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11469 POSTTHISCARD INEAR FRONT OF BUILDING !wMiTN UNITER 0 . . CITY OF CUPERTINO ' .T 1 INSPECTION DIVISION , '„ • ��”q JOB,INSPECTION REC RD 77 � w •.PERMIT EXPIRATION i JOB ADDR ESS y_ NT#k LOT# .PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPE TION DATE 5SIGNED �,' INSPECTION RECORD ANCE180 DAYS OF PERMIT ISSU- ' FOUNDATION - _ +`G LAST A LED DAYS FROM Ad�LLS L ` LAST CALLED INSPECTION. UFER.' — ' PERMIT VALIDATION PREGUNITE ' - POUR NO CONCRETE UNTIL ABOVE HAS BE -S'7 +42T o!X [tiA UNDERGROUND /SLABG 7— + PLUMBING - V`6(oO /1ni /j CT`"iL.l L ELECTRICAL — I ISSUANCE ATEMECHANICAL �se )c. ELECT. PLc. MEcq. ❑V /DO NOT POUR FLOOR UNTIL ABOVE HAS Ba - g �;o L4r;fj f BUILDING PERMIT WOOD FLOOR AW d G INFORMATION VA WAIION , r $/FT. PLUMBING rW/C� - I , MECHANICAL • 1,2 3L %•o ✓ 2 ' 5FPER ELECTRICAL" 0, lfa^A, !�/it p/6 /g PER T ' FRAMING -- - L-L 'r✓ -INSULATION, D Q / ,giGr /I (if9 1' sioRles rvP IcoNSTR. „ G pyx Nl C441- OCC.GROUP RES.UNITS PLACE NO.SUBFLOORUNTIL ABOVE HAS BEEN SIGNED -"^' v / A SO.FT.FLooRAREA TOTAL ACREAGE - ROOF DIAPHRAGM „+ BUILDING USE RLS, IND . CON PB O"R., APPLY NO.ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORSPARCELNO. ROUGH - PLUMBING �J'S'.$ TRACT NO. PARCEL NO, GAS TEST MECHANICAL - B. '�' Acc.OnrE ACC.FILE No. ELECTRICAL FINALS DATE INSP. FRAMING' e-..d LCL. .3-' , SAN # ' I I ZONING IENcsITE No. INSULATIONS - ,.�y �S- PLUMBING GAS _ MECHANICAL /� p FIRE SPgINK ENERGY T14 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' FLOOD zarvE A.u.a LATH—INTERIOR ELECTRICAL' v❑., NO v 1 N❑ LATH—EXTERIOR yy.;y FIRE DEPT. SHEETROCKj '_�-7 GRADE " • •:1" FEE SUMMARY SHEAR INTERIOR' � BUILDING,, /Z — + BUILDING - SHEAR EXTERIOR ' TEMPORARY APPROVALS FIREWALLS - ELECTRIC o�'��. PLAN CHECK _ - GAS - .FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY, SEISMIC FEE . . UCCUPANCY OF,BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. , MICROFILM- '.YARRANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC' H ONE WORKING DAYBEFORE.REQUIRED INSPECTION.' * " PLUMBING.'PLEASE GIVE JOB ADDRESS WHEN"PHONING. ' Z F MECHANICAL - SEE'PERMIT'FOR EXPIRATION DATE',- IMPORTANT' CONST,TAX ' PLEASE READ REVERSE SIDE BEFORE " A ;a. TOTAL . CALLINGTOR FINAL INSPECTION: . . OF.FICE COPY r - -- ,--- - ------ --. - ay�, . . '�+ S�� .dA' , .43 ; '. 1. • �`� a �,,, Pt/ � r, a �I� 1i 4 vit CITY OF CUPERTINO _ Y CERTIFICATE OF COMPLETION y ' ` .?•j { BUILDING INSPECTOR'S OFFICE Date ..........�.. .............. 19.CJ.. Building Permit No. - g --'.---..6....... .... .. a.�-7-......�... .. r .',,.,.• ltt 1. The Building Located at - 23 3 e1 Owned by ..f^Y�csS (... ....f dfr.A ........................................................................ b a Com leted ''-- ^^ e •• Has Bee! Foi Use As: ....� ,p �Y... ...•. -• ' '- -- -� _ ' (Altered) ... .... ..... . ...-.................-.................... - i .................... ...................... .. ""j, cif{ PD-7 BUILDING INSPECTOR tz.` , 1': ' ,a i1 .'wl,icdlaGSy�4 �'• r ?r iwui. .. _'._ �'A i f,"- _rP t.,`•t. v . ..\1 �'' ,a i. ,r _ + fil - , � ' _ ,'. , . .11?:,t„ � .i( �!*Z-' . -•1 io..7�. ., Y� ''�'vJr i',;:r tY is"��: '< . 't•.r,iy r,1�1-,= ;t'14art� ,;fpl . ... � >, ,. . +� � .L:. i ..0=: - '{ :Y+ . .1 r'�i'�4• :I.;�r. arm � ,�'^,�� 1 APPLICANT TO•FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY B4JILDING PROJECT IDENTI FICATION _ PERMIT NUMBER APPLICATION & PERMIT Ii LONG J AOnRESS • , Z S Il 1. BUILDING'- ELECTRICAL-PLUMBING-MECHANICAL 1 1469 ..-� OwN ER'S �C OJG� PLAN CHECK ALIDATION .