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3561 20653-60 CELESTE C1 R 3561 F DE ANZA PROPERTIES SCANNED BOX # 783 ---------- --- - -------- C I 1,y OF CUPERTINO 1NSr1X;TIOV RECORD (Of Ace ,Copy) 3561, Lot 2, Bldg '2 29653-6n Celeste Circle P1,pj1IT NO. SANITARY DIST. NO. LOT NO. ADDRESS Const. 8 Units DeAnza Properties PROJECT 01-INER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL Buildinp, 5-11-83 Date 1.11sp. lAectrical 4-.A& I# Power Pole I'Lumhin,gI.a Underground Mechanical 1-0 Rough Wiring g g. Temp. (;.is/l,',Icct. WaLis Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sign Notors Misc. Grounding Temp. Po,,., Other FINAL INSPECTIONS Not Approved Date I sp. r,,.,s Id-,PY PLUMBING F I ec t r i C 1"L I Date Ins' Plumbing i� -ILI Backflow p- Mechanicalk Underground Solar Underfloor Pool Partial Roughq- -1(di'i Cran Rough Complete 1''Lnnnin olar Rough er & Insulation p Health De' t. 'fain Drain Building R/of/S Drain Other Gas 6 t,,—a 41then ILDING %t Approved Date Insp. Pad Certification Foundation HECHANICAL Pre-Gunite Date Insp. Underfloor S.M. Slab-flembrane Ducts & Insulation Bond Beam Fire Dampers Underfloor Girders Fireplace TTo-o—rSteel AllZ Tiedowns Grease Duct & Ho4A Diaphra; One Hour, Shaft Condensat—eDral-r�— Saismic Bracing Equipment Anchorage Ualls-Pancls Frame Flues & Comb. Air Lath Other !T 11allboards Int/Ext. o­t—Approved� Firewalls 1 -4 t� [i,-�-r [A d-S ok Other Not Approved s- "Y(K, tock e� 574'u-'k —1-3Aq BUILDING ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS .APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY :BUILDING PROJECT ID561 ENTIFICATION [ - PERMIT NUMBER _ I�UiNG - AWKWON ON & PERMIT .',� DING—ELECTRICAL—.PLUMBING—MECHANICAL O NER'S - _-- PLAN CHECK VALIDATION NAME' :' OTV.-r ELECTRIC PERMIT FEE PH ,CONTRACTOR s O UTLETS-,SWITCHES-RECEP 5.00/1.00 - _,C.No. . LIGHTING FIXTURES 5:00/1.00 ' ADDRESS - -- PPLIANCES-RESIDENTIAL 4.00 - PHONE PANELS 5:00 DATEOF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR - - SIGNS 6.00 ENGIN SIGNS TRANS.. - 3:00 AD ARc .Ess SPECIALOIRCUO ErvG. PERMIT ALIDATIC - -zip -EMP.IMETER ORR 5:00 POLE INS. ' ;15.00 l' �Q� APPLICANT'S ADDRESS MOTORS SEE FEE SCH. ) SERVICE CHANGE 10.00 a,O o arfim tUCON A ORS DECLAR ION a /a�Tf�a EI/�9/1//' •' Q Z,u I�pereby affirm that ltam•licensed under provisions of Chapter 9, ISSUANCE A w ISSUANCEDATE Q a (commencing with Section 7000)of Drvisiorarof the Business and. BLOC. ELECT. PLG: MECH. r.D z Professions Code,and mylicense ia m full force and effect: Li _ ❑ ❑ ❑ ❑ Z O!.q cense Class` Lic.Number F n H j Date Contractor _ fe (c¢,a OWNER-BUILDER DECLARATION BUILDING PERMIT' — o o'er -. I INFORMATION w ; w Thereby affirm that b.am%exempt from-the Contmuur'xLicensp MISC. - .REFER TO ORD LL o Law forthe'.followmgrcason.ISec 7031.51 Business and Professions. VALUATION �a g/FT. - VALUATION 6:00 I�aa/ ice 40 Codeaa "" tyor county replan mymywresapermit io onstnict:alter:. ELEGCONTR. LIC:NO.. gp� e e Q 0 "Prove,he applic,or repair any structura,.prior to us issuance:also - ELEG. _ co y O.LL regwma one d P.-nl for sueF perms!to Glc a Signal sWtanenl lhet TOTAL PERMIT TO - w.� he is licensed pursuant Rem"provisionsof the Confr¢tor's.License Hsi Law(Ch Par 9( commencing wish Section]OOOIofUrvrsion3of file s/b�U/.rf^C✓ i 4 c Business and Professions Code)or that heir eaempl thercfromand QTV. PLUMBING PERMIT FEE M I- the basis for the alleged exehiption Any vidlaiion of Section 7031.5 STORIES. TYPE CONSTR. i; _ by anyg.,.,balfora panni!sublectstheapplic nttsacivil penally ALTER-DRAIN Be VENT-WATER�(EA.)-'4.00 of. _.,.,ban five hundred Aollars 15500).1: ❑ I::as owner of the proper y or my employees wish wages us 'BACK"FLOW PROTECT..DEVICE Char sole compensation.will do the work,dnd the structure is not 2.00 OCC.GROUP RE$.UNITS the ..tended or ofraped for sale IS u 7044, Business and Professions DRAINS-FLOOR,ROOF;AREA;COND. 4.00 - 7,,/ /Vrp - Code:The Contmclor's License Law does not apply loan owner of Property wfio builds or,improves thereon:and who does sucbwork FIXTURES-PER TRAP .4.00 50.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees. le.If,ed ec t such improve- ments mprove meimpro mensnot is old or within one y Sale.If,mpletior the ,ovageg GAS-EA.SYSTEM 11NC.4OUTLETS 4:00 AM or improvement is sold within Disc year of completion,t ild,or ee. provbuile r p have fof ale.). •DI pronng thuthe sl ld not M1uild,or.m- GAS-EA.SYSTEM-OV ER;4(EA.) 1:00 ..BUILDING USE prove for purpose otsale): INDUSTRIAL.WASTE INTER. 20.00' RES IND. CON- Pe 'Omar 1,as owner of the property.am exclusively contracting with �❑ a ED hied'contractors to construct the project l Sec.7044,.Business LAWN SPRINKLERS'-'1INC 5 V.B. 5.00 ASSESSORS PARCEL NO.. and ProfesskmsfCode:The Contractor's License Law does not apply. , to an owner of property who builds or improves Ihereon,and who LAWN.SPRINKLERS-OVER 5(EA.) 1,00 / contracts for such projects with'a conlractorts).licensed pursuant to: O me Contractor's License Law. SEWER-SANITARY-STORM EA.200ft%8.00 re Ianeexempt. n nSec_� B.