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3564 20662-69 CELESTE CI R 3564 F DE ANZA PROPERTIES SCANNED BOX # 783 CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE IU CITY OFF CUPERTINO C/ DATE Iy 1 7 , 19 0 BLDG, PERMIT NO. i THE BLDG. LOCATED AT 07 0 66 Z- g ( C e 7-e C�'r i OWNED BY _ U Z� HAS BEEN " PLEI ED, FOR USE AS (ALTERED), Cd UQ40 W I IA r i W J- / BUILDING INSPECTOR (/ 7 C-11'Y OF, CUPERTINO TITSPYGTIOI! RECORD (Office ,C 3564 Lot 3, Bldg. 3 20662-69 Celeste Circle Rpin'r NO. SANITARY SANITARY DIST NO. LOT NO. Const. 8 Units DeAnza Properties PROJECT OWNER JOB SITE P11014E NO. PERMIT ISSUED Date ELECTRICAL Building 5/11133 Date Insp. Electrical Power Pole lumhiny Underground Mechanical IR—ouOt Ilir, ng R Tem). Cls/Elcct. (labs Solar Ceiling Fire Sprinkler Fixtures int/Ext Sign llotors Grounding -2,3-JL .9 V Misc. Temp. Power Other FINAL INSPECTIONS Not Approved Date Insp. r,,7S Flee,tric PLUMBING Date Insp. PItimbity, Backflow Mechanical Underground Solar Underfloor Pool Partial Rough Grading Rough Complete ge Planning Fire De t. Solar Pough Water F, Insulation Health De t. Main Drain BUilding R/of/S Drain Other Gas Other BUILDING Not Approved Date Insp. Fad Certification IIECIIANICAL Foundation .3 -13-9 Date Insp. Pre-Gunite Underfloor S.N. Slab-Membrane Ducts & Insulation,* Bond Beam Fire Dampers Underfloor GirdersFireplace Floor Steel T�iedowns Grease Duct & Hood One Hour Shaft Dj,iplirams Condensate—Dra—in--- nL Equipmenl: Anchorage halls-Panels Flues Frame & Comb. Air lath Not Approved Flz—illboards Int/Ext. Firewalls *t Other Not Approved Rfa\,u vfikt -Q � U%T BUILDING • 1 i i ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS �i APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI'FICATION / PERMIT ER BUILDING ION & PERMIT 35�.A A RE9 - - J J `F DING-ELECTRICAL-PLUMBING,-MECHANICAL rveR's - -�- - , ------ - --�_- - -- - ------ PLAN CHECK VALIDATION ME CITY. ELECTRIC PERMIT - FEE MNAP. ONTRq TOR'5 NAMg UT.LETS-SWITCHES-RECEP 5.0011.00 5 LIC.NO. ILIGHTING FIXTURES 5.00/1.00 DOTRAS RRAcrons CONPPLIANCES-RESIDENTIAL, 4.00 PHONE PANELS - 5.00 DATE OF APPLICATION ARRCHITECT or 4AAA�RsSIGNS 600 PLAN CHECK FEE P,C.NO. ENG! SIGNS TRANS. 3.00 �iE_ZT ARCH: ALID N OR ENG. - PER T,V ADDRESS SPECIALCIRCUIT 5.00 �/yyy J{/� ZIP TEMP.METER OR'POLE INS. 15.00 APPLICANT'S_ MOTORS ADDRESS SEE FEE SCH617 1„nl/��"•A��jP (�/aAT/ �GKAf SERVICE CHANGE 10:00 w.o'o LICENSED CO RA ORS DECLARA ON <u.0 , I hereby affirm that Ilm]icensed under provisions of Chapter 9; G¢.w (commencing with Section of Division 3 of the Business and ISSUANCE DATE ]'i Professions Code,and.my license Is in full force;and effect BLDG. ELECT. PLG. MECH. ,. o 0 Wio License Class Lie.Number m s- j Date- Contractor F ¢¢ a OWNER-BUILDERDECLARATION _ BUILDING PERMIT H,oi" INFORMATION X I hereby affirm that l am.excinpt from the Contractor,.License MISC.- REFER TO ORD p1 e o Q Law for the following reason.(Sue 7031.5,Busine[[and Prz IessiGron VALUATION $/FT. I- a PERMIT ISSUANCE 6.00 f w�4 Code.Any City orcounty whichrequuesapermit toconstruct.alter, - -_t w ¢ 6,0 improve,demolish,or repair any structure,prior tO Its issuance;aL[o ELEC.CONTit LIC.NO. � ////..� DLL re come the tic... Such ermit to file a sf ELEC: "`�.fff///ffa/// 9 Spirit p fined AalLmcal!bat TOTAL w$ he Is licensed punualn to The provisions otitic Contnctor's License" PERMIT TO/ F i.Q Law(Chapter9-col-toCII,with Section7000)of Dllsion3 of D¢ /WEER `ATO fi:D ,-'aufor Profile, Code) that hemsexempt ih•rcl'rom and CITY. PLUMBING FEE ¢ H g tor he basis for the allagcd ekvmptloa Any violofioii of Section 7031.5 STORIES TYPE L,OAN.�$TAR. c;. by any applidantlOra permit subjects theapplicam macivilpenalty ALTER-DRAIN&VENT-WATER'(EA.) 4.00 �,�y men of not more than five hundred dollars(55001.1: of ❑ I,as owner of "0'so or my employees with wage-San BACK�F LOW PROTECT. DEVICE 2;00 'herr sole campensmton,will do the work und;.thu structure is nut OCC.GROUP: R NITS' intended or offered+or Sale (Sec 7044 Busioes[and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 4.00' Code:The Contractor's License Law does not apply to an owner,of C! property.who builds ar lmpraYes thereon and who does suet,work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA :TOTAL ACREAGE hoSe.,.is o'not intik his ownemred fors Providedwever.the improve- memsarenolinle is woffered employees. pe if,howe ur such improve- building., GAS-EA.SYSTEM-1'INC.4OUTLETS 4.00 �/ or Improvement Is sold within.one year of completion the owner-'. I�/ bolder.01,iave the buiden,of,proving that he did not build or im-- - GAB'-EA.SYSTEM-'OVER 4 IEA.), 1.00 BUILDING USE. Z 1.as wner of(he property; - INDUSTRIAL WASTE INTER. 20.00 - •RES' IND CON - -PB Diner h as owner of the tractthe project ISS contracting 7044Bu with �Q F1 [D cdnmd contractors od to eC.ii a the project!Sec.7040.Business': - LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The who builds o !improv law does not apply to tr ct.for such property who ba cont r improves thereon,and who LAWN SPRINKLERS-OVER 5(EA''.) 1.00 JNZ-1,0 10 con uacts focsoch cense L.wv h a contractor(sl licensed pursuant 16 - (/. 0 . the Contractor's p.INdc Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT.NO. PARCEL NO. re❑RI a exempt tide SFci .e.&7C.fyr th`i�s' WATER HEATER WIVENT 4.00 'Jy�jf Datr e•'!-G�f WATER SYSTEM / 7 4.00 ACC:DATE' ACC:FILE NO. ' WORKERS'COMPENSATION DECLARATION WATER TREATING'EQUIP. 4.00 I herchyaffirm ihatl haven certificate of consent to sell'-insure, ' or o cc,tife.le of Workers'Compensation Insurance or a certified ZONING NING. ENG.SITE NO. Copy thereof(See.3800.Lab.C.). - .Policy No Company 0, ❑ Certified copy is hereby furnished. - ! :FIRPSPRINK' ENERGY T�24 Z Z ❑ Certified copy is filed with the city 'in pectiol division: p: 0 .Applicant IMISC.- REFER TO-ORD. •� NE] Y>4 NE] jr T CERTIFICATE OF EXEMPTION'FROM WORKERS' PERMIT ISSUANCE 6.00 W• COMPENSATION INSURANCE PLG.CONTR; LIG FLOOD ZONE NO. .PLG: (This..Section need not be completed if the permit is For one TOTAL - YN y$1p•Q 5"Z hundred dollars IS MO)or less.) U'O 1 certify-that in the performance'of the'work for.which this:per-• CITY MECHANICAL PERMIT W F mit Is issued,I'shall not employ any,person in any manner sous to FEE 0 WU, become subject to the Workers Compensation Laws of California: O• Dine Applidan! ALTER OR•ADD TO MECH. 4, BUILDING ' } W .NOTICE TO APPLICANT' If,aricr making this.Certificate.of Ex- -00 y, F- Z emption,you should become subject to The Workers Compensation' APPLIANCE ro4.00 PLAN CHECK pvlsions;of the Labor Code. you must forthwith comply with ; U such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10,000.C.F.M0 3.00 FEE + CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 1000DGEM) 5.00 'SEISMIC.FEE r _. I hereby affirm that there Is.arconstruction lending agency for EXHAUSFHOOD(WITH DUCT) 2.00 - the perforrnance of the•.work for which this permit is issued(Sec. ` 3097,CN.CJ. HEATING UNIT IT 0100,000'B.T.U.) 4:00 MICROFILM_ Lender's Name Lender's Address HEATI NG UNIT(OV ER 100,000 B.T.U.)7.50 ELECTRIC '' I arbfy than have read this application and state that the above VENTILATION FAN'ISINGLE) 3.00 - :informauodu correu I agree to!comply.with all city y and count ordm Sees and:mine las platin to building BOILER-COMP(3H.P.orlOO.000B.T.U.) 4.00 PLUMBING g g conser upon and hereby aulhoed representor muco of on city to enter upon the abovemvnoonedgropeny for inspeUlon'purposes BOILER-COMP(Over 10O,D00 BTU)$EE FEE$CH, MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.'