8633 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-y4 BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
.1 MIND 1gZ� - LOT 2 APPLICATION & PERMIT 8633
ADORE.
' ex
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'$ PLAN CHECK VALIDATION
NAME Deknza Group, A Californi TY, ELECTRIC PERMIT FEE
ON _
DOME N; ACORs UTLETS-SWITCHES-RECEP 10.00/1.00
LIC&ARAim LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS 411 Borel Ave, Ste. 410
P"014151571-14PANELS 10.00 DATE OF APPLICATION
CHnrtELT MA t.IF A PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,0.NO.
on O
ENGINEER
LICM1 1712 SIGNS TRANS. 3.00
ADDRESS OR I Nc. SPECIAL CIRCUIT S,QQ -) PERMIT VALIDATION
2070 Business Ctr. 4220
T"ritrip, CA- zIP EMP.METER OR POLE INS. 20.00 I
APPLICANT SNs MOTORS SEE FEE SCH.
ADDRESS 411 Sorel Ave, Ste. 410
Ran MAtAn, rA- 04402 SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
TEMP.POLE 30,00
,, o 0, 1 herebyaffirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y< y (commencing with Section 7000)of Division 3 of the Business sed BLDG. ELECT. PLG. MECH.
r w i Professions Code,and my license is in full force and effect.
Z 0 m- License Class B Lit.Number ❑ ❑
OZ
t Date�31tSS Contractor
¢ m s -a BUILDING PERMIT
¢ ¢ w u OWNER-BUILD. DECLAR ION INFORMATION
K
3 LL m I hereby allinn that I am exempt from the Contractors License MISC.- ' REFER TO ORD -VALUATION $/FT.
F u
Get Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city.,county which requiresap,Trail to conMmch all,q '
ke ¢ ¢ 0 improve,demolish,or repair any'structure,prior to its wxuanCa,also ELEC.CO NTR. L.G.NO. ELEC.
- 0¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a 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 ofthe
Business and Professions Code)or that he is exempt therefrom and ATV. PLUMBING PERMIT FEE Vv
¢ =0 the basis for the alleged exemption.Any violation of Section 7031.5 STO IES TYPE CONSTR.
by anyonmos,tha lura permit subjects theupplicannuacivil penalty ALTER-DRAIN -WATER (EA.) 5,00
-, of not more Gann lova hundred dollars the applicant
f V( ( 1•�x
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compeoution,will do the work,and the structure is cut
intended or offend for sale(See, 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,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 5.00 SO.FT.FLOOR AREA TOTA ACREAGE
himself or through his own employees,provided that such improve- it
mems are not int6nded or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2,00
d builder will have the burden of proving that he did nol built]or im- BUILDING USE
R 5 IND CON PB • Other
L prove for purpose of sale). INDUSTRIAL WASTE INTER. 31 00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed.contractors to construct the project(Sec. 7044,BusinessLAWN 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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec,-,B&P.C.for this WATER HEATER W/VENT 6.00
rcus m
Owner Date WATER SYSTEM 5.00 ACC.DATIF ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificale of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab C.). -
rpuey ND.
❑ CCrti a rfbyyffffffui�ic +�e•` `•`•"`Y"v'J /' FIRE SPRINK ENERGY 1T 24
Z Z ❑� Certified c ,i - N�with the city inspection division. \
O Aplihcanl 11 MISC.- REFER TO ORD. Y❑ NQ Y ❑ N❑
' F rn PERMIT ISSUANCE 10.00
Lu - 017 I'IPROM WORK ER$' -FLOOD ZONE A.L.U.L.
W COMPENSATION INSURANCE PLG.WNTR. ,LIC NO. PLG. YE] N❑ Y❑ N[]O (This section need not be complete) if 11m permit is for one s TOTAL
� Z hundred dollars(5100)or lest)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any'person in any manner so as to
-c`.W become subject to the Workers'Compensation Laws of California. a
• n Date Applirent ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate o1lox.
