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3567
206.80-87 CELESTE CI R 3567 F DE ANZA PROPERTIES SCANNED BOX # 783 CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE j CITY OF CUPERTINO DATE -� 19-2� BLDG. PERMIT NO. 7 � 7 THE BLDG. LOCATED ATt7 OWNED BY HAS BEEN ICOLETEDI FOR USE AS 9 C 1 ri I (ALTERED) Cl CD (f-0 IA , i I ©. BUILDING INSPECTOR ----------I------ CIry 017 CUPE.RTINO 111SPECT101! RECORD (0 )MY jr3�5,67 Lot 4, Bldg. 5 2068n 87 Celeste Circle P Ij I:IIJIIT 1`10. SANITARY MST No. LOTr I ADDRESS Const. 8 Units DeAnza Properties PROJECT OWNER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL BuLldinp, 5/11/83 Date TrIsp. 1:1ect:rical flower Pole ?Irchanical Y-11�0-rf Rou h Wi ring Temp. Cas/Elect. Walls Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sign Motors Grounding Misc. Temp. Power Other FINAL INSPECTIONS Not Approved Date 9p 7 t% PLUMBING F1 O.C.t r 1.C: CC\ Plumbing 1 -14 - -- Arl, Date Ins p. - Backflow Mechanical A - Underground Solar Underfloor Pool Partial Rough• . Crarling I'Lanning Rough Complete Solar Rough Fire De t. Water & Insulation Health Dept. *Iain Drain Pmilding R/of/S Drain Other Gas Other BUILDING Not Approved Date Insp. 9 Vad Certification Foundati IYECIIANICAL on Date Insp. Pre-Gunite Underfloor S. Slab-Ifembrane M. Ducts & Insulation Bond Beam Fire Dampers UnderfloorGirdersLiLr I Floor Steel Tiedowns Grease. Duct & flood - Diaphrams q C& 0 One—flour Shaft Condensate Drain_ — Seismic Bracing Equipment Anchorage Ila I Is—?4cpvgQf Frame Flues & Comb. Er Lath Other Ilallboards Int/Ext. Not Approved Firewalls Other Not Approved b CK wit Yti1 Irk- r-10 t4 Ur p VA BUILDING ELECTRICAL PLUMBING • MECHANICAL MISCELLANEOUS APPLICANT TO+ILL IN INFORMATION ITHIN RED LINES - USE BALL POINT-PEN ONLY '~BUILDING PROJECT IDENTI FICAT10 - PE MBER BUILDING /, A0WtCATiON & PERMIT �k'1� AO E 5 CDING---ELECT RICAL-PLUMBING-MECHANICAL 3.5U I G� __ NE 's PLAN CHECK VALIDATION N ME QTY- ELECTRIC PERMIT FEE ; ONTRACTOR 5 1.'NAME G UTLETS-SWITCHES.-RECEP 5.00/1.00 ' EL J LIC.rvo. LIGHTING FIXTURES 5.00/1.00 CONTRACTORS '- ADDS SAPPLIANCES-RESIDENTIAL 4.00 .'.ONE PANELS 5.00 DATE OF APPLICATION ARCHITECT - PLAN CHECK FEE P.C.NO. OR SIGNS '6.00 /r'I ENGI NO, SIGNS TRANS.' 3.00 CN.OR ENG: ER IT VALI ADDRESS SPECIAL CIRCUIT 5.DO `n Zap _ EMP.METER OR POLE.INS. 15.00 APPLICANT'$ (/ ADORES, MOTORS, SEE.FEE SCH. SERVICE CHANGE 10.00 �T<'7�' (LN�/�/ /l✓ Woo LICENSED CONT LT RS DECLARATI a u u 'I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE I z w (commencing with Section 7000).of Division'3 of the Business and y`a uN . r o z Professions Cole and my licensees in full torn and effect. BLDG. ELECT. PLG. MECH, oli-' License Class '',C¢ Number W . Dere 'Contractor ' . ¢ ¢.¢4 a'. OWNER-BUILDER OECLARA'flOh BUILDINGPERMIT . oa MISC.- REFER ORD t INFORMATION I- I for the collo fthat ollowing mason.exempt from the CDmra d r s License - Fwy J Law Code: ny cityloriounty` .