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12297 (2) I fc" POST."T - - -, r CARD NEAR FRONT OF BUILDING ;ITY- OF.CUPERTINO ' PERMIT NDMBER J ---INSPECTION DIVISION. 12297 JOB INSPECTION RECORD /��2/ - PERMIT EXPIRATION JOB E. �/ / LIN• IT LOT# PERMIT EXPIRES IF WORK w"ER- •. CONTRACTOR IS NOT STARTED WITHIN NSPECTI N AT INS C OR INSPECTION CORD 180 DAYS OF PERMIT ISSU- +'+'"� FOUNDATION Z ,. NYCE OR 1800AYS FROM r UFER - r LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND,/SLAB PLUMBING �^' ♦ ELECTRICAL - - Y ASSUA C DATE. ,I• MECHANICAL eLOG. ELEcr. PLC. MECH. o ❑ ' ❑ . ❑ :. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD"FLOOR INFORMATION PLUMBING r - yAwnnoNsiFr. MECHANICAL ELECTRICAL - /Ay 'P7E�RMFTTO FRAMING- /4bj5 I ' INSULATION _y STORIES TYPE CONSTR. n - • OCG GROUP HES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM .. BUILDING USE , RES IND CON PB, OrM1r, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH - - ASSESSORS PA RCELNO. PLUMBIN " GAS TEST TRAcr ND. PARCEL No. MECHANICAL . - • ELECTRICAL— FINALS. DATE INSP. Acc.DATE ACC.FILE NO. FRAMING - .�• 7 SAN #• - - INSULATION - !�= PLUMBING, zo"wc - ENG.sIrE No. MECHANICAL FIRE SPRINK ENERGY T24' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. I Y ❑ N❑ Y ❑ N❑ LATH—INTERIOR - - ELECTRICAL FLOODZONE A­- LATH—EXTERIOR , -LATH—EXTERIOR r FIRE.DEPT. _ Y❑1 N❑ Y ❑ N❑ SHEETROCK - GRADE FEE SUMMARY SHEAR INTERIOR- BUILDING _ - SHEAR EXTERIOR 'TEMPORARY APPROVAL BUILDING ,* FIREWALLS - ELECTRIC •e. PLAN CHECK GAS - FEE , NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALIS SIGNED BY,BUILDING INSPECTOR. MICROFILM _ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC oOF. ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN.PHONING. PLUMBING - SEE PERMIT FOR EXPIRATION DATE MECHANICAL. % ' IMPORTANT! � CONST.TAX " PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. ` IIII OFFICE COPY. AFJ R ICANT TO FILL IN WfORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY S�- - PERMIT NUMBER •' BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - 7 v�� ADDRES _ O-/ •Li(/' 12297 _ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION • NnPne �( QTY. ELECTRIC PERMIT FEE r- .S� _ (1 ONE /Q��,y\- r CONTRACTOR'S NA �p ` UTLETS-SWITCHES-RECEP 10.00/1.00 �.�' � ,(e2iC .No. 2.2LIGHTING FIXTURES 10.00/1.00 CONTRACTOR PPLIANCES-RESIDENTIAL 4.00 ADDRESS g / ^� PRONE pG,]eJ PANELS 10.00 DATE OF APPLICATION ogcercPLAN CHECK FEE P.O.NO. scr PANELS (OVER 200 AMP) - 20.00 ENGINEER - Lic.NO SIGNS TRANS. 3.00 ARCH.OR ENG SPECIAL CIRCUIT S.QQ PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 AMOTORS SEE FEE SWAM /lliO,�w/p.r- ADDRESS ORESS SERVICECHANGE 00 woo LICENSED CONTRACTORS DECLARATION v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE H < n (Commencing with Section 7000)of Division 3 of the Business and CWMLDG. ELECT. PLG. MECH. r o i Professions Code, my license is iR full fur ff. ❑ ❑ ❑ z o in - License C aYp` Lic.Number L[� 1��AI 9 y L,, DIs1c �•" - Cmltractor a¢ aa saw BUILDING PERMIT LDER DECLARATp OWNER-BUI INFORMATION E ;A H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD w VALUATION $/FT. u o`a Law for the following reason.(Sec.7031.5.Business and Professions 9 H _ g PERMIT ISSUANCE 10.00 � Code:Any city or county which requires permit to construct,alteq Q ¢ a p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. to n¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w a- he is licensed pursuant to the provisions of the Contractor's License l rzi Law(Chapter 9(commencing with Section 7000)of Division 3 of the s an Business and Professions Code)or,that he isexempt therefrom and CITY. PLUMBING PERMIT FEE i M r$ the basis for the alleged exemption:Any applicant of Section malty STORIES TYPE CONSTR. n3 - by any applicant fora permit