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7038APPLICANT. TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BUIL DING PROJECT IDENTIFICATION - APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 7038 BUILDING ADDRESS 06no l J' / OWNER'S NAME OTY. ELECTRIC PERMIT FEE PLAN CHEf�� LIDATION PMit� C/ -SI / rHorvE I I r N •la 185 J„ Aof Cupertino E OF APPLICATION DATE CONTRACTORS JJ1-• N•A�M'Q[ �// /�I �CDUNT �•� e7pYD� UTLETS- SWITCHES -RECEP 5.00/1:00 LIGHTING.FIXTURES 5.00/1.00 nooisess TOR s 9JyD/ 1025-L ��n/ sf DN L�na•ii')•/S7 APPLIANCES -RESIDENTIAL 4.00 PANELS 5.00 ��N ARCHITECT6,00 OR ENGweER Mee '� .-- X33UCNO!l11 SIGNS PLAN CHECK FEE P.C. No. SIGNS TRANS. - 3.00 ARCH.OR EN4 ADDREss •� �'�• • Y zlr y5/1A SPECIAL CIRCUIT 5.00 PERMIT VALIDATION / EMP. METER OR POLE INS. 15.00 AMICANT's ADDRESS 1.2fG, �• /9h 11 93Yo/ MOTORS SEE FEE SCH. SERVICE CHANGE 10.00/ LICENSED CON' 1' RACTORS DECLARATION s I hereby affirm that 1 am licensed under provisions .f Chapter 9 (emnmenem, with Section 7000) of Division 3.1'the Business and ISSUANCE DATE BL ELECT. PLG. MECH. ect_ pmle,,a ns Cod' and }ny license is in full force and effR License Class_ -(Z/ Lic. Number yZgE40 ]Contractor Uute-/_Conlractorf04.:d SAv�aY_�.r'aC- _8S ❑ ❑ ❑ BUILDING PERMIT, - OWNER -BUILDER DECLARATION I hereby affirm III.( I am exempt from the Contractor's License on Law for the following reason. 7031.5, Businessand Professions Code: Any city., county which re9uinsa permit to construct, alter, improve, demolish, or repair any ,tnel.re, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pit rs...I to the provisions .1 the Contract.,', License INFORMATION' MISC. - REFER TO ORD n VALUATION SIFT. PERMIT ISSUANCE 6.00 ELEC. CONTE. LIC. NO. ELEC. TOTAL PERMI Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and pre, Code) or that he is exempt Oeretroo and the basis for the alleged exemption. Any violation of Section 7031.5 byanyapplicanl berapennit subjects the applicant loa civil penally of not more than Ove hundred dollars (5500).): OTY. PLUMBING PERMIT FEE TO ES TY E ONSTR, ALTER-DRAIN&VENT-WATER(EA.)4.00 BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP ES. UNITS tC I, as owner of the property, or my employees with wages as their sole compensation, will do the work, anJ the structure Is not intended or offered for side (Sec. 7044, Business and Professions DRAINS -FLOOR, ROOF, AREA, COND. 4.00 " Code: The Contractor's License Law doss not apply to an owner of properly who builds., improves thereon, and who does such work himself or though his own employees, provided that such improve- mentsarenotinlendedoroN'cred for sale. If, however, the building FIXTURES -PER TRAP 4.00 SD. FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SVSTEM-11NC.40UTLETS 4.00 r improvement is sold within one year of completion, the owner- builder will have the burden of proving that Ice did not build or im- prove for purpose of sale.). - . ❑ I, as owner of the properly, am exclusively con trusting with licensed contraelun to construct the project ISe<. 7044, Business GAS- EA. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE RES IND PB Omor ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER.. 20.00 LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSO RCEL NO. and Professions Code: T'he Contractor's License Law does not apply to un owner of property who builds or improves thereon. and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contraelods) licensed pursuant to the Commclor's hiccnsc haw. SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 4.00 ❑ lam exempt under tics. .B.&P.C. for this reason Owner Dale WATER SYSTEM 4.00 ACC.DATE ACC. FILE NO, WORK Ii RS'COMPI?NSA'I' ION DECLARATION WATER TREATING EQUIP- 4.00 I hereby Ifir... But I have a certificate of consent to%IGInsure, certificate of Workers' C.mpansation Insurance, or certified ZONING ENG. SITE NO. copy thereof(See. 3800, Lab C.). Policy No. Company- ❑ C-Jc.p is hereby fur '. J. ❑ I the c insDeclio. division. App ticPIiXI-Mill FIRE SPRINK Y N❑ ENERGY T.24 Y N❑ MISC.