The URL can be used to link to this page

3562 11 20716-23 CELESTE CIR 3562 F DE ANZA PROPERTIES SCANNED BOX # 783 • CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE/-+ ' C , 19 BLDG. PERMIT NO. 5 C I THE BLDG. LOCATED AT Z B 7 / C-- Z cf ( r rT r Cf ? (-ca. OWNED BY De A ti 2, /o /Z n P F p, 7- /l S' (COMPLETED) g I HAS BEEN FOR USE AS C U N / 7 5 (ALTERED( � O» //�BUICDING INSPECTOR C1PY or CUPF.R1'LI7O IIISI'liCT1Ot! RECORD (Office .Copy)--' : Ii. 3562 Lot 2, Bldg. 9 20716 - 23 Celeste Circle ' -- PERMIT NO. SANITARY DIST. NO. LOT NO.. ADDRESS const. 8 Units DeAnza Properties PROJECT OWNER JOB SITE PHONE N0. PERMIT ISSUED Date ELECTRICAL Building 5711/83 Date Insp. Electrical ..1.6 . K Power Pole Plumbing h1.7-7. 14 Underground Mechanical Rough Wiring 2 - Z R - g .. •.L Temp. Cas/Elect. Walls ' Solar Ceiling Fire Sprinkler Fixtures, Int/Ext Sign Motors Grounding Misc. Temp. Power Other FINAL INSPECTIONS Not A roved Date Insp. 5 �_�8`PY PLUMBING Electric -gds-Sy Plumbing t� i ._ Date Insp. 1 F - Backflow Mechanical ?=aS-8Y Underground _ Solar Underfloor / Pool Partial Rough d2 -/Q.0 /� • Grading Rou ,h Com late - � Planning / Solar Rough Fire Dept. SA/Ail ' y 'lam' Water & Insulation — Health Dept. Main Drain A --i6-11 Building C—C— 8 9' R/of/S Drain Other Gas Other BUILDING Not Approved Date Insp. Cad Certification MECHANICALFoundation 1(- 3 Date Insp. Pre-Gunite Underfloor S.M. Slab-Membrane Ducts- & Insulation -4?-5'1'A. Bond Beam — Fire Dampers Underfloor Girders j0-Ig-83 J Fireplace , _>7- 1 Floor Steel �y .__ Grease Duct & Hoo Tiedowns One (lour Shaft ,, Ilh Diaphrams ( rs(a.dr �.(/d(,(2 el V Condensate Drain Seismic Bracing Q (-(o-Rtfr l/alls-Panels Flues & ' Anchorage Flues & Comb. Air • Frame Ot( 4-1t(,r 4- P(69 2-27 4q %V Other Lath Not Approved - Wallboards Int/Ext. Firewalls Other 4110 Not Approved. Gev..cycfc. moo( Ib1 Iv'•4T 1-1343 u 2wi.. (tit t-1 s iSt 6ekt et 3. t. Id n 4ae, 0 .fes ' , am Opl'i ; BUILDING • / . 111 ELECTRICAL' PLUMBING • MECHANICAL L....aimmmmimimmmmimmmm.......m•H MISCELLANEOUS •' •LICANT TO FILL IN INFORMATION WITHIN,,RED LINES— USE BALL POINT PEN.ONLY ' ��r * i f,/ ' •. . , RMIT '�'iER'; BUILDING PROJECT IDENTIFICATION , „ : / n 35 6 2 RN,LD,NG �, L A ION & PERMIT •Ao.REss nILDING ELECTRICAL—PLUMBING—MECHANICAL tali jazz%lit : Y *1 .Ji f1 ,• _ __ - _ _._ -_ .ONNE-'5 - .PLAN CHECK VALIDATION NaME - Cat'��/�//� DTV. ELECTRIC PERMIT FEE 7 /� PH.917/114491 I/efr•/ 'CONTRA ORs { •UTLETS-SWITCHES-RECEP 5.00/1:00 - NAME G S LG LIG. LIGHTING FIXTURES 5.00/1.00 ' CONTRACTORS •PPLIANCES-RESIDENTIAL 4.00 _ ADDRESS PHONE PANELS .5.00 DATE OF APPLICATION ARCHITECT - SIGNS .- 600 'PLAN CHECK'.FEE I P.C.NO. ENGIN SIGNS TRANS. • 3.00 Ili ' E� "AR .OR ENG. . T• RM LVACID ADDRESS • SPECIAL CIRCUIT 5.00 • //�� \ - - • ZIP .EMP.METER OR'POLE'INS. 15.00 '%A APPLICANTS MOTORS SEE FEESCH. . - 7 .4 • • ��/� ; SERVICE;CHANGEi 10.00 Woo LICENSED CONTRACTOR DFCCARATI ..- 41 Si ,W Q'n. (commencing w h'Secl on 7000)of•Dry so ner r3 of theP.ovisions METER and BLDG. LEFT. MECH ISSUANCEDATE . f°2 Professions Code and my license is in full force and effect. PLG: z O w License Class Lic Number • - - . - ❑ ❑ •° z W' Date. - Contractor z w•a OWNER-BUILDER DECLARATION - - _ BUILDING PERMIT ° ° hereby MISC._ ' .REFER TO ORD INFORMATION • R.;,,::w I ' am exempt from the Contractor 'License - O j `Law for the following reason:(Sec 7031 S,Business and Professions PERMIT.ISSUANCEVALUATIOsi S/FT.. i 'n'n f Code:Any city.or county which requires a permit to construct alter. . 6.00 • �j♦��/�(�� V ELEC.'CONTR.. LIC.NO. .. IqV_/-g/W e: a 0 D 'improve,demolish or repair any,sm it tore,prion to its issuance,also - ELEC. r�(/llY m' 'requires the'applicant for such permit to file a signed statement that ' TOTAL - PERMIT TO x he is licensed;pursuant to the provisions of the Contractor's License - /J wz,Q. .Law(Chapter 9(commencing with Section 70001 of Division 3'of the /$gq l:619 //lw/ . f((z D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE (J�Af�� ` N ��il • e I-a. the basis for the alleged exemption Any violation ofSectiom7031.5 STORIESwTYPECONSTR:' a;; .. by any,applicant fore permit subjects the applicant toacivii penally IIMI ALTER-DRAIN VENT-WATER O� of not ore thae five hundrep (5500).): IEA.) 4.00 s../a{/i�L ❑ I.as owner of the property,or my employees with wages as //��"Nt�` their sole compensation,will do the work,and the and Profession? not BACK • • • 11 DCC.`GROUP gES;u NITS 'intended or offered for sale se 7044. Business and Professions •- ••- ROOF, • • 11 r-/ . flPry .Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work ..' 11 5 T.FLOOR EA TOTAL ACREAGE himself of through his own employees,provided that such improve 'menu arc not intended or offered for sale.If:however.the building. 11 /f��budder will have the burden'of proving that he didnot build otirn- / ' BUILDINGUSE • • pvy for purpose of sale.). 111 RES IND .CON PB Or Ias contra er of the property,am exclusively contracting with 'i nsed contactors mconstruct the project(Sec.7044,Business0 ASSESSORS PARCEL NOand Professions Cod The Contractor's LicenseLaw does not applya/�� /j� to fir owner of property s with a ds or improves rased pursuant and who ®LAWN SPRINKLERS. • 11 ® .Iss4�/`ice 49 contracts for such projects with tt contractons)licensed pursuant to the Contractor's'License La` • 11 11 TRACT NO. PARCEL NO. ❑, lam xemptu nS- . � 1 ,tl.&P.C.fur tl,i WATER .e, •rea } w — - �� 11 . Date \r...C. Wt.�NrAlll i Ow _/ • • 11 ACC.SATE ACC.FILE NO. i WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 11 - I hereby affirm that'I haveta certificate of consent to selk inure. or a certificate of Workers'Compensationllnsurance,ora certified __AWING - E'NG,BIT copy thereof(Sec.3800.1ab.C.). Policy No. Company ?wept . O 0 Certified copy is hereby furnished. ' • Z Z ❑ Certified.copy is. filed' with the city inspection division. FI`R,E�SPR INK ENERGY TQ4 F Q Applicant • ORD. Y VI ND V No,. K'y' CERTIFICATE OF EXEMPTIONFROM WORKERS' PERMI10 .FLOOD ZONE W > COMPENSATION INSURANCE 1 ,.:� Q (This section not be.completed if the,permit is for one Y 0 Yo-'IPa U Z. hundred dollars(S100)or less) 1 c issued,Ism the to y an of the n in a r winch this per. • • //,) en LL 0 mit i5 a issued, ttoatl not employersom person in any manner sr ia. !/ ��^ Q W become subject to the Worker?Compensation Laws of California. y Date - Applicant ' ALTERIOR •• • , 11 BUILDING //JJ//�� Op^ } 2 NOTICE TO APPLICANT If:after making,this Certificate of Ex- 17•x41 F... _ emptionpyou should become subject to the Workers Compensation provisions of the Labor Code: you must:forthwith comply.with 11 •PLAN CHECK C.1 such' provisions or this permit shall be deemed revoked. • • 1 111 ,i FEE ' CONSTRUCTION LENDING AGENCY AIR HANDLING • .10,00011 SEISMIC FEE- ' I hereby affirm that there;is a construction lending:.agency for ••• • 11 • .the performance.of for.which this permit.is issued(Sec. MICROFILM Lender's3097. ), • 100,000 11 Lender's Name ' Lenders Address ' HEATING UNITAOVER 100,000° 1 ELECTRIC I certify that Ihave read this application and stale that the above VENTILATION FAN MINGLE/ 3.00 — informaton tis correct I agree to comply with all city and countydi :• ;COMP PLUMBING • ordinances and state laws relating to building construction. and 11 111 : 11 - hereby authorize representatives of on ity.To enter upon the alio e-menbnned'property for inspection purpoies '• • 1 MECHANICAL (We),agree to save, indemnify.and keep harmless the City of • •- • Cupertino.against liabilities,judgments„costs and expenses which • CONST.TAX may in any way.accrue:against said City'in consequence of thePERMIT 1, Ur of this peN .,. MECH.CONT.: LIC.NO. MECH. TOTAL y_ S' lure'Applicant ontractor ” - $ate`-�—� • TOTAL �Q�� P -• OFFICE cQPY Y APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY LBUILDING PROJECT IDENTIFICATION PERMIT NUMBER evi,. NG - APPLICATION & PERMIT A f]�O. ' F - ADDf1ESs - fi'J 0 • r.I 7 Cefl•eS'afC 4V a BUILDING='ELECTRICA L-PLUMBING.-:MECHANICAL . 'OWNERS -- l: - PLAN CHECK VALIDATION 'NAME //y /5)1169 QTY. ELECTRIC PERMIT FEE ipO t I-1 Itx IA / 'e e PHONE . PAID' -- CONTRACTORS NAME _ UTLETS.-SWITCHES-•RECEP 5.00/1.00 0cc A 2A o,?,i, • a(-,l �Lu h/d-i/� Llc.No:�If l� 7bIGHTING FIXTURES 5.00/1.00 JAN 27 t•-:'- • CONTRPCTOR'a (f - APPLIANCES-RESIDENTIAL 4.00 " ADDRESS �1 r'�}fi,I� { '1 ( 0 .'Al 0 I/7/(4/4,IPHONE P-7(57 PANELS • 5.00 "(fs�b w! C(�ILpCrION OA f�PP A ION - ARCHITECT. PLAN CREME EE oR, SIGNS 6.00 ENGINEER tic,rvo: SIGNS TRANS. 3.00• ADORE°ss ENG. ' - SPECIAL CIRCUIT I 5.00. • PERMIT VALIDATION- • I• IP TEMP,METER POLE INS; 15.00 / APPLICANTS • MOTORS: SEE'FEE.SCH. os� . / a'1 t o '.