subjectsthe$500n.licant loacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(my em): ❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will(S the work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Cade:The Contractor's License Law does not apply to an owner of . property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve a'mems.,a not improvement is sold w thinoffered onefor year 11,however,thebuildingowner- GAS-EA.SVSTEM-1 1NC.4,OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that Ile did n01 build or im- RES IND CON PB Omer thp prove for purpose of e. INDUSTRIAL WASTE INTER. 30.00 ❑ El El ❑ 1:1❑ I,as owner of the property,am exclusively contracting with licensed contractors 10 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 a contractorfsl licensed pursuant to the Contractors License Law. SEWER-SANITARY-STORM_EA.2008/10.00 TRACT NO, PARCEL NO. CII am exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 -,ACC.DATE ACC.FILE NO. WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-inure, or a cerlificate of Workers'Comperi ggtin oluno n--,or a certified ZONING ENG.SITE NO. -opythereof(Sie.3800,Lab.C.).C2N/0 Ct4s49<0 CD Policy No. Company � ���✓�-ge!;l ❑ Cetlifled copy is hereby furusher d. FIRE SPANK ENERGY T 24 Z_iSO Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. Applicant Y❑ N Y❑ N❑ ~ rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU / CERTIFICATEONSATIOTINS FROM WORKERS' W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL O ('Phis section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ D Z hundred dollars(S 100)or less.) U O I certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,1 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 MECH. 5.00 BUILDING /3(,� } W NOTICE TO APPLICANT: If,offer making this Certificate of Ex- F Z amption,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 10=11F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE 33 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the Civ.0 ince of(he work for which this permit is issued(Sec. MICROFILM HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state 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 refiling to building construction, and BOILER-COIVP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to ember ,on the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We)'agree save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertin ai t li ilities,judgments, costs and expenses which CONST.TAX may i ay true•against said City in consequence of the PERMIT ISSUANCE 10.00 gran's his it MECH.CONT. LIC.NO. MECH. L I� TOTAL TOTAL, umof Applicant/Co Dote OFFICE COPY APPLICANT TO FILL IN 110SORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY { PEfl MIT NUMBER t J P BUILDING PROJECT ID TIFICATION - ' " 1 ' BUILDING APPLICATION & PERMIT AOORrr -^0 -7 _ )WIBUILDING-ELECTRICAL-PLUMBING-MECHANICAL 127.5 7 OWNER'S / PLAN CHECK VALIDATION rvamE ss' . �; V a/Q TY.' ELECTRIC PERMIT FEE CONTRACTOR' '•/II �y� 360 11 UTLETS-SWITCHES-RECEP 10,00/1.00 NAM[ T] C�OV�' I (NL1/W/ Vl- uc.No. LIGHTING FIXTURES 10,00/1.00 -o RAcroRs PPLIANCES-RESIDENTIAL 4.00 ADD,R 5 /1� '1/ yn - PANELS " 10.00 DATE OF APPLICATION ARC TELT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER ' uc.No. SIGNS TRANS. 3.00 ARCH. R ENG. S.00 PERMIT VALIDATION AODR EOSS SPECIAL CIRCUIT ZIP' EMP.METER OR POLE INS. 20.00 ^ CI - APPLICANT'S - MOTORS SEE FEE SCH. PAID ADDRESS - �c-W _ SERVICE CHANGE 20.00 w o o LICENSED CONTRACTORS DECLARATION EB 1987 ¢C,u I hereby affirm that I am licensed under provisions of Chapter 9 SCAN OA y<w (commencing with Section 7000)of Division 3 of the Business and L MECH. _F w i.. Professions Code nd my-license is in full for a d IT t. ❑' z O m- Liwnse Class Lle.Number- 2 o m �. Date�Conhaftor a m - BUILDIN ERMIT ¢ Q w < OWNER-BUILDER DECLARATION INFO ATION La g LL m I herebyaffirm that I am exempt from the Contractor's License 'MISC.