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7095CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) LLYI NO. • /�f�7Z OWNER BUILDING ELECTRICAL PLUMBING MECHANICAL MCELLANEOUS • 0 o APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY B LDI NG PROJECT 1 DENTI FICATION APPLICATION &PERMIT. BUILDING —ELECTRICAL— PLUMBING =MECHANICAL PERMIT NUMBER 7095 BUILDING ADDRESS Q //// S 7S ✓74y/'/s/5' L/zf( %�Lv�a OWNER'S NAME /�� erP /(//LNITUSM% �s>%NONE Z�j TJ pp0 O },d"kPw�EV}RML I LCTRI;KE PLAN CHECK VALIDATION AERAcroRaNM UTLETS- SWITCHES -RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 LIC. NO. ' ons CONTRACTORS ADORE55 PPLIANCES- RESIDENTIAL 4.00 PANELS 5.U0 'Al'/ FROrvE GATE OF APPLICATION ARCHITECT A Llc. rvo. SIGNS6.00 PLANCHECKFEE P.C. NO. SIGNS TRANS. 3.00 NG. S'�gya/Fg..Gsac.o 42 MlS51 .>T 3" 3Q! zip?4•IOS 5A"LICANT SPECIAL CIRCUIT 5.00 PERMIT VALIDATION . UL�[ , /q EMP. METER OR POLE INS. 15.00 1 MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions ol'Chapter 9 (commencing wilh Section 7000) of Division 3 of the Business and Professions Code, a is in full force an - t. License Class_ Lic. Numbcr L(//yv - ISS ANCE DATE ' BLDG. ELECT. PLG. MECH. •license Dam Contractor BUILDING'PERMIa�'.Jf#e" „ T " INFORMATION,!',,!;.•,. OWNER -BUILDER DECLARATION - 1 hereby affirm that 1 am exempt from the Contractor's License Law forthe following reason. (See. 7031.5, Business and Professions Code: Anycity orcounty wh ich requires a permit to construct, alter, itolose,demolish, of repair any structure, prior to its issuance, also requires the applicant for such pennil to file a signed statement Thal he is licensed pursuant to the provisions ol'the Contractor's License � � MISC. — REFER TO ORD PERMIT ISSUANCEVALUATION 6.00 //J��{�1r�r/) $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL 4 PERMITIED 5 ����an� #v 1 L. -(Chapter 9(commencingwith Section 7000)of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and - OTY•. PLUMBING PERMIT IF -{ A the basis for the alleged exemption. Any violation of Scction 7031.5 by any applicant for five Iniad ilsdljedsthe $500).licanl tnacivil penally of any applic nt five hundred dollars ($500) applicant - STORIES of CL'pertino TYPE CONSTR. 2y44 Ma ALTER -DRAIN ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of BACK FLOW PROTECT. DEVICE 200 . oce. GROUP s RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 4.00 FIXTURES - PER TRAP 4.00 SO. FT. FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who doessuch work himself or through his own employees, provided that such improve mems are not intended or offered for Sale. If, however, the building GAS - EA. SYSTEM - I INC. 4 OUTLETS 4.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving [hat lie did not build or im- prove purpose of sale.). 1, as o I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 100 . BUILDING USE HES IND CON PB Other Q 1-1 1:1 El INDUSTRIAL WASTE INTER. 20.00 licensed contraefols to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to am owner of property who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORSPARCEL NO. cammds for such projects the Cons for such vmw L with a rnntraelSr(s) licensed pursuant to License Law. SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO, PARCEL NO. Elform exe underFec RAP.G I'or this 1 1- WATER HEATER W/VENT q,00 ria. Owner %'' —._ flidcl!.,11-61.411 WATER SYSTEM 4.00 ACC.DATE ACC. FILE NO. WORKERS 'COM PENSATION OF [ARA'TION WATER TREATING EQUIP: 4.00 I hereby alfarm that I Lune a certificate of consent to self -insure. oror yapceerrliifycca(tlee )f Workers* Compensation Insurance, or a certified Pdl'Iry TONING ENG. SITE NO. FIRE SPRINK YE] NE] ENERGY T-24 Y No Cl Certified 's hereby furnished. ❑ Certified y.