-T,,,,CA,M-L /4 f' V SERVICE CHANGE 10.00 IT HO LICENSED-CONTRACTORS DECLARATION - 'Q.Z uO. I hereby affirm that I am licensed under provisions of Chapter 9 • ' UANCE DATE 1-.2 W. 1 omrnencing with Section'7000)of DiviSion 3 of the Business and - ,BLDG ELECT. LG MECH. 0" Professions Coda, pdym license Is in full forcgalM f el Z o,A? License Class ` �O I:Ic Number AO ��6 V' - 0 N H',w Dale 1 - '7. �Contractor O t A a•AA 0 ❑ 0 cc a'$a OWNER-BUILDER DECLARATION - BUILDING RMIT MISC. REFER TOORD� INFORM ION F. ;u u I hereby-affirm.that I am exempl,from the Contractor's License F IL o< Law:Anye following reason.(Sec. a,Business and Professions PERMIT ISSUANCE ' 6.00 VALUATION $/FT. vPj Code:Any city or county which requires permit to construct,alter, c a ¢p Improve.demolish or repair any structure,prior to its issuance,alio ELEC.CONTR.. LIC,NO: - ELEC.. O i` requires,itine applicant for such oviso is offile a signedt actor's ural TOTAL , PERMIT TO w10. re Is s th ed plicant the provisions the Contractor's License 1the1a /* - Law E'er> Business and.Prof ssio snCode)-or thatth ron he is exxemptt therefromrand QTY. PLUMBING PERMIT FEE f i'o ¢:r.g the hosts for the alleged exemption:Any violation of Section 7031.5 STORIES TYPE CONSTR: a ; rm by.any applicant for apeit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA:) 4.00 of not more than ive hudred dollars(5509M: ❑ I.as owner of the'property 'ormy'employees with wages as BACK FLOW PROTECT.DEVICE 2,00 then sole compensation,will'do the work,.and the structure is n0[ OCC:GROUP AES:UNITS . intended or offered for sale(Sec. 7044. Business and.Professions DRAINS-FLOOR,.ROOF,'AREA,COND: 4.00 • Code.The Contractor's Ucense Law doeStot apply to anowner of - - - - . '. properfir who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 i himself or through•his own employees,provided that such-Improve- SQ FT.FLOOR AREA TOTAL ACREAGE- . • ments arc not'intended•or offered for sale IL 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.) 1.00 BUILDING USE builder will have 'burden .of burdeof proving•thst-he did nor build or im- proveforpurposeofsaleJ.. INDUSTRIAL WASTE INTER. 20:00 RES ,IND: QQQoyyy PB Other ❑ Lias owner of the property,am exclusively contracting with - ❑ ❑ R]'' ❑ ❑ licensed contractors to construct the project(Sec.7044.Business LAWN SPRINKLERS-1 INC 6V:B. 5.00 ASSESSO PARCEL-NO. -and Professions Code:The Contractor s.License Law does not apply to an owner of property whdbuilds or improves thereon.•and who - LAWN:SPRINKLERS-OVERS(EA.)- 1.00 contracts for such"projects with a contractorlsflicensed"pursuant to • - theContractorsLicenseLaw: SEWER-SANITARY-STORM EA.200!2/8.00 X TRACT NO. PARCEL NO. ❑ lam exempt undecSec. .B.&P.C.for this / WATER HEATER W/VENT 4.00 �"--. ' reason 'Date Owner WATER SYSTEM 4.00 [iACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 . • • - I hereby affirm that I have a certificate olconsent to self-insure. ore certificate of Workers'Compensation Insurance.or a certified ZONING. ENG.SITE NO. ropy thereof'Sec.-3800;Lab.C.l. r/n t �/A IC/ Policy No. /`Company ' O ❑ Certified.copy.is hereby furnished. - Z z ;it- Certified yy��y ls ed ith he'city inspection:,division; - FIRE SPRINK ENERGY,T-24 - O Avplicam �f/, �•1L _ MISC.- REFER'TO ORD: • '.v❑ N❑ ',Y ❑ •NJ •cc c 'CERTIFICATE OF,EXEMPTION FROMWORKERS' PERMIT ISSUANCE' 6.004v FLOOD ZONE " . COMPENSATION INSURANCE PLG.CONTR.a OC NO: Q�,n O (-This section need not 6n:.completed if the permit is for one PLG.- TOTAL o7'/l/• ' V❑•- NO 1111 ND• D,Z• hundred dollars(S100)or less.): , ',certify that m the performance of the worg for which ihis:per-.. QTY MECHANICAL PERMIT FEE FEE SUMMARY CC) mills,Issued,I shall not employ any person'in any,manner so as to • O become subject to the Workers'Compensation Laws of California: , y Date - Applicant - ALTER,OR-ADD TO MECH. 4.00 'BUILDING } to NOTICE TO APPLICANT: If,after.making this Certificate'of Ex- - F Z emption,you should become subject to the Workers'Compensation APPLIANCE 4,00 PLAN CHECK provisions of the Labor-Code, you must forthwith comply With o such provisions or this permit shall be deemed revoked. AIR'HANDLING•UNIT(TO 10,000C.F-MFEE) 3:00 - CONSTRUCTIONLENDINGAGENCY AIR HANDLING UNIT(OVER 10,000CEM.1'5.00 SEISMIC FEE I hereby.affirm,that there•is a construction lending agency for EXHAUST HOOD(WITH DUCT) _ 2.00 • the performance of the work for-which this permit'is.issued(Sec. MICROFILM • 3097.Civ,C.). HEATING UNIT(TO 100,000 B:T.U.) 4:00 ' Lender's Name ' Lender's Address' - HEATING UNIT(OVER 100,000B.T.U.)7:50 ELECTRIC ' I certify'that.'have read this application and state that the above VENTILATION FAN (SINGLE) 3:00 w - . information is correct. I agree'to comply with all city and cousy BOILER-COMP PLUMBING J�s,� ordinances.and state laws,relating to building construction, and -(3 H,P.or 100,000 B:T:U.) 4.00 GGGgII hereby authorize representatives'of this.city'to enter upon'the BOILER-COMP(Over 100,000 BTU(SEEFEE SCH, ,aboed property,for inspection purposesMECHANICAL . (We) agree to'save, indemnify and keep,harmless the City of MISC.- REFER TO ORD.Cupertino against habili[les,'judgments, costs-and expenses which- CONST.TAX may in any.,way accrue against:said City in'consequence of-the' PERMIT ISSUANCE. ' 3.00 - • - • granlin of pen i` MECH.`CONT. , {IC.N4 MECH.�G : 22- Ff y TOTAL TOTAL 22,C� ignature of Applicant/Contractor Date OFFICE COPY .. ' • • r/-' • APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY • , BUI LDI NG PROJECT'I DENTI F.ICATION //SIWC PERMIT NUMBER BUILDING lVJ _ APPLICATION & PERMIT p �AODPE -On/‘ dezEs e E ,BUILDING .ELECTRICAL-PLUMBING-MECHANICAL / • OWNER'S .PLAN CHECK VALIDATION N°m QTY. ELECTRIC PERMIT ' FEE' • • CONTRACTOR'S •NnmEy� %-- - OUTLETS•-SWITCHES-•RECEP 5:00/1.00 Otto dS.7S Slav LIc.ND/'/O 244J/J LIGHTING'F IXTUR ES - • 5:00/1.00 jJyg2 CONTRACTOR' �!� y1' //�� ////// APPLIANCES-RESIDENTIAL `4,00 ,........-5-5 - • • .2¢g n �/ 'x�PHONt e 5/Oy4 PANELS' - 5.00 j.5-?-0.. DATE OF APPLICATION ARCHITECT ul // PLAN CHECK PEE .oR SIGNS• 6.00 ENGINEER • • Llc.No., SIGNS TRANS. 3.00 , - ADDRESS ENG. SPECIAL CIRCUIT 5.D0 PERMIT VALIDATION • • .alp TEMP.METER'OR'POLE INS. 15.00 . -. APPLICANT'S. . MOTORS �4 �/10 SEE FEEISCH': ,3‘,V. ADDPE�a • n / . . A9,9tr G/1/Oy ST iWM/Y01Cg SERVICE CHANGE , 10.00 ' 9.414iiii /B/( .woo' LICENSED CONTRACTORS DECLARATION - a u's~j, I hereby affirm•that 1 am licensed under provisions of Chapter 9 't Q•N (commencing with Section of Division 3 of the'Business and - - • ISSUANCE DATE ❑ Professions Codd��P38nndd,m license Is in full forceg�d'��f'e�,h BLDG: ELEC PLG.. MECH. a;•O v�'� • License Class(#-410,- y Li Number."( lS/J El' . ,. CI El 0'z it Lei I-ai' Date //--f1 Contractor <•x s d - BUI INC PERMIT rc 15 5 OWNER BUILDER DECLARATION - ' °'4..1-- - MISC REFER TO•ORD I IN ORMATION ' x ; I hereby affim that I am exempt from the Contractor'sLicense • - •.-. . VALUATION -, Law for the following reason.(Sec.7031.5. inessend Professions ' PERMIT ISSUANCE 6,00 �* S/FT. _°:;),,,o4, Code:-Any city or county Which reguirese permit to construct,alter: ` cc"// - el IC O' 'Improve,demolish,or repair any structure,.prior to Its Issuance,also ELEC.CONTR., LIC.NO. ELEC. hG[T� • ' w o LL requires the applicant for the Such'north!to Gla u signed actor's License that B/ C/c C/b g673XyAL �.�p -z_ . _ • x$ re es theapursuantto enthe pro ISe tiof theCnedstatei 3f iht CL.�' 91ERW�M/ITL✓�TO/. F z a- Law,(Chapter 9lcommencing with Section is f Division 3 of the f Z o. Business and Professions Code)or they he is exempt therefrom and OTY, PLUMBING PERMIT FEE ¢ b. . the basis forlhe alleged exemption.Any violation•of$eftion•7031.5 STORIES TYPE CONSTR. ;_$ by any applicant for •permit subjects the to penalty s ALTER-DRAIN;&VENT-WATER (EA.)4:00 - 'of not more than five.hundreddollan(5500).): ❑ I,as.owner of the property,or my employees with.wages as BACK FLOW:PROTECT! DEVICE' 2.00 '• their sole compensation,will do the work,,and the structure isnot _ _ OCC. RESUNITS intended or offered for sale i(Sec..7044: Business and Professions DRAINS-FLOOR,ROOF;AREA,COND- 4.00 • Code:The Contractor's License Law dies not apply to an owner of "- properly who builds or improves thereon,and who does such work FIXTURES.PER TRAP 4.00 SO.FL FLOOR AREA -TOTAL ACREAGE . • • himself or through his own employees,provided that such improve- ` - - _ ments are-not Intended'or offered for sale.II ho eer,the building GA$ EA:SYSTEM-1 INCA OUTLETS 400 or,improvement is sold within one year, r of completion,the'owner- builder„will have the burden.of proving that he did not build Grim. GAS:EA.SYSTEM,-OVER 4(EA.): '1.00 BUIL INC SE •prove for purpose of sale.). ,PES- IND PB Other . ❑ I.us ownerof the.property,am exclusively contracting with INDUSTRIAL WASTE INTER.' '20.00 _ 0 0 0 0 licensedcontractors to construct the project(Sec.7044,Business LAWN.SPRINKLERS-.1 INC 5 V.B. 5.00 . ASSESSORS CEL NO. and Professions Code:The Contractor's License Law does not apply - to an owner of property who:builds or improves thereon,and who LAWN SPRINKLERS-OVER-5(EA-I 1-.00 contracts for such projects with a contractors)licensed.pursuant to - the Contractor's License Law: - SEWER;SANITARY-STORM EA.200ft/6.00 TRACT NO. PARCEL NO. lea oil am• exempt under Sec. .B,&P.C.for this WATER HEATER W/VENT 4:00 • . Date Owner WATER'SYSTEM _ ,� - 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION. • WATER_TREATING EQUIP. ; . 