-. REFER TO ORD p VALUATION $/FT. uO ¢ Law for the following reason.(Sec.7031.5,Business Professions PERMIT ISSUANCE. 10.00 - -i Code:Any city or county whichrequiresapermittoconstruct,alter, 2 improve,demolish,or repair any structure,�prior to its issuance,also ELEC.CONTR. r - LIC.NO. ELEC. -O u requires the applicant for such permit to file a signed statement that TOTAL IFLOOR T TO B. w$ w re is licensed pursuant applicant for the provisions of the Contractor's License i rz) Law(Chapter9(commencingwith Section 7000)ofDivision3 of the - 4 c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE rc 1-o the basis for the alleged exemption.Any violation of Section 7031.5 TY E CONSTR. by any applicant for apermit subjects the applicant lDacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(8500).): ❑ I,as owner of the property,or.my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 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 Cade:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 TOTAL ACREAGE him self or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.4 OUTLETS 6.00 .in 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 kF IL0I NG USE builder will have the burden of proving that he did-not build or im- CON PB Other prove forpurpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 SORS 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 contructons)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA:200ft/10.00 . PARCEL NO. ❑ Iamexemptunder Sec. ,B.&PC.i'orthis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM ' 5.00 ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ENG.SITE NO. 'or'a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). _ Company O ❑ ed hereby furnished. K ENERGY T-24Z Z C c is ith a city inspection division. MISC.- REFER TO ORD. N❑ Y ❑ N❑Applies PERMIT ISSUANCE 10.00 NE A:L.u.c.CE TIFICATE OF EXEMPTION FROM WORKERS' vLU > COMPENSATION INSURANCE PLG.CONTE. uc.No. PLG. Y❑ N❑ Y❑ N❑ lis section need not be completed if the permit is for one TOTAL hundred dollars IS 100)or less.) FEE SUMMARY V O 1 certify that in the performance ol'the work for which this per- QTY... MECHANICAL PERMIT FEE LL - mit is issued,1 shall not employ any person in any manner so as to - LL w become subject to the Workefs'Compensation Laws of Califomm. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } w NOTICE TO APPLICANT: If, tasking aking this Certificate of Ex- ? 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 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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. HEATING UNIT(TO 100,000 B.T.U.) S. MICROFILM 3097,Civ.CJ. Lenders Name HEATING UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have read this application and state that the above VENTILATIONFAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned 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 Beer ,against said City in consequence of the, PERMIT ISSUANCE 10.00 granting of Is permit MECH.CONT. EIC.N0. MECH. 8 roTAL TOTAL Signature of Ap hca t/Contractor Date - s OFFICE COPY - ' APPLICANT TO FALL {N INFORMATION WITHIN RED LINES - USE BALL POINT PEN ON BUILDING PROJECT IDENTIFICATION PERMIT NUMBER - D,rvG APPLICATION & PERMIT � ��3^ Aoonass BUILDING - ELECTRICAL-PLUMBING-MECHANICAL G X 03 PLAN CHECK VALIDATION "AME QTY. ELECTRIC PERMIT FEE- / E.