The URL can be used to link to this page

3565 20671-78 CELESTE CI R 3565 F DE ANZA PROPERTIES SCANNED BOX # 783 i CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO �� DATE Iq� BLDG. PERMIT NO. THE BLDG. LOCATED AT O l Ce�P s�2 G l P OWNED BY d-I- Iq 2-' 0 1' ICOMPLET DI FOR USE AS HAS BEEN IALTEREDI C�. O LU OM � BUILDING INSPECTOR ..........- ...... , CITY Ot" CUPERTINO INSPECTION RECORD (Office Copy), 3965le PEP11IT DO— Lot 3, Bldg. 4 2%P. - 73 Celeste Circ. -SANITARY DIST. NO. LOT P10. ADDRESS Const. 9 Units . DeAnza Prooerties PROJECT 01-INER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL Buildinfr, 5111/83 Date Trisp. IA ectr Ecal Power Pole. Plumiling Underground Mechanical Rough Wiring 'Temp. Gas/1"Icct. Ualis Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sign Notors Grounding Misc. Temp. Power Other FINAL INSPECTIONS Not Approved Date Insp. F,I ec t r..LC PLUMBING Plumbing Backflow Date Insp. Nechanic.al 11,/ -57 Underground Solar Underfloor Pool Gradin I, Partial Rough • I'Lanning Rough Complete Solar Pough Fire De 4Ta—ter & Insulation Health Dept. Main Drain Building R/of/S Drain Other Gas . Other BUILDING Not Approved Date Insp. - fad Certification Founda MECHANICAL Date Insp. Pre-Gunite Underfloor S.M. Slab Membrane Ducts & Insulation Bond Beam Fire Dampers Underfloor Girders IqDer%q� L) Fireplace liedowns Grease Duct & Hood Dilphrams One Hour Shaft Seismic Bracing Condensate Drain K:z Equipment Anchorage----, Fra—me Flues & Comb. Air La th T)t h e r Ext. Not Approved Firewalls Other Not Approved It L ILN k �Rrpq-"- 4 rdL BUILDING ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS APP.;_ICANT TO FILL IN INFORMATION :THIN RED LINES - USE BALL POINT PE_N ONL. •• .r BUILDING PpOJECT IDENTIFICATION - PER ITMBER aUnNING. % GSA ION &.PERMIT •�� A RE ING—ELECTRICAL—PLUMBING—MECHANICAL 3 PLAN CHECK VALIDATION ME OTY. ELECTRIC.PERM IT FEE v CONTRACTORS NAME �L � uUTCETS-SWITCHES-RECEP 5:00/1.00 , ' CNO. L''IGHTI NG FIXTURES 5.00/1.00 r-ONTRACTORS PPLIANCES-RESIDENTIAL• _4,00 - 'ADDRESS PHONE PANEL'S 5.00 DATE OF APPLICATION ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.0 EN q NO: SIGNS TRANS. 3.00 PIRCH END. PER ADDRESS TVALID I . SPECIALCIRCUIT 5.00 zip TEMP.METER OR POLE INS. 15.00 ADDRESS rs MOTORS SEE FEE SCH. AOREss SERVICE CHANGE 10.00ff•Y1r� wo.o LICENSED CON A R5 DECLARA N au;w :,hereby affirm,that I:ambliccnsed:underprovisions of Chapter ' ISSUANCE DATE. I_ < (commencing'with Section 7000)of Division 3 of,the Business and Professions Code,and my license Is in full force and'effeet BLDG. ELECT. PLG. MECH. y' -License Clan Lic.NumberEl El 1 13 0Z .0�1w Date—contractor. H H J Q x��1 - BUILDING PERMIT ¢ ¢ ¢-.a OWNER-BUILDER DECLARATION °pU� - MISC.— ' REFERTO ORD : INFORMATION x ; 1 hereby affirm that I am,excrapt from the Contractor's License O< Law for the 4ollowmg reasort:.(Sec 7031:5.Busiesand Professions' VALUATION $/FT. E a PERMIT 6:00 �,W t�• Code:Any ounpair any rcgmresap prior ronsuance, tee ¢:¢ Q,° Improve;demolish.or repair any 5LrucluR.prior lints issuance, ELEC,LONTR. . LIC.NO: ELECr y A7/V E o u requires the applicantfocsuch permit to file asigneJ statement that TOTAL ol FERMI TO P.'w �,y La- licensedpursuantto the provwithSectin700 Contractor's License - `•�^'W tiV"//J p i.40 Bus4(Chand coCode)or Section Esexemttheron3 and Ec i,is Business and heallegedProfessions Code)or that he is exempt therefrom 1.5 QTY. PLUMBINGPERMIT FEE ¢ moo. the basis for the alleged exemption Any violation of Section 7031!$ - STORIES TYPE CONSTR. Lim by not more (ore permit subjects lheapplicant Toa civil penalty, ALTER-DRAINSI,V,ENT-WATER (EA.) 4.00'of not more cant five hundred dollars the iq .P. :. 000�� ❑ .L aaomper of the property,or my employees with re is no[ BACK FLOW,PROTECT.DEVICE, 2.00 OCC.GROUP RE UNITS then wee Downer of(li,will property,., the work:empandloyers structure w is not intended or.ifemd forma(Sec. 7044. Business snit Professions DRAINS-FLOOR,ROOF,AREA,COND: 4.00' / Code The Contractor's License Law does not apply to an owner of CC4!! himself or buJdssow.eovLSthere proYid'whodeessuchworkg. FIXTURES-PER TRAP' 4:00 $ .F�SORAREA TOTA�'EAGE mems are of ughintended de own emred Pols.proIf.hI leve such ibuildi e- S-40 ,. menlsarerment is oroffered(oraro I f,how the owner. GAS-EA.SYSTEM-1INC.4OUTLETS 4.00 or der.will have a solo burden of year that he did fon,the owner- GAS-EA.SYSTEM-OVER 4(EX..) 1.00 budder will have The sale.), proving lha(he did not build Snim- SUILDINGLSE 'prove for purpose ofsale.). INDUSTRIAL WASTE INTER. REE oAryD CON IPB Omer )fps I,as owner of the property,am exclusively contracting with. 20:00 V/El �- I' cnsed contractors in construct the project)Sec. 7044.Business LAWN.SPRINKLERS-1.INC 5 V.B. 5:00 f� ASSESSORS PARCEL NO. and Professions Coda The Conbuildsror License Law does not apply - I �r to'unmwnar.of property who builds tr hogs licensed ensed p,and who LAWN SPRINKLERS-OVER 5'(EAL) q..00 pTIJ contracts for such projects with a contractodsl ticensetl ptirtuanDTo - the Contractor's License Law. SEWER-SANITARY-STORM EA.200k/B.00 TRACT No. PAROL NO. rea❑ I :eke du Sec. O B.&P C.for his WATER,HEAT,ER,W/VENT "q•00 7Q / Date _ r _ WATER SYSTEM 4.00 ' ACC.-FILE NO: WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP, q-Qp - Ager DATE I hereby affirm that I.have a certificate:of consenvto velf.insure. or z certificate of Workers'Compensation lnsumnce,or a certified ZONING 'ENG:SITE.NO. Copy,thercof(Scc.3800,Lab.C.). ��. Policy No. Company O ❑ Certified eopy k Hereby furnished: Z 2 ❑ Certified copy is,riled with the city inspection dkismn, FIRESPRINK :ENERGY T-24 F O' 'Applicant MISC.- REFER TO ORD v� 'N� ,-v N� � y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE' tiiM4�J 'W > COMPENSATION INSURANCE PLG.CONTR. ,LIC.NO. ;PLG: C,y( 0- O (This section need not he complet•d'if the.permit is tirr,one ;TOTAL r f +�1Qfl �'2 hundred dollars(SIOG)or less.) _ - U'.O I !rtifyllhat'in the performtan a of the.work ror.which this per-. / LL I- mit Is issued,I'sholl not employ any,person in any manner so as m QTY' MECHANICAL PERMIT FEE L 0 W 'become subject to the Workens Compersonion',Lawsof C.1ifnrnia. a Date Applicant - ALTER OR ADD TO MECH. q,00 BUILDING >_ ;NOTICE TO APPLICANT: If.after making this C nifieate of Ex- F.,_ emption,you should become subject to The WorkersCompensation gppLIANCE. 4.00 PLAN CHECK .pronslons,of the'Labor Code, You must'forthwith comply with V such provisions or this permit shall be deemed'revoked. AIR-HANDLINGl1NIT,(TO 10ADOC-F:M) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER•10=CF.M.) 5.00 SEISMIC FEE. I hereby..affirm that there-isa construction lending agency]or EXHAUST HOOD(WITH DUCT) 2.00 the petformailce'of the work for which this permit is inned'(Sec. '3097.Civ.C.). ,,, HEAT:NG UNIT(TO 100,000 B.T:U.) '4:00 MICROFILM Lender's Name Lender's Address - HEAT:NG UNIT(OVER 100,0008.T.U.)7.50 ELECTRIC_ I certify that I hav read this applicationand-stale that The above VENTILATION FAN (SINGLEI' 3:00 - .