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5570 CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO _/ p DATE �c3 in / 19YT BLDG, PERMIT NO. 3� oa THE BLDG, LOCATED AT /Z 0 �'�� ° ce-4'ST`� OWNED BY C f Ul tt E' _ —IA 2-cq 5�f 6 HA� BEEN ICO P ETEDI FOR USE AS / In (ALTERED) Ga �A- (Z( . ,F C P M B ILDING INSPECTOR �_t CITY 01' CUI'E1tTLIIO II1SPECTIOL' RECORD (Office "Copy) 1 3568 _ Lot 4, nldg. 6 20639 - 06 Celeste Circle PI:PtIIT ND. SANITARY DIST. NO. LOT N0. ADDRESS ---- Const. R Units DeAnza Properties PROJECT OWNER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL Ilu-ildinr _ Date Insp. I;l.ectrical Power Pole_ I'lumhinr LInder ,r.ound — -- ifechantcal P,ouhh Wiring 'Temp. Cas/Elect. (Talk _ Solar Ceiling Fire Sprinkler Fixtures Int/Ext Si .,n ifotors Grounding . Misc. Temp. Power _ Other FINAL INSPECTIONS Not Ap ruved Date I P. Electric _ PLUMBING Plumbin , Date insp. (j-L Backflow Mechanical Underground Solar Underfloor ----- Pno.l Partial Pouch p_ S • Grading Rough Complete 11 I-nnni ng Solar P.ough Fire Dept. S 0 , C /� Water & Insulation Health De t. 'fain Drain Building ( - - R/of/S Drain Other Gas Other _ BUILDING Not Approved Date Insp. Pad Certification HECIIANiCAL Poundati.on6t(J-C-(� Date Insp. $ 13$ Underfloor S.M. Slab-Ifembrane Ducts- & Insulation Bond Beam Eire Dampers Underfloor Girders -7- ' Fireplace yy _ floor Steel Grease Duct & hood ' Tiedowns One (lour Shaft Dlaphrams 0- Condensate Drain Seismic Bracinglquipment Anchorage' alts- Panels Flues & Comb. Air Frame Ih-1 Other Lath II �R Q Not Approved Wallboards Int/fixt. Firewalls pi,A., a n eY(C-ePt 6:,d Other Not Approved to of sll l sT 30 " z�(�(Ci �Y(iGCGv� A BUILDING • 8-._q1 4• ELECTRICAL PLUMBING • 11ECHANICAL MISCELLANEOUS APPOCANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY I�, ,j-• BUI LRI NO PROJECT I DENTI FICATIOG�ATION & PERMIT YERMI ER q aUILOING - 3568 Awl PES LDING,-ELECTRICAL-PLUMBING.-MECHANICAL O NER'8 PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE CONI q OR$ NAME ,^ OUTLETS-SWITCHES-RECEP 5.0017.00 SE Lr sec No. LIGHTING FIXTURES 5.00/1.00 ADDRESS oRs - APPLIANCES-RESIDENTIAL - 4.00 PHONE PANELS 5.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR SIGNS 6.00 /^�1. ENGI �/,( o. SIGNSdRANS. � 3.00- A H,OR E.G. @EVAL ON ADDRESS SPECIALCIRCUIT 5.00 / zm - EMP.METEROR'POLE INS. 15.00 / APPLICANT'$ MOTORS SEE FEE.SCH. ADDRESS Igo 7 04, SERVICE CHANGE 10.00 w 00 L ENSEU CONTRA(- ORS ECLARATIO sro eHj I hereby that 1 am licensed under provisions o(Chupter 9 w ISSUANCE DATE N < (commencing with Section 7000)of Division 3 of the Business and H i Professions Code.and my limnLECT. PLG. MECH. is i"(all force and effect. BLDG. -❑ ❑ ❑ CIO y O License Class Lie. n:Number - P H J Date-Cont...I., < BUILDING PERMIT w u OWNER-BUILDER DECLARA'f ION INFORMATION Fw;n _ 1 hereby'affirm That I am exempt from the Contractor's License MISC.- REFER TO ORD F u m j Ps Law for(he following reason.(Sec,7031.1.Business and Professions PERMIT ISSUANCE 6.00 VALUATION SIFT. m 2 Cafe:Any city or county which rcgmresa permit tDConStra h alter, E- re w> 1( ar to a o improve,Demolish.or repair any sD tore.prior W is ss ce,also ELEG CONTR. LIC. ELEC. DLL requires the applicant fur such permit to file a signed statement that TOTAL PERMIT TO A w$< he is licensed pursuant to the provisions out 700 Contractor's n License n r- > law(Chapter Provmoris Code)or Section is exempt therefrom the g/Agf�A18'7,r-`WY F 4 O Business and Professions Code)or thin he is exempt therefrom and OTV. PLUMBING PERMIT FEE _ T I- $ the basis for the alleged exemption,.Any violation of Section 7031.5. STORIES TYPE CONSTR. d ; oyonyapplicha for a vehudre dollars SSOO).he licammacivil penalty ALTER-DRAIN -WATER (EA.) 4.00 P of not more than live hundred dollars(15°01.): ❑ I.as owner of the properly,of my employees with wages as gpCK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation.offered forwill(S the work,and the structure is net Code:The offered for ole (Sec. 7611, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Cole:The Contractor's License Law does not apply to an owner of properly whobuilds or improves thereon,and who floes such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR R TOTAL40REAGIE merits re through his own employees.provided that r.t h iasprovo- orimpr inot mprovement oroffered e year arof If,however.the building GAS-EA.SVSTEM-l1NC.40UTLETS 4.00 or lder.111 base it sold within proven r of he did completion.the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE bunter will have the burden of proving that he Did of built ofim- RES [NO CON PB Olber Prov{1,as ownerose of sole.). INDUSTRIAL WASTE INTER. 20.00 I�s -0 C] E] E ' �f}��,1,as owner of the property,om exclmivcy contracting with li7 LJ I' eased Contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5V:B. 5.00 ASSESSOORRSS PARRCCEEEL NO, and Professions C.drgrope The honbuilds r imp u Law does Rat apply �a6-/V /I to tr owner of property who tia co m ioproves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 commas for Buell projects with a Canlmtlon sl lieensedpursuanl to _ the Contractor's Lic• st LAw. SEWER-SANITARY-STORM EA:200ft/8.00 TRACTN PA CEL NO. ❑ me empt p erSa 01� ,B. P.C.4o this WATER,HEATER W/VENT 4.00 - reaso Date t r WATER SYSTEM 4.00 ACC.DATE 'ACC.FILE NO. ORKERS'COMPENSATION DECLARATION WATERTREATING EQUIP. 4.00 I hereby affirm that I have a certificate of consent to self-insure, or a«rtificate of Workeri Compensation Insumnte,or a certifiedNING' ENG.SITE NO, copy thereof(Sec,3800,Lab.C.). ^ �1 Policy No. Company 0 ❑ Certified copy Is herebyfumisled. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. F- 0 Applicant MISC.- REFER TO ORD. y NE 'V NE]. CC CI:RTIFICAI'I'OF EXEMPTIONTRONI WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 1 (This section need not be completed if the permit is for He TOTAL V❑ N Z hundred dollars IS l UO)or less) U O 1"certify that in the performance of the work for which this per- OTY MECHANICAL.PERMIT FEE FEE SUMMAflV LL f mit is issued,I shall not employ any person in any numner so as to 0 0 become subject to the Workers'Compensation Laws of California: n Date Applicant ALTER OR ADD TO MECH. 4.00 I,- >_ m NOTICE TO APPLICANT: If.after making this Certificate DI'Ex- I- Z emption,you should become subject to the Workers'Compensation APPLIANCE 4:00 PLAN CHECK provisions M the Labor Code. you must forthwith comply with ' U such provisions or this permit shall be'deemed revoked. AIR HANDLING UNIT(TO 10,000C•F.M.) 3.00 EEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10SWC.EM.) 5.00 SEISMIC FEE 9 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the performance of the work for which this pennil is issued(Sec MICROFILM 3097,CiPC.L - HEATING UNIT(TO 100,000 B:T.U.) -000 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B1T.U.17.50 ELECTRIC, ' I mrlify,that I have read[Misapplication and state that the above VENTILATION FAN (SINGLE) 3.00 ® information s is stat t 1 agree to comply with all coy and county PLUMBING hereby es and stat laws rebating to is city construction.upon the BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 hereby entioed roperty for inspection ns of this city es Einer upon the BOILER-COMP (Over 100•°00 BTU)SEE.FEE SCH: above-mentioned property for inspecu a I purposes, MECHANICAL (We) agree to wve, indemnify ..,it keep harmless thc'City of MISC.- 'REFER TO ORD, Cupertino against liabilities,judgments, costs and ex Penses which CONST.TAX may in any way ce against aid City' in consequence of flit PERMIT ISSUANCE 3.00 - lin8 f this pe 't. _ _ MECH.CONT. LIC.NO. MECH. TOTAL TOTAL J !9 Si 'lure of Applic:mt/Contractor Dau• OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY - BUILDINGPROJECTIDENTIFICATI N PERMIT NUMBER. IRALOING - APPLICATION & PERMIT 1 Jr VJ nncss 1 V C n 1 6 Ce ZaC'_ A. BUILDING'—ELECTRICAL—PLUMBING—MECHANICAL OwNER'S PLAN CHECK VALIDATION • rME OTY- ELECTRICPERMIT FEE p PHorvE CONTRACTOR S .AMEp /� UTLETS-SWITCHES-RECEP 5.00/1.00 &1014 —at FkT' Luc No u•� 7b LIGHTING FIXTURES 5.00/1.00 CONTRACTORS U IPPLIANCES-RESIDENTIAL 4.00 AO RE55 /^1 O _ 1!'1t (ate PHONE 370`S/ PANELS 5.00 DATE OF.APPLICATION ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO. ,OR ENGINEER Lmc.xo. SIGNS TRANS. 