�yy fi ith Ily mspcction division. Al+plicant 4 w _ MISC.- REFERTOORO. or S' CERTI i PTINS FROM WORKIiRS' PERMIT ISSUANCE 6.00 PLOODZONE A.L.U.C. . COME SA COMPENSATION INSURANCE (This section need not be completed if the pennil is for one PLG. CONTS., LIC. NO. PLG. TOTAL Y E, NEI Y N[:] hundred dollars ($ 100) or less.) 1 Certify that In the performance of the work for which Ibis per mit Is Issued, I Shall not employ any person many mannerso as to ,�N�,r +; , =!�' k� STY' ° t a '" MECHANICAL,P,ERMITp i :, R s p FEE v. I t' 'FEE SUMMARY k.. _ IUM BUILDING become subject to the Workers' Compensation Laws of California. Dam o Applicant NOTICE TO APPLICANT: If, after ranking this Certificate of P.x- ALTER OR ADD TO MECH. 4.00 APPLIANCE 4.00 AIR HANDLING UNIT (TO 109MC.F.M.) 3.00 PLAN CHECK FEE enlpliou, you should become subject In the Workers Compensation provisions of the labor Code, you must forthwith comply with such provisionsor this permit shall he deemed revoked. AIR HANDLING UNITIOVER 10=C.F.M.15.00 SEISMIC FEE ✓� ' CONSTRUCTION LENDING AGENCY - I herchy affirm that there is a Construction lending agency far EXHAUST HOOD (WITH DUCT) 2.00 file performance of the work fo which this permit is issued (Sec. 3097, Civ.CJ. MICROFILM HEATING UNIT ITO 100,000 B.T.U.) 4.00 Lender's Name HEATING UNIT (OVER 100,000 B.T.U.17.50 ELECTRIC Lender's Address - VENTILATION FAN (SINGLE) 3.00 I certify flat l have read this application and state that the above information is correct. I agree to comply with all city and County ordinances and slate laws relating to building construction, and PLUMBING I BOILER- OOMP(3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Con, 1EIQ000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. MISC. - - REFER TO ORD. PERMIT ISSUANCE 3.001CONST. TAX (We) agree to save; Indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any' way accrue against said City in consequence of the grgAM�o th��sy�jmit, y� — ((� 9G/ CG S %/L1SS MECH.CONT. LIC. NO. MECH. TorAL ;TOTALq, - /Z //% Y Signature oFAppli Data ry0.lLfrI IW. .vr Iq. . OFFICECOPY i O Z z F O W �u W - ao D z U o IL F- 0 0 F- A u 0 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI FICATIOQI APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMITNUMBER• 7095 BUILDING c / ADDRESS 2 ys �7Fvr. /s Pati �Ly�, OWNER'S /NAAMMEti /,, 1 S//ON CP1$I- 409 612 �QI /V2N/TUZI� PHONE��}� pb QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION NAIVEACTORS NAME UTLETS-SWITCHES-RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 Llc. rvo. 'CONTRACTORS ADDRESS AAPPLIANCES A / ,/ - RES IDENTIAL 4.00 PANELS S.00 ' PHOrvE DATE OF APPLICATION Al ARCHITECT rY camlFse�e Uv 2 uc. NO. SIGNS 6.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 AllIT Go $ ADDR,SS ENG. , /T�; 2.4 LO A I J! PTiS / x.v .STr. 501 ZIPgb IUS SPECIALCIRCUIT 5.00 PERMIT VALIDATION �� / �S,� T S TEMP. METER OR POLE INS. 15.00 APPLICANTS AOoness SaT/;VlNS Y_r: _ Vr MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 LICENSED CONT RACfORS DECLARATION I hereby affirm film I am licensed under provisions of Chapter 9 ISS AN( DATE' (commencing with Section 7000) of Division 3 of the Business and I'm4sxions cod" en 1 1 lice -c is in lull force and� effeJ� t License Class Numbe BLDG. ELECT. El PLG. MECH. ❑ , o Contractor Date Contractor BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's feine Law for the following reason. (Sec. 7031.5, Business and Prr ofessisi ons Code: Any city orcounly which requirese permit toconstruct,alter• Improve, denmhSh, Or repair any structure, prior to Its issuance, also requires the applicant Ro such permit t0 file a signed statement that he is li"nscd pursuant tD the provisions of the Contractor's Licence Law (Chapler9(commencing with Section 7000) of Division 3 oftllc Business and Professions Code) or that he is exempt therefrom and S MISC.