8622 APPLICANT TO FILL IN-INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
+1 9
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADORES
.'J - . LOT 25 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 8622
r Owry 5 PLAN CHECK VALIDATION
NAME DeAnza Group, a California QTY. ELECTRIC PERMIT FEE
PHONE -
NAMEACTOHs OUTLETS-SWITCHES-RECEP 10.00/1.00
The Alder rngtpiliny LIC.No. LIGHTING FIXTURES 10.00/1.00 to
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS 411 Borel Ave,Ste.410
PHONE _ PANELS i 10.00 DATE OF APPLICATION
RcnDPLAN
ARCHITECT PANELS (OVER 200 AMP) 20.00
OCHECK FEE P.0.No.
OR
ENGINEER
al Ic.No COI 3712 SIGNS TRANS. 3.00
ARCH,
ADDRESS ENG. SPECIAL CIRCUIT S,QQ PERMIT VALIDATION
2070 Business Ctr. #220 J
In- Z
ADDRESS 9971 9
EMP.METER OR POLE INS. 20.00
AEMOTORS SEE FEE SCH. •,J`Q"w-'�
ss /p
SERVICE CHANGE 20.00 �O S
woo San ] -��. "gIyTR�'(��2UECLARATIO,y TEMP.POLE 30.00
¢ o Dt I hereby affirm that I um licensed under provisions of Chapter 9 ISSUANCE DATE
wZ w - (commencing with Section 7000)of Division 3 of the Business and BLD ELECT. PLG. MECH.
F D A Professions Code,and my license is in full force ad effect. ❑ ❑ ❑
-• 0. License Class Lic.Number
. 8Z -0 Datc_5. Contranor
P Y f BUILDING PERMIT
¢ ¢ w a OWNER-BUILDIiR DFCLARA I INFORMATION
MISC.- REFER TO ORD
w H I hereby afl'irin that I um exempt from the Contractor's License VALUATION $/FT.
FLLoj Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00
� ww � Code:Any city orcounty which requires a permit to construct.al let, ELEC.CONTR. LIC.NO.
¢ ¢ a o improve,demolish,or repair any structure,prior to its issuance,also ELEC.
to
0 ¢ octanes the uns p,ovi 1' sutement
or ch pcnnit to file a signed stathat TOTAL p TO
n w m m he is licensed pursuant to the provisions of the Contractor's License
FZ >
Law(Chapter 9(commencing with Section 7000)ofl)ivision 3 of the
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢r o the husis for the alleged exemption.Any violulion oftiection 7031.5 STORIES P BTR.
dam _ by any applicant to,a pcnnit subjects the applicant tuacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 l
of not more than five hundred dollars(5500).): //`
❑ I,as owner at the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 O�ROUP ES.UNITS
their sole compensation,of the will do the work,and the structure n nos
intended or offered for sale(Sec. 7044, BU,iness and Professions DRAINS-FLOOR,ROOF,AREA,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 SO.FT.FLOOR AREA To ALACREAGE
• himself or through his own em PIOYces,provided that such improve-
mems are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 RUILot G USE
builder will have the burden of proving that he did not build or im-
prove for purpose of sale). INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON PB Omni
❑ I,as owner of the property,am exclusively contracting with ) ❑ ❑. ❑ ❑
licensed Contractors to construct lire project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 gSSESSOHS PARCEL NO.
and Professions Code:The Contractor's License Low 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 contmclor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA,200ft/10.00 TRACT NO. PARCELNO.
v x ❑ [am exempt under Sec.-,B&Plc.for this WATER HEATER W/VENT 6.00
on
Owner Date WATER SYSTEM 5.00 ZFFATFFC.FILE NO.
WORKI'RS'COMPENSATION'DI?CLARATION WATER TREATING EQUIP. 5.00 '
( I lie ub,affirm that I have o eerlifcate of consent to idf-instm,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec 3800,Lab C.). -
�- Policy c tied 7 1 dA ti-C01Gpan
Cc tied copy h - yluru shed. FIRE SPRINK ENERGY TY4
Z p Ap�can tified cop li n the city inspection division. MISC.- REFER TO ORD. y N v N
❑ ❑ ❑ ❑
CC Fy PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.uc.
