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3566 20707- 14 CELESTE CIR 3566 F DE ANZA PROPERTIES SCANNED BOX # 783 1 CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE �� -2-9 19�T BLDG. PERMIT NO. ��66 THE BLDG. LOCATED AT Q<CT -T <S' 2-0707--(* Cp l R� (a OWNED BY Qf'Uf1p�V��( T\ It HAS BEE )COMPLETED FOR USE AS �1 �� fA I / ALTERED) Co I,~J c n I I& C v kA ) BUILDING INSPECTOR r CITY OF CUPE1:11I10 INSPYCTIOL' RECORD (Office Copy) 3566 Lot 3, PIdg. R 20707 - 14 Celeste Circle Pi:mrr 1,10. SANITARY DISI. NO. LOT NO. ADOP SS --- Const. 8 'Units DeAnza Properties PROJECT OWNER JOB SITE PHONE• NO. PERMIT ISSUED Date ELECTRICAL Burildinr I 5/11/83 Date Insp. Electrical Power Pole_ PLumhing I Under ,r.ound - ---- Mechanical I Rough Wirin _Temp. Cas/1?lcct. IIaI7.s Solar I Ceiling, Fire S rinkler I Fixtures Int/Ext Sign I llotors Grounding Misc. Temp. Power Other _ - FINAL INSPECTIONS Not Approved Date I. sp. , — PLUMBING Electric /0-/ Date Insp. Plumbin , -I Backflow Solarical S - Underground Solar I Underfloor Poral Partial Rough x-F0- Grading Rough Complete y planning Solar Rough _ Fire De t. {' I !0 lj (,p Water & Insulation Health De t. 'lain Drain Building 6-2 Q $ R/of/S Drain Other Gas p,s Other BUILDING i Not Approved ,Date Insp. Fad Certification MECHANICAL-� Foundation - � Date Insp.. Underfloor S.N. Slab-Ilembrane Ducts & Insulation _2 _ Bond Beam Fire Dampers Underfloor Girders -z / FireplFloor Steel Grease Duct & Ifood =:t& One flour ShaftCondensate Drain BraEquipment Anchorage Flues & CombAir- Other - - Not Approved wallboards Int/Ext. Firewalls Other Not A? roved (T-1-14yO19L BUILDING r \ ELECTRICAL PLUMBING • MECHANICAL MISCELLANEOUS APPLICANT TO FILL IN, INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY •' d ER BUILDING PROJECT IDENTIFICATION - .PERMITN 35`66 BUILVING / TION & PERMIT A REss /� yyy.. DING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S •/�•� - - PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE NTR C R'$ AME,. UTLETS.-SWITCHES-RECEP 5.00/1.00 - U`. E L.: {— Lm.No, LIGHTING FIXTURES 5.00/1.00 CONTRACTORS ARRACroRs ADDRESS DDPPLIANC_ES-RESIDENTIAL 4100 PHONE PANELS 5.00 DATE OF APPLICATION ORCmrECT SIGNS 0•pp PLAN CHECK.FEE P,FNO. ,ENGINEStill %�. SIGNS TRANS., '3.00 - T AR E.G. ADDRESS - SPECIAL CIRCUIT '5.00 �P�RMI VALID I Azip EMP.METER OR POLE INS. 15.00 ' DDRESSEE MOTORS SEE FEE'SCH, �( noREss RIN•a SERVICE.CHANGE 10.00 w0"o LI ENSED CONTRACT RS ECLARATION Il herebyaffirm that I am licensed under provisions of Chaprc,E) (commencing with Section 7000)of Division 3 of the Business and 'ISSUANCE DATE Professions Code:and my license is in full force and Effect. BLDC. LECT. PLG. MECH. pz r-�,° License Class Lic..Number y y-j Date Contractor a vino.¢. OWNER-BUILDER DECLARATION - BUILDING PERMIT' ° •u MIST.— REFER TO ORD I INFORMATION X3: -m I hereby of gi.thal I am exempt from the Contractors License a.O j Law for the following reason.f3cc 7031 $,Business and Proless'ions -VALUATION S/FT. - _ PERMIT ISSUANCE 6.00 `Cade.Any city or county which regmrcs a permit to construct;¢her, a: Q Q, improve,demolish,or repair any structure.prior to Its issuance,also ELEC.CONTR.- LIC:NO. ELEC. " la i-L °I Ic 'requires the applicant for such permit to Ede a signed Statement that TOTAL w m.va he is licensed pursuant to the provisions of the Contractors License PERMIT TO F z¢' Law(Chapter 9(commercing wit h Section 7000)of Division 3 ol'the s z ° Business and Professions Code)or that he is exempt ih refrom and OTY. PLUMBING PERMIT' FEE (Q 1/fI1iV�i7 ¢,H$ ,the'basisfor the alleged exemption Anyviolat ion of Sect ion,7031:5 STORIES TYPE CONSTR. a'3- 'by any applicant for a pemtiI so blects the applicant to a civil penalty ;of not more than five hundreddollars(S500r): ALTEREDRAIN''&,VENT-WATEWMA-) 4:00 p? 3:111140" /J , ❑ I,as owner of the property,or nty'cmployccs svnh�wages as BACK FLOW.PROTECT.DEVICE 2.00 iEP 'their side compensation,will do the work,and the simct are is not OCC:GROUP RES.UNITS' 'intended or offered for.sale(Sec 7044.-Business and Professions DRAINS-FLOOR,ROOP,'AREA,COND. 4.00. Code The Contractor i License Law dues not apply to an owner at - - - i properly who builds or Improves thereon.and who docs such work FIXTURES-PER TRAP 4.00, 4D.ET./vLooR eq TOTALACREAGE himself ents re through his own employees provided that such improve- I IH' V•�—•O��J himself a not through his orottered employeesa provided that the building GAS-EA.SYSTEM 11NCr4OUTLETS 4.00 or improvement is sold within one year of,conmletmn the owner- GAS-EA. -OVER 4(EA:) ' ;1.00 'builder will have the burden of proving that he did not build or it. BUILOING USE prove for purpose of sale.); INDUSTRIAL,WASTE INTER. 20.00 R5 D CON PB .Other gg 1,io owner of the property,am exclusively contracting with El El ED andrised contractor,Cod to construct the project(Sec. 7044,Business LAWN SPRINKLERS-A.INC 5 V.B. 5.00 .ASSESSORS PARCEL NO. ,and Professions Code The.Contracrorsiicenx Law does net apply° A to an owner of property who'budds or improves thereon.and who LAWN SPRINKLERS-OVER'5 (EA.) 1"Ap ,(na6�/�/A; contracts retouch prmects with a contrricumil licensed pursuant to dmf C the Contractor's.License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. fe❑ lam exempt nd pec._s O ,B. P.C.tor Ibis WATER HEATER W/VENT 4.DO '� Date r,-�-- WATER SYSTEM 4.00 ACCC..DDATE ACC:FILE NO. WORKERS',COMPENSATION DECLARATION W TER TREATING E UIP, 4:00 �2g/ I h.mby affirm that have a certificate ofconsent mzelf-insure. `/� or a certificate Of Workers'Compenution hommoce,or;a certified199 G ENG.SITE NO. copy thereof(Sec.3800,1ab.C.). �TjJ Policy No. - Company / 0 ❑ Certified copy ii hereby furnished. Z Z ❑ Certified Copy is filed with the city inspection division. FIRE SPRINK ENERGY T-24' FO, Applicant MISC-- REFER TO ORD. Y N Y NC3 CC CERTIFICATE OF.EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE OJ - COMPENSATION INSURANCE PLG.CONTR. -LIC.NO. PLG. d O (This section need not be completed iLthr'permit is for one TOTAL ,Y O N � Z hundred dollars IS 100)or less:) "V O I certify that in the performanceofthe work for which.this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL {- mit is issued.TShall not'employ any person in any manner sit us to D.,w become subject to(he Workers'Compensation Laws of Califomia. y Date - Applicant ALTER OR ADD TO METH. qpp BUILDING �S" '} Z NOTICE TO APPLICANT: If,after making this CerNfhame of Ex- Q� emplion,you should become subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply.with C.7 such provisions or this permit shall be deemed revoked. - AIRHANDLING UNIT(TO 10=C.F.M.) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10 111F.M.1.5.00 SEISMIC FEE. 9 I hereby affirm that there is a construction lending agency far EXHAUST HOOD(WITH DUCT) 2.00 - the performance of the work for which this permit is Tissued(Sea. MICROFILM. 