- REFER TO ORD. PERMIT ISSUANCE 6.00FLOOD 20NE AL.0G. AUjpyMi?li ION PROM WOR KHRS, PLG. CONTR. LIC. NO. PLG. TOTAL NSATION INSURANCE section need net be completed if 0m permit is for one hundred dollars IS 100) or less.) f the work Im wch this per- 1 certify oral in the performance . hi mil is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Dale ApplicantALTER Y ❑ N ❑ Y E]N [3(This DTV. MECHANICAL PERMIT FEE FEEiBUNIMARV „•- '' BUILDING OR ADD TO MECH. 4.00 NO'ITCE TO AI'PIJCAN'I': If, after ....king this Certificate of Ex- emption, you should beerme 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 4.00 PLAN CHECK FEE 41, AIR HANDLING UNIT (TO 10900CF.NL) 3.00 AIR HANDLING UNIT (OVER 10,000 C.F.M.)5.00 SEISMIC FEE . CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM 1 hereby affirm that them is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, CP.C.).Lcndcrs (TO 100,000 B.T.U.) 4.00 T(OVER 100,000 B.T.U.)7.50 FAN(SINGLEI 3.00PLUMBING ELECTRIC Name Lender's Address I certify that l have read this application and state that the above ioli ntati.n is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, andhereby MHEATINGT 3 H.P.or100,000B.T.U.) 4.00 (Over 100,000 BTU) SEE FEE SCH. MECHANICAL authorise represcntalivcs of this city to soler upon the abovrmenli.ned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against Iiabidilics, judgments, costs Ind expenses which may in any w' accrue ugain ase City in consequence of the grapli • pelmll.MECH. REFER TO ORD. CONST. TAX PERMIT ISSUANCE 3.00 CONT. LIC. NO. MECH, TOTAL TOTAL ��. nl/ ontraclor OFFICE CUPY APPLICANT. TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BUIL DING PROJECT IDENTIFICATION - APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 7038 BUILDING ADDRESS 06no l J' / OWNER'S NAME OTY. ELECTRIC PERMIT FEE PLAN CHEf�� LIDATION PMit� C/ -SI / rHorvE I I r N •la 185 J„ Aof Cupertino E OF APPLICATION DATE CONTRACTORS JJ1-• N•A�M'Q[ �// /�I �CDUNT �•� e7pYD� UTLETS- SWITCHES -RECEP 5.00/1:00 LIGHTING.FIXTURES 5.00/1.00 nooisess TOR s 9JyD/ 1025-L ��n/ sf DN L�na•ii')•/S7 APPLIANCES -RESIDENTIAL 4.00 PANELS 5.00 ��N ARCHITECT6,00 OR ENGweER Mee '� .-- X33UCNO!l11 SIGNS PLAN CHECK FEE P.C. No. SIGNS TRANS. - 3.00 ARCH.OR EN4 ADDREss •� �'�• • Y zlr y5/1A SPECIAL CIRCUIT 5.00 PERMIT VALIDATION / EMP. METER OR POLE INS. 15.00 AMICANT's ADDRESS 1.2fG, �• /9h 11 93Yo/ MOTORS SEE FEE SCH. SERVICE CHANGE 10.00/ LICENSED CON' 1' RACTORS DECLARATION s I hereby affirm that 1 am licensed under provisions .f Chapter 9 (emnmenem, with Section 7000) of Division 3.1'the Business and ISSUANCE DATE BL ELECT. PLG. MECH. ect_ pmle,,a ns Cod' and }ny license is in full force and effR License Class_ -(Z/ Lic. Number yZgE40 ]Contractor Uute-/_Conlractorf04.:d SAv�aY_�.r'aC- _8S ❑ ❑ ❑ BUILDING PERMIT, - OWNER -BUILDER DECLARATION I hereby affirm III.( I am exempt from the Contractor's License on Law for the following reason. 7031.5, Businessand Professions Code: Any city., county which re9uinsa permit to construct, alter, improve, demolish, or repair any ,tnel.re, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pit rs...I to the provisions .1 the Contract.,', License INFORMATION' MISC. - REFER TO ORD n VALUATION SIFT. PERMIT ISSUANCE 6.00 ELEC. CONTE. LIC. NO. ELEC. TOTAL PERMI Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and pre, Code) or that he is exempt Oeretroo and the basis for the alleged exemption. Any violation of Section 7031.5 byanyapplicanl berapennit subjects the applicant loa civil penally of not more than Ove hundred dollars (5500).): OTY. PLUMBING PERMIT FEE TO ES TY E ONSTR, ALTER-DRAIN&VENT-WATER(EA.)4.00 BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP ES. UNITS tC I, as owner of the property, or my employees with wages as their sole compensation, will do the work, anJ the structure Is not intended or offered for side (Sec. 7044, Business and Professions DRAINS -FLOOR, ROOF, AREA, COND. 4.00 " Code: The Contractor's License Law doss not apply to an owner of properly who builds., improves thereon, and who does such work himself or though his own employees, provided that such improve- mentsarenotinlendedoroN'cred for sale. If, however, the building FIXTURES -PER TRAP 4.00 SD. FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SVSTEM-11NC.40UTLETS 4.00 r improvement is sold within one year of completion, the owner- builder will have the burden of proving that Ice did not build or im- prove for purpose of sale.). - . ❑ I, as owner of the properly, am exclusively con trusting with licensed contraelun to construct the project ISe<. 