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3697, 6226, 6063-FI PERMIT I 9 5o1ar Fire Misc. Gas Electric CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) ADDRESS LOT NO. OWNER IIS I - Z/___& _LAIL DATE INSP. -It Y,,- - 1 .L 1 V 3J�.r✓ W . Health t. Building Other Pad Certifi atic eisme alis- rame 0 s DATE INSP. ELECTRICAL DATE -INSP. Underfloor S . M.V. Ducts nsu ation Fire D ers ..... ._ ire ace Grease Duct & Hood One Hours at Condensate Drain Equipment Anchorage ,_, , Flues & Comb. Ass BUILDING ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS 0 2 ir Z < F- Z 0 Z to 0 cc cc > cc `t0 a FL CC x o oo APPLICANTTO FILL IN INFORMATION WITHIN RED LINE - USE BALL POINT PEN ONLY BUI LDINb PROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING ELECTRICAL- PLUMBING MECHANICAL mz, pY 0, PERMIT NUMBER 3697 PLAN CHECK VALIDATION BUILDING ADDRJPer OVVNfI I$ NAME ,E. MrqM,' DeVe10PMnbONE NE 287-5721 CONTRACTORS NAME = JVL,i- C , ; 1,4AY LIC.N1.,;t/I , UTLETS SWITCHES RECEP 5.00/1 -00 PAID APR 1$ 1984 LIGHTING FIXTURES 5.00/1.00 CONTRACTOR'S ADDRESS i 1APPLIANCES - RESIDENTIAL 4.00 - JPANELS, 5.00 625 MgGI INE 371-2717 j�W, Carrpbeh DATE OF APPLICATION ARCHITECT OR SIGNS 6.00 I P LA CfVJ SIGNS TRANS. 3.00: ffoGs"kim ]�nqineerS LIC. NO. C 18632 1 ARCH.OR ENO, ADORESI$ 501 S. Beiscom, Sari Jose zip 95128 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 15.00 APPLICANT'S ADDRESS 161 rfhe k=eda, San Jose 95126 MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION I hereby affilrrni; that I am licensed under provisions of Chapter 9 (commencing wili Section 7000) of Division 3 of the Business and Professions Cod�nd my license is in full force aq�t; .3 Lie. Nmnber__,3LH_❑ Dat( ISSUANCE DATE L MI A_ 7 V ONER-BUILDER DF( LARATION I hereby affirm� that I am exempt from the Contractor's License Law for the following reason. (See, 7031 S, Businessand Professions Code Any City Or, County which requires a permit to construct, after, improve. demolish, or repair any structure, prior to its issuance, also requires the applioiant for such permit to file a signed statement that lie is licensed pur�uant 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 misc. - REFER TO ORD PERMIT ISSUANCE 6.00 VALUATION $/FT. �6_, I PERMITTO �VvL-1- ELEC. CONTR. LIC, NO. ELEC.J�� TOTAL "14"r F tlE, STORIES TYPE CONSTR. the basis for theaes:enn pt ion. Any vio la t to n of Sect to 11 703 1. 5 byapplicant it subjects the applicant toa civil penalty of i'e�-,,P.'6'�,Tred dollars (S500).): J ALTER -DRAIN & VENT -WATER iEA.) 4.00 El rof the property, or my employees with wage as their tole compo , ation,'will do the work, and flat structutv is n0l Id BACK FLOW PROTECT, DEVICE 2.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 4.00 intended or offe for �jle (Sec. 7044, business and Professions Code: The Cont+tor's License Law does, not apply to an owner of properly who builds or improves thereon, and who does such work himself or througIt his own employees, provided that such improve- ments are not intprided or offered for sale, If, however, the building r-> nLD FIXTURES - PER TRAP 4.00 SOFT. FLOOR AREA 156,,-5 TOTAL ACREAGE - GAS - EA. SYSTEM - 1 INC, 4 OUTLETS 4.00 or improvement "sold within one year ofcompletion, the owner- m- builder will have " he burden of'proving that he did not build or im- PFfor purpoJof sale,). p 1, as ownep� of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE IND CON PB other 7 El El El INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS - 1 INC 5 V. B. 5.00 f ASSESSORS PARCEL NO, 167- ens to Construct the project (Sec. 7044, Business It enpscorecontractors an '4 �011101 I" de The Contractor's License Law does not apply to an owner of ty who builds or improves thereon, and who co tracts IF., s.J1 0 1 7 ipproillts with a contractorfs) licensed pursuant to I the Contractor's 'icense Law. r_j I am exempt under B.