� ordinainfinonces is stater 1 agree to g to b with all cny rid County PLUMBING, ordinances and state laws relating w building construcll m. and BOILER-COMP(3 H:P:Or 100,000 B.T.U.) '4.00 h reby aunhoriu r pr sen tati,es of this city to mer upon the above-mentioned property for inspection purposes. '601 LER-COMP 10vee400,000 STU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify'.and keep harmless the City of MISC.- ,:REFER TO!ORD. Cupertino against-eabilities,judgments, costs and expenses which CONST.TAX 'may in any wa ,accrue against said City in consequence of the PERMIT ISSUANCE 3.00 _ gfamlla of thh r hnMECH.YONT LIC:NO. MECH.MECH.CONL LIC:NO. MECH. TOTAL TOTAL �� St. ore ol'Applican[/Contmctor Uan OFFICE COPY t APPLICANT TO-FILL IN INFORMATION WITHIN RED LINES - USE BALL POI NT.PEN ONLY BUILDING'PROJECT IDENTIFICATION PERMIT NUMBER amLOmc -APPLICATION &'PERMIT 5. ADD Ess 1 Q�f�'I, �'n BUILDING—ELECTRICAL—PLUMBING—MECHANICAL _5.56 OWNERS L•e—y� / - : . `-- PLAN CHECK VALIDATION N // 4 OTY- ELECTRICPERMIT 'FEE • PHONE CONTPACTO.q I N -SWITCHES-RECEP 5.0011.00 . ODw / vD "W' �C� CNO. LIGHTING FIXTURES 15.00/1:00 .13.E - CONTRACTOR's //�/(1�' ^"y,�1 PPLIANCES-RESIDENTIAL - 4,00 ,(b. , G M�tmi HONf/�� {L�o PANELS'' 5:00 -j DATE OFAPPLICATION A" CHITECT - PLAN CHECK FEEP.C.NO. ON SIGNS 6.00 ENGINEER ' L.C.NO. SIGNS TRANS." 3:00 ARCH:OR ENG. PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5-00 Sar _ rrEMP.METER OR POLE INS. 15.00. PAID Avvucwrurs MOTORS `t SEE FEE,SCH. �j ADD Ess a(/ 0 JUL 121984' ��/J l7(J SERVICE CHANGE '10.00 pp .a woo LICENSED CONTRACT S DECL RATION sls A E p"In� w I, b QE <u u Ihereby affirm that 1.am licensed under provisions of Chapter waT (commencing'.with Section 7000)of Division 3 of the Business and BLDG. ELE PLG.. MECH. rqz 1Ilco wnsC ase ism full forcy'�I�Le17CCL, ❑ ❑. ❑ 02W cenveC Lc.Number �"/n /•'S /-� Dam Contactor f rnH � ¢ Q w¢ OWNER-BUILDER DECLARATION B LOING PERMIT °' ss MISC.— REFER TO ORD _ NFORMATION .x 3 ,y I,hemby affirm that I.am.exempt from the Contractor's License Fu0'.Q Law for the followmgreuson.(Sec 7031:5,Buseress id Professions. PERMIT ISSUANCE 6.00 Vn'UATION SIFT.. N; Code.Any city or countywWichrquimsa permit(o ConsimU,aller. - ez a ¢o Improve,demolish,or repair any structure,prior to its Issuance.also E CC NT LICA NO. ELEC. E m u requires the applicant.for such permit to file a signed.statement that I ,I. TOTAL W m he R IiFensed pursuant to the provisionsof the Contractor s License !PERMIT TO Fit Law(Chapter 9(commencing with Section 7000)ofUivision3ofthe Business and Professions Code).or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE X1— the basis for the alleged,exemption.Any violation of Scclion 703115' STORIES E CONSTR.. A. by any applicant for a permit subjects the applicant to a civil penalty - ALTER-DRAIN&VENT-WATER (EA.) 4.00 of not more than five hundred dollars IS 500L): ❑ I,psowner ittheproperly ororkean teeswithraiseas ACK:FLOW'PROTECT.DEVICE. 2.00 .00C.GROUP RES.UNITS. Ther wlc as of the will do(,or m k,and the structure is not intended o,,offered for.sale(Sec.7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code'The Contractors License Law docs not apply to an owner of -' - - properly who,builds or Improves Ihcreon,and wh does such work FIXTURES.PER TRAP 4.00 SD.FT.FLOOR AREA TOTALACREAGE • h enself or through his own employees provided that such improve. nems are not minded or offend for sal .IL howevr,the building GAS-EA:SVSTEM-11NC:4OUTLETS.4,00 or improvement Is'wld within one year of completion.Ihe'owner. GAS.-EA.SYSTEM-OVER�4(EA.) 1.00 budder will have the burden of proving that he did not build or im- BUIL NG USE prove for purpose of sale.(. - INDUSTRIAL WASTE INTER. 20.00 RES❑ I❑ co .❑ Other ❑ I,as owner of the property:am exclusively Contracting with liecmed'contraclors to construct the Project(Sec:7044,Business LAWN SPRINKLERS'-1 INC 5 V.6: 5.00 ASSESSO ARCEL NO. and'Professions Code:The Contractor's License Law does not apply man''owner of property who bullas or improves(hereon,and who LAWN SPR INKLERS-OVER:5(EA;) 1.00 contracts for such projectswill ll a contracto e)littnsed punumm'to the Cmilmators License Law. - SEWER-SANITARY-STORM EA.200ft/8.00 - TRACTNO. PARCEL NO. ❑ I um CxcmPt under SeC. ,B.&PC.r..this WATER HEATER W/VENT reason 4.00 . '- Own`r _ Data WATER SYSTEM 4.00 ACC:DATE ACC._FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING'EQUIP. 4.00 " I'hcrebyaffirm that l have a certificate of consent m s,lf-houne, o6a certificaro of Workers Cumpenswim, sunnce,pr.�Cmlifmd ZONING ENG.SITE NO. ' copy:thereof(S - 3800.T.,Can - / - Policy No. Company O ❑ Certified copy is hereby furnished. FIRE gPRINK ENERGY T-Z/ Z 2 ❑ Certified c s fie with the city inspection division. FO Applican( � YZLC2 MISC.,- -- REFER TO ORM - �Q ' N❑ v � N� m CERTIFICCATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A:h:U.C. �W'1 - COMPENSATION INSURANCE PLG.CONTR. - LIC:NO. - CL O This section need not he completed if the Permit is for one TOTAL V N V NEJ ,- U O hundred:delta.IS 100)or less.) I certify that in the performance of the work for which'Ihis per- Q7.,r . MECHANICAL PERMIT FEE FEE SUMMARY O W mit is issued,1 shall not employ any person in any mannerso as to income subject to the Workers'Compensation Laws of California: _ NOT APPLICANT: ALTER OR ADD TO MECH.. 4.00 - - BUILDING F. N NQition,you APPLICANT: If,after making this Certificate sa ion F. ? .orphan,you should become subject to(he Workers)Compensation APPLIANCE 4.00 PLAN CHECK such royof Iha:Sa per Cod hallo deemed comply with FEE U such Provisions or this permit shell d:dttmed revoknl. AIR HANDLING UNIT(TOIO,000CF.M) 3:00 CONSTRUCTION LENDING.AGENCY AIR HANDLING UNITIOVER I0,0MC.FM.) 5.00 SEISMIC FEE I hereby affirm Ihil there is a comaniction:lending agency for EXHAUST HOOD WITH DUCT)' 2,00 the performance of the.work for which this permit is issued(Sec_ 30nder's .am HEATING UNIT(TO 100,000 B.T.U.) 4:00 - MICROFILM 3097,CsName Under',Address HEATI NG UN IT(OVER 100,000 B.T.U.)7.501 ELECTRIC I certify that I have read this application and state(hat the above .VENTILATION FANJSINGL- 3.00 information is�ci)mcl. I agree m comply with aII city an count PLUMBING ONE nm and state laws relating to building construction. pad BOILER-COMP I3 H.P.or 100,0010 B.T.U.) 4.00 _ hereby authorize representatives of this city„lo enter upon the above-mentioned property for inspection put potts. BOILER-COMP IOvpLoo.000 BTUI,SEE FEE SCH. MECHANICAL, .(We) agree to Save, indemnifyrand keep harmless the City of MISC.- REFER TO ORD. Cupertino against babililies;judgments; costs and expenseswhich - may in any way, Seem. against said City in consequence 0f 1ha PERMIT ISSUANCE - '300 CONST.TAX', grunting �of this pc it. MECH:CONT. LIC:NO.. MECH. - - '3- To.nL TOTAL Signa[ fAppBcan(/Con(ndor - Date ' OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY BUILDING PROJECT.(DENTI FICATION PERMIT,NUMBER aDILDING APPLICATION PERMIT ' ADOR yS�rx ,r BUILDING -ELECTRICAL-PLUMBING-MECHANICAL - 5560 OWNERS UU II GC ,� ,.�/+�-'f�/� -0LAN CHECK VALIDATION N° D YT� QTY. ELECTRIC'PERMIT 'FEE - • U.0 r CONTRACTORS I - Oa 133 UTLETS,-SWITCHES-RECEP 5.00/10N ry&COJ L./NG, LIGHTING FIXTURES 5.00/1,00 00 CONTRACTORS f�.