8616 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
M.
APPLICATION APPLICATION & PERMIT
PLANl7 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 861
0
fki DW PLAN CHECK VALIDATION
NAME DeAnza Group, A CeliforDie QTY. ELECTRIC PERMIT FEE
ONE Alr/R71 "All
NAMERAcraRs UTLETS-SWITCHES-RECEP 10.00/1.00
Thp Alden riE,j, any LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S p
APPLIANCES-RESIDENTIAL 4.00
' ADDRESS 411 Borel Ave,Ste. 410
San Matpupt- ON _ PANELS 10.00 DATE OF APPLICATION
ORCHITECT PANE LS (OV ER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
R
'ENGINEER .�
c.No. SIGNS TRANS. 3.00
ARCH OR ADDRESS ENG. 2070 Business Ctr• 4220 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Tryinp. Ca- zip 9271 S TEMP.METER OR POLE INS. 20.00
APPLICANTS
411 Borel Ave, Ste. 410 MOTORS SEE FEE SCH.
ADDRESS
San Mateo Ca. 94402
SERVICE CHANGE 20.00 rJUL 2 91985
woo LICENSED CON'I'RAC ORS DECLARATION TEMP.POLE 30.00
u u 1 hereby affirm that I am licensed under provisions of Chapter 9 1}I6 14C TE
maw (commencing with Section 7000)of Division 3 of the Business and BLDG. EL CTs`rPPL ll MECH.
F y z Professions Code,and my license is in full frrce n e ecL ❑ ❑ ❑
z l2 w - License CI as,.31 B8 Con Number
g m r °m UateL ,._Contractor
mre a OWNER-BUILDER DECIAR ATION BUILDING PERMIT
-
R TO ORD o i u INFORMATION
w ; I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFE
LL i,, VALUATION $/FT.
Fa04 Lawfortheity following reason.ywhichrequires a peusinessand Professions PERMIT ISSUANCE 10.00
m� Code:Any city or<ounty which requires perm it to construct.alter, �.�}
<Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO' ELEC. ev
a wo u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
ro he is licensed pursuant to the provisions of the Contractor's License
Hzi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a [justness and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
re IIp the basis for the alleged exem plion.Any violation ofSection7031.5 STORIES TYPE CONSTR.
n ; by any applicant lora perrnil subjects lire applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500).1:
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 0 .GROUP E . N 5
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
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 S .FT.FLOOR AREA TO/AL ACREAGE
himself or through his awn employees,provided that such improve-
mmntsarenotintendedorofferedforsalalf,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owocr GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- UILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 R IND CON PB Direr
.
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors o 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 Cmulr llm(s)licensed purmmut to
the Contmaor's License Luw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No.
❑ lam exempt older Sea ,B.&P,C.for this WATER HEATER W/VENT 6.00
reason
Owner Dam WATER SYSTEM 5.00 ACC.DATt ACC.FILE NO.
WORK ERS'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 ccrtificma of Workers'Compensation Insurance,or u certified
copy thereof(pSepc.3800,Lab.C.). �' I 1 ( / }= I-
Policy No.-ppp�Jmy - - _ -
O ❑Ly CCrli Rdre6 i by a FIRE SPRINK ENERGY T 24
F O Ap Tcan�tifiud iy is d vith the city inspection division. MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
" CfiRTI EI'Al'h f E. E\IYTION 17RONI WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.u.c.
W > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL O (This Section need not be completed if the penuil is for one TOTAL V❑ N❑ Y❑ N❑
Z iiundred dollars 1S 100)or less.7
U O/ hum
certify that in lire perfonunnce of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner Su us to _
U U become subject to fire Workers'Compensation laws of California.
Date-Applicant BUILDING
} N NOTICE TO APPLICNT: If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00
Z eruption,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=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1000C.F.M.) 6.00 SEISMIC FEE / ..
