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LI CANT TO FILL IN INFORMATION WITHIN FLED LINES —USE BALL POINT PEN ONLY
13U1 LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
AP.DR
NG APPLICATION &PERMIT n O rBUILSSLOT8
BUILDING —ELECTRICAL— PLUMBING -- MECHANICAL b `J' 0%Ll/I /. PLAN 4
NgMEfl&
DeAnza Group, A CaliforniaPLAN
SIGNS TRANS. 3,00
ARCH.ENG. 070 usiness Ctr. 220
ADDRESS
Irvine, Ca.
ZIP 92715
CHECK VALIDATION
Ltd. Partnership 415/571-1 ELECTRIC PERMIT FEE
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9
commencing with Section 7000) of Division 3 of the usines andB
Professions Code, my license is in full force {[
License C156 Lid. Number
Date Contractor
N IV
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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 penult 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
the basis for the alleged exemption. Any violation Section
by any applicant fora permit subjects the applicantt loacivil penallypenally
of not more than five hundred dollars ($500).):
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
Code: The Contractor's License Law dues not apply to an owner of
property who builds or improves thereon, and who does such work
himself through his own employees, provided that such improve-
ments are not intended or offered for sale. If. however, the building
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.).
131, as owner of the properly, 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
contracts for such projects with a contraclor(s) licensed pursuant to
the Contractor's License Law.
lam exempt under Sec. B.&P.C. for this
reason
TEMP. POLE 30.00
PHONE
G. ELECT. c+u
CTOR'S
NAMENAME OUTLETS-SWITCHES-RECEP 10.0011.00
The Alden Company L,C.NO.
465640
PERMIT ISSUANCE 10.00
LIGHTING FIXTURES 10.0011.00
CONTRACTOR'S 41L BoreiAve,Ste. 410 APPLIANCES -RESIDENTIAL 4.00
ADDRESS
San Mateo, Ca. 944071DN/+15/571-14 nATF OF APPLICATIONPANELS10.00
ARCHITECT
OR
FqENGINE %alderon-Nakamur 0013712
c. No.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3,00
ARCH.ENG. 070 usiness Ctr. 220
ADDRESS
Irvine, Ca.
ZIP 92715
SPECIAL CIRCUIT S,QQ PERMIT VALIDATION
A-A—ld
JUL 2 9
J1
G1 18gA n Er DA
TEMP.METER OR POLE INS. 20.00
APPLICANT'S 411 BorelAve, Ste. 410
ADDRESS
San Mateo, Ca. 94402SERVICE
MOTORS SEE FEE SCH.
CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9
commencing with Section 7000) of Division 3 of the usines andB
Professions Code, my license is in full force {[
License C156 Lid. Number
Date Contractor
N IV
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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 penult 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
the basis for the alleged exemption. Any violation Section
by any applicant fora permit subjects the applicantt loacivil penallypenally
of not more than five hundred dollars ($500).):
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
Code: The Contractor's License Law dues not apply to an owner of
property who builds or improves thereon, and who does such work
himself through his own employees, provided that such improve-
ments are not intended or offered for sale. If. however, the building
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.).
131, as owner of the properly, 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
contracts for such projects with a contraclor(s) licensed pursuant to
the Contractor's License Law.
lam exempt under Sec. B.&P.C. for this
reason
TEMP. POLE 30.00
G. ELECT. c+u MECH,
PERMITBUILDING
INFORMATION
MISC. REFER TO ORD
VALUATION
9
5/FT.
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO. ELEC.
TOTAL PERMIT TO
QTY. PLUMBING PERMIT FEE
STORIESTYPE eply
lV// ALTER -DRAIN & VENT -WATER (EA.) 5.00
BACK FLOW PROTECT, DEVICE 4.00 OCC. GROUP RES, UNITS
JDRAINS -FLOOR, ROOF, AREA, COND. 5.00
FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTALACREAGE
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE
IND CON PB Other
ASSESSORS PARCEL NO.
I NDUSTR IAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS -OVER 5 (EA.) 1.00
SEWER -SANITARY -STORM EA. 200ft110.00 TRACT NO.
g
5v
PARCEL NO.
WATER HEATER WIVENT 6.00
Owner Date
WORKERS'COMPENSATION DECLARAT[ON
1 hereby affirm that I have a certificate of consent to self -insure,
or a certificate of Workers' Compensation Insurance, or a certifiedg2
copy there C.).
Policy No. y
Certifredcopy' yfu shed.
Certified copy is i the city inspection division.
Applicant N of
WATER SYSTEM 5.00 ACC. DATt ACC. FILE NO.
WATER TREATING EQUIP, 5.00
042 ZONING ENG. SITE NO.
FIRESPRINK
Y N
ENERGYT-24
Y N Misc: - REFER TO ORD.
CERTIFICATE OF XEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not be completed if the permit is for one
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' Compensation Laws of California.
Date Applicant
PERMIT ISSUANCE 10.00 FLOOD ZONE
Y N
A,L.U.C.
Y N
PLG, CONTR, LIC. NO. PLG.
TOTAL
QTY. MECHANICAL PERMIT FEE FEE SUMMARY
BUILDING
vALTERORADDTOMECH. 5,00
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption, 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
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097,Civ.C.). Bank of America, P.O.
Lender's Name
Lender's Address a O a.
1 certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
We) agree tv ave, demnify and keep harmless the City of
Cupertino again bi ties, j gments, costs and expenses which
may in any w cr a agai st said City in consequence of the
granting of this er it
5/31/85
APPLIANCE 5.00 PLAN CHECK
FEEAIRHANDLINGUNIT (TO 10,000C.F.M.) 4.00
AIR HANDLING UNIT (OVER 10p00C.F.M.) 6.00 SEISMIC FEE
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
H EATI NG U N I T I OV ER 100,000 B.T.U.) 9.50 ELECTRIC
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER -COMP (3 H.P. or 100,000 B,T.U.) 6,00
BOILER -COMP (Over 100,000 STU) SEE FEE SCH. MECHANICAL
MISC. - REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE 10.00
MECH. CONT. LIC. NO. MECH,
TOTAL
TOTAL
Signature of Applicant ontractor Date
OFFICE COPY
i
POST THIS CARD NEAR FRONT
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION
D .i
JOB ADDRESS T4" Q-m& /
OWNER CONTRACTOR
INSPECTION DAME SPECTOR
OF BUILDING
RECORD
UN # LOT#
AA
INSPECTION RECORD
FRMIT NUMBER
6 +
P'cRMITjEXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION. FOUNDATION1-.-
N' -
r
LIFER y
PREGUNITE Co-Yvr1
J-
a.-
A cQ
PERMIT ALIDATION
ri
w
JUL 2 8 1985
GlI.1 of "u"c r ISSUANCE Odl zo
CY S ZD
POUR NO CONCRETE UNTIL ABOVE HAS BE> SIGNED o -Zg S\x-b Wc+r P4iU_
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
B ELE T PL MEC
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BU DING ERMIT
I FOR ATION
WOOD FLOOR
VALUATION
71 /'-' .'
SIFT.
PLUMBING
MECHANICAL
ELECTRICAL
P .MIT TO
STORIES CONST.. 7FRAMING
INSULATION
OCO GROUP
r/
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO FT: FLOOR. AREA TOT L ACREAGE
BUILDING USE
INO CON PB Other
El 1:1 1:1APPLYNOROOFINGUNTILABDVEHASBEENSIGNED
ASSESSORS PARCEL NO
ROU
PLUMBING 1011tIr
GAS TEST
MECHANICAL %
p y
TRACT NO, PARCEL NO
ELECTRICAL FINALS DATE INSP.
ACC..DATE ACC. FILE NO,
FRAMING-Z,2.-i{ SAN #
ZONING ENG. SITE NO.
INSULATION PLUMBING hj
GA
FIRE SPRINK
r NE
ENERGY T-24
r N
M HA ICA Iy '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED H ATING
FLOOD ZONE
r N
A.L u. c.
r I] N[]
LATH -INTERIOR E ECTR AL - la--/ 3 '3
LATH -EXTERIOR FIRE DEPT.
SHEETROCK /_ lira GRADE FEE SUMMARY
SHEAR INTERIOR U - BUILDING Z.yq
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEE
fNOTAPEORPLASTERUNTILABOVE'HAS BEEN SIGNED JOCCUPANCY
OCCUPANCYOF BUILDING ISNOTPERMITTCD UNTIL BUILDING FINAL ISSIGNEQ BY BUILDING INSPECTOR. MICROFILM
Lu
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
SEE PERMIT FOR EXPIRATION DATE—
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
f
t,
OFFICE COPY