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3563 4940 4140 4141 4142 4144 4145 4148 4149 4150 r 20725-32 CELESTE CI R 3563, 4940, 4140, 4141, 4142, 4144, 4145, 4148, 4149, 4150 F DE ANZA PROPERTIES SCANNED BOX # 783 i CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE I CITYOFCUPERTINO DATE S O 19 a '� BLDG. PERMIT NO.—�S THE BLDG. LOCATED AT 6 7L 5 — Z C C C t T i c rn c c C v l P OWNED BY P F ern > P 7 o F r HAS BEEN (COMPLETED) FOR USE AS C o ti C T Ry / > S (ALTERED) i i li I 'BUILDING INSPECTOR (:jj'y 017 CUPEIRT10 INSPECTIOV RECORD (Office Copy) 3563 Lot 2, Bldg 10 20725 32 Celeste -n P1,Pj1I,r PID. SANITARY DIST. NO. LOT MO. ADDRESS Const. 8 Units DeAnza Properties PROJECT 01-INER JOB SITE PHONE NO. PERMIT ISSUED --- Date ELECTRICAL Buildinp, _ 5/11/83 Date Trisp. Electrical 94 '4P*? Power Pole PlumlliLig k1j, e rEr o i%nd Mcclinn ical Rou 10i Miring Temp. Gas/Elect. -1 Ta-.r I s Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sign Motors Grounding Hisc. Temp. Power Other FINAL INSPECTIONS Not Approved Datep- r,,,s oly 71W PLUMBING Electric Lc PlumbingDate Ins p. Backflow Nechanical 4q, Underground Solar Underfloor Pool Partial Rough Grading Rough Complete1 fir/ — Planning Solar Rough Fire De t. Water & Insulation Health Dept. — Main Drain Building IS-_5 a- A �R_/O_f/S Drain Other Other BUILDING Not Approved Date Insp. Qlaa 0,k 0+ 0-- 7K_ 7.i7 Cad Certification MECHANICAL Foundation Pre-Gunite Date Insp. Slab- Underfloor S.H. Bond Beam Ducts & Insulation Underfloor Gir Fire Dampers floor Steel fireplace_ Tledowns Grease Duct Fc il'oUrd One flour Shaft Diaphrams Seismic Bracing Condensate Drain a11s-Pancls Tl—pme-nt-Anchorage __ frame _Comb. Air Other l:nt hNot Approved Wallboards Int/Ext. Firewalls Others/1-e. 0 Not A, roved ff C_oVC.Nrrt vkbrq 1af 4k 9-0-g3 q . a'Ai (I-Pr ?-�e (IJ.4 t ( t 1- _'6-6-3 II�V 'K VO � A,&,6v- tfdt� wI (rc, BUILDING I ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS ��v -------------- ------------- APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE.BALL POINT PEN ONLY - _ PERMIT fl UILDING PROJECT IDENTIFICATION c. / AVL APPILMN& PERMIT ^r BUILDING n VS�'J1 Vh VS - tP ING ELECTRICAL-PLUMBING--MECHANICALOWNER'sl - - -- - --�`-_-"-- PLAN CHECK VALIDATION " ME QTY. ELECTRICPERMIT FEE CGNTRAL OR'B .. NAM` _1C UTLETS-SWITCHES:RECEP 5.00/1.00 ✓ E - r LIC.NO.. LIGHTING FIXTURES 5.00/1.00' 'noon EAACTORS APPLIANCES-RESIDENTIAL 4.00 , r PHONE PANELS 5.00 DATE OF APPLICATION ARCHITECT SIGNS 6.00 PLAN CHECK FEE C.NO. ENGIN II O. SIGNS TRANS: `3.00 0409 40 AM�,UP ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT,VALIDATION '. ZIP rrEMP.,METER OR'POLE INS. _ _15.00 APPLICANT'S • ADDRESS - MOTORS,). SEE FEE.SCH. SERVICE,CHANGIE 10:001 -, 40/700 AND LICENSED CONT CT SDECLARA N J]f/J/r as u. I,hereby affirm that.Faro Llicensed under provisionsof Chumcr9 - AF(/��,[I Nr �{Ijpf/� yia h (to Section 7000)of Division-3 of the Business and ELEC ISSUANCE PL E Hlya Professions Code,and my license Is in full force and effect. BLDG.. ELECT.. PLG. MECH. o C.9'c License Class Lic..Number - .H ,A i,H'J Date Contractor. El El 1:1 ¢ x s BUILDING PERMIT In ¢wI¢ - OWNER-BUILDER DECLARATION , E °'`O - MISC.— REFER TO ORD I INFORMATION 1 hereby affirm that I.am exempt from the Contractors License•, '00 J Law for the following reason,(Sec 703 1.5,Business and Professions - (VALUATION S/FT. 