- REFER TO : :ORD Cupertino against liabilities;judgments, costs and expenses wnicli CONST.TAX . may in any.way accrue against said City,in consequence of the PERMIT ISSUANCE 300 U pf t r It. MECH.CONT. LIC.NO. MECH. JTOTAL ate TOTAL �6 Si ore o(Appli n/ onuactar D�L OFFICE COPY APPLICANT TO FILL IN INFORMATION'WITHIN RED LINES - USE BALL POINT PEN ONLY , • •'• - _BUILDING PROJECT I DENTITICATION ' ,PERMIT NUMBER 1 BU"'c", . . ` " APPLICATION & PERMIT 41 80 AOOREss I �&^ A fir'-,„�/ / __— — I V {i^•' /l.x(V/S.(tlw\J/KD/ /V'l///a` BUILDING- ELECTRICAL-PLUMBING'-MECHANICAL OWNER'S - PLAN CHECK VALIDATION NAME //�f� '//�'/J�,(/ QTY. ELECTRIC PERMIT FEE . RACTO PNONE I Ord CONTRACTOR 5 //7.rye NAME �OUTLETS-SWITCHES-RECEP 5.00/7.00 �_II �N C LIGHTI NG`FIXTURES- 5.00/1.00 )3.0 �•s0 a� ADORES, OHS-. PPLIANCES-RESIDENTIAL . '4.00 aW - AO �EySa/,JI P �I O .��C.V JI .PHONE pyU PANELS 5.00 DATE OF APPLICATION ARCHITECT SIGNS .6.00 PLAN CHECK FEE P.C.NO: -ENGINEER • sec:No. � �=- SIGNS,TRANS. . 3.00' -ARCH.OR ENO, PER 4T TION ,ADPREas - SPECIAL CIRCUIT 5.00 - ZIP TEMP.METERtOR'POLE INS. 15.00 JUL '1 2,.1984 .APPLICANT'S - MOTORS' SEE FEE JVL 1(Ir 9 ADDRESS - ��-+•�� S'+ -'(',s•�/ - t ., JTa JN'IJloc SERVICE CHANGE - 10.00 City of Cupertino - '0o LICENSED CONTRACTORS DECLARATION Z I hereby affirm that I am licenses under provisions of Chopier9 ISSUANCE DATE H ,(commencing with Section.7000)'of Division 3 of the Business and - BLDG. E'ECT. PLG. MECH. Hoz Professions Code and my,licedse is In'full force ae fe( ' i.o q_ - .License lass ;Lac'Number i Y ❑ E Ory H w, D Contractor <'m BU DING PERMIT M w u 'OWNER-BUILDER DECLARATION x;.' H- I hereby affirm 1hal.I am exempt from the Contractor's License MISC."- REFERT R INFORMATION w 0< Law for the following reason:(Sec.703115„Business and Professions - VALUATION g)FT. _J :Code:An 'cit or count which requires PERMIT-ISSUANCE 8:00 ' y y y y y perani❑o construct, ac ¢ ¢o, improve,demolish or repair any structure,prior to its issuance,also E CLONTRy✓. ��J�. LIC NO ELE / �/� 'O LL, ;remakes the applicant for suchpermll to Dle a signed slaamcnt that u G� a r31 TOTAL I(¢.� PERMIT TO ><$m he is licensed pursuant to the withprovision'sti of the )ofDi tors License H i> Law fess and 9(commencingsoon, ode)or is exempt therefrom 3 and I i G the Business and he alleged exemption. or Thar he is exempt Iherefronand QTY. PLUMBING PERMIT FEE mrr� the say aplifor the alleged ermpubje Any violationof tto action703L5 STORIES, TYPE LONSTR: d,,; - -by any applicant fora permit subject[tic 500).)icam m a civil penalty ALTER-DRAIN IL V ENT-WATER JEAJ 4A0 of not more than Eve hundred dollars(5500).): _. ❑ 1,.as'owner of the property,or my employees with weyes es 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 far Sale (Sec. 7044, Business nntl Professions DRAINS-FLOOR.ROOF,AR EA,COND. 4.00 - Code:The Contrector's,License Low doeseot'apply to aonwner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SD Pr FLOG"HEA TOTAL himself or.through his own employees,provided that such impmvc - - •T . mens are notintended or offered for sale.If,however,the budding 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.) builder will have the burden of proving that he dad not build or im- 1.00 BUILDING USE. ,L -� prove for purpose of sale.): INDUSTRIAL WASTE9NTER- 20.00RES. IND o PB omen O I,asowner of the property,sin exclusively contrasting witli • 0 ❑ , ,licensedvcontractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS-�l"INC 5 V.B. '5.00 ASSESSOR P RCEL N0: and Professions Code:The CoMructro s License Law,does not apply toan'owner of property who builds or improves thereon..and who LAWN'SPRINKLERS-.OVER:5`(EA.) - 'too contractsfor such projects with,a cnrrtractons)licensed pursuant'to ' the Cuntmctor's License Law. SEWERSANITARY-STORM EA.200ft/8.00 ' - TRACT NO. PARCEL NO. R❑^I.am exempt uoder Sec. - ,8:&P.C.for this WATER•HEATER W/VENT 4.00 ssa "Date OwnCr WATER SYSTEM '4-00 aa.ACC.DATE ACC.FILE NO.. WORKERS'COMPENSATION DECLARATION WATER TREATING'EQUIP, '4,00 I limby.affirm that 1 haven certificate ofconsew to self-insure, or a certificate of Workersl.Comocamlion Insurance,o `certified ZONING. ENG.SITE NO, copy thereof)Sec.3800:Cdb.C.).w/A. Policy No.- 01 o. Company a♦/F 0 ❑ Certified copy is hereby(umished. FIRE gPRINK ENERGY T-24 Z'Z ❑ CertiEed�opy s�I�d with the MY inspccl ion division., H O Applicant 7" 4i MISC..- REFERiTO ORD. y'❑ No v 0 N❑ X w CERTIFICATE OF F-XEMH'I'ION.FROM WORKERS' PERMIT ISSUANCE - - 6.00 FLOOD ZONE A.L.U.G_. LU > -COMPENSATION INSURANCE PLG.CONTR. "LIC.NO. PLG. O' Q '(This section need not be completed if the permit is for one TOTAL - Y[:] N� Y Q NQ- Z hundred dollars IS 100)or less.) U O '1 certify that in theperformance of the work for which this per- QTY. MECHANICAL-PERMIT FEE FEE SUMMARY ” LL U mitis issued,I'shall not employ person in.any numner Se as to O W become subject to the Workeri Compensation Laws of California. _ y Date—Applicant, - ALTER OR ADD TO MECH. BUILDING } W NOTICE TO APPLICANT: after makingalhis Certificate of Ea 4.00 . F ? emption,you should Become subject to the Workers'Compensation APPLIANCE 4:00 PLAN CHECK provisions of the labor Code, you most forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO'IOMC.F.M.) 3.00 FEE CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10000C:RM.) 5.00 SEISMIC FEE 1 hereby affirm that them is 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 B1T.U.) 4.00 Lender's Name Lenders Address " HEATING'UNIT(OVER 100,000 B.T.U.17.50 ELECTRIC. I certify that i loWcoad thisappllcome and State that theahove VENTILATION FAN (SINGLE) 3,00 ar information is correct 1 agree to comply with all city and county PLUMBING ordinances rend slate laws"relating to building construction:-.and BAILER-CON�(3 H.P.or 900,000 B.T.U.) 4.00 hereby aulhori<c representatives of this city to enter upon,the BOILER -COMP(Over 100,000 BTU)SEE(FEE SCH: a� above Hommned property for inspection purposes. MECHANICAL (We) agree.Soaavgmdeninify and keepliunnlEx Ihe'CityioG MISC.: REFER'TOOR D_. Cupertino against liabilities,.judgment.,coststand expemes which. CONST.TAX May in",anyway.accrue against said City.in consequence of"the PERMIT ISSUANCE ,3.00 • granting of this permrt. MECH.CONT. LIC.N0. MECH. T� TOTAL TOTAL a af.Apphea Signt/Conmctor Date - OFFICE COPY A� . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY a .BUILDING PROJECT IDENTIFICATION PERMIT.NUMBER BUILOIND APPLICATION & PERMIT ADOREss , �� n 1� e /1 �.