�•� NAM 'MM11NF-^/o• DTV. ELECTRIC PERMIT FEE �fZ PHONEej� O' -36 3 a O NAME croR's UTLETS-SWITCHES-RECEP 10.00/1.00 /�/ 1.rrIIAr.X\ NAME LIC.No. LIGHTING FIXTURES 110:00/1.00 /& O i CONTRACTORS RFES AD �� PPLIANCES-RESIDENTIAL 4.00 ADDRES �. PHONE - PANELS 10.00 DATE OF APPLICATION \ ARCHITECT p PLAN CHECK FEE P.C.NO. lC OR PANELS (OVER 200 AMPI 20.00 ENGINEER uc.NO, ` p SIGNS TRANS: 3.00 '` ,. ARCH.GR ENG. SPECIAL CIRCUIT S,OO PERMIT VALIDATION ,Y` ADDRESS ZIP rrEMP.METER OR POLE INS. 20.00 (V0V AOORESNT'S - - MOTORS SEE FEE SCH. (W Ul �\lL]AA.1� K+CL❑ V\ SERVICE CHANGE 20.00 0 o O LICENSED CONTRACTORS DECLARATION ¢u U Thereby affront that I am licensed under provisions of Chapter 9 ISSUANCE DATE w a$ (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F w z Professions Code,and my license is in full force and effect.' El ❑o i a W License Class Lia Number Dam Contractor ¢ a, ¢ ¢ ¢ ONIi R-BUILDIiR DIiCLA RATION BUILDING PERMIT o M W s v - INFORMATION X ;H.y 1 hereby affiant that I am exempt from the Contractor's License MISC. REFER TO ORD - VALUATION 5/FT. H u o a Law for the hollowing reason.(Sec.7031.5,Busine,smd Professions PERMIT ISSUANCE - 10.00 Code:Any city or county which requires a permit io construct,alter, QQ improve,demolish,or repair.any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.' / a O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO " La m he is licensed pursuant to the provisions of the Contractor's License n�`�,� FZQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the O FJ Business and Professlmss Code)or that be is Cxempt therefrom and QTV. PLUMBING PERMIT FEE K F o [hC basis for the allege)exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR..' u ; by any applicant for a permit subjects the applicant toacivilpmelty of not more than five hundred dollars(55001.1: ALTER-DRAIN&VENT-WATER (EA.) 5.00 �� ❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECTDEVICE 400 their sole compensation;will d0 the work,and tire . , e structure is not OCC.GROUP RES.UNITS intended or•offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 4,p Code:The Contractor's License Law docs not apply loan owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6,00 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 lie did not build or in- BUILDING USE " pro for purpose of sale). INDUSTRIALWASTE INTER. 30,00 RES IND CDN PB Diner 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ lice sed contractors to Construct the project(Sec.7044,Rosiness LAWN SPRINKLERS-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 forsuch projects with a contractors)licensed pursuant to SEW ER1000 -SANITARY-STORM EA.200ft/ . the Contractor's License law. TRACT NO, PARCEL NO. ❑ I am exempt irrSec. B.&P.0 to this WATER HEATER W/VENT 6.00 / O "'\n reason CO'�l /" Owner Date? WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORICERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ' I batch,affirm that I have a Certificate.1 .Hnscio In wH-imure, ZONING - ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No7 Company _ O In Certified copy is hereby furnished. FIRE SPRINK ENERGY T.24 Z 2 ❑ Certified Copy is filed with the city inspection division. MISC.- REFER TO ORD. O Applicant Y C] N❑ Y [3N[] sn PERMIT ISSUANCE 10.00 � � CERI'IFICA'I'IiOP EXEMPTION FROMWORKERS' FLOOD ZONE A.L.Uc. J W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG: '" Y❑ IN IY [:] ❑ t CL 0 n(5 IThis section need nut be completed if the pemtit is for One TOTAL N hundred dolle100)or less.) U O 1 certify that in the performance of the work for which,this per- QTV. MECHANICAL PERMIT FEE FEE SUMMARY L L 1- mit is issued,I shall not employ any person in any manner ,,as to O W become subject to the Workers'Compensation Laws of California. n Dam APPh°amtALTER OR ADD TOMECH. 