4.00 - ' ' I herebY'affmlthat.' have a certificate of consent:to self-insmc. . or:a certificate-of Workers'Compensation Insurance,lir u'certified. - - ZONING . ENG.SITE.NO. copy thereof(Sec..3800:Lab.C.).t/„ 9aai f,2 _ PolicyNoy Company T O 1TlrCertified copy is hereby furnished. • FIRE SPflINK ENERGY T-24: Z Z ❑ Cnt p Ned with' the city inspection division.. MISC.- -ISSUANCE IFLO❑OD'20NE❑' - O Applicant _/1 MISC.- REFER TO ORD. v Q 'N� _ _. cc W CERTIFICATE OF EXEMPTION FROM WORKERS' 6.00 A,L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. PLG: 1 O• (This section need not he'uompleted if the permit is for one •- - TOTAL 7.fl N❑ .,Y❑ N❑ D Z -hundred dollars WOO)or less.) - U O I certify That in ilio performance of the work for which this per- Q.�r MECHANICAL PERMIT. FEE • FEE SUMMARY • Cp mitis issued',!shall'nol employ any(wrson in any manner so ash) • O m become subject to the Workers'Compensation Laws of-California, - . • : • y Date Applicant ALTEROR>ADDTO MECH: • 4.00 • BUILDING ' )w co, NOTICE TO APPLICANT:.If.after making this Certificate of Ex- F emotion.you should-become the Workers Compensation - APPLIANCE 4:00 PLAN�CH ECK provisions of the Labor Code, you must forthwith.comply with U such provisions or,this permit shall be deemed revoked. AIR HANDLING 10p00C.F:M.) 3.00 FEE ' CONSTRUCTION'LENDING.AGENCY AIR HANDLING UNIT(OVER 10pODC-EM.1•5.00SEISMIC• FEE: I hereby affirm that there is a construction'I nding'age sty for 'EXHAUST HOOD (WITH DUCT)', 2.00 the performance-Of.the work.I'or which.this.permit is-issued(See • 3097,Civ.CJ• HEATING'UNIT 770100,000 B.T.U.) 4.00 Lender's Name MICROFILM £ - ^' Lender's Address HEATING,UNIT(OVER 100,000 B.T.U.17:50 ELECTRIC • Icertify'that I have read this application and stat that about VENTILATION FAN'ISINGLE) 3.00 ' information'is correct I agree.to comply•with'all city and county PLUMBING. elordinances andstatelaws relating to building construction.,and • BOILER-COMP(3 RR or 100;000 B.TU:I 4.00 • hereby authorize representatives of this city.to enter upon the above-mentioned property for inspection purposes. Bpi LER-COMP I0ver 100.000 BTUI SEE FEE ICH. MECHANICAL ' '(We) agree to;save, indemnify and keep harmless the City-of MISC.- - REFER TO OR D. Cupertino against babilities,:jhdgmenls, costs.and expenses-which - may-in any way.accrue against said City ih-consequence of.the . PERMIT ISSUANCE' - 3.00 - CONST.TAX granting orb I[]ppermit. MECH.CONT. ALIO.NO., • MECH. ps .G / •� // _ TOTAL T •Signature of App=tractor Date ¢ - • TOTAL OFFICE COPY • . • -„ APPLICANT TO FILL IN'INFORMATION WITHIN RED LINES — USE BALL POINTPEN ONLY' ' • • BUI LDI NG PROJECT IDENTIFICATION (1) PERMIT.rvuMe1FR ' aU1LDING. • - • t :; APPLICATION &.PERMIT 41 6 6 'ADDRESS `F U 11 a0?/7 et-zes - cie. BUILDING—ELECTRICAL—PLUMBING—MECHANICAL • • ()maws - --- — _ — ----- —— _ PLAN CHECK VALIDATION • NAME /�/c �/((��J "//, �/ QTY. ELECTRIC�PERMIT. - FEE • • Lie ICI Z19 / O�PHON E/-?O'fl� I CONTRACTOR'S .NAME /�— �q OUTLETS-SWITCHES-RECEP 5.00/1:00 '', , • -�Es� Ethel- • Lic:NdeAJ 7 /y/ LIGHTING FIXTURES 5.00/1.00, /j , - • r-orvTRAcrows - ' APPLIANCES-RESIDENTIAL '4.00 g� ” • ;AooREss' • (^ a4,, / Eve/ 'S'A DNE 92_5 f PANELS •' • ' 5.00' ,cpb DATE OF APPLICATION ARCHITECT f l• /A_—` SIGNS 6.00... PLAN CHECK•FEE ENGINEER' • LIC.NO.. ' SIGNS TRANS. 3:00 - ARCH:OP ENG. - ' - PERMIT VALIDATION ADDRESS - SPECIAL CIRCUIT .. 500; ZIP TEMP.METER OR:POLE INS, 15.00 • APPLICANT'S oo ass?S MOTORS /y yo SEE•FEE-SCH. 3� *int t Evez 57.-6-60;,,A S • SERVICE CHANGE • 10.00 • 9? 7�/t F,o o' LICENSED CONTRA ORS DECLARATION • hi15 II hereby affirm that 1 am licensed under provisions of Chapter 9 - '2 ISSUANCE DATE ....•(commencing with Section 7000)of Division J,of the Business and - ,. BLDG: ECJ PLG MECH H o Z' Professions Co my license Is In full for- grid a t' - o" w License Class .lac Number'/�J/.� - - - O y F. w Date Contractor , F.a cr W,a OWNER-BUILDER DECLARATION I • 'BU DIORG MATRNIIT.. o I FORMATION x ; 1- 1 hereby affirm that 1 am exempt from the Contractor's License MIS C.— + REFER TO ORD _ w u:0 w Law for the following reason" 7031 5,Business and Professions VALUATION $/FL r „5 PERMIT ISSUANCE • 6:00 Code Any city or county whlcli regwresa permitroistruct,eller. • E Ic a p Improve,demolish,or repair any structure,prior to its Issuance,also ,E LECONT� LIC:NO. I ELEC. /l� ' Lu 'oft •regwres the applicant for suelt'permit to file a signed statement that KLLI pf/ A�i1//3/y1 TOTAL ?65o ERMI x'm y he Is licensed pursuant to the provisions of the Contractors Licinse I[[L.�..EEE��///III L�r++WGGrrr��/p ` R.ID Iff - pz> Law(Chapter 9(commencing with Sectionh7000)of Division 3 of the J i,4 a the basis t Profesged exemption. that he is exempt therefrom and QTY. PLUMBING PERMIT 'FEE - ¢;r the basis for the.alleged exern tion An 1.5 - STORIES TYPE CONSTR. ' - n.i:$ by any applicant for a permit subjects the applicant to a civil penalty . g p y violation of Section, of nm more then five hundrtd'dollars(55001.L ALTER-DRAIN&VENT-WATER/MA.) 4.00,'- _O. I,I;:as owner"ofthe.property,or.my=employees with wages as' BACK FLOW PROTECT..DEVICE 2.00, OCC.GROUP RES,UNITS 'their sole compensation,will do the work,-and the structure is not - - • intended,or offered for tale'(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 - — - propertywho'builds or improves thereon,and who does such work FIXTURES i'PER'.TRAP 4:00 SO?PT;FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- ; improve- ments are:not intended or offered 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.) 1 %BUILDING USE .00. builder will have the burden'of.provmg that he'did not build.or im- proveforpurposeofsale) - INDUSTRIAL WASTE INTER. .RES •tnlD 'Pa Other. 0 1,as ownerof the property am `xclusively contracting with '20-00 ❑ U El la licensed contractors to construct the project(Sec 7044,Business ' LAWN SPRINKLERS-1 INC',5 V-B-, 5.00' ASSESSOR P CEL NO. and Professions Code The Contractors License Law dies not apply • • , `r; to an owner'ofproperty.who-builds or improves thereon.and who LAWN-SPRINKLERS OVER 5 IEA.) ' 1.00 ' contracts for.such projects with a contractors)licensed pursuant to the Contractor's ' SEWER-SANITARY-STORM. EA:,200ft/8.00 TRACT'NO..- PARCEL Na re son am exempt under Sera B&P.C.lilt this WATER'HEATER IN/VENT 4:00 ' • a Date' Owner - WATER SYSTEM ' 4.00 ACC.DATE ACC.FILE NO., WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 - 1 hereby affirm that I have a,certificate oft consent to self insure. - - - - gorla certificate;ofyorkersl Compensation Insurance,orpa.ncertified - ZONING - - `ENG..SITE NO. , copy thereof(Sec.3800,Lsb:G14�/9 966 /13'7 Pahppy No. Company ): ' ,Q B^Certified copy is hereby,furnishd FIRESPRINK' ENERGY -Z,z • ❑ Certifier/./ ertifie is .fled With the city inspection division. pO Applicant .Q/I'�f/G •' MISC. REFER TO ORD:. v Q' NO 'V ❑• ND CC'‘13 CERTIFICATE OF:EXEMPTION FROM:WORKERS•. PERMIT ISSUANCE 6.00 FLOOD ZONE' q:c.u.c. W'? • COMPENSATION INSURANCE PLC.CONTR. Lm:No:, PLG. • ' a.o, = t--' hund(This d alis(II not rte'need,not se.),'" Leo if the permip is for one TOTAL - - v❑ N� ''Y _ N❑. • hundreddollarsthat(SI DO)perfor a - U O ',certify that in[he performance of the work for.which this per- QTY: MECHANICAL PERMIT FEE FEE SUMMARY LL employ any person in any manner.so as to - 0 w!. become subject to the Workers•Compensation haws of California. n. Date '--' i Applicant _ • 'ALTER OR`ADD TO MECH. 4,00 BUILDING } NOTICE TO APPLICANT: If;after making this Certificate of Ex- ' M • F Z; eruption'you should become subject to the WorkersCompensation. • APPLIANCE 4.00 - PLAN CHECK • • provisions of the Labor Code, you must forthwith comply with - FEEU such provislonsor this permit shell be deemed revoked. AIR HANDLING UNIT ITO'1OAW OF.M.)- 3:00 . . • , CONSTRUCTION• ENDING AGENCY . AIR HANDLING UNIT(OVER IQOIO C.EM.) 5.00 •SEISMICFEE 1 hereby,affirm'that there Isa,construction lending agency'for - EXHAUST HOOD'(WITH:DUCT) • 2:00 the performance of the work for which this permit is issued(Sec.mMICROFILM ' 3097 CivC ll - HEATING UNIT'(TO 100,000 B.T:U.) 4:00 Lender's Nae • - - LtnderzAddress • agree'to HEATING UNIT(OVER'100,0005 BS U./7ELECTRIC' /;,5V ' I certify thatI have read ibis application andstate that the above VENTILATION FAN (SINGLE) •-.3.00 (.f/ ,• information is?correct.I ' omply with all ity and ounty PLUMBING ordinances and.state laws relating to building construction:,and BOILER-tx1MP(3 H.P,or,100,0008.T.U.I 4.00 hereby authorize representatives of this city'to enter'upon the .BOILER-COMP, BTW SEE FEE$CH. • above-mentioned property for inspection purposes, MECHANICAL (We)•agree to save Indemnify and keep harmless:the.City.of MISC.