3097.Civ.C.). .HEATING UNIT(TO 100,000.B.T.U:) 4.00 Lender's Name Lender's Address H EATI NG UN IT(OV ER-100,000 B.T.U.)7.50 ELECTRIC I certify that I have read this application and state that Elie above VENTILATION FAN'1SINGLE) 3.00, information is ndcot et 1 agree to comply with all,cityand county - PLUMBING "ordinances and start laws relating to budding construction,Don, and BOILER-COMP(3 H.P:Or 100,000 B.T.Ui) 4.00'. hereby cr authorize representatives of this cityses.inter upon the .BOILER-COMPBT6)SEE FEE-SCH. above-mcn0oned property for iitsp Ulon purposes. MECHANICAL . (We)'agree to,Save. indemnify and"keep'hmmless the City Of MIST.- REFERTO ORD. Cupertino against Imbilities,judgments,'costs anLgpenses'which PERMIT ISSUANCE'. CONST.TAX .may In any way acente against said City in consequence of the 3:00 furi{g of this fie niL - - MECH.CONT. 11 LIC.N0. ,METH. TOTAL TOTAL store ofApp •ant/Contractor U - /Aft. OFFICE.COPY APPLICANT TO FILL IN INFORMATION WITHIN,RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING - - - APPLICATION & PERMIT • ADDRDESS fY &b.' J BUILDING,—EflECTRICAL—PLUMBING;—MECHANICAL 5 DINNER'. / !!'' ''/Ir( - PLAN CHECK VALIDATION Y qY-/{ QTY. ELECTRIC PERMIT FEE SHONE -' CONTRACTOR'S00 rvAM /I UTLETS-SWITCHES-RECEP 6.00/1.00 VV : uc.rvo.��Q J31 •LIGHTING+IXTURES 5.00/1.00 ,DO CONTRACTOR'S - APPLIANCES-RESIDENTIAL 4.00 ,DD 'ADORE (�J ,/L�/OpyJ 6 PRONE PANELS 5.00 .? . DATE OF APPLICATION ,OORRCMrtECi SIGNS 8.00 PLAN CHECK FEE , P.C.NO. ENGINEER LIC.NO, SIGNS TRANS. . 3.00 'ARCH09 ADDR'ESS ENG • SPECIALCIRCUIT '5.00 PERMI ION ZIP EMP.METERIOR POLE INS. 15.00 •� f,� APPLICANT'S MOTORS - 1 SEE FEE SCH. ,$� JUL 1 2 WO - AD .Y� � ' �1-(/G� SERVICE CHANGE 10.00 w 019 LICENSED CONTRA. ORS'DECLARATION City Of CUPaIt1f10 ' Q U°u. 1 hereby affirm,till,l am licensed ander provisioosof Chapter 9 - ISSUANCE y?"' (commencing with Section,7000)of Division 3 of the Business and Q - BLDG. E PLG. MECH. I-',,,i ,Professions Cad,' -d license is m full force yt 'effe- 2.V2,0 Ucenx Class_ '/u Lic.Number -L7/7 1 /3 oF. , Date '•-7--3-- Comtractor PP,L J Q > .2S ': BUI DING PERMIT' a: ,w.u, OWNER-BUILDER.DECLARATION K.;LL i hereby,affirm'tltal I am exempt from Dm Contractor's License MISC:- REFER TO ORD INFORMATION F:u-y'g. Law for.the following reason.(Sce,703 1.5,Business and Professions PERMIT ISSUANCE 800 .VALUATION '$/FT: m.w Code:Any cityurcuunty which mquiresapermit toconstruct,alter: - Q Q Q�'• ImprOV¢,d[IOOIiSh,Or repaiL aOy slmClurt:priOT tO its lSsuanlY,3150 EC;C Is LIC.NO. ELEG 50 n O LL regmres the applicant for Such permit,o file a signed statement that TOTAL w'$m he ns licensed pursuant to the provisions of the Contractor%License P MITTO - . ,rz> Law(Chapter 9(Commencing with Section 7000)of Division 3 of the Business and;Professions Code)or,that he is exempt therefrom and QTY. PLUMBING PERMIT FEE. 2:1-$ the basis for the alleged exemption Any violation or Section 7031.5 STORIES TYPE CONSTR. i3 - by any applicant for a pemutsublecisthe applicanttoaclvd penalty ofmit more than five hundred dolhum($5001.Li ALTER-DRAIN&VENT-WATER IEA,)4:00 ❑ I,as owner of the propertyor my employees witll'wages as BACK FLOW PROTECT.DEVICE' 2,00 their Sole compensation,will do the work.and the stuctare is net OCC.GROUP RES.UNITS Intended or offered for Sale(Sec._7044, Business and Professions DRAINS-FLOOR,ROOF,AR COND. 4,00 ." Code:The Contractor's:License Law does not apply to an owner of , property who builds or improves thereon!amf.ho does such work FIXTURES-PER'TRAP 4.00 SO.FT.FLOOR AREA 'TOTAL ACREAGE • himselforof intends ownemred for e.I f.ed that however' the improve- GAS-EA.SYSTEM-1'INC.4OUTLETS 4.00 mems roveme intended or offered for sale I f however,the howne g or improvement Is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1,00 BUILDI G USE builder will have the burden'of proving That he did not build ur im- pr0 1,as owner the formerly.- INDUSTRIAL,WASTE INTER. 20.00 RES IND C PB Other ❑ d as owner o;the struct ..'exclusively Project (Sy contracting with ❑ ❑ ❑ ❑ , andPvdfCoions Code:The eContrtt.,' License La.7044.does not apply LAWN SPRINKLERS,--1 INC5 V.B. 5.00 ASSESSOR PARCEL NO. aril Professions Code:The Contractor's Licence Law doe.not apply - - toao'ers owner efproperty wlro..bacontactonsvesrnsed pu uentto LAWN SPRINKLERS-OVER:$IEA'.P 1.00 e Ccortam etor's LiceneLwith acontmctortsliiccnsed'pursuvN to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCELNO. the Cont ni'exe a License Lew:; re❑nl um exempt ender See: B.&P.C.br.this WATERAEATER'W/VENT 4:00 , Owner Date WATER SYSTEM 4.00 'ACC:GATE ACC.FILE N0: WORK ERS'COMPENSATION DECLARATION WATER'TREATING EQUIP. 4.00 I.hereby alUrm'that I have a ccrlificm¢of cnnami to self-insure; - oca.certificateofWorkers ComperoatioWinsurince.or'a certified ZONING ENG.SITE.NO. copy themoftSce.3800,Lab_C.). A w //I A y_/ Policy No. Company' �V I IGKA - 0. ❑ Certified copy is hereby,furnished: FIRE SPRINK ENERGYT-24 Z Z. 13Certified.copy.is O cd with the city inspection vision. O 'Applicant X11(_of0 "diMISC.- REFER TO ORD. YE] N V N m CERTITI FICATh OF EXEMPTION FROM WORKERS' . PERMIT.ISSUANCE 6.00 ',FLOODZDNE❑ A.L❑.u:C. ❑ LU > COMPENSATION INSURANCE PLG.CONTR. .LIC.NO: PLG. CL O' (This saC,idn need ODI be completed iP the.permit-is for one TOTAL V❑ N❑ Y❑ NO 0 Z" hundred dollars aloof or less.) - U O`. I certify that in the performance of the work for which This per QTY.• MECHANICAL.PERMIT - FE_E SUMMARY LL U Iml is issued:I shall not employ.any.person in any manners l as to FEE 0 W become subject lO the Workers'Compensation Laws of California. Date Applicant CH. 4-p0 } N Datc TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MEBUILDING F ?, amp,ion,you should become subject to the Workers Courpenaation' APPLIANCE 4.00 PLAN CHECK provisions of the Lobor Coda, you must forthvidi,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 UNIT(OVER 10MC.EM.),5.00 SEISMIC FEE 1:hereby affirm than there is;e construction lending agencyifoF EXHAUST HOOD(WITH DUCT): 2,00 the,p rlormince of the work for which this permit is issued(See MICROFILM 3097.Civ.C.). R G.UNIT 100,000 B.T.U.) 4.00 Lender's Name Lenders Address - no UNIT 100,000B.T.U.)7.50 ELECTRIC I certify that I have read this application and lrtal'llidl the anove (SINGLE) 3.00 . Information is Correct I agree t0 comply with II city and county - i PLUMBING ordinances.and'stale laws reLbng to building construction, andr 100,000 B.LU.I 4.00hereby aLIlm,i,v rept-sentalives of this city to enter'Upon-theabev[menhoned properig.for inspection purlmxs. iW,000 BTU)SEE FEE SCH: MECHANICAL(We) agme ,o save. indemnify and keep'hernlleas the City ofREFER'TO ORD:Cupertino against lianililies,judgments, costs and:expenses whichCONST.TAXmay in any. way accrue against said'Cityin consequence of the3:00 _&votingofthisit, - .NO. MECH.TOTAL TOTAL Signal of Applicant/Contractor Dale - • OFFICECOPY �OGg'7 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY • .BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER BUILDING. APPLICATION &PERMIT ADORE55 C C C 1 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL J J J I MNER's 1 - - PLAN CHECK VALIDATION " 7 =4'Qt4 OTY.' ELECTRIC PERMIT FEE • PHONE CONTRACTOR 1 �' O ^�'�� ;N E O/\ UTLETS'-.SWITCHES-RECEP 5.00/1.00 . ktauc.ND:. LIGHTING FIXTURES 5.00!1.00 / coNrflwc/roR's I. ppLIANCES=RESIDENTIAL '4:00' :(Ja . •• V LI �(�'1 PRONE- '��I� PANELS 5.00 A5.w DATE OF APPLICATION ARCHITECT SIGNS - $.00 PLAN CHECK FEE P.C.NO. on ENGINEER ' LIC.No. SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT '5.00 PERMIT vj)IJLi7 - ZIP TEMP.METER OR POLE INS. 15.00 - 1f"+' L17_ wwucANr(s� MOTORS SEEFEESCH. V,0 JUL 121984 wrygq (j I� dV SERVICE CHANGE. 