F Z emption,you should become subject to the Workers'Compensution APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.NL) 4.00
CONS'1'RUCfION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
lire 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 NameiCa- e- HEATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Addres.v p F ELECTRIC
\ I certify that I I �Xd t lis apl}IioaLon�IPill:1 � 8ubov, VENTILATION FAN (SINGLE) 4.00
• information is correct. I agree to comply with a tysY county - PLUMBING
ordinances and slate 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 BAILER-COMP(Over100,000BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) a e t save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino n I t hub
iV'g
' judgments, costs and expenses which CONST.TAX /
miry in a acctainst said City in consequence of 111, PERMIT ISSUANCE 10.00 7"
granting f I \ MECH.CONT. LIG NO. MECH.
1 TOTA` TOTAL j1 y a
' Signature Ap locant/Contmclor t � QOK�
INSPECTOR COPY
0
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cc
LU
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LL
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i
LICANT TO FILL IN INFORMATION WITHIN RED LINES -- USE BALL POINT PEN ONLY
BL11 LDI NG PROJECT I DENTI FICATION
APPLICATION & PERMIT
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NUMBER
8633
DING7ADDFIESSLOT 2
PLAN 2ER•%
E DeAnza Group, A Californi4olfy ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
Ltd. Partnership PHON415 571-1 l
CONTRACTOR'S
NAME OUTLETS -SWITCHES - RECEP 10.0011.00
LIGHTING FIXTURES 10.0011.00TheAldenCompanyuo"5640
ADDRessTORs
411 BOrel Ave, Ste. 410 APPLIANCES - RESIDENTIAL 4.00
1 PANELS 10.00SanMateoCa.94402 PHO415 571-14 DATE OF APPLICATION
ARCHITECTPANELS
ORENGINE
CaR
deron-Nakamura LICOO.13712
OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. N0.
SIGNS TRANS• 3.00
AARCH,
ORDDRESS ENG. 2070 Business Citr. IP220 SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
EMP. METER OR POLE INS, 20.00IrvineCa. zIP92715
Aaoa SSTs 411 Borel Ave, Ste. 410 IMOTORS SEE FEE SCH:
SERVICE CHANGE 20.00SanMateoCa. 94402
ys
AUACK
y/
LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00
1 hereby affirm that I am licensed under provisions of Chapter 9
commencing with Seciian 7000) of Division 3 of the Business and
Professions Code, a my license is in Full fot F t.
License Class Lic. Number
1ATE S
SLOG ELECT. I
y
PLG. I MECH.
1 I it El
Date T l7 R 5 Contractor
OWNER -BUILDER DECLARATIO •
1 hereby affirm that [ am exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5, Business and Professions
Codc: Any city or county which requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
C
BUILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
VALUATION SIFT.
PERMIT ISSUANCE 10.00
ELEC.CONTR. LIG. NO, ELEC.
TOTAL PERMIT TO
F7 pQTY. PLUMBING PERMIT FEE
STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for
rive hundredofnotmorethanfivehundred dollars (500).): 5tVl ALTER-DRAIN VENT -WATER {EA.) 5.00
1, 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
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve -
merits are not intended or offered for sate. If, however, the building
BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00
FIXTURES - PER TRAP 5.00 50. FT. FLOOR AREA TOTALACREAGE
GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year or completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.).
O 1, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE
R IND CON PB Other
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 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 properly who builds or improves thereon, and who LAWN SPR INKLERS - OVER 5 (EA.) 1.00
contracts far such projects with a contractor(%) licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM'EA.'200ft110.00 TRACT NO. PARCEL NO.
lam exempt under Sec: , B.&P.C. for this
reasonJ.
WATER HEATER WIVENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATA ACC. FILE NO. ,
WATER TREATING EQUIP. 5.00WORKERS'COMPENSATION DECLARATION
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. 38 0, Lab. J.
Policy No. n
Corti to co re b rm ed.