- BUILDING—ELECTRICAL—PLUMBING—MECHANICAL5538 OWNER'S (J .PLAN CHECK VALIDATION. "AME QTY. ELECTRIC PERMIT FEE - , PHONE 2 1 • _ _ - CONTRACTOR'S • NAME �1 UTLETS'-SWITCHES.-RECEP 5.00/1.00 ' len 1' C�1 r eQ( LID,No.` LIGHTING FIXTURES - .5.00/1.00 O CONTRACTOR'S - PPl1ANCES-RESIDENTIAL".' .4.00 - ADDRESS'o , -VWX40 PANELS 5.00 , DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.'NO. oR SIGNS6.00 (ENGINEER ' Lic:No. SIGNS TRANS. 3.00 - _ ADOREW ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zip. EMP.METER OR POLE-INS. 15.00 PAID APPLICANT'SM St _ MOTORS SEE FEE SCH: soI ADORESS� 'A, /1 SanJ,xc� SERVICECHANGE 10.00. JUk- 12 984' 1-o O LICENSEED(CONTRACTORS DECLARATION µ-L• 'I MW t I.hereby affirm thaj 1 am licensed under provisions of Chapter 9 CI, ;��, LOO „mow (commencing with Section 7000).of Division'3 ofthe BusinesSapd 6tH BLDG. ELECT. PLG. MECH. s-g'2 Profeenooa Code i license is in full force ny cffep z•o" Liu..S'jp- Lie, Number !o'/•3/'�' - - ❑ ❑ ❑ O T P',w Dale_L Contractor < V s a ' BU GING PERMIT ¢ ¢o(C O OWNER-BUILDER DECLARATION - FORMATION, X g •y I hereby;affirm'Ihm I am exempt from the Contractor's License MISC.— REFER T ORD F 0 c Law for lM1e.following reasoh(Sec.703L5.Businisxand Professions, PERMIT ISSUANCE VALUATION. !/FT. mom$ Code:Any city or county which romima pchan wm[ruct,Mter. ' Q O improve,demolish.or repair any structure,prior to is issuance,also E EC.CONTR. /t LIC.NO. .3 ELEC.'" O n r gaud the applicant for sachpermit to file aligned Statement that `I D Z�D 1/I TOTAL' r1v P RMIT TO w$,A he is licensed pursuara to the provisions of the Contractors License _ Q Law(Chapler9(commencing with Section 7000)of Division 3 of the Business'and,Professions Code)or that lie is exempt Iherefromand QTY. PLUMBING PERMIT . FEE— I the the basis for.the alleged exemption Anyviolation ofSeclion 7031.5. _ STORIES TY E ONSTR, n 3 'by any applicant for.permit subjects the applicant moa civil penalty , of not more than'five hundred dollar (SS00),): ALTER-DRAIN&:VENT-WATER (EA.)4.00 O o;a emEper of the property, work,and tees'truch -isot BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation;will day,or m . and the structure-wages is not intended or offered forsale(Sec 7044, Business,and Professions DRAINS-FLOOR,ROOF;AREA.COND: 4.00 Cudc:_Thc ConlmctorYLicense Law docs not'apply to an owner of property who builds chimpioves thereon,and who does such work FIXTURES-PER'TRAP 400 SOFT.FLOORAREA TOTALACBEAGE an • himself thmugh his own employees;provided thm'such improve- memsarenotintendedoroffeted for sale.IL however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 4'OO or Improvement D Sold within one yearof completion,the owner- GAS-EA. -OVER 4(EA:) '1.00 ' builder.will have the burden of proving that lie did not build or im- BUILDING USE prove for purpose of sale.), RES IND ' CON PB Oihn O I,m owner of the property,am exclusively contractingwith 20 INDUSTRIAL WASTE INTER. ❑ ❑ ❑ ❑ ❑ IIL•nsed,omu6clors:io construct the:project(Sec.7044,Business LAWN SPR IN KLERS-i INC:5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License_Low docs not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 t - .mractsdeir such projects with a,comnicto0s)licensed pursuant to - (he CnnUaitm'sLicense Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. O lam exempt under Sec...BAP.C.for.this reUfon 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 a.certificale of cmisent io self-insure, or a certificate of Workers'Compensation Insurance..or a certified ZONING .,ENG.SITE NO. copy thereof(Sce.3800,Lab.C:), Policy No. 'Cnmpany_NA "I"AOa2' 0' ❑,. Certified copy is hereby.furnished. - Z Z O ;CertiFIRE$PRINK ENERGY T.20 fiedcopy is' filed with the city inspection division. Fp Applicum_SQ/Q � MISC.- REFER TO ORD. Y.E] NEI v0 .NEI ir m CERTTIyFIICCAATY`EEOF ExEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE -A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. uc.NO. :PLC. 1 O (Thi, Section reed nal be.completed if thmpenu I is for one TOTAL Y.E 'N( Y'� q❑ Z hundred dollars IS 100)or less.) V O I certify that in the.performanceof the work for which this per. Q•ry FEESUMMARY - 0 F mit.rs issued;1 shut)not rkers' ony person in any manner so is to MECHANICAL PERMIT FEE O W hccamc subject m the Workcls'Conmpensalion Laws ol'Calilbrniu. - - y Dam . Applicant ALTER ADD TO MECH. 4100 BUILDING } m NOTICE TO APPLICANT..If:.after.making,this Certificate of Ex F ? c...Fran,yciu'should became subject the Wofker Compensation APPLIANCE 4.00 PLAN CHECK provisions of the labor Corte, you must forthwith comply with_V FEE such provisions or permit shall be deemed`revoked. AIR HANDLING UNIT LTO 10,0MCF:M.) ;3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10.0000 F.W 5.00 SEISMIC.FEE I hereby affirm that thereis a construction lending agency for the performance of the workforwhich:jhis permit EXHAUST HOOD(WITH DUCT) 2.00 is issued(Sec. - MICROFILM 3097,Ch.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 LcnderiName - Leader.'sAddress - HEATING UNIT-(OVER 100,000 B:T.U.)7.50 ELECTRIC I cenify,th.t I ha a read thisappli-alion And stat I c that the above. VENTILATION FAN'ISINGLO 3:00 • information n cameo 1 agree IO comply with coy and county BOILER PLUMBING herebyordinaa.nnd emit lawsesent Lives -t building const r cion,;[he 13 H.P.Or 100,0008.LU.) 4:00 hereby authorize representatives for ins ection -city to enter upon.the BOILER-COMP .above menlioncd properly for inspection purposes. '(Over 160,0D0 BTU(SEE FEE SCH: --' MECHANICAL (We) agre<(to.save, indemnify and keep harmless the City of MISC.-. REFER TO ORD. Cupartino against liabilities,judgments, costs�,and expenses-which :CONSTti TAX may in'any way accrue'against said City,in consequence o4 the 'PERMIT ISSUANCE 3.00 -' - gmnOng of(his pe d- MECH,CONT: LIC.NO. MECH. TOTAL TOTAL Sig m o Applicant/Contractor Uale OFFICE COPY �J�l APPLICANT TO FI LL,IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY. BUILDING PROACT IDENTIFICATION - PERMIT NUMBER eDILDING. APPLICATION &PERMIT AooR� y„ A,i � / BUILDING—ELECTRICAL—PLUMBING.—MECHANICAL 55,3.9 OWNERS u/ - - c — PLAN CHECK VALIDATION NAME n.- - OTY. ELECTRIC PERMIT FEE W) MsoxPAO . Nox>ERAcroR' UTLETS'-SWITCHES,RECEP 5.00/1.00 C LIC.NZ halo 133 LIGHTING-FIXTURES ' 5.00/1'.00 TRAc ORs ' � . PPLIANCES-RESIDENTIAL 4.001 r D 'aD 4- <u-; Ess 'f/1� C . ; PHONE J%I PANELS, 5.00 DATE OF APPLICATION ARCHI ECT , PLAN CHECK FEE - P.C.NO. OR SIGNS 6.00 'ENG INEEfl - ' LIC.NO. SIGNS TRANS: - -3.00 ARCH.OR ENG.. PERMIT.VALIDATION 'AODNESS SPECIAL'CIRCUIT -5.00 - IIP EMP.METER OR POLE INS. 15.00. - PAID ODR TE AMOTORS SEE FEE SCH. - AvvucAN n SERVICE CHANGE - 10.00 JUL 12 984 , �i .. w oa LICENSED CONTRACTORS DECLARATION Qi,u , L hereby affirm, that'I am licensed under provisions of Chapter 9 �no (commencing with Section 7000)of Division-3 of the Business and BLDG. E ECL LG. MECH. z Professions Cod- an my license Is m fell role ayd aj[�ci Z i W License Sigz Lle N tuber (a - m H ,Dale Contra for ¢¢w.oQa.