10.00 1 vY 'H o o, LICL'NSF.0 CONTRA ORS DECLARATION CI6r Of Aune.11no <i W' 1 hereby.affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE - •- (commencing with Section 7000)of Division 3 of the Business and w 6s BLDG. ELE PLG: ,MECH. H TZ Prof stuns Code,,y�d icense Is in full forc,�yltj eft}Iil./ O.Z,u,O Lusa. ss I' ILII Numbe, -�fi f'S El r , I_j Date ,.,'577 Conlm'lor ¢ M M <' OWNER-BUILDER DECLARATION B ILDING PERMIT MISC:-, REFER TO ORD _ INFORMATION X 3's I- I renby afBrm'lhalT am exempt from the C.n1iJdOrs License VALUATION S/FT. -.E, Lu .fur the following reason:(See.T031.5..Buxnemind Prdfessiuns 5 .W grn. PERMIT ISSUANCE " g;pp ¢ y Coii: de: y modish or my wh ny str u tune P riot 16 is coca d;almq a ¢Q Improve,demolish.or repair structure:prior to Its Issuaniti,also E F CONTR. • LIC:NO. ELEC: - O¢ r genres Ibe appbcantf.r such permit to file a signed slalerirenl that '10 t3/31T OTAL 76-09 e w m w Ile is licensed pursuant to the provisions of the Conlmctor's License _, PEWIT TO 'F',z > Law(Chapter 9(commencing with Section 7000).(Divisian3al'the �'z o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING.PERMIT FEE the basis for the alleged exemption Any violation.f5eclion 7031.5 STORIES TYPE CONSTR. by any applicant for.permit subject the applicant to a civil penally; gLTER-DRAIN -WATER (EA:) q;00. .f not more than five hundred dollars(8500).): - O I,asowner'oOlhepropeny.,ormy'employtTswilh,wagesas ' BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP REB:UNITS . their sole compensation,will do the work;and the structure is not intended or offered for sale(Sec. 7044,Business,and.profeseions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 - Code:The Contractors,License Law does not apply to an owner of,' -- - - - property who builds or improves thereon,and who dors such work F IXTUR ES'-PER TRAP 4.00 SQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees provided that such improve - mentsarenotintended or offered for sale:If.however.the building GAS-EA.SYSTEM-I INC.4 OUTLETS.4.00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4(EA.) 1.00Bu1LDI G USE prove for.purpose of sale.). RES IND N PB O ❑ 1,as owner of the;property,;am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 nix 1:1 El C1 11 licensed contractors to construct the.project(Sec.7044,BusinessLAWN.SPRINKLERS-1.INC.6'V:B. 5.00 A55ESW PARCELNO. and Professions CWe:.The Gintmclor's License Law does not apply, 10 an ownerof property who builds or improves thereon:and who LAWN SPRINKLERS-OVER conlractsforsuch projects with o contiactons)licensed pursuant ao - the Conumclor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT Ng'_ PARCEL NO. rt 0I^I am exempt under Seca ,e.&KC.I.,this VATER'HEATER W/VENT _4,00 Owner „Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKF,RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 _ I hereby affirm that I have a miliftcam of consent to sel Ginsure. or a certificate of Workers Compensation Insurance,or acertified ZONING ENG.SITE NO.: Copy thereof(Sec 3800,W b.0). ' Policy.N.. Company PVr7 c'1/D 7 /J 0' O Certified Copy is hereby furnished. - Z z 0 Certifiedpy H Bled With the city inspection division. FIRE SPHINX ENERGY T-N H O', Applicant j MISC. REFER TO ORD: r0 NEl YO ,NE] in H CERTIFHRTIFH OF EXEMPTION FROM WORKERS' PERMITISSUANCE 5.00 FLOOD ZONE A. IL > COMPENSATION INSURANCE. '. vLG-cONTR: - LIC.No. PLG. LU.Q• . IL -liras section meed not he Completed if the permit is for ane TOTAL '/,[] NEI V No � 2 hundred dollars 18100)or less.). c - U O I certify that In the p rlormaere of the work for which this Per- Ory. MECHANICAL.PERMIT FEE SUMMARY LL F mit is issued,Ishall nod employ any person in any manner so as to .FEE O W'. come subject to the Workcrs'Compensation Laws of Culif.rnia. Is. Date Applicant ALTER ADD TO MECH. 4.00 BUILDING* > to NOTICE TO APPLICANT:If,after making this Cenifwate of E.. F.2 emplion,you shouldbecome subject to the Workers:Compensation roAPPLIANCE 400 PLAN CHECK' previsions . .of the labor Code, you most forthwith comply with U such provisions or this permit shall be domed revoked. AIR HANDLING LINIT(TO I0p00C.F.M) 3.00 FEE CONSTRUCTION:LENDING AGENCY AIR HANDLING UNIT(OVER 10pMC.FM) 6.00 SEISMIC"FEE I hereby affirm that them Ioa constrodion IenAing ageaeyior EXHAUST rfHOOD(WITH DUCT) 200 the pe .rmanei of the work for which this permit is issued(Sec MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T-U.) 4.00 Lender's Name Lender's Address HEATINGUNIT(OVERJ00,000 B.T.0-)7.50 ELECTRIC' I certify that l have read thisapphution and state that the above VENTILATION FAN (SINGLE) 3.00 mfonnation,is Lorrvet 1_agree.to comply with all city and county PLUMBING bNmances'and tam laws relSbnB to buildin8 c.nstrudion,.dnd BOILER-ODMP(3 H.P-or 100,000 BTU.) 4.0p Im mby author¢e rcpie motives of this city lo'emer upon the gO1LER•COMP tOver 100,000 BTU)SEE FEE Seg: above-mentioned property,for inspection purposes MECHANICAL (We)sWft to save, indemnify.and keeps harmless-,the;City ol', ' MISC.- REFER TO ORD: Cupertino against liabilities,judgments•costs ad expenses which may'm any way accrue against said City in consequence of the. PERMIT'ISSUANCE g,Og CONST.TAX gmnling of this per it MECH:CONT. - LIC.NO. MECH: TOTAL TOTAL Signalur Applicant/Cuntmctor "Dale OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL P.OINT'PEN ONLY BUILDING PROJECT 1 DENTI FICATIoN, - PERMIT NUMBER ,BUILDING APPLICATION & PERMIT aoopEss /1 lD QQ A, BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 5,550 L PLAN CHECK VALIDATION r• ' E )J ��i�,'(I'/I I OTY. ELECTRIC• PERMIT FEE_ I" PHONE U '1�hI . . • NTpgLTORs UTLETS'SWITCHES-RECEP LIGHTINGFIXTURES 5.00/1'.00 ( .OD roNTRgc7oRs /l' - PPLIANCES-RESIDENTIAL 4.00 .$' QD - L- f W PHOT V /0(kJ 4D PANELS` 5.00' •� DATE OF APPLICATION ARCHITECT OR SIGNS6.00 PLAN CHECK FEE P.C.NO. _ .. - ENGINEEN ' ,uc.NO SIGNS TRANS. 3.00 ARCH.OR ENG. P ATION ADDRESS _ - SPECIAL CIRCUIT '5.00 ZIP EMP.METER OR POLE'INS.._ '15.00 JUL 2.��A AvvucANn MOTORS P. 'SEE'FEE SCH. .� q SERVICE CHANGE 10.00 w o'o `LICENSFU COM'RA ORS DECLARATIO - City of Cupertino 1 hereby'affinn that I am•licensed under provisions of Chapter 9' ISSUANCE DATE Ieommennng with Section 7000)of Division'3-of the Business and (-n<,A - - BLDG. E C PLG: MECH. r z Ikofessims Code 'nil m license re m full force and$ffect� ❑ O ❑ Z,o,'Ai'— License CIasss� LicNumber -1 'C 3 V w Dale 7/.4 Contractor's ae M U OING.PERMIT B a: .4 OWNER-BUILDER DECLARATION FORMATION X 3 a.,t; I hereby affirm that I am exempt from the Contractors License IMISC.— REFER TO ORD w' VALUATION' F 0)J Law for lhe(ollowin&reason.