-r l^r L� PPLIANCES-RESIDENTIAL i 4.00 �ADDREss �fX'/ G✓" PHOPANEL$ 5.00D DATE OF APPLICATION ARCHITECT SIGNS - -8.00 PLAN CHECK FEE - P.C.NO. ENGINEER LIC.NO. SIGNS TRANS. ' 3.00 ARCH.OR ENG PERMIT VALIDATION ADDRESS SPECIAL'ICIRCUIT 5.00 !zip rrEMP.METER OR POLE INS.. 15:00 Pa{�D .1 AnaucANTs C MOTORS '( 'SEE.FEE SCH. - JUL 12189 ` AOOREs laft n SERVICE CHANGE •- '10.00 - W o o LICENSED CONTRACTORS DECLARATI(3 CIi� of CoBIfInO u'y 1Vhemb,affirm am rovins Yhat 1 licensed under psioof Chapter 9' IS C CE DATE m<s (mmmm�cing with Section 7000)of Division 3 of the Business and BLDG. E ECT. PLG. MECH. F i Professions Cod and �(Llicense is in full force�tPd�eff l Z z vr'W D acnss LL_Lie.NumberL-(p f 7 - _ El �. Date ` Cie.boo or. Q Y f J ¢ ¢w a OWNER-BUILDER DECLARATION B LDING'PERMIT K ..A,O MISC.- REFER TO ORD NFORMATION x 9 1-. l hereby affim rm[hal l aexempt from.the Contractor's License Fuy'a' law for the following reason.ISec.7031-5,Business sero Professions' PERMIT ISSUANCE 5�. VALUATION v, Coil AnycaycR county which requrmsa pemiil lomnslrucL al ter, f 2' re Q o improve;demolish,or repair any structure,prior to Its issuance; Be, E C CONTR. _ LIC.NO:- ELEC. •%f /� m'LL ¢quirts the.Pplicant{or such permd to Ole a signc0 slatemem that / TOTAL �.J uAKi hers licensed personI to the pronvons of the Cononctor s Liccnso, �- -P RMIT TO F i Q Law(Chapter 9,4 On racing wnh Section 7000)of Division3of the 4 o 1, Aness snit Professions Code)or lhab he is ezcmpl themfrom and OTV. PLUMBING PERMIT FEE' ¢r o the basisfpr the alleged exemption.Any violation ofSeclion 7031.5 - STORIES TYPE CONSTR. A. !-a by hnyapplicanttora permit subjects the applicant rose civil penalty. of not more than r"It. red dollars(5500).): - • ALTER=DRAIN&VENT-WATER (EA.)4.00 - ❑ I,as owner of the property,pr my employees wi1H wages as. BACKFLOW PROTECT:DEVICE their sole'Compensation;Will do I C work,and thcslructure rs not 2.00 OCC,GROUP RES:UNITS mended or offered for sale(Sec.7009. Business and-ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 4.00 ' Code:The Contractor's License Law does not apply to an owner of property who_builds or improves thereon,and who does such work. FIXTURES-PER TRAP 4.00• SO.FT.FLOOR AREA TOTAL ACREAGE'himself or lhrough his own employees,provided that such improve- - - -- - mentsamnot intended or.offered for ale-,If,however'the building GAS-EA;SVSTEM-11NC.40UTLETS 4,00 or Improvement Is suld within one year of completion,thc•ewner- GAS-EA.SYSTEM-OVER 4(EA:). bullder,will have the burden of proving that he didnot build or am- 1.00 BUILD( G USE. prove for purposeof ale.). INDUSTRIAL WASTE INTER - .NES OND' Pe Other - O I,as owner of the:propeny inn exclusively conlmcting w .ith' 20-� licensed conracteirs to construct dre'prnjecl.(S c 7044.Business LAWN SPRINKLERS-11NC 5.V,B. 5.00 ASSESSONS RCEL NO. and Profeisioos Coder The Contmorn s License Taw does not apply to an owner,ohproperty who builds orimproves thereon,and:who LAWN SPRINKLERS-OVER 5(EA:) - 1:00 con tracts for such projects with a con tractods)licensed pursuant to the Contincturs License Law. - - SEWER-SANITARY-STORM EA.20015/8.00 ' - TRACT ND. PARCEL No. reason WATER under5_ee ,B.&P.C.for this WATER"HEATER W/VENT 4.00 Owner Date -400WATER SYSTEM . ACC.DATE ' ACC FILE NO: WORKERSICOMPENSATION DECLARATION WATER TREATING EQUIP- 4-00 - i hereby affirm that[',have a certificate ofcommnl to self-insure, ' Ora certificate of Workers'Compmalion yn ,:,ora certified. ZONING ENG:SITE NO. Copy thereof(Sec.3800,Iab.CJ.s /�//�/ '[r 77 Policy No. Company rV/T Q(o6. �7D . O' ❑ Certified wpy is hereby furnished. Z Z ❑ Certified b filed with the oily inspection division: - FIRESPRINK ENERGY.T 24 F O Appli and o MISC."- - REFER TO ORD: v N C3 YEJ N• PERMIT ISSUANCE LrN CF:RTIFICATF:ONSATIO I'INSUROM•WORKERS' 6.00 FLOOOZONE A.Lu.C. W > COMPENSATION INSURANCE PLG.CONTR. - u0.NO. PLG: ' d O (This section need not lie completed if the permit k4oi one TOTAL Y N❑ Y � Z hundred dolh,s(SIDO)or less.) U O I certify that in the performance of the work for which this_per- W QTY MECHANICAL PERMIT :T AEE. - FEE SUMMARY ,F mit is I shall'not employ any person in any manner so as to O w become abjccl to the Workers'Compensation Laws of California. D IL ate ant Applic . }.IL alle ,TO APPLICANT:.If.alter making this Certifiale of F.k- ALTER OR ADD TO MECH. 4:00 BUILDING F. Z coalition,youshould become subject to the Workers'Compvcmion APPLIANCE - 4.00 PLAN CHECK pronsions of the Labor Code,you.moSC forthwith comply;wilh ' U such:provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.114) 3.00 'FEE CONSTRUCPION'LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 5.00 SEISIli I hereby affirm ( that there "s A e.ma action'lending agency for EXHAUST HOOD(WITH DUCT) 2.00 [beperformce of the work for which th@Ipt,mnr is issued(Sec, - 1 3097:0c"C):anHEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM Lender's Name - Lender's Address HEATINGUNIT(OVER-100,000B.T.U:)7.50. a ELECTRIC I,cerlify that l have read this application and slate that the above VENTILATION.FAN(SINGLE) .3,00 information is wrmct I agree to comply with all city and county•. o 'PLUMBING ritunces and star laws relating to building construction;and! BOILER-COW 13 H.P.or 100,000 B.T.U.) 4,00 hemby mimuize-nepulem,hHwes of this,cily to enter upon the above-mentioned property:for inspection purposes. 801 LER-COMP(Over 100,000 BTU)SEE FEE SCH. granting of this permit. MECH. TOTAL MECHANICAL (We) agreelo ave,'indemnify.and.keep•harmlcss the city of MISC.- REFER TO.ORD. Cupertino against lubilltics,'judgmemn. costs and expenses which may In any waytauru-�against said Citylin consequence of the PERMIT ISSUANCE 3.00 CONST.TAX �. / MECH.CONT. LIC.NO. s-J{ fY/l Signa 1' pplicanUConlmctor •}Date TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY 13UI LDING PROJECT I DENTI FICATION PERMIT NUMBER BUILDING APPLICATION &PERMIT /DOHE55 BUILDING.—ELECTRICAL—PLUMBING—MECHANICAL 5559 O NEWa �.r PLAN CHECK VALIDATION NAME _72CC-�J��! QTY. ELECTRIC PERMIT 'FEE •^ PHONE CONTRACTOR V ICr012 1,1313 UTLETS-SWITCHES-RECEP 5.00/1.00 47. LlL1(.LJI�LIC.NO; LIGHTING FIXTURES 5.00/100 ,OD ADD EAcroR's PPLIANCES-RESIDENTIAL 4.00 ry� ADD §L5 U� �8•/ // 40 -W 71775 I ( S*414E LV PANELS 5.00 [[I1ffss DATE OF APPLICATION AflcnriECr - PLAN CHECK FEE P.C.NO:.. OR - SIGNS 6.00 ENGINEER LIC.NO. SIGNS TRANS: 3.00APCH.OR - ADDRESS SPECIAL SPECIAL CIRCUIT 5.00 ,. PER TION i1vrrEMP.METER OR POLE I S. 15.00; 111' q q pQAA APPLICANTS MOTORS 'SEE FEE SCH. {aJUL 1 2 �9v`i ' r . . o77O ` v 14r p SERVICE CHANGE 10.00 p y no 0-W;o LICENSED CONTRA ORS'DECLARATION City of Cupertino Qu,u I.hereby affiml,thot,l-am licensed under provisions of Chapter 9 y a'a (commencing with Section 7000)of Division 3 of the Business and 'ISSUANCE DATE r ski Professions C.dc ed my license is in full force and effect' :SLOG. EL C PLG.r MECH. z O Lmensc Css.3/ Ls •Number J (p /'S 1�i EJ p . w' Datc Contractor_' - s ¢ Y2 J a m w¢. OWNER-BUILDER DECLARATION 8 LDING PERMIT o" " MISC. REFER TOORD - NFORMATION w,u. w' I hereby affirm ing mason, exempt 31.5. u Contractor's andi s License u.o¢ Law for thefollowingor county which 70resa mit toccad Professions vA AT10N $/FT. �`— �. - PERMIT 8:00- Code:, e,dAny demolish, counpair any regmrese Omit alter, c ¢ ¢,�' improve,demolbh,or repair any structure,prior to Its Issuance,also E EC:CONT LIC NO. ,s ELEC. / �•s n m Be requires the applicant for such permit to file"a signed statement that C�o.2loi31 TOTAL 6?v w._ w he is licensed pursuant to the provisions of the Contractors License .'PERMIT TO r 2.