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3700, 6229, 6066-FCITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) } PEWITO. ADDRESS LOT VO—. OWNERPTMEcT PERMIT ISSUED DATE ELECTRICAL DATE INSP' guilding lectxi.ca PREing Power Pole Mechanical rgroun Temp as ec RouZh Wiring I Gas X111 re vet. eat Dept. Buildin - ei DATE I INSP. Pad Certification Foundation k e re- unite r„ M llIa nrams eismec Bracing Walls R. Frame o - I at _ _ oars Int/Ext. :lrewa s t er Not Approved fixtures l otors rounding e Power of i)rov PLUMBING Backflow DATE. INSP. ELECTRICAL DATE INSP. Underfloor S.M. Ducts & Insulation Fire Dampers iren ace One Hour Shaft Condensate Drain Equi ment Anc ora e Flues & Com . Air Ot er Not Approve `7-l5�8'5 BUILDING ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS i 9B 0 z 2 CC 10 UJ > 0 z 0 LL 0 CL z A APPLIGAN-( TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUI LDI N43 PROJECT I DENITI FICATIQ�N APPLICATION & PERMIT ADDRESS L0LDING — ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER 3700 OWNER'S •PLAN NAME E. Mrgen' Developmnt,,L287-5721 CHECK VALIDATION PAID APR 18 1984 Ow of culmirtino F APPLICATION CONTRACTOR'S NAME NO. OUTLETS SWITCHES RECF-P 5�00/1.00 LIGHTING FIXTURES 5.00/1.00 rONTRZ_TORS ADDRESS 625 McGlitcy, Can-pbellNE 371-2717 APPLIANCES -RESIDENTIAL 4.00 PANELS 5.00 ARCHITECT OR WKIns F, iigineers LIC. No. C 18632 6. SIGNS 00 PLAN CHECK FEE F P.C. NO. SIGNS TRANS. 3.00 ARCH -OR ENG. ADDRESS i 501 S. Ba�copl, San Jose z, 95U8 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 The . daWda, San Jose 95126 LICENSED CONTRACTORS DECLARATION I hereby affirm ;that I am licensed tinder provisions of Chapter 9 (commencing withi Section 7000) of Division 3 of the Business and Professions 4dend my license is in full fore— I jrc License C1 Lie. Number Date -1-7 4 �_Contractor ISSUANCE DATE B D ELECT, PLG. MECH. F_J 7-771 MN I �N OER-BIJILDER DECLARATION I hereby affirm !that I am exempt from the Contractor's License Law for the following reason, (Sec. 7031 S. Business and Professions Code: Any city orlcountymhich requiresa permit toconSITUct. after, improve, demofish or rep4ir any structure, prior to its issuance. also requires the apoli I n I f h permit I to file a signed statement that 'IOr Site' he is licensed p4 ant lathe provisions of the Contractor's License Law (Chapter titcommencing with Section 7000) ol Division 3 ofthe Business and Professions (,,'ode) or that he is exempt therefrom and the basis for the aleged exemption. Any violation of Section 7031 5 by any applicant for a permit subjects $5 applicant to a civil penalty of not more than hive hundred dollars ($500).): MISC, REFER TO ORD PERMIT ISSUANCE 600 . VALUAT I ON $/FT, ELEC. CONTR, LIC, NO, TOTAL —PERMIT TO -7777777-77 7 777 -- ALTER -DRAIN & VENT -WATER (EA,) 4.00 STPRIES TYPE CONSTR. 0 1, as owner f f the property, or my employees with wages as their sole compentiation, will do the work, and 111C SIVACtUre is not BACK FLOW PROTECT, DEVICE 2.00 OCC. GROUP RES- UNITS DRAINS -FLOOR, ROOF, AREA, COND. 4.00 intended or offer4d 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 employees. provided that such improve - merits are not inteInded or offered for sale, It, however, the building FIXTURES - PER TRAP 4.00 SO. IFTIFLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - I INC, 4 OUTLETS 4.00 of "m rovernent i4l, sold within one year of completion, the owner- improvement k w m- builder will have e burden of proving that he did not build or im- prov Zpro for purpose C4 f sale,j; I , as owner fthe property, arn exclusively contracting with R.s'd contract�11, to eonstrUct the project (Sec. 7044, Business all dProfessaonsC c: The Contractor's License Law does not apply to an owner of timperty who builds or improves thereon, and who - EA. SYSTEM - OVER 4 (EA.) GAS 1.00 BUILDING USE IND CON PB Other 0 0 0 0 INDUSTRIAL WASTE IN . TER. 20.00 .