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16185 (2) POST THISCARD:NEAR FRONTOF:BUIL`DING - _ r FlE RMITNUMBER 1 CITY:: 0F CUPERTINO , INSPECTIONDIVISION' -` JOB,INSPECTION_',RECORID i RE RMI7 EXPIRATION JOB ADDRESS l ECV L_7' W? UNIT# LOT# - -, - , PERMIT EXPIRES IF,WORK OWNER V 'CONTRACTOR �V Y70 L V_ X4- j j,�. IS 'NOT STARTED•WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD - 180 DAYS OF PERMiTISSU. FOUNDATION •' "11- ANCE OR 180 DAYS FROM " NOTE LASTCALLEDINSPECTION. i LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH'.THE APPROVED,PLANS AND'CITY OF- . PPRMIT-VAuuATIoN CUPERTWO STANDARDS. GARAGE SLABS - - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _5�gct • o5e, )jam L�U - k I.� 'UNDERGROUND /.SLAB PLUMBING . 1 " 1 %LI`I`+L' A' ,13 ELECTRICAL - _ I MECHANICAL "' ` ISSUANCE UATE ` p I UG BEI77 PLG MECH � - 1'�'I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT WOOD FLOOR `` o C-7 "� INFORMATION PLUMBING ` C yALUATIOW SIFT: w �U MECHANICAL .. ELECTRICAL l}J� - la�� 1 �—� I " PL MR To12cK'.T, .x FRAMING 1!, � � ., .`.p..-.r�...� TORTE INSULATION. _ YPE CONSTR. r � �' - � ,- �L, �A'-� T - - 6;9eA 9 ` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGIOD ' . '' ^ - -ROOF � NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SOFT.ILOOP AREA TO IAL ACREAGL' 'S DIAPHRAGM THE CONSTRUCTION TAX IS PAID - BUILDING USE ROOF SHEATHING1 7 : - PES IND CON, PS Om., ' APPLY.NO ROOFING UNTIL ABOVE HAS BEEN SI NED FINALS DATE'. INSP. ❑ 0 .❑ .❑ ❑ ROUGH SAN.N - ASS ESSORSPARCELNO. PLUMBING ' ELECT.ENERGY F ' TRACT NO. PARCEL NO TUBS 8 SHOWER PAN - PLUMBING ENERGY - - MECHANICAL MECH.ENERGY " .ELECTRICAL l BUILDING ENERGY ACC.DATE ACC,FILE NO FRAMING ---77­7� EUECT.'FINAL TEST " ZONING ENG SITE N0. - INSULATION - -� PLUMBING �- r ' GAS TEST GAS FIRE SPRINK iENERGYT-j9 MECHANICAL' v [3 "N❑ r ❑. :.N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGN D HEATING ' • - LOOD . ` EXTERIOR SHEAR - ..(( „ � . ELECTRICAL RELEASE ��L� FZONE ac,u C r ' ❑ ' INTERIOR SHEAR FIRE DEPT. YNE] Y ❑ ;N❑ ,' �', SHEETROCK GRADE. FEE SUMMARY EXTERIOR LATH BUILD] INTERIOR 'LATH ORARY, APPROVALS BUILDING' SCRATCH COAT ELECTRIC, - PLAN CHECK ,FJ` • - - GAS - _ FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY -f SEISMIC FEE- /..Q&Q•t OCCUPANCY OF BUILDING IS NOT PERM ITTED UNTI LBUIL•DING F INAL IS SI GNED BY BUILDING INSPECTOR. 'MICROFILM. ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY•BEFORE REQUIRED INSPECTION PwMeiNG 00� PLEASE,GIVE JOB ADDRESS WHEN PHONING;' SEE PERMIT FOR-EXPIRATION DATE - -'.: , . MECHANICAL,, IMPORTANT!' oN ' :T P 7jY, . PLEASEREAD REVERSE SIDE BEFORE ,' �'Q�' CALLING'FOR FINAL INSPECTION.' TOTAL (� OFFICE COPY I e APPLICANT TO FILL IN INFORMATION WITHIN RED LINES_-,USE BALLPOINT PEN-ONLY - B -PERMIT NUMBERUILDINGPROJEC7JDENTIFICATION 7'{'bmLoirv$cA- ADORESAPPLICATION PERMIT BUILDINGELECTRICAL-PLUMBING-MECHANICAL 16185 OwrvER's , PLAN CHECK VALIDATION NAME - OTY. ELECTRIGPERMIT FEE 1410 Me�Vr gNE2 -i 3;74 ,*AR -Z �� f CONTRACTOR'S E ) OUTLETS-SWITCHES-RECEP. ,10.00/1.00 `..-�_ No. LIGHTING FIXTURES 10:00/100 rorvrRacroR's � /1PPLIANCES-RESIDENTIAL 400 ''f'Ea RES$ Z r/p p / PHON Z, PANELS, ':1000 • DATE OF APPLICATION. ARCHITECT -. PLAN CHECK FEE , •P.C.NO.. OR PANELS (OVER 200 AMP) 20.00 ENGINEE SIGNS TRANS, - 3.00. AARCH.OR DDRESS ENG SPECIAL CIRCUIT 5,00 'PERMIT VALIDATION ZIP' EMP.METER OR POLE INS. 20.00 APPUCANT's 'MOTORS SEE FEE SCH. A DDREss SERVICE CHANGE 20.00 Foo LICENSED CONTRACTORS DECLARATION / a i w 1 hereby al firm thin 1 um licensed under provisions.1 Chapter 9. IbSUANCE GATE ; (commencing w'Ih$ecfi 7000)of Division 3 of the Business Doti a ELECT. PLO. y MECH. m i Professions Cqt{� ry1 my license o In full fo� o�eIt_ret i m:-24 License Lia Number VY�_ , ❑' 2 m JDate,-x&p : -4Q�Contract., .. . ¢ ¢ w a OWrNNERR-Bu1LDFR DECLARATION V LDING PERMIT- E: ;A N I hereby affirm that I am exempt from the Contractor's License MISC.