I hereby alfirnf that there is a eonsr'uelmn lending agency For EXHAUST HOOD(WITH DUCT) 5.00 '
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name Rank of America_ P.0_
Lender's Address �.lo- 77 @HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
hcertify that have read this applicat ion anJki4ib8 above VENTILATION FAN (SINGLE) 4.00
• information is correct. I agree o Comply with 411 City and County PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMP Q 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 purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, ii demnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities.judge rants, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any wMceagainst aid City in consequence of thegranting of this MECH.CONT. LIC.NO. MECIT
OTALTOTAL ra Dale
INSPECTOR COPY
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
POST THIS CARD NEAR FRONT OF BUILDING _
FRAMING r
IN rORM&ION
CITY OF CUPERTINO
PERMIT NUMBER
VALUA ION SIF ,
PLUMBING
GAS `
MECHANICAL
INSPECTION DIVISION
MECHANICAL - V7,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
JOB INSPECTION RECORD
PERMIT TO
ELECTRICAL
Cr e kV iJ
UNIT# LOT#
PERMIT EXPIRATION
FRAMING
JOB ADDRESS J
SHEETROCK I
PERMIT EXPIRES IF WORK
TVPECON$TR.
OWNER CONTRACTOR /4't IS NOT STARTED WITHIN
1B0 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION DATE INSPECTOR INSPECTION RECORD
FOUNDATION.
U F E R g jj/,yl/. d
1 F'
PREGUNITE
PLAN CHECK
FEE
PERMIT VALIDATION
AAQiy
GAS
SEISMIC FEE
OCC"GROUP RES UNITS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
MICROFILM
JUL 2 9 1985
UNDERGROUND/L B
SQ, FT FT FLOOR AREA
PLUMBING
ROOF
ISSUANc DATEELECTRICAL
DIAPHRAGM
MECHANICAL
BUILOIIVG USE
BLDG_ @L j LplGI AEC
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
BUILPANG PIE MIT
FRAMING r
IN rORM&ION
WOOD FLOOR
ENG, SITE NO.
VALUA ION SIF ,
PLUMBING
GAS `
MECHANICAL
ENERGY T,24
Y N
MECHANICAL - V7,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
PERMIT TO
ELECTRICAL
LATH -INTERIOR
FRAMING
FIRE DEPT,
SHEETROCK I
STORIES TVPECON$TR.
INSULATION
SHEAR INTERIOR BUILDING
BUILDING
SHEAR EXTERIOR t oTEMPORARY
1 F'
ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEE
OCC"GROUP RES UNITS
OCCUPANCY
MICROFILM
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN
SQ, FT FT FLOOR AREA TOYAL ACREAGE
ROOF
B
DIAPHRAGM
BUILOIIVG USE
RESIND CON PB Oih¢r
El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO
ROUGH
PLUMBING
TRACT N0, PARCEL N0.
GAS TEST J
MECHANICAL 5'
ACC.DATE' ACC- FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING r SAN #
ZONING ENG, SITE NO.
INSULATION _ o_ PLUMBING )r- . —
F
GAS `
FIRE SPRINK
Y N[3
ENERGY T,24
Y N
MECHANICAL - V7,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE
V N
A. L.U. C.
Y N
LATH -INTERIOR ELECTRICAL U r 6Q
LATH -EXTERIOR FIRE DEPT,
SHEETROCK I GRADE FEESUMMARY
SHEAR INTERIOR BUILDING
BUILDING
SHEAR EXTERIOR t oTEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEENOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDOCCUPANCY
OCCUPANCY OF BUILDING ISNOTP
I
ERM11TEDUNTILBUILDINGFINALISSIGNEDBYBUILDINGINSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-x#505 ELECTRIC
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!
It CONST, TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
OFFICE COPY
TOTAL
r
K
7i
AbPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
136 LDI NG PROJECT IDENTIFICATION
APPLICATION &PERMIT
BUILDING -ELECTRICAL- PLUMBING -MECHANICALOWN
PERMIT NUMBER
Q C I
o U U
BUILDING LOT 17AppRESS
PLAN 4
NAME
S
DeAnza Group, A California
Ltd. Partnership PHONE 415/571-1
QTY. ELECTRIC PERMIT FEE
81
PLAN CHECK VALIDATION
CONTRACTOR'S
NAME OUTLETS -SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00TheAldenCompanyLEC.No. 465640
DATE OF APPLICATION
CON ess °RS 411 Borel Ave, Ste. 410
San Mateo, Ca.94402HON415/571-14
APPLIANCES - RESIDENTIAL 4.00
1 PANELS 10.00
ARCHITECT
OR
EIVGINEEdalderOn-Nakamurac.NO. C013712
PANELS (OV ER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
SIGNS TRANS. 3.00
ARCH, OR ENG,
ADDRESS 2070 Business Ctr. #220 SPECIALCIRCUIT 5.00 PER VlLLZTION
at e
TEMP. METER OR POLE INS. 20,00Irvine'Ca. zla 92715
Ld
QUL 2
ADDRESSTs 411 Borel Ave, Ste. 410 MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00SanMateo, Ca. 94402
city of CupertinoLICENSEDCONTRACTORSDECLARATIONTEMP. POLE 30.00
I hereby affirm that I am licensed under provisions of Chapter 9
commencing with Section 7000) of Division 3 of the Busi ess and
Professions Code, d my license is in full for qt
License Cl s_ Lic. Number `F
Date Contractor
ISSUANCE DATE
BLDG. ELECT,
1:10
PLG. MECH.