�LLG/� PHONE p0� CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 ((/VA I5_ ' Uc.No. LIGHTING FIXTURES 10.00/1.00 O DDORs ADDRESS PPLIANCES-RESIDENTIAL 4.00 A / Z S PHorvE /9 PANELS 10.00 DATE OF APPLICATION ARCHITECT - PLAN CHECK FEE P.C.NO. on .. PANELS (OVER 200 AMPI 20.00 ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRESS ENG SPECIAL CIRCUIT 5.00 - - PERMIT VALIDATION 2,p TEMP.METER OR POLE INS. 20.00 APILNANTS Q. OX 3-7 MOTORS - . SEE FEE SCH. %1J`^,//1 ADDRESS w E ,� SERVICE CHANGE 20.00 / F w 7. o o LICENSED CONTRACTORS DECLARATION -�/�/• a u 1 hereby affirm that I am licensed under provisions of Chapter 9 PAMISSUANCE DATE w<y (Commencing with Section 7000)of Division 3 Of the Business and BLDG. ELECT. PLG. MECH. I- o Z Professions Codei Rn license is in full fort and of a t1"? s ❑ ❑ ❑ Z, 0= - License I ss Lic.Number o °u Date Contractor p� BUILDING PERMIT E a w u OWNER-BUILDER DECLARATIONINFORMATION w0 u N 1 hereby affirm that I am exempt from the Contractor's License M ISC.- 0 _ u o 2 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 4 VALUATION $/FT. - Code:Any city or county which requires a permit to construct,alter, - ac ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC. ac 00 - LL requires the applicant for such permit to file a signed statement that TOTAL ( PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License H z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the 4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE re H the basis for the alleged exemption.Any violation of Section 7031.5 I STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 C. of not more than five hundred dollars($500).} ❑ 1,as owner of the 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(See. 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 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE r* himself or through his own employees,provided that such improve meats are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6,00 or Improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE k builder will have the burden of proving that he did not build or im- prove for purpose of sale.). RES IND CON PB Other WASTE INTER. 30.00 O 1,as owner of the property,am 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 the Contractor's such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. -PARCEL NO. the Contractor's License Law. ❑ lamexemprunder Sec. ,B.&P.C.fortbis WATER HEATER W/VENT - 6.00 reason Owner Date -� ° WATER SYSTEM 5.00 ACC.DATE -ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.CJ. v Illi Policy No. Company 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 OR D. ' O. Applicant V❑ N❑ V ❑ N❑ it W s / CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c. 'LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. a - (This section need not be completed if the'permit is for,one TOTAL v❑ N❑ Y❑ N❑ "0 Z hundred dollars(S 100)or less.) r ) O 1 certify that in the performance of the work fur which this per- . MECHANICAL PEflM1T FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as tobecomesuy�ect t he Workers'Cor�pensa[ion sof California. w !-Jb� Applicant__M_4- J�- lr- BUILDING C ��IL, f ALTER OR ADD TO MECH. 5.00I E TO AP (CANT: If,after mak ng this Cert ate of Ex- emption,you should become subject to the Workers'CompensationAPPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE suchprovisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE I hereby affirm (bat there is a construction•lending agency forEXHAUST HOOD (WITH DUCT) 5.00 - the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. - HEATING UNIT(TO 100,000 B(T.U.) 8.00 - Lender's Name HEATING UNIT(O VER 100,000B.T.U39.50 ELECTRIC Q 0* Lender's Address I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct 1 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 100,00013TU)SEE FEESCH. MECHANICAL above-mentioned 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 accrue against said City in consequence of the PERMIT ISSUANCE 10.00 granting of this permit MECH.CONT. LIC.NO. MECH. 6 Signature of plcnContror Da TOTAL TOTAL - ` OFFICE COPY t -