7044, Business GAS- EA. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE RES IND PB Omor ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER.. 20.00 LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSO RCEL NO. and Professions Code: T'he Contractor's License Law does not apply to un owner of property who builds or improves thereon. and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contraelods) licensed pursuant to the Commclor's hiccnsc haw. SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 4.00 ❑ lam exempt under tics. .B.&P.C. for this reason Owner Dale WATER SYSTEM 4.00 ACC.DATE ACC. FILE NO, WORK Ii RS'COMPI?NSA'I' ION DECLARATION WATER TREATING EQUIP- 4.00 I hereby Ifir... But I have a certificate of consent to%IGInsure, certificate of Workers' C.mpansation Insurance, or certified ZONING ENG. SITE NO. copy thereof(See. 3800, Lab C.). Policy No. Company- ❑ C-Jc.p is hereby fur '. J. ❑ I the c insDeclio. division. App ticPIiXI-Mill FIRE SPRINK Y N❑ ENERGY T.24 Y N❑ MISC.- REFER TO ORD. PERMIT ISSUANCE 6.00FLOOD 20NE AL.0G. AUjpyMi?li ION PROM WOR KHRS, PLG. CONTR. LIC. NO. PLG. TOTAL NSATION INSURANCE section need net be completed if 0m permit is for one hundred dollars IS 100) or less.) f the work Im wch this per- 1 certify oral in the performance . hi mil is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Dale ApplicantALTER Y ❑ N ❑ Y E]N [3(This DTV. MECHANICAL PERMIT FEE FEEiBUNIMARV „•- '' BUILDING OR ADD TO MECH. 4.00 NO'ITCE TO AI'PIJCAN'I': If, after ....king this Certificate of Ex- emption, you should beerme 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 4.00 PLAN CHECK FEE 41, AIR HANDLING UNIT (TO 10900CF.NL) 3.00 AIR HANDLING UNIT (OVER 10,000 C.F.M.)5.00 SEISMIC FEE . CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM 1 hereby affirm that them is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, CP.C.).Lcndcrs (TO 100,000 B.T.U.) 4.00 T(OVER 100,000 B.T.U.)7.50 FAN(SINGLEI 3.00PLUMBING ELECTRIC Name Lender's Address I certify that l have read this application and state that the above ioli ntati.n is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, andhereby MHEATINGT 3 H.P.or100,000B.T.U.) 4.00 (Over 100,000 BTU) SEE FEE SCH. MECHANICAL authorise represcntalivcs of this city to soler upon the abovrmenli.ned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against Iiabidilics, judgments, costs Ind expenses which may in any w' accrue ugain ase City in consequence of the grapli • pelmll.MECH. REFER TO ORD. CONST. TAX PERMIT ISSUANCE 3.00 CONT. LIC. NO. MECH, TOTAL TOTAL ��. nl/ ontraclor OFFICE CUPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER ^ BUILDING ADDRESS 10600 BUILDING- ELECTRICAL- PLUMBING - MECHANICAL J 7 O 3 OWNER'S PLAN CHECK VALIDATION NAME i QTY. ELECTRIC PERMIT FEE PHONE DATE OF APPLICATION CONTRACTOWS NAME }1 / [ -n.PV AT LA,' OUTLETS - SWITCHES -RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 ADDRpE`ss'oRs •93 y0� l[1 1 /NJ -Ie '/,' �A/ ONE '/)/•/�/ PPLIANCES-RESIDENTIAL 4.00 PANELS - 5.00 ARCHITECT OR ENGINEER � y /'-/F �iUL• LIC.N.,' l31) SIGNS 6.00 PLAN CHECK FEE P.C. NO. ' SIGNS TRANS. 3.00 'i, AR. ENG. ADDRESS 11r'1 N /d �AW K�• , ] zIP 9S_ //2 SPECIAL CIRCUIT 5,00 PERMIT VALIDATION a. I \J V� I EMP. METER OR POLE INS. 15.00 APPucnmrs ADDRESS i� -c % ,�GNn 93yo/ MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 LICENSED CONI RACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions L'Od}'. and my IICCn50 Is III fell force and Cf)Cll License Class.-L.(?L__ Lia Number-La0? j0�El BL ELECT. ❑ PLG. MECH. ❑ Dale J" 7- $� Contra lolxld .x4;0� BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Ivw for ihefollowing rcason.