6UIL PERMIT
OWNER -BUILDER DECLARATION
I hereby affirm drat I am exempt from the Contractor's License
Law for the following reason. (Sec. 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
L
is licensed pursuant to
in
provisions of the )
oI'
Dici
ion
License
Law(Chap ter 9(commencingwith Sec: ion 7000)ofDivision3ofthe
Business and Professions Code) or that he is exempt therefrom and
INFORMRM ATIONO
MISC, - REFER TO ORD
VALUATION
d /r q,
JFT.
PERMIT ISSUANCE 10.0011
ELEC. CONTR. LIC. NO. E LEC.
TOTAL PERMIT TO
QTY. PLUMBING PERMIT FEE
STORIES TYPE CONSTR. the basis for the alleged exemption..Any violation of Section 7031.5
by any applicant forrive hundred SSOO).
he licanttoacivilpenalty
of not more than five hundred dollars (5500)J:
ALTER -DRAIN & VENT -WATER (EA.) 5.00
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 (See. 7044, Business and Professions
BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP RES.UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00'
Code: The Contractor's License Law does not apply to an owner or
property who builds or improves (hereon, and who does such work
himself or through his own employees, provided that such improve-
mcnts are not intended or offered for sale. If, however, the building
FIXTURES - PER TRAP 5.00 SO. FT. FLOOR ARBA TOTALACREAGE
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 im-
prove for purpose of sale.).
D 1, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE
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 property who builds or improves thereon, and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for such projects with a oontractor(s) licensed pursuant to
the Contractor's License Law.
Li[ am exempt under Sec. , B.&P.C. for this
SEWER SANITARY STORM EA. 200ft/10.00SEW NO. /
jJ/'
y/-
PARCEL NO.
WATER HEATER WJVENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC. DA E ACC. FILE NO.
WATER TREATING EQUIP. 5,00WORKER5'COMPENSATION DECLARATION
1 hereby affirm that I have a certificate ofconsent to self -insure,
or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO.
b.C. .
Policy No.7 ny - lie Aiden Compan,e
q_ Certified co h Irnished.
Certified c py is jt!2cc city inspection division.
copy thereof (Sec. 3800,
EXEMPTION
Applicant
re
FIRE SPRINK
Y N
ENERGY T-24
Y N' MISC. REFER TO ORD.
CERTIFICATE 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 E]N E]Y E]N
QTY. MECHANICAL PERMIT FEE FEE SUMMARY
hundred dollars (S 100) or less.)
1 certify that in the performance or the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
BUILDING
become subject to the Workers' Compensation Laws of California.
Date Applicant ALTER OR ADD TO MECH. 5.00
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
APPLIANCE 5.00 PLAN CHECKcmption, you should become subject to Elie Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
FEE
AIR HANDLING UNIT (TO 10)WOC.F.M.) 4,00
AIR HANDLINGUNIT(OVER 1omiar-M.) 6.00SEISMIC 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.
3097, s). Bank of America P.O. Lender',s NaName
Lender's Add ress OX ;30_ 3.
MICROFILM
HEATING UNIT (TO 100,000 e.T,U.) 8.00
H EATI NG UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC
I certify that I have read this application and state t at 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. Dr 100,000 B.T.U.) 6.00
BOI LER-COMP (over 100,000 BTU) SEE FEE SCH. MECHANICALherebyauthorizerepresentativesofthiscitytoenteruponthe
above-mentioned property for inspection purposes.
MISC. - REFER TO ORD.
CONST. TAX
We) agree to save, fe nify and keep harmless the City of
Cupertino
agaij5J,
ili, judg cuts, costs and expenses which
may in any wgainst 'aid City in consequence of the
granting of thisMECH.
5/3(/85
PERMIT ISSUANCE 10.006-1
CONT.LIC. NO. MECH.
TOTAL
TOTAL 1i
Signature aF App " an1( ntractor Date Z(/
OFFICE COPY