&I'.C..for(Itis. WATER HEATER-W/VENT .4.00 TRACT No Date Own• . PARCEL No. 3 - WATER SYSTEM 4.00 Ace.DATE ACC.FILENO. WORKERS'CONIPENSATION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm ihaf:l havcla...tificme of consent m sejr-ina.11, _ hr a cerlificate of Workers'Compensation Insurance,or.certified - ZONING ENG.SITE'NO copy thereof f Se 3800,Lab.CJ. _ Policy No, Company' -0 ❑ Certified'copy is hereby furnished. PPERMIT '- FIRE SPRINK EN G T-24 :z Z ❑ Certified copy is filed ;with the city inspeclion division. Applicant" - REFER TOORD. v N� v N� �cr O ISSUANCE �.H CERTIFICATE OF EXEMPTION FROM WORKERS'- 6.00 FLOOD ZONE iLu �. COMPENSATION INSURANCE LIC.NO. Pia.CL Q (This section need not he-completed if the permit is for oneTOTALD.Z hundred dollars lS 100)or less.)'LL certify that in th p rfrrmance of(lie work lar which[Itis per- MECHANICAL.PERMIT LL,'.V mil is issued,1 shall not employ any person.in an) manners,as to FEE become subject to the Workers Compensmion Laws of California.Date - Dv NOT Applicant ALTER OR ADD TO MECH. 4 BUILDING, } Z NOTICE TO APPLICANT_ .s after.making this Workers' Compensation cation - - 00 .v emvision you shouldbor Code, to the Workers Ccomplymion APPLIANCE 4.00 PLAN CHECK such provisions of.the Labor-Code, you must drtvoked, ..ply wills - - U such provisions or this peniat shall be deemed revoke!. AIR HANDLING UNIT(TO TOX0C,F.M) 3,00 FEE .. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C:F.W 5.00 SEISMIC•FEE A!5 9 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. 3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 400 MICROFILM Lenders Name - Lender's Address HEATING UNIT(OVER 100,0008.T.U.11 51 .ELECTRIC I certify that l have read this application'and stale fhii the above VENTILATION.FANISINGLE)(' 3.00 infonertify is coir,6 I ugreer. mnply with all city and county - PLUMBING. ordmances.lind state laws relating to building construction. and BOILER-COMP(3 H.P.orloO,000B.T.U.) 4.00 hereby authodxe representatives of this Cry'to enter upon the xbovrmentioned',property for inspection puTows - BOILER-COMP IOe—10QWO8TU15EEFEE SCH, MECHANICAL; (We) agree to save, indemnify and keep harmless file City of MISCI- REFER,TO ORD. Cupertino against liabilities,:judgments, costs,and expenses-svhich' CONST.TAX may many`-way accrue against,said City,in conwme"ce of the '.PERMIT ISSUANCE 3:00 granting diispern MECH.CONT: 'LIC.NO. .MECH. TOTAL TOTAL Si 1 re of Applicant(Contraaor ate �'�� ' OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY :.,e •BUILDING PROJECT.IDENTIFICATION ,PERMIT NUMBER r/ BUILDING. APPLICATION &'PERMIT p (]f��f AODRESg ' CIcS 'r.L 4 J 3 f Q � BUILDING-ELECTRICAL-PLUMBING-MECHANICAL � - OWNER'S - PLAN CHECK VALIDATIONL NAME {`��1 q CITY. ELECTRIC PERMIT. FEE 4 A' /V \' .rte PHONE 'CONTRACTOR'g NAME OUTLETS-SWITCHES-RECEP 5.00/1.00 PUTA /-A w/101 LIC Dn 2Se o41 ILIGHTING'-FIXTURES 5.00/1-00_ ADDRESS ofl•s A PPLIANCES-RESIDENTIAL '4.00 CONTRAC qf - Qr( 6, /SPCA/�'IL PHONE MIT/ PANELS 5.00 DATE OF APPLICATION. ARCHITECT-. SIGNS 6.00 PLAN CHECK.FEE' P.C.NO, OR IENGINEER LIC.NO. SIGNS TRANS. 3.00 ' ARCH.OR ENG. PE MIT ALIDATION , AOGRESS - SPECIAL CIRCUIT 5.00 ZIP EMP,METER OR POLE INS. 15.00 fl �ADDRESS MOTORS" SEE FEE.SCH. C U -fes �`J/TAA1,+L CL,1 SERVICECHANGE 10.00¢iFOO LICENSED CONTRACTORS DECLARATION ".Q. I hereby affirm that A am licensed',under provisions of Chapter 9 (commencing with Section,7000)of Division 3 ol'the Business and CE DATE F Z Professions Cmicertil Igy'I� am IS in fall frrc a ��ffnO BLDG. EL MECH; oh. c License Class V�--rJ f. Lie.Number E'�Jr y,r w Date_-z - -.w Contractor. a �'a a OWNER-BUILDER DECLARATION, BUI LDIN PERMIT r o a" - - I INFOR ATION x ; H I hereby:affirm.that I am exempt front the Contractor',License MISC.- REFER TO ORD. w'o A,- Law for.the following reason..(Sec.7031.5,Business and Professions VALUATION 'S/FT. G. J PERMIT ISSUANCE 6.00 Code;Any airy or county which regmresa permit to construct alter ELEC.CONTR. LIC.NO. .ter¢p improve;demolish,or repair any sl cl re.prior to is ins mace.also TEL IC D;¢ requires the applicant for such permit to flea signed statement,lhat - TOTAL PERMIT TO Q. m A he is licensed;pursuant to the provisions of the Contmuor's License . �..-Z,.Q Law,(Chepler9(commencing with Section 7000)of Division 3 of the , -Z.4 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE. tel-.$ ,the basis for the alleged exemption.Any violation ufSection7031.5 'STORIES - P CONSTR. a'R by my applicant for a Permit subjects the applicant too civil penalty ' of not more than five hundred dollars(S5001): ALTER-DRAIN III'VENT-WATER (EA.),4.00 ❑ I,as owner of the propemy,'or'my'employees with wages as BACK FLOW PROTECT.DEVICE .2.00 their sole compensation,will do the work.and the structure is not OCC.'GROUP PES.UNITS intended or offered for .]a(See. 7044,Business ad ProfessionsGDRAINSiFL00R;.ROOF,AREA,COND. 4.00 Code:The Contractor's.'License Law does not apply to an owner of property whabuiI'S or improves thereon;'and who does such work ' FIXTURES-PER,TRAP 4.00 a 'gO,FT:FLOOR AREA TOTAL ACflEAGE himself or through his own employees,provided that such improve. . ments are not intended or,offered for sale.If,however.the building GAS-EA.SYSTEM-I INC.4'OUTLETS 4.00 or improvement is sold within.one year of completion,-the owner- - builder will have the burden'of proving that he did not build'or im. GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE - prove for purpose Of Sale.), RES IND N PB. Omer - ❑ I,as owner of the property,am,exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 El El EVI 0 licensed:contractors to construct the project(Sec,7044.Idminesx LAWN SPRINKLERS-1 INC 5 V.B. 5.00 gssE55GR CEL No. El and Professions Code:The Contractor's Liduse Law does not apply to an owner of'propertyWho;builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ... contracts forsuch.projects with a elantractrinf)'licensed pursuant to - - the Cnmrinam'sLiecose'Law. - SEWER-SANITARY-STORM EA.200ft/6.00 TRACT NO. PARCEL NO. re❑n l am exempt under See._.8,&P,C.to,his WATER HEATER W/VENT 4.00 ' .Dale OwnCr' WATER SYSTEM 4.00Or ACC.DATE. ACC.FILE NO: WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.U0 I hcreby,mri mttliat I have,a certificate of cunsent to self-insure, or.a,ccrtifmrtle of Workers'Compensation Insurance.ora certified ZONING ENG:SITE NO: copy tirer out(Sec-3800,Lab.C.). - Polley'No. Company /�s('/�jAN - •O - ❑ Cc rtified'copy'is hereby. urmisled. `Z Z 0" Certified co s 0 rtl tl(e I(y inspection. division. FIRE SPRINK ENERGY T44 rp Appbcant hr�G . MISC.