&P.0 f I Ir"I LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA, 200ft/8.00 TRACT NO. 9.1 PARCEL NC. WATER HEATER WJVENT 4.00 soDate n 2 ---- ------ - - - - ---------- Owne"'Wo WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 4.00 WORK I RS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workp,,rs' Compensation Insurance, or a certifiedZONING ENG. SITE NO. 1791 Y- 725 copy th 800, LabC), P ly'N - __ Comp ly, ........ .... vtqid at _<,04770 -1 11,141-- FIRE SPRINK Y [:] N ENERGY T-24 Y Ej NM Certified copy is hereby furnished, fileil with the city inspection division. APPlicant .;M *�, Ise. - REFER TO ORD.-- TF, �I. EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A. L. U, C. PLG. CONTR, LI TOTAL I 'COMPENSATION INSURANCE (This section heed not be completed if the permit is for one Y [] N ❑ Y ❑ N ❑ of MIECHANJC4 PEO(w1IT F Ef Ty hundred dollars ($ 100) aT less.) I certify that iii the performance of the work for which this per mit is issued, fshall not employ any person in any manner so as to become subject t6 the WorkersCompensation Laws of California. Date___ :'- Appli"int __ . ....... NOTICE, 'To APPLICANT: If, after making this Certificate of Ex- BUILDING - ALTER OR ADD TO MECH. 4.00 - APPLIANCE 4.00 PLAN CHECK emption, you sh4uld become subject to the Workers'Compensation provisions of tlie Labor Code, YOU must forthwith comply with'-ii)FEE such provisions � this poIrmit shall be deemed revoked. AIR HANDLING UNIT (TO 10=C.F.M.I 3.00 AIR HANDLING UNIT (OVER 10,1000C.F.M.) 5.00 SEISMIC FEE CONSTRLx:,TION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 2.00 1 hereby affiropri that there is a construction lending agency for the perforrnaoceof the work for which this Permit is issued (Sec. 3097, Civ C.) ' Le 6Na'm', 6A Lender L e i i of e r's A d d ICS, s112 YJ Y, z;#& MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATING UNIT (OVER 100,000 B.T.U.)7.50 ELECTRIC I certify thane 1AWle read this application and state that the above information K c4trect. I agree to comply with all city and county ordinances and itate laws relating to building construction, and VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER - COI H. P, or 100,000 B.T.Ul 4.00 BOI LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby juI represe.otatives of this city to enter upon I above -mentionedproperty for inspection purposes. MISC. - REFER TO ORD. (We) agree U1, save, Indemnify and keep harmless the ('fly of Cupertino agairm,� liabilities, juAigments, Costs and expenses which may in any way accrue against sai( C', in Consequence of the grintin I 0 -ml CONST. TAX PERMIT ISSUANCE 3.00 MECH. CONT. LIC. NO. MECH. TOTAL - '717 `Sign are A, It- I i Dab acrz map q UU � z w ut4y y 2 z -0 nl-w aa� w N woe w } � L C 0 X 0 a w`0(n F- 2 2 = o 0 F C0 it > W _ CL a 00 U_ o UJ r a to Z PPLICA IT TO FILL iN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUI LDI WG PROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 6226 BUILDING ADDRESS 3/ OWNER'S NAME / PHONE // / / r �j�/ j /�/ �� / CHECK VALIDATION DATE OF APPLICATION CONT RAC oR S NAME ` LIC. NO ; / OUTLETS - SWITCHES - RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 CONTR7 CTOR's ADD S f PHONE.Yfi1Z / APPLIANCES - RESIDENTIAL 4.00 PANELS 5.00 AR HITEC7 OR ENGINEER uc. No. SI',GNS... 6.00 PLAN CHECK FEE TP.C. NO. SIGNS TRANS, 3.00 ARCH,ADDRE 3 ENG ..... zip !SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR. POLE INS. 15.00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH.J SERVICE CHANGE 10.008„t,. LICI;,NSED CON FRACTORS 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 o an m license is in full fore ^f License Lic.Contra Date.