- REFER TO ORD. Cupertino against liabilities,'judgnients, costs and expenses which' . niay in-any'way accrue.against said City-in'consequence of-the 'PERMIT ISSUANCE 3.00 - granting ofth' ermLL - MECH.CONT.• LIC-NO. MECH. / //^ 8,4TOTAL - _ TOTAL / . Signature of Appli Dent/ tor Date - 10 OFFICE COPY , _ - APPLICANT TO FILL-IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY : . BUILDING PROJECT IDENTIFICATION. 1 PERMIT NUMBER BUILDING - • APPLICATION & PERMIT • A - • ADDRESS' (� �/e- etztere 6/2. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL • OWNER'S PLAN CHECK VALIDATION "-='%�� y�Z(J J� '//��J(--- ,/�/• QTY..` ELECTRICPERMIT FEE • N A /1 /K�t PHONE27 t/1c _ - CONTRACTOR3 NAME � jt�� OUTLETS-SWITCH-ES-RECEP 5.00/1.00 ¢,et I(} / SZLrc.No.e/O2 ./d/a" LIGHTING FIXTURES. 5.00/1.00/30:5•\, CONTRACTOR'S - . /APPLIANCES-RESIDENTIAL • 4.00 3 O 'ADDRESS7' • G- �7 ai'g"A r .Voy S/a PHONE..B,-.cO 0 PANELS 5':00 LSA DATE OF APPLICATION ARCHITECT ! PLAN CHECK FEE 9.C:NO.. OR - SIGNS - 6.00 ENGINEER • LIC:NO. - SIGNS TRANS. 3.00 • ADDRESS DR ENG. • SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP..METER,OR POLE INS. 15.00 • • - S. APPLICANT'S MOTORS /Y/0 7 SEEFEE'SCH. c7Sri j' ADORE L n - 48.�'� Evoy' J-zrN T'ra SERVICE CHANGE 10:00 • ',�/„Ab�k w a0'. LICENSED CONTRACTORS DECLARATION _V Q ia'rua I hereby affirm that),am.licensed under,provisions of Chapter 9 m z'w (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE < A BLDG. E T.' PLG. MECH. o s-o" Professions Coodds�pp m license is in full forgyqu 1 gffest. ,.2- License Cla_/t--- ' Lic:Number.)/�/.S /..� o 0 0 Date /—/r�dr•¢. Contractor. < x _I BUI DINGPERMIT ¢ ¢ ¢ a" OWNER-BUILDER'DEC:LARATION - g 4 • I FORMATION w ',� thereby affirm that I am•exempt from,the Contractors.License MISC.- REFER TO ORD _ w o.a Law for the following reason.(Sal"]031:5,Business and Professionsv4LU TION q/FT.' I- - w PERMIT'ISSUANCE 6.00 Ew> Any city or County which requiresa permit to consnalso. ¢ ¢ <'0 improve,demolish,or repair any structure,prior tons issuance,also ELEC.CONTR. �yIG,NO. ELEC. wD¢ requires the applicant for sucliparmn la file a signed statement that V•c(/ 'cch CA C/iron L (W� PE _ $'N he Is hcensed,pursuanl to the provisions ofthe Contractor's License ••� L�a� /'�f4 Law i': g, Business andrProfesslns Cod)w'or th Section heis0exxemptDivision theefroml and QTY. PLUMBING PERMIT FEE FEE1..g, ¢i-,� thebasis'.for the alleged exemption.Any violation of Section 7031.5 - ,STORIES: TvvECONSTR. ,t, E.",2 by any applicant for:permit subjects the applicant toacivil penalty. ALTER-DRAIN'&VENT-WATER'(EA.) 4.00 of not more than five hundred dollars WOOL): ❑ I.as owner of the property,'ochry employees with wages as BACK FLOW PROTECT-DEVICE 2:00' .00L.GROUP RES.UNITS 1 their sole compensation,will:do the work,and the structure is not intended oroffered'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 owneeof • Piot-Tier-1y 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- - mentsarenotintendedorbffered for.sal .ti,hosaver.the building GAS-EA.SYSTEM-1INC.4OUTLETS 4.00 or improm vemeis sold withio�one year of complelmn,.lhe owner GAS.-EA.SYSTEM''-OV ER'4 (EA:) 1.00 - BUIL N USE budder will,have the burden.of proving that he did not build or im- - proveforpurposeofsale). INDUSTRIAL WASTE.INTER. RES IND �0{p ,Pe Omer' ❑ I,as owner of the property am exclusively LOnlraciing with 20.00 U ❑ !tf El • 0 licensed contractors to contra t the project(Sec 7044,Business LAWN SPRINKLERS- 1 INC'S V.B.- 5.00 ASSESSOR P RCEL NO. and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who' LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a Contractor(s)licensed pursuant to - . the Contractor's'License Law. SEWER-SANITARY-STORM EA.200ft/6100 TRACT NO. PARCEL NO. ❑ ram exempt,under Sec. ,B.&P.C.for this , WATER HEATER W/VENT 4:00 - reason DRIB - - Owner WATER SYSTEM ' 4,00 • ACC:DATE. ACC..F ILE NO. WORK ERS'COMPENSATION'DI;CLA RAT ION WATER TREATINGIEQUIP, 4.00 I:hereby affirm that I have,a certificate of consent to self-insure, - .. or a certificate of Workers'Compensation Insurance.or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800.Lab.C.L ' ' Policy No. Company 4/4" 70r-Co f¢.7 4 0 iCertified copyis hereby furnished. • . Z ,❑ 'Certifie y is filed.with the city inspection division. • FIRE SPRINK ENERGY T-24 .F O Applicant ATy fen MISC.- REFERO'ORD. EFN❑ Y ❑ No cc W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE. 6.00 - rFLOOD ZONE W`. COMPENSATION INSURANCE PLG CONTR. . . LIC.NO. PLC: •a.0 (This section need,not be completed,:if the'permit isd'Or one TOTAL - 'y e0 v D-z 'hundred dollars(5100)or less.) - • - - 'IC U 0 I certify that in the performance of the work for which this per QTV FEE•SUMMARV F- LL mitis issued,1 shall not employ any.person in-any:mann•r so as to MECHANICAL PERMIT FEE. 0•W become"subject to the.-Workers'Compensation La s of California. • y Date Applicant ALTER OR ADD TO MECH. 4.00 - BUILDING >,- to NOTICE. TOSAPPLICANT If,after making this Certificate of Lx- -F.Z' emotion.you should became subject to the Workers'Compensation • APPLIANCE 4,00 provisions'of the Labor Code, you must'forthwith comply with PLAN"CHECK' U. such provisions or thispermiVshall be deemed revoked. AIR HANDLING UNIT(TO 10p000:F.M.) 3.00 • FEE • CONSTRUCTION'LIiNDING AGENCY AIR HANDLING UNIT COVER 10000QF,M.) 5.00 SEISMIC FEE I•hereby affirm that there is•a construction lending.agency for EXHAUST HOOD(WITH DUCT) 2.00 • • the performance of the work for which this permit is issued(Sec. • 3097.Civ.C.). . HEATING UNIT ITO'100,000 B.T.U.) 4:00 MICROFILM L nder'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.(SINGLE) 3.00 • information is,correct. t agree toomply with:all eity1 an county ' i PLUMBING • ordinances and eat laws relating to building construction. and BOILER OOIAP.(3 H.P.or 100,000 B.T.U.) .4:00 hereby authorize representatives of this city to enter.upon the above-mentioned property for inspection purposes. BOILER-COMP(Owe 100,000,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 . CONST.TAX may in any way accrue against said'City in consequence of the PERMIT ISSUANCE '3:00 • granting of erntif - oA MECH.CONT LIC.NO. (MECH.. • TOTAL X •/--//—gy TOTAL' 1 OTAL - l ✓Y{7/1 .Signatu oe cant/Contractor Dale • Ix/tn_ 1/� • OFFICE COPY' • s • APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY ' •BUI LDI NGPROJECT IDENTIFICATION PERMIT,NUMBER '' APPLICATION & PERMIT 4164 BUILDmG ADDRESS' 02O2/q Cher/La Ci,e_ BUILDING_. -PLUMBING=MECHANICAL OWNER'S • J PLAN CHECK.VALIDATION ' NAME �jJ(��J o Pp -A/.r9D Q�/� QTY. ELECTRIC PERMIT FEE. • - • /T//L�'I //L.D�PNONE/VGJ�/TI-� CONTRACTORS .NAME OUTLETS-SWITCHES-RECEP 5.00/1.00 ¢J�' (Jig/ aZtc ZT. LIC.NoC/Q;26/J/J - LIGHTING FIXTURES 5.00/1.00 /3 • CONTRAcrowS - APPLIANCES-RESIDENTIAL 4.00 S ..ADDRESS - ��s��-•• �l�g/'fr Eyoy sTPHONE,2 2O' ' PANELS `5.00 x7 DATE OF APPLICATION o• pcN eCT SIGNS _ 6:00 • PLAN CHECK FEE. ENGINEER im:Na. SIGNS TRANS. . 13.00' • ADDRESS EMG ARCH.OR ' SPECIAL CIRCUIT 5,00. PERMIT VALIDATION zIP TEMP.METER-OR POLE INS. 15.00 �P • •�.� S ADDRESS is - MOTORS I��' //l SEE FEESCH. 3 t� .ADDRESS SERVICE CHANGE 10.00 "/ woo: LICENSED CONTRACTORS DECLARATION - .Q'u u. I hereby affirm that-1 am licensed'nder provisions of Chapter 9 ISSUANCE DATE N,a� 1, (commencing with Section7000)-of Division 3 of the Business and • BLDG: ELECT PLG. MECH. ,yz Professions Cody,,apymylicense is is in full ofjuy z f W License..Clnss// Cic.Number /.T/� • , ,, 11 F ST— Dele•% ��-by Contractor- < x 2 BUI • ING PERMIT ¢ ¢ ct OWNER-BUILDER DECLARATION IN ORMATION • x ;g.' a I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD • Law for the followingreason:(Sec 7031.5 Business and Professions'. VALUATION $/FT. I- G-to a PERMIT ISSUANCE ;6.00 Copra•A,d molsh countywMch requiresapermit.to DnscMo el ¢< p improve;demolish,or repairany alNclure,prior to its issuance,also. ELEC.C"p�-NSTR, LIC:NO. ELEC, /�/J e) . ,^ _ a. m¢ requnesihe applicant for such permit to file a signed statement that e7r7— ail:/J/O2// qL t(7 P MIT TO x- 'he is licensed pursuant to the provisions of the Contractor's License M1/ Earl:/ .h ��! '5. Law(Chapter 9(commencingwlth Section 70001ofDmsion 3 of the z < Buelness for the ons Code)or that tie is of therefrom and OTT. PLUMBING PERMIT • FEE l,i o qJ ¢.r•m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. • i 3 by any applicant for a permit subjects the applicant to acivil penalty • of not more loon fivehundrcddollars(35001.): - ALTER-DRAIN -WATER IEA.) 4.00' 1. 0 'I.as owner of the property or my employees with wages as BACK FLOW PROTECT.DEVICE 2:00DCC:GROUP • RES:UNITS • then sole compensation,.will do the work,and the structure is not intended,oroffered for sale(Sec. 7044.