(See requires perBusmit to construct. Professions PERMIT ISSUANCE 6.00 VALUATION $/F7: - y improve. A.demoloreounpair i�hany structure permllromnsuane,also P wP E. ELEC.CONTR, UC.NO. - ¢ ¢ a o Improve,demolish,or repair any structure, to its issuance,also _ ELEC. o requires the applicant for such permit to Nle a signed.statement that TOTAL PERMIT TO w'$.y he is licensed.pursuant to the.provisions of the Contractor's License 11 F'i Q Law(Chapter 9(commencing with Section 7000)of Division 3 of the 3,4 O Business and Professions Code)or that he Is exmnpt therefrom and OTY: PLUMBING PERMIT FEE i ¢II-c� the hash,for the alleged exemption Any violation ofSectiun 7031.5 STORIES TYPE CONSTR. a 3 by anymomtha fora hundred dollars theapplicant0).) toacivil penalty . ALTER-DRAIN&VENT-WATER (EA.) 4.00 0�(f of not more cant fora h permit dollars the .1' Aldo ❑ has,owner of the property or my employees with wages as' BACK FLOW PROTECT.DEVICE their sole compensation,will do the work.,and Ih rfracture is act 2.00 OCC.GROUP REi UNITS Inlended'or offered for'sale(Sec 7044 Business and Professions- DRAINS-FLOOR,ROOF,:AR EA,COND. '4.00 Cad• The Contractor's License Law does not apply to an owner of properly who'butldz or improves thereon and who does such'work. F.IXTUR ES.-PER TRAP. 4.00 saTT:FLooR SEA TOTALACREAGE • himself re through his own employees..Provided that such improve,doing or nts improvemenotnt intended isSold or within sed one or year o If, completio the the building GAS EA.SV$T.EM-1 1NC.4'OUT,LET$ 4.00 ar'+ or improvement ¢sold rdcoo one year of he did of build Einer builder will have the burden;of proving that tlad not tiuild or im GAS-'EA.SYSTEM-OVER 4'(EA.) 1.00 BUILOtNGUSE- Prov for purpose of sale.)., RES D ' CON PB OOSS p INDUSTR IAL WASTE - ❑ ❑ ❑ ❑ y(L h as owner of the property,he exclusively.contracting with 20.00 tended contractors:construct the pricensl Se 7044.Business LAWN'SPRINKLERS-'1 INC5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions f Cody The who s License Law Joes not apply+/D to tr owner of h projects who bacon tr improve them p.and who . LAWN SPRINKLERS,-OVER 5.IEA.1• 1.00 contracts for mtor*s hpro/ccis with a wnlractarl sl acenxtl pursuant to the Contractor's ' code 8w. O SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. NO, I dc S a cxem - ao. / B.& '.ft this 400 sea n .WATER HEATER W/VENT Dete n t WATER'SYSTEM q 00 ,ACC: ATE 'ACC.FILE NO. WORKERS'coMPENSATION DECLARAT1oK _ WATERTREATING EQUIP. 4:00 1 herebyjaffirm that 1 have.a ttrlificale of consent inset ISm'ure. ora certfi'am of Workers Comp nsation Ialtimo lo,,n1 ified - ONING ENG.SITE NO. copy thereof(Se 3800 I-lil Policy No Company D ❑ .Cerhlled copy ass Filed(with th ZZ ❑ Certified,copy is filed with the tip' inspection division, FIRE SPR INK ENERGY T24 'Applicant MISC.- REFER TO ORD: "y N❑ 4 N❑', ~:rn 'PERMIT ISSUANCE K - CERTIFICATE COMPENSATION FROM WORKERS' - 6.00 FLOOD ZONE W COMPENSATION INSURANCE PLG.caNTa. LIC.No. PLO d O (This section need'not be completed if the permit is ] r one. TOTAL Y❑- N 0 Z. hundred dollars(S IOD)or less:) V O 1 certify that in the performance of the work for which this Per- LL U mit is issued,I shall not employ,any person in any m:macr m as to OTY, 'MECHANICAL PERMIT FEE t become subject to the Workers Compensation Laws of California. ii Uate - ApplicatD ALTER OR ADD TO MECH. BUILDING >_ to NOTICE TO APPLICANT: It;after making this Certificate of Ex.. 4:00 D.�+ F.