- REFER TO ORD. - r11 'VE] v ❑ ' N13 Ir.- CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT,ISSUANCE 6.00 :. W > COMPENSATION INSURANCE FLOOD ZONE A,L.U.C: PLG.CONTR. LIC.rv0. PLO fo e CL o (This section need not be completed if the permit is fur one TOTAL 2SY N� Y N� �,Z hundred dollars IS 100)or len.) L),O 1 certify that in the performance 01 the work for which-this per- + .LL F- nut is issued,1 shall not employ any ppumn.in a manmrso aceto DTV. MECHANICAL PERMIT FEE FEE SUMMARY O became s�r� t CoA'a Workers'Colbnlns L" sof ahfomia: y DateLJ1UJApplicant YY1I%%�y ALTER 08 ADD TO MECH. '4.00 BUILDING >_ 0NOTICE TO APPLICANT: If,after making this Certificate of Ex- F Z' emplion,you should become subjectto the Workers'Compensation 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 10MOOF.NL) 300 FEE' CONSTRUCTION;LENDING AGENCY. AIR HANDLING UNIT(OVER:10000.F,M.) 5.00 - SEISMIC FEE I hereby affirm.that there is,. construction.lending agency for EXHAUST HOOD(WITH OUCT) 2.00 the performance.of the work for which this permit is issued iSee MICROFILM 3097,Civ.C.), HEATING UNIT'(TO 100,000 B(T.U.) 4.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000B.T.U.M50 ELECTRIC I•� certify that(.have read this apphwUon and state Ilmt the above VENTILATION FAN (SINGLE) 3.00information!is correct 1 agree to comply with all city and county - PLUMBING ordinances and state laws relating 10 budding construction. and BOILER-CDIVPI3 H.P.or 100,000 B.T.U.) 4.00 hereby aulborizn npnsentative$ of this eityd0 enter upon the above.mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree ao'save, indemnify and keep harmless the Cir'at MISC-.- - Cu Cupertino a - - y REFER TO - p against liabilities;judgments, cost, expenses which may in;any way accmL,against 4said City in consequence of the� -PERMIT ISSUANCE 3.00 CONST.TAX It 1 got tt�i�perm�J MECH:CONT. LIC.NO. MECH. 2 �- TOTAL TOTAL Signature of Appbcant/Contractor Uate L OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN REDLINES — USE BALI_ POINT PEN ONLY a ,¢UICDING PROJECT IDENTIFICATION n J PERMITNUMBER BOILDNG APPLICATION &PERMIT ADDRESS a06s6. ALGST� / 2 � BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 4156 1 [C .OWNER'S. - PLAN CHECK VALIDATION "A•M//,E�/Y /�(Jy/.��f,yy /�/�)J0 OTY. `ELECTRIC PERMIT FEE • D15 hl"Z4'' /eC!/ PHONE - CONTRACTORS NAME �- OUTLETS-SWITCHES-REC_EP 5.00/1.00 E " LIre CR IcrNo.CIDQ�L� - LIGHTING FIXTURES 5.00/1.00 An CONTRACTOR'S- 'APPLIANCES-RESIDENTIAL 4:00' gkSIO ADDRESS ^• — 3 PHONE PANELS + 5.00 a` O �I3/7� GATE-0FAPPLICATION A9q.ITECT SIGNS 6.00 - PLAN CHECK.FEE P.C.NO. OR ENGINEER ' LIC.No. SIGNS TRANS. 3.00 ADDRESS E"G' SPECIAL CIRCUIT 5.00 - PERMIT VALIDATION ZIP EMP:'METER OR POLE INS. 15.00 `T A - - MOTORS SEE:FEESCH.zyr ADDDRESSDRESS T 1/b S2. SERVICE CHANGE 10._00 LICENSED CONTR CTORS DECLARATION 1 /-• �.0 I•i :1hereby affirm that 1 am licensed under provisions of Chapter 9, ¢ a-w - ISSUANCE DATE vi¢a Professions (commencing Section 700i of Division 3o the Business and - BLDG. ISSUANCE T, PLG. MECH." F o i Professions s dq ay/�t}yjLmy license i .N full for Slj SIJ fyc ❑ O Z O�aS - L«enx Clast_4�-L L.Number �J / •. El o -,D . _Contractor m H J Date /_-Y/. S Qw,L� OWNER-BUILDER'DECLARATION- q BUI DING PERMIT I INFORMATION Whereby I'hereby'affirm that 1,umexempt,from the Contractor's license MISC. REFER TO ARD au u o.J Law for the following reason.(Sec.7031.5,Business Bnd,Professions. pERM1T'ISSUANCE 6:00.. VALUATION $/FT. i Code:Any,city or county which req 'resapermit unconst et.alter, Improve.demolish,or repair any Slruclure,prior to its issuance.also ELEC.C TR:. LIC NO. ELEC. w o.4 requires the applicant lot such permit to file a signed statement.OmL61 �� TOTAL p To w R' , he Is licensed pursuant la the provisions of the Contractors License: F i,QNLaw(Chapter 9(commencing with Section 7000)ofDIvl9Rrn 3 ofthe 4.O Business and:Professions Code)or that he isexempbtherefrom and' QTY. PLUMBING'PERMIT FEE IC 1- $. the basis for the alleged exemption.Any violation af5eclion 703115 STORIES TYPE CONSTR. by anyapplicant for a permit subjects the applicant to a civil penalty ALTER'-DRAIN -WATER (EA.) 4.00 of not more than five hundred dollars(S500).); ❑ I,as;owner ofthe property,or,-my.employees with wages as BACKFLOW PROTECT.DEVICE 2.00 their sole compensation,will do the work,and the structure is Mn OCC.GROUP RES.UNITS intended or offered'for Sale(Sec. 7044,Business and'Professions', DRAINS-FLOORROOFAREACOND., 4:00 Code:The Contracmes License Law does not apply to an owner of , , , - property who builds or)improves thereon.and who does such work F IXTUR ES-PER TRAP 4.00 himself Or 11nough his own Employees,provided that such improve" SO:'FT,FLOOR AREA TOTAL ACREAGE • ments are not intended or offered for sale.If,however.the building GAS-'EA.SYSTEM-1.INC.40UTLETS 4,00 or improvement Is sold within one year ofcomPletion,theownco builder will have the burden,of proving that he did not build or Ira- GAS'-EA.SYSTEM-.OVER (EA.) 1,00BNI L USE prove for purpose of sale-).' INDUSTRIALWASTE INTER. RES[:] lOthe Ll h 20.00 0 '0❑` as owner bf the property,.am exclusively contracting with . ND licensed contractors tojconstrucl the Project(See in 7044,Business LAWN SPRINKLERS-1 INC.5''V.B. 5:00 ' and Professions Code:The Contractor's License law does not apply ASSE&So PARCEL NO. to an owner ofproperty who builds or improves thereon,;Ind who LAWN SPRINKLERS-OVER'5(EA.) too Contractsfor such Projects with a contractors)licensed pursuantto the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00TRACT NO. PARCEL NO. lam exempt under Sec..,B.