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3698 6227 5482 6084-FCITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) Io&z-. AJ E ADDRESS LOT NO. )MJ/ &--- - OWNER PERMIT ISSUED DATE ui in lar re 4 Misc. ELECTRICAL DATE TNSP. Underfloor S.M. Ducts & nsu ation p j Fire DanVers ire ace Grease Buct & Hood Equipment Anchora e Flues & Comb. Air Other Not Approved 7 BUILDING ELECTRICAL PLUMBING MECHANICAL A1ISCELLANEOUS 12 U cc z -00 CC ,z. rnd Z z CI cc CaCC C 4 0 CC 2 EE a a: 1-0 A I�,%Wwrl PPLICA NT TO, FILL IN INFORMATION WITHIN RED UN ES - USE BAL-L 1:,01NT PEN ONLY SUI LINO PP� BUJI-DING ADDRESS APPLICATION & PERMIT BUILDING ELECTRICAL- PLUMBING - MECHANI,CAL '4k PERMIT NUMBER 3698 OWNERS NAME E. Mortzpa EewlopnentONE 287-5721 PLAN CHECK VALIDATION PAID APR 1$ 1984 CONTRACTOR S NAME OC_ 176A] LIC. NO OUTLETS SWITCHES RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1-00 CONTRACTOR'S ADDRESS 625 McG114cyt CanipbelIN, 371-2717 APPLIANCES - RESIDENTIAL 4.00 PANELS- 5.00 ARCHITECTPLAN OR.SIGNS H69*InS EIgineerS LIC. No. C 1$6, 2 6.00 CHECK FEE- P.C. NO. 1 SIGNS TRANS. 3.00 ARCH, OR ENG. ADDRESS 501 S. Ba�Bcom, San Jose ,95128 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION /,/// � TEMP. METER OR POLE INS. 15.00 APPLICANT'S ADORES$ MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 1611 'Tile Alamda, San Jose 951-26 5� 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 ftof,s,ion,�Cude,"rd my license is in full t� ff" License Lie. Number Date -3 -C-�t4, OV)NER-BUILDER DFCLARATION I hereby affirtr License ,I khat I am exempt from the Contractor's Law for the following reawn. (Sec. 7031 5, Busimsisind Professions Code Any city or county which requires a Permit to construct, alter, hinprove, ilLmotislij or repair any structure, prior to its issuance, also requires the applictint for such permit to file a signed statement that he is licensed pieta aril to the provisions of theContractor's License Law (Chapter � (commencing with Section 7000) of Division 3 of the Business and ProNssions Code) or that he is exempt therefrom and ISSUANCE DATE IG ELECT. PLG. El 1:1 MECH, 1:1 MISC. - REFER VALUATION, $IF T. PERMIT ISSUANCE 6,00 ELEC. CONTR, LIC. NO. ELEC. LT.T�L PERMIT TO P tv M IN 1,11 STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031 " 5 J by any applicant five dyed the applicant to a civil penalty of'not morethan five hundred dollars ($500).): '7 ALTER -DRAIN & VENT -WATER (EA.) 4.00.- 0 1, as owner Dftlie property, or my employees with wages as their Solt corn en will do the work, and the structure is no intended or offert'd for sale (See. 7044, Business and Professiorus Code The Conitr4tor's License Law does not apply to art owner of property who buibds or improves thereon, arid who does such work himself or through his own employees, provided that such improve- ments are not (rittijrided or offered for sale, If, however, the building or improvement i� sold Within one year of completion, the owner - builder will have e,�ie burden of proving that he did not build or im- rv0 p -for purpose Dfsale,), La�, owner 19f the property, am exclusively contracting with BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP R RES. UNITS DRAINS -FLOOR, ROOF, AREA,CONCI. 4.00 FIXTURESTRAP 4.00 SO. FT. FLOOR AREA TOTAL ACREAGE JGAS- EA.SYSTEM-1 INC,40UTLETS 4.00 GAS - EA. SYSTEM - OVER 4 (Ek) 1.00 BUILDING USE IND CON PB Other 0 0 0 I I NDUSTRIAL WASTE INTER. 20-00 LAWN SPRINKLERS - 1 INC 5 V�B. 5.00 licensed contractors to construct the project (Sec. 7044. Business and Professions Cddc: The Contractor's License Law does not apply to an owner of m )perty who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's L cense Law. ASSESSORS PARCEL NO. NO. FIARCEL NO. LAWN SPRINKLERS -OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 2001t/8.00 U I am exemp under Sec____,--. - - ------ _B.