- Z. emp0on,you should become subject to the Work•rs Comliensation 'APPLIANCE ' ' pro olons of the Labor•Code. you must forthwuhscumply with 4.00 PLAN:CHECKr U such PtOVlnlOnn or this permit shill bdee..,ldrevoked. AIR;HANDLING UNIT ITO 10=C-F.IvL) 3.00 FEE CONSTRUCTION LENDING AGENCY' AIR HANDLING UNIT(OVER 10,000QEM.) 5.00 SEISMIC FEE a,_P I hereby affirm that Iheie.is,a construction lending agency in, EXHAUST HOOD(WITH DUCT) .2.00 tile,performance of the.work for which this permit is issued(See. 3097;Cie.C.). - - HEATING UNIT ITO 100,000.B.T.U.) 4.00 MICROFILM Lender's Name - - Lender's Address HEATINGUNITIOVER.100,000B.T.U.)7.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE)mfo3.00 Ordinances an correct I s rel to comply with all city and meaty PLUMBING hereby ws and stale laws relating m building usnster eon, and. - BOILER-COMP(3 H.P.Or 100,000 B.-T.U.) d,00 hereby authorize representatives of on puny ro tier uponpropMyfar inipe Non purpose.. COMP(Over 100,000 BTU)SEE FEE$OH. MECHANICAL (We) agree to save. Indemnify and keep harmless thcTitymf MISC.- REFER TO ORD. Cupertino against liabilities,judgments costs.and expenses which, may in,,.any.way accrue;against saW'City'in'cOnscyuencc,of the, PERMIT ISSUANCE 3._0.0 - CONST.TAX( gr ntin ol'this iC MECH:CONT. LIC.NO. MECH. TOTAL TOTAL Si ture of APPlicancJContractor a e S9/ OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY-' BUILDING PROJECT IDENTIFICATION I PERMIT NUMBER Bo,LOINGDREM APPLICATION & PERMIT 1p a. ' , BUILDING ELECTRICAL—PLUMBING—MECHANICAL . ' - 5.6 92, OINN.5 PLAN CHECK VALIDATION mE r .ONE OTV. ELECTRIC PERMIT ^FEECONTa NAAMERAcions UTLETS-SWITCHES-.RECEP 5.00/1.00 • a{ uc.No�3'3,ZJ. LIGHTINGFIXTURES 5.00/1x00 ' 9 AA TORE .ADDRESS P ( _ )) PPLIANCES-RESIDENTIAL '4.00 'NHL I "IHONE��O—`��C3 PANELS 5.00 DATE OF APPLICATION• ORearteci - _ SIGNS ., 6:00 PLAN CHECK FEE .P.C..NO. ENGINEER LIC.No. SIGNS TRANS., 3.00 ARCH.ORENG. PERMIT VALIDATION 'ADDRESS' SPECIAL CIRCUIT. 5.00 ZIP EMP.METER OR POLE INS. 15.00 ' AvaLICANTS (" ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 10.00, w 00 LICENSED CONTRACTORS DECLARATION a u� I herebyaffirm:that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section]000)of Division 3 oflhe Business and - BLDG. ELECT. PLG: MECH. m z ProfeA "0.-1 sion d license is in fullioa�(.�dyffecti• ❑ ❑ ❑, Lmen Clue Lm..Number_h .et . Oa mow' Date Comanor - a Y f OWNER-BUILDE 'DECLARATION BUILDING PERMIT R Da-� INFORMATION I ' xg.LL,y P'hereby affirm [flat l am exempt from the Contractor's License MISC.— REFER,TO ORD - O'J Lawior thefollowing reason.ISei 7071'.S,Business and Professions .VALUATION. SIFT. r y,w. PERMIT ISSUANCE F Law f orAny citythe ful or county which e.703 -permit to construct,after, 6.� a ¢Ia 2O Improve,demolish,or repair any vtmd um,prior to Its Issuance;also ELEC:'CONTR; LIC.NO. ELEC. - O., 2 requires the applicant for such permit to file a signed statement that TOTAL x8" he Is licensed pursuant to the provisions of the Contractor's License PER ATO Fza., Law(Chapter 9(commencing with Section 7000of Dlvlsnsn 3 ofhe Business and Professions Code)or that heisexempt therefrom'and OTY: PLUMBING PERMIT `FEE ¢ s- o -the basis for the alleged exemption..Any violations of$ectlon 7031:5 _ STORIES. TYPE CONSTR. x3'4 by any applicant for a permit subjects the applicant to a civil penalty • ofnot more.than five hundred dollars(S500)J: ALTER-DRAIN&'VENT-WATER''(EA.) 4,00 O 1..as owner of the property or my employees with wages us BACK FLOW PROTECT.DEVICE. Thar sole'compenSation,will Jo 