-Business.andProlessions DRAINS-FLOOR,ROOF,'AREA,COND. 4.00 'Code:The Contractor's License Law does not apply.to an owner of - - , . . property'.whdtiuilds or improves thereon,Pnd'wno docs suchwork FIXTURES'PER TRAP 4:00 -�so PT.FLOOR AREA ToracaeREAGE himself or through'his own employees:provided that suchiimprove- mentsarcnot'intended ocoffered for sale.If,howeveC the-building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or improvement 'scold within one year of completion,the owner- GAS'-EA.SYSTEM-OVER-0,IEA.) 1.00 builder .will-have the burden of proving that he did not build or in ,BUILDING USE- .proveforpurposeofsale). • INDUSTRIAL WASTE INTER. RES❑ I❑ 0 PB❑ o❑ C I,as owner of the property m aex elusively contracting with 20.00 • ' licensed contractors to construct the project(Sec 7044.Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 - ASSESSOR RCEL NO. and Professions Code'The Contractor's License Lawdoes not apply - toan owner of property who.builds or improves thereon,and who _ LAWN SPRINKLERS.OVER 5(EA:) 1,00 - .. . • • forsuch projects with'a Lontra Contracts clorlsl licensed pursuant to - the Contractor's License'Law.. . SEWER-SANITARY-STORM EA.200ft/8:00 -TRACT NO. PARCEL NO: re ❑cool am exens funder.Sea .B.&P,C.far this WATER'HEATER W/VENT '4.00 Date Owner. WATER'-SYSTEM .4.00AGC..DATE ,ACC.FLLE NO. • WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 - • - . I hereby affirm that.I haves certificate of consent'to self-insure. - -or a certificate of-Workers'Compensation Insurance:or a certified - ZONING. ENG.SITE NO. PolicyNreonsec 3BCompan:y J,/ 9G!/fs2 , - - • ,PopytherC Com an ). - �' a.—Certified copy is hereby furnished. Z`Z ❑ Certih c p Is_ pled with. the city. inspection division. py� FIRE SPRINK ENERGY T:24' Q Applicant \�e/yQ MISC.— REFER TO ORD: y N Y N CC N 'CERTIFICATE OI°EXEMPTION FROM-WORKERS' PERMIT ISSUANCE 6.00 - ❑ ❑ ❑ I ❑ w ? • COMPENSATION INSURANCE PLO.CONTR. - FLOOD ZOrvE' A:L.U.C. 1 O' LIC:NO.. ITOTALThis lion.need not be completed if the permit is for one dolY N� 'V � ' N❑� n Z. -hundred dollars(S100)Or.less:) U O I certify that in the performance of'die work for which this per- QT•1r MECHANICAL PERMIT FEE SUMMARY LL V mitis issued.l shall loy any person'in any manner so as to FEE .� W become subject to the Workers'Compensation Laws of California. Date - Applicant ALTER;OR-ADD TO MECH. 4,00 'BUILDING', } Z NOTICE TO APPLICANT:.If,after making dhis Cerlificule of Ex. emption,you should become subject to the Workers.Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code: you must forthwith,comply with - o such provisions or this permit_shall be deemed revoked. ' AIR'HANDLING UNIT(TO IOpoo C.F.M:) 3.00 .FEE CONSTRUCTION-LENDING AGENCY • AIR HANDLINGUNIT(OVER 10pooC.FM.) 5:00 SEISMIC FEE I hereby affirm that there is a construction Iending'agency for EXHAUST HOOD(WITH DUCT) 2:00 the performance of the work for which.this permit'is issued.(Sec. MICROFILM • 3097,Civ.C:). - HEATING UNIT(TO 100 :00 ,000 B.T.U.) 4 Lender's Name- - • 70W. Lender's Address HEATING UNIT IOVER100,000 B.T.U.17:50 ELECTRIC _ I certify-that I have read this apPlicalion and state that the above ' VENTILATION'FAN (SINGLE) '3.00 • information Is correct.I agree to comply'wilh all city and county - PLUMBING 'ordinances and state laws'relatinoft balding construct ion,.and BOILER-COMP(3 or400;0006:T.U:) 4.00 'hereby authorize ropertyforins of this city to enter-upon the BOILER-COMP(Over 100000 BTU)SEE FEE SCH. above mentioned property for inspection purposes ., MECHANICAL (We) agree.to save indemnify and keep harmless the City of, MISC.- 'REFER TO ORD: Cupertino against accrue s,judgments, costs and expenses whieh • .may in any way acmue against said City in consequence of the PERMIT ISSUANCE 3.00 CONST.,TAX • granting of •. elttlil. - p MECH.CONT. - LIC:NO. MECH. ^ // p GTAL TOTAL 7/_59 - Signature -Applicint(Contractor Date /� OFFICE COPY APPLICANT TO FILL.IN INFORMATION WITHIN REDLINES -. USE BALL POINT PEN ONLY , ^- BUI LD(NGPROJECT I.DENTI FICATION PERMIT NUMBER ., BUILDING JJ/,� • � APPLICATION'&PERMIT ryj AV✓720 l�uLce7 .0/,Q- BUILDING-ELECTRICAL-'PLUMBING-MECHANICAL .��- U OWNER'S _ NAME c �/ p /�'J�7 QTY. ELECTRIC PERMIT FEE P �3kA�¢ CONTRACTORS. - pry NAME }•/1TpOUTLETS-SWITCHES-RECEP 5:00/1.00 9f , 8461 Se rioakc.Noon/66-/ LIGHTING FIXTURES 5.00/1:00 !3 CONTRACTOR'S ADDRESS �/L I APPLIANCES-RESIDENTIAL •4100 goo . fie/'C EVO7 S27ONE2OI# PANELS 5.00. 1/44'''CO DATE OF APPLICATION ,ARCHITECT / PLAN CHECK FEE DR SIGNS 6.00 ENGINEER - • ' •sec:NO. SIGNS TRANS: 300. . ' AARCH.OR DORES,ENG.. SPECIAL CIRCUIT 5.00 • PERMT.VALIOATION - ZIP TEMP.METER OR POLE INS.. - 15.00 ' , _' APPLICANT'S MOTORS Jy fir SEE.FEE SCH• .10 CO,.- �� ADDRESS e / f/ '7qlN,��(/Oy S� ...(7/91/21-X.: SERVICE CHANGE 10.00 . �.v/(t0 W 00,cc 0 LICENSED CONTRACTORS DECLARATION • - Q'u'u 'I hereby affirm that I am licensed under provisions of Chapter 9' • - I.-2'W (commencing with Section 7000)of Division 3()Elbe Business and I55u CE DATE w'< BLDG. ' E T. PLG: MECH. p Dti Professions Cpgp�aT) license is in full fora ;act. i Ov"i'— License Class!'hr.' Lie.Number '< I".1-- - Date / �./fief Contractor _ _ _ a e S _i . . - ' B LDING PERMIT • Ic',5..‹ OWNER-BUILDER DECLARATION ° ° MISC.— REFER TO ORD I. NFORMATION W.;a a Thereby affirm that I am.exempl from the Contractor's License F'a o,J Law for the following reason.(Sec.7031:5.Business and Professions PERMIT ISSUANCE 6.00 VALUATION SIFT. E w4-.02 Code:Any city.or county which-requires a permit to construct,alter, Q ¢ Im• prove:demolish,orrepair any structure,prior to its issuance,also. ELEC.CONTR.-�, ,IC.NO. ELEC. �/50 ALU °'LL requires the applicant for such permit to file a.signed Stan:Mint that l f LF.6/4 , f 2a 7/n°TAC a. - RMIT T • w$. he is licensed pursuant to the provisions of the Contractor's License J / /^�' .G E z,Q. Business ndrProfessiospCode)�or thah rhe ion s exempt therefromandQTY. PLUMBING PERMIT FEE se i.0 6 H,$ thebasisafor plitae alleged ermitsexemption. ectsthviolation t tSection malty .STORIES TYPE CONSTR. u;,•_ by any applicant fora permit subjects the applicant toecivilpenahy ALTER,DRAIN'&VENT-W ATER'(EA.14,00. of not more than five hundred dollars(5500).1: - ❑. I,as ownerof tae property,or my employees witlrwages as BACK FLOW PROTECT.DEVICE -2.00 their sole compensation,will do'the work,.and the structure is not :OCC.GROUP RES.UNITS intended or offeredfor sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF'AREA,COND. 4.00 - . se Code:The Contractor's LicenLaw does not apply to an owner of -j property who builds or improves thereon,and who does such work FIXTURES.PER TRAP 4.00s°.FT:FLOOR AREA TOTAL ACREAGE .• himself,or'through-his own employees:provided that such improve- - - - ments are not intended or offered for'sale...If.however,the building GAS-EA.SYSTEM'-1 INC.4 OUTLETS 4.00 • or improvement is sold'within one year of completion.-Ole Owner• - builder will have the burden of proving that he did not build orim- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 _ BUJ LOIN USE . prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 20.00 RES IND 0 PB Other. 0 I,as owner of the properly,am exclusively ontra ting ith ❑ ❑: ❑ ❑ licensed contractors to construct the project(Sec 7044 Business LAWN SPRINKLERS-1 INC 5 V.B: 5.00 ASSESSOR PARCEL NO. and Professions Code:The Contractors License Law does-not apply - '" loan owner of property who builds or Improves thereon and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 ' contracts..for such projects with a eontractoef sl licensed pursuant to • the Contractor's License Law. SEWER'-SANITARY-STORM EA.200ft/8.00 TRACT NO: PARCEL NO. ! reasonvm excmpLunder Sec. ,B.&P.C.for this WATER,HEATER W/VENT 4.00 Date Owner - WATER SYSTEM 4,00 ACC.DATE'. ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER-TREATING EQUIP. 4,00 • I hereby affirm.that I have a certificate of consent to self-insure.' ' or a certificate of Workers'Compensation,lnsurance,or a certified ZONING' ENG,SITE NO. copy thereof(Sec.3800,Lab.C.). p/' „f �., - " Polis No. [ Company elfel' /Mann T�L • O rertified copy is hereby furnished. FIRE BPRINK ENERGYTY4 Z z ❑ Certiflyp copy I iled' with the city inspection division. — O Applicant I—eCt � MISC.- 'REFER TO'ORD. v fl 'N❑ v ID NEI 0C N CERTIFICATE OFEXEMPTION'FROM WORKERS' PERMIT ISSUANCE ' 6.00 . FLOOD ZONE A.L.U.G. W >, _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ij -2This section need hot'he completed-if the permit is for one -' TOTAL V'❑ N • •Y D. NO hundred dollars IS 100)or less, 0 O' 1 certify thanm the performance•of the work fur which this per` QTY 'MECHANICAL PERMIT FEE O. 