5.00 BUILDING } W NOTICE 1'0 APPLICANT: If,after 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 most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000C.F.M.) 4.00 CONS'rRUC'rION LEND]NG AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm,Ilia, 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 Lender's Name HEATING UN IT 100;000 B.T.U.)9.50 d Lender's Address ELECTRIC info[,"Rify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 rmation is correct.1 agree to comply with n[[city and County PLUMBING ordinances and state laws relating to building construction, and BOILER•COMP(3 H.Ror100,000B.T.U.) 6.00 hereby.authorite representatives of this city IN enter upon the above-mentioned property for inspection purposes. BOILER-COMP (DVBr 100,000 RTU)SEE FEE SCH. MECHANICAL (We) egrce m Save, Indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX pZ�fq 0- nay in any way accrue,agar nst said City in cc',a1wene, of the grAnting Of thisyy��rmll. � - - MECH.CONT. - LIC.NO. MECH. ``// �r.CM�rs.ln"�r1J,�lkn_nAfc 1�1�1ES:o TOTAL, TOTAL Oto ,X Signature nl Applicant/Contractor Date - OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY a PERMIT NUMBER W1 LDI NO PROJECT IDENTIFICATION APPLICATION & PERMIT \l "°'"° 1, 1691 °Lms BUILDING'-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION AME zbl QTY. ELECTRIC PERMIT FEE ON IJ CONTRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00 _ NAME UC.NO, LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) '20.00 PLAN CHECK FEE I P.C.NO, OR ENGINEER LIE.No.. SIGNS TRANS. 3.00 ARCH.OR ENG. 5.00 PERMIT VALIDATION ADDRESS - ' SPECIAL CIRCUIT . - ZIP EMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS EE SCH. ADDRESS PAW - � SERVICE CHANGE '20.00. y � /y� Olcz .� 0 (O '.02 LICENSED CONTRACTORS DECLARATION I :Jr / v U I hereby affirm that I am licensed under provisions of Chapter 9 1 ISSUANCE DATE a w (commencing with Section 7000)of Division 3 of the.Business and y Hi Professions Code,and my license is in full force and elfecL I11n0 BLDG. ELECT. PLG. MECH. z 0 w License Class• Lic Number Q/ ❑ ❑ C3Cs Date Contractor < x - BUILDING PERMIT I[w OWNIi R-GUILDER DECLARATION _ INFORMATION o AMISC.- REFER TO ORD X3 u I hereby affirm that I am exempt from the Contractor's License VALUATION • $/FT. F u 0 a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 O ' Code:Any city or county which requires a permil to construct,alter, pQ Q' ImptoV e,demolish,rR repair any structure,prior to Its issuance,also ELEC(CONTR. LIC.NO. ELEG 3q - DLL requires the applicant for such permit to file a signed statement that TOTAL V , PERMIT TO n w m he is licensed pursuant to the provisions of the Contractor's License 7&/-(,0,H z i Law(Chaf er9(commencing with Section 7000)of Division 3 of the ( &&/- Al 4a -- WH Business and Professions Code)or that he is exempt therehom and QTV. PLUMBING PERMIT FEE 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. T R§ by any applicant for a permit subjects the applicant toe civil penalty ALTER,-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,el owner of the property,or my employees wlOrwnges as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and lire structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractors License Law does not apply to an owner of - prOpCrty Who nUthis Or Improves thereon,and who does such work FIXTURES-PER TRAP, 5.00 SO.FT.FLOOR AREA TOTACACREAGE himself or through his own employees,provided that such ilnpmve- vienlsareGetintendedorofferedforSale.If,however,the building ' GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or t'de"' vensemt is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or int- RES ,IND CON PB Omer prove forpurpuse of sale.). INDUSTRIAL WASTE INTER. 30.00 '❑ ❑ ED ❑ ❑ I,as owner of the properly,or exclusively contracting with licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-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 it co dractoGs)licensed pursuant to - theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ 1 mexempta er Sec. .B.