&P.C.for this reason - WATER HEATER W/VENT 4.00 Date Owner WATER SYSTEM - 4,00 ,ACC,DATE ACC.FILE NO.- WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby;affirm that I have.certifiems of Consent to self.insum, or a cerlifica le of Workers'Compensation.Insurance,or a certified ZONING ENG..SITE NO: copy,thereof(See.3800,Lab.C.).-.b Poliy'�No, Company/j'!� 9�OG X12 - Q ff�Ccitified Copy is hereby furmshed. FIRE SPRINK ENERGY T-24 Z Z ❑, Certifiep.,ppy�¢ fled with the city inspection Division. FO. Applicant �yir/c-J�/9 - MISC.- - REFER TO ORD.. YE] ,NE] YEl N0 CC N CERTIFICATE OF F•x EMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTE. uc.NG. PLG. 1 O (This section'need not be completed if the permit is for one - TOTAL 'Y❑, N� Y ❑ NO, :�'Z hundred dollars IS 100)or less.) - L) O 1 certify that In the performance of the work for which this per QTY. MECHANICAL PERMIT FEE SUMMARY LLk- mit u issued,)shall not employ any.persom in any,manner so as to FEE O.w become subject to the WorkerslCompensation;Laws of CBlifornia: Dale - Applicant ' } 0. NOTICE TO APPLICANT: If,alter making this CerUficaloolALTER OR ADD TOMECH4,00 BUILDING ` .Ex- - � _ emptlon,you should become subject to the Workers.Compenrnion APPLIANCE - 4:00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with C.7 such provisions or.this permit shall'bedecmed,revoked. AIR HANDLING,UNIT(TO IOX0CFJA) 3:00 .FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.EM.) 5.00 - SEISMIC.FEE - I',.hereby affirm [but them is.aconstruction lending agency for '.EXHAUST HOOD(WITH DUCT) 2;00 the performance of the work for which this m rpilis.issued(Sec. - -0 3MICROFILM Lender's am HEATING UNIT(TO,100,000'B.T.U.) 4.00 307,Ci Name' Lender's Address HEATI NG UN IT(OV ER 100;000 B.T.U.)7.50 ELECTRIC Icertify,that I have mild this application and state that the above VENTILATION.FAN.(SINGLE)' -3.00 information is correct I agree to comply with all city and county PLUMBING and na ccs and'stale laws relating to budding.construction and BOILER-COMP(3H.P.or100,000B.T.U:) 4.00 It authorize representatives of this city to nt r•upon the gOILERCOMP IDveY tpp,000 RTU above-mentioned property for:inspection,purposes )SEE FEE SCH, MECHANICAL (we),agree.to save, indemnify and keep harmlCss the City of MISC.- REFER'TO ORD. 'CupeRino against'Ilabllilies,judgments, costs and;Lxpemses.which may.in way accrue against said City in consequence of the PERMIT ISSUANCE .300 CONST.TAX granfing of Is pcpppprt.. � i yam' _/ MECH.CONT: LIC.NO. MECH. SI nature o A�/ `�� �� TOTAL TOTAL, R PPIcantlCon—T---trmror Ua«' OFFIC@ COPY APPLICANT TO FILL IN INFORMATION WITHIN RED.LINES — USE BALL POINT PEN.ON LY J3U I LDINGPROJECT I DENT FICATION V - ` PERMIT NUMBER sr -` noloA sG BUILDING APPit CTRIICCALOIPL&BInIR—NI CHANICAL 415 :OWNER'S — — -- --- -- - --^— -- PLAN CHECK VALIDATION rvnME/m/ QTY. _ ELECTRICPERMIT PEE O 'F/E //�O PHONE" - •• ,CONTRACTORS NAME- _, r:, ,OUTLETS,-SWITCHES-RECEP' _5.0011.00 ZZcr- �' m.No Q - LIGHTIN 3:FIXTURES ,5.00/1,00, DNrRAcioRs. PPLIANCES-'.RESIDENTIAL 4.00 m AODREas p7' -' 'V :PHONE D PANELS - 5:00 (SIM DATE OF APPLICATION ARCHI ECTPLAN CHECKFEE PC NO. OR .. SIGNS 6.00 _ ._ ENGINEERII LIC.NO. SIGNSTRANS. 100 - ARCH.ORENG. .- PERMIT VALI DATION ADDRESS .. SPECIALCIRCUIT 5.00, - :ZIP TEMP.,METER OR=POLE`INS. 15:00 APPucarvrs' _ - MOTORS, SEE FEESCH: �� � ,ADDRES - � /� , O Sia. C/?y IV SERVICE CHANGE:: . 10.00 LICENSED CONTRACTORS DECLARATION - �'/�/ ' I hereby.affirmdha[1 am licenred under provlslons of CHapter9 - H-¢, _ -'E NCE DATE (commemm�g with Sectmn]000)of Divisiun 3 of the Businessand D Z Professions Code n - BLDG: ':E PLG. '.MECH. s- z y license Is m full fow{�nd [{�L; _ z Z u� - Li'"in Class tic Number�!!� fS /3 �. - °� �.°w! Date ¢ ¢ a. r r•eOWNER-BUILDER DECLARATION - B L ING'PERMIT °w° MISC - ' REFERITO'ORD - I /INFORMATION X,3:LL•N, I hereby affirm That I am exempt from the Con[raclor's'License VALUATION' $/FL. u.°¢'. Law for the followin reason.(Sec_7031.5. Professions '6.00 I- .y - g PERMIT'ISSUANCE a Cade Any city or county which requrzesa permit to o..suanc .also, - ¢ ¢ ¢X Improve,demolish or repair any structure;prior to ns Issuance,also ;CLEC:CONTp ^, �/O /`/ ELEC... ,�` °¢ 'requires nthe'dpursua forshe pieomni.of the Contscale's ntlhat F4f/�rt•�'6J .C3O TOTAL LT To. w.$y" ^he rs licensed pursuant to ing with of the Contractor's License - - r (Chapter 9 or that ]000)ofDWisionom the and Business for the allege ns Code)or that he is exempt actio rom 1.5 CITY. - PLUMBINGiPERM1T 'FEE: ¢H c the bans for.fie alleged exemption:Any.