'HPERMIT ISSUANCE 6.00' i Code:Any city or county;which regmresa permit to construct.alter. z z¢.0 improve,demolish,or repair any structure,prior to IIs Issuance,also ELEC.CONTR. LIC.NO. ELEC. o. Fa(¢ requires theapplicant for such permit to:file a signed statement that. TOTAL w�iy he is keened pursuant eothe provisions of the Contractor's Licensee PE�MIT �� • ri.Q' Laww(Chand Professions Code)or Section is exempt theion3 and C J F i s the themes and he alleged xemption that he is exempt therefrom and QTY. PLUMBING PERMIT-. FEE ¢ I- the any a for the alleged exemption Any violation of Section malty $ y STORIES TYPE CONSTR.. n,3�- by any applicantfor a Permit subjects the applicant toacivil Penalty ALTER-DRAIN -WATER�(EA.) q-00. PJ/� �• of not more than five hundred dollars(S500).):employees 'r -XION ❑ I, compensation, the will do or my employees with wages asCK.FLOW PROTECT. DEVICE V �N/� their sole coiopensahon.,will do the work.andhhe structure is not 2.00 OCC.GROUP RE NITS intended of offered for sale(5ec 7044. Business and ProfessionsAINS-FLOOR,ROOF,AREA,COND. 4.00 / �' Code The Contractor's License Law does not apply to an owner of property who builds ur improves thereon,and who does such work. XTURES-PER TRAP 4.00 aD:FT.FLOOR' REA gOTAL'ALREAGE himself re of rote de own employees:le,If,provided such improve- _ or unpravemenntended oroffered for aro I Lhowetio the building -EA.SVSTEM-11NC.4OUTLETS q,00or improvement is sold rdenofone year of completion,tlieowner- S.-EA.SYSTEM-OVER 4(EA'.) bmllder will have the burden ufproWngthat he did no[build ocim- 7.00 BUILDING USE prov forpurposeofsale). INDUSTRIAL WASTE.INTER. ,40.00 RES. IND' CON PB ' Othe7 �{$ Las owner of the property am;exclusively contracting with tensed Contractors to construct theproject(Sec.7044,Business LAWN SPRINKLERS-1 INC5=V.B- 5.00 ASSESSORS PARCEL 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 far such projects with'a contractorlsl licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.,200ft/8.00 TRACT NO. PARCEL ND: ❑ I u exempt u er .,, C ,B.&P.C.for I 's / reaso WATER HEATER W/VENT 4,00 Date - Owne WATER SYSTEM 4•00 AM.O TE ACC.FILE NO. WORKERS-COMPENSATION DECLARATION WATER TREATING'EQUIP. _ 4.00 ,I hereby affirm thabl have a'certificate of conwnl to self-insure, ora certificate.of Workers'Compensation Insurance,or u certifiedING ENG.SITE NO. copy thereof(Sec 3800,L b.C.). O Policy No. Company • 0 ❑ Certified copy is herebyfurnished.. 'Z 2 ❑ Certified copy•is filed with-the city inspection division. FIRE SPRINK ENERGY T 24 p,0 Applicant MISC.- REFER TO ORD. y e0 Y N[J crV CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 LU,> COMPENSATION INSURANCE PLG.CONTR. _ LIC.NO. .. PLG. FLOOD ZONE CL-.CI his section need not be completed if the permit is for one TOTAL Y.Q hundred dollars IS 100)or less.). L) O '1 certify that in the performance of the work for hich chis per QT�r FEE SUMMARY 1- mit is issued,I shall not employ an MECHANICAL.PERMIT ILO p y y person any manner ui is to FEE _ D W' become subject to the Workers Cqmpen anon Laws of Califomi:c .to Date Applicant ALTER;OR ADD TO MECH. 4,00 BUILDING( �f0�, } N NOTICE TO APPLICANT: IC aRcr.making this rs'Compe of Exn. O• f- Z emvision you should become subject totheWorkers Compensation APPLIANCE 4.00 PLAN CHECK provisions of'thc Labor'Code:.you must forthwith comply with ' 5 such provisions or this permit shift be deemed revoked. AIR HANDLING LINIT(TO 10DWC.F.M.) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOCEM.) 5.00 SEISMIC FEE 1 hereby affirm that there is.a construction leading agency for EXHAUST HOOD(WITH DUCT the performance-of Ihe.work for which this Permit is issued(Sec. MICROFILM" 1 2 00 3097,Ci4.