3.00 ADOREsi ENG. - SPECIAL CIRCUIT '5,00 - PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 15.00 (' APPLICANT'S DMOTORS SEE FEE'SCH, J ORES^ SERVICE CHANGE 10.00 D O o LICENSED CONTRACTORS DECLARATION ZU I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE. a e (commencing with Section 7000)of Division 3 of the Business and - SLOG. ELECT.I PLG. MECH. f i Professions C-ode,.and my license is in full fo e'nc f jc G o.o License CI s �Lov+'p'�—Lia Number S F y r j Dalc�t—p�_Conirac Wr ` a ys LNJ BUILDING PERMIT s O>� OWNIi R-BUILDER UIiCLARA'fION INFORMATION X ; r I hereby affirm that I con exempt from the Contractors License MISC.— REFER TO OR F u o a Law for the following reason.(See.7031.5,Businessand Professions PERMIT ISSUANCE 6 VALUATION S/FT. m j Code Any city or county which mquama permit to construct,alter. 2 ¢a improve.demolish,ar repass any st met om,prior to its Issuance,also CLEC.CONTR. UC.NO. ELEC. a iL m u mgmres the applicant for such permit to 111ep signed statement that TOTAL PERMIT P T z he is licensed pursuant to the provisions of the Contractor's License �` a Lo (Chapter 9(commencing with Section 7000)of Dl msion3 ofthe +-( EE O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE M r$ the haus for the alleged ext mpliou.Any violation affection 703 L5 STORIES TYPE CONSTR. by anyapplivani for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00 of not mom,than'five hundred dollars(S500).1: ❑ 1,is owner of the properly,.or my employees with wages as BACK FLOW PROTECT.DEVICE their sole compcnalion,will do the work,and Mi,structure is not T•00 OCC.GROUP RES.UNITS intended or offcmd for ale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO: 4.00 Code:The Contractor's License Law docs not apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 M.FT FLOOR AREA TOTALACREAGE • himself or through his own employees,provided(hat such improve- Tentsarenotintendedoroffered.for sale.I L however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4,00 or improvement is wild within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 7,00 BUILDING USE builder will have the burden of pmving that he did not build or ice- REB IND SON PB Omar prove for purpose of ale.). INDUSTRIAL WASTE INTER. 2000 ❑ 1,as owner.1 the property,am exclusively contracting wills . E3 ❑ `l 0 ❑. licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.. and Prol'essinns Code:The Conlnctor.i License Law does not apply 10 an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 contracts I'or such projects with a contractors)licensed pursuant to the COmrbcwn's License Law. SEWER-SANITARY-STORM EA.200ft/8:00 TRACT NO. PARCEL NO.. ❑ 'I am exempt under Sec. ,B.&.P.C.liu this rea on WATER HEATER W/VENT 4,00 Owner Dale WATER SYSTEM 4.00 ACC.DATE ACL.FILE NO. WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby off un that I have a certificate of consent to svl6insure, ar a certificate of W'orkeri Compenalian Insurance,or a verified ZONING ENG.SITE NO. copy thriem(Sec.3800.LAC.). / , �i E Policy No. 6,/66, Companyv i L•p� O Con ified copy is hereby furnished Z Z 'crtifiS 4�opY yy led with the ciryinspection division. FIRE SPRINK ENE RGY T-24 � O Applicantilf4Nt--a+• MISC.- REFER TO ORD. YQ N❑ Y ❑ N� C 1:R'I'I FICAI'1:OF EXE M FIRON 1:ROM WOR K 1:KS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.U.C. LLI 1 COMPENSATION INSURANCE PLG.CONTR. UC.NO. PLG CL O (This section need not be. completed if the permit is for one TOTAL Y NE] Y❑ NE] ::) Z hundred dollars(S 100)or less) U O 1 cert i I y Ihar in the performance of the work for which III is per. DTV MECHANICAL PERMIT FEE FEE SUMMARY UL U mil is issued,I shall not enmploy any prem in any manner so as to , become subject to the Workers'Compensation Laws of California. CL Date ApplicantALTER OR ADD TO MECH. p q,0p - BUILDING } m NOTICE TO APPLICANT: IL at making this Certificale of F:a- f.— Z_ emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code,.you must forthwith comply with all tV such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT 1T O 'FEE CONSTR UCTION LENDING:AGENCY AIR HANDLING UNIT(OVER l0A110C.F,M) 5-00 SEISMIC FEE I hereby affirm Ilmt them is a construction lending agency for ar EXHAUST HOOD(WI Q(tj� h the performance of the work for which his sonoitis issued ISec. MICROFILM 3097,Civ C.1. HEATING UNIT(TO 100,000B:T.U.) 4.00 ,3'( Lender's Name Lender's Address HEATI NG UNIT(OVER 100,000 B.T.UJ7.50 ELECTRIC I certify that 1 have mad this application and state that the above VENTILATION FAN(SINGLE) 3.00 - int' ton is correct. 1 agree to comply with all city and county' PLUMBING ordmanoes and slate laws relating to building construction. and BOILER-OONP I3 H.P.or 100,000 B-T.U.) 4.00 hereby authorize mraresenlalives of this city to enter upon the BOILER-COMP IOva1-10p,000 BTUI SEE FEE SCE. t abom-mentioned properly for inspectionpurposes. MECHANICAL (We) agree to cove, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments,costs and expenses which May in any way accrue against aid City in.consepuence of the PERMIT-ISSUANCE 3.00 CONST.TAX R Ing of this pe I MECH:CONT.. '-LIC.NO. MECH. t/f/J/L�' // aa..�Z't'L' TOTAL _sc. TOTAL Slgrma"tum of nl/Contnclor Uate 7- OFFICE"COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER gmO LRG 'APPLICATION'& PERMIT AnDREss BUILDING —ELECTRICAL—PLUMBING—MECHANICAL 5796' OwNER'S b - PLAN CHECK VALIDATION "' A♦ O4&ii'J OTY. ELECTRIC PERMIT FEE - ' 1. PHONE - NAME T0H UTLETS-SWITCHES-RECEP 5.00/1,00 uC.EHO LIGHTING FIXTURES 5.00/1.00 CONTRA ArmleACTORs PPLIANCES-RESIDENTIAL. 4.00 ' HONE 2- PANELS 5.00 DAT E OF APPLE CAT ION ARRCHITECT SIGNS 6.00PLAN CHECK FEE P.C..NO. ENGINEER LOC.No. SIGNS TRANS. 3.00 AARCH,OR DDRESS ENG. - SPECIAL CIRCUIT 5.00 .PERMIT VALIDATION nv rrEMP.METER OR POLE INS. 15.00 APPLICANT'SDDRESS AMOTORS , SEE FEE SCR: SERVICE CHANGE 10.00 - 0 W z Foo LICENSED CONTRACTORS DECLARATION F i 6 I hereby affirm[fiat l am licensed under provisions of Chirpier 9 IBSUANCE O/ATE' a (tom mencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F D i professions Code nd m lirenst is in full fo«e '70 1:1 El O N�0 Data ttlas� Lic.Number - F D Data— SS Conlmctur BUILDINGPERMIT M a m u OWNER-Nl/1LUHR DELLA RA'f10N INFORMATION w ;LL F I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD F u o j Law for the Following reason.(Sec.7031.5.B.,amassind Professions PERMIT ISSUANCE VALUATION SIFT. w0 Code:Any city or county which requiresa pemrit leconstmct.alter, 6.00 a �.¢p improve.demolish.or repair any stnm[ure:prior In its is also ELECT CONTR. LIC.NO. ELEC. g e u requires the applicant for such permit to file a Tigre[statement lh3n TOTAL PERMIT TO n w as he is licensed pursuant to the provisions of the Contractors License Fit Law(Chapter 9(commcncingwinh Section 7000)ofDivision 3 ofthe Pt U/ BiNp 4 o Business and Professions Code)or that he is c,o mpt therefrom and OTY. PLUMBING PERMIT FEE a'I- o the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. n ;m by anyappticant fora permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 of nut more then ftvc hundred dollars(S5OG.): ❑ I.as owner of[he.property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation•will do the work,and the structure is not intended or offered for sale (Sea 7004, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4:00 asj Code:Tile Contractor's Licenx Law does not apply'to un owner ofac property who builds lir improves thereon,and who does such work FIXTURES-PER TRAP 4.00 50.FT:FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such Lmprova- memsamnet intended or offered for sale.IL however,the building GAS-EA.SVSTEM-I 4.00 , or improvement is,sold within uric)year of completion,the owner- GAS-EA.SYSTEM-OVE 7.p0 BUILDING USE builder will have the burden of proving that he did not build or am- RES IND .CON PB Omry prove for purpose of the property, INDUSTRIAL WASTE INT 20.00 O d as owner of to const arty,am exclusively commcl ing with licensed coionsctod to construct the project(Sec. 7004,Business LAWN SPRINKLERS- 1 C' V.B. 00'. ASSESSORS PARCEL NO. and Professions Code 1'hc Contractor's I.ICCnSe Law does rofapply to an owner of property who builds or improves thereon.and who LAWNS'R:N KLERS R IEA. 1.Op - contracts for such projects with a contractonsl licensed pursuant I. Dlc Contractor's License Law. SEWER.SANITARY•ST M .2002/6.00 � TRACT NO. PARCEL NO. ❑ 1 am ckevtps under Sec._,B&P.C.for;this WATER'�HEATER W/ .00 mason Owner Date WATER SYSTEM 4.00 A16 _ ACC DATE ACC.FILE NO. WORK ERS'COMPF.NSAT'ION DECLARATION WATER TREATING EQUIP. 