- REFER TO ORD VALUATION /6 000.00 ) $/FT. PERMIT ISSUANCE 6.00 ELEC. CONTE. LIC. NQ ELEC. TOTAL PERMIT T, W4 5. % QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not nulm than tire lmndRd dIullars (S500).): ALTER -DRAIN -WATER (EA.) 4.00 Zed C,1,0r,-e ❑ I, lis owner of the property, or my employees with wages as their sale compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 12.00 OCC. GROUP � t1 /1 s F(.T/i �� RES.UNITS •G -� DRAINS -FLOOR, ROOF, AREA, EA,CON D. I41.00 Code:'I'he Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself' or through his own employees, provided that such improv merits are not intended or offered for sale. If, however, the building -' FIXTURES - PER TRAP 4.00 SO. FT. FLOOR AREA TOTALACREAGE 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 icer prove for purpose of sale.). ' 7)I, as owner of the property. am exclusively contracting with GAS - EA. SYSTEM; OVER 4 (EA.) 1.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ - INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS -I INC 5 V.8. 5.00 + . LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL 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 improves thereon, and who` contracts for such projects with a conlmctorts) licensed pursuant to the Comrador's License Law. SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO. PARCEL NO. O ill am exe underScc ,BAP.C. for this reasol WATER HEATER W/VENT 4.00 Owner Date WATER SYSTEM 4.00 ACC.DATE ACC. FILE NO. WATER TREATING EQUIP. 4.00 WORKERS'COMPENSATION TiATION s I hereby mfinn that I I18vf a CertlflCAtf Of CORSeIIt t0 Sflf-II1sU re or certificate Compensation Insurance. Or a certified ZONING ENG. SITE NO, faa $�off,3Workerrs' PdS1fY M.(X7 ((,�1$ ZWI}il/eh�f C ❑ Certified copy is hereby furnished. ❑ Certified- o� y It filed, with tt1 ty inspection division. Applicmlt /6 r ///... ! - FIRE SPRINK V ❑ NE] ENERGY 24 V E] NE]+'�%°Grc MISC. - REFER TO ORD. _ CER'EIPICATIi 01' I7XEMPIION,PROM WORKERS' PERMIT ISSUANCE 6.00 FLooD ZONE A.L.Uc. PLG. CONTE. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE ('P[iis section need not he completed if the permit is for one V E] N❑ v El. N[3 hundred dollars (51(10) or Ic.T I 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 become subject to the Wmkers' Compensation Laws of California. Applicant NOTICE '10 APPLICANT: If, after making this Certificate of fix.. QTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING //� S"Date ALTER OR ADD TO MECH. 4,00 APPLIANCE 4.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this perm)i shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10)300CF.M.) 3.00 AIRHANDLING UNIT(OVER 10=C.F.M.15.00 SEISMIC FEE CONS'rRUCrION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00 the performance of the work (which this permit is issued (Sec. 3097. Civ.C.). MICROFILM HEATING UNIT 170100,000 B.T.U.1 4.00 HEATING UN IT (OVER 100,000 B.T.U.P.50 ELECTRIC Lender's Nam e Lender's Address I certify that I have read this application and star, that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby rot mrize representatives of this city to enter upon the above mentioned property ]or inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against Said City in consequence of the CONST. TAX PERMIT ISSUANCE 3.00 gralDi'gof this rntil. i��e //iG/s S MECH. CONT. LIC.NQ MECH. TOTAL TOTAL Signature o2 Applicant Centrador Date INSPECTOR COPY.