> Law(Charter 9(commencing with Section 7000).(Division 3 of the - i.o,, Business and Professions Code)or that he is exempt therefrom and QTY: PLUMBINGPERMITFEE ' te 1- the basis for the alleged exemption,Any.violation'of5ection 7031.5 - u b yuan a licanl!ora permit subjects thea applicant toa civil - STORIES. TYPE CONSTR. Y t PP P I pP penalty ALTER-DRAIN&VENT-WATER (EA.) 4,00' .Pool mom than five hundred dollars(my cm1: ❑ 1.as owner oLthe'property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2,00 Ibeirsole'.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,AREA;CON_D.-4.00 Code The Contractor's License Law does or apply to an owner of _ properly who bmhis or Improves thereon,and who does such work. FIXTURES-PER TRAP ' him If i through his own employees,provided.that such improve- - 4'� SO.FD aDR AREA TOTAL ACREAGE merits are norintended or offered for Pale.IF.however,the building GAS-EA.SYSTEM-I INCA OUTLETS 4.00 , ' '..• .- .r improvement is sold within one year of completion.the owner- GAS-EA.SYSTEM-OVERA IEA.)' builder will have the burden of proving that he did not build or ire- 1:00 BUILDIN SE prove',for:purpose of sale:): I INDUSTRIAL WASTEINTER. RES IND-„ - PB 'Other" ❑ I,as owner of Ihe,property,-am exclusively mntmcting with - 20.00 IN S '.licensed eonlmct.srtolconshuct the,.project(Sec. 7044,Business LAWN SPRINKLERS' INC 5 V.Bt - 5:00 q55 5g SPARCEI NO.- 10 and Professions Code,The Cm,hactor s Licenm law does not apply men owner of property who builds or improves thereon.and who- LAWN SPRINKLERS-OVER 5(EA.) , 1.00 - contracts for such projects with a contractors)licensed pursuant to the Contractors License Law._ -' - SEWER-SANITARY•STORM EA:200ft/8:00 TRACT Na. •PARCEL NO. ramal vm exempt under Ser. ,B.&P.C.for this WATER HEATER W/VENT 4.00 - Ownci' Date WATER SYSTEM 4.00 „ ' + ACC.DATE ACC.FILE N0. WORKERS-COMPENSATION DECLARATION WATER TREATING EQUIP, 400 I hereby affirm that I�Imve15 certificate ofconsant to self-insure.. or a certificate of Workers'.Compensation.Insumnee:.r ncertified ZONING ENG.SITE NO: copy thereof f5.. 3800,Lab.C). / /(/�� - Policy No. Company furnished. !(0 LO Y' Z ❑' Certified'' is hereby fifamish cd. Z Z ❑ CerttOed'copy is Oled with the city'inspection division_ FIRE gPRINK ENERGY,T 24 " F O APPliunf 3 �'r-Q iPLGC.ONET:R ISC.- REFER TO ORD. : - Y:[] N� - ,vEl". NEI CERTIFICATE OF EXEMPTION FROM WORKERS' T ISSUANCE 8.00 PLWD20NE A.L.u.c:W`> COMPENSATION INSURANCE - uC:NO PLG d O lfhirseclion need not'be'completed'if the:perrnit is.for one TOTAL Y N� Y❑ NQZ hundk--d dollars(5100)or less.) O I cerrify9hat.in the performan ce o!the work for which this perF. , mit Is issued.Ishall'not em to an MECHANICAL'PERMIT 'FEESUMMARYlL p y y pssrson in any manner so as to _ FEEOc) become subject to the Workers'Compensation"Laws of California. 0. -0me' Applicant $UILDIy 'NO710E'TO`APPLICANT. IL,aflcr making this Certificate of Ex- OR ADD.TO MECH:' < 4.00emption,you should become subject tb the Workers'CompensationPPLIANCE provisions,df lhe',Lahor Code, you:m usrlorthwith comply with - - • - 4.0 PLAN CHECK, U such provisions or this permit shall be mail revoked. __— — AIR HANDLING UNIT(TO 10J30041F.M.) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVER I0.0WQFF4) 5.00 SEISMIC FEE ' I hereby,affirm that there is'a construction lending agency for EXHAUST HOODJWITH DUCT)' 2-00 .the performance of the work for which this permit is Tamed(Sec,. - - 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) .4,00 MICROFILM Lender's Name -Lender's Address FMECH.CONT. !UNVER.100,000 B.T.U.)7.50 'ELECTRIC�"•.• - Ic•Itify that l have 6d this application and stale that aboveN (SINGLE) 3.00 • information is correct 1 agree to comply with all city and county - PLUMBING .nlmantts and stat laws Mating t.,building construction, andDP.Or100,000B.T.U.I 4.00 .hereby authorize representatives of thio-city to enter upon theabove-mentioned property far inspectionpurposes: r100,I100BTUISEEFEESCH. MECHANICAL (We) agree m save, indemnify and.keep harmless the City of - REFER TO ORD.Cupertino'aguinsI liabilities;judgments,costs and expenses which CONST.TAX may In any way accrue against said City-in consequence of theS3.00 Sm—Ung?lhispermit. ,LIC.NO. - MECH. TOTAL TOTAL Signa u o Applicant/Contmetor Date OFFICE COPY APPLICANT TO FILL 1N INFORMATION WITHIN REDLINES = USE BALL POINT PEN ONLY iBUILDING PROJECT lDENTI FICATION - - PERMITNVMBER 6UILDINc /moo' APPLICATION & P.ERMIT rr� sr�sr� :Aeon O I v. lX•.L-YAC/-Ll� WLa 5 5,5 BUILDING—ELECTRICAL—PLUMBING--MECHANICAL OWNER'S �-/1 1/+�J/.L(I fL�I PLAN CHECK VALIDATION N4 t QTV. - ELECTRIC PERMIT FEE r •. PNONF .CONTflgCT0R3 l/�/( 10.2/Yl� •"AY 141 t4$11 UTLETS'-SWITCHES-RECEP 5.00/1.00 .0 (jf/VLl/LC/M.Ic.NO. LIGHTING FIXTURES 5.00/1.00140 CON RACTOR'Snyr/v, PPLIANCES-RESIDENTIAL "4.00 -�',QQ � a0 RE eL !2vY M- :PHONE coW PANELS S.00 . DATEOFAPPLICATION - ARCHITECT SIGNS 6,D0 PLAN CHECK FEE P.C.NO. ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION AnURESs'., SPECIAL CIRCUIT - '5.00 _ZIP EMP.METER OR.POLE INS: 15.06 - PAID • APPLICANTSJUL q A MOTORS' SEE FEE SCHJ ' 12 984 O((Y l-• C�c.(.al SERVICE CHANGE 10.00 oat i 00 LICENSED CONTRA ORS DECLARATIONCIt� of-Cupertino U 1 hereby.affirm that l am licensed under provisions af(Tapter9 w rt m (commencing with Section 7000)of Division 3 of the Business and ISSUA CE DATE BLDG. E C PLG. MECH. H H z ProfeMimns Code and'm license is in full forcey1 gqef(cy ❑ o i N o License Lic.'Numbm Ell l0 f3 / '3 I-ooUmc Contractor a,y a OWNER-BUILDER DECLARATION 'BUI- DING PERMIT" J n o:p sa INFORMATION X 3,IL'a I hereby .1rm that I am exempt from the Contraclori LittrBq MISC-,— REFER.TO ORD -- - aOa' lawfor(hell acing reamn.