4.00 I hereby uftirml I have acertific to ofconsent to%elf-insure, or a certificate of Workers'Compensation.Insurance.or s certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Leb.C). a Policy No. Company—//-//ffJYI t{,,♦'+��— O ❑ Cerlitiedcopyiihc«by,lurnls(«d. �/' ej1f1U6j6 FIRE SPRINK ENERGY.L24 Z Z ❑ Certili• copy p- fled Ih In c'y iiispeCLlop divisor. O Applicam_�P�/ q_Z/—�t'-I,.�t.(.�rr antes MISC.- REFER TO ORD, Y El rr� r �. NE] CCT CERTIFICATEor(EXEMPTION FROM WORKIi PERMIT ISSUANCE 6.00 t0 FLOODZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. OL O I'I'his uctidn'need not be completed if the Permit is for one TOTALO`ZS Y.❑ 'N❑ Y❑ NQ' Z hundred dollars IS 100)on'tess.) U O 1 cenffy that in the peifirmo mce of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is Tuned.I shall not employ any person in any manner m as to - hecorne subject to the Workers'Compensation Laws of California. U., Daly ApplicamALTER OR ADD TO MECH. q;00 'BUILDING } W NOTICE TO APPLICANT: If;after„making this Ccrtificme til Ex- t.. ? caption.you should Become subject to the Worktrs Compensation APPLIANCE '4.00 PLAN CHECK provisions of the Labor Code, ydu must forthwith comply with U imh provisions or this permit shall be Aeeatd«yoked. AIR HANDLING UNIT ITO'10MC.F.II 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10A00C.RM.) 5.00 SEISMIC,FEE I locrehy from that there is a mastruction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 tile performance of the walk for which this purmit is issued,(Sce, MICROFILM 3097,Civ.C.1. HEATING UNIT ITO 100,000 B.T.U.) Cool, Lender's Name Lcndch Address HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC I verfily.that I have read this application and state that the above VENTILATION FAN(SINGLE) 3.00 inf(,Zaii,In is coo« 1 1 ogrec to amply with all city and county 'PLUMBING p2� ommarecs aad tate laws relating.to building construction,.and BOILER-COMM(3 H.Ro*100,000B.T.U.) 4.00 lir by authorize «mnsemative4 of this city to cater upon the above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. 'MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.'- REFER TO ORD_. Cupertino ligation liabilities,judgmtnts,costs and expenses which CONST.TAX may in'any w accrue against soiA•City in consequence of the PERMIT ISSUANCE 8,00 Br Ihl "an MECH.CONT. LIC.NO. MECH. . s �1 t� TOTAL TOTAL Signature of Apphcant)Cmrtamor Ua« , OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LD1 NG PROJECT IDENTIFICATION PERMIT.NUMBER BUILDING APPLICATION &PERMIT 0 ADDRESS ' -Z0t� v vrir BUILDING—ELECTRICA C—PLUMBING—MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME —72Z�gr-1414 LJ4Lf QTY. ELECTRIC PERMIT FEE• �ly. PHONE — PAJ4Y CONTR,xCiOR'S NAME OUTLETS G5.00/1.00 IVZ41313 AUG I Lm.No. LIGHTING FIXTURES 5.00(1.00 � - AUV CON7RAcrOns - PPLIANCES-RESI DENTIAL 4.00 19841 ADDRESS •� /1� �� S� PHON�7�G�� PANELS 5.00 oX{EzopRb ORRCH(TECT . SIGNS' 6.00 PLAN CHECK FEE P. .NO. 4NGINEER tic No. SIGNS TRANS. 3.00 noon'Ess ENG' - SPECIALCIRCUIT '5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 15.00 bilk APPucANra AO LICAN MOTORS SEE FEE SCH. M ) SERVICE CHANGE 10.00 ww OR o LICENSED CONTRACTS DECLA A'f10N FP w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE ¢ (commencing with Section 7000)of Division 3 of the Business and w Ay, BLDG. EAE T.. PLG. MECH. r y Professions C a licenv is in full row and effect Z D,�- License ClussLic.Numbed 3 1 oN D Date_Q_— Contactor ¢ y 4 J a a s OWNER-BUILDER DECLARATION B ILDIRM PERMIT ap w u - INFORMATION. as ss it a N I hereby slim irm that I am exempt from the Contractor's License MIS0.— REFER;TO ORD ' - H ww j Law for rhe following reason.(Sec.7031.5,Btomessand Professions PERMIT ISSUANCE 6 — VALUATtON $/FT. > Code.Any 61yorcounty which requires a permit tocceslruct;alter, - a.¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC: c O LL requires the applicant for such permit l0 File asigned statement that. �/ / TOTAL O Z P W�y he is licensed pursuant to the provisions of the Contractor's License, RMITTO } z Q La..(Chapter 9(commencing with Section 7000)of Division 3 ofthe i D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE', st $ the buts for the alleged cxemplion.Any violation of Section 7031.5. STORIES TYPE CONSTR. a g ,- by any applicant for a Permit subjects the applicant to a civil penally of not more than Five hundred dollars 155001): ALTER-DRAIN'&VENT-WATER (EA.) 4.00 ❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC. their sale compensation,will do the work,and the in ruclure is not GROUP RES.UNrtS. intended or offered for sale See, 7044, Business and Professions DRAINS-FL.00R,ROOF,AREA,COND.�4.00 Code:The Contractors License Law does not apply to an owner of Properly who builds or improves thereon.and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- memsarcnotintendedmmi'madlorSale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or improvement is Sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1,00 BUILDING USE builder will have the burden of proving that he did not build or,im- Prove for purpose nfsale). E INDCON PB 'Other ❑ I.as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ licensed contractors to construct the project ISec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.8. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractors Lt...Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 ¢oNra is Im such projects with it consactoirO licensed pursuant to the Contractor%License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,BAP.C.for this reawn WATER HEATER W/VENT 4,00 Owner Date WATER SYSTEM 4.00 - ACC.BATE ACC.FILE NO. WORKF.RS'COMPI'NSAI'ION.DECLARATION WATER TREATING EQUIP, 4.00 I hereby alfrm that I have a certificalcofcunsenl.toself-insum. or a cerlilicle ol"Workers'Cnmpcnsation Insurance,or a certified. ZONING ENG:SITE NO: copy thereof(Sec.3000,Lab.0) �(d_4 II/if l Policy No. Company (1-� _ 0 ❑ Ccrtilied copy,is hereby furnished. - .FIRE SPRINK ENERGY T-24 Z Z ❑ Certified co s fjed with the city inspection division. FO Appieant 'S ��u MISC.- REFER TO ORD. Y❑ N❑ v❑ N CC T CERI'IFICATF.OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. LU > . COMPENSATION INSURANCE PLG,CONTR. LIC.NO; PLG: CIL Q Ihis Section.need not be completed if the permit is for one TOTAL Y❑ N❑' Y N❑ Z hundred dollars IS l W)or,less.) U O 1 certify that in the performance of the work for which this Per. QTY MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I Shall not employ any person in any manner So as 10 become subject to the Workers'Compensalion Laws of California. n Lime—ApplicantICANT: ALTER OR ADD TO MECH. .4.00 BUILDING } H 'TO APPLICANT: If,after making this Certificate of Ex FZ emption,you should become subjectto the Workers'Compensalion APPLIANCE 4.00 PLAN.CHECK provisions of the Libor Code, you must forthwith comply with _.. - U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO IQ=C.F.M.) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.)'5.00 SEISMIC FEE I hereby affirm that there is a.construction lending agency for EXHAUST HOOD(WITH DUCT)' 2.00 the performance of the work for which this permit is issued(Sec. EXHAUST 3097,CIv.C.). M-OOT G UNIT(TO 100,000 B.T:U.) 4.00 Isnd<r's Name Lender's Address GUNIT(OVER 100,000 B:T:U.)7.50 ELECTRIC I certify lhat'I have read this application and state Nat the aboveLATION FAN ISINGl:E1' 3.00information is correct.I agree to comply with all city and countyPLUMBING ordimm. and stare laws relating'to building construction.and -CONP(3 H.P.or 100,DDO B.TU.). 4.00hereby outhorice representatives ofthis city b enter upon the -COMP IDwf 100aMvcmentianed Properly for inspectionpurpns. .000 BTUI SEE FEE SCN. MECHANICAL (We) agree In save, indemnify and keep hannlLv the City ofREFER TO'ORD.Cupcnino against 0abilitics,Judgmcnls,sorts and expenses whichCONST:TAX may in any way Im5nm`a inst Said City in consequence of the ISSUANCE 3,00ling athispermit LIC.NO. MECN.