'reit is is sued, t shall not employany in any manner so as to FEE SUMMARY 0'w heroine subject td the Workers'Compensation Laws of California. - p- Date Applicant 'ALTER OR ADD TO MECH, q•00 BUILDING - } 0- 'NOTICE TO APPLICANT: IL.after aking.this Certdicate of Ek- I— •eruption-you shouldbecome sum bjeet to the Workers Compensation APPLIANCE 4,00 'PLAN CHECK ' • ,provisions of the Labor Code, you must forthwith.comply with - FEE ,CJ ' 'such provisions or.this permit shall be deemed revoked.. AIR HANDLING UNIT(TO 10,000CF,M:) '3.00 CONSTRUCTION LENDINO'AGENCY AIR HANDLING UNIT IOVERig000C.F.M-1-.5.00 : SEISMIC FEE I hereby affirm that there.is a construction,lending'agency for EXHAUST•HOOD(WITH':DUCT) 2.00 The performance of the work.for which this.permit is.issued I Sec. -, ' 'M ICROFILM • 3097 Civ:C.):_ HEATING UNIT ITO'100,000.B.T:U:) 4:00 ' Lenders Name HEATING UNIT 100,000B.T-.0-)7:60 /y 1' Lenders Address ELECTRIC / 57` I ertify that Thrive read this application and state that the above VENTILATIONFAN (SINGLE) . 3'.00 ' N • information is correct.I agree to comply-with all city and county BOILER- - PLUMBING • ordinances and,state laws relating to budding construction. and COMPI3 H,P:W,100,000 BTU.) 4:00 ..hereby authorize representatives of this city to enter upon the 'BOILER-COMP'IOver 100,000,87UI SEE FEE SCH. • • above mentioned propertyfor.inspection.purposcs. MECHANICAL (We) agree;to save indemnify and keep harmless (hi, City oh MISC.- REFER TO ORD. Cupertino against hebilities,.judgments Costs and expenses which• - may In any"way accrue against said City in Consequence of the, PERMIT'ISSUANCE - 3.00 CONST:TAX granting oft ' emu{s�� MECH:CONT, . LIC:NO. MECH. /CJ77•LA --f/ �I.• • I TOTAL ' 'TOTAL - ',Signature of APPh antan/Contractor Date , OFFICE'COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY • - • • BUILDING PROJECT IDENTIFICATION • (dr PERMIT NurnBER, BUILDING APPLICATION.& PERMIT /I q C 9. - ADomess'/I qp1 `I I 0 L. 40/1. . eel�s'/E' 'C/PCC• BUILDING-ELECTRICAL-PLUMBING.-MECHANICAL OWNER$ ---' - - - - ---T-- --- - PLAN CHECK VALIDATION - NAM j(j. Ac QTY. ELECTRIC PERMIT • FEE . / 2W /iO�HONE�JA fiT! CONTRACTORS NAME _ OUTLETS-SWITCHES,'RECEP .5:00/1:00. ¢ m0 • • BEST" 6Z ec C'/C/j CIC:NoC/O.Zre(? LIGHTING FIXTURES 5.00/1.00 /3 lee ..- . CONTRACTOR'S - •PPLIANCES-RESIDENTIAL - 4.00 Pte^ - ADDRESS - U Bis 29R/Y4 fvo/ 57.7.3,267-,z)9657.7.3,267-,z)96 PANELS, . 5.00 xS-• DATE OF APPLICATION ARCHITECT ',.SIGNS -6:00 PLAN CHECK.FEEO • ENGINEER - ' SIGNS TRANS. 3.00 ARCHADDRESS ENG. - ' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP' TEMP.METER'OR POLEINS. 15.00 C : APPLICANT'S / .J AooREss ,yy 7-• -MOTORS .-'� 7CII0 SEE FEE SCH. 54,2 �' JJJ ....Nie/)1C ebby57 g .--Xii, SERVICE CHANGE 10:00 U"/�� 'CY 0 ' LICENSED CONTRACTORS DECLARATION _ - `37 cit;u I hereby affirm that I-am licensed under provisions of Chapter 9 - - w ISSUA CE-0LG. H a; (comrnencing,with'Section 7000);of, un(on 3 of Business and• - °r{ BLDG. E C . PLG. ..MEOH. H,y,i Professions Cod ylicense.is in full.forSr-ad eQusyL ozHw • .m-, License Class- Lic:Number Cee/ (J 'S I D E 0 Date-/ // pA__ Sr Contractor if a¢ ¢ OWNF.R.BUILDER DECLARATION BUI ING.PERMIT �- 'D MISC..- REFER TOORp IN ORMATION x a. y. 1 hereby affirm that f am 31.5,Be Contractor's License W , VALUATION -' SIFT. H O`J` •Eaw for the followingwh(Sec 7031.5,Businessand Professions' PERMIT ISSUANCE • - 6.00 Code:Any city or county which requires a permit to construct,alter, ' rELEC,CONTR. • DIC.NO. - • ci �ia<,f0 improve.demolish,or repair any sirudure;�prior toils issuance,also .ELEC: - DfLL he the applicant for such rovisi to filch signed statement'sLiCC al E"S'T ELs4G�/0.�/l/NOTAL �� E w S'a- he is licensed pursuam en the with Section of the Contractor's License Fi> Lai(Chapter9.(cosions Cod with Section is exempt 3 of the • • ' e :a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING.PERMIT FEE ' 1-;q. the basis•for the alleged exemption.Any violation of Section 7031.5 Ig.' i � by,uny.applicant for apermil subjects the applicant to a cavil penalty • .STORIES TVPEWNSTR. of not more than five hundred dollars(55001.): ALTER-DRAIN&VENT-WATER{EA.) 4.00' • ETI,anownerof the property,or my employees with wages as BACK FLOW PROTECT..DEVICE 2.00 s their sold<Ompensation,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;COND. 4.00 Code:The:Contractor's License Law does not apply to an owner of - propertywhobuildsorimprovesthereon,and,who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA 'TOTALACREAGE • himself,or'through his own employees,provided that such improve-• . . ments are not intended or offered for sale.If.hoc er,the building GAS'-EA.SYSTEM-I INC.4 OUTLETS 4.00 or improvement is sold one year of t he diduo t the owner- GAS- A.SYSTEM-OVER 4(EA.) LOO BUILDING USE. builder will.have the b withinf yea.that he did not build'Ior im- _ • prove for purpose of sale.): INDUSTRIAL WASTE'INTER, 20:00 RES IND N PB Omer• ❑ I,as owner of the property am exclusively contracting will - - ❑ ❑ • ❑ - ID licensed contractors to construct the project(Sec 7044 Business. ' LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS RCEL NO.and Professions Code:The Contractor's License-Law does not apply . - to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-'OVER%5(EA:) 1.00 - ' • contracts for such projects with a contractor(s)licensed pursuant lo• - • the Contractor's LicenseL'aw. SEWER-SANITARY-STORM. EA..200ft/8.00 -TRACTNO. PARCEL NO. reason. am exempt under Sec. ,B.&PC.I'or this WATER HEATER W/VENT ' . •'4t00 Date" Owner WATER SYSTEM 4.00 ACC.DATE- ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. - 4.00 l hereby,affirm that l'have a certificate of consent to selltinsure, - or a certificate.of Workers'Compensation'lnsurance,or a certified • . - ZONING' :ENG.SITE.NO. copy thereof(See.3800.Lab.C.)..'/ p. ' - - • Policy N,,o. Company 4/ 900/9;2 - , 0 .IYCertified copy is herehy,furnished. - z z O Cerlifi.eq p s BI d with the city inspection division. FIRE SPRINK ENERGY TQ4 F O ,Applicant ...37,DA7�?' MISC.- REFER TO ORD. v N❑ V .NO; CCN • CERTIFICATE OF EXEMPTION FROM,WORKIiKS• PERMIT ISSUANCE '6.00 FLOOD ZONE 'W.> COMPENSATION.1NSURANCE PLC.CONTR. LIC.NO. PLG. .d O (This section need not be'completed if the permit is for one - I TOTAL. VD ND V ❑ ND ' p'Z :hundred dollars($100)or lessll ' (JO I certify That'in the performance Of the work for which this per. QTY FEE SUMMARY 0- a • mit Is issued,)shall not employ anypersonin a w manner so as to . MECHANICAL'PERMIT FEE • w become subject to,the Workers'.Compensation Laws of California: • a Date Applicant ALTER OR ADD TO MECH. 4',00 BUILDING' ).- en NOTICE TO APPLICANT', If,after making this'Cerllficate of Ex- I I .Z emption„you should become subject to.the Workers Compensation APPLIANCE • 4.00 . PLAN CHECK ' provisions of the Labor Code, yoo`must,forthwith comply with 0' such provisions or this permit shall'-be deemed revoked. AIR HANDLING UNIT(TO 10,000 CF-M.) .3.00 FEE CONSTRUCTION LENDING AGENCY - AIR HANDLING UNITIOVER 10A03CF.M:) 5:00 • SEISMIC FEE • ' I(hereby'affirm'that there is a'construction lendingagency for EXHAUST HOOD(WITH'DUCT) 2.00 • the performance of•the,work.for which this.permit-is issued(Sec. MICROFILM 3097.Civ.C.). HEATING UNIT(TO 100,000.B.T.U.) 4,00 Lenders m Nae HEATING UNIT(OVER 100,000 B.T-U:)7.50 tk Lenders Address � ELECTRIC (, 50 I certify that have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00 ' information u%correct I agree-to comply With'all city and-county ',BOILER'- PLUMBING , , ordinances and slate laws relating to building construction. and CONY(3 H,P:Dr 100,000 B-T,U.) 4.00 hereby authorize representatives of this city to enter upon the above-mentioned property forinspectionpurposes. BOILER-COMP. (Over 100,Opp BTU/SEE BEE 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 consesjuence'of the PERMIT ISSUANCE.. • 3.00 .CONST.TAX ' granting of this p,,�m+L " A MECH.CONT. LIC.NO. MECH. • �Itio ' /l- �T TOTAL• TOTAL �, W Signature of Applicant/Contractor, Date `f" OFFICE COPY - APPLICANT TO FILL IN INFORMATION'WITHIN REDLINES - USE BALL POINT PEN ONLY ' • BUILDING PROJECT I DENTI FKATION PERMIT NUMBER BUILDING APPLICATION & PERMIT Al C ADDRrss I U I • 40722C'EL 9?E C1/a , BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S ' PLAN CHECK'VALIDATION NA w' S. /�!)� • //,y /f ATV: ELECTRIC PERMIT FEE: - 0,PHONE • CONTRACTORS ". NAME r .-- OUTLETS-SWITCHES-RECEP• 5:00/1.00 e2.• DES/ ELEC ZZ-LeAtle•NDj/ 24/147 LIGHTING FIXTURES 5.00/1.00 /3 c`! • -a • -CONTRACTOR'S. - APPLIANCES-RESIDENTIAL ' 4.00 81942 • ADDRRESS IQ ,((/ JIQNc Eye/Sion PHONEV,40 96 , PANELS 5:00 IS' ,CHT CHECK FEE LIGATION • ARCHITECT - - SIGNS. 600 9LAN FEE ENGINEER • tic.No. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ,ADDRESS - _ SPECIALCIRCUIT- 5.00 ZIP • TEMP.METER OR POLE INS. . 15.00 i. APPLICANTS - - ' MOTORS ¢ p 3 �� ADDRE'S'S: • _ .