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9518Y 4 ZZ N L W CL Uo LL W } pJi H � A • 0 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 13UI LOI NO PROJECT I DENTI FICAT APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 9 518 BUILDING AgPRESS WNE f Nj•1 /i-'\ rRonE �- ;J::.":.'.-,.--_,-ySk Oi'r`�. BCEETwID PER�iF'I:+:/•r;� ��•, P LAN CHECK VALIDATION DATE OF APPLICATION CONTRACTOR'S NAMEOUTLETS A.i T(,I yPrS ZI)CSt/(,• .NO. 6 G39 -SWITCHES-RECEP 10.0011.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORSPPLIANCES soDREsa � /� O4 -y C AONfyob - RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT ErvcmfEn 174,A_C UC. NO. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE C.NO. SIGNS TRANS. 3.00 ADD ESS area. ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION PAID SEP 2 01985 C11 TEMP. METER OR POLE INS. 20.00 AE x ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Codeoilld my license is in full force eft c 3 License NNu lb`11 octor, ra�{M e�no ISSbNICATEo ELECT. PLG. MECH. ❑ 1:1Lic. ❑ Dam _ contractor, 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 ProfessionsVALUATION Code: Any city or County which requima permit to construct. alter. I mprove, demolish, or repair any structure, prior to in issuance, ala Imquins the applicant for such permit to file a Signed statement that Provisions of t00 Contractor's License he is licensed pursuant to the(commencing the Law (Chapter and t Division o and Profsionse) or Section is exempt Business fnd the xempt or that he r'5 exempt therefrom and the basis for the alleged exemption. Any violation of Section en t.5 loacivil penally by any applicant fora permit dollars the ($500).): of not more than five hundred dolhn (f300).1: ' ' f/FT. MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL OiM •, .-c-yT c ;1 .. Y. Y •i a' PERMIT TO STORIES TYPE CONSTR. ALTER -DRAIN BI VENT•WATER(EA.) 5.00 ❑ I, as owner of the property, or my employees s with wagas 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. 7046, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who don such work himself or through his own employees, provided that such improve ments an not intended or offered for sale. If, however, the building F IXTUR ES - PER TRAP 5.00 GAS • EA. SYSTEM -1 INC.4 OUTLETS 8.00 SQ FT. FLOOR AREA TOTAL ACREAGE 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.).NDUSTR ❑ I, as owner of the property, am exclusively contracting with GAS • EA. SYSTEM •OVER 4 IEA.) 2.00 BUILDING USE R IND CON PB Omer ❑ ❑ ❑ 11 INDUSTRIAL WASTE INTER. 30,00 LAWN SPRINKLERS • 1 INC 5 V.B. 8.00 LAWN SPRINKLERS • OVER 5 (EA.) 1.00 licensed contractors to construct the project (Sec. 7044, Business and Profexions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who A RSPARCEL N0. contracts for such projects with a contrectorts) licensed pursuant to the Contractor's License Law. SEW ERSANITARVSTORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ 14M exempt under Sec. ,B.AP.C. for this reason WATER HEATER WNENT 8.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WATER TREATING EQUIP, 5.00 WORKERS'COMPENSATION DECLARATION 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 thertof(Sec. 3800. Lab C').' Policy No. Company ❑ C."rsed y' her! fu ❑ CCnI IS InSpeCllOn dIY1L0n. Applicant FIRESPRINK Y ❑ N ❑ ENERGY T 24 y C3 NQ MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This section need not be completed if the permit le for one y N r N PLG. CONTR. LIC. NO. PLG. TOTAL hundred dollars (S100) or lex.)