[[�L� ( '/L — z �QTOTAL TOTAL SD tureofA lirant Contractor Date OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - PERMITNUMBER agILDING APPLICATION & PERMIT ADDRESS ZUrDqU ` BUILDING-ELECTRICAL-PLUMBING-ME CHANICAL OWNERS - ' - T - ---' PLAN CHECK VALIDATION NAME - L/(�L�LI- QTY. ELECTRIC PERMIT , FEE • - PNONE �, CONTRACTORS `4 i �ppg� NAME /�I � -OUTLETS-SWITCHES- 5.00/1.00 -I 1 Q v�1 313 LIGHTING FIXTURES 5.00/1.00 LIC NO. p pp ADDRESCTURs APPLIANCES-RESIDENTIAL 4:00 AUG 2 7 1964 ADDRESS '2�-� Z PRONE o / PANELS 5.00 - DATE OF�APPLICATION OR SIGNS SIGNS 6.00 nuI P.C.NO. ENGINEER LIC.NO. SIGNS TRANS.. 3.00 ANR'ESSSS ENG' SPECIAL CIRCUIT S.00 PERMIT VALIDATION _ zip EMP.METER'ORPOLE INS. 15.00 AAPPLICANT'S • I CORE MOTORS SEE FEE 0.00 �l ,J < SERVICE CHANGE 10.00 2 0 WI` FOO LICF:NSIiU CONT ACTORS DECLARATION a u s~j I hereby alfinm that I am licensed under provisions.f Chapter 9 ISSUANCE DATE a.y G fcommencimg with Section 7000)of Division 3 of the Business noel BLDG. EL T. PLG. MECH. F n Z Profession Codes,end�n!i(liana is in full force' J effect. ❑, ❑ ❑ Z O,n License lass- q LR,Numlre,`L�13j_ - 9 T row Daley'Z' Contract., Sc yf ¢ ¢w a OWNHR-BUILDLR DECLARATION BUILDING PERMIT MISC.- REFER TO ORD INFORMATION X ;LL r 1 hereby al'lirm that I am exempt from the Contractor s License VALUATION 5/FT. F w u 4 Law'In,the fallowing reason.(Sec 703 1.5,Business and Professions PERMIT ISSUANCE (f,00 - Code Any cityor county which requires a permifto construct.alter, a2 ¢ improve,demolish•or repair any structure•prior to its issuance.also ELEC.CONTR. LIC.N0. ELEC. wO u .requires the applicant for such permit In Ne a5ig0<d'statement 11151 -/ a TOTAL �, 5 ERMIT TO w ao he,is licensed pursuant to the provisions of the Contractor's Licenx vi Law(Clmptcr )(eommencing with Section 7000)ol-Division 3 or the F z o Business and Professions Code)Or that ha is exempt therefrom and QTY. PLUMBING PERMIT .FEE ¢ F g the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n; _ by any applicant lona permit subjects the applicant to a civil penally ofmol more than five hundred dolNrs15S00),)o ALTER-DRAIN&VENT-WATER (EA.) 4.00 ❑ I,asownerat the property,or my employees structure wages as BACK FLOW PROTECT.DEVICE. 2.00 OCC.GROUP RES.UNITS their sole towner ofithe will do the work,and the sl meta re is not intended oroffend for sale[Sec. 7044, Business end Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00 Code The Contractor's License Law does not apply to on owner of property who builds Or improves thereon,and who does Mich work FIXTURES'-PER TRAP 4.00 SO.FT.-FLOOR AREA TOTAL ACREAGE hunself or through his own employes provided that such improve- - mcmxarenutintnded or offered for sale 117 however the budding GAS-EA.SYSTEM-11NC.4 OUTLETS 4.00 or Improvement Is sol within one year of completion the owner, builder will have the burden of proving that he did riot build or Dr. GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDINGUSE prove for purposvofsale..); - INDUSTRIAL WASTE INTER. 20.00 ❑ CO IND CON PB Other ❑❑ I,as owner of the property,am exclusively contracting with - licensed contractors 1. construct the project ISec. 7044,Business LAWN SPRINKLERS-1 INC SV.B., 5.00 ASSESSORS PARCEL NO. and Professions C.dc:The Ctormero,s License Luw d.cs not apply to an owner.l_properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts Ao such projects with dcnntmUonsl licensedpursuant t. III,Contractor's.Liceme Law: SEWER-SANITARY-STORM EA:200ft/8.00 TRACT NO. PARCEL NO. ❑ Lunt exempt under Sec. .B.&P.f..Tnr this reason WATER HEATER W/VENT 4.00 Owner Dole WATER SYSTEM 4.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATIONDECLARATION WATER TREATING EQUIP. 4.00 ' I hereby elfin.) that I have a ceirifc.leurcoment t.sot-insure. or A certi0mle of Workers Cmnpcnsatiom copy _ Ins . n� Sed ZONING ENG.SITE NO. : eocofISec,3A00,W.b.Ca. Polley NVo- 7 O ❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑' Cert ifie oPyy is ❑le with tire city inspection division. FO Applicant P,S_}!f MISC.- REFER TO ORD. Y� N� Y � N CC CIER1IFIICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 PLOODZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. ,PLG. C' O (This sclior; need nut be completed If the'pcomit is for one TOTAL Y N❑ Y N❑ U O hundred dollars 6100)m less.) I certify HuH in.We performance of the work for which this per' QTY. MECHANICAL PERMIT FEE. FEE SUMMARY LL 1- mit is issued, 1 shall not employ any person in any manner um,. O U become subject to the W.rkers'Compensation Laws of Cxlifomia. y Dal` Applicant ALTER OR ADD TO MECH. q-00 BUILDING >_ W NOTICE TO APPLICANT: If.after umkins this Certificate of Ex- �. - emptimq you should become subject to the Workers'Co spensmi.o APPLIANCE 4.00 PLAN CHECK' provisions of tire Le abor Code. you muss forthwith;comply with U such provisions or this pennit shall be deemed revoked. AIR HANDLING UNIT(TO 10AMC.F.1%) 3.00 FEE CONSTRUCTION LENDING AGENCY. " AIR HANDLING UNIT(OVER IODOOCEM.) 5.00 SEISMIC FEE I hereby affirm that there is A contrucUon lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the performance of the work for which this permit is.issued(Sec. 3097,Cie,C.). HEATING UNIT(TO 100,000 B.T.U.)' 4.00 MICROFILM' Lender's Name f Lender's AddressHEATING UNIT(OVER 100,000B.T.U.)7.50 ELECTRIC 'Jc. I certify that l have read this application andsmle that the above VENTILATION FAN (SINGLE) 3.00 ® information n correct Lagree ti comply building all city and county' PLUMBING ordinances and stun laws elating m building constructi.n:.and BOILER-COMP(3H.P.Or100,000 B.T.U.) 4:00 " hereby authon,, representatives of this city t. en to upon [he BOILER-COMP(Over 100,000 BTU)SEE FEE BCH: above mentioned property for inspection purposes. MECHANICAL (We) agree to Save. indemnify and keep harmless the City of MISC.- REFERTO ORD: _ Cupertino against liabilities,judgments. costs and expenses which CONST.TAX may in any way acerae against said City in canuyuen« of the PERMIT ISSUANCE 3-00 ling of this Mrmil. / _ MECH.CONT. LIC.NO. ,fMECH:,eT7 L( ro1nL TOTAL gna[ure of Applicant/Contrnctor Doe OFFICECOPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —,USE BALL POINT PEN ONLY BUILDING PROJECT 1 DENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS • BUILDING—ELECTRICAL—PLUMBING —MECHANICAL 5572 OWNER'S PLAN CHECK VALIDATION NAME • 7 41 OTY. ELECTRIC PERMIT FEE Pf_(J PHONE COONTRACTo UTLETS;SWITCHES•C-1 RECEP 5.00/1.00 v7Jnf313 + 5 ( I LIC.NO, LIGHTING FIXTURES 5.00/1.00 'ALONrRACroR's OvHONZE�7 �O Lib APPLIANCES.-RESIDENTIAL 4.`00 M IFp ' IltNPANELS 5.00 d7PLI�Lvp7W��t � OR SIGNS 6.00 PLAN CHECK FEE P.C.NO. 'ENGINEER - (InH��,,', B L.C.No. SIGNS TRANS. 3.00 `Ot7YBtl0 p IROI AARCH.CH DDRESS ENG SPECIALCIRCUIT $,Dg PERMIT VALIDATION zIv EMP.METER OR POLE INS. 15.00 APPLI A'ADDRESS MOTORS 1Z'skJ JJ SEE FEE SCH. > 7-4,K- 6 SERVICECHANGE 10.00. -02 LICENSED CONTRA ORS OECIARATION- a u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE r ICommencin with Section 7000)of Division 3 of the Business add A a n g w BLDG. ELEC PLG. MECH. F 7 i Professions Co ,a J ny license is in full force and ppffecl. ❑ ❑ ❑ ZO 2 O License asx Lin. ractor �(¢I ' ��}— F u, j Date_ Comraclar. Q >< 2 - BU DING PERMIT a m Q OWNER-BUILDER DECLARATION INFORMATION na MISC.