CISk'I'IIHCATIi OF XPMI'fION FROM WORKERS'
LU 1 COMI'FNSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y[:] F] N
N❑ Y ❑
hundred did I ius(S 100)oe less.(
U O •1 certify that in the.perfonnunce of tire work for which this per- CITY. •MECHANICAL PERMIT FEE FEE SUMMARY
LL H oris is issued,I shall not employ any person in any manner so as to
toO become subject to the Workers'Compensation Laws of California.
ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
'} W NONCE TO APPLICAN 1: If.after making this Certificate of Fx-
Z emplion,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 Dtis,penmil shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONsLRUCLN 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
f pooriance of the work IMICROFILM
Joe which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name-Aank nP A19erirA-P-O.
Lender's Address oS. OB�SD�elO�TfO�GB. HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify thin l have read this application and state t7CR tlidu"bove, VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and 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
above-mentioned property for inspection urposes.
601 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
p
(We) agree to ve, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino again -abi ties,j gments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any w er a agai st suiU City in consequence of the
S`
granting Of this c it. MECH.CONT. LIG NO. TECH. '
5/31/85 TOT"` TOTAL �oZ So2
Signalureof Applicant Contrator Date
INSPECTOR COPY
it-
ruoi 11-110 U/AnU 1%lr_M S r-nUIV
7
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION
J
JOB DRESS t(/ `ek// 6
OWNEH ?/ CONTRACTOR
1 Ur DUIL-UIPY0
r+r
1
RECORD
UNNII,TiP 26 LOT #
fin, .
PFR r
PERMIT EXPIR,
PERMIT
IT
EXPIS IF W`
IS NOT -STARTED WITFiIr
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR INSPECTION RECORD
FOUNDATION —
a-3_r ' _ pKLIFER
PREGUNITE r-, -5_ 7_u S
PERMIT VALIDATION
ISSUANCE DATE
G rS
POUR NO CONCRETE UNTIL ABOVE HAS BEEff SIGNED
UNDERGROUND/,SLAB
PLUMBING
ELECTRICAL
MECHANICAL BLDGr ELECT. PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
1
fr
BU
pRGATEl
I
MIT
WOOD FLOOR
VALUATION $)FT.
F •' t % '
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
y
r , FRAMING
INSULATION
STORIES TYPE-CONSTR.
r' y
7CC,ROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SQ.FT FLOOR AREA
f
r ,
TOTALACREAGE
DIAPHRAGM O—
BUILDING USE
RES IND CON PB Ocher
if El APPLY NO HOOFING UNTIL ABOVE HAS BEEN SIGNED
ROUGH
L ASSESSORS PARCEL NO.
o • PLUMBING
GAS TEST _ C
MECHANICAL 1
TRACT No.
f711
PARCEL NO
ELECTRICAL —f - FINALS DATE INSP.
ACC.'DATE ACC. FILE NO.
FRAMING ) .f f SAN # 7/ ,
INSULATION I _ b PLUMBING i
ZONING ENG SITE NO.
GAS
FIRE SPR INK
Y [:] N'
ENERGY 7.24
Y N
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE
YEI N
A.L.U. C.
Y N'
LATH -INTERIOR ELECTRICAL /
LATH -EXTERIOR FIRE DEPT.
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR _ Y BUILDINGPtwa pikw
BUILDING
SHEAR EXTERIOR to *I -s< TEMPORA Y APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEENOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDOCCUPANCY
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-X4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION. o
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 f -
ti
OFFICE COPY
I, A NT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
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A
BUFLDI NG PROJECT I i3ENTI FICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL-- PLUMBING - MECHANICAL
PERMIT NUMBER
8622
REG lv LOT 25
LOAN 2
OWNER'S
DeAnza Group,a California QTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
Ltd. Partnership PHONE415/571-1 81
CONTRACTOR'S
NAME OUTLETS -SWITCHES - RECEP 10,0011,00
LIGHTING FIXTURES 10.0011.00TheAldenCompanyLIC.No. 465640
ADDRESS
oR s 411 Bore 1 Ave, S to . 410 APPLIANCES- RESIDENTIAL 4.00
81 PANELS 10,00SanMateoCa.94402 PHoNE415/571-14 DATE OF APPLICATION
ARCHITECT
ORENGINF R.