(Sc.7031`.5,Earnmmand Professions PERMIT ISSUANCE 6.00 5lFT. m va Code Any city or county which req.imsa pearl Oaconslr¢L alter, CE 2¢o, improve,demolish,or repair any structure,prior tm its issuance,also .ELECT CON LIC.NO. ELEC. s../) O,u requires the applicant for such'permit to file a Signed statement that ' TOTAL �� vim+ A w ce,� he is licensed pursuant to the provisions of the Contractor's.License RMIT Hi> La-(Chapter 9(Commencing with Section 7000)of Division 3 of the . z o Business and Professams Code)or that he is exempt therefrom and QTY'. PLUMBING PERMIT FEE XF$, the basis for the alleged exemption.Any violation of Section 7031:5 STORIES. TYPE CONSTR. a'; _. by any applicant fora permit subjects the applicant ma civil penalty ALTER-DRAIN&VENT -WATER (EA.14:00 of not more than five hundred dollars($500)JC ` - ❑ 1,as owner of the property,or my employee IT wages as' BACK FLOWPROTECT:DEVICE 2.00 their sole compensation;will do the work,end the structure is not 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 docs not,apply to an owner of. Property who builds or improves thereon,and who doessuch work - FIXTURES-PER TRAP 4.00 50.-FT:FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- mentsare not.intended or offered for sale If.however;the building GAS-EA.SYSTEM-1 INCA OUTLETS 4:00 or improvement rs sold within one year of completion the owner- GAS-EA. -OVER (EA:) 'builder will have.the burden of proving that he did not build or ins- 1.00 ..BUILDING USE prove for purpose ofsa)e,h INDUSTRIAL.WASTE INTER. 20:00 RES' -IND' -CON. Pe other ❑ Las owner of the property,am exclusively contracting with - ❑ 0;- ❑ ❑ 'Q licensed c.nnoctors.luConstruct'1he,.project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5'V.B. 5:00 g55EggORSPARCEL NO. and Professions Code:The Contractors License Law does not apply. Into owner or property who builds or improves thereon.and who LAWN SPR INKLERS-,OVER 5MAI 1.00 contracts for such projects with a contractods)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200k/B.00 TRACT NO. PARCEL NO. reason WATER under Sec ,B.tlrP.C.lor this! WATER HEATER 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 selfinwre. or a certificate of Workers!Compensup.crm'Insu nee„ora certified ZONING ENG:SITE NO. copy thereof(Sec 3800,Lab.C.) if(N -. / / /1/32 Policy No. - Comppny— !PCU Y - - 0 ❑ C rtified copy is hereby furnished. Z Z ❑ Certified c py is filed'with'the city inspection division. FIRESPRINK ENERGY T-24 Fp Applicoo - MISC.: REFER:TO'ORD, El N❑ Y❑ N� fLN CERTIFTE-0PIiXEMPI'ION FROM WORKERS' PERMIT ISSUANCE.- 6-00 FLOOD ZONE A.L.0.C: EL ? COMPENSATION INSURANCE PLG:CONTR. LIC.NO. ,PLG. n' O (This section need not be completed;if the permit is for one TOTAL Y❑ , No. Y i] No Z hundred dollars IS 100)or less.) L) 0 I certify that in.the performanceiol;the work for which this per. QTV MECHANICAL•PERMIT FEE FEE SUMMARY .LL F mil Is.issued.1 shallnot employ any person to any manner so as to O.W become subject to the WorkerslCompensation Laws of California a Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING, } to .NOTICE TO APPLICANT: IL'�ofter-making this Certificate of Ex. - - F. Z emptiosr,.you should become subject.ro the Worker'Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply•with 'U such provisions or this Permit shall be deemed revoked. AIR HANDLING UNIT(TO 10AMCEM) 3.00 FEE- . CONsfRucriON.LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.EM).5A0 SEISMIC FIE ' I.hereby affinn that there is a.constructionocrdingagency for EXHAUST HOOD(WITH'OGCT) 2.00 the performance of the work'fodwhich this Permit is issued(Sec. - MICROFILM 3097:L'lv.C.)� .HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name Lenders Address HEATI NG UN IT(OVER 100,000 B.T.U:)7.50 ELECTRIC I certify that I have readthis apphcnim and state that Iheabove VENTILATION FAN (SINGLE) 3.00 • mrormalion'is correct. I agree to Comply with all rty and.County PLUMBING - ordinances and sate laws refiring to building construction, aril, BOILER-COAAP(3 H.P.Or 100,000 B.T.U.) 4.00 hereby authorize representatives of this city to enter upon the BOILER-COMPVOvor 700,000 BTU)SEE SCH. above-mentioned property for,inspection purposes. MECHANICAL. (We) awce,hc su c;lindemnify and'kuep`harmless thc=City ofrMECH. MISC. REFER TO ORD. Cupedino.againsL liabilities,judgments,cost.and expenses which CONST.TAX may in any way'aceme against mid City in co sequence of thePERMIT.ISSUANCE 3.00 granting of chirp sit. �� CONT. LIC.NO. MECH. TOTAL TOTAL Signal u a Applicant/Contractor Date OFFICE COPY. O �. APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENT[FICATION - PERMIT NUMBER ADLD,NG- '.AP,PLICATION'&.PERMIT ' ADD ESS _ 5-549 D. BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S - - -1 PLAN CHECK VALIDATION Nrl •////��I/C�,_IL{1 OTY. ELECTRICPERMITFEE . •' ':PHONE Kmsa!/ CO RACTOR6 LI 102- o130 •, E UTLETS-SWITCHES-RECEP 5.00/1.00 47W L C.NO, LIGHTING FIXTURES 5.00/1.00 13.E - c NrRAcrofls APPLIANCES-RESIDENTIAL 4.00 PO 'AODRE /�/Jp{�y/� I-Js��Cy/�� ' 8 C PHONEd Y I _F PANELS 5.00 DATE OF APPLICATION onCHrtKT SIGNS 6.00 PLANCHECKFEE 'P.C.NO. ENGINEER -' - LIC.NO. SIGNS TRANS. 3.00. l moo iii ENG. SPECIALCIRCUIT - 5.00 PER MOTION ZIP EMP:METER;OR.PO_LE INS. 15.00 f/111�,q e A AP LICAN(TTs A� J �N MOTORS I 'SEE FEE SCH. JUL Z (+ 198a 6 (`1�� . aif.1A SERVICE CHANGE _ 10.00 y - w,o�o LICENSED CONTRA ORS DE LARATION - , City.Of'cupQIIIIIo .- tc U u I hereby affirm 16,1 am licensed under provisions of Chapter 9 < - ISSUANCE DATE ,Hm<,a (commencing with Section 7000)of Division 3 OLIhe Business and BLDG. E CT PLG. MECH. F 3 z 'Professions Code nd m liunu ns m full forcejtgs(cff o iD License-Class ` Lrc Number L � ❑ 1-1 'Date Comm'tor.- y F w a<�� R BU OING PERMIT a ,2 u 'OWNER-BUILDER DECLARATION - ' ss 3 LL r - I:hereby,affirm th.Ll am exempt from the Contmclor's License MISC.— REFER TO ORD _ INFORMATION so�.O J Law for.the following reason.(See.7031.5,Businessand Professions PERMIT ISSUANCE- 6.00 VALUATION, _$1FT. ., w� Code Any city or county whichrequucsapermlt toeonstruct.alter. ' K'¢ < p i npruve,.demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - i 0'u requires the applicant for such permit to rile a signed statement that _ TAL (,.�f in m he Is licensed pursuant to the,provisions of the Contractor's License / - E MIT.TO z < Law(Chapter 9,(commencing with Section 7000)of Division 3 of the 4 D Business and'Professions Code)or that he is exempt therefrom and QTY: PLUMBING PERMIT FEE m+ o the basis for the alleged exemption.Any violation bf Section7031.3 STORTES TYPE CONSTR. s ; as by any applicant for a permit subjects the applicant to a civil penalty of not more then:five hundred dollars(8500).)i ALTER-DRAIN III VENT-WATER (EA.) 4,00 - ❑ 1,as owner of the property,or my employees with.wages as BACKF.LOW PROTECT.DEVICE 2.00 their sole compensation,will do the work,and the al tincture is not OCC.GROUP .RES.UNITS ,intended or offered for sale(Sec.7044, Businessand Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00, Code:The Contractors License Law does not apply to an owner of - properly who builds or Improves(hem-on,and who does such work FIXTURES-PER TRAP 4.00 aO FT.FLOOR AREA TOTAL ACREAGE himself or through,his awn employees,provided that such impro - meatsareootimendedoroffcmdforsale.If.however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 4.00 - or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM.-OVER 4 IEA.) builder will have the burden of proving that he did not build or im 1,00 BUILDING USE prove l'or.pur,me,of sale.): INDUSTRIAL WASTE INTER. 20,00 RES IND CON PB Oma, ❑ I,;as owner of the property,am exclusively contracting with ❑. O El 0 licensed contractors to constru9 the project_(Se6:7044,Business LAWN.SPRINKLERS-1 INC 5V.B. . 5.00 ASSESSORS PARCEL NO. and Professions Code'The Contractor's License Law.does not apply - , _ t"an ownenof property who builds or improves(hereon:and who LAWN SPRINKLERS'-OVER 5(EA.) 1,00 contracts for such projects with a contmctor(sl licensed pursuant to - - theContmctor'sLicenseLaw. SEWERSANITARYSTORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ l am exempt under Sec. ,B.&P.C.for this re nWATER HEATER W/VENT 4.00 Owner 'Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPF-NSATION'UECLARATION' WATER TREATING EQUIP. q,00 I here by;affrm that I have a certificate orconsam to self-insure. m A certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE,NO. crFy thereof(Sec.3800,Isb.C.).1ViL:q/. / 1143'2- Policy 1/ �Ja Policy No. Company— r1 7k71O 'tJ 01 ❑ Certified copy is hereby furnished. Z'Z u Certified c py is filed with the city inspection division FIRE SPRINK ENERGY T-24 H O Applicant�'^G•p�)�+ - MISC.- REFER TO ORD. Y N❑" v Q -R❑ CrN CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE. -6.00 FLOODZONE A.LU.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG: CIL O (this section need "Or be completed if the permit-.is for one TOTAL Y❑ 'N Y NE] Z hundred dollars IS 100)or 1 ceRify that in the performance of the work for which th-s pe- r less.) - - e- U O. LL F mit is issued,1'shall not employ any q:nan in any manner so as Io Gry MECHANICAL PERMIT. I•FEE' �'�• FEE SUMMARV O W become subject to the Workers Compa cation Laws of California. - - CL Date Applicant ALTER OR ADD TO.MECH. q-00 BUILDING } rD NOTICE TO'APPLICANT: If.niter making this Certificate of Ex _ F Z ernpbon.you should become subject to the Worked Compensation provisions of the Labor Code, you must forthwith'comply Willi, APPLIANCE 4.00 PLAN CHECK U such provisions or this permit shall be deemed revoked., AIR HANDU NIG UNIT(TO IOpODGF.ItL) 3,00 FEE- ' CONSfRUCT1ON LENDING AGENCY AIR HANDLING UNIT(OVER 10p000.F M).5.00 SEISMIC FEE I hereby alLrm:lhat there'¢La,consouctiolr lending agency for EXHAUST HOOD(WITH DUCT) ZOO the performance of the work for which:this permit is issued(See MICROFILM 3097,Civ.C.). HEATING UNIT-(TO t00,ODO B.T.U.). 4.00 ' Lender's Name .Lender's Address _ HEATING UNIT(OVER 100,000 B.T-U.)7.50 ELECTRIC' I,e"ify thafl have read this application and state that tAeabove VENTILATION FAN(SINGLE) 3.00 • .information is correct.I agree to comply with all city and county BOILERPLUMBING ordmunees and:slate laws mlatmg to building construction,_and -COMP H.P.HPor 100,000 B.T.U.) 4.00 _ hereby authorize representatives of this city to enter upon the BOILER above-inentimoul property for inspection purposes -COMP(Over IOD,ODO BTU)SEE FEE SCH: - MECHANICAL (We) agree to save, hidemnify'and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgment;.wits coilon expenses which mayin any'way accrue.against said City in consequence of ince PERMIT ISSUANCE 3.00 - CONST.TAX grating of this period. MECH.CONT. LIC.NO. MECH, TOTAL TOTAL Sign u I Applicant/Contractor Date, OFFICE COPY l2 7 �O APPLICANT TO FILL IN INFORMATION'WITHIN RED LINES= USE BALL POINT PEN ONLY.;" BUILDING PROJECT I DENTIFICATION 'PERMIT NUMBER - So,LD,NG APPLICATION& PERMIT - - AD �yE / BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 5548 ' OWNER'5 PLAN CHECK VALIDATION "AM // OTY: ELECTRIC PERMIT FEE • PHONE Y - .. CONTRACTORS V UTLETS,-SWITCHES-RECEP 5.00/1.00 '47 LIGHTING FIXTURES 5.00/1.00 ,00 ., CONTRACTOR'S �^ �,t�, APPLIANCES-RESIDENTIAL 4.00 ,(p ` ADD Es1IsI/ l ��[�y � - Ty .� PHONE Qt;(IY(,J PANELS 5.00 DATE OF APPLICATION 'ARCHITECT. - - SIGN$ B-O0 - PLAN CHECK FEE - P.C.NO. ENGINEER LIC.NO.. SIGNSTRANS '3.00 ARCH.OR ENG. PER m ION ADDRESS SPECIAL•CIRCUIT ''5.00 ZIP EMP..METER'OR POLE INS. 15.00 JULn ��A -. .APPLICANTS _ - MOTORS 1 SEETEESCH, 6V UL -(,r 4 ADDRESS'„//` SERVICE CHANGE 10.00 .a w G S? LICENSED CONTRA ORS DECLARATION CIi]I Of Cupertino I hereby affirm that Lam licensed under provisions of Chapter 9 ° ISSUANCE GATE v,z i Icommencing with Section 7000)of Division 3 of the Business and a BLDG. EL CT' IPLG. MECH. F D Z. Professions Code and my license is in full force a elle,,•}. O z.m W LicenseC s _ ,.Li6:Numb.1 !WIC-4,13 , . a Y,� J Detcr Contractor ¢ ¢¢ OWNER-BUILDER DECLARATION B DING PERMIF S p A.v . NFOJIMATION X ; LL y I hereby.aflirm that l am exempt Trom.the Conlructor s.Liccnse MISC.-- REFER TO ORD F w.o J Law for Wefollowmg mason. 7031.5.Busmesstnd Professions PERMIT ISSUANCE " .500 V LUATION $/FT.. E I; Code. Any or county which requiresapermlt loconstrucLulter. _ 4 , te Se <0 improve,demolish.or repair any SWcture,prior to its issuance,also E C.CO TR LIC:NO. ELEC. i D¢ requires the applicant forsuchtrermit to file a signed.statement that Q0�1 Cn91,131-31.TOTAL Jf� Wm N he is licensed punmanl to the provisions of the Contractors License' RMIT TO r,'z > Law(Chapter 9(commencing with Sect ion 7000)a f Division 3 of the ¢ Business and Professions Code)or that he is exempt therefrom and OTY: •PLUMBING PERMIT FEE. ¢,F 0 the basis for the alleged exemption.An violation ofSectiun 7031.5 6< P Y STORIES TYPE CONSTR. by any tore tha fort panne subjects S500).licanl loacivil penalty of not more than Five doliam(5500)d: ALTER-DRAIN&VENT-WATER-(EA.) .00 - ❑ 1,as owner of the rruperty or myemployees with wages as. BACK FLOW PROTECTDEVICE '.2A0 their sole compensation,will do the.work,and the.structure is not. . - OCC.GROUP RES.UNITS intended or offered for We(Sec 7044;.Business and Professions DRAINS',FLOOR,ROOF,AREA;COND. 4.00 Code:The Contractor's.License Law doe not apply to an owner of property who builds or improve thereon.and who does such work FIXTURES-PER TRAP 4,00 SOFT:FLOOR AREA TOTAL ACREAGE • himself or through his own employees;provided that such improve- ments are not intended or ffered for We.If,however,the.building GAS-EA.SYSTEM-d INC.4 OUTLETS 4,00 or improvement is sold within one-year of completion,the owner- GAS-EA.SYSTEM-OVER 4•(EA.) ',1.00 •BUILDING USE budder will have the.burden of proving that he did not build or or. prove for purpose ofsale.): ZO DD RES IND CON PB Other ❑ 1,'aslowncr oflhel ro d am exclmivel 'contmclin INDUSTRIAL WASTE INTER. ,13 ❑ ❑ 0, •❑ p W Y. Y e with licensed contracton'toconstruct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 . ASSESSORS PARCEL NO. and Professions Codc:The Contractor's License Law does 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 a hontracmns)licensed pursuant to the Contractor's License Law. - SEWER-SANITARY-STORM' EA.200ft/8.00 TRACT NO. 