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lende'r's Name Lender's Address - HEATING UNIT(OVER 100,0008.T.U.17.50 ELECTRIC 1 certify that I have read this.pplicalmn and state that the shave VENTILATION FAN (SINGLE) 3.00 10 information nd.slrect I s rel ting to b with all coy and county PLUMBING hereby u and state laws relating to building construction. and BOILER-OOMPI3 H.P.Dr.100,0008.T.U.) 4:00 _ above- authorize representatives. ct this.city to enter upon the BOILER_-COMP(Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purposes. - MECHANICAL a(we) agree, st save..indemnify and keep harmless the Cit'. MISC.- � REFER TO ORD! Cupertino against accrue ties,judgments, costs and expenses which. may in anyway accrue against'said'City,in consequence of the PERMIT ISSUANCE 3.00 CONST.TAX grentingo this perm' MECWCONT. .CIC.NO. MECH. ht /93 TOTAL 40"? StImpfulleofAppicant/C ntraator care TOTAL %S/ I OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY r �1 PERMIT NUMBER sSU_ .�UI L�DING PROJECT IDENTIFICATION APPLICATION & PERMIT _ /1 nix A,0 ADDRESDINS (1 t9J(1 L Y ADOREss 7• f I 16 Ce�t'rSl 'C Q. - BUILDING-ELECTRICAL-PLUMBING-MECHANICAL , OWNERS. -- - - -- - - - -- - -�-. -- PLAN CHECK VALIDATION NAME DTV. ELECTRIC PERMIT FEE 4N.� 50k I.PHONE Pa�� CONTRACTOR'S nnrnF UTLETS--SWITCHES-RECEP 5.00/1.00 q p,1 - ,Q AN'7_A ! �'e'n LIC.ND. 2 0 7 LIGHTING FIXTURES. _ 5.00/1.00 2_ JAN 7 1984 CONTRACTOR DDRESS 'S - - PPLIANCES-RESIDENTIAL 4.00 O }�� ^rrff ((!!11ffIIpp�T1 0,�,GO /y//CAI.(1-L-pnonE ��Z-�(r� , PANELS 5.00 •CIxfpryfElSF 4.F3uc)Tloia :onnHITr SIGNS 6.00 PLAN CHECK FEE P.C.NO: ENGINEERI - LOC.NO SIGN5TRANS. 3.00 ' ARCH.OR ENO. PERMIT IDATION. :ADDRESS. SPECIAL CIRCUIT 5.00 zip TEMP.METER 08 POLE INS.- 15.00 Appucnnrs'' MOTORSSEE FEE.SCH. - ' /O ;xLD - -T e' IN Le-_'L`.p. SERVICECHANGE' 10.00 `\N w 0'o. LICENSED CONTRACTORS DECLARATION /- a u w I hereby„affirm that.l am licensed under provisionsof Chapter 9 _ ISSUANCE DATE. I- (commencing with Section 7000)of Division Sof the Businessand ¢c - - BLDG. ELECT. PLG..q MECH., y z. Prof 5iour Co 'nd riw license is in full fineQa9d0eflyafz D Z z m w inert Cla J C c Number O Dafe -Cools for- a I LDING' ER ¢ ¢ m OWNER-BUILDER DECLARATION BUI0 T ;INFORMATION sws iS"I I hereby affirm that I am eaempl from the Contractors License MISC.- REFER;TO ORD W u 0 Lew for the following reason.(Scc,7031.5,Businessand Professions - vA WAnON S/FT. - G - g PERMIT'ISSUANCE .6.00 fir Y 'improe,de demolish, County ny structure permit o sissuance, suance,also ¢ ¢¢ O rm quires demolish,or repair any structure;prior to its ss once,,also ELECT CONTR. LIC.NO. ELEC. ix. u. rein licehed,plicant rsuint or to the permittoOlcu signed statement nuhal _ TOTAL ,4ERMIT TO w$H :he ws Chaped,purom to the with Smnsof the Contractor's License z< Law(Chand Profession, (commencing Section is exempt Dl therefrom Gfthe s z O "Business and Profettions Codel or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE ¢.1- $ the basis for the alleged exemption Any violation of Section 7031.5 STORIES - VPE CONSTR. 6.3 by any applicant fora permit subjects the ipplicaut to a civil penalty of not morethan five hundreddollars(S500),I: ALTER-DRAIN'&'VENT-WATER (EA.).4100 _ O 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 structure is not intended•ordffered for sale(Sec. 7044.:Business and Professions DRAINS-FLOOR,:ROOF,AREA;COND. 4.00 Code:The Contractors,License Law does not apply'.to an owner of n property who-buildsor improves thereon,andwho docs such work FIXTURES-PER TRAP 4.00 A 'SO.FT.FLOORAREA 'TOTALACREAGE himself or through his own employees.provided that such improve. mens'.an not.intended or offered for ulci If,however the building GAS-EA.SYSTEM INC. OUTLETS 4.00 or improvement is sold within one year.of,completion the owner- GAS-EA_:SYSTEM-OVER (EA.) budder.will,havc the burden of proving that he did not build.or an; 1.00 BUILDi G'USE- prove for purpose of sale.). RES .IND N -PB Omen ❑ . . I,.osowncr of the property am_exclusivcly commcting with INDUSTRIAL WASTE INTER. 