- LAWN SPRINKLERS - 1 INC 5 V.8. 5,00 ASSESSORS PARCEL N 3i & LAWN SPRINKLERS -OVER 5 (EA.) im contracts for such project , s with a contractor(s) licensed Pursuant to the Contractor's L cerise 1 a. Cl I am exemp undersec. BAP.C, fox t is reason-,-, ...... ..... . ....... . .. .... ... ......... . . . ..... SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO. PARCEL NO, WATER HEATER W/VENT 4.00 Date— J - ------ __.Owner WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 4.00 WORK F.'�S'COMPTNSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate,ol'Workers' Compensation Insurance, or a certified copy there f Sec 1 Po Jjr ZONING ENG, SITE NO. FIRE SPRINK y f -I N [-I ENERGY T-24 Y E] NF Certified co y is he'reby furnished. " co 0 Certifie , py is ;filed with the city inspection division, Appli �a 2, MISC. REFER TO ORD. PERMIT ISSUANCE 6.00 FLOOD ZONE ❑ N A. L. U,C. Y 7 N7 C1E'tRTIF1 OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section heed I not be completed if the permit is for one PLG. CONTR. LIC. NO. TOTALY BUILDING r" hundred dollars, (%l 00) or less.) I Certify that m the performance of the work for which this mper- mit is issued, I shall not employ any person in any manner as to become subject -the Woskers'Compensation Laws ofCafil'urnia, Date_._ I .- pplicant ------- NOTICE, TO A IC T: if, after making this Certificate of Ex- APPLIANCE 4.00 PLAN CHECK emption, you shin Id become subject to the Workers' Compensation provisions of the Labor Code, you must Forthwith comply with Such provisions or this pLanit shall be deemed revoked, FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 100 AIR HANDLING UNIT(OVER 10SWC.F.M.) 5.00 SEISMIC FEE S CO. STRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM 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 I Lender's Name nefer's Addrv4s,m HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATING UNIT (OV ER 100,000 B.T,U.)T50 " --", ELECTRIC I ecriify that I have read this application and state that the above information is correct. I agree to comply with All city and County ordinances arid state laws'relating to building construction, and hereby authorizelrepregentatives of this city to enter upon the 4boye-mentioned property for inspection purposes. VENTILATION FAN (SINGLE) 3.00 PLUMBING 8011-ER-COMP(3H.P.orlOQ,000B.T.U.) 4.00 BOILER -COMP (over 100,000 BTU) SEE FEE SCH, MECHANICAL MISC.. REFER TO ORD. CONST. TAX (We) agree ti save, iqdernnify and keep harmless the City of Copertuto agains0liabilities, judgments, costs and expenses which may in any wuyaaccryt,a said City in consequence of the gra f thl q11 7, /R,4 mat of 11va n itract Dafe Fva n PERMIT ISSUANCE 3.00 MECH. CONT. LIC, NO, I'MECH. TOTAL,:/, 77,77-7 Till," j 10/11" 7 OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING —ELECTRICAL PLUMBING — MECHANICAL PERMIT NUMBER 6229 U .17 I ADDREES OlNNER1 NAME 014e P'ONE:47 -572-1 77 177 MT 's. ars 0 16 -SWITCHES - RECEP 5.00/1-00 PLAN CHECK VALIDATION CO RA HISJTLETS NAW AVO�% LIC NOSS DATE OF APPLICATION LIGHTING FIXTURES 5.00/1.00 (-,OWTRACTOR,S .oN,,717 JV,A&Z APPLIANCES - RESIDENTIAL 4.00 PANELS 5�00 — ARCHITECT 0A CNGINEER LIC NO SIGNS 6.00 PLAN CHECK FEE I P.C. NO - SIGNS TRANS. 3.00 ARCH, OR ENG ADDRESS SPECIAL CIRCUIT 5.