alderonr-Nakamura_,c.No. C013712
PANELS (OVER 200 AMP) 20,00 k f;NCHECKFEE P,C,NO,
SIGNS TRANS. 3,00
ADDRESOR
S ENG, '2070. Business Ctr. #220 SPECIAL CIRCUIT 5.00 k 6 J - J IPE
EMP. METER OR POLE INS. 20.00IrvineCa. z912715Irvine,
fAPPLICANT'S
ADDRESS
MOTORS SEE -FEE SCH. City
SERVICE CHANGE 20.00411BorelAve,Ste.410 r pf/
Q
San MaE619EVIZONTAY&2DECLARATION TEMP. POLE 30,00
1 hereby affirm that I am licensed under provisions of Chapter 9
commencing with Section 7000) of Division 3 of the Busi ss and
Professions Code, a my license is in full fttrc ec6
License Class Lic. Number o4
Date 7 Contractor
ISSUANCE DATE
L ELECT. ALG. MECH.
10 BUILDING PERMIT
OWNER -BUILDER DECLARATIO
I hereby affirm that I am exempt from the Contractors License
Law for the following reason. (Sec. 703 1.5, Business and Professions
Code: 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
INFORMATION
MISC. - REFER TO ORD
VALUATION
zw
FT.
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO. ELEC,
TOTAL PERMIT TO
vI ')Titer
QTY. PLUMBING PERMIT FEE
STORIES TYPE CONSTR.
JV
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant fora
hundred
dollars
S500).
he licanttoacivilpenalty
of not more than lire hundred dollars(5500)J:
ALTER -DRAIN & VENT -WATER IEA.) 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
BACK FLOW PROTECT. DEVICE 4.00 RquP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS -FLOOR, ROOF, AREA, COND. 5.00
Code: Thc.Conlractor's License Law does not apply to an owner of
properly who builds or improves thereon, and who docs such work
himself or through his own employees, provided that such improve
mems are not intended or offered for sale. If, however, the building
FIXTUR ES - PER TRAP 5.00 SO. Fy AS TOTALACREAGE
GAS-EA.SYSTEM-1 6.00
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 afsafe.).
1, as owner of the property, am exclusively contracting with
contractors to construct the project (Scc. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner ofproperty who builds or improves thereon. and who
GAS - EA. SYSTEM -OVER 4 {EA,) 2.00 BUILDING USE
E IND CON Pe Other
El El 1:1 13licensedASSESSORSPARCELNO.
INOUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1,00
contracts for such projects with a contraclar(s) licensed pursuant to
the Contractor's License taw. SEW ERSANITARY TORM EA. 200ft/10.00 TRACT NO. f PARCEL NO.
1 am exempt under5ec. B.&P.C. for this WATER HEATER WIVENT 6.00
reason
Owner Date WATER SYSTEM 5.00 CC. DATE ACE. FILE NO,
WATER TREATING EQUIP. 5.00WORKERS' COMPENSATION DECLARATION
I 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 thereoITtq ) he Alden Com anPolicyNo. y
PCC Certified copy y fu ed.
Certified cop i f the city inspection division.
Applicant
7
FIRE SPRINK
Y N
ENERGY T•24
Y N MISC. - REFER TO ORD.
CERTIFICATE OF WEMOPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE 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 N
QTY, MECHANICAL PERMIT FEE FEE SUMMARY
hundred dollars (5 100) or less.)
I certify that in the performance of the work for which this per-
mil is issued, 1 shall not employany person in any manner so as to
BUILDING
become subject to the Workers Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, after making this.Certifiicate of Ex-
DALTERORAD TO MECH. 5.00
APPLIANCE 5.00 PLAN CHECKemption, you should became 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 10PW C.F.M.) 4.00
AIR HANDLING UNIT(OVER10j000C.F,M.) 6.00 SEISMIC FEECONSTRUCTIONLENDINGAGENCY
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.).
ank ri P, Lenders Name
Lender's Address r
MICROFILM
HEATING UNIT (TO 100,000 B.T,U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
PLUMBING
BOILER -COMP(3 H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP IOver100.000BTU) SEE FEE SCH. MECHANICALherebyauthorizerepresentativesofthiscitytoenteruponthe
above-mentioned operty for inspection purposes.
We) agree I ave, ' demnify and keep harmless the City of
Cupertino again ab' ities, j gments, costs and expenses which
may in any w' c e agai st said City in consequence of the
granting of this eI'.
5/31/$5
MISC. - REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE 10.00
MECH.CONT. LIC. NO,
TOTAL
TOTAL aSignatureofApplicantContractorDate
OFFICE COPY