- /h� SEE FEE SCH. / 218 ivk EvoyC'/, esl„/os SERVICE CHANGE 10.00 �'/ /k`r - wo.o LICENSED CONTRACTORS•DECLARATION• ' . . ! III • <d u' I hereby affirm that Lam licensed under provisions of Chapter 9 • H ¢'y. (commencing with Section.7000)of Division 3 of the Business and: - ISSU• CE DA-FE BLDG. •ELE ,PLG. MECH. D' Professions CadP.ay y m license Is in full for 9d yea. - • _ ❑ O,i _,, ', License Class•L "/ e N Llumber �(OO �I A; I '' 0 • 0 F w t-oJ Dale j `/ --•ec Contractor a ¢,Q¢a OWNER-BUILDER DECLARATION BUI DING PERMIT 2 •."-' I I FORMATION w 1- I hereby affirm that lain exempt from the Contractor's License' MISC:— REFER TO ORD ' _._ u O:j., Law for the following reason.-(Sec.7071.5,Business and Professions VALUATION •S/FT: - I- PERMIT ISSUANCE • • ...to Code:Any city or county which requirese permit to construct,alter, 6.00- a to¢�, im•prove,demolish,or repair any sWeture,prior to Its Issuance,also ELEC:CONTR. LIC.NO. ELEC.- /�/ ,, ~Z u' requires the applicant t totor •th provisil ro Gle a signed slmcme iconsehat �jtr'f/_r 0.424/v?OTAL /f7, Pen..IT Tea" / se re R licensed pursuant to the with tool'the Contractor'stant tthe• tics/ 6L!'C%a333 fly/�i1F✓'RMI TT , .w >. Law with Section 7000)Of Division Sof the f;i'o. Business anrthe allegeds Code)or that.he l exemi l therefrom.and QTY. PLUMBING PERMIT FEE • cc.t g the basis for the exemption.Any violation of Section 7031.5 STORIES , TYPECONSTR. ..3- by,any applicant fora permit subjects the applicant to a civil penalty , • • of not more than five hundrcddollars(SSODLY.' ALTER=DRAIN&VENT-WATER•(EA.1'4,00 ' ' ❑ I.as owner of the property,or my employees with wages as ., BACK FLOW PROTECT:DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,.and the slructure.is not 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 - ' - - - 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- ments are not intended of offered for sale:If,however,the budding GAS-EA.SYSTEM-1 INC:4 OUTLETS 4.00 all or Improvement is sold•within on year of he ditfU of the owner- GAS-,EA.,SYSTEM-OVER 4.IEA.) 1.00 '• eUILDINGUSE owner- builder-will have the burden of proving that he dig:not build or im- prove for, purpOle of solea, • ❑ INO \Ip PB❑ O, - -❑ I,as owner of the property am exclusivelycontractingwiih, INDUSTRIAL WASTE INTER. 20.00 K}Y��tIA licensed contractors to construct the project ISec 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSO S P RCEL NO. . . -and Professions Code:The Contractor's.Lieense Law does not apply. • toan.ownet.ofproperty'who;buildsor improvesthereon.and who LAWN.SPRINKLERS-OVER 5(EA.).. 1.00 . contracts for such projects with a contractod sl licensed pursuant to theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ luinixempl under,Sec ,B:&P.C.for this WATER•HEATERW/VENT 4.00 , reason Date . Owner- ' WATER SYSTEM. . 4.00 - ACC DATE ACC:FILE NO. WORKERS''COMPENSATION DECLARATION •' WATERTREATING EQUIP; •'4.00 1`hereby affirm that I have a certificate of consent to self-insure. . or a certificate of Workers'Compensation insurance,or a certiliedl • ZONING ENG.SITE NO. copy.thereof(Sec.3800,.Lab,C.1. / - .. Poli y No. ' Company N/4 7�C/939, t . 0 -terlified copy,s hereby furnished. - • . Z z ❑' Cerlifie f ed with' the city inspection division. -FIRE SPRINK ENERGY T-24 .F O Applicant - MISC.- • REFER TO ORD. - y C N ID Y C ND tr Fp , CERTIFICATE OF'EXEMPTIONFROM WORKERS' PERMIT ISSUANCE . 6.00 :FLOOD ZONE- A.L.U.C. - W 5 - • ' . COMPENSATION INSURANCE PLGrCONTR., •LIC.NO. PLO - ' d O (This section need not be completed if the.permit is for-one :TOTAL - V NO V NO D Z hundred dollars(5100)or less. IJ,O .. I certifyllhat in therperformanle of.the work:for which Chis per- ' LL F mil is issued;I shall not employ-any person in any n - iso as to QTY. MECHANICAL PERMIT FEE 'FEE SUMMARY • , U become subject tothe Workers'Compensation taws of California. �'a Date Applicant ALTER OR ADD TO.MECH. 4.00 ' ' BUILDING >,->,-.(0. NOTICE TO APPLICANT:.IL'aftermaking this Certificate of Ex- I—'Z emption;you should:become Subject.to the Workers'Compensation , APPLIANCE ' 4.00 . PLAN CHECK provisions of the Labor Code;you must forthwith comply with Osuch provisions or this permit shall be deviled erevokedi AIR HANDLING UNIT(TO 10,000C.F.M) T3.00 • FEE • • `r .. CONSTRUCTION LENDINGACENCY AIR HANDLING UNIT COVER 10,000C.EM:) 5.00 SEISMIC FEE. - I hereby affirm that is a construction:lendnig,agency for EXHAUST HOOD(WITH DUCT) • 2.00 the performance oLthe work,for which this•permit is.issued(Sec 3097'Civ.C.l: HEATING'UNIT(TO 100,000 B.T.U) 4,00 MICROFILM . - Lender's Name • • Lendrs'Address HEATING UNIT COVER 100,000 B.T,U.17.50 . ELECTRIC /D . I certify that I haveread this application and state that the above ' VENTILATION FAN (SINGLE) 3.00 �r :� • information.is correct I agree'to comply with:all city and,county .:11 PLUMBING• ordinances and state laws relating to buildin8construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 h • ereby authorize representatives of thin city to enter upon the BOILER• -above-mentioned property for inspectionpurposes. COMP�Iover,100,000 ETU)SEE FEE SCH. MECHANICAL- . ,(We) agree to save, indemnify. and;keep,harnd•ss the'City of' ' MISC.-. REFER=TO ORD'. • Cupertino • ,against liabilities,'judgments,.costa.and expenses which .PERMIT ISSUANCE CONST.TAX (nay in any way accrue against said Cily'in consequence of the 3.00 ' granting ofJr''m'/'�r�perm - - .MECH.CONT. LIC.NO. f4G/l.d�C.. ,__,,,..- 9,,e. META. . . TOTAL TOTAL ' . 'Signature of Applicnnl/Contractor Date -7(0,61' • OFFICE COPY ' - Q APPLICANT TO FILL IN'INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATI ON, ' PERMIT NUMBER BUILDING APPLICATION & PERMIT ARDRE41'59 ` AO��j �IE�ES,/E C�2� BUILDING,- ELECTRICAL-PLUMBING-MECHANICAL OWNER'S " - - —_---' PLAN CHECK VALIDATION -• OW. ELECTRIC PERMIT FEE ' • ' aVE RA XiQO/12 PHONE k ' CONTRACTORSAy�f' NAME�/ �� /- .-- / OUTLETS'-SWITCHES-RECEP 5.00/1.00 pf UGS� E'c%F/c/T`LIC.me,/Qg/o/3/3- LIGHTING FIXTURES. . 5.00/1:00 J3di.jba CONTRACTOR'S APPLIANCES,.RESIDENTIAL 4.00 croC ADDRESS p.� �,y J�VS,�/P/� 1,el /LS/ PHONE1g,��Q' PANELS - -5:00 Sere . PATE OF APPLICATION ARCHYTET ` SIGNS • 6.00 PLAN CHECK FEE P-C..NO. ' ENGINEER - -- - - - - .. LIC.ND. SIGNS TRANS.. 3.00' • ARCH:OR ENG. - PERMIT VALIDATION ADDRESS ' SPECIALICIRCUIT. -,5.00. • ZIP • TEMP.METER OR POLE INS. 15.00 , APPLICANT'S ADDRESS ,..-.-- e -/— MOTORS /�yf0�` . SEE FEE SCH, ,7a ' a91 mit E'vop Sl /e'V'Yr-- SERVICE CHANGE 10.00 • . vf.lp/� I wO D LICENSED CONTR CfORS DECLARATION . - - - /// , <ZIL~a I Hereby affirm that I um licensed''under provisions of Chapter 9 _ ISSUANCE'DATE' (commencing with Section-7000)of Division 3 of the Business and 1-n „I,le. I BLDG. ' E E PLC. MECH. r 0't; Professions s(' my license IS in full for�'q O/vl�c� D. ❑ ❑ z o,�- License Class(' Uc.Number ILO(.T l� I o .w Date /1/- rt Contractor x rc w a OWNER-BUILDER DECLARATION - - BU LDING PERMIT - cr. o A u I • INFORMATION I hereby,affirm that I am exempofrom the Contractor's License MISC.= - - REFERTOORD x ;.w i - w-u0 Law for the following reason.(Sec.70365.Busme's and Professions VALUATION - $/FT. r - Ie,-, Coder:Any city or county'which requires a permit to construct:alter. PERMILISSUANCE, 6.00 . Q'at Q ¢,2- improve,demolish or repair any structure.prior to its issuance,also- ELEC.CO TR. / LIC.NO. ELEC: /�/-s .0 re requires the applicant for such.permn to OIL a signed statement that ret C/QX/3/DOTAL `no — PERMIT TO xs'„, he is licensed puistrant tome with Section of to Conractors License. 4,- 6-4-/ - • //l) f.i p Business Law andrProfessiosnCode)ior Shat he is exxemptltherefromivision 3 rand QTY'. PLUMBING PERMIT FEE I�'�Iecee- / 2 s- ;,' the basis for the alleged exemption.Any violation.of Section 7031.5 - - _ STORIES TYPE'CONSTR. . n ;- by any applicant for a permit subjects theapplicant to ucivilpenalty _ ALTER;DRAINI&VENT-WATER (EA.).q,00 of not more than five hundred dollars(S500)•Y - ❑ .1„us owner of the property or my employees with wages as BACK-FLOW-PROTECT.DEVICE' 2.00 - their sole.compensation;will do the work,End the structure is not OCC,GROUP RES.UNITS intended or offered for sale.(See. 7044, Business:and Professions DRAINS-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 through his own employes provided that such improve- ments are not intended or offered for sale. mprove-mentsarenotintendedorofferedforsale.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-OVER4(EA'.) 1.00 Bl11LCIN USE builder will have the burden of proving that he did not'build or im- prove for purpose of sale) ' INDUSTRIAL WASTE INTER.. . RES IND ��(Ls PB other ❑ 1,as owner of the properly,am exclusively<ontmetBu with - 20.00 licensed comractoto construct the project ISec 1044,Business LAWN SPRINKLERS-1 INC S.V-B, 5.00 ASSESS(( S P RCEL NO. and Professions Code:The Contractors Lmenie Lawdoes not apply, to an ownerof property who builds or Improves thereon,and who LAWN SPRINKLERS-OVER 5(EA:) :1.00 the Cocls'�for projectiwith a controcwrts)licensed'pursuant;to - theContractor'sLicencense'Law. SEWER-SANITARY-STORM EA,200ft/8.00 TRACT NO. PARCEL NO. resonl am exempt under Sec. ,B:&P.C..for this WATER HEATER W/VENT 4.00 - -Date Owner WATER-SYSTEM 4.00 'ACC.DATE ACC:FILE NO. • WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, I hereby al firm that P have certificate of consent to self-insure, - - or a-certificate of Workers Compensation Insurunee.or;li(certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.I.. 5. a./11;2 • Palicy.No. Company 9 0Cerrilied copy is hereby furnished. • FIRE SPRINK ENERGY T•24 Z z ❑ Certifierp is filed with'the.city,inspection division. F O Applicant loopy_ MISC.