(Sec.703L5,Businessand Professions VALUATION S/FT. r — PERMIT ISSUANCE Code'AnYcity or coun'y which requtrtsapertnrtloconslrvcl.alter, 6•� ,) w C_a Q'to improve,demohsh.or repair any slroctum.prior 10 Its issuance.also IC.NO. - ELEC. y w —O LL• requires the appli m for such permit to We a signed statement that Go�i3r TOTAL- 7� m$w he is licensed pursuant to the provmons'of she Contr-aclor's License E C-C NT ,. ERMIT TO Hsi a Lsw(Chi ptcr9(rommerrcine with it..7000)of Isis- n3ofthe � 1 i o Buv it.and'Professhms Codebor that he is are Pat ercfrom and QTV: PLUMBING PERMIT 'F j ¢,.1-o the basis far rhe all exemption.A ny,violalionof5ection703L5 _ j .STORIES TVPECONBTR. a ;m by any�applicanl for a permit oo ccts the applicant too civil penalty of not mom than five hondmd dollars(35001.1: - ALTER-DRAIN&VENT-WATER (EA:114.00 ❑ I.as owner of the property,or my employees with wages as BACKFLOW PROTECTDEVICE their sok compenvlion,-will do Ike work,and the atrvcturc is not . .2.00 OCC:GROUP RES.UNITS intended by ol'(cad for In(Sec.:7044, liminess'and Professions DRAINS-FLOOR,:ROOF,AREA.COND. 4,00 Code:The Contractor's License law does not apply to an owner of properly who builds Or Improves thereon,and;who does such work FIXTURES-PER TRAP 4.00 s6 Fr:FLOOR gREq TOTALACREAGE • himself or through his own employees,provided that such improve- meusarenotintendedoroffered for sale..If,however,thebuilding GAS-EA.SVSTEM•11NC.40UTLETS 4.00 or Improvement is sold within one year ofcompletmn,the owner- - builder will haveithe;burden of proving that he did norhuild or on. GAS-'.EA.:SYSTEM-OVER 4(EA.)' 1,00 - BUILDING USE RES prove 1,as owner of sale.) . - +IILNDUSTRIAL WASTE INTER. - ❑ I❑ ❑ Other❑ ❑ 1,as owner oI 'tic property,he exclusively contracting with 20.00 andlicaProfession., ince constructtheproject(Sec.7044,BusinessSPRINKLERS-1 INC 5 V.B. 5,00 ASSESSOR RCELNO. and Professions prope The honimctoh improv LawJoos.and w o 'Io.an owner ofpwpertywho.builds oeimproves thereon.and whoSPRINKLERS•.OVER 5'(EA.) 1;00 contracts for su h projects with'a contractogs)licensed pursuant to the Commetor,L t,..Law:. � -SANITARYSTORM EA.200ft/8.00 TRACTNO. 'PARCELNO:re❑Inl_ani exempt und¢cSec ;B:&P.C.for thisR NEATER W/VENT 4.00 - Owner Uule 4.00 ACC.DATE ACC:FILE NO. ,•r - WATER .,WORKERS;COMPENSATION DECLARATION WATER TREATING EQUIP. q;(XI. I hereby affirm,that I have'."certificate Ore.ricat to self-insam, - _ or a certificate of Workers'Compense'ion Insurance,or .cersifmd- - ZONING .ENG:.SITE NO. copy thereof(See 3800, p.ryLah.C.). �3� Pnlicy No. Company 0' ❑ Certified copy is hereby furnished: ' rZ 2 ❑ �Cerlified op 'is led with the city inspection division. FIRE SPRINq ENERGY T-Z4 '- O APp'iwmI�`-�` '-i MISC.- REFER TO ORD. r'[D NLj. k❑ No jr tri. CLRTIFICATEOF EXEMPTION FROM WORKERS:' PERMIT.ISSUANCE 6.00 FLOOD ZONE A.CU.C. LU > ' ` COMPENSATION INSURANCE PLIC CONTR; LC.NO. PLG: d O (This section need not be completed if the permit is for one - TOTAL 'y.� NE Yo NE 7 Z' hundred dollars($100)Or.less:)' 'U O 1 certify that In the performance of the work for which this per- QTy. MECHANICAL PERMIT FEE FEE:SUMINARY. ly U mU rs issued:1 shell not employ any personjin any manner so as to 'U w become e eine"sutijecltot'A Workers:Compensation Lows of California.' 0. Dole— I Workers 'ALTER':OR'ADD,TO MECH. q;pp - BUILDING . } 2 NOTICE TO APPLICANTS Ir after'making.'his Certificate of Ex- ,F— _ emp'am.yooshould ticcome subject mlhe Workers'Cmnpensatimn. APPLIANCE' 4.00 PLAN CHECK provnam of the Labor Code, you mus' fortkwi[h comply wim FEE 'U s..If r.visi..a or this permit shall be decried revoked. AIR HANDLING UNIT.(TO IOAMCF.M.) -3,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0AWC.FM.)^6.00 SEISMIC FEE I hereby affirm that them is a construction lending agency-for EXHAUST HOOD(WITH DUCT) the performanceof the work for which'this permit k Issued(Sec. 3097.Civ.C:). - HEATING UNIT(TO 100,000 B.T.U.)- 4,00 MICROFILM Lender's Name Lender's Address - HEATINGUNIT(OVERl00,000B.T.U:17.50 ELECTRIC 1 certify that I have mad this application and state that the above VENTILATION FAN (SINGLE) 3.00 •, .information is correct. I agree to comply with.11 city and county PLUMBING. ordinances and state laws relatingto building construclion.,aod BOILER-ODNP I3 H.P:Or 100,000 B.T.U.) 4;00 hereby authorize representatives of this City to anter-upon.the. above men'ioncd property,for inspection purposes BOILER-COMPyOver IOO.000 BTUI SEE FEE SCH. MECHANICAL (We) agreeno ,tb.save; indemnify and keep harmless me,City'of MISC:- Y REFER.TO ORD. Cupertiagainst liabilities,.judgments,-costs and expenses which . may in any way accrue against said.C1ty in consequence or the PERMIT ISSUANCE' CONST.TAX 300 lamming of this permit MECH,CONT. LIC.NO. MECH. . Torgc TOTAL " Sign an Of Applict/Contractor Data .OFFICE COPY Q��7✓tel��l APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PENONLY 'BUILDING PROJECT I DENT(FICATION y: PERMIT.NUMBER BUILDING APPLICATION &.PERMIT -' Aoo Ess' - &7S BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 5557 OWNER'sf ' /, / PLAN CHECK VALIDATION " E ��6��'1 Y CITY ELECTRIC PERMIT ,FEE • PHONE CO TRACTOR'S HEMP..METER UTLETS-SWITCHES.-.RECEP 5.00/1.00 -00 (�J �I-U-Cua..N•fD. �(U JIGHTING.FIXTURES 5.00/1.00 D0cox RAGroRsn +1U7.-t^, (DPPLIANCES-RESIDENTIAL 4.00 A REAS l //y� 1-6 .DLJ`�I-., "HONE ANELS �•'� 5.00 �('0 DATE OF APPLICATION ARCHITECT PLAN CHECKFEE P;O.NO. OR - IGNS• 6.00ENGINEER uc:NO, IGNSTRANS. 3.00 ARDRE55ENG- PECIAL CIRCUIT - -5.00 .PERMIT.VALIDATION zap OR POLE INS. 15.00 -PAID AP MOTORS Pucnwrs- �+�__ SEE FEE SCH. AP s;; /I y f/n .HE .I 11 zf SERVICE CHANGE 10.00 JyL 1 2 984 FDO LICENSED CONTRA(-"S DEC RATION C i w' I hereby affimt that I am licensed under provisions of Chaplet.9 - Ino ( ommencing with'Sechon 7000)of.Division 3 of the Business and,., �,Z Pioles,nons Cod- and my lice me is in Tull'force and sffey-I. - BLDG. CT., PLG. MECH.- z o m. License Class Con Nicobar 7Jn 161 1_ El � ' < m s° Date ' '�- - Contractor - eEw,<' 'OWNER-BUILDER DECLARATION `BUI DINGRERMIT X 3:LL,y I herebyaff.,.that 1 am,exempt from,the Contractor's License' " MISC.- REFER TO ORD 'i FORMATION' u o 4'. .Law for the followingreason.(Sec 7031.5.flusinessand Professions - VALUATION. SIFT. a,, PERMIT ISSUANCE 'g•pp ' Code Any City.or county which requires a permit to ornlmet,alter, 'Improve:demolish,or repair any structure N0.prior to its Issuance,also E C:CO TR. LIC. to ' ELEC- /..� w W'm u 'requires the applicant for.such permit to file a signed.statement that 13I TOTAL�� he Is licensed pursuant to the provisions of the Contractor's'License _ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe. 4 D Business and Professions Code1 or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE + Ic the basis for the alleged exemption.Any violation of Section 7031.5 - ` STORIES' - TYPE CONSTR, m _d5 by any applicant for a permit subjects the applicant to a Civil penalty ALTER-DRAIN III (EA.) 4.00 Of not mom than five.hundred,dollars(S500).)x. ,. _ - ❑ Las owner of the property,or my employees with wages as BACK.FLOW'PROTECT'DEVICE 2.00 their sole compensation,will do Ike work,and the structure is not, . OCC.GROUP RES.UNITS ,!heir or offered for sale-(See..7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 " Cme;.The Cootractor,'s License Law does not apply to an owner of ' property who:builds or improves thereon,and who doessimh work FIXTURES-PER TRAP 4.00. Sd FT.FLOORAREA TOTAL'ACREAGE himself or through his own employees,provided that such improve- mentsarcnotintendedoroiTcrCdforsale.If,however,the building GAS-EA.SYSTEM-1 INC;4OUTLETS 4,00 or Improvement Is sold within one year;of completion;the owner- GAS-EA.'SVSTEM,-DVER'4(EA.) builder.will have the burden of proving that he did not build or im- '1':00 BUILD! G USE prove fors wn,e 6f sale'. RES h INDUSTRIAL WASTE INTER. 