'PARCEL NO. reason m exempt under Shh. ,B.&P.C.for this WATER HEATER.W/VENT -4,00 Owner Date WATER SYSTEM - 4.00 'AOC:DATE ACC.FILE No: WORKERS'COMPENSATiON DECLARATION WATER TREATING EQUIP. 4.00 '.I hereby affirm that I'have a e.r1ific.1corcoment lowll=insure ora eerlificals of Workers Compensation Insurance,or a certified - ZONING ENG.SITE NO.-- copy thereof(Sec.3R00,Lab.Cd.A/A qfo -�l/g 2. Policy No. - Company T.J Q'T ❑.Certified copy.is hereby furnished: Z Z ❑ Certified copy e'01ed with the city inspection division. FIRE SPRINK ENERGY T34; O - Appli TAREFER TO ORD. V ' N V N CERTIFI ATE OIs EXEMPTION FROM WORKERS' . PERMIT ISSUANCE ' _ 6.00 FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG:CONTR- LIC:NO:, CL O (This section need non-be completed if the permit is for one TOTAL Yo NF] "v❑ _ No U O hundred dollars(SIOWOrlem.) I certify that in the performance of the work for which this per. GTr MECHANICAL PERMIT FEE SUMMARY LL V mit (sissucd:l•shall not employ any;person.in any.manner so as to FEE become subject to.the Workers Compensation'laws of California. Oy Uam Applicant - ALTEROR,ADD TO MECH. 4.00 ,BUILDING } w NO1'ICIS TO APPLICANT: If.after making this Certificate of Ex emption,you should become subject to the Workers'CompenWion APPLIANCE 4.00 PLAN CHECK provisions of the,Labor Code, you-.must forthwith comply with such provisions or this permit shall be deemed.revoked_ AIR HANDLING UNIT(TO 10/000QF.NL) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT•(OVER IO.0MC.EM)-5.00SEISMICTEE' , I herebyafDrm Ihat thereis a construction lending agency for EXHAUST,HOOD(WITH DUCT)W..NT -00 .the performance of the work for which'this permit is issued(Sec. MICROFILM 30971Civ.C.). GUNIT(TO 100,000.B.T.U.) 4.00 Lender's Name' .,. Lender's Address HEATING UNIT B.T.U.)7.50 ELECTRIC Icertify that l have read this application and State that the ab.JcLATION FAN (SINGLE) •3.00 • mforma(im, is torr ct I agree to comply with all city and county. - PLUMBING ordmances and state laws-relating to building distrudirm, and (3 H.P.or 100,000B.T.U.) 4.00 hem-by authorize representatives of this City to enter upon the -COMP(Over 100,000 BTUI SEE FEE SCH. above-mentioned property for inspection purposes: MECHANICAL (We) Npee'to Gave, indemnify and.keep harmless the City of REFER.TO ORD. Cupertino against'liabilities;.judgments. costs and expenses which .ISSUANCE - 3 CONST.TAX may {many way theme against said City in consequence of the granting of this Permit �� LIC:NO:.i MECH. - '/ �.lil/ TOTAL TOTAL Sam of Applicant/Contractor Dale OFFICE COPY Q� /„mss APPLICANT TO FILL IN INyFORMATION WITHIN REDLINES - USE BALLPOINT PEN ONLY BUILDING PROJECT I DEN IIFICAT16N PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS C C BUILDING—ELECTRICAL—.PLUMBING—MECHANICAL JJ O ERS - - - —— _ - PLAN CHECK VALIDATION NAME // OTY. ELECTRIC PERMIT FEE_ • - PRONE t"Y - - C TRA....s, ME" �'//^,, -7 UTLETS=SWITCHES-RECEP 5.00/1.009,00 ua.xO. i%�� LIGHTING FIXTURES '5.0011:00 ,DO CONT A TORSVO PPLIANCES-RESIDENTIAL 4.00 Haa-yylI - - HON PANELS S.00' •VO DATEOFAPPLICHTION 'ARoAnrECT - PLAN CHECK FEE P.C.NO. OR SIGNS 6.00 ENGINEER ' 'LIC.NO: SIGNS TRANS. 3.00 wRCn.OB ENG. - PE I]�\{/y1yDATION- ADDREss SPECIAL CIRCUIT . 5.00 �!`/ Zip EMP.METER OR POLE INS. 15:00 Awucwxr's - MOTORS.. I I A� SEE FEE SCH: ;� 'JUL 2 AU Ess - C /� 9 J\ SERVICE.CHANGE 10.00 {I� D o'2 LICENSED CONT CfORS DECLARATION City of CUpQrtlno <Z u. Ilhereby affirm that I am licensed under provisions of Chapter9 ISSUANCE DATE In a a, (commencing with Section 7000)-of Division 3 of the Business and F N;In Professions Cod• and=yy1icen se is in lull force�Tn cffec BLDG. EL CT PLG: MECH. p z`—'o. License Class _ 1.L.Lie..Numbed I / Doc Conlmctor ..v wa. OWNER-BUILDER DECLARATION _BU DING PERMIT ` °acs MISC.— REFER ORD I FORMATION' w ; w,� 1 hereby affirm that 1 am exempt from the Contractor's License F w 0 Us Law for the followimf casod(Sec.703115,Busineisand Professions PERMIT ISSUANCE 6.00 . ,V AL_ATION S/FT. Code Any city or county which requlresa permit to construct,alter, 2 G a;0' .Improve,demolish,or repair any structure.prior to Its issuance,1150 EL C.CO TR. LIC:NO. ELEC. ii:c a requires the apphcanl for such Permit G'ro Gla a signed'slalemenl that C 13 TOTAL �6'So w m'u he is licensed pursuant to the prov stuns of lbe CcmI,.Ior's License _ PMIT T .F zi Law(Chapter.9(commencing with Section 7000)of Division 3 ofthe Business and ProfessionsCode)or that he isexempl therefrom and•. QTY. PLUMBING'PERMIT FEE ' a:1-othe basis for the alleged exemption.Any violation of Section 7031.5 - - STORIES TYPE CONSTR. 'n 3 m, Eby.any applicant for a permit subjects the applicant toacivil penally of not more than fivehumdred dollars($500L)i ALTER-DRAIN&VENT-WATER.(EA.) 4.00 ❑ I asimvm:i of the property,or my employees with wages as BACK.F LOW'PROTECT. DEVICE - then holecompensalion,will do,the.work,and ilia structure is not 2•�' OCC.GROUP- RES.UNITS intended or 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 'property who builds or improves thereon,and who does such work FIXTURES-'PER TRAP 4.00 SOFT.FLOOR AREA TOTAL ACREAGE O 'himself or through his own employees,provided that such improve- ments are not intended or offered for sale.IL however,the building GAS-EA:SYSTEM-11NC:4 OUTLETS_4.00 or Improvement is hold burden one year ofclie did of the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILD G USE or improvement builder will ant the burden of proving that lie did not build or i=- lonecFar purpose ofsale). INDUSTRIAL WASTE INTER. . 20.00 ❑RES t❑ O ❑ O❑r ❑, I,as owner,of the property,am exclusively contracting With licensed Contra In. to construct the.project(Sec. 7044:Business LAWN SPRINKLERS-1 INC 5 V.B:. and Professions Code:The Contractor's License Law does not apply - .5.00 ASSESSO ARCEL NO: -to an owner of property who builds or improves'thircon.and.who LAWN SPRINKLERS-'OVER 5'(EA.) 1.00 - Contracts for such projects willyd<ontraclodsl licensed pursuant to - - TheContractor'sLlCenseLaw. SEWER-SANITARY-STORM EA.2001t/6.00 TRACT NO, PARCEL.N5. reason WATER em exempt under Sec.—,B.&P.C:for this WATER HEATER W/VENT" Owner- Dale WATER SYSTEM - ' • _ - 4.00 ACC.DATE .ACC.FILE NO.. WORKERSICOMPE„NSATION'.DECLARATION' WATERTREATING EQUIP. 4.00 1'hereby affirm that I'have a certificate of ermu mt to self-insure. ora certificate of Workers'Compenmlion:lnsurance.,or b certified ZONING. ENG SITE NO. copy thereof(Sec.3800,Lab.C.L •/A L1 q/ ,I r �.L l Y' Policy.No. -Company A /7 `7 !O ' U- ❑ Certified Copy Is hereby furnished. Z Z ❑ Certified oggqy is Filed with the city mspeclion division. FIRE BPOINK ENERGY T34 F O APpuiant.,=.�n/J,l.1/J.y ” Misc.- REFER TO ORD. Y❑ N[] Y ❑ 'NE] Lu N CERTIFICCAA7TEEOOF�E�XEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE- A.L.U.C. 113COMPENSATION INSURANCE PLG CONTR. ,LIC.NO. .PLG d 0 O IThis.sediun need not.he completed if Ihopermit is forone .TOTAL Y❑' NC] Y NEI �.Z hundred d.Ikus(S100)orless.) U l0,. 