(See ]031.3, Businessand Yrofcssions Coda Any city orcounty which requiresa permit to construct, alter, improve, demolish, or repair any stn¢ture, prior to its issuance. also INFORMATION MISC. - REFER TO ORD VALUATION //[/ j OOO• S/FT. PERMIT ISSUANCE 6.00 ELEC. CONTE. LIC. NO. ELEC. requires the applicant for such permit to file :t signed statement thatTOTAL he is licensed pursuant to the provisions of the Contractor's License PERMI QTY. PLUMBING PERMIT FEE i. Law (Chapter 9 (commencing with Section 70001 of Division 3 at the Business and Professions Centel or that he is exempt Otcrcfrom and / STORIES' TY E QONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 ALTER-DRAIN&VENT-WATER (EA.)4.00 by any applicant for a permit subjects the applicant ton civil Penalty of not more than five hundred dollars ($500).): _ ❑ 1, as niece, Of the Property, or my employees with wages as their Sale compensation, will do the work, and the structure Is not BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP AES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 4.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does riot apply to an owner of property who builds or improves thereon, and who does such work FIXTURES - PER TRAP 4.00 So. FT FLOOR AREA TOTAL ACREAGE himself' or through his own employees, provided that such immove- ments arc not intended or ffered for sale. If. huweveq the building ' I GAS - EA. SYSTEM -1 INC.4 OUTLETS 4.00 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.). ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE RES IND PB Omer ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSOR VRCEL NO. licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improve., thereon, and who contracts for such projects with a eontmcomo licenser) pursuant to the Contractors License Law. SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO, PARCEL NO. ❑ l am exempt umder See ,B.&P.C. for this Hellon WATER HEATER W/VENT 4.00 Owner Date WATER SYSTEM 4.00 ACC.OATE ACC. FILE NO. WORKS RS'COMPENSAI ION DECLARAnoq WATER TREATING EQUIP. 4.00 1 hereby affirm that I haven Certificate of eoment to self -insure, m a certificate of Workers' Compensation Insurance, or a certificd ZONING ENG. SITE NO, copy thereof) Sec. 3800, Lab C.). " Pricy No. Company ❑ C' - d cop is hereby fun d ❑ Tiff y s f the ci inspection division. pylic. ret „tiy' PIC /1017 EXEMPT ION FROM WORKERS' may, V-1 COMPENSATION INSURANCE • `PLG.CONTR. (Phis Section need not be completed if the permit -is for one / FIRE SPR INK Y❑ .,,.N O" ENERGS' T 24 ,,._/ Y N❑ MISC.- REFER TO ORD. PERMIT ISSUANCE 6.00 FLOOD ZONE Y ❑- _ N ❑ A.L.Uc. Y 1:1 N 1:1 LIC. NO.PLG. v� TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY. hundred dollars ($100) or IC,1 1 certify that in the pcdurimence of the work for whidt this per- mit is issued, I shall not employ any person in any manner so as to BUILDING �1 •�(/ become subject to the Workers' Compensation Haws of California. Date Applicant a ALTER OR ADD TO MECH. 4,00 NO'I'ICI. TO APPLICANT: If, after making this Certificate of I'-x- emption, you should become subject to life Workers' CompensationAPPLIANCE provisions of the Labor Code, you must forthwith comply with such provisions'or this permit shall be deemed revoked. -- 4.00 PLAN CHECK FEE 2 J AIR HANDLING UNIT (TO 10=C.F.M.) 3.00 AIR HANDLING UNIT (OVER 10=C.F.M.15.00 SEISMIC FEE CONSTRUCnON LENDING AGENCY I hereby affirm that Ihem is a construction lending agency for the permoriance of the work lu?/which this permit is issued (Sea 3097, Civ.C.). / - EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 d LIN NIT (OV ER 100,000 B.T.U.)7.50 '� ELECTfl IC - Lender's Name Lender's Address Icertify Out I have read misapplication and state mat the .hove Information is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, and VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER-CONP(3H.P.or100,000B.T.U.) 4.00 IOve r 100,000 BTUI SEE FEE SCH. MECHANICAL hrechy amborim reprcrentzUvcs of this city to enter upon theBOILER-COMP abrovomentioned properly for inspection purpnms. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of ha Cupertino against liabilities, judgments, costs and expenses which may in any w' accrue again id City in consequence of the CONST. TAX PERMIT ISSUANCE 3.00 CONT. LIC. NO. MECIT TOTAL TOTAL gmntin Permit.MECtI. d5' i ala of p ret/ ontractor a V INSPECTOR COPY N