— REFER TO ORD w LL N I hereby affirm'Ihal 1 am exempt from She Contractor's License r VALUATION w 0 af Law For the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00 L2 1 SIFT. - IA0 Code:Any cityorcounty which reyuireso permit loconstruel,.Iter, 2 u, Q p improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTH; LIC.NO. EIEC. n w0 LL Teyuircs the applicant for such permit to file a signed.statement that C./Q 4 TOT PERMIT TO $r, he is licensed pursuant to the provisi.ns Of the Conlmc(or i License _ Fir Law(Chapter 9(commencing with Section 7000)of Division 3 of the Q Business and Professions Code),or that he is exempt therefrom and OTV. PLUMBINGPERMIT FEE. IFHat the basis for the alleged exemption..Any violurion of Section 7031.5 STORIES .TYPECONSTR. u ; _ by any applicant for a permit subjects the applicant to civil penalty of not more than five hundred dollars(SSOOL)' ALTER-DRAIN&VENT-WATER IEA.) 4.00 ❑ Las owner at the property,or my,and tires with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS their sok towner or the will property, the work,and Ile stwith w is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,HOOF,AREA,COND. 4.00 ,Code:The Contract.,',Licenso Law does not apply t.an owner of - property who builds or improves thereon.and who does such work FIXTURES-PER TRAP .4.00 SQ FT.FLOORAREA TOTALACREAGE • himself.or through Ilii own employees,provided.that such improve- no,mSarenot intended or offered for sale.11,however•the building GAS-EA.SYSTEM- INC.40UTLETS 4.00 or impmvei mem is sold within true year of completion,the owner builder will have the burden of proving that he did net build or im- GAS-EA.SYSTEM STEM--0VER 4 (EA:) '7.OQ BUILDING USE prove for purpose of sale.). - INDUSTRIAL WASTE INTER: 20.00 RES IND CON PS Omar ❑ I,.as owner of the pmpetly,an,exclusively contracting with licensed contract.,, to crns11ut9 the prm.0(.Sec.7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Pmfcssions Code:The Contractors License law does not apply to au owner of property who builds or improves daemon.and who LAWN SPRINKLERS-OVER 5 MA.) .1,00 Contracts Of such projects with a omraclorls)licensed pursuant to the Contractor's License Law. SEWER-SANITARYSTORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ Lam exeniprwider Sec. ,tl.ffiP.C.for Ibis WATER'HEATER'W/VENT mason 4.00 ' Owner Date WATER SYSTEM 4.00 ACC.DATE ACC:FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have a certificate Mmnxom sclpnisure, or a certificate of Workers'C unpensation Insurance„or a c,ohled ZONING ENG:SITE NO. copy merenf(See.3800,LAC.). n Q/ /.t`!�7' Policy No. Company_ /I1' /V - O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGYT]4 F- Z 2 ❑ Cer(ifie copy is filed with the city inspection division. O ApplicantgM/a MISC. REFER TO ORD. Y� N❑. Y [3 NO, iryCLRTIFICATE&EXEMPIION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG. B• o (This Wain. need not be completed if the permit is for one TOTAL Y N� Y NEI ZO hundred dollars IS 100)or Iess.l 1 certify 111.1 a. the perfomlance of the workforwhich this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY r UL )- mil ds issued.I shall not employ any person in any manner ad as I. 0 W become subject to the Workers'Compensation Laws of California. Datcn NOT APPLICANT: ALTER OR ADD TO MECH: 4.00 BUILDING } N NOTICE TO APPLICANT:IL after making this Certilicate of I>x- 2 eruption,you should become subject to the Workers'Compensatium APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with- U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1000011F.M.) 3.00 FEE CONS'rRUGTION LENDING AGENCY AIR HANDLING UNIT(OVER l0,00DCFM) 5.00 ' SEISMIC FEE I h ,chy affum mat'there ex a construction lending agency for EXHAUST HOOD(WITH DUCT) 2,00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 BiT.U.)' 4.00 Lenders Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)7.50 MELECTRICI Certify that l have read(his application and state Ian t he al ve VENTILATION FAN (SINGLE) 3.00 information 6 correct.1 agree to comply with allcityandcountyordi...es and stale laws trialing to building construction, and BOILER-COW(3 H.P.or100,0008.T.U.) 4.00hereby authorize representatives of (his city 1. areruponIhr1 LER-COMP IOvgr lOD,0008TU1 SEE.FEE SCH.above-mealiuned property for inspection purnxs(We) agree to save, indemnify and keep harmlms the City of MISC.- REFER TO'ORD.Cupertino against liabilities,judgments,costs and expenses which may in any way toeme against said City in consequence of the PERMITISSUANCE 3;00lif this Perot. MECH.CONT. LIC.NO. MECH.teTOTALignutury of Applinan(/Con(racmr Uatc � OFFICE COPY. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL-POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING. APPLICATION & PERMIT ADDRESS BUILDING'-ELECTRICAL-PLUMBING-MECHANICAL 3 OwrvEuS - - PLAN CHECK VALIDATION NAME • 77-f_4k+%-J STV. ELECTRIC;PERMIT FEE PHONE CONTRACTOR 5 NAME CAD 131.2 UTLETS-SWITCHES-RECEP 5.00/1.00 Le \ Llc.No. J LIGHTING FIXTURES 5.00/1.00 CONTRACTOR'S ADDRESS PPLIANCES-RESIDENTIAL � 4,00 . ' nEss -�L� //1R, ' PHONE PANELS 5.00 - „lu' 7FAIARATION ARRCHITECT SIGNS 6 PLAN CHECK VEE P.C.NO. ENGINEER sac.No. SIGNS TRANS. 3.00 City of C1! ADDRESSN EG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 15.00 nouncss TS MOTORS GNGPr SEE FEE10.00 3, U rj-} ' SERVICE CHANGE 10.00 w o o LICENSIiUCO RACTORS DECLARATION au u I hereby affirm I am licensed under provisions of Chapter 9 ISSUANCE DATE N <N (commencing with Section 7000)of Division 3 of the Business and• - - BLDG. ELECT. PLG. MECH. F Z PndessiC Cods u- license is in'full'hire,and of ❑ ❑ ❑ cz W Lic,nu Class-'Ty= Lic.Number - 0 Z h 0 Contractor < x B ILDING PERMIT ¢,�re 4 OWNFR-BUILDER DECLARATION o E A LLQ Ihereby aflirn that hl am exempt from the Contractors License MISC.- 'REFER TO ORD r u D 4 Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE' VALUATION , $/FT. CoJc:Any city or county which requires permit to construct.alter. 6.00 ELEC.CONTR. 'LIC.NO. a Q 4 p improve,demolish,or repair any structure,prior to its-asuance,also ELEC. 2 ` a wO LL ayuires the upplicam fur such permit to file usigned Sutemcut that { G�U�4 TOTAL V ERMIT TO .�y. he is licensed pursuant to the provisions of the Contractor's License r t r' Law(Chapter 9(edmmencingwith Section 700010(Division 3 ofthe i o Business coil Professions Code)nr than he is exempt therefrom and OTY. PLUMBING'PERMIT' FEE T IS w;s-$ the basis for.the alleged exemption.Any violation of$ection 7031.5 - STORIES TYPE CONSTR. A ; by any applicant fora Permit subjects the applicant roacivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 error more than Teo,hundred Jullms(S5001d: ❑ I,as owner of the property,at my employees.with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP- RES.UNITS their sale compensation,will do the work..and the structure is not' intended m offered for Sale(Sec. 7044. Business.and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 4.00 Code:The Contractor License Law does not apply to an owner of property who huilds'or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE • himself'or through his own employees,provided that such improve- room,are not intended or offered for sale If.however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 4.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA:). 1.00 BUILDING USE builder will have the burden of proving that he did not build or im- prove rot purpose ofsale.). INDUSTRIAL WASTE INTER. . IND '.CON PB Other O I,as owner of the property,am exclusively contracting with 20.00 D ❑ 13 13 licensed contractors to construct the.project(Sec. 7004.Business LAWN SPRINKLERS-.T INC 5 V.B. 5.00 ASSESSORSPARCEL NO. oeA Professions Code:The Commemr's License Law docs not apply to an owner of prop,ny who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA), '1.00 millruet6 IDr[uch Prujee6 with a Con Gactorto licensed Parsaallt to - the Contractor's License Law. SEWER-SANITARY-STORM EA.200f4/8.00 TRACT NO. PARCEL NO. re0 nlam exempt under Sec ,B.&.P.C.Ii•r this . WATER HEATER W/VENT 4.00 Owner .Date WATER SYSTEM 4.00 ACC:DATE ACC.FILE N0: WORK ERS'COMPF.NSAIION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have acertificaleofconsent toself-insure, or a.certificate of Workers Compensation Insurance,ora certified ZONING ENG.SITE NO. copy thereof l See.3800.wn.C..) �, `1 G 1 LF�iZ Policy Nn. Company-`' O ❑ Certified copy i\hereby furnished. FIRE gPRINK ENERGY T.q4 Z 0 Certified py is life with the city inspection division. O nnn0caot MISC.- REFER TO ORD. Y.