(l0 PERMIT VALIDATION TEMP. METER OR POLE INS. 15.00 ZIP APPUCANT'S ADDRESS MOTORS SEE FEE SCH, SERVICE CHANGE 10.00 LIC!",MI'D CONTRACTORS DECLARATION I hereby affirm� that I am licensed under provisions of Chapter 9 (coninivricing with Section 7000) of Division 3 of the Business and Pr fessi C I d y1wenti, I n full forc,, o 0 011, 0104, 11" ,� a&% Lie '0 License C, �$_ ��_ ISSUANCE DATE BLDG. ELECT- I PLG,JMECH. EJ Contractor!�W*i OWNER -BUILDER DECLARATION Misc. REFER TO ORD I hereby affirar that I pin exempt fromthe Contractor's License Law for the following reason. (See, 7031.5. Business and Professions Code: Any city Pecounty, which requires a permit to construct, alter, improve, demofir%ji, or repair any structure, prior to its issuance, also aoqufires the apphoAnt forsuch permit to file a signed statement that he is licensed pursuant to, the provisions of the Contractor's License Law (Chapter 9 (commerrenig with Section 7000) of Division 3 of tae Business and Professions Code) or that he is exempt therefrom and the basis for the alleged Q*erription. Any violation ol"Section 7031,5 by any applicant An- a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): PERMIT ISSUANCE 6.00 VALUATION $/FT. I ELEC. CONTR. LIC. NO. TOTAL ErIgggin ass 71, ALTER -DRAIN VENT -W PERMIT TO STORIES TYPE CONSTR, 1, as owrI the property, or my employees with wages, as their Sol � 1 1 Chere compentation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 4,00 — intended or offemd for $Ole (See, 7044, Business and Professions Code: The Contri,etor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or throrig ,� his own employees, provided that such improve- ments are not 4-ft0nded or, offored for sale. If however, the building or improvement is sold within one year of completion, the owner - builder will have, file burden of proving that he did not build or im- prove for purposciot'sale.), ne of rty, am exclusively contracting with U 1, as ow r! thepropL FIXTURES, PER TRAP 4.00" "`y^ "'Sa FT. FLOOR AREAJ TOTAL ACREAGE GAS - EA. SYSTEM - 1 INC. 4 OUTLETS 4.00 GAS - EA. SYSTEM- OVER 4 (EA.) 1.00 BUILDING USE RES IND CON PB Other 0 0 0 0 0 INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 S-__ ASSESSORS PARCEL NO. h,,n.1 conli-aelli-, to ,,n.,,,,,c, h, project See, 1044, Business : ,5,joflS ('ode Th. License cense Law does not apply and Pr _ ole s to all owner of property who builds or improves thereon, and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contrac's "(,,jects will, a eontractons) licensed pursuant to thc SEWER -SANITARY-STORM EA. 20OW8.00 TRACT NO. PARCEL NO. IamexcmJ=ndcrSec_,.___.....T ..--.-- ,B,&P,C. for this reason. ACC,DATE ACC, FILE NO, WATER HEATER W/VENT 4.00 '76 (?weer . .... ... ..... .. ....... . . .. Date WOUF,ks,com PENSATION DECLARATION WATER SYSTEM 4.00 c WATER TREATING EQUIP; PAIT- 4.00 I hereby affirm! that I liavc a certificate of Qonscrit to self -insure, or a certificate oti Workers' Compells t, I ncc, or a certified (:op Ihcrcofl$ec,�3800,11, C 'or nsou, Poll" NO_C u1 17 i I by furnished 10 UO2-0 inspection rvision. Applic - i"fQ I i—tir-19 ZONING ENG. SITE NO, FIRE SPRINK YEJ NE] ENERGY T-24 Y [] NE] MISC. - PERMIT ISSUANCE 6,00 CERJLFJ(',,NTF OF EXEMPTION FROM WORKERS' MPf',NSATJON INSURANCE (This section need not he Qompluted if the permit is for one hu 1drQd dollars (S 100) or, less) rtify that ul the pbrforinaricc of the work for which this per- it h4ll not employ any person ill Oily manner so as, to m is issued, I s become Subject lei the IWOrkers' Coin pensat ion Laws of California. Date -, , ­­ L-Appircant _ . . ..... .. ...... _. NOTIct, TO APPLICANT: If, after making this Certificate of Fx- eruption, You 410 Ict bec6mc subject to file Work Qrs'Coin pensat ion provisions of thell Labor� Code. you must forthwith comply with such provisions or'this rerjuit shall be deemed revoked, FLOOD ZONE Yo N A.L.U.C. YE] N PLG. CONTR, LIC. NO, PL_ TOTAL F '7, _71 _47 7 5 7g r7ggl 77 s g 711001UT1113' 1. 