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8632 APPLICANTJO FILL IN INFORMATION WITHIN RED.LINES - USE BALLPOINT PEN ONLY -" BUILDING PROJECT IDENTIFICATION FICATION PERMIT NUMBER aDILDING 8632 AouRess APPLICATION & PERMIT LOT 24 t �•1--'! / (y BUILDINGELECTRICAL- DW PLAN CHECK VALIDATION NBME DeAnza Group,' a California QTY_ ELECTRIC PERMIT FEE • PHONE 415/571 NAME D Wq_- UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.ND, LIGHTING FIXTURES 10.00/1.00 r, c en APPLIANCES-RESIDENTIAL 4.00 ADDRESS 411 Borel Ave,SCe.410 PHONE PANELS 10.00 DATE OF APPLICATION oR RMC PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER Ic.ND. SIGNS TRANS. 3.00 n ADDR.D PERMIT VAt ON ADDRESS SPECIAL CIRCUIT 5.00 try(. 2070 Business CCr. 4220 zla EMP.METER OR POLE INS. 20.00 /� o ADOREas lel+ MOTORS SEE FEE SCH. ' t 2 SERVICE CHANGE 20.00 91985 QTOLD G8• 964'f TMD CONTRACTORS DECLARATION s TEMP.POLE 30.00 City of CU ¢ v O I hereby affirm that I am licensed under provisions of Chapter 9 y p//1���{{ 2 w ISSUANCE DA?M/7 m ¢w (commenemg with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. D z Professions Code,and my license is in f.11,fome a eff t. z o - License Class_�� Lic.Number 4 se Date a /e�Yor Contractor Q y E �T ¢ tc w ¢ OW'NER-BUILDBR DIiCL NRA )• BUILDING PERMIT o T" INFORMATION E: g LL y 1 hereby affirm that I am exempt from the Co ctor's License MISC.- REFER TO ORD O ¢ Law for the following reason(Sec.7031.5,Business unJ Professions VALUATION $/FT. PERMIT ISSUANCE 10.00 Code:Any city or county which req Lines a permit to construct,alter, IS a, a0 improve,demolish,or repair any structure,prior t0 its issuance,also ELEC.CONTR. LIC,NO. ELEC. n O¢ requires the applicant for such permit to file a signed statement that o TOTAL u w es s- he is licensed pursuant to the provisions of the Contractor's License '/ R T TO r z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the x O Business and Professions Code).or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE re r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant o a civil penalty' ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or nsy employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP s. NIT 452 their sale compensation,will on the work,and Om s' tructure is not intended or offered for sale (Sec 7044, Business 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 cr improves thero"n,Itml Who does such Work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTALACE ACREAGE • himself rethrough his own emredfors, .[1,hothatsuchimprove- mentsded or within od Gyeasale.lhowever,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of clic did ion, the owner- GAS-EA:SYSTEM-OVER 4 IEA.) 2.00 Pry builder will have the burden of proving that he did oat build.r ilm IL INN USE Prove 1,is nee of the INDUSTRIAL WASTE INTER. 30.00 RES I❑ ❑N ❑ D❑ ❑ 1,as owner of the PropeHY.am cxclusive)Y convent ing with licensed contractors to construct the proicct (Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'Fhe Contract.,',License Law docs not apply to an owner of property who huilds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contracton(s)licensed Pursuant t. Om Contractor's License Law, - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO. - ❑ I am exempt antler Sec. B,&P.C.fur this WATER HEATER W/VENT 6.00 /] on / Owner Date WATER SYSTEM 5.00 IAW.DT ACC�F ILE NO. WORKERS'COMPEN'SATION DECLARATION WATER TREATING EQUIP. 