❑ N� Y.0 No CERTIFR-ATF:OF EXEMPT ION FROM WORKERSPERMIT ISSUANCE 6.00 FLOOD ZONE - AL.U.C. Lu > COMPENSATION INSURANCE PLG.CONTR. LIC.NO: PLO, O' O (This section need nal Ix completed if the permit is for one _ TOTAL Y❑ NY❑ N� Z hundred dollar,IS 100)or less.) U O 1 certify that in the performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued.I shall not employ any person in any.manner was to O U Invnmc subject to the Worker'Compensation Laws of California. C. Dale Applicant ALTER OR ADD TO MECH. 4.001 ,BUILDING >_ Z, Nona. 10 APPLICANT: If,after making this Certificate of Ex- ' F ensption.you should become subject to the workers'Compensation APPLIANCE 4.00 PLAN CHECK pmvoions of the labor Code. you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,0MC.FNL) 5.00 SEISMIC FEE I hereby affirm that there kv a-construction lending agency.for EXHAUST HOOD(WITH DUCT) 2:00 the performance(if the work lot which this permit is issued(Sec. - MICROFILM 3097.Civ.C.1. HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lcndc,'s Name Lenders Address HEATI NG UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC I certify that I have read this application and smte that Ilan above VENTILATION FAN (SINGLE) :3.00. infnnouton is eu 'rr,ct. Lagree to comply with all"''Sod county - PLUMBING ordinances and smtcllawS relating.to building construction..and BOILER-COA/P(3H.P.Or100,000B.T.U.) 4,00 hereby authorize representatives of this city toenterupon the above-mentioned property for inspection purposes BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL - (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may i&any wry accrue against Said City in consequence of the PERMIT ISSUANCE 3.00 - 'nlingaflhispcnrd MECH.CONT. LIC.NO: MECH. TOTAL TOTAL JY Igna ure of Applicant/Conlmctor Date OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION PERMIT NUMBER BULLOING APPLICATION & PERMIT .. AmRfl SS BUILDING-ELECTRICAL-PLUMBING.=MECHANICAL WNER'S 1 5574 PLAN CHECK VALIDATION "AME CITY. , ELECTRIC PERMIT FEE -' • PHONE ranine Ass°Rs UTLETS-SWITCHES-RECEP 5.00/1.00 "cNo, Q LIGHTING.FIXTURES' 5.00/1.00 DRESS oR' PPLIANCES-RESIDENTIAL 4.00. AOORE55 S�M& PHONEZir7-� PANELS 5.00 DATE OF APPLICATION 'ONpN1TECi SIGNS 6.00 PLAN CHECK FEE P.C.NO. 'ENGINEER ' LIC.No, SIGNS TRANS. 3.00 ADDRESS E"°' SPECIAL CIRCUIT '5.00 PERMIT VALIDATION A ZIP TEMP.METER OR POLE IM 75.00 / APPLICANT'S / •']]](JJJ/_(//� ADDRESS MOTORS ` 1.9 SEE FEE SCH. !J 'Z- (�'1 O SERVICE.CHANGE 90.00 // Ceti 7j r o o LICENSED CONTRACTORS DECLARATION X,W I hereby affirm that 1 am licensed under provisions of Chapter 9. 'ISSUA DATE (commencing with Section 7000)of Division 3 of the Business and rA a n BLDG.. E PLG. MECH. zi z Professions Code,an`T license.is in full force and effect. ❑ 0' ❑. GZ .W Liccnu Class Lice-Number 7 /„ (�/ 3 m f Dare_ ]< Conion"or `a x i M et W a OWNER-BUILDER DECLARATION BUILDING PERMIT ,°- MISC.- REFER TO ORD INFORMATION w ;e I hereby offirm that 1 am exempt from the Contractor's License r• u v0i j saw for the following reason.See.7031.5.Businessand Professions PERMIT ISSUANCE 6.W .VALUATION -5/FT.1 Code:Any City or County which requires.permit tncmer .u t'alter. s et et a O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE' LIC.NO. ELEC: Zh O C u squires the applicant for such permit to file a signed slaUmCut that �(� (i -�/ TOTAL P IT40 A W es he is licensed.pursuant to the provisions of the Contractor i License R� i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe i o Business and Professions Code)or thathe is exempt therefrom and OTY. PLUMBING PERMIT FEE W f the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. e ; _ by any applicant for o permit subjects the applicant to civil penalty ofI,.[marc than ftvc hundred dollars(S500).): ALTER-DRAIN& VENT-WATER (EA.) 4.00 ❑ I,as owner of the property,or my employees with.wages as BACK FLOW PROTECT.DEVICE 2.00 OCC:GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended cr offered liar sale IS". 1044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Cmde:'The Contruelor%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 eta FT:FLOOR AREA TOTAL ACREAGE • himself or through his own employees.provided that such improve- .ants are not intended or offered for sale.If.however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 4.00 or improvement is sold within con,year of cuatpletion,The owner- buiNcrwill have the Burden of proving that he did not build or ire- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE Prove for purpose of saleJ. RES TND CON PB . Other ❑ 1,as owner of the property,um exclusively contracting with INDUSTRIAL WASTE INTER.. 20.00 ❑ ❑ ❑ ❑ ❑ licensed contractors iia conlrtel.the project ISce. 7044.Business. LAWN SPRINKLERS- I INC5 V.B. .5.00 ASSESSORS PARCEL NO. and Prom fessions Code:The Curactor i License Law does not apply _ to an owner of prupesy who builds or improves thereon.and who LAWN SPRINKLERS-OVERS(EA.) .1,00 comrucss for such projects with a aontract°dsl licensed pursuant to the Contractor's License Law. SEWER'-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. .Used um exempt under.Sec. ,B.&PC.for This WATER HEATER W/VENT 4,00 Owner -0am WATER SYSTEM 4.00 ACC.DATE -ACC;FILE NO. WORKERS'COMPENSATION DECLARATIONWATER TREATING EQUIP. 4:00 I hereby affirm that I!mCC a certiticateufcoleant to self-insaro, m a Certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy themof(Sec.3800,Lab.C.��//nn Polley No. ComPuY&✓7T 0 ❑ Certified copy is hereby.furnished; FIRE SPq INK ENERGY T-24 Z Z LI Certified copy is fled with the city inspection division. H O Applicant- �_Jm G� - MISC.- REFER TO ORD. y❑ NE] r❑, -N❑ CrN CERTIFIICATE 017 EXEMPTION PROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. IL 2 COMPENSATION INSURANCE PLG:CONTR. uc.No. PLG. CL O I'I'his section need not he completed if the permit is for one TOTAL V❑ N❑ N ❑, N❑' Z hundred dollars(S 100)or lCuA - _ V 01 ceORy that in the Performance ofto the work for which this per. FEE,SUMMARY LL employ any Person in any manner m to 1- mil is issued,1 shall not em QTY. MECHANICALPERMITFEE 0m become subject to the Workers:Compenzatiun Laws of Californi.a. n Dat` APPLICANT: BUILDING >. WNOTICI° TO APPLICANT: IL eller making(hisCeniliCntu of Ek- ALTER:OR ADD TO MECH- 4.00 (.- ? emption,you should haWom Subject to the Workers'Compensation APPLIANCE .4:00 PLAN CHECK provisions of the Labor Code, you must forthwith.Comply with U .FEE such provisions or this permit shall be deemed revoked., AIR HANDLING UNIT(TO'10AWC.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=141F.K) 5.00 SEISMIC'TEE I hereby ai'fnm that there is a construction lending agency for EXHAUST HOOO(WITH DUCT) 2.00 the peOimnamee'of lire work fur which this permit is issued(Sec MICROFILM 3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.1 4.00 lender's Name Lenders Address HEATI NG UN IT(OVER-000,000 B:T.U.17.50 ELECTRIC I certify that I have mad this.pphcat.n and slate that the aboveNB VENTILATION FAN (SINGLE) 3.00 'info .tion u Correct. I agrm to comply.with all city,and county PLUMBING ordinances and aaLL laws relating to budding construction, andOILER-CORM(3 H.P.of 100,0008.T.U.) 4.00hereby authorise representatives of this city - enteupon theBOILER-COMP,(Over 1WAW BTUI SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (We) agree to save, indemnify and keep harmless the City.of MISC:- REFER'TO ORD. Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX may in any way accrue against said City..in consequence of the PERMIT ISSUANCE 3,00 anting of this Peron. I n r� G MECH:CONT. LIC,NO. MECH. � ,It:./r-?6.* -O h--l. TOTAL TOTAL Z Jj Ignatum of Applicant/Contmetor OFFICE COPY APPLICANT TO FILL IN INFORMATION WITH tRED LINES - USE BALL POINT PEN ONLY BUILDINGPERMIT NUMBER "BUILDING IDENTIFICATION amlmxG APPLICATION & PERMIT ADDRESS c I BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 5575 xER l� PLAN CHECK V 10mb NAME OTY. ELECTRIC PERMIT FEET • S PHONE L L IA( ? rvAMEp TO s UTLETS-SWITCHE '-RECEP 5.00/1.00 G rypop t uc.No.G(O Lie I LIGHTING'FIXTURES 5.00/1.00 / 4 . one ADDRESS - APPLIANCES-RESIDENTIAL 4.00 ADDRESS G13 PHONE -�L4 PANELS - 5.00 DATEOF APPLICATION aRnCm7ECT SIGNS 6.00PLAN CHECK FEE P.C.NO. ENGINEER ' • uc.NO SIGNSTRANS. 3.00 _ ARCH,OR OORER ENG SPECIAL CIRCUIT '5,00 - PERMIT VALIDATION ZIP EMP.'METER OR POLE INS. 15.00 APPucgxrs A APPLICANT'S MOTORS I •_SEE FEE SCH. 7,SU 2 a6 Me SERVICE CHANGE 10.00 v 0 o LICENSED CONI'RACfORS DECLARATION a Z W I hereby affirm that I am licensed under provisions of Chapter 9 ISSII E DATE. G a e (commencing with Section 7000)of Division 3 of the Business and BC: E T. PLG. MECH. F D i RoRsrions l'o�4ca aqqJ license is in full furca v d v(fyy tt,, ❑ ❑ Z.o'vl' - Liccn' CIuss�L Lic.Numbor 'JI�' ' ow r w [)are�rtT- Contractor K s BUILDING PERMIT. ¢ a OWNER-BUILDER DECLARATION Be o s° INFORMATION vva a. r I hereby flues that I am exempt from theContractor's and P's License MISC.