- Date...__._ _ ISSUANCE DATE BLDG. ELECT. PLG. MECH_ ❑ 4�J �., / -$/F C,JWNLR BUILDER DECLARATION��ALUATION 1 hereby affnrrt that I am exempt from the Contractor's Licence Law for the folid�•mg reason (Sec. 7031.5, Business and Professions Code: Any city ort county which requiresa permit to construct, alter. Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applixant fofsuch permit to file a signed statement that he is licensed 1lArMlBait to the pray/StanS (?f the Contractor License Law (Chapter 4) (Commencing wlth Section 7000) of Diviston 3 of the ' Business and Prnh:ssions Code) or that he is exempt therefrom and p the basis for the aheged exemption. Any violation of Section 7031.5 by any applicant for a Permit Subjects the applicant to acivil penalty of not more than dive hundred dollars 6500),): MISC, - REFER TO ORD PERMIT ISSUANCE 6.00 , ELEC, CONTR. LFC, No. ELEC. TOTAL , / , // ///' / //„r j i/ / r;/%//i / ; ii/i /f/ %/, i///// // ;////%/' ' /if // //; / f ALTER -DRAIN &VENT -WATER (EA.) 4- nn Q�a, a w , 1 PERMITTO , q 'Ax (•., ,74 STORIES TYPE CONSTR. (:'I I, as owner of the property, or illy employees with wages as their sola>, compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contr4ctor's License Law does not apply to an owner of propertyll” who builds or improves thereon, and who does such work hint elf or throe � t his srzun employees, provided that such improve - merits, are not int nded or offered for sale If, however, the building, BACK F LOW PROTECT. DEV ICE 2. ”"'� ROUP sn. FT. Loon AREAJ RES. UNITS TOTAL ACREAGE AT DRAINS -FLOOR, ROOF, AREA, COND. 4.00 """" i TRAP GAS -- EA. SYSTEM iNC, 4 OUTLETS 4 00 � or improvement r sold within one year of completion, the owner builder will have xhc burden of rovin that he did not build or im- rove far ur vats of sale,). proving prove P p I I 1 1, as ownee of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business all of Prof"essionst"bdc The Contractor's License Law does not apply to an owner of property, who builds or improves thereon, and who GAS - EA. SYSTEM OVER 4 (EA,) 1.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 y ASSESSORS PARCEL NO. - LAWN SPR INKLERS - OVER 5 (EA.) 1,00 contracts for suulip roj ects with a contractors) licensed pursuant to the CantraLicenseor's License Law. w SEWER -SANITARY -STORM EA.200ft/8.00 TRACT NO. PARCEL No. ❑ 1 am exeript urider Sec _.._..__...__ _____- B.&P.C. for this -' WATER HEATER W/VENT 4,00 Owner Date --. WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 4.00 WORK[IRS'C'OMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate or Workers' Compensa " n I urance, or a certified copyyh reel ("s+.c 3k00, Lpaby.).,� P<:itc xla .., COMPay ZONING ENG. SITE NO. FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N reb furnished. �/,� 7 Cer[ifuwith r city inspection division. n C"tr1'wllxz� Appliunly[ �„-.-._.. ._..._._� MISC. - REFER TO ORD. ,�� C t R'1'tb"1C,A 1 L OF; EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. PLG. CONTR, LIC. NO. PLG. // / / /, , // . „ /!!