&P.C, to this reason _-1 �o WATER HEATER W/VENT 4.00 I Date ..... ...... . ---Owner. I _. WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. - WATER TREATING EQUIP, 4.00 WORKFS'COMPFNSATION DECLARATION I hereby affirmthat I have a certificate of consent toself-inSUre, or a certificate ofiWorkers' Compensation Insurance, or a certified copy t ) P3N a cy ZONING ENG. SITE NO. FIRE SPRINK Y f NF ENERGY T-24 Y [:] NF� red e Cc r t I fi e c I c y i s hmetp,b y furnished. U (,7.erfified is filed with the city inspection division. Applicant - ----- ­ -=MISC. - REFER TO ORD. CE4RT1,JC -OF EXEMPTION FROM WORKERS' C PERMIT ISSUANCE 6.001 FLOOD ZONE A,L.U,C� PLG. CONTR. LIC. NO. PLG TOTAL COMPEASATION INSURANCE (This section fted not be completed if the permit is for one YE NF❑ I - 'NWPtO 0"T MECH AAL" BUILDING ...... ... . . -02,0 hundred dollav;0100) or less) I certify that fit the performance of the work for which this per mit is issued, I shall not eniploy any person in any manner so as to become subject t6 the Workers 'Compensation Laws of California. Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 4.00 APPLIANCE 4.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of Labor Code, you must forthwith comply with such provisions this peruit shall be deerned revoked, CONSTRUCTION LENDING AGENCY FEE AIR HANDLING UNIT (TO 10=C.F.M.) 3.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 5.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 2.00 I hereby affirid that there is a construction lending agency for theperformance Of the work for which this permit is issued (See, 3097, C' C ) I Le MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATING UNIT(OVER 100,000B.T.U.P.50 ELECTRIC certify certify that I have read this application and st!�,�YPEI,.'e inform4lion is co i krect. I agrcv to comply with ,III city arid county ordinances arid state laws relating, to building construction, and VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER - OOMP (3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,OQO ETUl SEE FEE SCH, MECHANICAL repTeseritatives of lfiv�, city to Qnter upon t It c above-mentiomW )roerty for Inspection purpom hereby authorizetsavp, MISC. - REFER TO ORD. CONST. TAX (We) agreeiruleninify anti keep harodess the City of Cupertino againsti, it lifics, judgments, costs arid expenses which may it ac rue against a' City in consequence of tine us thi t Srft-o-o' `F�IiVoflpo e0artr/Ci5n ra ctor )ate PERMIT ISSUANCE 3.00 MECH. CONT. LIC. NO. MECH. TOTAL 32 - OFFICE COPY 0%, 0 Z Z P: 0 OC T UJ > z 0 U_ L- 0 0 Lu CL Cf) Z Al APPLICANTTO FILL,, IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING — ELECTRICAL—PLUMBING — MECHANICAL PERMIT NUMBER 6227 BUILDING ADDRESS V, NAME PRONE 7 V M J 1110,11/1111 Y OM/ - SWITCHES - RECEP 5,00/1.00 PLAN CHECK VALIDATION CONTRACT R /7 O' D7 AQLIC. C N0 LIGHT LIGHTING FIXTURES 5.00/1-00 _ H 2 NT ACIORS T ADDRESS ARCHITECT OR ENGINEER LIC. NO APPLIANCES IAPPLIA - RESIDENTIAL 4,00 DATE OF APPLICATION PLAN CHECK FEE7 P.C. NO. 1PANELS 5,00 SIGNS 6,00 [SIGNS TRANS. 3.00 ARCH. OR ENG, ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 15.00 zip APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 I LICENS ED CONTRACTORS DECLARATION I hereby affirri that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cod,:,'.jd my license is' full to c,, jixlo� License Class Liu. ISSUANCE DATE BLDG- ELECT- PLG. MECH. Date—__ _......