20.00 1N D❑ ❑ Other❑ ❑ I as owner of the property,he exclusivelyec (Sec. 70 coding with ffJ beenaed contractors The for project La. does not44. apply LAWN SPRINKLERS-.1 INC 5'V.B.. 5.00 - ASSESSO PARCEL NO. and Professions Code:The Conbuildsr s improin Law does not apply to Contracts ctsfo ouch'prerty who bacon or Improves!hereon,and who LAWN SPRINKLERS--OVER 5(EA.) 1.00 (he Cons7m su h cen a,Law with a conimdads)lianud'pursuant to (he Contractor's Lcense Law_ SEWER-SANITARY-STORM EA:'200ft/8.00 rgACT.ryO: PAgeECNO. re❑n 1.am exempt under See. ,B.&P.C'-1'or this WATER HEATER W/,VENT 4.00 '0 Owner Dam WATER SYSTEM - 4:00 ACC::DATE ACC.FILE NO. WOHKFRS'COMPENSATION DECLARATION WATER,TREATING EQUIP. 4:00 Phereky affirm that 1 have a certificate of consent toell'-insure, or a ec,tificam of Workers'Compensation 1 surunce,or a c<rtified ZONING ENG:SITE NO. copy Ihemcf(Sce 3800,'Lab.C'•).N/1 /1�/ I.f 3+'f o - - Policy'NO. - Cs mpany /7 `7 l0 1 W /� O' -❑ Cewified copy,isherebydurnished. - _IZ Y pection division. FIRE SPRINK ENERGY T44 Z ❑ Certified I . led qIth the cit 'ins 0 ' Applicant �y Il _ MISC.- REFER'TOORD. Y:❑ .No . 'y.[] NO ~ PERMIT ISSUANCE 'CERTIFICATE ONSATIOFINSURAN WORKERS' 6.00 FLOOD ZONE - A.L.U.C. W � COMPENSATION INSURANCE PLG.cONTR. LIC.No. ,PLO_ f1.0 (This.s,e isln need am be completed.if the;permit is-for one TOTAL Y[ NE] Y[:] NO LZ) Z bandied dollmrIS 100)or less.) I _ ) 0' 1 certify that iii the performance of the work for which this per-, QTY- MECHANICAL PERMIT FEE_SUMMARY. IL U mN Is issued.I shall not employ any person in any manner so m m FEE O;m became.subject to the Workers'Compensation Laws of California. C. -Dote Applicant ALTER OR ADD TO-MECH- q.00 BUILDING' I "i } W :NOTICE TO APPLICANT!IL after making this Certificate oLEx- F.:Z emptier,you slmuld become subject to the Workers'CompensationgpPLIANCE - 400 PLAN CHECK pro visions:of the;tebm Cod., you . , Us( forthwith comply with U such provisions or this permit shall be deemed revoked.-_ AIR'.HANDLING UNIT(TO 10MOC.F.M.) 3,00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNlTiOVER 10=41F-M.) 5.00 SEISMIC FEE I hereby.affirm that there is a constructionlending agency for EXHAUST HOOD(WITH DUCT)' . 2,00 the performance of[lie work for which this permit is issued(Sec. -MQ - 309PCiv.C). UNIT ITO l00,00trB.T:U.) 4.00MICROFILM Lender'sName LendeirAddrcss UNIT(OVER 100,000 B:T.U.)7.50 ELECTRIC ! certify that l have read thisapplmalion and state that the above TION FAN (SINGLE) 3.00 information ism e t f afire.t0 romplywilk:BI1 citYand county OMP PLUMBINGOrdinances and state laws.relating to building.construction; and (3 H.P.or 100,000 B-T.U.)n4:00hereby iauthorize mpresentatives of this.city to;enter upon dheabovcmentioned property forinapc,ion purposes. COMP(0.,100,0008TU1SEE FEE SCH. MECHANICAL (We) agree to save, indemnify.and lomp'harmless the City of. flEFER1T0 ORD.Cupertino.against liabilities:judgments, costs and'expenses which _ CONST.TAXmay in any way acerae against said City in consequence of the. SSUANCE 3100 gmnlin6Of this pesmil..� MECH. LIC NO. - MECH-� TOTnL TOTAL Signalu Applicant/Contractor Date - OFFICE COPY. . APPLICANT TO FILL-IN INFORMATION WITHIN RED LINES- USE.BA,LL POINT PEN ONLY BIUI LDI NG PROJECT IDENTIFICATION PERMIT NUMBER BUILDI.G APPLICATION & PERMIT aAODRE55 C 5.5 r7bBUILDLNG-ELECTRICAL-PLUMBING—MECHANICAL J J J wxeR' CITY PLAN CHECK VALIDATION "AME '//_UICJ Ll141-11 TY.' ELECTRIC PERMIT FEES PHONE .CONTRA ORI N , ClO.�n'�3�3 UTLETS-SWITCHES-RECEP 5.00/100 q ;00 uc:xo._ LIGHTING,F I XTURES 5.0011.00 ADDRESS n ��ltb.li, PPLIANCES-RESIDENTIAL 4:00 CONTRACTORS` q L% .AL'/YLJ nr1 . o , Of PHDNE .PANELS 5.00 ,W DATE OF APPLICATION 'ARCHITECT LjPLAN CHECK FEE P.C.N0: , OR' ENGINEER LIC.No.. SIGNS TRANS, 3.00 - - ARCH.OR E.G PERMIT VALIDAT ON ADDRESS SPECIAL CIRCUIT 5.00 PA` ZIP EMP:METER OR,POLE INS. 15.00' APPLICANT5MOTORS t Lf SEE FEESCH. Q 1U 1 D '19�A SERVICE'CHANGE 10.00 w'o o' - LICENSED CONTRAC RS DE LARATION 01 �pp8111t16 ,,�u I hereby affirm marl am licensed under provisions of Chapter 9 I A CE DATE P.<n Icommencing with Section 7000)of Division 3 or the Business and BLDG, .ELECT. PLG: MECH. ' H z Professions Codc�Tnd'mblicense is in fall rorce aOd effect ❑ O S? 0 in O License Class—{..=/•,y Lic.Number f Dote Contractor c a:;w u OWNER-BUILDER'DECLARATION BUI ING PERMIT 'Y';'u r '1 hereby affirm that P ani exempt from the Contractors License MISC.- REFER TO ORD - IN ORMATION wVALUATION 'S/FT. rLy4 Law for thefollowing reason.(Sec..7031.5..Business and Professions - PERMIT.ISSUANCE - 5,00 sit Code:Anycityorcounly which requiresa hermit reconstruct.alter, a PO. nm rove,demolish or repair any slmUare,prior to Its Issuance.also LEC CO T _LIC.NO. (� ELEC. m`LL re)uires the applicant for such',permit to file a signed statement that l/f/ TOTAL A w he is licensed pursuant to the provisions of the Contmctor'ti License 'PERMIT TO z i Law(Chapter 9(commencing with Section 7000)erDivisior. .... n3lthe o Business and Professions Code)or that he is exempt therefrom and OTY: PLUMBING.PERMIT' FEE ¢',I- the basis for rhe alleged exemption.Any,violation of Section:7031.5 STORIES ,TYPE CONSTR. n 3- by any'applicanl far a permit subjects the applicant to a civil penally' ofear more than rive hundred dollars(5500):/: ALTER-DRAIN&.VENT-WATER (EA.) 4.00 ❑ 1,as owner,of.lheproperty,or my employees with wages us BACK FLOW PROTECT.DEVICE '.2.00 DCC.GROUP • their sole compensation,will do.the work.and the structure is not RES.UNrtS. ' intended dr.olfered far sale.(See. 7044. Business and Professions DRAINS-;FLOOR,ROOF,AREA;COND. 4.00 Cade:The.Contractor's License Law does not apply to an owner of ' property who,builds or Improves thereon,and who does such.work FIXTURES,-PER TRAP 4.00 SO.FT.FLOOR AREA "TOTAL ACREAGE • himself or through his own employees.provided that such,improve- , mems armor intended oroffered for sale,'If.however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or improvement Is sold within one year of completion,the owner- GAS-EA:SYSTEM-'OVER 4(EA.) y,00 BUILDING USE bud der will the burden of proving that he did not build or int- pruvc fui purpose of sale.). WD -PB Osner ❑ Las owner of theproperty,amexclusivel INDUSTRIAL WASTE INTER. 20.00 tt y.7044 Basin ss 11 0 licensed.centmetors lis construct tire project(Sec.7044-Business LAWN SPRINKLERS-1'INC:5 V.B. 5.00 ASSESSOR PARCEL NO. .and Professions Code:The Contractor's License Law does not apply town owner of property who builds or improves thereon.and who LAWN_ SPR INKLER$-OV ER-5(EA.) 1,00 contracts for such Projects with a contractor(s),licensed pursuant to the Contractors License law. _ SEWER-SANITARY-STORM EA.200ft/8.00 - TRACT NO. PARCEL NO. reason I,am exempl.onder:See.- .11&P.C.for.sins WATER HEATER W/VENT 4.00 . Owner -Date WATER:SYSTEM 4:00 ACC.DATE ACC:FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4100 I hereby affirm that.( have a certificate of consent to self-insure. .ora certificate of Workers Compensation Insurance,or a certified ZONING - ENG:SITE NO. copy thereof ISec.3800,Lab.y ` p /_/ Poli Cert Company f!