12M, q",/w,�'m W, ALTER OR ADD TO M .0 BUILDING APPLIANCE . . . . . . . . . . . . . 4.00 PLAN CHECK FEE AIR HANDLING UNIT,{ 4 3,00 4r,,I0'0'C. AIR HANDLING UNITt(idVEA 16JAdA IM) 5.00 SEISMIC FEE CQNSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of tile Work for which this permit is issued (Sac. 3097, Civ,C,), EXHAUST HOOD (WIT P,DW9T) rd"kA2,00 MICROFILM fi HEATING UNIT (TOs1b6,6b04` �6.) 4.00 H EATING UNIT (OVER 100,000 B.T.UJ7.50 ELECTRIC Lender's I certify that I �iavt� read this appBeeston and state that the above information is correct. I agrec 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 BTU) SEE FEE SCH. MECHANICAL Z-0 livreby an I Innize, representatives of this city to enter upot; file above-montioned property for inspection purposes, Misc.- REFER TO ORD. . CONST. TAX (We) agree to ,save, ifidemnify and keep harmless the City of Cupertino agamstliabilities, judgments, costs and expenses w ... cu y W11, ;accrue against said City in consocluence of the gran is 0 1 pa.MA a re tract PERMIT ISSUANCE 3.00 MECH. CONT, LIC, NO, MECH. TOTAL APY`�. CANT TO FILL IN INFORMATION��lLRED LINES - USE BALL POINT PEN ONLY BUI LCIING PROJECT I DENTI FICATION PLICATION &PERMIT G ELECTRICAL PLUMBING MECHANICAL6066 PERMIT NUMBER BUILbtfqc,, AD WNEFS01111011111 NAME PHONE //� MINE' OUTLETS RECEP 5.00/1.00 PLAN CHECK VALIDATION DATE OF APPLICATION aONraacroRs 'Ird' ,„LIC. NO. C �� GHT NG F FIXTURES RAcroa s r.ONT ' yypp�� S �" „ A d.1 PHONE w„ „, AF NTIL 4.00 APPLIANCES - RESIDENTIAL PANELS 5.00 ARCHITECT OR ENGINEER E,. ✓', uc.No.„.cw��, SIGNS 07.00 PLAN CHECK FEE F,C, NO. SIGNS TRANS. 3.00 _ ARCH. OR ENC, AnoaEss � „ vm Z.I SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 15.00 APPLICANT'S A RES ✓ mm aCAM/" to MOTORS SEE FEE SCH, SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION I hereby affirm' --that I Sul licensed under provisions of Chapter 9 (commencing w'il Section 7000) of Division 3 of the Business and Professions Coe),(p , all license is cell err, � c � License Clan Lic. Numbcrt"� d '...� ,.__ Dafe_ .. _ _ -Contractor ISSUANCE DATE BLDG. ❑ EL CT PLG. MECH. El �q� W , OWNFR BUILDER DECLARATION 1 hereby affirm; that I am exempt from the Contmctor'sLicense Law for the foillowing reason (Sec, 7031 5, Businessand Professions (:ode. An cit or,count which re tires i permit to construed alter, Y Y Y q P improve,demafssld, or repNiS eny xtruc't t+re prior to Its Issuance, also requires the applidant forsuch permit to file a signed statcdntnt that he is fuensed pursuant to,the provisions of the Contractor's License Law (Chapter e) (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 esernption. Any violation o(Section 7031 5 MISC. - �y ORD PERMIT ISSUANCE 6'00 '"� VALUATION$/fl"il�i T, .LEC. DN7R- LIC NO G ELEC. '", "�-'�, ..,3,� TOTALf'), ,�/ , I ri�� %� ii/,�! ,,;",,, , , ; �„ ,,,% ,�, , „ ; !;-'„,pi� i,' E MI T TO STO ES E CONSTR by any applicant, for a pci)nit subjects the applicant to civil penalty of not more than five hundred dollars (5500).): _ _ „ ALTER -DRAIN &VENT -WATER (EA.) 4-00 l� I as ownWof the property, or my employees with wages as their sale compenisation, will do the work, and the structure is not intended or offer�,d for sale (Sec. 7044, Business and Professions ner s not apply to an or's License Law e: The property wfro hiar)ds or huprovw thereon, ,and who does such work hunsertylf t h ll ds o owe em es, thereon, parand that es s improve- wef menta are not inkended or offered for sale, It, however, the building ments or improvement I� sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- proveforpurpose-ofsale.). 