_—Contractor OWNLR-BUILDFR DECLARATION I hereby affam,that I am exempt from the Contractor's License I �3w for the following reason. (Sec, 7031.5, flusinessand Professions (ode Any City Or County which requires a permit to Construct, alter, improve, denlolish, or repaii any structure, prior to its issuance, also requires the applic ant forsaich permit to file a signed statement that he is licensed pursu o fie provisions of the Contractor's License art I I Law (Chapter 9 (commencing with Section 7000)ofDivision3 of the misc. — REFER TO ORD PERMIT ISSUANCE 6.00 VALUATION �_/FT Al R ELEC, CONTR. LIC. NO. 11/1 §7 2 L PERMIT TO Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption- Any violation ofsection 7031.5 by any applicant for a permit subjects the applicant toacivil penalty of not more than five hundred dollars WSOO)): ( ALTER -DRAIN & VENT -WATER (EA.) 4.00 STORIES TYPE CONSTR_ 1, as owner,of the property, or my employees with wages as their sole compenliation, will do 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 o4A property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve. merits are not intended or offered for sale. if, however, the building BACK FLOW PROTECT. DEVICE 2,00 �2 OCC. GROUP RES- UNITS DRAINS -FLOOR, ROOF, AREA, COND. 4.00 FIXTURES - PER TRAP 4,00 Z So. FT. FLOOR AREA TOTAL I . . ....... ..... . '' GAS - EA. SYSTEM - 1 INC. 4 OUTLETS 4,00 or Improvement is sold wi(hin One year of completion, the owner- builder will have the burden of proving that he did not build or im- bu prove, for purpose I of sale.). [) 1, as owner of theproperty, am exclusively contracting with licensed contnWtors 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 OF improves thereon, and who GAS - EA. SYSTEM -OVER 4 (EA.) 1.00 BUILDING USE RES IND CON PB Other 0 0 0 0 0 INDUSTRIAL WASTE INTER. 2000 . LAWN SPRINKLERS - 1 INC 5 V.B.5.00 ASSESSORS PARCEL NO. LAWN, SPRINKLERS - OVER 5 (EA.) 1.()0 contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 2006/8.00 ACT TRACT NO. PARCEL NO. C-1 lamexempt underSec - -------- B.&P.C. for this reason ... . ...... ..... O.ner Date 'I WATER HEATER W/VENT -00 PA I Lx�_ WATER SYSTEM 4.00 ERN ' DATE ACC, FILE NO. WATER TREATING EQPLLID"�114�9 WORKF'AS'COMPFNSATION DECLARATION I hereby affirrm that I have a certificate of consent to self insure, or a certificate of', Workers' Co . I ! or a certified copy thereof (Ser � 3800, , ab.C��uranc( , .......... Com' 4, Policy No. pan -Z Company F ------ I I Cc rt fi,d Wo)y is hereby furn�hed.�AZO 40,0 CIII:11:11; filed if city inspection di Applic ZONING ENG, SITE NO, Cit y of i`alpertirlo FIRE SPRINK Y IN E] ENERGY T-24 Y [:] IN ❑ REFER TO ORD. . 7 CFRI 11 ICATE )F EXEMPTION ROM WORKERS' PERMIT ISSUANCE 6.0 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC, NO. TOTAL J s J 4.00 ALTER OR ADD T 1 � i APPLIANCE 4.00 COMPENSATION INSURANCE (I'llis section need not be completed if tile permit is for one hundred dollars 1$ 100) or less,) I certify that in the performance of the work for which this per- out is issued, I sliSil not (mploy any person in any mannerso as to become SUbjCCt, to the Workers'Compensation Laws of California Date, Applicant- -------- --- NOTICF TO APPLICANI: It', after making this Certificate OF[--,( eruption, yousbotild become subject to the Workers' Compensation Y E] IN F] Y E] IN F] BUILDING PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked, FEE AIR HANDLING UNI�, JTF M.) 3.00 P JQPft�' AIR HAN DLINGkAnWEW,1 ObW*. M.) 5.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I iierchy affirm that there is a Construction lending agency for the. performance of the work for which this permit is issued (Sec. 3097, (iv.C.). EXHAUST HOOD .