/!! Z' ❑ Certifiedcopyis hereby(with tit ' Z.Z. ❑ Certiriedam y .s Jed.with'the city inspection division. FIRE SPRINK ENERGY T44 F'O Applicant MISC. REFER TO ORD. YE'. NEI Y ❑ NE ••�:w. CERTIFICA EOFEXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.O.C. -W �' - COMPENSATION'INSURANCE PLG.CONTH:' LIC.No. ptG d,0 fTiiis section-reed not he completed if the penoi Cis for one TOTAL Y O , N� Y C] NC] Z hundrep. d doll..IS 100)or less. CJ O' add that in the performance of the work forwhich this per- ' .LL F- mit'.is issued,1 shall notalnploy any person in any manner so as m CITY. MECHANICAL PERMIT FEE 'FEE•.SUMMARY -, Q. iKwmc subject to the Workersmns Copeation Laws of California. y Date -nnphxam 'ALTER OR .00 ADD TO.MECH. 4BUILDING },2, ' NOTICE TO APPLICANT: If,after making this Certificate of Ex-coalition.you should become subject to the Workers'Compensation' APPLIANCE 4.00 PLAN'CHECK provisions of the Labor:Codc, you must forthwith comply with, -U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10MCF.NL) '3.00 FEE •CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 110D00CRIA)^5.00 SEISMIC FEE 1 hereby�affirrn that them is a.construction lending agency for EXHAUST HOOD(WITH DUCT) 2,00 the performance of the work for which this permiCis issued':(Sec. MICROFILM 3097.Civ.C,).'' c HEATING'UNIT(TO 100.000 B.T.U.) 4.00 '- Lender's Name Lender's Addresr- HEATING UNIT IOVER 100,000 B.T.U.I7:50 ELECTRIC GL y I cerN(y that I have read this apphcalion and'slBle that the above VENTILATION FAN (SINEI 3:00 Information is'correct.I agree;to comply wilh:.all city and county PLUMBING mdmances and stale taws relating to building construction„and BOILER-=COW13 H.P.or 100,000 B.T.U.)*4,00 • .hereby authorize represenlalives of this city to enter upon the above-menimmed properlyfor inspection purposes. BOILER-COMP(Over 100,000STU)SEE FEESCH. MECHANICAL (We) agree'to save, indemnify and keep harmless;the City of MISC.- REFER TO ORD. Cupertino.against liabilities;judgments, Costs and'expenses which may in any way, accrue;against said,City in consequence of the PERMIT ISSUANCE 3.00 CONST.TAX' gmntinguflhu Couit. '/ ^ MECH.CONT. LIC.NO. MECH. r / L(OJL _ - - TOTAL Signal, o Applicant/Contractor Date . . TOTAL OFFICE COPY :APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY. LBW LLDI NG PROJECT I DENTI FICATION PERMIT NUMBER AO ` APPLICATION &'PERMIT BUILDINC -ELECTRICAL-PLUMBING-ME -MECHANICAL 5555 OWnER'S. - � �� ' '. - - - -- - .PLAN CHECK VALIDATION •a, "A Qi ELECTRIC PERMIT FEE ' PHONE o .. CONTRACTORS /110 /�� UTLETS-SWITCHES-RECEP 5:00/100 NP C / uC.No. LIGHTING FIXTURES 5.00/1.00 13.C6 ,CONTRACTOR'S - PPLIANCES-'RESIDENTIAL ' 4.00. ' ,Qo 'ADDRESS - NON PANELS S. DATE OF APPLICATION AOR RCHITECTU. - SIGNS S.00 :PLAN CHECK ENGINEER ' LIC.ND: SIGNSTRANS. 3.00 ARCH,OR ENG - SPECIAL CIRCUIT 5.00 r�{�PERMIT s(�,�.�1g16 'ADDRESS . ZIP TEMP..METER OR'.POLE'INS. 15.00 _ Avvucnnn MOTORS f SEE EE SCH. 3, JUL 12 1964 AM,e L: FJU SERVICE CHANGE '10.00is L woo :'LICENSIiU CONTRACT S DECLA ATION City Of Cllpei IInO sWa'U Thereby affirm that lam licensed underprovisions of Chapter.9 ISSUANCE GATE ' a w (commencing with Section 7000)of Division.3 of the Business and z, Professions CoJ •-dm icense rsmfulfdorce vpd pffe BLDG. E'E PLG. MECH. Z,0 oZ - License Cys Lie Number— '2,z umber L(p I ElO z;,wDate Contractor. El 'OWNER-BUILDER DECLARATION - BU DING PERMIT X 3'A,N i her•tiy affirm[hal i am exempt from the Contractor's License MISC.- REFER TOORD I FORMATION. Fwy J Law'for the following Texaco.(Sec.7031.5?Business and Professions pERM1T ISSUANCE .500 VALUATION SIFT. f w f Code:Any city or county which requires permit to construct,alter, re re ¢O,, Improve:demolish or repair any structure,prior to Its Issuance.also 'E .C T LIC:N0: z ELEC. W mmac requires the applicant for such permit to file.a signed statement that '�13 TOTAL �6 RIMITT he is licensed'pursuant to the provisions of the Contractors License zQ.. Law(chapter 9(commencing with Section 7000)Of Division 3 oflhe 4 c. Business and Professions Code)or thalthe'is exempt therefrom and QTY: _ PLUMBING PERMIT FEE' 1C s-$ .the:basis forAhe alleged"exeroption.Anyviolation of Section 7031.5 ' - - STORIES TYPE CONSTR.. . i3 - by any applieanl for:a permit subjects the applicant thanOn civil penalty ALTER-DRAIN III (EA.) 4.00' of not more ,five hundred dollars(5500).): - ❑ I,as owner of the property,or my employeeswith wages as BACK'FLOW PROTECTDEVICE. - their sole'compnnsafion,will do the work.and the stioclure'is not . 2.00 OCC.GROUPRES.UNITS• intended or offered'for sale(Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND:'. 4:00 Code:The Contra tori Lmenu Law docs not apply to an owner of - property whobuilds or improves thereon,and Who does such work FIXTURES-PER TRAP 4.00 'SO.FT.FLOOR AREA TOTAL'ACREAGE himself or thmugh,his own employe",provided that such improve. - - - mentsamnot.intended or offered for sale.IL howeer,the building GAS-EA.SYSTEM-111NC.40UTLETS 4.00 or improvement is sold within one year of.Completionr the owner- GAS-EA.SYSTEM-OVER 4(EA.) builder will have the burden of proving(hat.he did'not build or im 1:00 BUILDING USE prove for purpose of sale.). ,.RES IND "-CON PB Other ❑ 1,as owner of the properly,am exclusivelycontracting with INDUSTRIAL WASTE INTER.. 20.00 ❑ ❑ ❑ ❑ ❑ licensed,Professionsctod :construct the project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. to rvowner of Code:The who o License Law does not apply mancwn or inhProjeywho buildsorimrl a)liensed pursuant who LAWN SPRINKLERS-OVER 5.(EA.)'' ,1:00 contracts f un's License projects with n conlmclor(s)Iicenudpursuanl to _ Ole I*,am exe ptudr aw.SCC. SEW ERSANITARVSTORM EA.200ft/5.00 TRACT NO: PARCELNO. reason)dm exempt Sec. ,B.&P.C.for This WATER HEATER W/VENT 4.00 Owner ,Dine WATERSYSTEM 4.00 ACC:DATE ACC:FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4,00 I,Ilcmby"affiirn that I.have a certificate of consent to self-insure. or a certificate,of Workers Compensation 1 umncb,ora scrolled .ZONING ENG:SITE NO. copylhereOf(Sec.3800,Lab.C.).A//� ' Policy No. Company �VrT IO LO 4' L ❑ Certified copy is hereby fumished. Z Z ❑ Certified eOpy,�/�8 lied Willi the city inspection division. FIRE SPRINK ENERGY Td4 FO Applicant 4� MISC.; REFER TO ORDS Y❑ 'N❑ r❑ N❑ it T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 8.00 FLOOOZONE A.L.U.C. L > COMPENSATION INSURANCE PLG:CONTR. LIC.NO. PLG_ - d IThis:seclion need.not.be completed if the-permit is'for one % TOTAL Y 11N❑ Y❑ N❑ ::).Z hundreddollars(SI00)orless.) 0.0 1 certify,that in the performance of the work for mwhich this per- CITY - ' U. F mil Is issued,I sh°ll not employ any person in any manner so MECHANICAL PERMITAs to V•FEE FEESUMMARY O;'.W bccomesubject lO the WorkeWCompensation Laws of C.lif.mi.. - - i W NOAppli } w NOTICE TO APPLICANT:Jf,cher making This Certificate afEx- ALTER OR ADD TO MECH. 4;00 BUILDING F;? emplion;you should become Subject to the Workers'Compensation APPLIANCE 4.00 PI-ANCHECK provisions'of the labor Code, you most forthwith comply with U such provisions of this permit shall he deemed ievoked,' AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 FEE. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0P=MC.F.PA) s.00 SEISMIC FEE- ' I hereby, affirm that thereisa construction-lending agency for EXHAUST HOOD(WITH DUCT) 2,00 the ,•rfo.C.).