`vioialion of Section 7031:5 - STORIES TYPE CONSTR. .,F.w- by any applicant for a permit subjects the applicant7to a civil penalty of not more than five hundred dollars(S500).): - ALTER-DRAIW&VENT-WATER (EA;):"4.00 ❑ 1,as,owner of the.property,or my employees with wagesas -—'BACK FLOW-PROTECT:DEVICE': their sole compensation,will do the.work and the structure is not 2,00 OCC.GROUP RES:UNITS Intended or offered for.,ale (Sec..7044. Business and Not'csxioms DRAINS-FLOOR;ROOF,AREA,COND. 4:00 'C.de.,The Contractor.'s License Law does not.apply to'an'owner of - ; property who tiilds or Improves thereon and who docs such work FIXTURES-PER TRAP' ,4,00 - SO.FT:FLOOR AREA TOTAL ACREAGE O 'himself Or through his own employees provided that such improve- - _ . - , mens are no[intended or.ffered for sale If,however the building - GAS-EA.SYSTEM-1 1 NC.4OUTLETS 4.00 . or improvement is Sold within one year,of comp........The.owner- ' _ builder will have"the"burdemof proving that lie didnot build or.ion. GAS EA.,SYSTEM.yOVER 4'(EA.), •1,o0 BUILD USE 'prove for L'aso nee of sale).- INDUSTRIA, L.WAST,E INTER. HES: .IND PB. Omar . ❑ I,'as owner of the property•am exclusivdygcontracling wish 20.00 ❑ -� hcenwalaomtractors to construct the'projec['.(Sec..7044.Business' LAWN,SPRINKLERS-1'INC5 V:B: '5.00 A$SESSOARCEL NO. ,and Professions Code:The Contractor's License'Law does not apply.'_ - - to an owner oLproper[y who buildsor"infrove,thereon:and who LAWN SPRINKLERS-OVER 5(EA'.)' 1.00 ' 'contracts for such projects with a conlrac[or(s)licensed pursuant to - '- 'the Contractor's�LlcenseLew. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. _PARCEL NO.11 - �reesonlamexemptunder,Sec: tB&P.0::for finis ' WATERT HEATER WJVENT - 4:00 Data Owner WATER=SYSTEM . 4':00 ACC.DATE ACCrFILE NO. WORKERS'COMPENSATION DECLARATION. WATER2REATING EQUIP. 4100 1 hereby affinovdiat 1 have a certificate,ofco..sent'to sell'-insure; -. :or:a certificate of Workers'Compensation lnsummc or eScer(ifitd. ZONING., FNGi SITE NO: :ropy thereoflSec 3800;Lab.C.). '°p - - - N Policyy No Q, fd�Tertified'copy is hereby Yurnished;' ' Z z ❑'Cert I;fI with the city inspection div,ision.- _ FIRE SPRINK 'ENERGY T 24 P:'2 'Applmant C (J MISC.;_ REFER TO"ORD . y � NQ v0- N�, 2'y CERTIFICATE'OF.EXEMPTION.FROM WORKERS' .:e PERMIT'ISSUANCE ` i. - 6.00 F LOOD ZONE A.L.U.C: ' UJr>_, COMPENSATION INSURANCE PLG:CONTR. C.NO. PLO 9 (This section need not be completed,it"llic permitlis for one -- TOTAL ` ,v N Y[ NE] -)'Z• hundred dollars IS 100)or less. : - - L5 I eertity,that in the performan a of the work for which lhis per- FEE'SUMMARY' LL f mit Is issued,'[shall not employ,any persomioany..no no us m' Qom' (MECHANICAL PERMIT FEE O w became subject to the Workers'Compensation Laws of Calif.nia. a. Date -APPLICANT: ALTER OR;ADO TO MECH. - BUILDING } Z; N prion,you APPLICANT.e suafter to the this rs'Comp of ion - 4.00 „- _ emvision yor s he L become Cosubject tmost Workers Gcomply with, APPLIANCE' " - ,. 4.00 ' PLAN CHECK provlslons of the Labor Code; you most drevoke=comply with FEE U such provisions or this permit shall be deemed revoked. AIR-HANDLING UNIT(TO 10,000GP.M.) '3.00 - CONSTRUCTION.LENDINGAGENCY AIR HANDLING UNIT(OVER.10=C.EM:),5.00 .SEISMIC FEE I hereby affirm that there'is a construction lending agency for EXHAUST HOOD(WITH'DUCT) 12;00 the performance of the.work for which.this permit islissue,ISeci _ - MICROFILM 3097 Civ:c.)I - HEATING UNIT(TO100,000 B.T.U.): 4.00 tender's Name Lend I certifyahat I have read this appllcation and state that the above VENTILATION FAN (SINGLE)0 B T U`IT!50. ELECTRIC ' (SINGLE) 3:00 ` ordinances n correct I.gran.comply-withbuilding all nstrund countynd - PLUMBING', .ordinances and state laws relating t building onster,ion, and .BOILER-COMP(3 H.P.°''100,0008T.U.)'4.00 ,hereby authorize roperty for ins of this citytoentero upon.the - , ,hereby for inspection purposes. BOILER-COMP'IOver tO0,000HTW SEEFEE$CH.: MECHANICAL. &(We) agree lo:save,'mdemnify,and keep harmless the,City:oL MISC:- REFER'TO'ORD. -' Pertlinm a geinst'habihtses;judgments, Costs and expenses`which, - may in any weyacerue against said City In consequence of tlie: PERMIT ISSUANCE; .3,00 CONST.TAX - granlingof spermit.,- MECH.CONT. - LIC.NO,� MECH. aTOTAL. ' S Signature of PPUCant(CortTaCtO1 Date - `OFFICE.COPY - - f APPLICANT TO F:ILL,IN INFORMATION WITHIN RED LINES - VSE BALL_ POINT PEN ONLY w .BUILDING PROJECT IIDENTIFICATION/ -i�l% ' PERMIT.NUMBEq APPLICATION'& PERMIT BUILDING — 4 - • wDDRESan J�' /7 rC /•' oC�(pJ� C�ELES" C.X R� BUILDING— ELECTRICAL-PLUMBING—,MECHANICALS - ' OWNERS r �- - PLAN CHECK VALIDATION'_ NAME ELECTRIC PERMIT -FEE - �' ��' • ��jPXONE�J 6' •' •CONTRACTOR'a NAME rvAME '- �•,• UTLETSSWITCHES-RECEP> '5-00/1'!00 `�[ ,�/�Q�prTEMP.,METEROR LIGHTING FIXTURES 5.00/1.00 ADDRESS APPLIANCES PPLIANCES-RESIDENTIAL' 4.00 /° -�H PHONE PANELS 5.00"4- DATE OF APPLICATION ' ARCHITECT PLANCHECKFEE P.C.NO. OR - SIGNS 6.00' , ENGINEER LIC;NO. SIGNS TRANS: " 3100 ARCH.OR ENG. - - PERMIT VALIDATION' ADDREss SPECIALCIRCUIT 5.00 _ ZIP POLE INS. "15.00' ADDRESS Ta - MOTORS • 11A SEE'FEE SCH. t.7- aCY MSC cL/O SL p�� SERVICE CHANGE 10.00' FO o LICENSED CONTRACTORSDECLARATION l / Q,u I hereby affirm that 1 am licensed under provisions of Chapter 9 a a_a, (commencing with Section 7000)of,Division'3 of the Business and (SSU NCE DATE p. Profession C and m .license Is In full foryy BLOC. ELE T. PLG. MECH. o 0,12 c L¢ense Class y LieNumber?t(!1/ .3 ,1.. El 1:1 � N f. DaleT i Contractor Q y f J ¢ ¢.w 4 OWNER-BUILDER DECLARATION' - BUILDING PERMIT a o w x ;LL_r I herebyaffirm that I am exam IRroln the Contractor's License MIBC:— REFER TO ORD INFORMATION ' - u, u. La.rorte following reason.(Sec.7031.5,031.5,Business and Professions PERMIT ISSUANCE B.00' VALUATION $/FT. 