1 certify that in the performance of the work for which this Per- FEE SUMMARV' H mit is Issued;[:shall not cin to an a -- QTY• MECHANICAL PERMIT ,0 O p C y person any manner sm as to - FEE Q'W become subject to The Workersl Compensation Laws of Calilomia. y Dale + Applicant - ALTER OR ADD TO MECH. '4.00 - BUILDING }'.W NOTICE.TO,APPLICANT: ILIfler making this Certificate of Ek: F Z e=ption,you should.becomesubjecl tothe Workers'Compensation APPLIANCE ' 'provisions of the Labor Code, you must forthwith comply withU'. '-c 4.00 ,PLAN CHECK such provisions or.this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M)' 3.00 FEE' " CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000QRM15.00 'SEISMIC,F.EE . - - I herebyaffirm that there is a constructionlending agency for, EXHAUST HOOD'IW ITH DUCT) the performance of the work for which this permit is issued(Sec. - - •2.00 309TCiv.C.). HEATING UNIT(TO 100,000 B % Lender's Name .T.U.) -4.00 ' MICROFILM Lender's Address H EATI NG UNIT(OV ER 100,000 B.T_.U.17.50 'ELECTRIC I certify []rat I have read thisapplleal on.and state that the above VENTILATION FAN(SINGLE) 3.00 " information is correct I,agree to comply witVall city and county BOILER;COIYID PLUMBING ordmances and state laws,relaung to building construction, and (3H.P.Or1( 000BT.U.) 4.00 I ereby authorize representatives of this city to enter upon the above-mentioned properly.for.inspection purposes. BOILER-COMP(over 100,000BTU)SEE FEE SCH: MECHANICAL (We) agree.to.save, =damnify and keep harmless (he City of MISC.- REFER'TO ORD. Cupertino.against liabilities,judg=ems'Costs and expenses which ' may in any way accrue against said City in consequence Of the. PERMIT ISSUANCE '- 3.00 CONST:TAX granting of thisApe it��-/�/�� / Y(�/ MECH.CONT. - LIC.NO. MEW llif Ll/Vse,/✓V / =.3�V •r - - TOTAL Signalu o1'.Appicant/Contractor Date TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES -1 USE BALL POINT PEN ONLY BUI LDI NG_PROJECT IDENTIFICATION PERMIT NUMBER BUILDING 'APPLICATION & PERMIT • ADDRESS / BUILDING—ELECTRICAL—PLUMBING-MECHANICAL 5546 PLAN CHECK VALIDATION " MB' QTY. ELECTRIC PERMITFEE • rHON - '{ljCl TflACTOR'S /�/) E /.,EI �; UTLETS_-SWITCHES=RECEP 5.00/1:00 LJJ . L.C.N(/"IO' LIGHTING FIXTURES' 5.00/1.00 . NTRACTORS APPLIANCES 4.00. AD E //�x`�/r��'/y�nJ'I��((()J]�f�1 - 'g - pROxE /`a/ /O'A+ IO' PANELS . 5.00 DATE OF APPLICATION ORCNIT i _ PLAN CHECK FEE P.C.NO. . OR SIGNS: - "6.00 - ENGINEEfl ' uc.eo, SIGNS,TRANS: - 3.00 a CH.OR ENG. SPECIALCIRCUIT 1&00 PERMIT V I SS ZIP. EMP.METEFL POL I .- '15.00 ry eg,1 Foo ICAB'S ,�/� MOTORS ,I .SEE FEE SCH. JUL' 12-1984 ��L1JY( Dv SERVICE CHANGE 10-00 p . - woe. ' LICENSED CONTR CI'ORS ECLARATION - - Clhl O{1 CUDOf y{IDO a=.�. I herehya Ffima that l am licensed under,provisions of Chapter9 ISSUANCE GATE (commencing with Section 7000)of Division Sof the Business and ' BLDG. ELECT PLG. -MECH. 0` Professions Code, red myyy license is in Tull Torte 1pppQ;I`N(�t. ❑ ❑ X012 W License Cla La:.Contractor O!�..� r. Date T d Coni actor ¢.¢ W;¢ - OWNER-BUILDER DECLARATION' - BU DING PERMIT x ;',N 1 hereby adore.that I.am exempt from the Contractor's License MISC. .REFER TO.ORQ 1 FORMATION F ,ore Law for the!foilusvingonson.(See.7031.5,Businessand Professions' , PERMIT ISSUANCE ' 6:00' VAWAitON - S/FT. Nom. Code Any city-orCounty which requiresapermd to conslmd:alier. ' rt x¢-o Improve,demolish,or repair any structure.prior to its issuance,also EL C.CONT LIELEC. C.N/O. 0 LL. requires the applicant for such permit to file a signed statement(hot- C! TOTAL 7� w�X$m he is licensed pursuant to the.provisions of the Conlmctor's License ERMIT O fir Law(Chapter9(commencing with Section 7000)of Division 3 of the f 4 o Business and professions Code)or that he is exempt therefrom'and CITY: PLUMBING PERMIT FEE ¢ 1_$ the basis COT the alleged exemption.Any violation of Section 7031.5 - b an applicant fora permit sub eels the applicant toncivil null STORIES TYPE CONSTR. a i _ y r ore P' i vv' Penalty. ALTER-DRAIN&VENT-WATER IEAJ 4.00. of not more than five hundred dollars(5500).): ' ' ❑ 1,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:Th.Conlmetor's License Law does not apply to an owner of - propertyrwho builds or improves thereon.and who does such work' FIXTURES-PER TRAP' 4:00 • himself of thmogh his own employees,provided that such improvb - SG.FT.FLOOR AREA TOTAL ACREAGE menteme,mavintendcd or offered for sale.If,however,the building GAS-EA.SYSTEM..1 INC.40UTLETS 4.00 or improvement is sold'within one year of.completion the owner- budder evill have.the burden of moving that he did notbuild or im- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BULL IND USE prove for purpose of sale.). RES I I CO PB Other ❑ 1,as owner of the properly,am exclusively.conlmcting with INDUSTRIA L'WASTE INTER. 20.00 , Q licensed eomractors to coristruet lhe.fum"l.(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B, 5.00 ASS1 SPARCEL NO. and Professions Code:The Contractor+License Law docs not apply to an owner of;pioperty who builds or improves and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for suchprojects with a eonfiectods)licensed pursuant to - theCmaractorsLicense.Law. I SEWER-SANITARYSTORM EA.'200ft/8:00 TRACT No. PARCEL No. Mason Ma❑ l.am exempt under Sec.—.B&P.C.for this WATER HEATER'W/VENT 4,00 Ownery WATER SYSTEM 4.00 -ACG:DATE ACs.FILE NO. WORKF.RS''COMPENSATION DECLARATION. WATER'TREATING EQUIP. -4.00 . - 1 hereby at firm'that I have a certificate ofoonsenl to self-insure,. or a certificate of Workers'Compensation Insurance.lrr a Certified ZONING 'ENG.SITE NO; copy thereof(Sec.3800,Leb.C. . LAH PolicyNo. Company H / /I/ O" Yr / � ❑ ,Certified copy is hereby furnished. Z Z ❑ Certifiedy ¢ filed with'the City inspection division. FIRE SPRINK ENERGY T-14 p AVPlicant f1�� ' MISC.- REFER TO ORD. 'r�:• nI C] Y E NQ - m CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6;00 W.� FLOOOZONE A.L.U.C. COMPENSATION INSURANCE PLG.CONTR. - LIC NO. pLG„ 'd O (This section need not he completed if the permit is for one. TOTAL 'Y o N CO, N[]Z hundred delta.IS 100)or less.) UO I cerlify'ihat.in [lie performance of the work for which,this per- QTY MECHANICAL PERMIT FEE; FEESUMMARY ' LL mit is issued.Lshall not employ any person in any manner so as to _ O.L) become subject to the WOrkeis'Compensation Lawsof California. y Date Applicant } W NOTICE,TO APPLICANT: IG after makinethis Certificate of Ex ALTER OR ADD TO MECH.' 4.00 BUILDING _ F Z emotion,You should become subject to the Workers'Compensation APPLIANCE :4.00 prowprovisof the'LaSor Code. you must forthwith comply with - PLAN CHECK. U such provisions or this permit shall be decmednevokad. AIR HANDLING UNIT(TO 1000C.F.M) 3.00 FEE 'CONSTRUCTION:LENDING AGENCY AIR HANDLING UNIT(OVER 10=QF.M) 5.00 SEISMIC FEE I hereby affirm that there.k.a construction lending agency for . `the perfortnance.of,the work for.whiels this permit.is issued(See EXHAUST HOOD(WITH DUCT) 2,00- MICROFILM . 