- REFER TO ORD u o¢ Low far rho following reason:(Sm.7071.5,Business and Professions - VALUATION 5/FT. F - PERMIT ISSUANCE- 6.00 Qy� 'Cod¢Any mulish county whiny requirescture permit o its becal ,also 'E 0 e eqoilimprove,JemOI15h,sir repair pray rWoof,palm la Its latrine e•t h0 ELEC.CONTR. 'LIC./tuO. ELEQ +-� O¢ rvquires the vpplicanl for such permit to file a signet slalcmcnl that C IUZF./3/ TOTAL$ w vex,'m w he is licensed pursuant to the provisions of the Contractor s Limh P MIT TO Fri Law(Chapter 9(commencing wily Section 7000)ofDivisian 3 Effie a Business and Professions Code)or that he is exempt therefrom and DTY'. PLUMBING PERMIT FEE Be F$ the boos for the alleged i3 - aIle ed exemption.An iSecliun STORIES TYPE CONSTR.by any mor he for aPermit subjects the applicant toe civil penalty of of mon then fine hundoJ dollars(S5001.) ALTER-DRAIN&VENT-WATER (EA.) 4.00 . ❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not .. intended or offered for sato(Sec. 7044, Business and Profession 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 thercon,and who does such work FIXTURES-PER TRAP 4.00 rSQ FT:FLOOR AREA TOTALACREAGE. • himself or through his own employees.provided that such improve-. mems me not intended oroffered for sale.IL however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4;00 or improvement is sold within one year of completion•the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1,00 BUILDING USE builder will have the burden of proving that he did not builder im- p0 fors owner ofsale,/. RES INDUSTRIAL WASTE INTER. 20,00 tO art 0 oO ❑ d as owner of the property,he exclusively contracting with11 licensed ebnlndod to construelContra the project(Sec. 7044•of apply LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and owner n if pope The who builds S Limns law does not apply . toa.trcts for ofhprojeys with aildsaFimproves thereon.nsPavoJ who LAWNSPRINKLERS-OVER 5(EA.) 1.00 [he Cont ler such projects with a COnlmdad S)IiseoScJ pursuant to the Contractors License Ww. - SEWERSANITARVSTORM EA.'200fT/8.00 -TRACT NO. PARCEL NO. refsJonlam exempt under Sec. ,B.flP.C.for this WATER HEATER W/VENT 4,00 Owner _ Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSA'I-ION DECLARATION WATER.TREATING EOUIP:. 4.00 I hereby affirm that 1 have a certificate ofcoment to slf-inwrc, or v mnifime of Warkcn'Compensatian Insurance,or a codified .ZONING ENG.SITE NO. copy Inerear r Sec.3500.1ab.c.f^'Ps y�4/(�-3.Z_ Policy No. Company- / - O ❑ Certified copy is hereby famished. Z Z ❑ Cenifted cop filed with the city inspection division. FIRESPRINK ENERGY T-N O Applicant �-� MISC.- REFERTO ORD. "�- TT❑ N Cr m CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD N❑ZONEA.LU.C. W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. a O (This section need not becompleted if the permit is for otic Y 0 NEI Z hundred dolars(SI00)or less.) U O 1 codify that to the performance of the work for which this Per. OTY MECHANICAL PERMIT tFEE. FEESUh)MARK IL F mit Is Issued,1 shall nor employ any person in any manner so as to { O to became subject to the Workers Compensation laws of Califomie. a. Dat` APPLICANT: ALTER OR ADD TO MECH. 4.00 BUILDING } w NOID.te 'f0 APPLICANT: If,after making[his Certificate of Ex emotion•you should become subject to theeWurkeri Compeniation APPLIANCE 400 PLAN CHECK ' provisions of the labor Code,you most furlhwith comply with .U FEE such provisions or this perms shall be deemed revoked. AIR HANDLING UNIT(TO IOAMCF.M) 3.00 CONSTRUCIION LENDING AGENCY AIR HANDLING LaymoVER 1Q000CEM.1.5.00 SEISMIC FEE I hereby affirm [bar there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the performance of the work I'or which this Permit a issued JSec. 3097,Civ.C.). _ HEATING UNIT ITO 10&'000 B.T.U.) 4.00 MICROFILM Lender's Name Leader's Addeces HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC I citify that I Imm read this applicationBad slate that the be, VENTILATION FAN ISINGLE) 3.00 information is carred.I agree tog to b with all city.and county PLUMBING ordinances and stale laws elating l0 building conslruclian, end BOILER-COMP(3 H:P.Or 100,000B.T.U.) 4.00 hereby authorize reponnntathen of this city to enter upon the above-mentioned property for inspection purposes. BOI LER-COMP(Owl 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments,costsand expenses which may in any way accrue against said City in consequence of.the PERMIT ISSUANCE 3.00 CONST:TAX noting of this perm. 3 �J MECH.CONT. LIC.NO. _ - MECH. -z TOTAL TOTAL sgnaNe of.Applicant/Contractor Date OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDItJG PROJECT I DENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 5 57 6 ADDflcu r b .BUILDING — ELECTRICAL—PLUMBING—MECHANICAL OwNERa - PLAN CHECK VALIDATION NAME ELECTRICPERMIT FEE • 427a 02 PNGNE /W�YY CONTRACTOR NAME GIv7�3) UTLEIL -SWITCHES-RECEP 5.00/1.00 sec.No. " LIGHTING FIXTURES 5,00/1,00_ 's AD -�1E r}EZ PPLIANCES-RESIDENTIAL 4.00 DR AR l M( (/Q PHONE /— Y"V PANELS 5.00 DATE APPLICATION ORRCHITECi SIGNS 6-00 PLAN CHECK FEE P.C.NO. ENGINEER - LIC.No. SIGNS TRANS. 3.00 ARCH,OR ENG. PERMIT,VALIDA TION ADDRESSSPECIAL'CIRCUIT 5.00 , zm TEMP.METER OR POLE INS. 15.00 ADDRESS rs MOTORS SEE FEE aooREu .SCH. sD 0 Z mLcfrtto (JS( SERVICE CHANGE 10.00 w02 LICENSED CON'fRACI'ORS DECLARATION I hereby affirm That I am licensed:under,provisions of Chapter 9 ISSUANCE DATE ¢. (commencing with Section 7000)of Division 3 o the Business and RL G. ELECT- PLG. MECH. H y,i Professions Cod my license is in full foL f and G Z x w License lass f/ Lit.Number L��1 r�i N r. Date =Z Contractort> < ss f BUILDING PERMIT Tem ¢ OWNER-BUILDER DECLARATION INFORMATION I MISC.— REFER TO ORD w 3 0 I hereby affirm I am exempt(rO.5 the f ODsand P x License VALUATION r- w o a Law for the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE5/FT: aj Code:Anycityorcounty which re9ulresa permit to construct,alter. 6,00 improve,demolish,or repair any structure,prior to its issuance,also Et=-CONTR. LIC.NO. ELEC: ' n'e 0, requires the applicant for such permit to Ne a signed statement that _ TOTAL g_7 w w$m he is licensed pursuant to the provisions of the Contractor's License P RMIT TO Law(Chapter 9(Commencing with Section 7000)of Division 3 ofthe - z o Business and Proknions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE I - M I- $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES 'TYPE CONSTR. i ;_ by any applicant for a permit subjects the applicant to a civil penalty, . ALTER-DRAIN$VENT-WATER (EA.) 4.00 of not more than'five hundred dollars(5500).1: ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2,00 OCC.GROUP RES.UNITS their sole compensation,will er the work,and the structure is nos intended or offered for sale(Sec. 7044, Business'and Profassions DRAINS-FLOOR,.ROOF,AREA,COND. 4.00 Code:The Contractor's.License.Law does not apply to an owner oI' properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 S6 FT-FLOOR AREA TOTAL ACREAGE 110 , - himself or through his own employes provided that such imP'"a" - mrmTmenobintendedorofferedfor- le:l I.however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or improvement is sold within ane yecoati Icuon, the owner. GAS-EA.SYSTEM-OVER 4-(EA.) 1.00 BUILDING USE budder will hav•the burden of proving thus.he did not build or im- Pmve for purpose of sale.). IND CON PB DOW ❑ I',as owner,of the property,am exclusively contracting with INDUSTRIAL WASTE INTER: 20.00 - ❑._ ❑ ❑ ❑ licensed contractors: tons act Ilio project Lo 7044,Rosiness LAWN SPRINKLERS-1lNC 5 V.B. 5.00 ASSESSORS PARCEL NO. toil Professions Code:The Cirobuids or License Law does not apply coanowncr of property who ba contrimprovcs thercon. pursuant ' LAWN SPRINKLERS-OVERb(EA.) 1,00 contrails for such projects with a cOnlraClorl s)licensed purfpanl to the 1dan Contractor's License Sec. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCEL NO. reason urn exempt under Sec. B.&P.C,for this WATER HEATER W/VENT 4.00 Owner Date WATER SYSTEM - 4.