�. I certify that in the performance of the wank for which this per, mil is issued. I shall not employ my person In my manner an as to become subject to the Workers Compmastion Law of Califomu. Date ApplicantALTER r,F a' `IIl�garl�eeYgi;I'ta ' ='- '• ' "G" _ ) ,s BUILDING OR ADD TO MECH. 5,00 NOTICE TO APPLICANT: If. after making this Certificate of Ea• 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. APPLIANCE 5.00 AIR HANDLING UNIT ITO 10=C.F.M,) 4.00 PLAN CHECK FEE Alli HANDLING UNIT OVER I(IMC.F.M.) 8.00 SEISMIC FEE , CONSTRUCTION LENDING AGENCY 1 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.). HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICflOFILM Lender's Name Lenders Address HEATING UNIT (OV ER 100,000 B.T.U.) ELECTRIC I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is cornet. I agree to comply with all city and county ordinances and slate laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. PLUMBING ��-COMP(3 H.P. or 100,000 B.T.U.) 8.00 BOI LEfl•COMP IOver, t00,0000TU1SEE FEE SCN. MECHANICAL MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmlm the City of Cupertino AS t liabilities, Jud a, costs and expenses which may in ay ccrue i i in consequence of the grantin is s ure pli omractor Date CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH.. TOTAL ;'WTAL. eY �7 `IV OFFICE COPY POST THIS C RD NEAR FRONT OF BUILDING 4 CITOOF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ' JOB ADDRESS /ill / �j 11'1_�r16Lll�� UNIT tt LOT , OWNER' 1/ CONTRACTOR wwmnIS PLRMIT NUMBER " PERMIT EXPIRATION' •PERMIT EXPIRES IF WORK NOT •STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM - LASTCALLED INSPECTION. INSPECTION DATE I IN PECTOR INSPECTION RECORD FOUNDATION' - _ • - - UFER PREGUNITE , _ PEN/LRTION SEP 2 01985 ' CItj;of Cupertino ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED = ' UNDERGROUND/SLAB PLUMBING - ELECTRICAL -- - MECHANICAL - -" L a ELECT. I 1-1❑ PIA. MEOW ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED -- BUILDING PERMIT INFORMATION ' WOOD FLOOR PLUMBING L/.111'Y / VALUATION �M $/FT. , . MECHANICAL' ' ELECTRICAL � - � ,^ PERMIT TO FRAMING INSULATION � '., -STORIES TYPE CONSTR. • OCC.GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - - SO, FT, FLOOR AREA TOTALACREAGE DIAPHRAGM _ BUILDING USE IND CON PB Oleer ❑ ❑ ❑ ❑ SSESSORS PARCE L NO. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH • - PLUMBING .• GAS TEST - - - TRaCINO. - CEL NO 'PAR. . MECHANICAL ELECTRICAL . FINALS DATE INSP. ACC. DATE , ACC. FILE NO. FRAMING SAN # INSULATION PLUMBING '. - ZONINGENG. SITE NO. " GAS ., - - MECHANICAL _" FIRE S1RINK Y ❑ "❑ ENERGY L]4 Y E]"❑ COVER NO. WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR. ELECTRICAL FLOOD ZONE Y❑ '•N,❑:. a.L u.c. Y❑ N❑ LATH—'EXTERIOR FIRE DEPT. SHEETROCK GRADE FEESUMMARY SHEAR INTERIOR BUILDING �3 BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS - FIREWALLS ELECTRIC - PLAN CHECK FEE ' GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, i- ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB_ADDRESS.WHEN PHONING. -SEE,PERMIT'FOR EXPIRATION DATE'- v ELECTRIC' PLUMBING.- MECHANICAL." CONST.,TAX • IMPORTANT! - PLEASE READ REVERSE SIDE BEFORE '.: CALLING FOR FINAL INSPECTION. TOTAL ' OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI FICAIA1116 APPLICATION & PER BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 9 518 BUILDING aD0flE95 OwNE 's Yr\ PHONE ' OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION NAMrRacTORs Al iN RI NO. 39 UTLETS- SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S aDDRE55 APPLIANCES - RESIDENTIAL 4.00 !Oo 04.bDOBe j,?Aoxe DATE OF APPLICATION PANELS 10.00 ARCHITECT OR ENGINEER ..-L ( sec. No PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG. SS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP PJND SEP 2 01985 f1x,1f ino APPLICANT ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 I hereby affirm that I an licensed under provisions of Chapter 9 (commencing will, Section 7000) of Division 3 of file Business and Professions Code license is in full force I e{f c 3 Chits Lie. Number ((1s��{{sI�� ffss�� ISSWF2ENitATEper L G. ELECT. PLG. MECH. ❑ ❑ El _my Date Contractor BUILDING PERMIT' INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from tire Contractor's License Law for the following