- REFER TO`ORD.. v.J N❑ Y 0 ' Na •CCN' CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT:ISSUANCE 6:00 FLOOD ZONE A:L.U.C. - W > • COMPENSATION INSURANCE PLC.CONTR. LIC.NO: PLG! a- O (This section need not be completed if-the permit is for one - I TOTAL Y'J N❑ Y❑ .N❑ Z hundred Dollars 0100)o.less.) • U O I certify that In the performance of the work lir which this per. QTY • MECHANICAL PERMIT FEE SUMMARY .LL f• mit Is Issued, Ishall no employ any hersor in any manner so as to. FEE • , O W' becomesubjectto the Workers'Compensation Laws of California: • , _ • - d Date Applicant - , ALTER OR ADD TO MECH. q-00 - BUILDING • ),- In NOTICE-TO.APPLICANT: If,aftermakinggthis Certificate of Ex- Z emotion,you should become subject•to the Workers Compensation APPLIANCE 4.00 PLAN:CHECK provisions oflthe Labor Code, you must forthwith comply with - FEE • U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M) 3.00 ' • CONSTRUCTION-LENDING AGENCY •. 'AIR HANDLINGUNITIOVER 10,000C.EM.).5,00 - ' SEISMIC FEE - I.hereby affirm that'there,is a.consruction lending agency Tor _ EXHAUST HOOD(WITH DUCT) 2:00 the performance of the work for which this permit is issued(Sec. - MICROFILM 3091 Ci C.),- _ - HEATING UNIT(TO 100,000.B.T.U.) 4.00 - - / Lender's Name Address P70;59 L ndlss - HEATING UNIT IDVER 100;0008 T.U.17:50 ELECTRIC I certify that-I have read this application and state that the above VENTILATION FAN (SINGLE) 3:00 - • information is correct.I agree to comply with.all city and county _ , -COMP PLUMBING ordinances and state la s:relating to bolding construction. and (3 H P.or 100,000 B T.Ui) 4.00 !hereby uthoriee'representatives at this city to enter upon the BOILER,BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. above mentioned property;ibr inspection purposes. • MECHANICAL ' (We) agree'.to save,-indemnify and keep,harmless the City of MISC,- • REFER:TO ORD. Cupertino against liabilities,-judgments, costsand expenses which - CONST.TAX . may in,any way accrue'-against said City.in consequence of the t PERMIT'ISSUANCE - 3.00 granting of perrtiii MECH.CONT,at LIC:NO. MECH. ra /— ,,,— T(TAL TOTAL - 1 _�Z) Signature of Applicane/Contractor Date - ((a 'OFFICE COPY •- -• APPLICANTr1O FILL IN INFORMATION WITHIN RED LINES.— USE'BALL'POINT PEN ONLY • BUILDING PROJECT"IDENTIFICATION PERMIT NUMBER - - r.2'o a"ss Sk id..,,' tic/ APPLICATION & PERMIT p qI • BUILDING —.ELECT,RICAL—PLUMBING—MECHANICAL [� Lr ' - - '117 7/I- 07a 3 cd es-Si . einae- — --- -- -- -- -- ---- - OWNER'S - PLAN CHECK VALIDATION NAME yqQ QTY. ELECTRIC PERMIT FEE �eAnra /?r �S ;vH NVT" e/iii/a'/ • CONTRACTOR'S • OUTLETS-SWITCHES-•RECEP 5.00/1.00 • .LIC.NO. LIGHTING±FIXTURES 5.00/1',00 • • CONTRACTOR'S TORS APPLIANCES-RESIDENTIAL, 4.00 • PHONE PANELS 5.00 GATE OF APPLICATION 'ORCHITECT - SIGNS ,6,00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.NO, SIGNSTRANS: 3',00 • A�DBEaa OR ENG. - SPECIAL CIRCUIT '5,00 PERMIT.VALIDATION •• . • •• ZIP TEMP.METER OR POLE INS. 15.00 . ' APPLICANTS• • DDRESSMOTORS SEE FEE SCH. ,�-5 • ADDRESS - SERVICE CHANGE 10.00 • /0/d4/p:7 2o•o • LICENSEDCONTRACTORS'DECLARATION <et IL hereby affirm that I am licensed under,provisions of Chapter.9 ' ISSUANCE DATE I- z70 (commencing.with Section 00)of Division 3 of the Business and 3'a Professions Code,and my licensers infull',force and'effect. BLDG., ELECT. PLG. , MECH. O Z _.W License Class Lie.Number ❑ 0 ❑ ogi r Date Contractor ti.km aw-a OWNER-BUILDER DECLARATION • BUILDING PERMIT A'DMISC.— REFER TO ORD INFORMATION • K ; w,N • (hereby affirm that I am.exempl from the Contractor's License r • Oa Law for the following iemon.(Sec.7031,5,Business and Professions' PERMIT ISSUANCE vwLugnON §/FT. y. Code:Anymolishcounty wMny struiturepomtonsuaic.aeq or 6.00 Q.Q,at� Improve,demolish;or . . any structure,prior là. its I. ... . :also ELEC.CONTR, LIC.NO. ELEC w O.m requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w m'w he rs licensed pursuant to the provisions of the Contractor's Licensee - �..��[ ri> Law(Chapter 9(commencing wnh Seaton 7000)of Division of the. MCeT f i.;o . Business and Professions Code)or•that he•is miernof therefromand OTY. PLUMBING PERMIT FEE' se 1-,,$ 'the basis for.the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR, i; oy,any applicant fora permit subjcns,the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA:) 4.00 ofnot more than five hundred dollars 155001,); - C •I,as owner of the'property' or my employees with,wages as. BACK FLOW PROTECT.,DEVICE 'their sole:compensation.will do the work.and the structure is not 2,Q0 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 -- - . property who builds or Improves thereon:andwho does such work F IXTUR ES-PER TRAP •4.00 so,FT.FLOOR AREA TOTAL ACREAGE ' .. himself or through his own employees,provided that such improve- ments are not intended ar offered for sale.If,however.ihe,building GAS-EA.SYSTEM-i INC.40UTLETS.4.00 or Improvement ri sold wdhim.one year of completion,the owner- GAS-EA'.SYSTEM-OVER 4(EAC) 1.00 owner- builder wilLhave the burden of,proving tharhe did not huild or int- .' BUILDING USE prove far purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 RS IND' CON PB . Omer ❑ 1,as owner of the property.am exclusively contracting.with ❑ - 0 ❑ ❑.-.r'❑ licensed contractorslto.construct the project(Sec. 7044„Business LAWN SPRINKLERS'.1 INC 5,V:B. 5.00 - ASSESSORS PARCEL NO: • and Professions Code:The Contractoes.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 contractod sl licensed pursuant to ,- the Contractor'iLicenseLaw:' SEWER-SANITARY-STORM EA..200f1/6.00 TRACT NO, ' PARCEL NO. ❑ I am cxcm.1 under Sec. ',B�&PCforthis • . . 4.00 rca •• WATER HEATER W/VENT ' /'� r _ - Owna W,4TER SYSTEM • 4.00 AcG.GATE ACC:FILE NO. •I - /ry7/aron- - WORKERS' OMPENSATION DECLARA ION WATER TREAT,ING'EQUIP. 4.00 • -I hereby affirm that I have a certificate of consent io self-insure. - or a certificate'of Workers'Compensation Insurance,dr a certified ZONING ENG.SITE NO: copythereof(Sec.3800,Lab.C.). Policy No, Company O 0 Certified copyis hereby furnished. r FIRE SPRINK ENERGY T-24 •Z Z ❑ Certified copy is-filed with the city inspection division. F0 ApplicantMISC.- REFER-MORD. • rEl.' N r❑ NO 1' NCERTIFICATE OREXEMPTION FROM.WORKERS' PERMIT ISSUANCE - 6.00 FLOOD ZONE W,-' COMPENSATION INSURANCE' PLG.CONTR. LIC,NO. PLG. 0' O (This section need:not'he completed'If the permit is for one • TOTAL Y 0 N0 V El NE U+O. hundred dollars 18100)or less:) I certify that in the performancc•of the work for which this Icer- QTY. MECHANICAL PERMIT. FEESUMMARY LL I- mil is issued,I shall nor employany person in any manner so as tdFEE _ ' O,W become subject'to the Workers Compengition Laws of California: y Date Applicant ALTER OR ADO'TO'WECH, q-0o ' BUILDING ),- to 'NOTICE TO APPLICANT If.:after making this Certificate of Ex- I-.Z emotion.you should become subject to the Workers'Compensation - APPLIANCE 4,00 PLAN'.CHECK provrslons,of the Labor.Code„you must forthwith comply with - U FEE such provisions or this permit.shall be dcemedrevokcd. AIR,HANDLINGUNIT•ITO 1 I. 3,00 - CONSTRUCTION LENDING AGENCY • AIR HANDLING UNIT(OVER 0 - M./ 5.00 SEISMIC FEE' I hereby affirm that there'isa'construction I nding,agency for . 'EXHAUST HOOD IW UCC' 2.00 the Civ.manee of the;work for which Ihis,permd-is issued(Se' tit:, L y iQ0'}OO MICROFILM 3097.rformancHEATING UNIT LTO 0000(T8YY11 10.700 • • Lender's Maine ' • L•nderi Address HEATING UNIT IOVF,R OO,QQO,B.T.U.1T:50ELECTRIC I certify thai'l have read this appl bon and'st tr that the above VENTILATION FAN (WSjj ITfCG7`^peltlntQo • information is. I agree to comply with all city and county PLUMBING. ordinances and stale laws relating to bolding•construction, and BOILER-COMPI3 H.P.Or.100,000 B,T,U.) 4.00 j` liereby autllarizc representatives of this city, to cnt f upon the above -mentioned property for:insp Ilonturposes. BOILER-COMP(Over 100,000 BTU)SEE FEE§CH.32SL�L MECHANICAL a (We).agree to save, indemnifyand keep harmless'the City of MISC._- REFER'TO ORD. and Cupertino against liabilities,judgments, costs expenses which may m any way accrue against said'City in consequence-of the PERMIT ISSUANCE 3.00 'CONST,TAX'; . 'ting oft ' ermit. MECH.CONT, LIC.NO, ' MECH, • moi i .L , TOTAL -1 [N Signature ofAp•lica.1/Contractor tate - • - 7 t_ TOTAL OFFICECOPY