'v, Code:Any city or county which requires a permit to construct.alter,. - - a ¢ 4Improve,demolish,or repair any structum,prior to drssam s uce:also ,ELEC.CONTR. LIC.NO. ElE0. / n a.01¢ regwres the applicant for such permit l0 file a signed statement ��Y'% G'O�6/ TOTAL '(p X�'�w he Is licensed pursuant to the provisions of the Contractor's License PERMIT TO Fi> Law(Chapter 9(commencing with Section 7000)ofDWisiun 3 ofthe zc Business andProfessions Code)or that he is exempt lherefrom and CITY. PLUMBING PERMIT FEE. the basis for the alleged'exemption.Any violation of5eclfon 7031.5 STORIES TYPE CONSTR. by any applicant U fora permit subjects the applicanoecivil penally ALTER-DRAIN -WATER of not more than five hundred dollars(5500):); (EA.) 4.00 ❑ 1,as owner:of the property,or my employees with wage,., BACK FLOW PROTECTDEVICE 200 theinsole compensation,will do the work,and;the.structure is not' : . 'OCC.GROUP' 'RES:_UNITS intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AR EA,CONE). 4.00 Code:The'Contmelor's,License Law does not apply to an owner.of - - propertywho builds or improves thereon.and'who does such work FIXTURES-PEO TRAP 4.00 saFT.FLaoR AREA -Torwc ALREweE • himself or through his own employees,provided'that such improve- ments are.nol intended or offered for sale.If,Imovevier,the building GAS-EA.SYSTEM-11NC.4,0UTLETS 4.00 . or Improvement Issold withinone year of complUron,.the.owner- builder will have the burdenmof pmving that he did not build or im- GAS-EA.SYSTEM-.OVER 4(EA.) 1.00 ,BUILDING USE provefor purpose of sale.). - ARES ILO: P0 - Ouiar. ' ❑.9,as;owneroflthe property,am exclusively contracting with INDUSTRIAL WASTE INTER.' 20.00 - ❑ ' _ El I. licensed contraclois to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5:00 and Professions Code.The Contractor's License Law does not apply - - a 11" PARCEL NO: loan owner'of'property who builds or improves'fhereon,and who, LAW_ N SPRINKLERS-'OVER 5(EA.) 1,00 . .. contracts for such projects with a,contractorl s)'licensed pursuant l0 - - - the Contractor's License Law., SEWER-SANITARY-STORM EA.200ft/8.00 TRACT No. PARCEL NO. ❑ 'l'am exempt under Sec..,B.&P,C.kir Wit reasonWATER HEATER W/VENT 4.00 Date Owner WATER SYSTEM - 4.00 ACG DATE ACC.FILE NO. WORKERS'COMPF,NSATION DECLARATION WATER'TREATING EQUIP. 4.00 ' I hereby affirm that ['haveacertificate of consent ro self-insure',. ' or aleerliffcale of Workers'Compensation Insurance,or a certified - ZONING ENG.SITE NO. Policy No; f5ec.38Co Lany*'�yti p/.:/9 - - , Policy No: is hereby ed. _ 0 ef"0 Ccrlifmd cop k,hereby furnished., - FIRE SPRINK ENERGY T Q4 "Z Z ❑ Certifiey�, i' filed with 41ie city inspection division. F O Applicant -tip �7• MISC:- REF,ER TO'ORD. Y Q N ,v NQ' .M'N ,CERTIFICATE OF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A:LlU.C. LU COMPENSATION INSURANCE PLc�coNTR. LIC.,No. PLG ' Q. O (This.section need of be completed.if the permit is for one TOTAL 'Y Q N� Y�, N� �,Z hundred dollars IS 100)or less.) ' V O 1-certify that in the performance of the work for which this per- CITY FEE SUMMARY LL F mit is issued,1,shall�wl employ any person any'mannvcso as to MECHANICAL PERMIT FEE O,W become subject to the Workers'Compensaliom Lawspf California: _ '0. .Dale 0 1Applicant ALTER OR BUILDING' ' } w NOTICE TO.APPLICANT: if,alter making.this Certificate of"Ex, ADD TO MECH. _ 4.00 •�-Z emption;youshould Become subject totbe WorkeK.Compenvation APPLIANCE provlsions:of the Labor Code,.you must forthwith cnmPLAN CHECK ply'with 4.00 d / U such provisions or this permit'shall be deemed revoked. - AIR HANDLING UNIT(TO 10,WOCF.M1 3.00 ; I FEE _ CONSTRUCTION LENDING'AGENCh' AIR HANDLING UNIT(OVER I0100CFM.) 5:00 ';SEISMIC FEE 1 hereby.affirm that the. is a construction lending agency for EXHAUST HOOD,(WITH'.DUCT) 2.00 Lha performance of the;work for which this.permit is issued(Sec. - - - MICROFILM - 3ender%.am HEATING UNIT(TO 100,000 B'.T.U.) 4'.00 .Lender's Name - ��77ss Lender's Address - HEATINGUNIT(OVER100,000B.T.U.)7.50 ELECTRIC ' I certify that l have read this application and state that the above ' VENTILATION:FAN (SINGLE) :300 . - information is correct I agree to comply . With all City und4bunly PLUMBING - ordinances and,state laws relating to building construction. and BOILER-COMP 13 H.P.or 100,000 RT.U.) 4.00 hereby authorize represumativeg of this city to enter upon the above-mentioned property for inspection'purposes. BOILER•COMP(Ovari(D,OOO BTU)SEE FEE SCH: „ MECHANICAL (We)'agree 10 save. indemnify and keep harmless the City of MISC..- .,REFER'TO ORD: Cupertino against liabilities..judgments, costs andexpenses which - may in any way,accrue again said City in consequence of the PERMIT ISSUANCE 9:00 CONST.TAX grdnlingOpemll[. /y MECH.CONT. LI C.NO. - MECH. f2—T=X•� TOTAL TOTAL A ;Slgnetureof Applicant( oridouror Date / OFFICE COPY // APPLICANT TO FILL-IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 'BUILDING PROJECT IDENTIFICATION ' PERM I?NUMBER BUILDING APPLICATION & PERMIT p ADDRESS - L� C' LE3 ea BUILDING —ELECTRICAL-PLUMBING—MECHANICAL 157 OWNER'S -- - - - - -- —'-- --- --- - — '-- PLAN CHECK VALIDATION "Am! bTY. ELECTRIC PERMIT' FEE /r']eO HONE ' F CONTRACTOR'S NAME �j' UTLETS-SWITCHES.-RECEP 5.00/1.00 viiRg G`' LIC:rvo /r' (p/,3/ LIGHTING FIXTURES .5.00/1.00 CONTRACTOR'S ADDRESS PPLIANCES-RESIDENTIAL. � 4100 App_ l7 PHONEW;; PANELS 5:00 DATE OF APPLICATION ARCH TECT PLAN.CHECK FEE PC.NO. OR - SIGNS- - 6.00 ENGINEER ' LIC.No. SIGNS TRANS. 