� OWNER-BUILDER DECLARATION B ILDING PERMIT K �^'y 1 hereby affirm that I.amexempt from the C d,.etori License MISC.- - REFER T ORD - NFORMATION FLLo4 Law.to,the following reason:.(Sec.7031.5.Business and Professions PERMIT ISSUANCE-' ' VALUATION 5/FT. Code:Any city.orcounty which requiresa penn(toconstrucLaller. - 6• C R G p in ,,demolish,or repair any structure;prior to its Issuance,also E C.CONTR LIC:NQ ELEC. ii:m'LL .requires the upplic,at for such pennit to file a signed statement that ' .3�I TOTAL 1(� c w he is licensed pursuant to the'provisions of the Contractor's License ERMIT TO ' Law(Chapter 9(commencing with Section 7000)ofDeision3 orthe. f.4 o Business and Professions Cale)or thal,hc is eiempt therefrom ani QTY. - PLUMBING-PERMIT 'FEE ¢ I-$ the basis for the alleged exemption.Any violation of Section 7031,5 - SIES TYPE—CONSTR. by any applicant for a permit subjects the:applicant to a civil penahy ALTER:DRAIN'&'VENT-WATER;IEA.14:00 of not more than five hundred dollars(SS 001:):. ❑ I.as owner of the property,or my employees,with wages as` 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 sale(Sec. 7044, Business and.Professions DRAINS-FLOOR,ROOF,AREA;COND. 4:00, Code:'The Contractor's License Lawdoes not apply to an owner of, " . property who builds or improves thers.on.and who does such work FIXTURES-PER TRAP q':OO, 66FT:FLODRAREA TO hiniselforthrough his own employees pruvidedthat suthdmprovej - . TOTALACREAGE . A ments are not intended or offered for sal•..If,however,Ne,buiiding GASEA:SYSTEM-1 INCs40UTLETS 4.00 - or improvement ss soldwithinof r year of completion, oil owner GAS-EA..SYSTEM-OVER 4(EA.) -1.00 BUILDING USE prover will of sal,den of proving thin he did not buil)or im- " prove far purpose of sale.). - - ' INDUSTRIAL WASTE INTER. 20.00 RES - IND CON' tPa Other ❑ I as owner of the properly,am exclusively onlracting.with - O _ �' a licensed"contractors to eunetmet the`,riject(Sec'7044,13usimos LAWN SPRINKLERS- I-INC 5 V:B. 5.00 ASSESSORS PARCEL NO.. and Professions Code:The Contractor's License Law dues nol'apply . , ' to an owner of property who builds or improves thereon.`an0 who • LAWN'SPRINKLERS-OVER 5(EA.) 1,00 " contracts Ibruch projects with a tnntractons)licensed parsudm to _. the Contractor's Lirem.Law: SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO: PARCEL NO, renlamexempt under 5ec: B&p.C.for,this . WATERHEATERW/VENT •' 4,00 Owner -Date -' _ WATER SYSTEM - - 4:00 Ace.DATE. aca.BILE ND. WORKERS'COMPENSA I[ON DECLARATION• - WATER TREATING EQUIP, - 4.00 I hereby E(firm that I-have a certificate of consent to self-in u,' v or a certificate of Workers',Compensalion Insurance.of a certified' ZONING copy there 'ENG.SITE NO. of(S.e.3800,Lab,C.) n 1/ 3 Policy No. Company NA 9�0�7 'L O ❑ Certified opymIIcrcby furnished: FIRESPRINK` ENERGY T24 Z Z ❑ Certifie4O_o�y_is Bled with the city'Inspection division ` H O Applicant ya�n.0 MISC., REFER TO ORD: Y N❑ Y-Q NO Ky CERTIFIIC'ATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE 'A.L.u.c. W > COMPENSATION.INSURANCE PLG:cONTq. uc.No. PLG. " ' 1 O (This section need not,be conipleteJ iffihe'.permit is for on- TOTAL Y N� Y N� Z hundreddolkus(SI00)orless.) e U O I certify IMI,in the performance of the work for which Ibis per Qry FEE SUMMARY f mut rs issued,1 shall not employ an MECHANICAL PERMIT - FEE LL P Y y person in any manner so as to O W becomesubject to the Workersl Compensation Laws of California,. Q. Date Applicant ALTER OR ADD TO MECH. q-00 BUILDING >_ W NOTICE TO APPLICANT: If,after making this Certificate of Px - F ? emption.you should become subject lb'the Worked Compensator - APPLIANCE. -la4.00 PLAN,CHECK 'provisions of the Labor Code, must forthwith comply with. U such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT,(TO IO=C.FbI) 3.00 •FEE - CONSTRUCfIONLENDINGAGENCY i AIR HANDLING UNITI0VEA 10000C.F.M15.00 SEISMIC FEE I hereby affirm thin them is a construction lending agency for EXHAUST'HOOD(WITH DUCT) 2.00 the perfoommoc of the work for which this permit isissued(Sec. .3097,Civ.C.). HEATING':UNIT(TO 100,ODO MICROFILM B.T.U.) 4.00 - Lender's Name - Lender's Address • HEATING UNIT(OVER 100,000 B:T.U.)7:50 . ELECTRIC 1 certify That I have read This application and slate that the above .VENTILATION FAN(SINGLE)' 3.00 information is correct..)agree to comply with all city and county• PLUMBING, ominamees and state laws.cooling to building construction, and BOILER I3 H.P.or 100,000 B.T.U.) 4.00 - hereby authorize representatives of thiscity to enter upon the above-mentioned ProPerty.forBOILER•inspection.purposes. COMP�IOvarlDo,D00 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'unit expenses which I CONST.TAX may in any way accmo-against said'City.m consequence ofthL. •PERMIT ISSUANCE - .g,pp emntine Of this permit " MECH:CONT.` LIC NO.. MECH. TOTAL TOTAL Sign fAPPlicant/Caninetor Date ' OFFICECOPY`-s �S APPLICANT TO FILL IN INFORMATION WITHIN RED LINES =.USEEBALL POINT PEN ONLY r. BUILDING PROJECT I DENTI FICATION - ` - PERMIT NUMBER, BUILDINGAPPLICATION & PERMIT ADDRESS r BUILDING-ELECTRICAL-.PLUMBING-,MECHANICAL 5.5/p�-7'0 OWNER'S _ PLAN CHECK VALIDATION-' NAME AU CITY. ELECTRIC PERMIT FEE HONE [XJ(Iy - - CONTRACTORS I N E /t f.�n!-�31r� UTLETS-SWITCHES-RECEP 5.00I7.00 CD At I_ LIGHTING FIXTURES 5.00I7.00 " CONTRACTOR'S - y/y�I�(�/ PPLIANCES-RESIDENTIAL '4.00 (� j PHONI 0%4 PANELS 5.00 �� DATE OF APPLICATION ARCHITECT SIGNS 6.00 PLAN CHECK FEE' - PC NO., OP ENGINEER uc.No. SIGNS TRANS: - 3.00 _ ARCH.OR ENG: PERM • - ION ADDRESS SPECIAL CIRCUIT '5:00 . �� ZIP EMP.METER OR POLE INS. 15.00 • I'` q f� ® A APPLICANT'S MOTORS y SEE FEE SCH. - ' - JUL 12.1964 • AODREss ^ L:. SERVICE CHANGE 10.00 p .i w.o 2a LICENSED CON'T'RA& ORS DECLARATION - . .VIa) Df CUpBIIIIIO _ <Oz U Lhereby affirm that I am licensed under provisions of Chapter') ' F z w ISSUANCE DATE (commencing with,Section 7700)of Division'3 of the Business and _ r i Professions Code�I ny license It in full foreGG�,'sn of@cy BLDG: E E -PLG. MECH.. z O Llcen Is I Le.Numbcr d.�o/ 3 , O z.FD Dale Contractor - - ❑ r❑ a y'E`� ac WIu OWNER-BUILDER DECLARATION' '.B LDING PERMIT X;a.N I.hereby affirm that I am exempt from the Contractors License MISC.-. REFER TO ORD NFORMATION Fwoa Law for the following mason.