- - REFER TO ORD INFORMATION LL VALUATION $/FT. . F L o Law for the fallowing reason,TSce,7031.5,Business and l'mficssions g Code:An 't orcoum PERMIT ISSUANCE, 10.00 ¢ wQ ymY Yir my structurep rioiltoconsuance,also 1-��/,r� r,r, ¢ <p improve,demolish,or repair any structure,prior In its issuance,also ELEC.CONTR. - LIC.NO. ELEC. U W ¢ requires the applicant for such permit to file a signed stmement that TOTAL - u w m�` he is licensed pursuum to the provisions of the Contractor's License o 1- PE MIT,TO , F z r Law(Chapter 9(commencing with Section 7000)of Division 3 oftheA 4 o Business and Professions Code)or that he is ex uild therefrom and OTY. PLUMBING PERMIT - f FEE' ��"� � the basis for the alleged exemption.Any violation of Sect ion 7031.5 I STORIES TYPE CONSTR. byanyapplicant for a permit subjects(He applicant macivtl penalty ALTER-DRAIN IEA.) 5.00 of not more than five lumdrtd dollars($500).): - ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE - 4.00 t their sole compensation,will Jo the work,and the structure is not O D.CROUP RES.UNITS imended•or offered (or sale (Sec. 7044, Ifusine. and Professions DRAINS-FLOOR,ROOF;ARENCOND. 5.00 _ Code:The Contractor's License Law does not apply to an owner of property who builds Or Improves lherroq and who does such work FIXTURES-PER TRAP 5.00 s0.FT.FLOOR AREA TOTAL ACREAGE ' himself or through his own employees,provided that such improve- - mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 •, or improvement is will within one year of completion,the own e -r- l�V . builder will have the burden ofov pring Hot lie did not build or int- GAS EA.SYSTEM-OVER 4 (EA.) 2,00 BUILDING USE Prove for purpose of sale.). RES IND CON PB Color ❑ d as owner of the property,het exclusively.7044,Bu with INDUSTRIAL WASTE INTER. 30.00 „❑ ❑ ❑ ❑ ❑. licensed contractors m iconstructe Contra the project(See. times Business LAWN SPRINKLERS-1'INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions property Contractor's i License s til does not apply co:in trowner of Property who bIs welt Ingaavcs used n,pursuant to LAWN SPRINKLERS-OVER 5(EA.) 1.00 - ' contracts for such projects wish a amtramorts)licensed Pursuant m SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO., PARCEL NO. ❑ Lam uxempl under Sec. ,B.&P.C.f..(],I, WATER HEATER W/VENT - -6.00 ' reason Owner Date WATER SYSTEM 5.00 ACC.DATE Acs FILE ND. .- WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. - 5.00 I hereby affirm that I have a cerlificate ol'Coh.mnt In seh6insure' ZONING ENG.SITE N0. or a certificate of Workers'Compensation hrsurance,or a certified copy thereof(Sea3800,Lany 1. �� A 9AT ^1� Policy ere Co tpa C I aVaGf - Zf] CerlilieJ Cop is]' •reb meshed. FIRESPR INK ENERGY T@4 �y,,. }{ Certif y fit with Ute city inspection division, MISC.