3.001 ' ARCH,00 ENG. $PECIALCIRCUIT 5.00 PERMIT,VALIDATION ZIP TEMP.METER OR POLE INS. 15.00 - APPLICANT'S AODREssi n �" MOTORS SEE FEE SCH. ( j,(•-/ J J N d SERVICE CHANGE 10.00 w ac 000 LICENSED CONTRA ORS,DECLARATION au L, I hereby,affirm that I am licensed under,provisions of Chapter 9 _ N (commencing with w���ith Section 7000)of Division.3 of the Business and ISSUANCE DATE 'H4 <.x BLDG.. E PLG. MECH: r D.i Professions C my'licenseis inlullfdf6,mlyu((s� - a; O — License Clatt Lm.Number':[Cd/S/LT � ,El El 9 Zm p.w Dale/Contractor ac W a OWNER-BUILDER'DF.CLA RATION BUILDING PERMIT S.O A o - 'INFORMATION X ; I- Thereby affirm that l am'exempt from the Contractor's Lice nu MISC.— REFER TO ORD' . u O a Law for the followingreason.(Sec.7031,5•Businessland Professions VALUATION SIFT. 3 -m - u PERMIT ISSUANCE 6.00 - 2 w'>. Code. e.demysh county which Structure permrtoits ito ssuance: also - aa; <l�p. Improve,demolish,or repair any siructum,prior to its rssuancefalso ELEC.CONTR. LIC.NO' ELEC. e m requires the applicant for such permit to file a.signed stalemenl that 5'^_ GI/Q��/�/ OTAL�6 iw�'M he Is licensed pursuant to the provisions of the Contractor's License PER T TO Li>. Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)'or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE I$ the basis for the alleged exemption.Any violation of Section 7031.5. STORIES, TYPE CONSTR. iR by otmony applicanthar five Permit subjects 5500).licam toacivil penalty ALTER-DRAIN VENT-WATER (EA.) 4.00 of not mart owner foo hundred eerty,o(my em: ❑ [.as owner of the property,or my employees with:wages as BACKFLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation.will'do'the,work;and thestrudure is not intended'or.offered Too sale(Sec. 7044. Business.and Professions DRAINS-FLOORROOF, 4.00 Cade:The Contractor's License Law does not apply to an owner.of , , -- propertywho 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. ` ments are not intended,oroffered.for sale.If,however the building GAS-EA.SYSTEM-11 NC.4 OUTLETS'4.00 or improvement is Sold within one year of completion:the ownerr. GAS EA.SYSTEM-OVER 4 IEA.) .1:00 builder will have the burden of proving that he did not build or int- IU I L121NQ USE prove for Lass neeose of sthe.). INDUSTRIAL WASTE INTER. ❑ I❑. ❑ O❑` ❑ I,as owner of aft.). rty,am czdusively uommcting wiW 20.00 licensed contractorsgo construct the project(Sec. 7044,Business LAWN SPRINKLERS. 1 INC 5•V.B. 5.00 gS51 a CEL No-. and Professions Code.The Contractor's License Law does not apply I. to Bn owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 eontnewdor such projects with a contractor(s)licensed pursuant to the Contractor's License Law: SEWER-SANITARY-STORM EA.200ft/8:00 TRACT NO. PARCEL NO. re1 am exempt under See.son ,BAP.C.for this WATER HEATER W/VENT 4.00 .Dote Owner. WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS-COMPENSATION.DECLARATION - WATER TREATING"EQUIP. 4.00 Ihereby affirm that Chave a certificate of-consent to self-insure, or a certificate of Workers Compensation Insurance,ora certified, ZONING .ENG.SITE NO; copy thereof(Sec.3800,Gb.G.).�/g p /A - - Poli�cY�a. Company Q Ids LertiGedtopy is hereby furnished. thth. O Z 2 Cerlifiey��, isI-nl wrb-, e city-insped FIRE SPRINK ENERGY Td4 Tun division. O Applicant L�'U"NN�J MISC.- REFER TO ORD. y ] No Y ❑ N� H CERTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE: A.L.U.C. IL > COMPENSATION INSURANCE.- P,LG:CONTR. LIC.NO. PLG. ' a IThis,seclion need not be completed if the permit is for one - TOTAL E] Y E) NE] � Z hundreddollars(SIOOtarhss.) U O I certify that In the performans.epfthe work for which this per- OT7. -MECHANICAL PERMIT FEE SUMMARY LL F mil is Issued, r hall not employ any person in any mann r do as to FEE`- O W become subject to:the Workc.'Compcm.2R Lawsof California. y Darr Applicant ALTER OR ADD TO MECH. 4.00 BUILDING } W NOTICE TO;APPLI Applicant ll;after making this Certificate of Ex Z cmotion,'yop should hvcome'subject to the Workers.Compensation APPLIANCE 4.00 PLAN CHECK provisions of theLabor Code, you must forthwith comply with C..1 such provisions or this permit shall be ticemed revoked. AIR HANDLING UNIT(TO'10JX0QF.M.).. 3.00 FEE CONSTRUCTION LENDING ACENCV AIR HANDLING UNIT(OVER10MC.F.M.) 5.00 SEISMIC FEE - I hereby affirm that there is-a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the performances of the work,for'which this',permit is.issued(Seca - MICROFILM '3097,CN.C.). HEATING UNIT(TO 100.000 B.T.U.). 4.00 . Lender's Name Lenders Address 14EATI NG UNIT(OV ER 100;000 B.T.U.)7:50 ELECTRIC certify that have read'this application and state that the above VENTILATION FAN (SINGLE), 3.00 .information is cot eU I agree to comply with;all city and county PLUMBING ordinances and slate laws relating to budding onstruction. and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00 hereby authorize representatives of Ihns city toe ter 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.OR D. Cupertino,against liabilities;,judgments, costs and expenses which may In any,way accrue against said City in consequence of the. PERMIT ISSUANCE 3.00 CONST.TAX Starting Is.Pe�it, MECH.CONT. LIC.NO. MECH. 114/ � /— /9— ,V' TOTAL- Date . TOTAL Signature of ApphranUCanlradar OFFICE COPY f APPLICANT TO FILL IN INFORMATION:WITHIN RED LINES- USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT,NUMBER BVILDINa APPLICATION & PERMIT. A 1 C Q ADDRESS - ft I J 0 D(o60C'ELESIE L'/,2� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S - PLAN CHECK VALIDATION NAME�/J�/C//tJ.yw' ,7 n OTY. ELECTRIC PERMIT FEE Y-/G( /V�IT �OPPHONE ,[ - • �CONTRACTORS NAME r UTLETS-SWITCHES-RECEP 5:00/1.00 LIGHTING FIXTURES 5.0011.00 ADDRESS - CDNTRACrOR•s. APPLIANCES-RESIDENTIAL 4.00 - - 6 s'FPHonE PANELS 5.00 —S7qd, DATE OF APPLICATION ARCHITECT. SIGNS 6.00ENGINEER PLAN CHECK FEE P.C.NO. uc.No. SIGNS TRANS. - 3._00 ARCH.OR ENG. PERMIT VALIDATION, 'ADDRESS SPECIAL CIRCUIT - 5.00, ` ZIP .EMP.METER OR.POLE INS. 15.00 (' APPLICANT'S - MOTORS SEE FEE SCH1 J ADDRESS, 5'7- qW SERVICE CHANGE 10.00 W o,o' LICENSEDCONTRACT RS DECLARATION a u u I hereby affirm that 1 am licensed under provisions 61 chapter 9 _ " I a tcommencing with Seetion7000j of Division 3 of the Business an0 ISSUANCE DATE o Oz Professions Code d,�,prlIYy license is in full for'��//yynnd;;QQac}} BLDG. E 'EC . PLG. 