- 'of the work I'or which This.permit is issued(Sec: HEATING UNIT(TO 100 3097 Civ.C.l. MICROFILM Lender's Name - ,000 B.T.U.) 4,00 Lender's Addreis HEATING UNIT(OVER 100,000 B.T.U,)7.50 ELECTRIC I ertlfy that l heveread this application end stale that the above VENTILATION FAN (SINGW�FEESCH. 0 • information is correct.1 agree to comply with'ell my and'manYy' - PLUMBING 'ordinances and stale laws.relating to building Construction, and BOILER-COW 0 H.P.Or 1000 hereby authorize representatives of this-city to enter upon the above-menlionedproperty for inspection purposes. BOILER-COMP(Ove/lo0,000H. - MECHANICAL (We) °gree to sve, Indemnify and keep'hannleas theCity of MISC.- D.Cupertino Agalnsi Babihties,judgments:<,a,,-"d estimaes which CONST'.TAX may in any way ac.i ole against said City'.inconsequence of the PERMIT ISSUANCE0 .grantingofthis permitICNO.7-3 O TOTAL y Signature o Iiwnl/Contractor Date - OFFICE COPY • gz�� APPLICANT TO FILL,IN•INFORMATION WITHIN REDLINES — USE BALL POINT PEN ONLY '. -BUILDING PROJECT IDENTIFICATION PEFamrt rvua+eER, auRGiNG APPLICATION S& PERMIT ADDRESS o 5554 BUILDING—ELECTRICAL-PLUMBING_MECHANICAL OWNER I,'/ p PLAN CHECK VALIDATION ,. NAy.�QTX. ELECTRIC PERMIT FEE PHONE- CONTRACTOR'S C-/O/T/ �I I J . Nn E-, .• / Vim`//WA ✓11J•} UTLET$--SWITCHES.-R_ECEP 5:0011.00 .� sic:Na: LIGHTING'FIXTURES 5.00/1.00 ,DO -CONTRACTOR'S - !•-/r'a,/,/�s� PPLIANCES-RESIDENTIAL 4.00 qg1� ONEEE PANELS I � 5.00 5.Go DATE K APPLICATION AR rtscr SIGNS 6,00 .PLAN CHECK FEE - P.C.NO: OR ENGINEER ' sic.No. SIGNS TRANS. 3.00 ' ARC..OR ENG., PERMIT ATION ADDRESS _ SPECIAL CIRCUIT•. - 5.00 .p � iIP EMP..METER.OR POLE INS. 15.00 - -AvvLICANrsC MOTORS 1 'SEE FEE SCH. •� J111 Il 2.1��A ' ADDRESSbd4JA V L SERVICE CHANGE 10.00' Doi LICENSED CONTRACT RSD CLARATION of Cupe�ino a Zl,w I hereby,affirm,thut l am licensed under provisions.(Chapten 9. city DATE < (commencing w th Section 7000)of Division 3 of the Business and. ._ BLDG. ELECT. PLG. MECH. r z Professions Code ted Aicense is in Full forceb effect ❑ a z o h 4cense.Class - _ tic:Number e2I 'S I Z o z— O Uate 7 Contractor M m s � - BU DING PERMIT ¢,Q w.0 OWNER-BUILDER DECLARATION /INFORMATION K ;a 'I herebyaffirmlhnf I am excmpf(rant the Cnntractods License MISC. REFER TO ORD won. - VALUATION F u_ y.l- Law for the ity ar County which quire .a penninessarid Professions PERMIT ISSUANCE S.00. Code:Any city or County mp which requ tune p prior o its issuance, alter. _ 2 a : Improve,dtmohsh,or repair any stnleturc.prior mils tssuanee,also E C CO TR CI NO.' ELEC. a 0 at requires the applicant(.r.such permit to file J,Signed stat Inenl flint ' I'3 TOTAL �'s•O '.w he is licensed pursuant ld the provisions of the Contractor's'License ERMITTO Law(Chapter 9(Commencing with Section 7000)of Division 3 of the - E 4 o Business and Professions Code)or thathe isextmpbtherefrom and QTY: PLUMBING PERMIT FEE ¢ I- the hands for the alleged exemption.Any,violationofSecfion 7031:5 +. , ST IES TYPE CONSTR. ' A. byany applicamfor a permit subjects the applicant toa civil Penally gLTER°DRAIN.&VENT-WATER (EA.) 4-00 of net more than five hundred dollars($500).): ❑ Las owner of the property,or my employees with wages usBACK FLOW;PROTECT.DEVICE 2.00. -,OCC.GROUP ' . their sole'COMpensafun,will do the work.,and the structum is not REs.UNITS intended or.Offered for sale,(Sec. 7044, Business and Profession( DRAINS-FLOOR,ROOF,AREA,COND.,4.00' 'Code:The Co"In ctor's License Law does not apply to an owner of - property who builds or improves thereon ani who does such work FIXTURES PER TRAP 4.00' SCL FT.PLOOR AREA TOTAL'ACREAGE • hlmeclf or through los own employees,provided that suel,nopnove- - Counts are not unleaded 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,complation,the owner- budder:will'have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER ER'4(EA.) 11,00 BUILDI G USE prove for purpose of sale-): INDUSTRIAL WASTE INTER. .' 20.00 ❑RES 1Pe❑ ❑ Other❑ ❑ -1,.as owner of the property,am exclusively,contracting with licensed contractors to construct the project(Sec.7044,-Business LAWN SPRINKLERS-1INC 5 V.S. 5.00 ASSESS SPARCEL NO. and Professions Codc:The Contractor's.License'Law docs not apply. IO:an Owner of property who builds or improves thereon.and who LAWN SPO INKLERS-OVER'5(EA.) 1.00 - - contracts for such projects with a contraclons)licensed pursuant t. .file Contractor's License:Law. 1 SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO., PARCEL NO. reasLam exempt under.Sec.—,Bf&p.C.for Uiis onWATER!HEATER,W/VENT 4.00 Owner - - pate. WATER;SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'C'OMPENSATION.DECLARATION' WATER.TREATING'EQUIP. 4,00 . I hereby affirm that 1 have a certificate of eonwnt to self-insure. or a certificate of Workers Compensation Insurance,or a certified ZONING ENG:SITE NO. copy thercof.(Sec.3800,LWC.). PolicyNo. Cconpany NA YOIn 1-432 0' ❑ .' Certified ropy is hereby furnished. FIRE sPR INK ENERGY T.24 Z Z , ❑ Certified o y is Filed with the city Inspection division. H O Applicant h//�M-,P MISC. REFER TO ORD. - rE] NF VQ NE] CrIiTIFICA7 ,OF Exi-mPTION TROM'WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.LU.C. U1 COMPENSATION INSURANCE. PLO CONTR.. - - d,Q LIC.ND. PLG. -' ndriddollirs need not.ha,completed ifthe.pennil is for.nn TOTALI - v� .NE] YE] N[J I certify that h the.t empmance of the wink for which This per; OTY MECHANICAL PERMIT FEE.SIIMMARY 0 F Coil Is issued, to Ili W.rk ploy any persooin any of so California.lo. FEE W become Subject to the Workers'Compenvlion'Laws of Caliin _ W Dan Applicant ALTER OR ADD TO MECH. q:00 BUILDING } In NOTICE.TO APPLICANT:.If,after making'this Certificate of ISx- 2 empaon:youlshould'become subject to lbeMorkcrs=Compensation APPLIANCE .4.00 PLAN CHECK provisions of'the,Labor Code, you must forthwith'.Comply with •+ U - such provisions orthis permit shall be deemed revoked. AIR HANDLING UNIT(T,0 10,000CF.M) 3,00 FEE CONSTRUCTION LENDINWACENCY AIRHANDLING UNIT(OVERAOp00QEM) 5.00 ' SEISMIC FEE I hereby affirm that there is a construction lending agency 1'or' EXHAUST HOOD(WITH DUCT) .2,00 the performance or the work for which this permit'.is issued ISec MICROFILM 3097Civ.C.). - HEATING'UNIT(TO 100,00 Lender's Name - -0:B:T.U:)+ 4:00 r Lender's Addre(sH EATI NG UNIT IDV ER 100,000 B:T.U.)7:50 ELECTRIC Ic:rtify'that I have read,this application and state that the above VENTILATION-F,AN(SINGLE) 3:00 'information is con t I.agree t.comply with all city.and bounty - �• 'ordinances and state laws refining to building construction,.and BOILER-.00)'IP(3 H.P:or-100,000B.T.U.) 4,00 PLUMBING- hereby LUMBING•h reby authoitecripreSentatives of this city to enter upon the . gOILER- -isbo c-memimed property for inspecuonOurpows, COMP-(Over 100,000 BTU)SEE FEE SCH. .MECHANICAL !We) agme ha savta_indemnit'y and keep harmless file Cifylof MISC.- - REFER TO ORD. Cupertino against Babilities,.judgments„costs_and expenses which pERM1T ISSUANCE . 3 CONST.TAX, may.in'any way, accrue against,said;City inconsequence of the grantin6 this ermit. / `�� MECH.,CONT. LIC.ND. MECH. 441r [ lye TOTAL TOTAL Signator Applicant)Contmclor Date ./ OFFICE COPY -