- REFER TO ORD. p� APPlicam� Y ❑ N❑ Y ❑ N❑ 'cc rn CERT11 P ICATF. F EXFMPT'ION FROM WORKERS' PERMIT ISSUANCE ,' 10.00 FioGD mNE A.L.u.C. CL CO. I'IiN$A'1'ON INSURANCE PLG.CONED. r7 LIC.NO. PLG.' ' C O (This section need 'nut be completed if the permit is for Dae TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dollars($100)orless.) - , - U O I certify that in the perfonnmme of the work for Willett this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL- F mit is issued.I shall not employ any person in any manner sons to O W hccnlne subject to the Worktry'Camponsulinn Lows of Cvlifornia. - , ��� a Datc ApplicantALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE APPLICANT: If,after making this Certificate or-I.-- � Z, empfion,you should hacomeld,col to the Workers Cmnpcnsnllon APPLIANCE` ' ' . 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply will1 ^` U such provisionsor this permit shallQW be deemed revoked. AIR HANDLING UNIT(TO 10,O90 F.M.) 4.00 FEE Q CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.FM.) 6.00 SEISMIC FEE . 40 80,- 1 hereby affirm ihul there is a constro,liud'landing agency for EXHAUST HOOD(WITH DUCT)'- 5.00 . the performance of the work for which this permit is issued(Sec. MICROFILM' ' 3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nome HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC I CLender's Address i I certify that I have read this application and stale that the above 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-COMP(3 H.P.oil 00,000 B.T.U.) 6.00 hereby aulhorue representatives of this city to enter upon,lhe above-mentioned property for inspection PurPOses. BOI LER-COMP (Over 100,000 BTU)SEE FEE SEN. MECHANICAL - (We),agree to save, indemnify mul keep hornless fila City of MISC.- - REFER TO ORD. Cupertino against liebiliUes, Wgmmt costs and expenses which CONST.TAX ~' ay..in,any ay accrue ag nst sa' City in cons acre of the PERMIT ISSUANCE 10,00 moll tis permit'Nx MECH.CONT. LIC.NO. MECH. _ - ,��s�h.-a:•v� TOTAL TOTAL Sign' re of Applicun 11 Con actor D.IF OFFICE COPY ,. POST THISCARD:NEAR FRONTOF:BUIL`DING - _ r FlE RMITNUMBER 1 CITY:: 0F CUPERTINO , INSPECTIONDIVISION' -` JOB,INSPECTION_',RECORID i RE RMI7 EXPIRATION JOB ADDRESS l ECV L_7' W? UNIT# LOT# - -, - , PERMIT EXPIRES IF,WORK OWNER V 'CONTRACTOR �V Y70 L V_ X4- j j,�. IS 'NOT STARTED•WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD - 180 DAYS OF PERMiTISSU. FOUNDATION •' "11- ANCE OR 180 DAYS FROM " NOTE LASTCALLEDINSPECTION. i LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH'.THE APPROVED,PLANS AND'CITY OF- . PPRMIT-VAuuATIoN CUPERTWO STANDARDS. GARAGE SLABS - - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _5�gct • o5e, )jam L�U - k I.� 'UNDERGROUND /.SLAB PLUMBING . 1 " 1 %LI`I`+L' A' ,13 ELECTRICAL - _ I MECHANICAL "' ` ISSUANCE UATE ` p I UG BEI77 PLG MECH � - 1'�'I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT WOOD FLOOR `` o C-7 "� INFORMATION PLUMBING ` C yALUATIOW SIFT: w �U MECHANICAL .. ELECTRICAL l}J� - la�� 1 �—� I " PL MR To12cK'.T, .x FRAMING 1!, � � ., .`.p..-.r�...� TORTE INSULATION. _ YPE CONSTR. r � �' - � ,- �L, �A'-� T - - 6;9eA 9 ` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGIOD ' . '' ^ - -ROOF � NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SOFT.ILOOP AREA TO IAL ACREAGL' 'S DIAPHRAGM THE CONSTRUCTION TAX IS PAID - BUILDING USE ROOF SHEATHING1 7 : - PES IND CON, PS Om., ' APPLY.NO ROOFING UNTIL ABOVE HAS BEEN SI NED FINALS DATE'. INSP. ❑ 0 .❑ .❑ ❑ ROUGH SAN.N - ASS ESSORSPARCELNO. PLUMBING ' ELECT.ENERGY F ' TRACT NO. PARCEL NO TUBS 8 SHOWER PAN - PLUMBING ENERGY - - MECHANICAL MECH.ENERGY " .ELECTRICAL l BUILDING ENERGY ACC.DATE ACC,FILE NO FRAMING ---77­7� EUECT.'FINAL TEST " ZONING ENG SITE N0. - INSULATION - -� PLUMBING �- r ' GAS TEST GAS FIRE SPRINK iENERGYT-j9 MECHANICAL' v [3 "N❑ r ❑. :.N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGN D HEATING ' • - LOOD . ` EXTERIOR SHEAR - ..