reason. (Sec. 7031.5, Businessand Professions Code: An cit or count which re uiresa Any y y q punnittocansuace, MISC. - REFER TO ORD pERMIT ISSUANCE 10.00 VALUATION � how $/FT. ELEC. LONTR, LIC. NO. ELEC. TOTAL improve, demolish, or repair any structure, prior to its issuance, also also he is tic ne applicant for such permit to filo a signed statement ase he is licensed pursuant en the ng with sects of the Contractor's 3 at t e Section 7000) Law(ChapterProfessions Code) Utherefoof the PERMIT TO /'k - ^ Business and Professions Code) or that he is exempt therefrom and or iveAemf QTY. PLUMBING PERMIT 'FEE the basis for rase alleged exemption. Any violation oto. Civil by any applicant l' ora permit subjects the applicant Rlacivil tetchy malty of not more than five rdollars (my STORIES TYPE CONSTR. ALTER-DRAIN-WATER(EA.) 5.00 the ❑ Las owner at the willdproperty, ti or my employees with wages as employees their sale compensation, will work, the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions (S c, Business Code: The License Low does not apply an owner of FIXTURES -PER TRAP 5.00 GAS-EA.SVSTEM-l1NC.40UTLETS 6.00 SO. FT. FLOOR AREA TOTAL ACREAGE hContractor's ywho builds or wnemloyeereomand who tl such ihwork o himself himself re through his own employees, provided that such ire building memsure not or If, hawevcq tire rone Duall icn old year is sold within one ving of completion, the owner Withinthe owner. Or hdrbuilder ill have builder will have the burden of proving that he did not build or ire- GAS - EA. SYSTEM - OVER 4 IEA.) 2.00 BUILDING USE prove for purpose ❑ as owner of t.,,Steely, am exclusively contracting with PB R IND CON Other,Sfsaie.l. ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 licensedd contractors too construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to anowner of property who builds or improves thereon, and who ASSESSORS PARCEL NO. for such projects with a contractor(s) licensed pursuant to the Cont the Contractor's License Law. ❑ I am,exempl under Sec.-, L&PC, for this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Dale WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WOKKIIRS'COMPENSA'TION DECLARATION 1 hereby affirm that I have a certificate ofconunl to self -insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certified copy thereof ISce. 3800, Lab CJ. Policy No. Company ❑ Certified y here furl ❑ Cetlifie Is inspection division. Applicant FIRESPRINK Y❑ N❑ ENERGY T-24 Y❑ N❑ MISC.- REFER TO ORD. CHRI'1171CATE OF EX EM PTION F ROM WO R K I: RS' COMPI7NSAT1ONINSURANCE Ul In, section need not be completed if the permit is for one PERMIT ISSUANCE 10.00 FLOODZONE Y ❑ N❑ A.L.U.C. - Y ❑ N❑ PLG. CONTR. LIC. NO, PLG. TOTAL hundred dollars ($ 100) Or Tess.) 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 CITY. MECHANICAL PERMIT FEE FEE SUMMARY become subject to the Workers' Compensal ion Laws of California. ALTER OR ADD TO MECH. 5.00 Date Applicant BUILDING NOTICE TO APPLICANT: If, after making This Certificate of lix- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10,000CRM) 4.00 PLAN CHECK FEE emption, you should became 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 10,000C.F.M.) 6.00 SEISMIC FEE 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.C.). EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)9,50 ELECTRIC. VENTILATION FAN (SINGLE) - 4.00 I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and gOiLER-COMP(3 H.P. Of 100,0008.T.U.) 6.00 PLUMBING this city to enter upon the hereby authorize representatives for ins inspection above-mentioned property farinspection puitous. BOILER -COMP (Ovar 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. Cupertino aga' at liabilities, juit Is, costs and expenses which may in ay came agai soi i In consequence of the granlin Is r CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOW L Ig tura f pIrU n ontrachsr 61 Date OFFICE COPY