&P.C,rimthis WATER HEATER W/VENT 6.00 63/0 / reason _ - Y Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKHRS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5,00 hereby affirm Ilett I have a certificme of consent to self-inoue, - ZONING ENG.SITE NO. or a certificate of Workers'Compensat inn buurance,or a certificA copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑' Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ 'Certified copy is filed with the city inspection divisiun'' MISC- REFER TO ORD. Q Applicant - Y O N Y ❑ No t--' w - - PERMIT ISSUANCE - IU.00 FLOOOZONE A.L.uc. Cr CERTIFICATE OF EXEMPTION INS pROkt WORKERS' lL COd Got e coo INSURANCE if the i PLG.CDNTR. LIC.N0, PLG. Y❑ N❑ Y❑ N❑ d O (This suction need not hu completed if fire permit.is for one � � TOTAL Z hundred dollars IS 100)or less.) ' U O I certify that in tiro 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 so as to U become subject to the Workers'Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECkW 5.00 BUILDING } W NOTIC17 '1'0 APPLICANT: If,after making this Certificate of Ex- 2 emption,you should become subject to tire Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U a¢h provisions Or this permit shall be deemed revoked. AIR HANDLING.UNIT(TO 10,000QF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M1,15.00 SEISMIC 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 this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,CN.C.).- Lender'sName HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 -ELECTRIC 36 K Lender's Address 1 certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information.is correct.I agree to comply with all city and cuonty PLUMBING ordinances and stale laws relating to building construction, and BOILER-COMPI3 H.P.ar 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL uboveanentioned 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 accr a against said City in consequence of the PERMIT ISSUANCE 10.00 gra ting of this perm . 1 MECH.CONT. LIC.NO. MECH. TOTAL TOTAL ignatureof Applicant onlmetor Usle OFFICE COPY APPLICANT'TO.FILL IN INFORMATION WITHIN.RED LINES —,USE BALL POINT PEN ONLY BV I LDING PROJECT I DENTIFICATIQN_• ,.a PERMIT NUMBER BUILDING APPLICATION & PERMIT a ADD RESs� . (I •', •Z'Z?� .` BUILDING—ELECTRICAL—PLUMBING—MECHANICAL F NANER'S _ �tIS - PLAN CHECK VALIDATION PHONE OTY. ELECTRIC PERMIT FEE CONTRACTORS cTDRs UTLETS-SWITCHES-RECEP '10.00/1.00 NAM0 — LIC.No. - LIGHTING FIXTURES , 10.00/1.00 CONTRACTORS - '�APPLIANCES-RESIDENTIAL '4.00 ADDRESS - ' I. PHONE PANELS 10.0 DATE OF APPLICATION ARCHITECT - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR O ENGINEER y LIC.NO SIGNS TRANS. 3.00 ADDRESS ENG. SPECIALCIRCUIT .5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 (1 •_rpm/—! APPLICANT s ADDDRORESS MOTORS SEE'FEESCH. 7 ' SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION10 ASP ato i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE H ¢ w (commencing with Section 7000)of Division 3 cfthe Businessand BLOC. ELECT. PLG. MECH. D z Professions Code,and my license is in full force aad effect ❑ ❑ ❑ �•o,A - License ClassLia Number r o m t: Dale . Contractor y�p 1n4 IS m a < OWNER-BUILDER DECLARATION VVY"� BUILDING PERMIT o a O 4 - INFORMATION w ; u H I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD y If usincss anA Professions VALUATION ,$/FT. HLLo,a Luw far the lollowin•rcasml.ISec.7031.5, PERMIT ISSUANCE 10.00 4' w> Cade:Anycity orcounty which reyuiress permit to construct,alter, ¢.p ¢ , improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR.License • LIC.NO. ELEC, .O-e d E m, requires the applicant for such permit to life a signed shurmeal that TDTX.a. PERMIT TO he is licensed pursuant to the provisions of the Contractor's License ac z rt ac Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �L arc—f,4 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE IS H$ the basis for the alleged exemption.Any violation of Section-7031.5 n 3 - STORIES •TYPE CONSTR. by any applicant for a permit subjects the applicant to civil penally ofnotmore than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ 1,as owner ofthe property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or,improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SG,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS 6.00 mems are not intended or offered for sale.If,however,the building _ or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im BUILDING USE prove for purpose ofsaleJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other ❑ I,as owner of the property,an,exclusively contracting with licensed contractors to construct the project(See.7044,BusinessLAWN SPRINKLER$- 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 contractons)licensed pursuant to , SEWER-SANITARY-STORM EA.200ft/10.00 the,Contractors License Law, - TRACT NO. PARCEL NO. ❑ 1 rl exempt undo ec. ,BAP.C.for this reason WATER HEATER W/VENT 6.00 Owner p _ D't' ZA111bl WATER SYSTEM 5,00 ACC.DATE ACG,FILE No. WORKERS'COMPENSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00 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 thereof(Sec.3800,Lab.CJl- Policy No. I ICompany O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. O Applicant y E] N❑ Y ❑ NE] H N 'PERMIT ISSUANCE 10.00 LU — •CIiRTII%CCOIONEXEMPTION ION PROMS WORKERS' FLOOD ZONE A.L.U.C. lL COMPENSA'T'ION INSd it the ' PLG.CONTR. LIC.NO. PLG. y❑ N Y ❑ D D 1This section need not be compinted if lhu pnrmitl is for one TOTAL N � Z hundred dollars(S 100)or IessJ . U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL )- teltis Issued,I shall not employ any person In any manner so as m O W' become subject to the Workers'Compensation Laws of California. n Dam Applicant - BUILDING } W NOTICE 1'O APPLICANT: If,after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 ? 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 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC 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 this permit is issued(Sec. MICROFILM 3097,Cie C.). HEATING UNIT(TO 100,000.B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 e� 'Lender's Address - ELECTRIC " I certify that I have read this application and state that the aboveVENTILATION 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000BTUI SEEFEESCH. MECHANICAL above-mentioned properly 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 PERMIT ISSUANCE. 10.00 CONST.TAX m intany way ace against s''d City in,conse, a of the S Illing of this perm'. - MECN.CONT. LIC.NO. MECH. TOTAL TOTAL ignalure of Applicant ontractor. � Date - r _ OFFICE COPY - A 'I DANT TO.FILL IN INFORMATION WITHIN RED LINES -'USE'BALL-POINT PEN ONLY . BWI LDI NG PROJECT 1 DENTI FICATION APPLICATION & PERMIT PERMIT NUMBER BUILDING - _ ' ADDRESS z2 33(� . 14.216 _ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME-G y 40$ DTV. ELECTRIC PERMIT FEE � YV� PHONE '� Z CONTRACTORS NAMEUOTLETS-SWITCHES-RECEP 10.00/1.00 NAME !� t LIC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR ADDRESS APPLIANCES-RESIDENTIAL 4.00 Ae1 PHONE PANELS 10.00 DATE OF APPLICATION ARCHIrncT - "• PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. DA ENGINEER _• LIC.No. SIGNS TRANS. 3.00 _ moo ess ENc SPECIAL CIRCUIT 5.00 PERMIT VALIDATION - ZIP TEMP.METER OR POLE INS. . 20.00 APPLICANTS, MOTORS SEE FEE SCH. ADDRESS / SERVICE CHANGE - 20.00 `�O-L✓'0.�� w 0 o LICENSED CONTRACTORS DECLARATION ISz U u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE 4 (commencing will,Section 7000)of Division 3 of the Business and - BLDG. ELECT. 'PLG. - MECH. Q n v y i Professions Code,and my license is in full force and effect. ❑ ❑ zO 0 w W License Class Lic.Number - - Dme ' Contractor _ ¢ x f BUILDING PERMIT ¢ a a 4 OWNER-BUILDER DECLARATION - INFORMATION E:- 0 LL N thereby affirm that 1 an exempt from. Contractor's License MISC.- REFER TO ORD VALUATION aa w w la Law for the following reason.