(( „ � . ELECTRICAL RELEASE ��L� FZONE ac,u C r ' ❑ ' INTERIOR SHEAR FIRE DEPT. YNE] Y ❑ ;N❑ ,' �', SHEETROCK GRADE. FEE SUMMARY EXTERIOR LATH BUILD] INTERIOR 'LATH ORARY, APPROVALS BUILDING' SCRATCH COAT ELECTRIC, - PLAN CHECK ,FJ` • - - GAS - _ FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY -f SEISMIC FEE- /..Q&Q•t OCCUPANCY OF BUILDING IS NOT PERM ITTED UNTI LBUIL•DING F INAL IS SI GNED BY BUILDING INSPECTOR. 'MICROFILM. ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY•BEFORE REQUIRED INSPECTION PwMeiNG 00� PLEASE,GIVE JOB ADDRESS WHEN PHONING;' SEE PERMIT FOR-EXPIRATION DATE - -'.: , . MECHANICAL,, IMPORTANT!' oN ' :T P 7jY, . PLEASEREAD REVERSE SIDE BEFORE ,' �'Q�' CALLING'FOR FINAL INSPECTION.' TOTAL (� OFFICE COPY I e APPLICANT TO FILL IN INFORMATION WITHIN RED LINES_-,USE BALLPOINT PEN-ONLY - B -PERMIT NUMBERUILDINGPROJEC7JDENTIFICATION 7'{'bmLoirv$cA- ADORESAPPLICATION PERMIT BUILDINGELECTRICAL-PLUMBING-MECHANICAL 16185 OwrvER's , PLAN CHECK VALIDATION NAME - OTY. ELECTRIGPERMIT FEE 1410 Me�Vr gNE2 -i 3;74 ,*AR -Z �� f CONTRACTOR'S E ) OUTLETS-SWITCHES-RECEP. ,10.00/1.00 `..-�_ No. LIGHTING FIXTURES 10:00/100 rorvrRacroR's � /1PPLIANCES-RESIDENTIAL 400 ''f'Ea RES$ Z r/p p / PHON Z, PANELS, ':1000 • DATE OF APPLICATION. ARCHITECT -. PLAN CHECK FEE , •P.C.NO.. OR PANELS (OVER 200 AMP) 20.00 ENGINEE SIGNS TRANS, - 3.00. AARCH.OR DDRESS ENG SPECIAL CIRCUIT 5,00 'PERMIT VALIDATION ZIP' EMP.METER OR POLE INS. 20.00 APPUCANT's 'MOTORS SEE FEE SCH. A DDREss SERVICE CHANGE 20.00 Foo LICENSED CONTRACTORS DECLARATION / a i w 1 hereby al firm thin 1 um licensed under provisions.1 Chapter 9. IbSUANCE GATE ; (commencing w'Ih$ecfi 7000)of Division 3 of the Business Doti a ELECT. PLO. y MECH. m i Professions Cqt{� ry1 my license o In full fo� o�eIt_ret i m:-24 License Lia Number VY�_ , ❑' 2 m JDate,-x&p : -4Q�Contract., .. . ¢ ¢ w a OWrNNERR-Bu1LDFR DECLARATION V LDING PERMIT- E: ;A N I hereby affirm that I am exempt from the Contractor's License MISC.- - REFER TO ORD INFORMATION LL VALUATION $/FT. . F L o Law for the fallowing reason,TSce,7031.5,Business and l'mficssions g Code:An 't orcoum PERMIT ISSUANCE, 10.00 ¢ wQ ymY Yir my structurep rioiltoconsuance,also 1-��/,r� r,r, ¢ <p improve,demolish,or repair any structure,prior In its issuance,also ELEC.CONTR. - LIC.NO. ELEC. U W ¢ requires the applicant for such permit to file a signed stmement that TOTAL - u w m�` he is licensed pursuum to the provisions of the Contractor's License o 1- PE MIT,TO , F z r Law(Chapter 9(commencing with Section 7000)of Division 3 oftheA 4 o Business and Professions Code)or that he is ex uild therefrom and OTY. PLUMBING PERMIT - f FEE' ��"� � the basis for the alleged exemption.Any violation of Sect ion 7031.5 I STORIES TYPE CONSTR. byanyapplicant for a permit subjects(He applicant macivtl penalty ALTER-DRAIN IEA.) 5.00 of not more than five lumdrtd dollars($500).): - ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE - 4.00 t their sole compensation,will Jo the work,and the structure is not O D.CROUP RES.UNITS imended•or offered (or sale (Sec. 7044, Ifusine. and Professions DRAINS-FLOOR,ROOF;ARENCOND. 