(Sm.703,1.5 Bwoneuand Professions PERMIT ISSUANCE VgLUATION SIFT. Code Any.city or county,which re4uuesa permit toconarruch alter, - '6:00 _ - a rt¢ Improve.demolish,or repair any structure,prior to its issuance,also° E C.CO TR LIC.NO. - . ELEC. DILL requires ilia applicapl for such Parrett lU fll<a Signed statement Ihel ' 1 TOTA:I_ PERM T w m at he is licensed pursuant to the provisions of the Contractor's License - H z.,> Law(Chapter 9(commencing with Section TODD)ofDivision 3afthe. s z_o Businessand Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE' " ¢ I-a the bads for the alleged exemption.Any violation of Section 1031.5 STORIES,_ TYPE CONSTR. i;m 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 dcllars($500).): ❑ [,as owner,of the property:or my.employees with wages u. BACKFLOW PROTECTDEVICE - their.sole compensation,will do.the work;and .the structure is not 2.00 OCC.GROUP RES:UNITS intended or offered for sale(Sec. 7044, Burin.and Professions. DRAINS-FIAOR;.ROOF;AR EA,COND. 4.00 ' Cody The Conlractor's License law does not apply to an ownauof - Property Who builds or improves thereon,and who does such work FIXTURES-PER TRAP - ' 4.00 52 FT.FLOOR AREA TOTAL ACIIEAGE himself through his own employee,provided that such improve- '• mens am not intendcdurnffered for sale.IL however,the building, GAS-EA.SYSTEM-I1NC.40UTLETS 4.00 " be improvement Is Said within one year of completion,the owner- GAS EA'.SYSTEM-OVER (EA.)budder will.ham the burden of proving that he did not:build or im- too _ BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE'INTER. - �� RES IND .CON - pe Oram U J.as owner of;the property,am exclusively contracting with - 1-1, - Q El licensed contractors.lo,onstruct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B: 5.00 ASSESSORS PARCEL NO. and Profcsions Cade:The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN,SPRINKLERS-'OVER 5(EA.) 1;00 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License.Law. SEWER-SANITARY-STORM EA.20011/8.00 TRAC'fNO. - PARCEL NO. mDont am exempt under Seo.: ,B.AP.C.for this WATER HEATER WNENT 4.00 Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING_EQUIP. 4.00 ' . . I hereby affirm that 1 have a certificate ofconsent to self-insure. or a certificate Or Workers'Compensation,Insurance.or a certified ZONING ENG.SITE NO. copy lhereof(Sec.3800,Lab.C.). PolicyNb. Company - 0- ❑ Certified copy Is hereby furnished Z Z Y Y inspection division. PERMIT ISSUANCE FIRE$PRINK ENERGY T-24 ❑ Certified co s filed with the cit Ins p Applicant MISC.- REFER TO ORD, vQ N0 YElNEI H CERTIP CATEOFFXEMPTION.FROM WORKERS' CE ,600 'FLOOD To_NE A.L0.C. - W > - COMPENSATION INSURANCE PLG.CONTR. LIC:NO. PLG. d Cl- 'IThis sedidm need not he completed if the permit is for one _ TOTgI Y N� Y O N� � Z hundred dollars(SI00)or less) ) O 1 certify thai'm the performance of the work for which that par- QTY' MECHANICAL PERMIT FEE SUMMARY LL F mil is issued.Lshall not employ any person in any manner so as to FEE .010 become subject tojlm Workers'Compensation laws ofCalifornia- - - _ .D. Date - Applicant W . 'BUILDING }�W NOTICE'TO'APPLICANT: If,eller making this Certificate$f Eri- ALTER OR ADD TOMECH. 4.00 ' F Z coalition,you should become subject to the Workers�Compensation APPLIANCE provisions of the Labor.Cade,•you must forthwith Comply with 4.00 .PLAN CHECK U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r_F.1A). 3.00 FEE 'CONSTRUCTION.LENDING'ACENCY AIR HANDLING UNIT(OVER 10p00CF.M.) 5:00 SEISMIC FEE I hereby,'affirm that them is a.construction lending agency,for EXHAUST HOOD(WITH DUCT) 2.00 the performance of the work for which'this pencil is issued(Sea. MICROFILM. 3097 CN.CS HEATING UNIT.'(TO 100,000 B.T.U.) 4.00 - 'Lender's'Name Lender's Add. HEATINGUNIT(OVER'100,000B.T:U.)7.50 ELECTRIC I certify that l have read thiaapplication and stale that the above VENTILATION FAN(SINGLE) 3.00 , . information is'c.mcs t I agree to comply with all city and county - ordl noes andis BOILER-�(3 H.P.or.100,000B.T.U.) 4.00 'PLUMBING rat laws relating ro buildings.Conslrudion.•anJ hereby huthurin repreunlatives of this city to Care, upon the BOILER-COMP(Over 100,000 BTUI BEE FEE SCH. above mentioned property for inspection purposes MECHANICAL (We) agree to save indemnify and keep bit last The.City,of MISC.- REFER TO ORD, Cupertino against liabilities,judgments, costs andexpenses which COE mayIn any way accrue against said City in n uence of the PERMIT ISSUANCEcccggq ttg ..m3.00 anlin6 a(lhis perti /F 1 vsECH.CONE LIC.NO. MECH:/ /UY TOTALsips o Appucant/contraDlar Dale - " OFFICE COPY D Lj� APPLICANT TO FILL"IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY.' BUILDING PROJECT I DENT[FICATION PERMIT NUMBER' BUILDING APPLICATION & PERMIT ADDRESS D BUILDING-.ELECTRICAL-PLUMBING-MECHANICAL 5541 OWxeRS - --- - ••{ PLAN CHECK VALIDATION ME GTV.; ' ELECTRIC'PERMIT FEE. PHONE NA ^Crop, CI ��31 iE UTLETS-SWITCHES-RECEP 5.00/1:00 `" - y{�JU(n J^9r 1C.No. ✓ LIGHTING FIXTURES 5.00/1-00 CONTRACTORS - PPLIANCES-RESIDENTIAL 4.00. "DDRESS a Ove PMON ANELS 5.00 DATE OF APPLICATION ' ARRF CHITECT SIGNS' 6.00 PLAN UREUK EE P.C.NO. O ENGINEER Lie.NO. SIGNS TRANS. 3.00 ADDR SS ENG,. SPECIAL CIRCUIT 75.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 15.00 PAID APPLICANT'S - MOTORS SEE FEE`SCH- aDDRE Q� /y1 T I")CCr VV 1, DO SERVICE CHANGE 10.00 JUL y 2 190A aDs;.o o. UCENSEUCONTRACTORS DECLARATION r V9 <-0 0 I hereby affirm that l amlicenscd.underprovisionsuf Chapter 9 Ci h Q n ,commencing wiHr Senibd 70001 of sion3 tithe Business end - YOLDG. Et Professions Code d y licenseis in full farce�gdeff ds .i:: License Clas contra mher2N�_ Date fLie.N mb< tor wu OWNER4BUILDER DECLARATION,w;LL y 1 hereby affirm ilial I am exempt from=the Contractor's Licenu MISC.- REFER T ORDo; Llw for the,follow greasoo.(SPe 70315,Businessand PLO...h s pERM1TISSUANCE 00.- Code Any,city orcounly whichregmresapermitloconstruct,aller,ree a,22 Jmprove.demolish,or repair any structure,prior to Its Issuance,also ELEC.CO TR LIC.NO. I`I ELEC.A D'LL regumn the applicant for such permit to rite a signed statement that' J4 TOTAL w m he T's licensed pursuant to the provisions of the Contractor's License PE M T TO i Law(Chapter.9(commencing with Section 7000)of Division 3 of Lite ¢ao Business and Professions Code)'or that he is exempt therefrom and OTY: PLUMBING PERMIT FEE ¢ r$ the basis for the alleged exemption Any violation of Section 7031.5 - STORIES P CONSTR. a, ; _ byany applicant for a permit subjects the applicant too civil penalty,' _ ofrot momthan fivchundred collarslS5000.I: ALTER-DRAIN&VENT-WATER:(EA.),4.00 , ❑ i,.as owner of the property,or my employees with wages as gACK'F LOW PROTECT.DEVICE 2.Q0 their.Sole compenlsation,will'diathc'work,.and.thostructure is nut - OCC.GROUP RES.UNITS intended or offered'for sale(Sec. 7044, Business'and'Professions DRAINS-FLOOR,ROOF.AREA,COND. 4.00 - Code:The Contmetor's.License Law docs not.apply to an owner of properly who builds or Improves thereon,and who docs such work F IXTUR ES-PER TRAP t 4,00 g6 FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- .anis are not intended or offered fe,sale.i1.however,the building' GAS-EA.SYSTEM-11NC.4OUTLETS 4.00 or improvement s sold within one year of completion,the owner/ GAS-EA.SYSTEM-OVER.4(EA.) "budder will have the burden of proving that he did not build or im- 1.00 BUILDING USE prove for purpose of sale)._ - INDUSTRIAL WASTE'INTER. +PES BIND CON, PS Other O I,as owner of the property, x am exclusively contracting with 20.00 -E] licensed contractors to contract the project ISec.704.Business LAWN SPRINKLERS-1 INC$'V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code;The Contractor'slacense law does not apply -' I - - , to inowner of property,who builds or improves thereon.and who LAWN SPRINKLERS-OVER'5(EA.) 1.00 contracts for such projects with a contmetoast licensed pursuant to the Contractor's License Law.