/ /%/// / i, / / ,/ ,/ i! ALTER OR ADD TO MEC 4.00 COMPOI TION INSURANCE If his section Iracd IRA be completed if the permit is for one hulo1 I certify that Orthe performance of the work for which this per- mit is issued, I L14a11 not employ any person in an manner so as to become subject @r; the W'orkeis' Compensation Laws of California. Date. ,. _, .Appliaant ,_ ..._... __._ NOTICE TO APP[ ICANT It, atter making this Certificate of Ex- �jki+i I BUILDING •---- APPLIANCEs m 00 )' AIR HANDLING UNIT i C. ) 3.00 PLAN CHECK FEE emption, you should bece'arne subject to the Workers' Compensation provisions of Out Labor Code, you must forthwith comply with such provisions of this permit shall be deemed revoked. AIR HANDLING UNIT 00 EXHAUST HOOD (WI 2.00 SEISMIC FEE (,','0 NSTRuc,rLON LENDING AGENCY 1 hereby attarin that there is a construction lending agency for the po-rformat e, "of the work for which this permit is issued (Sec. 3097, Civ.C.). MICROFILM HEATING UNiT (TO 100,000 B.T.U.) 4.00; ' HEATING UNIT (OVER 100,000 B.T.U.0.50s ELECTRIC Lender's Name,,-.',-. — Lender's Addra,y i 1 certify that I have read this application and state that the above Information IS a«drrcct I agree to comply with all city and countyBOILER-CLMVIP{'3 ordinances and<tate htuY relating to building construction, and VENTILATION FAN (SINGLE) 3,00 , PLUMBING H.P. or 100,DOOB.T.U.) 4.00 BOI LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize reprewntatives of this city to enter upon the above-menhontd property for inspection purposes. MISC. REFER TO ORIS. _ (We) agree to; save, indemnify and keep harmless the City of Alpert ;against liabilitt.s judgments, costs and expenses which ay ' an wai I cnie agal id City in consequence o the ng of [n '%j, / s/ saturet6f' A c;an�t/C a rector atE — P - CONST TAX mm._ PERMIT ISSUANCE 3,00. MECH. CONT. LIC. NO. MECH. TOTAL _,.., f j /// �/ G'MR i I LICA dT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING ELECTRICAL- PLUMBING MECHANICAL PERMIT NUMBER 6063 r BUILDINr, 'U AD C Rens /_V1 A/wx LI&J�117_ "NE INA M I 17— AJ it IBM, "Nomp o4ggrs ruffirl, yo OUTLETS SWITCHES - RECEP 5.0011-00 PLAN CHECK VALIDATION N '0 LIC, NO!��4:� LIGHTING FIXTURES 5.0011-00 1,014tRACrOR'S ?�, RESS ZZ2, PHONE ' 9'1��jm 4,00 sss J APPLIANCES -RESIDENTIAL PANELS 5.00 DATE OF APPLICATION ARCHITECT _Lahe 0r, ENGINEER L I C. NO ew SIGNS 6.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS- 3.00 AACH, OR ENG, At)ORESS W SPECIAL CIRCUIT 5.00 TEMP. METER OR POLE INS. 15.00 PERMIT VALIDATION Al ICANT'SMOTORS SEE FEE SCH. iSERVICE CHANGE QAAr% 10.00 LICI`,N$LD CONTRACTORS DECLARATION a r I hereby alli that I am licensed under provisions oIrChapter9 C lencing widt Section 7000) of Division 3 of the Business and ( omn 1, rofi�ssirir!s y licensc is in full for ff, Lice . I❑ Dat( _CantractcLic- Nur ccit 1)*NFR-80ILDER DECLARATION ISSUANCE DATE IJ L, I BLDG. I ELECT.... PLG._TMECH El y of Cupertino IMISC. - REFER TO ORD PERMIT ISSUANCE 6.00 I hereby affirr� j1hat I am exempt from the Contractor's License. law t or the follow Ing reason. (See, 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, dem fish, or repair any structure, prior to its issuance, also lecluireN the appli4ant for Such permit Cu file a signed statement that lie is licensed purluant to the provisions, of the Contractor's Licensee Law (Chapter 9 (c�omm"aein( with Section 7000)ofDivision3 oftlic Iusirl and Prorpssiong Code) or that he is exempt therefrom and the basis for tlu:aileged exemption. Any violation o1 Section 7031.5 fly anYapplicant for a permit subjects tire applicant to a civil penalty Of not more than five hundred dollars ($5000: VALUATION $/FT. FLEC eC ELEC 7 "M ALTER -DRAIN & VENT -WATER (EA.) 4.00 PERMIT TO Z ST DRIES TYPE CONSTR_ 11 1, as ownerof the property, or my employees with wages as (heir 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 does not apply, to an owner of iproperty who builds or improves thereon, and who does Such work or through his own enaployceS, provided that such improve- ments are not Intended Or offered for sale. If, however, the building BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, HOOF, AREA, COND. 4.00 FIXTURES - PER TRAP 4.00 So- FT. FLOOR AREA TOTAL ACREAGEhimself GAS- EA. SYSTEM - 1 INC. 4 OUTLETS 4,00 or innprovcrmrnt is sold within one year or coulpiction, the owne _ builder will have ifie burden of proving that he did not build or fill- prove for purpose � of sale.). 