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 Law does not apply to an owner of; - properly,who builds or Improves thereon,and who does such work FIXTURES-PER TRAP - 4.00 '• Sa.Pr:Flooa AREA '.TOTAL ACREAGE himself or through his own employees,provided[hat such improve- mentsunnountended or offered for sale-If,however the building GAS-EA.SYSTEM-I INC.4 OUTLETS'4.00 or Improvement ns sold-within one year,of,completion theowner- GAS EASYSTEM-OVER.4(EAT)' 1:00 builder will have the burden of proving that h - .e did not build ovim- -BUILDING USE th prove for purpose of e.); INDUSTRIAL WASTE INTER20.00 ,RES uilO CON PB Other ❑ I,as owner of the property,am ex'Llusivdy:contrauling with . �❑ licensed-contractors to constru t the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.- and Professions Code:The'Comracror s License Law does not apply to an own"ofGproperiy'who builds or improves thereon,and who LAWN.SPRINKLERS-,OVER`5(EA.)' I,Op _ r ntracls for su h projec(s.with a conlraetons)licensed pursuant to - ' the Contractor's License Caw. SEWER-SANITARY-STORM EA.200ft/8.00 toner NO. ' PARCEL No. rc❑rel am exempt unJcrSec. ,B.&P.Clor this. .WATER HEATER W/VENT 4,00 r1 Owner Data _ WATER SYSTEM 4,00 - WORXhRS'COhIPENSATION DECLARATION WATER TREATING.EQUIP, 4.00 ACL.DATE ACC.FILE NO. I hereby Arson DI3t [,have u certificate ofconsent to selfi.ame, .- o ie certifncaleof Workers'Conipen aliominsurance,or s«rti0ed - ZONING .ENG.SITE NO, wpY4h,mof(Sec..3& Lab.C.). Policy No. -Company t7.I-- �L.r C)' '❑'/Certified copy is hereby fu coshed. ' Z 2 f�N Ceaifie�COPY is f W th the sly in.peel an diJision. FIRESPRINK ENERGY TSO FOnla .•�/9pG� �� MISC.- 'REFER TO ORD. YQ. N� Y [] N❑ - iN CERTIFICATE OF EXEMPTION FROMWORkERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A;L.U.C. LU > COMPENSATION.INSURANCE: PLG.CDNTR! LIC;NOCL 0 . PLG. .(This,section need not be completed:if the permit is for.one TOTAL Z handed dollars(S I 00)'o,less.) U,O I certify that in the performance of the work I'or which this par- OT,r MECHANICAL PERMIT ' FEE FEE SUMMARY LL V J is issued,IShall not employ any:person in any answer so asto become subject to the Workers CompermlionL Laws of California. D th Data Applicant ALTER OR ADD'TO MECH. ism_ .BUILDING } to NOTICE TO APPLICANT:-1f,.afmr making Ihis'Certifilalc of Eli- F ? amp ion,.you should became subject to the Workers'Compensation 'APPLIANCE provisions,of,the Code, you must forthwith comply with 4.0 'PLAN CHECK - - U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO _ ) • FEE CONSTRUCTION'LENDING AGENCY AIR HANDLING LINFTIM/ScO-Inflinip,.F,IsI .00 SEISMIC FEE I hereby affirm that there is a conMruclion lending agency for EXHAUST-HOOD(WIT ) .the performance of the work.for which this permit Is issued(Sze: - - t MICROFILM 3097 Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 4.00 8 — :Lender's Name .Lender's Address HEATING UNIT(OVER 100,000 B.T.U,)7.50 . ELECTRIC I certify,that have read this application and state that the above .VENTILATION,FAN.ISI NG L E) '3.00iy— .information is correct.1 agree to comply with all city and county - N 'PLUMBING oaa ces and Stam law, refining to'building construction,and BOILER-CDIVP(3 H.P.or 100,000 B.T.U.) 4.00 ." hereby authorize representatives of this city to enter upon the abovementioned property for inspection purposes. BOILER•COMP(Ovar.to0,000STU)SEEFEESCH. MECHANICAL 7J" (We) -gree in save, indemnify and:keep harmless the City of MISC.