1.-)I, as owner,of the property,w exclusively contracting write BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND, 4.00 FIXTURES - PER TRAP 4.00 SOL FT. FLOOR AREA "TOTAL ACREAGE GAS - EA. SYSTEM - 1 INC. 4 OUTLETS 4.00 GAS - EA. SYSTEM - OVER 4 (EA.) 1.00ye) BUIL©ING USE - ND CON PB Other ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 licemaed contractors to construct the project (Sec. 7044, Business and Professions Crc)de 1 hei Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 he ocontracts for such cerin e(s with a contractor(s) licensed pursuant to the Contractors Euccnsu (Law. SEWER -SANITARY -STORM EA, 200ft/8.00 TRACT NO.. PARCEL. NO, A Iamexerni#undef-Sec .. ,_.__._. _. .__..._.__,B.&P.C'.forthis reason. WATER HEATER W/VENT 4.00 --- --_- Owner Y _ _- Date WATER SYSTEM 4.00 ACC. DATE ACs. RILE NO. WATER TREATING EQUIP. 4.00 WORKE),Rs (OMPFNSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate uf,Workers'' Compensation Insurance, or a„certified ZONING ENG. SITE NO. o`Y ttN f C�n j bty.dd°f"C Policy _..__.- FIRE SPRINK Y ❑ N❑ ENERGY T-24 Y ❑ N❑ Ca <'ertitiedeavpy is hc�;reby furnished. �. ietlOn dIV lClon. IY Y 1 ApplicranttlP�d is city MISC. REFER TO ORD. PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u.C. CERTIF"ICATF.OF EXEMPTION FROM WORKERS, PLG. CONTR. Ltc. NO. PLG, TOTAL /i//tcertify l %�,i/p% /� /��� %i i'�„iii�� �/�1/m/0-No %/�//�l Libecol //„ ,,, „ /// 0, // 0//,.,,,/ / ALTER OR ADD TO MECH. 4.00 COMPENSATION INSURANCE (This section Aced next be completed if the permit is for one hundred dollars ($100) or'le s.) at izf the perfo ante ofthe work for which this per- mit is inner [ YrFpl not pia any porn. any rrranner so as to�/, W kers' ° m e a alit"onus Apple -- NO "I Or A I ICA N '. after making this Certificate of E':x- empticru, you should bee .subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be. deemed revoked. Y N Y + N BUILDING APPLIANCE 4.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10i1MC.F.M.) 3.00 AIR HANDLING UNIT (OVER 10MC.F.M.) 5,00 SEISMIC FEE CW4STRUCTION LENDING AGENCY I hereby affirin Chat there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30)7, CivC'.). EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM HEATING UNIT (TO 100,000 B.T.0-) 4.00 HEATING UNIT (OVER 100„000 B.T.U.)7.50 ELECTRIC Lender's Name__ _ , Lenders Addre .r_. v_ I certify that I have read this application and state that the above inror,nation is cc0cct I agree to comply with all city and county errdi'lances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 3.00 B(7ILER-COMP(3 H.P. Or 100,000 B.T.U.) 4.00 PLUMBING BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize, representatives of this city to enter upon the above-mentwnu�a) irroperty for inspection purposes. We) agree to save, mdemnify and keep harmless the City of MISC. - REFER TO ORD. Cu rtino agairssf liabilities, judgments, costs and expenses which ma` in any w� ',accru9 against said City in cons�cluence of the lElrig t r ignature of Applicant/Contractor Da CONST. TAX PERMIT ISSUANCE 3.00 LIC. NO. MECR, CONT. TOTAL �j j0% / �Ef"'>� OFFNCE COPY /` \ CD CD .\ �- 0 0> 'XI Q, Q, > Q) /` \ CD CD .\ �- Q, Q) Q) > 0 0 Jk \ Q) � _2 -C Q) Q) -0 � \ \ \ ƒ0 0 < z }