* SEWER-SANITARY-STORM EA.200ft/8.00 TRAcrrvo. PARCEL No. m❑ni um exempt underSec. ,e.&.BC.for this WATER HEATERW/VENT 4.00 Owner Dale WATER SYSTEM 4.005 ACC.GATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION s. WATER TREATING EQUIP. 4.00 I hereby afOrm.that I have a certificate of consent to self-insure. or a certificate of Workers:Compensation Imannce,or a certified ZONING. ENG.SITE NO. ropy thereof(See.3800,lah.C_WA 9/pG NIL- Policy No. Company Ca' - 0' ❑ Certified copy iShereby furnished. FIRE SPRINK ENERGY T"Za Z Z ❑ Cerlifie ➢pDpyy.,i�s Ifced with the city inspection division. _ ,F,O ArpFeam �IX�/rO MISC.- REFER TO ORD. _ Yn N❑ Y.E] NE] CC ul `CERTIFICA'IF OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE' A.I.U.C. .W"> COMPENSATION INSURANCE !PLG.CONTR. LIC.No, PLG. d ❑ (This section need nal be completed if the permit is for one TOTAL .V N ', Y❑ NEI 0 Z hundred dollars I S 100)or less.)O. I c rtifyahat m the purformance'ofthdwork for which tots per- TT'. MECHANICAL PERMIT " FEE SUMMARY - LL_V' coli Is issued.I'shall not employ any person in any manner.so as to - FEE h ome subject 4o th•Workers:Compensation Laws of Culifomia. ^ U a Date - - 'Applicant- ALTER OR ADD TO MECH. '4:00 BUILDING }._Z NOTICE TO APPLICANT: If,:after making this Certificate of Ex- - F - caption,you should become subject to the,Workers'Compensation' APPLIANCE 4.00 .PLAN CHECK provisions of the Labor Code:you mnl;forthwith comply with U such provisions or this permit shall be deemed revoked FEE AIR HANDLING UNIT(TO 10A000.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=r_F.ML) 5.00 SEISMIC FEE I hereby affirm that them iia construction; lending agency.for . .EXHAUST HOOD(WITH DUCT) 2.00 the performance of the work for which this.permit is issued(Sec. 3097,Civ.C.). HEATING UNIT(TO 100,000 B:T:U.) 400 .MICROFILM Lunde,'s Name : Lender's'AddressHEATINGUNIT(OVER100,000B.T.U.17:50 . -ELECTRIC I:certify that I have read this application and state that the above VENTILATION,FAN ISINGI I 3,QQ • information is correct. I wee to comply with all city and county PLUMBING' ordines a ancnd state laws relating to.building-construction, and BOILER-COMP(3 H.P.or 100,000&LU.) 4.00 hereby authorize representatives of this city to caler upon the above-memioned property forinspection purposes. BOILER-COMP'(Over 100,000 RTU)SEE FEE SCH. MECHANICAL (we) agree to save, indemnify and keep harmless the City of MISC.- REF,ER TO ORD. Cu"ino,against liabilities.judgments, vests and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00 CONST.TAX gmntingof is eemit. __�7/7 MECH.CONT. LIC:NO: MECH. - - TOTAL TOTAL- ' Sign reef Applicant/Contractor Dete' _.. OFFICE COPY i APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-'USE BALL POINT'PEN ONLY i BUILDING PROJECT I DENTIFICATION ` PERMIT NUMBER BU LD,NG - APPLICATION & PERMIT aoDREss, - ' /• BUILDING '.ELECTRICAL-'PLUMBING—MECHANICAL 55'4Z' OWNERSf0 — - PLAN CHECK VALIDATION NAME ' / .CITYELECTRIC PERMIT FEE W /NONE,n // / CONTRACTORS'- M NamE /1 Il UTLETSSSWITCHE&='R ECEP 5.0011:00 NO ebLIC:NoI'1b�2&13& LIGHTING FIXTURES . . 5.00/1,00 corvTRacrofls - PPLIANCES-RESIDENTIAL4.00 ,� COO Es /f '/�///)1(1y'//1 (� PHUry 7ptl/ I`+ PANELS." •5.DD DATE OF APPLICATION AOpCHrtECT " - SIGNS I - •5.00 PLAN CHECK FEEr ENGINEER LIC:NO. SIGNS TRANS: _• 3:00 ARCH.OR ENG. PERMITVALIDATION. ADDRESS SPECIALCIRCUIT • 5.00 ZIP TEMP.METER OR POLE INS:. 15.00 . PAID APPLICANT MOTORS t y SEE'FEE,SCH. 5U J v SERVICE CHANGE 10.00 �JOC.121984. ao LICENSED'CONT ACTORS DECLARATION ' <-u ta -I herehy effims that 1 amlicensed under provisloHv of Chapter 9� Z'a (commencing wnh'Section'7000)of Division 3'of the Busbuxuand tis a BLDG. EC PLG. MECH. p L i Profwions_Codesan l license Ism full force��y,mlQQ e e'I ❑ 2 O:_ License CI s L c Number 'O z w Uatc--_��,,jl��Conlmdor �w� � ax a.¢ OWNER-BUILDER DECLARATION BU FORMATIONT x ;LL.rR 1 hereby affirm Ihat 1 am exempt.from the Contractors Licenser [MISC. ° REFER T ORD - Fa. Low for the following mown.(Sec 703R5,Businessand Plofessumsr PERMIT ISSUANCE 'S 'VALUATION S/FT. S:m n Code:Any city or county which regwresa permil to consimcl,alter, rt rc a O Improve.demolish,or,repair any structure,.prior to its issuance,also E 'EC.DONTR: - LIC.NO. ELE / /11 w•d•OLL 'q has the appllcantfor such Permit to file a signed statement that CI 13..'� TOTAL .�•�'J ERMI w es he,Is licensed pursuant to the provisions of the Contractor's License F z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the E i.O Business and Professions Code)or that he is exempt therefrom and OTY. .PLUMBING'PERMIT - FEE II ¢o-$ the basis for the alleged exemption Any violation of Section 7031.5 STORIES TYPE CONVR. by any applicant for a permit subjects the applicant to a civil Penally ALTER-DRAIN -WATER(EA.) 4.00 of not more than five hundred dollars($500)J: O I as owner of the property,ormy employees with wages as BACKFLOW PROTECT.DEVICE 2.00 !heir sole compensation,will do the Work,and lhcsliuclure.is not OCC.GROUP RES.UNITS intended or offeredifor sale (Sec. 7044„Business and Professions- DRAINS-FLOOR,ROOF,AREA, 4:00 Code:The who build or License,li does not apply dr s i owner of - properly who builds or improves4hereon,end who does suchwork FIXTURES-PER'TRAP 4.00 SO.FT.FLOOR AREA rTOTALACREAGE - himself or through his own employees;provided that such improve - - mintsarenotintended'or offered for aide.IF.howev a,.the building, GAS;EA.SYSTEM'-I INC.4 OUTLETS,4.00 .. -- or'improvement is sold within one year of completion,.the owner GAS-EA.SYSTEM-OVER 4'IEA.) .1.00 BUILDING USE builder'will have the burden.ofproving!hat he did not build or.im- two.for purpose ofwle.). '`+' - INDUSTRIAL WASTE.INTER. RES' IND ' -CON PB Omer. ❑ I,as owner of the property,mn exclusively.contracting . 20will, .00 1:1 El El El ❑, liscosed contractors to,i+onstroct the project(Sec.7044,Basiss LAWN SPRINKLERS-1 INC 5 V.B. 5.00 gSSESSORS PARCEL NO. and Proresrons Code:The Contractor's License Law do.not apply ' to an owner of property who builds or improves thereon,and.who LAWN.SPRINKLERS-OVER 5 IEA.) 1!00 contracts for such projects with Lontraclur(s)licensed pursuant to the Contraelm'.s LcenseLaw. - SEWER-SANITAR,YSTORM. EA.200ft/8.00 TRACTNO,' PARCEL No. ne soot am exempt under Sec: ,B.AP.C.for this WATER HEATER W/VENT 4;00 Owner UuleWATER SYSTEM '.'4.00 - ACC.DATE •ACG FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING,EQUIP. .4.00 ;'l hereby affirm that.Ihave certificate of owserm to self-inwre, or a certificate of Workers''Compenaation Insurance,or a.certified, ZONING. ENG:SITE NO: copylhemof(Sce.3800.L b.C.) �N1 n /I qW - - PolicyNo. Company- N'n , 14 X,2 O ❑`Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified "0 _±.is filed with-the.cityinspection division, - "O Appbca n lu�N 0 - MISC - 'REFER TO ORD. J�'•"N� Y� NQ _~ w PERMIT ISSUANCE UjCERTIFICA MPENiAEMP1'I NSUFROMNCWORKERS' 6.00 FLOOD ZONE. A.LU.a