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have.certificate.ofc.ascal to selginsme. or a certificate of Workers'Compenmtinn Insumnu,or a certified. ZONING ENG.SITE NO. Copy Uereuf(Sec.3800,"ITC.1 Policy Nn. Company AA, G l6 / 3 Q ❑ Certified copy is hereby/orntiIT - FIRE SPRINK ENERGY 744 Z Z ❑ Cedi copy Is filed with the city inspemion division. p Applicant /7 MISC.- REFER TO ORD. v❑ N❑' Y❑ N❑ CCT' CER71FICA'I'EOFEXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FL000 ZONE a.L.U.C. W COMPENSATION INSIIRANCIi PLG.CONTH. LIC.NO. PLG. R O T"rhis section.need not be completed if The permit is for one TOTAL E] N❑ T❑ N❑ Z hundred dollars IS 100)or less.( C.7 O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY IL U mit is issucti.1 shall not employ any person in any manner an as to become subject to the Workers'Compeasalion Laws of California. o'. Date IC NT: I ALTER OR ADD TO MECH. 4.00 BUILDING } Ed Date i 'fU APPLICANT: If,lifter making this Certificate of Ea- r ? cotillion.you should bccomC subject to the Workers'Compensation APPLIANCE 4.00 ,PLAN CHECK provisions of The Labor Code. you muss forthwith comply with U FEE such provisions or this permit shall be deemed revoked AIR UNIT(TO 110=4 .F.ML) "3:00 CONS'fRUCfION LENDING AGENCY . AIR HANDLING UNIT(OVER 10AW RNI15.00 SEISMIC FEE I hereby affirm that themk is a hick the p mit is agency for EXHAUST HOOD(WITH DUCT) 2.00 the pa iv.C.t a of the work for which this permit is¢sued(Sec. MICROFILM 3097.r's Na 1. HEATING UNIT 170 100,000 B:T.U.) 4,00 Lender's Name Lenders Address HEAT]NG UN IT(OVER 900,000 B.T.U:17.50 ELECTRIC - I certily That I have read this application aad [at.that the above VENTILPFAN (SINGLE)GLE) PFE formation is correct.I agree so comply with all city and county PLUMBING oNinances and state laws relating to building construction, and BOILER- 00,000 B.hcrcby aushonzc representatives of the city Io enter upon the BOILER- D08TUI SMECHANICAL ahuvc-menlinned prortyforinspectinpmpow,.(We) agree to save, indemnify and keep.harmless the City of MISC:- REFERCupertino against liabilities,judgments.costs and expenses which CONST.'TAX against mid City in consequence of the. PERMIT MECH.CONT. TOTAL Uz oleic of AppOLaN/Contmclor Uate ' - OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT 1 DENTI FICATION PERMIT NUMBER 9UILOI NO APPLICATION & PERMIT - ADDRESS 5.5 7 7 .�t fC) BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S (y ` - - PLAN JJ I CHECK VALIDATION NAME nul.(�yyy OTY. ELECTRIC PERMIT FEE • _ tjA CiPHONE I _ CONTRACTORS UTLETS-SWITCHES-RECEP 5.00/1.00 NAMEc)�?�e 1.x)3 CIT LIGHTING FIXTURES' 5:00/1.00 -oNrnwcrons / PPLIANCES-RESIDENTIAL 4.00 wODRE55 2-D -f-ZQ L�p Licr '/ PHONE PANELS5.00 DATE OF APPLICATION ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO. , OR .ENGINEER Lie NO. SIGNS TRANS. 3.00 - DURESS ENG. SPECIAL CIRCUIT 5.00 - PERMIT VALIDATION - v A ZIP EMP:METER OR POLE INS. 15.00 APPLICANT MOTORS f.{ i SEE FEE APPLICA LL Q l{r0" (Y1LEU0 ST, SERVICE CHANGE 10.00 w 0 0 LICENSF.DCONfR CTORS OLCLARATION a u 1 herchy affirm ihm I am littnsed under provisions of Chapter 9 ANCE DATE n<w (commencing with Section 7000)of Division 3 of the Rusinces and BLO ELE T: PLG. MECH. 7'A P"'casums('od,,e qt license is in full for C a J effect. ❑ ❑ a' o'^n License Clas fly Lic-Number -Ca f3 f'�i 4 Z H w Oate. -7omractor Y f �IBUILDINO PERMIT Ix m u OWNER-BUILDER DECLARATION INFORMATION w 3 LL N 1 hereby affirm[hat I am exempt from the Cuntmclm's License MISC.- REFER TO ORD VALUATION H LL n j Law for the following mown.(Sec 7031 5.emirs rail Professions PERMIT'ISSUANCE. 6.00 L S/FT:. Qv, improve.m Any m o or county which r gmrcsu Desert toronstru ce,al .' - - J Q Q Q qui. he applicant repairany permit to prior In IIS atom rat o1w EL .GO TR. LILA.fN Off.! ELEC. OLL regm,es the applicant fosuch permml hs til•.a signed sl tem`nt lhap II CIt/ ({o/'I TOTALg'Zfi�Q ERMITTO A. w$m he w licensed pursuant to the provisions of the Contractors License H z a Low(Chapter 9(Commencing with Swim 70o0)of Diviiiun3 al the f z O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT •FEE E.$ llm basis for the alleged exemption.Any violation of Section 707 CSSTORIES Tx'PE CONSrR. i 3 - by any applicant for a permit subjects thu applicant toa civil penalty of not more than five hundred dollars(S500).): ALTER-DRAIN&'VENT-WATER (EA.) 4.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE, 2.00 OCC:GROUP RES.UNITS [heir sole compensation,will do the work.and the structure,is not intended or offered for vk(Sec. 7004, Business and Professions DRAINS-FLOOR,ROOF;AREA,COND. 4.00. ' Code:The Contractor's License Law dos 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 AREA TOTACACREAGE himself or through his own employees,provided that uch improve- •... mems are not intended or offered for ole.11,however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 4.00 or improvement Is Sold within one year of completion,[he owner- GAS-EAJSYSTEM-OVER 4(EA.) 1,00 BUILDING USE builder will have the burden of pmving that he did not build or im prove for purpose of sae.). INDUSTRIAL WASTE INTER. 20.00 E IND CON Pe -Door, ❑ I,as owner of the property,am esdruively Contracting with; licensed contractors [o construct the Pmjee(Sec.7094,Business LAWN SPRINKLERS-,1 INC'5 V.B. 5.00 g55E550fl5 PARCEL NO. and Pmfesione Code:The Conlmeto s License Law does not apply to art owner of property who builds or improves thereon,and who LAWN SPRINKLERS.-'OVER'5(EA.) 1,00 mn[meB for such projects with a conleac[ods)licensed pursuant to the Contractor's License law. SEWER-SANITARY-STORM EA.200ft/8.BO I .TRACT NO. PARCEL NO. re.van am exempt under Scc. .B.AP.C.for Ihw WATER HEATER WNENT 4.00 Owner Date WATER SYSTEM - 4.00 m,1ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATERTREATING EQUIP. 4.00 7- I hereby affirm that I have a certificate of consent to sell=insure: it,a cmnificalc of Workers'Compensation Insurance,or o ttrtifed ZONING ENG.SITE NO. ropy Nore q 9S 3800,Iab.C.l. �5 rra k J Li PDD No. Company✓ '. / ❑ CeniOeJ 'oPY whereby funmishal. FIRESPRINK ENERGY T-N z Z ❑ Certified�o py b filed with [tic•city inspeolion division. ApnlicaZl (i MISC.- REFER TO ORD. . Y❑ NO -vlo NEI ~ O / PERMITRSSUANCE tLy CIiRTIPICATIi Ols EXEMPT ION FROM WORKERS' 6.00 FLOOD ZONE' Atr.U.C. W COMPIiNSAI'ION INSURANCE PLG.CONTR. - LIC.N4PLG. L y N Y 0 N� 1 O (This xx tkm need nal be Completed if the permit w for one _ TOTA U O. hundred dollars(SIO0)orkss.) I candy that in the,performance of the workt wTor which this Per- QTY MECHANICAL PERMIT FEE :•+FEE'SUMMARYv LL F mit is Issued,1 shall Out employ any pern in any manor,w as lo_ + O W become subject to the Workers'Compem.Tlion Laws of California. Us Dat` Applicant I ALTER OR ADD TO MECH. 4.00 BUILDING } rn NO] TO APPLICANT-: IL after.making This Cenifimpe sa ion � 2 emplion.you the Labor me Code. you to the forthwithorkcrscomply with , APPLIANCE 4.00 PLAN CHECK provisions of the lahm CoJc, you must forthwith ComPIY with ' U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO MODC.F.M.) 3.00 FEE' CONSTR UCIION LENDING AGENCY AIR HANDLING UNIT(OVER 10SWC.E1,01.)5.00 '. SEISMIC FEE I hereby affirm that [hereis a construction lending Agency for EXHAUST HOOD(WITH DUCT) 2.00 the pclfammantt of the work for which this permit is issued(Seo - - - 3097,Civ.C.): 'HEATINGUNIT LTO 100,000 B.T.U.) 4.00 - MICROFILM Lenders Name Lender*,Address I HEATING UNIT(OV ER 100,000 g:T.U.)7.50 ELECTRIC I certify[hat 1 have read this application and state[flat the once !PERMIT ATION FAN(SINGLE) - 3.00. information w correct I agree(m Comply with all city'.and county. PLUMBING , mAim,nees and-state laws relating to building construction, andCDMP(3 H.P.of 100,000 B.T.U.) 4.00 hereby authorD representatives of this city to enter upon the -COMP[Over'100,000BTU)SEE FEESCH. above-mentioned property for inspection purPmses. MECHANICAL (We) Uns, to save, indemnify and keep barrel= the City or REFER.TO ORD. Cupertino against liabilities,judgments;costs and expenses which CONST.TAX may in any way accrue against said City in'.consequence of[he. ISSUANCE - 3,00 LIC.NO. MECH. Z $ TOTAL TOTAL ignamre of Applicant/Contractor Date OFFICECOPY