3097, HEATING UNIT(TO 100,000 B,T.U.), 4.00 1 Linder hdcr's i Name Lenders Address - HEATING.UNIT(OVER,100,000 B.T.Ui)7.60 - 'ELECTRIC' 1&,lily that I have read this apple aton a"' 'are dial the above VENTILATION FAN.ISINGLE) 3.00 S :information is c I recr agree 1.comply withall cit9'and county PLUMBING ordinances and state lawsr relating to building construction,and BOILER'COW(3 H.P.or 100,000 B-TU.) 4,00 .hereby authorize representatives of this city„to e mer upon the ER-COMP(Over1W,OOp BTVI SEEFEE SCH, q. above_mentioned properly for inspection purposes. BOIL 'MECHANICAL CAL (We) agree to,save„Indemnify and keep'harmless lhe,Cily of MISC.- REFER TO ORD. Cupertao against habililies,judgments, costs and expenses which” may DIOnyway accrue against said City in.wnsequence of the PERMIT ISSUANCE- 300 CONST.TAX gmnho ortht�hii///splfyr�(miIL4J/�/,/I MECH.CONT. LIC.NO. MECH, 7U� - TOTAL c Si 'ul AApplicant/Contractor are TOTAL, OFFICE COPY ' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER BUILDING PROJECT IDENTI FICATION APPLICATION BI,PERMIT - BUILDING 'e ADDRESS-n • _ a.O/�I _ BUILDING-'EL'ECTRICAL-PLUMBING-:MECHANICAL 5545 OWNER'S _ - - --'• - PLAN CHECK VALIDATION' y/(///�) OTV. ELECTRIC T FEE r P-ON . NEE MNT .ct°n s. I UTLETS-SWITCHESRECEP 5.00daAU /1.00 ,(�J L...N -'0;*I� LIGHTING FIXTURES 5.00/1.00 AOTOR�s - Pp VIE .4.00 g - ADOREsa C vxor+�CA / ANECS 4W I OATE OF APPLICATION ARRCHI OT = SIGNS g;g0 PLAN CHECK FEE - P.C.NO. ENGINEER --. UC.NO. - SIGNSTRANS- 3.00 - ARCH: OR ExG. PEI'PILVAtdDAT10N ADORES - ` SPECIAL CIRCUIT -5-00 „��V ZIP. TEMP.METER OR.POLE INS. '15.00 APPLICANT'S - MOTORS ` 1 SEE FEE SCH. 'J.� 'JUL 12 1904 'ADDflE �/ �1 E'JC 6J i SERVICE CHANGE 10.00 . w'00 LICENSED CONTRACTORS.DECLARATION CIOIj Cupertino IIIO Q'uu I.hereby affnm that,I am licensed under provisions of Chapter ISSUANCE DATE n<y (commencingwith Section 7000).of Division 3 of the Business and - BLDG. .FL CT. .PLG. MECH. r y z Professions Cod• undm license is in full forcylgd (f d, - ❑ ❑ ❑ Z c E, Liccose C ass I - Lie.Number Lin l 1 3 - 9!2 L Date Conimdor ¢ a a'a OWNER-BUILDERDECLARATION - BUI DING PERMIT °'�" MISC. - REFER TO'ORD 1- FORMATION E g 1.hereby affirm that I am exempt from the Cannactor's Limnu ✓w U. a law for.the following reason.(Sec.7031.5.Busioessand Professions PERMIT ISSUANCE ' VALUATION SlFT.' Code,Any,cily or county.which requires a permit to construct,alter,. 6.60 ¢ ,o"t 20 nnprovq demolish,or.repair uny structure,priorto Its issuance,also ELAC. ONTR: LIC:NO: ELEC., •-c1] - ii:o u r quires the applicant for ouch permit to!ilea signed smtemasCllml / TOTAL , u he is licensed punuant to the provisions of the Contractor's License P MIT TO - ri> Law lCh3pter 9(cc- ie irig.ith Se.ti6n7000)ofDivisi.n3ofthe Business and:Professions Code)or that he isexempuherefrom and OTY-' .PLUMBING PERMIT FEE .a W I_ $ the basis for the alleged exemption_Any violation of Section 7031.5 _. STO ES TYPE_ CONSTR. d ;_ by any:applicant for a permit subjects the applicant toll civil penalty. ALTER-DRAIN -WATER (EA.) 4.00 of not more than five hundred dollars(1500).): .'❑ I',as owner of the'.property,or my employees with wagesas, - BACK FLOW PROTECT:•DEVICE' their sole compensation.will do the,work,and,[lie structure is not - '2.6° , r OCC:GROUP RES.UNITS Intended-or offered for sale(Sec. 7044,:Business and Pmfessions DRAINS=FLOOR,-.ROOF,AREA,COND. 4.00 - Code:The Contractor's License Law docs not apply to an owner of property who builds or Improver thereon.and who does such work FIXTURES.-PER TRAP 4.00 SO;ET.FLOOR AgEATOTAL ACREAGE himself or through his own employees;provided that such improve- mEutsareknotintended oroffered for sale.If,however,the building' GAS-EA.SYSTEM-11NC.40UTLETS 4,00 or Improvement is Bald within one year of completion..the owner builder will have the burden of rovin that he did not build or int. GAS-EA.SYSTEM-OVER 4'(EA.) 1.00 P g - RUILOING USE prove lbs purpose of sale.).p RES IND PB Omar ❑ d as owner of the Property,mn exclusively . 7044,ing with �NDUSTRIAC WASTE''INTER. 20.00 El El licensed ContractorsCd :Thestiudtireor project(Sec. does net appy LAWN.SPRINKLERS-'11NC5 V.B. "S.DD � ASSESSO SPARCELNO. and Professions Code:The Contractor's License Lew docs not apply _ to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 outsets for so�h projects with conlmctodal licensed putsuanLto - the Contractors License Law.:' - I SEWER-SANITARY-STORM EA.200ft/8.00TRACT.NO FARCE NO. re❑wltl am exempt Sec jB.&P.C.f'os this WATER HEATER W/VENT .4.00 Owner Date WATERISYSTEM 4.00 ACC.DATE ACC.FILE NO, WORK FRS'COM PENSATION DECLARATION WATER TREATING'.EQUIP. ;4.00 I hereby affirm(hat['haven certificate of consent to self-insure. or a certificate"'.kers Compensnton nsumnce,or a cetlified - ZONING ENG.SITE NO. copy thereof(Scc CO„Lub.C.)./1/{� U1 a/ t!f.,j Pn0Cert Company fu(ished. 1(�(Q�- y PL.1 ❑ Certified copy is hereby furnished. -2 'Z 2 ❑ Certified �opy� A filed with 'the city Inspection division. FIRE BPRINK ENERGY.RZ4 iZ Applicant MISC.- REFER TO ORD. Y � N❑., YQ, NO O .PERMIT ISSUANCE CERTIFICATE OF EXEMPTION FROM WORKERS' 6.00 FLOOD ZONE A.L.u.C. W COMPENSATION INSURANCE' _ PLG.CONTR. - LIC.NO. PLG. CL 0 (This section need'nor be Cmrn lkledfif the permit i for one TOTAL Y N� Y NEI hundred dollars IS 100)or lees.) V O (certify Nat in the performance'or the work for which this per- LL er MECHANICAL PERMIT FEE'SUMMARV f)_ f mit Is Issoed,.l shall not employ any,person in any,manner so W to QTY' FEE j O•w become subject to the Workers'Compensation taws of California. " .a Date Applieam ALTER OR.ADDTO MECH. 4.00 BUILDING ' } to NOTICE 1'OAPPLICANT: If•after,making this Certificate of.Ex- - F.2 emptioo,you should become subject to the Workers*Compensation APPLIANCE provisions of the Labor Code;;you must forthwith comply.with 4.00 mPLAN CHECK U .such provisions or this permit shall be deemed revoked. .. AIR HANDLING UNIT(TO 10pODCF,14) 3.00 FEE CONSTRUCTION LENDING AGENCY "AIR HANDLING UNIT(OVER 10=r.FM) 5.00 SEISMIC'FEE I hereby'.affirm that there is a construction lending agency for EXHAUSTHOOD'(WITH DUCT) 2.00 the performance of the work for which th¢,penni6 Lender'sName is issued!Sec. MICROFILM r'i - .HEATING UNIT(70'100,000 B T.U.) 4.00 Lender's Lenders Address .HEATING UNIT(OVER 100,0008.T.U.)7.50 .ELECTRIC. 1 certify that I have read this application and state that Ne'above VENTILATION FAN (SINGLE)' 3.00 information rd orreet I s agree to comply witti all nty;and county BOILER. PLUMBING lembycuthori state laws relating to,building.city construction: and CONT I3 H.P.on100,000&T.U.) 4:00 hereby authorize representatives ec this city to enter upon the above mentioned property for inspection purposes BOILER-COMP_ (Over t00,OD0 BTU(SEE FEE SCH: MECHANICAL (We)'agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino,against liabilities.judgments• costs and-expenses which - - may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00 CONST.TAX. granting of lh� it... ., n MECH.CONT. LIC:NO: MECH. / `�/ TOTAL TOTAL Signator (Applicant/Contractor .Date - ' • OFFICE COPY Zr