(WITH,P_YqT-,r1 2.00 MICROFILM HEATING UNI U.) 4,00 HEATING UNIT(OVER 100,0008.T.U.)7.50 ELECTRIC Lenders Name,:_ Lenders Address—__ ---------- --- I certify that I have read this application and state that tile above information is correct. I agree to comply with all city and county ordinances and „date laws relating to building construction and hereby authorize representatives of this city to enter uponi the above-mentioned property for inspection purposes. VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER - COMP(3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (over 100,0008TU) SEE FEE SCLC. MECHANICAL MISC. REFER TO ORD, (We) agree to 'save, indemnify and keep harmless the City of Cupertino against, liabilities, judgments, costs and expenses which may 111,4m)� way accrua agaipst said City in consequence of the granti Of t Sig'.; re FA��pp,;cintA/Co�n,,,,,., at CONST. TAX PERMIT ISSUANCE 3.00 J -MECH. CONT. MEC 'H TOTAL OFFICECOPY Cz1_r\Ck.d cz_ ­­ "APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - APPLICATION & PERMIT BUILDING — ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER 5482 - a 8 U fit ' INC, 7_-�Wlell ADDRESS A 4re 4—IA24 OWN OWNER'S ER'S NIAME x /,v PHONE3' CONTRACTORS NAME "W rldr LIC. NO. 1m/%/ _7172721/771/7—w ........... OUTLETS - SWITCHES - RECEP 5.00/1,00 PLAN CHECK VALIDATION DATE OF APPLICATION LIGHTING FIXTURES 5.00/1.00 roNTHACTOR'S 7 2 6 C7_ss,�_ J -_ t A R DREVS '/ °r' PHONIi APPLIANCES - RESIDENTIAL 4.00 PANELS 5,00 ARCHITECT on ENGINEER LIC. NO, SIGNS 6.00 PLAN CHECK FEE P,C. NO, 1 SIGNS TRANS. 3.00 ARCH' OR ENG. ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 15.00 ZIP APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICECHANGE 10.00 vr% ;" P41, A 9 W LICENSFID CONTRACTORS DECLARATION Rnn 0 eir I Ar IN 60 1 1984 I hereby afforni'that I am licensed under provisions of Chapter 9 Section 70) of Division 3 of the Business and omencinith 00 Icmg w Pro fessions Code) and my license is in Rall force and ffe-t License Class11­49--, Lic. Numberig-7-t. .......... ... .. Date_y/-aq�-* *.— Contra cfor OWNEIR-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the lotiowing reason. (Sec. 7031,5, Businessand 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 theappliCOnt for Such pernnil to file signed statement that he is licensed pursuant to -the provisions of the Contractor's License Law (Chapter 9 (cornme neing with Sect ion 7000)OI'Division 3 ofthe Business and Professions (ode) or that lie is excirlpt therefrom and the basis for Che. sH, cged exemption. Any violation ofSection 7031,5 by any applicant PDT a permit subjects the applicant Ica civil penalty of notmore than five hundred dollars (5500).): ISSUANCE DATE BLDG,-FFL7ET. PLG. MECH- El El ❑ City of peftOORD CEp MISC. — FER PERMIT ISSUANCE 6.00 V LUATION $/FT. ELEC. CONTR. LIC, NO. E :LEC. TOTAL Iffig, ii;WE, M S INSIDE 6 ALTER -DRAIN & VENT -WATER (EA.) 4.00 PERMIT TO STORIES TYPE CONSTR. 1 1, as owner of the property, or my erriployees with wages, as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 100 OCC, GROUP RES. UNIT DRAINS -FLOOR, ROOF, AREA, COND. 4.00 intended or offered for Sale (S". 7044, Business and Professions Code. The Ciortr,.ector's License Law does not apply to air owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- ments are not Intended or offered for sale, If, however, the building FIXTURES - PER TRAP 4.00 SO, FT. FLOOR AREA, TOTALACREAGE GAS - EA. SYSTEM -1 INC. 4 OUTLETS 4.00 or ilraprovernent is sold within one year of completion, the owner- builder will have fire burden of proving that he did not build or im- prove for purpose of sale,). i_l 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE RES IND CON P8 Other 1:1 El El El D INDUSTRIAL WASTE INTER. 20,0 0 LAWN SPRINKLERS - 1 INC 5 V,B, 5.00 ASSESSORS PARCEL NO. licensed contractors to construct the project (Sec. 7044, Business ar'Profcssionw Code: The Contractor's License Law does not apply to air owner of property who builds or improves thereon, and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for sucir projects with a contractor(s) licensed pursuant toTRACT the Contractor's License Law, SEWER -SANITARY -STORM EA. 200ft/8.00 NO. PARCEL NO. El I am exempt under Sec _ BAP.C. for this ream.)n Owner. Date WATER HEATER W/VENT 4,00 WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP, 4-00 WORKEAS'COMPENSATION DECLARATION I hereby affiftin that I