........---••---.-..-..-•-
ContracFor Johnson & Made Construction C...ompany
................................ .....................•--------•-•-•••-.
Building Permit No. .__5;� T5.ik-•-----•---------------Plan No. ....... VAL-...............................................B
�as been inspected and the following occupancy thereof is herebyauthorized.
/1/ I an 1 kI/ arP . . . al . .. ._
ax.
r Loads per sq.
Basement -------------------------
•---•--•------•-----•-----• ...................... ..........................._...--------------••-•-----
Istfloor...._Offices & Light Manufacturing 1?5 lbs.
...........................•---........------•---•-
.......-••--•--••-...-•--..._...-•----...---•.............................................................•---------•----•------------••------
50 lbs.
2n floor ........................................................
......................................... ----------------------------------------- -------------------------------------------------------------
3 rd floor ......................
.....-•---.......--•----•--------------------------------------------------•....... .............................................................
4thfloor ------------------------------- -..................................... .............................................................
Add floors as necessary------••..............•-----...-------•--=------....----
.....-•----------------------------------------••---...._...----•--••-----._....... _
Roof.................... ° e
.................................... W ............................................ i....................................................
City of CUPERTINO ................. March.21________________ I 73_---
`..'
- Chief Building Inspector
Phis certificate must be posted and permanently maintained in a conspicuous place at or
close to the entrance of the building or structure referred to above.