- REFER TOORD. Cupertirmirgursl liabilities,judgments,costs and expenses which - • may in any way accrue against Said City in consequence.of the PERMIT ISSUANCE 3.00 - CONST.TAX tiln/of�`"td71is Pe L I�- MECH,CONT. LIC.NO. TOTAL (/n gra Ni � !J �, !� 1/ f - I alureo(Appl /Contactor Date - r— — TOTAL OFFICE COPY - AP,P.LICANT TO FILL IN'INFORMATION WITHIN RED LINES — LISE'BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION s PERMIT NUMBER' So'LEING • , w A. - APPLICATION &.PERMIT r ADDRESS "� O , I BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S: - - - - _ -- - '— PLAN CXECK VALIDATION - NAME I CITY. - ELECTRIC PERMIT 'FEE PRONE CONTNAMER"croRs UTLETSe SWITCH ES-RECEP 5.00/1.00 ' P r L.C.No.- LIGHTING FIXTURES '85.00/1.00 . ADDRESS ons PPLIANCES'-RESIDENTIAL 4.00; ADDRESS NTH PHONE- 2r` PANELS - .5:00 -, DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. on SIGNS 6100 ENGINEER •-LIC.NOI SIGNS TRANS. . 3.00 ADDRESS ENG- SPECIAL'CIRCUIT - '5;00 .PERMIT VALIDATION Zip EMP.METER OR POLEANS. 15.00 A - MOTORS. - SEE FEE SCH. ADDDRESSDRESS SERVICE.CHANGE 10.00 t wo,o LICENSED CONTRACTORS DECLARATION ,Q o,u I_hereby affirm that I am licensed under,provisions of Chapter 9 ISSUANCE DATE Gz w (commencing with Section 7000)of Division 3 of the Business and D.z Professions COJ an y licensem in full force nil ef(a(. 0 - SLOG ELECT. PLG'. MECH. 0.,2 n.o LrofIse mi loss (�La-N full r . . E El �i. y H,w USle _ Conlmclor, ,C!-�+A�rt�aaAea^ f- J g�1 a w,�' OWNE.R:BUILDER DECLARATION. " hA GPERMIT ' ED. I I'hemby'affirm that I.am exempt from.the Contractor's Licenm MISC.— REFER TO ORD t+ (�MATION F,u a'a Law.for the following rensoo,(Sec.7031,5,Bud nessmnd Professions PERMIT ISSUANCE VALUATION SIFT. ww' Code:Any city or county which requiresa permit townslrucLaller; 600 AUG p ¢<D� unprove.demolish,or repair any slruclum.,pliur to its issuance;also ELEC.CONTR. .LIC.NO. ELEC. it V V U r O LL_ requires the appheaur or such permit to file a signed Statement that TDTgI W m` he is licensed pursuant to the provisions or the Contractor's Limnu p PERMITSO r z,Q Law(Chapter 9(cummencingvei(h Section 70DO)of Division 3 of the CiW4f"e6j JC_ i3O Business and Professions Code).or that he is exempt therefrom and OTY. PLUMBING PERMIT- FEE '`"UFCf4 nV.' ar f..� ' the Basis for the alleged exemption Any violation o(Section 7031:5' - STORIES TYPE CONSTR. w. byany applicant fora permit subjects the applicant loacivilpenalty ALTER-DRAIN -WATER'IEA.) 4.00 of mt more than five hundmd dollars($500f): ❑ f as owner of,the property,or my employees with wages as' BACK FLOW PROTECT.DEVICE .Iheir sole Compensation,will'do.the work,.and the structure is not 2•00 'OCC.GROUP RESP UNITS intended oroffered for.sale(Sec. 7044, Bmarnev'nnd Professions 7 It DRAINS-FLOOR,ROOF,AREA;COND., tOO Code,The Contractor's License Law does not apply In an owner.of - - - property who builds or improves(hereon,and who does such work FIXTURES-,PER TRAP 4:00 SQ FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees;provided that Such marmov - '- mentsAmnotintendedorofferedforsaleJLhowever,(tie buildinGAS B -EA:SYSTEM-1 fNC.40UTLETS 4.00 or improvement is sold within one year of completion;the