W � COMPENSATIONdNSURANCE � PLG:CONTR. LIC.NO: ALG; d O (This section need not,be completed-if the permit is for one r TOTAL 0 Z hundred dollars 15100)pe less.) MECHANICAL PERMIT FEE- LL O ' I certify,that m the to employ ofthework for annex sr, Per QTY. FEE SUMMARY LL F mot n issued. Lshall not employ any person in manner m us to O.w Date subject to the Workers:Compensation laws of California. tt .Dam Applicant ALTER OR ADD TO MECH. 4.00 BUILDING } N NOTICE•TO APPLICANT:4f, Fier making this Cerlifmaate of Ex- - F_? emplion,ryuu should become subject to the Workers'Compensation APPLIANCE'- 4.00 . PLAN CHECK Provisions of the Labor Code, you must forthwith complywilh FEE V' such provisions or,this permit shall be deemed revoked, AIR HANDLING UNIT LTO 10AWC.F.M.) 3.00 CONSTRUCfION'LENDINGAGENCY AIR HANDLING UNIT(OVER 10MIC-F.M.) 5.00 SEISMIC FEE .m I hereby affirm that there is a construction leading ageHcy for EXHAUST HOOD(WITH DU= 2.00 th performance of the work for which this permit is issued(Sec: MICROFILM C.).CiJ.C.). HEATING UNIT(TO 100,000 BIT.U.) 4.00 Lenders Name r. Lender's Address HEATING UNITIOVER 100,000 B.T:UO7.50 ELECTRIC: I erHfy that I have rearithis application and stale that the about VENTILATION FAN.ISING LE) 3.00 _ information'is.correct I agree to comply with all city and county, - .PLUMBING ordrwees`.und state laws,mlating to building construction, and BOILER-COfW(3 H,P.or 100,0008.T.U.)4.00 hereby authorize representatives of Lha city to enter upon,the BOILER-COMP(Dwr 100,000 BTUI SEE FEE gGH. otiose mentioned properly for inspection purposes MECHANICAL (We) agree to save..indemnify and keep.hSamluss,the City of MISC.- Cupertino REFER TO ORD. 'againsl habilitics,Iutlginams, costs and expenses which pERMITISSUANCE 300 CONST.TAX' may in any-way accrue against said City-in conseqpenoe'of.the granting of this permd. - �'� I�'� MECH:CONT. LIC:NO. MECH: I TOTAL is um of ApplicantlCmitractor - Uate ..TOTAL, OFFICECOPY e7V p \v I f APPLICANT TO F(LL IN.INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY , BUILDING PROJECT IDENTIFICATION PERMIT NUMBER RUILOING APPLICATION,&.PERMIT , ' ApoRE� BUILDING ELECTRICAL—PLUMBING—MECHANICAL '` 5543 OWNERS „ e , PLAN CHECK VALIDATION - NANE - CITY,. iELECTRIC'PERMIT FEE.'• HGNE .. ' CO TRACTORS if NA OUTLETS,SWITCHES-'RECEP 5.00/100 'uc.No. LIGHTING FIXTURES5.00/1.00 CONTRACTORADDRESS; s PPLIANCES-RESIDENTIAL 4.00 g ,PHONEpr{' /� O PANELS - _.. 5.00 .5,10 'DATE OF.APPLICATION ARCHITECT SIGNS B.00 PLAN CHECK FEE P.C.NO. - OR ENGINEER LIC.Na. SIGNS.TRANS. 3.00 _ ARCH.OR ENG, - - PEIg AL fLLIIOATION - ADOREss SPECIAL CIRCUIT 5:00 r TIP EMP.METER OR POLE INS. 15.00 ' APPLICANYR OTORS JULApp isM f,/ I. z �J 84yO SERVICE CHANGE . 10.00 oar Foo CICENSI U CONTRACTORS'-0ECLARATION City DB►fipo < of Cu 0 0 I hereby affirm that I um licensed under.provisions of Chapter ISSUANCE DATE w$1 s (commencing.with Section 7000)of Division 3 of the Business and <' - BLDG. E E T. PLG MECH., p 0 i - Professions CoHe.,allnd.m.lirense Is in full force a d IT BLDG.❑ ❑ ❑ Z 0)'is— Liccnu h Q Lic.Number 0 a:T w Date Contractor Iy rs � - - ILDING PERMIT ¢o i OWNER-BUILDER DECLARATION ' INFORMATION- 4 MISC.— REFER T ORD - W 3 G hereby affirm that reason. (ec.7 from the Contractor'sss." License VALUATION LL.o Law for thefollCwmg reason.(Sec.7031.5,Businessand Professions STET. I- — g ,PERMIT ISSUANCE 5tW - C d A.demolshCormpouunty achre9uture,prmnlocansuancalio, u, 1 ¢Q Improve;dcmolRh ortepair any3WClurc.prior to d5 L55Udnce:.250 ECE -CONT CLIC.NO. EEC. ,^//� A. 0 di, r lulrcs the applicant'.for such permit to File a signed statement that CL 10 � T I( ou roma- he is licensed pursuanPto the provisions or the Contractor's.License PER TTO FIQ Law(Chapter 9(commencingwith Section 1000)of Division 3 oflhe o' F,i,o ' Business and Professions Code)or that he is exempt G therefrom and OTY. PLUMBING PERMIT ''FEE I , the basis for the alleged exemption.Any violation of Section 7031:5 _ STORIES TYPE CONSTR. by,any.applicant ror a permit subjects the applicant to a civil penalty - - ofnotmorc.than five hundred dollars(55001d: ALTER-DRAIN&VENT-WATER (EA.) 4.00. I ❑ 1;us owner of the property,or my employees w c,urc is BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,employe the stwith a is not intended or offered'ror sale (Sec. 7044, Business and Profession. DRAINS-FLOOR;ROOF,AREAr COND. 4.00 Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who do such work F IXTUR ES-PER TRAP 4.00 himself..,h through his Own employees,provided that saCh.improve- RO FT.FLOOR AREA TOTAL ACREAGE. ments are not intended'proffered formic.IL-huacvcr the budding GAS-.EA.SYSTEM'-1.INC.4 OUTLETS-4,00 . • of improvement Is sold,within one year of completion the owner GASr EA.SYSTEM-OVER 4(EA.) 1,00 BUILDING USE builder will have the burdem,of proving That he did not build or.im- proveforpurposeofsale.). - INDUSTRIAL.WASTE.INTER •RES ,IND" CON PS Other 1, 1.as owner.of the property am exclusively contracting with -20.00 licensedcontractors to construct the project(Sec.7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO: i and Professions Codc:The Contractor's License Law does not apply . to an ownc,r1properry who,builds or impro'vds thereon.and who, LAWNSPRINKLERS-OVER5(EAAr 1;00 conlracts for such projects with a contractorfa)licensed pursuant to, theComractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ I am ckcmpt under Sec.—,R&P,C.for this, WATER HEATER'.W/VENT reason 4.00 Owner Date WATER SYSTEM .4.00 ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION, WATER TREATING EQUIP. .4.00 > I hereby affirm that I have a certificate of consent to self-insure, or •rtificote of Workers'Compensation Insumn.Co.or'u/certified - aTOORID: ZONING ENG.SITE NO. wpcy.No.or fs:c..3s0o,.lub.c_WA [� / / �.(�.7 Pp0No. Company rf U1IQ ❑ Certified copy is hereby furnished.. the FIRE SPRINK ENERGYJ24 Z Z O certified ,o!l��Y L filed,wLLli the city inspection divison applum b^�,;� _ MISC.- - r0. rJ� r0 NQ ~ O /_— PERMIT ISSUANCE y CIiR'fIFiCATE OP E%EMYfION FROM FLooD zoNE A.L',U.C. ,Z p RANCE PLG.CONTR.'