5.00 ' 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.3800,Lab.C.). Poli<Y No, r I " , . O ❑ Certilie µrdan CoWparr RE SPRINK ENERGYTH4 Z Z L� CerldieJ s tl ith the city inspection division. FO APpLut MISC- REFER TO ORD. YE] NE] YE] N[J ft, rn CERTIFICATI OP EXEMPHON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.c. L COMPENSATION INSURANCE PLG.CONTE. LIG NO. PLG. 0 (This section need not be completed if the permit is for one TOTAL v N� v ❑ N� Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of The work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY UL 1- mit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. U a Date Applicant ALTER OR ADD TO MECH. 500 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of fix . ♦- Z emption,you should become subject In the Workers'Compensali.n APPLIANCE 5.00 PLAN CHECK provisions.of_the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)M0GF.M.) 6.00 SEISMIC FEE �- I hereby affirm [hut 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 MICROFILM 3097,Civ.CJ, HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name &!M �- HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Addr Lender's Andyess f1,..V::- ,�Q� I certify that I have read this application and staetY$tbove VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws reaming to building construction, and BOILER-COMM H.P.or 100,000 B.T.U.) 6.00 hereby entioined representatives Inspection this city to cmc, upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL herebyn ruliorii propertyI.,vesp of this purposes. ` (We) agree to ,av indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino agT is li tilities judgmm�t,, costs and cxpenxcs which CONST.TAX may in any o a true a Lfivo said City in er'crlucn.. of the PERMIT ISSUANCE 10.00 FT. oft ', n [`, MECH,CONT. LIG NO. ME 10.00 fy�,•wF °TA` TOTAL Signature of Ai,)ic nt/CmHr mor Laic P INSPECTOR COPY r POST THIS CARD NEAR FRONT OF BUILDING + rf-r CITY OF CUPERTINO ' INSPECTION DIVISION JOB INSPECTION RECORD J % d JOB ADDRESS • e6l Ceree+1R UNIT## LOT# OWNER ,* CONTRACTORLde-n Co. PFRINIT NUMBER QQ8632 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 = y f_`r UFER PR EGUN ITE PE J_VALIDATION gg ieJ<d% JUL 2 91985 City of Cupertino ISSUANCE DATE POUR NO NCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING 3a - ELECTRICAL MECHANICAL BLDG: E CT, PLG. MECH. A [A DO NOT POUR FLOUR UNTIL ABOVE HAS BEEN SIGNED Bu LDING ERMIT 1 FORMATION WOOD FLOOR, VALUATION S/FT. PLUMBING MECHANICAL ELECTRICAL r PERMIT TO fFRAMING INSULATION STORIES' T FONSTR. OCC. GROUP REFiUNITS" PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - SOL FT. FLOOR AREA TOTAL ' ACREAGE DIAPHRAGM Q "( i t BUILDING USE A .S', IND' CON PB Other El El El Q ASSESSORS PARCEL NO, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH PLUMBING GAS TEST TRACT NO. i , PARCEL NO. MECHANICAL% }f' ELECTRICAL (ti FINALS DATE INSP. ACC: DATE ACC. FILE NO. FRAMING SAN # ZONING ENG. SITE NO. INSULATION _ PLUMBING ,2-``-- y/ Qp( 7OGAS f- /V "- FIRESPRINK Y N ENERGY T-74 Y N MECHANICAL L 21 -sl COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE Y N A.L.L.0 C. Y N LATH—INTERIOR ELECTRICAL a -0m LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR Z BUILDING _ -x -- BUILDING SHEAR EXTERIOR TEMPORAW APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS SEISMIC FEENOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDOCCUPANCY OCCUPANCYOFBUILDING ISNOT PERMITTED UNTIL BUILDINGFINALISSIGNEDBYBUILDINGINSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. O PLEASE GIVE JOB ADDRESS WHEN PHONING. z SEE PERMIT FOR EXPIRATION DATE — MICROFILMLU r ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL. INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY O Z z CC N LU > ao z UO_ LL E - Om y I•- Z LAI BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT PERMITNUMBER Bull, C, ss J LOTOD BUILDING - ELECTRICAL- PLUMBING - MECHANICAL 8632 S NAME DeAnza, Group,. a California QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION Ltd. Partnership PHONE 415 5 1-1 CONTRACTORS NAME UTLETS-SWITCHES -RECEP 10.0011.00 LIGHTING FIXTURES 10.0011.00TheAldenCompanyLIC. NO. 465640 CONTRACTOR'S ADDRESS 411 BOrel Ave,Ste.410 APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00SanMateoCa. 