Ap
canrtified
c p A511f with the city inspection division.
FIRESPRINK
13 N
ENERGY T-24
Y C3 N MISC. - REFER TO ORD.
CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
PLG. CONTR. LIC. NO. PLG.
TOTAL
COMPENSATION INSURANCE
This section need not be completed if the permit is for one
Y [:] N Y E] N
QTY. MECHANICAL PERMIT FEE FEE SUMMARY
hundred dollars (S 100) or less.)
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 Workers'CompensatlonLaws ofCalifornia.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
BUILDING
ALTER DR ADD TOMECH500
APPLIANCE 5.00 PLAN CHECKemption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
FEEAIRHANDLINGUNIT (TO 10MC.F.M.) 4.00
AIR HANDLING UNIT (OVER 10= r-F.M.) 6.00 SEISMIC FEE 71CONSTRUCTIONLENDINGAGENCY
1 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.
3097, Civ.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T,U.) 6.00
HEATING UNIT(OVER 100,0008.T.U.)9,50 ELECTRIC
Lender's Name Annlr of A-er-, Dn.-
Lender'sAddress
1 certify that I have read this application and stgt t' pmc above
inis correct. 1 agree to romply with all city an county
ordinances and state laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER-COMP{3 H.P. or 100 000 B.T.U.) 6.D0
BOILER COMP (Over 100,00043TU) SEE.FEESCH. MECHANICALherebyauthorizerepresentativesofthiscitytoenteruponthe
above-mentioned property for inspection purposes.
MISC. - REFER TO ORD. We) a e t save, indemnify and keep harmless the City of
Cupertino a liabi ties, judgments, costs and expenses which
may in acc against said City in consequence of the
granting f I r it.
CONST. TAX
PERMIT ISSUANCE 10.007-7
MECH. CONT. LIC, NO, MECH.
TOTAL
TOTAL A 16'
a
Signature of App leant/Contractor Dale
OFFICE COPY
POSTTHIS CARD NEAR FRONT OF BUILDING _ -
CITY. OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
l/y`7 Vfri%/ + r' • UNIY# LOT# JOB ADDRESS ,
OWNER CONTRACTOR ftm Oa.
I ,
PF.A MIT NUMBER
V w
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION DATE INSPECTOR INSPECTION RECORD
FOUNDATION t .9q w A
3a 1 3- 61LLIFERQ
PREGUNITE
PERMIT VALIDATION
J
ISSUANC MATE
5 -{7
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
LO
f
ELECT. L M
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
l
BUl DING ERMIT
I FORMATION
WOOD FLOOR VAL ATlON IFT. S
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
STORIES TYPE CONSTR.
FRAMING
INSULATION
OCC. GROUP RES, UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO. FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
SUILOING USE
IND CON PEI Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO.
ROUGH
PLUMBING L -
GAS TEST p
k"e (.I,
TRACT NO. PARCEL NO
MECHANICAL j L
ELECTRICAL
G
FINALS DATE INSP.
ACC DATE ACC_ FILE NO.
FRAMING , SAN # O ZONING ENG. SITE NO.
INSULATION PLUMBING 3-
a+ GAS)—it FIRE SPRINK
Y N
ENERGY T•24
Y NE]
MECHANICAL
COVER NO WORK UNTIL'ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE
Y [:] NE]l
A.L.O,C
Y N
LATH -INTERIOR ELECTRICAL •
r
LATH --EXTERIOR FIRE DEPT.
SHEETROCK,G GRADE FEE SUMMARY
SHEAR INTERIOR _^ BUILDING 3
BUILDING
SHEAR EXTERIOR 0-3f,. PPROVALSTEMPORARYAPPROVALS-
F] F]REWALLS ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEESiNOTAPE0RPLASTERUNTILABOVEHASBEENSIGNED. OCCUPANCY
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
O ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z
PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE-
ELECTRIC
PLUMBING
MECHANICAL
CONST, TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY