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3694 6223 6060-FCITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) w PERMIT NO. 'ADDRESS L S �rnJ L-0&4-ada- !� �Z PR–OJ–E—C7-- PERMIT ISSUED DATE ELECTRICAL DATE INSP.'- Building NSP.'- ul in Electrical Power Pole Jnderground Rough i.rin Walls DATE I INSP. s PLUMBING DATE j INSP. Backflow MMU 11 Wil Se Le -, Solar` oug Water '& Insulation —f ELECTRICAL DATE I INSP. Underfloor S.M. Ducts & Insulation Fire Dampers Fireplace cease Duct oo . Air BUILDING ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS /G M 0 z 0 LU > CL a Z) z 00 LL 0 0- C/) A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL Vunsd I r..N BUILDING PROJECT IDE"NTIFICATION PERMIT NUM13ER BUILDING APPLICATION & PERMIT ADDRESS UI WING — ELECTRICAL-- PLUMBING — MECHANICAL 3694 OWNER'S PLAN rH,CK VALIDATION H NAME -57 E. Mo:�gen DevelopmentOINE 287 21 PAID CONTRACTORS OUTLETS SWITCHES RECEP 5.00/1-00 NAME /JOL—L C,6WSJ'rtJ)C "10, LIC. NO. 3 LIGHTING FIXTURES 5.00/1.00 OR 18 1984 CONTRACTORS RESIDENTIAL 4.00 ADDRESS APPLIANCES 625 MdGliky, CanVbe31J1N, 371-2717 PANELS •TION ARCHITECT 6.00 FEE _P C111 NO, OR SIGNS Ht ,9 Engineers LIC. N0,C 18632 SIGNS TRANS. 3.00 ADDARCH. 0ENG. ADDRESS SPECIAL CIRCUIT 5.00 3PER A T D ON TEMP. METER OR POLE INS. 15.00 501 S. Baswm, San Jose zr95128 APPLICANT's ADDRES 1611 The Alarreda, San Jose, 95126 HS SEE FEE SCH. MOTORS SERVICECHANGE 10.0 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, ji�qd my license is In ftill' foL d ff License "las Lic NunibQ r- Date— Contractor, OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's L.i"nsc Law for the following reason, (See, 7031.5, Business and Professions Code: Any city or county which requiresa permit tocoristruct, after. 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'5 License Low (Chapter 9 (commencing wi Ili Section 70001 of Division 3 off fie Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 ISSUANCE DATE LECT. PLG, ME H, El Z VA L $/Fb " T. 07 TIO, -74-1 Misc. REFER TO ORD PERMIT ISSUANCE 6.00 ELEC.CONTR, LIC, NO. ELEC. TOTAL f fERMITTO 77� J h, 3" T�, P�1(1' MAI, Wp7q STQ8 S TYPE CONSTR, by any applicant for a pernut subjects the applicant to civil penalty of not more than five hundred dollars (S500).): ALTER DRAIN & VENT -WATER (EA.) 4.00 I 0 1, ,is owner of the property, or my employees with wages as their sole corn pe risat ion. will d0 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 eruployQes, provided that such improve means are not intended or offered for saic. If, however, the building BACK FLOW PROTECT. DEVICE 2.00 — OCC. G� CUP RES, UNITS DRAINS-FLODR, ROOF, AREA, COND. 4.00 FIXTURES - PER TRAP 4.00 SO.FT.FLOORAREA TOTAL ACREAGE GAS -EA. SYSTEM - I INC. 4 OUTLETS 4,00 or improvement is sold within out year ofcomplefion, the owner- builder will have the burden of proving that liv did not build or un- pr for purpose o fof sale.) 1, f the property, ani exclusively contracting, With 0% owner 0 - GAS - EA. SYSTEM OVER 4 (EA.) 1 �00 BUILDi NY) CON PB Other 0 0 0 INDUSTRIAL WASTE INTER, 20,00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. li cn,3ed contractors to construct the project (See. 7044, Business and Professions Code: The Contractor's License Law dot, 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 the Contractor's License Law. C, 1 a P,C M exempt under Sec . . . . . ...... ... . .......... — BA or it reason SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT�,'NO. . PARCEL. NO, WATER HEATER W/VENT 4.00 L Date . ...... WATER SYSTEM 4.00 ACC. DiATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm that I have a certificate of consent towif-insure, or a certificate of Workers' Compensation Insurance, or a certified _F0_NIW(7_ ENG. SITE NO'd coptopt qc.,3800 Lob("), Polic C if d is hereby furnished. 1 01 13 cclr�f;11�o is filed will) the city inspection division. Ilk I �nt ifie . ....... PPIe FIRE S�RINK Y N ENERGY T-24 Y [] N misc. - REFER CERTIFf , F OF EXEMPTION FROM WORKERS' '4 PERMIT ISSUANCE 6.00 FLOOD�ZONE A I,. U.C. COMPENSATION INSURANCE (This section need not be completed if the livrrint is for one YE) f N Y EJ N[J PLG,CONTR. LIC. NO, PLG, TOTAL haldollars IS 100) or less,) rforance of the work for which thr- I certify that in (lie pem is pe mit is issued, I shall not employ any person Inane pianner so as to become subject to the Workers' Compensation Laws of California. M 21", Date— __—Applicant NOTICE TO APPLICANT: If, after making this Certificate oFF�11_ ALTER OR ADD TO MECH. 4.00 BUILDING APPLIANCE 4,00 PLAN CHECK emption, you should become subject to the Workers' Cornpensirt ion provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall tic deemed revoked. CONSTRUCTION LENDING AGENCY FEE AIR HANDLING UNIT (TO 10,OOOCF.M) 3.00 AIR HANDLING UNIT (OVER 10,=C.FM.) 5.00 SEISM JC FEE 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.0 Lender's N ain e LA_ Lender's Address I certify that I have read this application and elate I i�,J? above information is correct, I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authoriic representatives of (his city to enter upon the above-mentioned property for inspection purposes. EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM i HEATING LIN IT (TO 100,000 B.T.U.) 4.00 HEATING UNIT 100,000 B.T�U.)7.50 VENTILATION FAN (SINGLE) 3,00 I ELECTRIC i PLUMBING BOILER - COMP (3 H.P, Or 100,000 B.T.UJ 4�00 j BOILER -C OMP (Over 100,000 BTU) SEE FEE SCH, MEC14,,ANICAL R SC. -REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses Much may in any way accrue against City in consequence 01' the gra f V 7 �,Uee 4oA PERMIT ISSUANCE 3�00 MECH. CONT. LIC NO. MEET TOTAL F NIS 0 OFFICE COPY APPLICAN"r TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERtoi Or NUMBER APPLICATION & PERMIT BUILDING ELECTRICAL— PLUMBING MECHANICAL 6223 BUILDING ADDRESS 14/o 3/4 V�y — — PLAN CHECK VALIDATION OWNER'S NAME 41 PHONE UTLETS -SWITCHES - RECEP 5. 00/1.00 CONTRACTOR S' NAM LOC. N LIGHTING FIXTURES 5,00/1-00 APPLIANCES - RESIDENTIAL 4.00 CONTRACTOR'S ESS Z/ �V PHON &I PANELS 5.00 DATE OF APPLICATION ARCHITECTPLANCHECK FEE SIGNS 6.00 P.C. NO. OR ENGINEER LOC. NO. SIGNS TRANS- 3.00 ARCH. OR ENG ADDRESS PEFIMIf VALIDATION SPECIAL CIRCUIT 5.00 ZIP TEMP. METER OR POLE INS. 15.00 MOTORS SEE FEE SCH. APPLICANT'S ADDRESS SERVICE CHANGE 10.00 LICENSUD CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and❑ License Cu�d my ficense is in full forcv License Class, Lie. Number_;;?, BLD G� MECH. A Daft' Confractor -'F Aa� OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from Ole Contractor's License MISC. — REFER TO ORD T. Law for the following reason. (Sec. 7031.5, Businessand professions PERMIT ISSUANCE 6.00 Cade Anycityorcounly which requiresa permit to construct, after, improve,, demolish, or repair any structure, prior to its issuance, also ELEC. CONTE L LIC, NO. EC - requires the applicant for such perrint to file a Signed statement that TOA4 I ii; VOL Itaq� Ire is licensed pursuant to (lie provisions of the Contractors License Law w (Chapter 9 (commencing with Section 7000) of Division 3 of 1 8 usiness and Professions Code) or that he is exempt therefrom a Business 4- e, 'lV , V-�(- 11, I/Mil `11 the basis for the alleged exemption. Any violation ot-Section 7031.5 tll STORIES TYPE CONSTR. by any applicant for a permit subjects the applivant to a civil penalty ALTER -DRAIN &" VENT -WATER fEA.1 4.00 of not than five hundred dollars 0500),): 11110re 0 , as owner of the propQrty, or my employees with wages as their sole compensation, will do the work, and the structure is not j, I—BACK FLOW PROTECT. DEVICE 2.00 —ocEGR660 RES. UNITS intended or offered for sale (Sec- 7044, Business and Professions DRAINS -FLOOR, ROOF, AREA, COND. 4.00 Code: The Contractor's License Law does Rot apply to all owner of property who builds or improves thereon, and who does such work F IXTUR ES - PER TRAP $0, FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such Improve- nkents are not intended or offered for sale. If, however, the building GAS - EA. SYSTEM - 1 INPAgVTLETS 4.00 or iniprovement is sold within one year of completion, the owner- builder will have the burden of proving that he, did not build or int -GAS - EA. SYSTEM - OVER 4 (EA.) I BUILDING USE prove for purpose of sale.). CI 1, as owner the exclusively with INDUSTRIALWAffif4 20.00 RES IND, CON PB Other 01 Eli El 0 El ofproperty, am contracting licensed contractors to construct the project (Sec. 7044, Business pe LAWNS RINKLE9§" I I f4C t �B 5.00 ASSESORS PARCEL NO. and C'ontractor's Professions Code: The License Law does not apply to all owner of property who budds or improves thereon, and who LAWN SPRINKLE tbRMiE�,WNg too contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 1SEWER-SANITARY-S. Odkq A. 206ft/8.00 TRACT NO," PARCEL NO, L-1 I am exempt under See . . . . ..... WATER HEATER W/VENT 4.00 reason --------- - owncr Date WATER SYSTEM 4.00 —-bAT15 ACC, FILE NO, AM WCORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm that I have a certificate of consent to self insure, or a certificate of Worke ' sqwnce, or a certific ZONING ENG. SITE NO. copy therrof(Sec. 3800' L.b.lf,"' Poicy No. - , .1. Company er ifie�d �burnisAed. by d Fins d i �e 1' Cerlific led FIR SPRINK ENERGY T-24 a C Ith y in�peion n1i ]on. I tl tit Applicant— � MISC�❑ REFER TO ORD. Y Y El N[] r 1, 0 ,MPT CFRflVICA I-, OF EXEMPTIONFROVIWORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A�L.U�C� COMPENSATION INSURANCE PLG. CONTR. LIC. NO,PLG Y N TOTAL !E] Y F f' his section need not he completed if file permit is for one r ,it,, d i dollars 100) Or les&)ii Certify that in the performance of the work for which this per _/iii. 7, 777", 77 nu, is iSSLIC(L I shalt 110( employ any person in any triam become subject to the Workers' Compersa t ion Laws oM Date_ - - Applicant BUILDIN ALTER OR ADD TO MECH. 4.001 NO fICF TO APPLICANT: if, after making this Certificate of Ex- APPLIANCE 4.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10)000C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY A113HANDLING UNMOVER 10)Q00C.FM.) 5.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HO**", DUCT) 2.00 theperformance of the work for which this permit is issued (Sec. 3097, CivC.). --t MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name . . .. ............. ... . —.-------- Lender's Addrcs;� ....... . . . . . . .. ... ....... .. . ... ... .. --L 00 B.T.U.)7.50 ELECTRIC HEATING (OJ4�# I certify that I have read this application and state that the above forniation is correct. I agree to with city _3 VENTILATION FAN (SINGLE) 3.00" PL6MBIN1�13 comply all and county BOILER -CO W41"N"OW B.T.U.) 4.00 f ✓ ordinances state laws relating to building construction, and r :OMP (over 100,000 BTU) SEE FEE SCH. MEPHAN i�CAL / (i hereby all,horize representatives of this city to enter upon the above-mentioned property for inspection purposes, (We) agree to save, indemnify and keep harmless the City of REFER TO ORD. Cupertino against liabilities, judgments, costs and expenses whichNST. TAX may in w accrue 19 Id City in conseqpence/ the PERMIT ISSUANCE 3.00 - gra lu e MECH. CONT. LIC. NO. MECH. TOTAL lure f ficant . ractor Date/ ' 1 1/ OFFICE COPY 0 z CC to w>_ aoz (.)o LL 0 F- z LIW N A/ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -'OSE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING — ELECTRICAL— PLUMBING — MECHANICAL PERMI I TNUMBER 6060 BUILDING ADDRI-S, W. E R'5 NAME MEN/ PLAN CHEq ALIDATION PHONE ""7AOUTLETS -SWITCHES - RECEP//5.00/1/40 L,7. ey) C CON No LIGHTING FIXTURES 5,00/1.00 is/, eo APPLIANCES - RESIDENTIAL 4.00 PANELS 5m T %6N CONTRACTOR'S !RE: PHONE PL P.C, NO. ARCHITECT OR rNGINEE�11 v No � Ill. e� �0,� SIGNS 6.. SIGNS TRANS. 3.00 Tf3_CH, OR ENG. ADDRESS PPECIA L CIRCUIT 5.00 PERMIT' VALIDATION - FIA " Rmzj�� ZIP 0 t — 11 . C PPLICANf-S f Be Lift APDRES �TEMP, METER OR POLE INS. 15.00 MOTORS SEE FEE SCH. , 0, �dr -1c, SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9leZANN DATE (commencing with Section 7000) of Division 3 of the Business and BLDG. EL C PLGMECH, Or Professions Co8 at license to I License Class Lic� Number 4% El Date___ C fa OWNER -BUILDER DECLARATION fin I hereby affirm that I am exempt from the Contractor's License misc. — REFER TO ORD VALUATI, N' Law for the following reason. (Sec, 703 1.1, Business and Professions PERMIT ISSUANCE 6.00 Code: Any city or county which requires 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 ELEC. LIC. NO,ELEG ;KNIT TO he is licensed pursuant to the provisions of the Contraclot's License Law (Chapter 9 (commencing with Section 7000) of'Division , �' the and Professions (,"ode) or that lie is exempt themft. I - %Business, p% the basis for the alleged exemption. Any violation of'Sectioi -1 . . . . . . . . . . . &T,01�IES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER DRAIN VENT -WATER i of It t or than five hundred dollars (5500),): L, I as owner of the property, or my employees with wages as r " -, thei sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 2.00 OCC, GROUP RES, UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS -'FLOOR, ROOF, AREA, COND. 4.00 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 4.00 __SO. Ft, FLOOR _8_rA, TOTAL ACREAGE himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building GAS- EA. SYSTEM- I INC. 4 OUTLETS 4.00 i or improvement is sold within one year of completion, the owner wner- builder will have the burden of proving that he did not build or im- builder GAS - EA. SYSTEM - OVER 4 IEA.) 1.00 BFJILD(NG USE prove for purpose of sale,). IJ 1, the — INDUSTRIAL WASTE INTER. 20.00 RES INDCON PB Other ❑1:1 D �� 0 1:1 1:1 as owner of property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 ASSCSS�ORS 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 f - or such projects with a contractor(s) licensed pursuant to the Contractor's License Law, SEWER -SANITARY -STORM EA. 200ft/8,00 TRACT NO, PARCEL NO. I am exempt under Sec. B,&P_C. for this WATER HEATER W/VENT 4.00 read OwnerDt c WATER SYSTEM 4.00 ACD.DATE ACC. FILE NO, WORKE,RS'COMPFNSATION DECLARATION WATER TREATING EQUIP, 4.00 1 hereby affirm that I have a certificate of consent to self insure, or a certificate of'Workers ' Compensation Insuran, ^ ora equi-iod BONING: ENG. SITE NO. copy thew 4' 00, Lab.C. I Policy N(Vlfo Company. I I Certified Copy is hereby furnished. FIRE SPRINK ENERGY T-24 rJ Certified cop t ty '11 division. ,y is f d with lie el t 11 t 'f�6a a , 74❑ Applican %kel lell 4& misc. - REFER TO ORD. Y C] Y E] No CFRTIFICATFOF EXEMPTION 1 -ROM WORKERS' PERMIT ISSUANCE 6,00 _F L 00 D Z 0,� I- A,L.U.C, COMPENSATION INSURANCE PLG. CONTR. LIC. NO. PLG TOTAL Y, � 0 N El Y ❑ N .section need not be completed if the permit is for one ('[his s 137/777' 7777//—&7,�/� 01M hundred dollars ($ 100) or less.)7,7577 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 Workers' California. !D become subject to the Compensation Laws of B U ( I N G NOTICF 10 APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 4.00 I APPLIANCE 4.00 — — - — PLAN CHECK 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, AIR HANDLING UNIT (TO 10)"C.F.M.) 3.00 FEE t AIR HANDLING UNIT (OWER 10=C.FM.) 5,00 SEISMIC FEE CONSTRUC`fION LENDING AGENCY EXHAUST HOOD (WITH DUCTI 2.00 —_ MICROFILM I hereby affirm that there is a construction lending agency for the of the work for which this is issued (Sec, performance permit 3097, Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name Lender HEATING UNIT (OVER 100,000 B.T.U.M50 ELECTR�IC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 information is correct I agree to comply with all city and county- Ordinances and state laws relating to building construction, and COM BOILER P(3H.P.or100,000B.T.U.) 4.00 PLUMBING abocreby authorize representatives of this city to enter upon the ve-mentioned property for inspection purposes. BOILER -COMP (over 100,000 BTU) SEE FEE SCH. — MECHANICAL (We) agree to save, indenimly and keel) harm fess the City of i Misc.- REFER TO ORD. pu Into against Wilitics, judgments."'" a t I S which I t may I any a against S' ( City ,y I in of the granti .I I IT PERMIT ISSUANCE 3.00 CONST."TAX MECH.CONT. LIC. N MECH. TOTAL & lure Applicant/Contractor I of Eto OFFICE COPY { I fOl Q L ZCC Z Z a- a_ L t CD a iu LL LL jH 0LU j ul ' V1 LA- W O i N d u N c CJ a m C) O (} CP c N v L O O m v7 a c w --Dui °swro j eio0w ® os�poedS i LU 0 0 Z LU Lu LL 0 LU 4A cJ W w -.Jul swjoj ss'ou!sng aitoW @ jes!poodS 0 0 BUILDING INSPECTORS NOTICE CITY OF CUPERTINO ig To You ore hereby authorized to Connect electrical service for Owner or Tenant— At No. of Wires Size of Wires Motor Lood Heating load Voltage K. W Size of Switch Phase Valtoge Light-] 10NewService Reconnect No. of Meters Heat - 120 - Three Wire - More Service No. of Add. Meters Power --ji,ree Phase. Move Meter ?k & m ELECTRICAL INSPECTOR CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE r g CITY OF CUPERTINO '. DATE 19 BLDG, PERMIT NO. E THE BLDG. LOCATED AT , � ' 6 =®�ICA AF- �o OWNED BY =� a ; HAS BEEN FOR USE AS _ k- .. ., i A I T CD�.R4