5.00 _ Code:The Contractor's License Law does not apply to an owner of property who builds Or Improves lherroq and who does such work FIXTURES-PER TRAP 5.00 s0.FT.FLOOR AREA TOTAL ACREAGE ' himself or through his own employees,provided that such improve- - mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 •, or improvement is will within one year of completion,the own e -r- l�V . builder will have the burden ofov pring Hot lie did not build or int- GAS EA.SYSTEM-OVER 4 (EA.) 2,00 BUILDING USE Prove for purpose of sale.). RES IND CON PB Color ❑ d as owner of the property,het exclusively.7044,Bu with INDUSTRIAL WASTE INTER. 30.00 „❑ ❑ ❑ ❑ ❑. licensed contractors m iconstructe Contra the project(See. times Business LAWN SPRINKLERS-1'INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions property Contractor's i License s til does not apply co:in trowner of Property who bIs welt Ingaavcs used n,pursuant to LAWN SPRINKLERS-OVER 5(EA.) 1.00 - ' contracts for such projects wish a amtramorts)licensed Pursuant m SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO., PARCEL NO. ❑ Lam uxempl under Sec. ,B.&P.C.f..(],I, WATER HEATER W/VENT - -6.00 ' reason Owner Date WATER SYSTEM 5.00 ACC.DATE Acs FILE ND. .- WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. - 5.00 I hereby affirm that I have a cerlificate ol'Coh.mnt In seh6insure' ZONING ENG.SITE N0. or a certificate of Workers'Compensation hrsurance,or a certified copy thereof(Sea3800,Lany 1. �� A 9AT ^1� Policy ere Co tpa C I aVaGf - Zf] CerlilieJ Cop is]' •reb meshed. FIRESPR INK ENERGY T@4 �y,,. }{ Certif y fit with Ute city inspection division, MISC.- REFER TO ORD. p� APPlicam� Y ❑ N❑ Y ❑ N❑ 'cc rn CERT11 P ICATF. F EXFMPT'ION FROM WORKERS' PERMIT ISSUANCE ,' 10.00 FioGD mNE A.L.u.C. CL CO. I'IiN$A'1'ON INSURANCE PLG.CONED. r7 LIC.NO. PLG.' ' C O (This section need 'nut be completed if the permit is for Dae TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dollars($100)orless.) - , - U O I certify that in the perfonnmme of the work for Willett this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL- F mit is issued.I shall not employ any person in any manner sons to O W hccnlne subject to the Worktry'Camponsulinn Lows of Cvlifornia. - , ��� a Datc ApplicantALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE APPLICANT: If,after making this Certificate or-I.-- � Z, empfion,you should hacomeld,col to the Workers Cmnpcnsnllon APPLIANCE` ' ' . 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply will1 ^` U such provisionsor this permit shallQW be deemed revoked. AIR HANDLING UNIT(TO 10,O90 F.M.) 4.00 FEE Q CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.FM.) 6.00 SEISMIC FEE . 40 80,- 1 hereby affirm ihul there is a constro,liud'landing agency for EXHAUST HOOD(WITH DUCT)'- 5.00 . the performance of the work for which this permit is issued(Sec. MICROFILM' ' 3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nome HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC I CLender's Address i I certify that I have read this application and stale that the above 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-COMP(3 H.P.oil 00,000 B.T.U.) 6.00 hereby aulhorue representatives of this city to enter upon,lhe above-mentioned property for inspection PurPOses. BOI LER-COMP (Over 100,000 BTU)SEE FEE SEN. MECHANICAL - (We),agree to save, indemnify mul keep hornless fila City of MISC.- - REFER TO ORD. Cupertino against liebiliUes, Wgmmt costs and expenses which CONST.TAX ~' ay..in,any ay accrue ag nst sa' City in cons acre of the PERMIT ISSUANCE 10,00 moll tis permit'Nx MECH.CONT. LIC.NO. MECH. _ - ,��s�h.-a:•v� TOTAL TOTAL Sign' re of Applicun 11 Con actor D.IF OFFICE COPY ,.