.' LIC.W COh1PFNSATION.INSUOL 0 (Thrssection n•ed not:be coin letedif the p t isfar one •Y❑ N YQ- NQUO hundred dollars(5100)ar less.)I certify that In The performance of the work for which this per. QTYT- PERMIT FEE SUMMARY LL mit mil Is Issued,I,shall not employ any person in any manner so as to FEE Q•0 become subject to the Workers:Compensation Lawsof Califomia. UJ C. Date am C. APPLICANT ` •ALTER,OR.ADDTQ,MECH. a00 'BUILDING }' NOTICE TO APPLICANICAN T: after making thisCertificattof Ex: F _ enlption,you should become subject to the Workeri Compensation APPLIANCE" 4.00 PLAN CHECK provisions of the Labor Code. you most forthwith comply with U; FEE suchprovisions or this permit shall be deemed rooked, AIR HANDLING UNIT(TO 10MOCF:M) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOMC.RIaU X5.00 SEISMIC FEE I hereby affirm that there is a construction lendingagency for - EXHAUST,HOOD(WITH DUCT) 2.00 theiperfonnance of the work.for which this permit is issued(Sea 3097.Civ.C.L HEATING UNIT(TO 100,000'6.T.U.) 4.00 'MICROFILM Leaders Name LenderN Address r1IG UNIT(OV ER 100,000 B.T.U.)7.50 ,,.ELECTRIC I certify that I have read thisepplicmion and state final aboveTION FAN(SINGLE) 3.00 • mfortnaUon iscorreci 1 agrac to aomplywilh ill ally and'rountyPLUMBING ordinances and late lows relating to building eonstrumion. and0MP(3 H.P.or'100,000 B.T.U.) 4.00hereby nuthariza rLprcsentatives of lois city to enter upon te above-memim, property for inspectionurposes. COMP'to.,100.0008TU)'SEEFEE SCH. .'MECHANICAL ,(lfe) agree t0 save, rndemnffy..mLkeep harmlem the City ofREFER TO ORDi Cupertino.:against liabilities{judgmontsj costs andexpenses which - CONST:TAX may inany way accrue against said'City In con uenceof theISSUANCE 3.00grantig of this perm�)pp� I / LIC.NO. - MECH. d 2- %I- �S`yTOTAL TOTALbunatt o Appllcimixiintrector Date FICE COPY \' AIPPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE.BALL POINT PEN ONLY BUI LDI NG'PROJECT,I DENTI FICATION. PER.MIT NUMBER BUILDING _ APPLICATION &'PERMIT AOGR ss a.[/� (�`/ BUILDING—ELECTRICAL—PLUMBING—MECHANICAL5544 " OWNER'S - PLAN CHECK:VALIDATION Me PNONE /U �U DTV- ELECTRIC PERMIT FEE �. s wC OR5 NAE Ann OUTLETS 5.00/1.00 LID.X IOA 1313 LIGHTING FIXTURES 5.00/1:00 7,, CONTRACTOR'S . ADAPPLIANCES PPLIANCES-RESIDENTIAL 4.00 M`-' - YO ' vHONEOID r(QlJ PANELS' 5.00 :DATE OF APPLICATION AOPRCHITECT SIGNS 5.00 ;PLAN CHECK FEE P.C.N0. ENGINEER uc:NO. SIGNS TRANS. 3.00 ' In ADDRESS''ORENO' - - SPECIALCIRCUIT '5.00 PERMIT VA I A APPLICANITS (f ZIP EMP..METER OR:POLE INS. 15.00- JUL 12 1984 i wooREss �s MOTORS I' -' SEE-FEE$CH: , C� SERVICE CHANGE I 10.00 City 01"Cupertino .,00 rLICENSED CONTRA ORS DECLARATION Q u-u I,hereby affirm thin I amdicensed undei provisions of Chapter 9. a: ISSUANCE DATE as Q h (commencing Section 7000)of Division 3 of the Business and BLDG. EL C PLG. MECH. H N..-z Professions Code aedm license Is in full farce' ff Oz i m W -4Lense CI ss Llc Number - Dale 7 Contractor ¢ 2a El OWNER-BUILDER'DECLARATION B LOINGPERMIT Q y o a" - NFORMATION..- i X 3 w•yi I hereby efPrm Ihat.lam exempt from.the Contractor's License,. - MISC:— REFER TO ORD - sa 041 LAW,I'OrlhSfellowmg reason:(SeL'7031.5;Buslnessand Professions' PERMIT ISSUANCE . 6.00 V UAT1ON E/FT. Code Any city Or county.whichagmresapermil townstr o.alter, '. ¢ ¢ Q 0. Improve,demolish or repair any structure;prior to Its Issuance,aim EL .CON R. LIC.NO. ELEC. Fr-S requires the applicant for such permit to file a signed statement that Ci I• ' TOTAL N� gMIT x miy he is licensed pursuant to the provisions of the Contractors License rzLe > Low(Chapter9fcommencing with Section 7000)of Division 7 of the. - a, Business and Professions Code)or that he is exempt therefrom and OTV. 'PLUMBING.PERMIT . 'FEE s4D ¢I-$ the any basis pli the alleged exemption.Any violation t 111. vel ...t:5 STORIES TYPE CONSTR.. a 3 by any applicant for a pdrtni(subjects the ay.);cant too civil penally ' of not lnorethan fivehundreJ dollars(EE00).);•- ALTER-DRAIN&VENT-WATERIIEA.14.00 - ❑ 1,as owner of theproperly,ormy employees with wages as BACK FLOW PROTECT.DEVICE their sole compensation,,will do the work:and the structure is not •2-00 DOE.GROUP RES:UNITS' intended or offered for Sale(Sec. 7044, Business and Profesdons DRAINS-FLOOR,ROOF,AREA,COND, 4-00 Code:The Contractors License Law does not apply to an owner of property'who builds or,improves lhcmon,and who does such work FIXTURES-PER TRAP• 4-00 got FT.FLOOR 4REA TOTAL ACi1EAGE himself or his own employees,provided that such improve- meetsarenotintendedoroffered forsale.If,however,the building GAS-.EA.SYSTEM-1 INCA 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 IEA.). 1.Op P 6 - - - - - BUIUQINGAASE prove for purpose of sale.) I - INDUSTRIAL WASTE INTER. 20.00 RES AND Pe Dshm ❑ L as owner of the properly,he exclusively.contracting Buswrth �' iRV El El Iind andP. contractors to construct the License La.does not apply LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSE SPARCEL NO. and Professions Cale:The Contractors License Law does not apply to in owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5IEA.) 1.00 ' Contracts for well projects with a contractor(s)licensed pursuant to - - theComracwr'sif L;cense Law. - SEWER-SANITARY-STORM EA.200ft/5.00 TRACTN PARCEL NO. reason am ex am Sec..,B.&P.C.for this WATER HEATER,W/VENT 4.00 _ Owner Date WATER SYSTEM 4.00 - R R ACC.GATE ACC.FILE NO. ' WORKERS'COMPENSATION Df:CLARATION WATER TREATING EQUIPa q-fp I hereby affirm that I'have a'certificate of eonwot to self-insure. n ur a cartif*..(c of Warken'Corlipcnsaliyn I suran".or a mnifwd ZONING- ENG.SITE NO. copy thereof lStt 35Cou L,,any- /1/H !ll 1 1(42'•7 Policy No. Company ,is _f(OYJ 7/" Z ❑ Certified copy is hereby furnished: - Z Z ❑. Cerlificd ro is filed with the city in division: FIRE SPRINK '� ENERGY T-N 'F, O Applicant MISC. REFER TO ORD y0 N❑ v� N� CC'w CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE _ 6•00 -FLOOD ZONE A.L:U.C: W.? COMPENSATION INSURANCE'S PLa coNTq: LIC.NO. FLG: ' :(:Z (This Section need.not be compleled'if the permit is for one - TOTAL s v N� Y Q. N❑' UIQ ,hundred dollars 1E 100)or less.) _ 1 esnify that in the performance of the work for which this per- Orir� MECHANICAL PERMIT t FEE'SUMMARY' U. mit Is issued,1 shall.not employ any person Wany manner so as to FEE O.w become subject to the Worken'Compensation Laws of California D, 'Date Applicant - ALTER OR:ADD TO MECH. 4.00 "BUILDING' } NOTICE TO�APPI.ICANT:T: I W L after making This Certificate of Ex ? emption,.you should become subject to theeWorkaril Compensation " APPLIANCE ` 4.00 "PLANCHECK previsions of Ibe.Labor per Cod hall b must forthwith comply with FEE C) such provisions or this permit be deemed revoked: � AIR HANDLING UNIT(TO t0,000CF:M) 3.00 CONSTRUCTION LENDING AGENCY " ' AIR HANDLING UNIT(OVER 10=QF.M) 5:00 .SEISMIC FEE - , Ihereby from that there is a construction lending agency for EXHAUST HOOD(WITH'DUCT) 200 the prm erfoance of the work.for which this Permit . is issued - MICROFILM 3097Civ.C.). _ HEATING UNIT(TO 100,000 B.T.U.) 4:00 `- LendcrsName Leader's Address HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC I rertily lhinlhevi•read ihisapphwnanand stale that lheabovc. - :VENTILATION,FAN'(SINGLE) 3,00 information nd state et. I agree.to g to b with all my and many BOILER- PLUMBING - hereby ccs and Stam )sen relining to building' onw-tionand (3H-P.01'100,000 B.T.U:) 4.00 hereby authored propertyforins of on rpoes em r.upon the above-mentioned properly far inspection purposes. 'BOILERCOMP IOver 100,000 BTUI SEE FEE SCH. -MECHANICAL IW-) agree to save, indemnify and keep harmless the City of MISC:- REFER TO ORD. Cupertino.against liabilities,judgments, costs and b expenses which CONST.TAX may-in any way accrue against said City in Dom2—Tv of the PERMIT ISSUANCE ' - 300 ' granting of thispertnil. �/� MECH:CONT. LIC.�NO. MECH.. , TOTALTOTAL Signa a AppOcanl/Contract 'r OFFICE COPY gZ