94402 PHONE 415/571-148l DATE OF APPLICATION ARCHITECTPANELS aRENGI NE CHalderon-Nakamuralc.NO. C013712 OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. N0. SIGNS TRANS. 3.00 ARCH. OR ENG. 2070 Business Citr. #220ADDRESSV / Irvine Ca. 92715 ZIP SPECIAL CIRCUIT 5,OD PERMIT VALIDATION n aPAMO 2 9 EMP. METER OR POLE INS. 20.00 APPLICANT'S IADDRESS4 , MOTORS SEE FEE SCH. SERVICE CHANGE 20.00411BorelAveSte.410 San Mateo JUL 1985 IN .dA91Mer 1aG Ca- Q&*{52DCONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9ISS TEMP. POLE 30.00 commencing with Section 7000) of Division 3 of the usiness and Professions Code, and my license is in full force a Wil License Class Lic. Number B G. I ELECT. PLG. I MECH. Date .77 Contractor BUILDING PERMIT OWNER -BUILDER DECLARA I I hereby affirm that I am exempt from the Contractor's License Law far the following reason. (See. 7031.5, 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 INFORMATION MISC. - REFER TO ORD VALUATION SIFT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL ERMIT 70 QTY. PLUMBING PERMIT FEE Law (Chapter 9 (commencingwith Section 7000) of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation al'Section 7031.5 rlJ t/ STORIES by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred d ollars (S5 00).): awgLTERDRAIN &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 BACK F LOW PROTECT. DEV ICE 4.00 OQUP RES UNITS DRAINS -FLOOR, ROOF, AREACOND. 5.00intendedorofferedforsale (See. 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 does such work himself or through his own employees, provided that such improve- meets are not intended or offered for sale. If, however, the building II IFIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - 1 INC.4 OUTLETS 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 fm- for purpose of sale.). 1, as owner of the property, am exclusively contracting with 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 GAS EASYSTEM -OVER 4 {EA.) 2.00 BUILDING USE RE IND CON P$ Other ASSESSORS PARCEL NO. INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -I INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a cantractor(s) licensed pursuant to the Contractor's License Law. 200ft110SEWERSANITARY, .00STORMEA TRACT rem. P/ ARCEL NO. I am exempt under Sec. B.&P.C. for this WATER HEATER WIVENT 6.00 reason Owner Date WATER SYSTEM 5.00 Acc.O ! ACC - FILE NO. WATER TREATING EQUIP. 5.00WORKERS'COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate ofconsent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. 44copythereof (Sec. 3800, Lab.C.). Policy No. pT7 _'1'hc Alrinn f'mm n FIRE SPRINK Y N ENERGY T-24 Y N q_ CK2 ertiE<ed is ereb furnished. Certified s I with the city inspection division. tai 3 Applicant MISC. - REFER TO ORD. CERTIFICATE 1: 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 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- mil is issued, 1 shall not employ any person in any manner so as to BUILDING become subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: 1Q after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 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. CONSTRUCTION LENDING AGENCY FEEAIRHANDLINGUNIT (TO 10PM C.F.M.) 4.00 AIR HANDLING UNIT(OVER10p000.F.M.) 6.00 SEISMIC FEE 6) 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 UN IT (70 100,000 B.T.U.) 8.00 H EATING UNIT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender'sAddrecc OX a O TJa 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 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 (Over 100,000 BTU) SEE FEE SCH. MECHANICALherebyauthorizerepresentativesofthiscitytoenteruponthe above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX ind coaly and keep harmless the City ofwe) aVsHCupertinoitieudgments, casts and expenses which may in ae a ainsl said City in consequence of the granting o 5/31/85 PERMIT ISSUANCE 10.OD MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Sigictor Date OFFICE COPY