1,1 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 1.00 8UILOI�G USE RES IND CON PB Dire, El 0 El E) 1:1 INDUSTRIAL WASTE INTER. 20�00 — LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 — ASSESSORS PARCEL NO. licensed contractors to construct the project (Sec. 7044, Business and Profmions Code: The Contractor's License Law do" not apply To an owner ol'proverty who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuarit to file C olit"actor's License Law, SEWER -SANITARY -STORM EA. 200ftl&00 TRACT NO. PARCEL NO. UI am e)(Cffirit under Sec....-_... B.&P.C. I -or t Ili's ACC. DATE ACC, FILE NO. WATER HEATER W/VENT 4,00 (fCaS011 )%vocir --------- - --- — Date WATER SYSTEM 4.00 WATER TREATING EQUIP. 4.00 WORK IiRS'COM PENSATION DIECLARATioN, 1 hereby affirm that I have a certificate of consent to self -insure, 01 it eXrhficate or Workers' Compensation I nsurarip or � certified copy tile j)00, Lal Po tiler Compan W21-Ad --inma, ZONING ENG. SITE NO. Certified copy is herchy furnished- Ccoified copy is filed with the sit nspection division. Aprdicant� k� (, illwv�,On-�0*06 — FIRE SPRINK Y [J NE] ENERGY T-24 Y E] NE] !misc.- REFER TO ORD. (,TRTIF`R'ATI- OF EXEMPT I ON FRO%1 WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. Pi TOTAL M W, �O y 0 `00 F '7' ALTER OR ADD TO MECH. COMPE,N'SATION INSURAN( , F (I'fll% section need not be completed if the permit is for one hundred dollars t $ 100) or less.) ce rtify that loo the performance of Che work for which this per - nut is issued, I ShAll not employ any person in any manner so as to �)ccoule subjecf, to the Workes'Compensation Laws, of California. - Applicant .. ..... ... .. ... ---------- NOTICF, 1`0 APPLICANT: If, after making this Certificate of I. -x- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply will) such provisions, or this permit shall be deemed revoked. Y E] NFJ Y Nr IMMI/ BUILDING I APPLIANCE 4.00 AIR HANDLING UNIT (TO 10PMC.F.M.) 3.00 PLAN CHECK FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT (OVER 10MIC.F.M.) 5,00 SEISMIC FEE I hereby affirill that there is a construction lending agency for tile [,crformanue of the work for which this permit is issued (See. 3097, Civ,C). EXHAUST HOOD (WITH DUCT) 2.00 -1 —, MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4,00 HEATING UNIT (OVER 100,000 B.T.U.)7.50 ELECTRIC Lenders Na ne. ........ Lende I certify that I hate read this application and state that the above information is correct. I agree to comply with all city anti county Ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 3.00 11 PLUMBING W—' BOILER -COMP (3 H.P. or 100,000 B.T.U.) 4. BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. hereby aUthorize, representatives of this city to enter upon the above-mentioned property for inspection purposes, MECHANICAL misc. - REFER TO ORD, (We) agree to save, indemnify and keep harmless the City of ino against liabilities, judgments, costs and expenses Witten fe�i I rue avirst Sal( y in 0 may if any C I of the grand of t I I tgal � 0 A r / lye — PERMIT ISSUANCE 3.00 CON ST. TAX MECH. CONT, LIC. NO. MECH. TOTAL 01, OFFICE COPY 1� i w, D fir, `n y e Lo 1 k N c ra In f3 } a p 4 `c .c 3 0 0 1� i 4 r , 7E, / IS a,a ,c w-•3ul 'swioj sseursng. ojgpyv Q 49stpoos m (i J 7 �p �� E o� o O n W p C_ � N € (�� LL 1/ m W Q N u tt