have a certificate of consent to self -insure, or a certificate W:Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. - icopy thereof (Sec. 3800, Lab C). Policy No, _... , Company V14 te-_FIRE SPRINK ENERGY T-24 Y [] NE] Y f'� I U Certified copy is herrnpe"by Iurnis C1 rt f Vd copy is filed w the oil Inspection division - A pp c misc. - REFER TO ORD. PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. CERTIFICATEOF EXEMPTION FROM WORKERS' PLG. CONTR, LIC. NO. PLG I TOTAL QN7 157, ell 11 'N '//7/ Wit/ )1/11 9111111111 ALTER OR ADD TO MECH. 4.00 COMPENSATION INSURANCE (I his, section need riot be completed if the permit is for one hundred dollars (5100) or less) I certify that in the prxformance of the work for which Ihis per - Hilt is issued, I shll not employ any person in any manner ,so as to become subject Loathe Workers'Corr ipensation Laws of Calif ....... Date , _ _ ___ Applicant __ .. ...... . .. . .. ..... NO`FICF TO A111"LICAisrf: If, after making this Certificate of'Ex- Y E] N El Y E] N El BUILDING 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. FEE — AIR HANDLING UNIT (TO 10=C.F.M.) 3,00 AIR HANDLING UNIT (OVER 10)"CF.M.) 5,00 SEISMIC FEE CONSTRUCTION LFNDING AGENCY EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM I hereby affirar that there is a construction lending agency for tile performance of' the work for which this permit is Issued (See, 3097, Civ,C.). HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATING UNIT (OVER 100,000 B.T.L1,M50 ELECTRIC Lender's Name—,___ — -------- Lender Adds I certify that � have read this application and state that the above information is correct. I agree to comply with all city and county ordinauces and state lawe relating to building construction, and VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,0008TUI SEE FEE$CH. MECHANICAL hereby authorize ielpre.,sentatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which i may in any way accrue against said City risequence of the Co granting of Ihis permit. IX LSIE, Ifta er tractor ate CONST. TAX PERMIT ISSUANCE 3.00 MECH. CONT, LIC_ NO. MECH TOTAL OFFICE COPY 0 cc z X00 U U JW z _1 0 U LL 04 >- 0 cc X w OS to A /;1z" fiAl APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL PO9NT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING ELECTRICAL- PLUMBING MECHANICAL PERMIT NUMBER 6064 nUH-DING AD RESS OWNER R's W _ NAME e- PHONE UTLETS -SWITCHES- RECEP 5.00/1.00 -Ai PLAN CHECK VALIDATION DATE OF APPLICATION CONTRACTOR S Li. N 0. g' ,C�11 2& _6 LIGHTING FIXTURES 5�00/1.00 la, Q ACTOR'S AP SS CONTRPH ft APPLIANCES ES - RESIDENTIAL 4-00 6e) PANELS 5.00 #L2 ARCHITECT OR r NGINEER L I C. N 0. SIGNS 6.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 H.OR 9NG. AO D,LtL Ss 5 )-4 z SPECIAL CIRCUIT 5.00 PERMIT VALIDATION T TER OR POLE INS 15.00 EMP. MELICANT'S APP ]�S_L& Ojll� MOTORS SEE FEE SCH. 0-i) SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I sin licensed under provisions of Chapter 9 Iconimencing with Section 7000) of Division 3 of the Business and Professions "I " license is in full to f Licens?e � IM LIN y - ----- Lie, Date, OWNER -BUILDER DLCLARATION I hereby affirirl� (list I min exempt from the Contractor's License Law for the following reason, (Sec. 7031 5, Business and Prolessions Code. Any city or�county which requires a permit to construct, alter, i improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a sigrwdKtatement that he is licensed pursuant to the provisions of the Contractor's License- Law (Chapter 9 (c6mmeneing with Section 7000) of[)ivision 3 of the Business and Professions Code) or that he is exempt therefrom and the basisfor the aAeged exemption. Any violation of'Suction 703 1.5 by any applicatit for a permit Subjects the applicant toa civdpenafty of not more than five hundred dollars 0500).): ISSUANCE DATE PAID PLG. El MECH, El C, 