'MECH. o2:�r-x.o. Lscox'ClassCL'Lic Number�I(lx7 _ ❑ Q,y f.� Daley.11=_PSI�Conlrac[or.' ¢ ¢.X sr • OWNER-BBUILDER DECLARATION - BUI DING PERMIT > O : MISC.- REFER TO ORD INFORMATION x 0 W.N I hereby affirm IhaDl'am exempt from the Contractor's License F o J, Law for the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 6.00 VALUATION SIFT w.os COdeAAny citynr county!which m4turesapernit toconslrucl,alter. ¢ ¢ Q O Improve,demolish.orrepair.any structure:prior to its issuance,also ELEC.0 TR i v._. LIC.NO. ELEC - c g D u quires the applicant for such permit to file a signed statement That CS� e CT CIO r�� AlL of PERMIT TO w e4 m' he is licensed pursuant to the provisions of the Contractors License - > Law!Chapter 9(commencing with Section 7000)of Division 3ofahe f 4 c Buainesa and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE' ¢'}e the basis for the alleged exempllon.Any,violation of Section 7031.5 „ STORIES TYPE CONSTR. aim . by 4ny epplicam faro permit subjects the applicdnrtoacivil penalty ALTER-DRAIN'&tVENT-WATER IEAJ 4.00 of notmore th4n five hundred dolmrs(45001.):: ❑ 1.as owner of the property,or my employees with wagcsas BACK FLOW,PROTECT.DEVICE '2,00 their Sale compensation,.will.do[lie work,and the slruel um IS not OCC.GROUP RES.UNITS intendad;or offered for.sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code The.Contractor's.License Law does not apply to as owner of property who-builds or improves lhemon',3nd 1odocssue1,wor1 FIXTURES-PERTRAP 4.00 3O:FT.FLOOR AREA TOTAL ACREAGE himself ar:Ihrough,hls own employees.provided that such.improve- 'mems are not intended orIoffered for sale If.however,the building GAS-EA.SYSTEM-I INCA OUTLETS 4.00 or improvement Is Sold within one year of completion.the owner- GAS-EA.SYSTEM-OVER 4 IEA.) y•OO builder:will have tile.burden of proving that be did not build or ism BUIL IN USE prove fon purpose of sale.)'.i INDUSTRIAL WASTE INTER. 20.00 RES IND - CO PB' Other ❑ L.asowner of the construct lY.he rojectvc ec. 7044. Business ih ❑ ❑ ❑ 0 and Pod,mntmclors toe the pmcenslS c. does r Business LAWNSPRIN SPRINKLERS-1 INC 5V.8• 5.00 ASSESSON RCEL NO; to in owner os Code' ty who hbuildsContractor's improv Law does not apply to aq cts for of property s with builds sono licensedes pursuant who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a commctbnsl licensed pursuarii to the Contractor's License.Law. SEWER-SANITARY-STORM EA:200ft/8.00 TRACT NO. PARCEL NO.. ❑ lam exempt under Sec. .B.&flC'.lin.ibis re4.00 . mason WATER I Date Owner WATER.SYSTEM 4,00 ACC.DATE i ACC:FILE NO. WORKERS'COMPENSATION DECLARATION WATER:TREATING EQUIP. 4.00 I hereby;affitto that I !hive a certificate of consent to self-insure, SII, oTa cerli5cam of Workers'Compensation Insurance:or a certified ZONING ENG.SITE NO: copy thereof lSec.3g00l Lab,CPoli .1.'/�„q�G/ 9��• ., enified copy is hereby Krnished. Z 2 O CertifiZ y y�is. l with the cityinspectiondivision. FIRESPRINK ENERGY 24 F"O APphcant- QPC-lU MISC.- . REFER TO ORD. r�„ N�,; Y [] N , X N CERTIFICATE OF EXEMPTION'.FROM WORKERS' PERMIT ISSUANCE 6.00 PLOOD ZONE A.L.U.G. El W 1 COMPENSATION.INSURANCE PLO.CONTR. _ LIC.NO. ' ,PLG. CL Z (This section need not be completed if the permit is for One TOTAL YN� Y� hundred dollars IS 100)orlesa.)' - f) OLcertify that In the performance'of the work far which this per 'QTY. LL U mit Is Issued,.)shall not employiany person in any Manner so as toy 'MECHANICAL PERMIT FEE IEEE SUMMARY O W become subject to the Workers.Compensation Laws of Califooiia. y Date Applicant - ALTER OR ADD Ta MECH. .4.00 BUILDING } N ,NOTICE TO APPLICANT: If,alter making;this Certificate.of Ex- ?' emp!um,you should become subject to the Workers'Compnsat eion APPLIANCE C 4.00 provisions of the Labor Code, you'must forthwlth,comply with PLAN•CHECK fJ such provisions or this permit shall be deemed'revoked.. AIR HANDLING UNIT(TO 10=C.F.M.) •3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVERIOp00GFM.15.00 SEISMIC FEE I hereby afOrm.that there is alconstruction lendiog'ugency for EXHAUST HOOD(WITH DUCT) 2,00 the performanceof the work for.which this permit is:issued Sec. - 3097 CY.C.)., HEATINGiUN IT(TO100,000.B.T.U.) 4.00 MICROFILM Lender's Name Lender's Address HEATING UN IT(OVER B.T.UJ7.50. ELECTRIC I Certify.that l have mad this uppl¢ationand stale that the above VENTILATION FAN (SINGLE) 3.00 'information n correct I agree to comply with all nst ucti county BOILER-COMP PLUMBING ordinances uthori state laws atives k to building -enter upon and (3 H.P.or 100,000 B.T.U:) 4:00 .hereby artionezc roperty far ins of on pu po to Ater upon aha BOI LER-COMP IOver100.000 BTU)SEE F,EE SCH. .above-mentioned property lar inspection purposes. - MECHANICAL (We) agree toaave_Indemnify and:keep'harmlcss Ole Cil,of MISC_.- REFER.TO'ORD. Cupertino against liabilities,judgments, costs and expenses which - may in any way awrue against said City'in konse4,u,rce of the PERMIT ISSUANCE. 3 CONST.TAX granting' mis permit. MECH.CONT. FIC.NO. MECH: gl nature of FAL- TOTAL Date TDTAL. g pPllwnt/Contmdor ` OFFICE DOPY -