(Sec.7031.5,Business and Professions .PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, rc ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. _ F DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO d m he is licensed pursuant to the provisions of the Contractor's License 9 p • Uzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe P PLO - V- 1 i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ r the basis for the alleged'exemption.Any violation of$ection7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars(550OLL O 1,as 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 tae work,and the structure is not intended or offered to 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 - '� properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.99 e l 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such Improve. !- .Cuts are not intended or offered for sale.ll & ',hcovue,.the building GAS-EA.SYSTEM-1 6.00 . or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) .2.00 ��..Y_, BUILDING USE bihilder will have the burden of proving that he did not hail!or im- P prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Omer ❑ 1,as owner of the property,am exclusively contrasting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-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 therenn,and who LAWN SPRINKLERS-OV,ER-5,(EAJ 1.00 contracts for such projects with a contraclor(s)licensed pursuant In SEWER-SANITARY-STORM EA.2001t/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I' exempt unJ�FSee. ,B.&I'.C. 'oI this WATER HEATER W/VENT 6.00 son_ Owner Date -- l_ WATER SYSTEM ,C•LI ) 5.00 S ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION - WATER TREATING EQUIP.O rn04t105.00 I hereby affirm that I have u certificate of consent to self-insure, C�LY V7 r ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy I a Nor(Sec.3900,Lu b.C.). Policy No. Company I. O ❑ Certified copy is hereby furnished. FIFE SPRINK ENERGY T-24 Z Z. O Certified ropy is tiled with the city inspection division. MISC.- REFER TO ORD. O Applicant - V❑ ry❑ v❑ � N❑ W~ InPERMIT ISSUANCE 10.00 > CERT'll'ICATE COMPEAJSATONIINSUR FROM NCE ORKIiRS' PLG.CONTR, LIC.NO. PLG. Q FLOOD ZONE A.L.U.C. CL Z( This section need not be completed if the permit is for one TOTAL Y[-] N❑ v ❑ N❑ hundred dollars IS 100)or less.) U O .1 certify film in the performance of tire work for which thisPer V MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued, I shall not employ any person in any manner so as❑a a O L) become subject to lire Workers'Compensation Laws of California. 0. Dale'ICApplicant ALTER OR ADD-TO MECH. 5.00 BUILDING } W NOTE TO APPLICANT: If,after making this Certificate of Ex- . F. 2 enptim,,you Should become Subject to the Workers'Compemsaticn APPLIANCE I.4, 5.00 PLAN CHECK provisions of the Labor Code, you.most forthwith comply wills FEE U such provisions or this penllil shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) ,4.00 _ CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVERI,I0000CIF,M!I6.00 SEISMIC FEE I hereby affirm that there is a cnnslruction lending agency for EXHAUST HOOD (WITH'D(JCT) 5.00 the performance of the work for which this permit is issued(Sec. - I r_ MICROFILM 3097,Civ.C.L 1 `�. HEATING UNIT(TO 100,000 B.T.U.) 8.00 V' - Lender's Name'- HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC ' ./ I certify that l have read this application and stale that the above L4 VENTILATION FAN (SINGLE) 4.00 information is Correct. I agree to comply with all city and county g01LER-COMP13 H.P.Or 100,000 B.T.U.) 8,00 PLUMBING ordinances and state laws relating to building construction, and hereby aullmrize representatives of this city to enter upon the Over 100,000 BTUI SEE FEE SCH. MECHANICAL' L !/Z above-mentioned property for inspection purposes. BOILER-COMP (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. C amino against liabilities,judgments, costs and expenses-which PERMIT ISSUANCE 10.00 CONST.TAX In in any way true.against said City in consequence of the g citing of this mit. MECH.CONT. 'LIC.NO. MECH. p X TOTAL Sigat"re of Applicant/Contractor Data n tit•.u .�v OFFICE COPY v I '� .•