owner. builder will have the burden of proving that he did not build or im- GAS-'EA.SYSTEM-OVER 4(EA.) 1.00 - 'BUILOING USE prove for purpose of sale,. INDUSTRIAL WASTE INTER, 20.00 - RES IND CON PB Other ❑ Las owner of tire property.am exclusively contracting with - licensed Contractors a Contractor's the project(Sec. do Business LAWN SPRINKLERS:-1 INC 5 V.B- 5.00 ASSESgORS PARCEL NO. and Rofessions Codc:The Contmcmr's License law docs nut apply. to an owner of property who builds orini thereon,mrd who LAWN SPRINKLERS-OV ER.5(EA:) 1.00 Contracts for such pmjcc(s with a kromrsctors)Imented pursuant to the Contractor's License Law. I ISEWERSANITARY-STORM EA.200ft/8.00 O TRACTNO. PARCEL NO. reason lam exempt under Sec.—.B.AP.C.for this WATEWHEATER•W/VENT 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 xlf-insure. ora certificate of Workers Compensation Insurance,or a.certified - ZONING ENG.SITE NO. ' Copy,thereof(See.3800.Lith.C.1.,� 'i "- Policy No. Company G'nn�1sc h t '/...rl U ❑ Crtified copy is hereby( ., e . J (Ar FIRE SPRINK ENERGYT-24 Z'Z ❑ Cc rl ific o y fitC�d ilh 1 c city iA63�s-scion division. - FO npphcamC ��lA./a'I/JJn MISC:- REFER TO ORD. 4E], No Yo N❑' w CERTIFICATE OF EXEMPTION FROM.WORKERS' - PERMIT ISSUANCE 6._00 6 - W > COMPENSATION INSURANCE FLOOD ZONE A.LU.C. PLG.CONTR. LIC:NO.mPCG. �_99 ^�-fi�tt N� YQ NQ. 0-13 (This section need not be completed if the Permit is.for one TOTAL CJ S_b Y'❑ � Z hundred dollars(S 100)or less-) U'O 1 certify,thul in the performanceof the work for which(his per, CITY. FEE SUMMARY -+ IL F mit is issued.1 shall not employ any person in any manner m as to MECHANICAL PERMIT 'FEE Q,w beconam subject to.the Workere Compensation.Laws of California. _ °' .Dat` Apph°ant ALTER OR ADD TO MECH. q:0o BUILDING } N NOTICE TO APPLICANTo-If,after making this Certificate of Ex. � ? emp'ion,.you Should heiome subject to the Workers'Compensation APPLIANCE 4.00 PLAN'CH CHECK provisions:of (hr Labor Codc,'you must forthwith Complywilh U such provisions er this permit shall be dcemAN ed revoked, AIR HANDLING UNIT(TO 10ADC.F.M.) 3!00 FEE CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER10=CFM.) 5.00 _' SEISMIC FEE I hereby affirm That (here is a construction Iendingmgency for EXHAUST HOOD(WITH DUCT) 2.00 the performance of the wnrk.foewhich thrslpermil is issued(See. MICROFILM Lender's end is Nam � : HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender mc): ,Lender's'Address - .HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC I er(ify'hat l have read this application and state that the above VENTILATION FAN ISINGLO 3,00 ' --f ® mdinancion is citale la spree to comply with all ity and county - BOILER-OONP PLUMBING oZsa ordinances authnd sum laws relating to building Construction.enter and' 13 H.P.or 100,000&T.U.) 4.00 hereby authorize repretyfor' es c ion city to enter upon the above mentioned property forinspec(iompurpoms. BOILER-COMP 10ver100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save—indemnify and keep harmless the City M MISC,- REFER TO ORD. Cupertino against liabilities,judgmen(s;,cosm.and <fpenu,which may in any way,acerae against aid Cityinconsequence of the PERMIT ISSUANCE 3.00 CONST,TAX ' grpplin&'Qfftthis p ��nIL MECHi CONT. LIC.NO. MECH. L/ TOTAL . Si p arum o• m.ntl ontmctor Dote a TOTAL OFFICECOPY '