2 MISC- REFER TO ORD ssu* PERMIT I r1.00 AYEof Cunerfino VALUATION $/FT. ELEC CONTR. LIC NO, ELEC TOTAL ALTER -DRAIN & VENT -WATER (EA.) 4.00 PERMIT TO STORIES TYPE CONSTR. r1 1, as owner'ofthc property, or my employees with wages as their sale compensation, will do the work, and the structure is not mended or offered for sale (Sec 7044, Business and Professions Code: The Contractor's raceme Law does not apply to an owner of P""pc`ty who builds or improves thereon, and who does such work himself or throu,h his own employees, provided that such improve- ments are not intended (fl, offered for sale. If, however, the building BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS DRAINS- FLOOR, ROOF, AREA,GOND. 4.00 FIXTURES - PER TRAP 4.00 SQ FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - 1 INC. 4 OUTLETS 4.00 or improvement: is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or ini- prove. ("or purpose of sale.). U 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 - EA. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE RES IND CON Ps Other El 1:1 El El El INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO, LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such; projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ftl8.00 TRACT NO. PARCEL NO. U I an) exemlyl B.&P.C. for this reason Owner,.-- Date WATER HEATER WIVENT 4,00 WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 4.00 WORK 1;AS'CO,,MPFNSATlON DECLARATION 1 hereby affirtly, that I have a certificate of consent to sell -insure, or a certificate oP Workers' Compensation Insuran 'a er4ified copy tfier� 8f0,LabC-W PoIicy Ndg* ompany I Certified copy is hereby furnished. Ccrnf,'%d copy is "file the y ins t fi , I I wi th ty, Q, kecti, X% ,,,v ion, Applican CERTIFICATE Of EXEMPTION FROM WORKERS' I ZONING ENG. SITE NO, FIRE SPRINK E] No ENERGY T-24 I [] N REFER TO ORD� PERMIT ISSUANCE 6.00 FLOOD ZONE A. L. U.C, PLG.CONTR. LIC, NO, PLG ITOTAL 7UT7777 WIN 2171/1 1 11110, 7/a/1, 111 0 or ALTER OR ADD TO MECH. 4.00 COMPENSATION INSURANCE (This section need not be completed if tire 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 can la any person in any rnannerso as to become subject to the Workens'Compensation Laws of California. Date ICE TO AP____ . . .. .. ... PLICA....... AppNF� licant after making th........ . ... _ ------ ­E NOTif, is te of x_ YE] NE], Y ❑ N ❑ BUILDING APPLIANCE 4.00 PLAN CHECK eniption, you should become subject to the WorkerCertificas' Com pensa I ion provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10, WC.F.K) 3.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 5.00 C.ONSTRUCTION LENDING AGENCY SEISMIC FEE EXHAUST HOOD (WITH DUCT) 2,00 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.). Lender's Name. Lender's Add . . . ......... .. . .. ..... . - -- --------_------- - MICROFILM HEATING UNIT (TO 100,000 B.T,U.) 4.00 HEATING UNIT (OVER 100,000 B.T.UJ 7.50 ELECTRIC I 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 VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER - COMP (3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,000 ETUI SEE FEE SCH, MECHANICAL hereby authorize 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. I CupeNno against, liabilities, judgments, costs and e.pe 1- w u'll mantiay I flfy, Wa n cru - , gm . list said City in conseq nce the gr Of A' to ign lican t/C;n tractor CONST. TAX PERMIT ISSUANCE 3,00 MECH. CONT. LIC. NO. MECH TOTAL OFFWE COPY �w V � u r � k /�� (♦7 V„ v L �q, M ng 1��k Z W >1 w � f LAI v p O ll�/ x � N U Q W m �a LLI o � s 1 w _ ` s c a O c o O w v v a, -p o v _0 c 0 O 0 O Q Z = Z Z CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO ��' �'bATE 19 BLDG� RMIT NO. E z THE BLDG, LOCATED AT o N OWNED BY x ;ICOMPLETEE21 .; HAS BEEN �.,._ ��� FOR USE AS e o r �ALTERED� O " y c \ F � ya, N a n � � M ,I BUILDiNOINPTCR