200011 El El licensed contractors to construct the ro'e.ut(See.7044.Business - P j" LAWN'SPRINKLERS-.1 INCINC5 V:B• 5.00 ASSESS SPARCEL NO. and Professions PropCcdcerty who o improves thereondoes oafapply to an owner of properly who builds olimproves(hereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a.conlractorls)licensed pursuant to , 'the Congmctor's License Law, SEWER-SANITARY STORM EA..200ft/6.00 TRACT NO. PARCEL NO.. rea❑ l am exempt under Sec. .& 8P.C:Tor this sonWATER HEATER W/VENT 4,00 Date- 'Ow{ter WATER SYSTEM 4.00 -;ACC,DATE ACC.FILE NO: WORKF-RS'COMPENSAI'ION,DECLARATION WATERTR EATING EQUIP.. 4:00 I hereby'affirm that I have a certificate ofcoment to self-insure. ,or a Certificate of Workers'Compensation Insurance;or ocertified ZONING ENG.SITE NO. copy thereof(Sec.3800,L.b:C.)., (/1 Y " Policy No. Company- �r11 0 ❑ Cenifie opy i hereby fume had Z:Z Ce CO Eley tilt h City Inspection division. FIRE SPR INK ENERGY TQ4 p0. ppllnupf _ MISC.- REFERiTO-0RD. � �. ❑ Y N Y N CC T CERTI FICATE OF EXEMPTION FROM WORKERS' - PERMIT ISSUANCE . 6.00 FLOODZONE AIL:0.C. 11J > COMPENSATION.INSURANCE PLG.CONTR. sec,rv0. PLO. - a 0v fThis Section need not be'Completed if,the'permil Isfor one TOTALY❑' NE1 Y ❑ N� Z hundred dollars IS 100)or less.) . >, U O 1 certify thavin the performance of the work for which this per. OTV MECHANICAL PERMIT FEE .FEE SUMMARY U_ U mit is issued.I shall not employ any'person in anymarner so as to become subject to the Workers'Compensation Laws of California. 0 i Date Applicant 'ALTER';OR ADDT-0 MECH. 4:00 F. 'BUILDING } N NOTICE TO APPLICANT: fr.after.making this Certificate of Eu Z empNon..you should become subject to the Workers'Compensation 'APPLIANCE 4,00 PLAN CHECK provisions o. toe Labor Cote, you must drevoke.comply with FEE U such provisions Gr this permit shall be rimmed revoked. AIR HANDLING UNIT(TOlOp00GF.M) 3100 ' CONSTRUCTION'LENDING AGENCY AIR HANDLING UNIT(OVERIO,000C-RM.) 5.00 SEISMIC FEE ' I hereby affirm that there-is.a.consiructhm lending agency.for EXHAUST HOOD(WITWDUCT) 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 HEAT(NG UN IT(OV E R'100,000_B.T.U.P.50 ELECTRIC I certify that I have read thisapphcatmn and slate that the above VENTILATION FAN (SINGLE) 3.00 _^ . 'information n corree, I agree,ln g to-ywith all city and county BOILER COMPLUMBING a/ hereby ccs and state laws relating to building construction, and 13 H.P.H.P.Of-000,000 B:T.U.) 4.00 j hereby by entoerept n tabnuof this.city s voter upon the - BOILER-COMP(Over 100,000 BTU)SEE FEE SCH: abovementioned a 'property forinsppcuon purposees. - MECHANICAL. (We) agree to save indemnify and keep harmless the City m' MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may imany:way.accrue..against said City in consequence oflhe. .PERMIT ISSUANCE 3.00 11�` �' oryq is pe set - MECH:CONL LIC.NO. MECH, N' 1 / / - � 7`� �_ TOTAL TOTAL. •W Signature of Applicant/Contractor Date ' OFFICE COPY APPLICANT TO FILL IN INFORMATIONWITHIN RED LINES -USE BALL-POINT PEN.ONLY BUILDING"PROJECT.I DETIO NTI FICAN ®' PERMIT BUILDING �C -- _ _- A-PPLICA- TIO- N &---PE-RM-IT ADDRESS /OJeT" CBUDNG-ELECTRI - - ---- 4140 L9 ' PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC.PERMIT FEE PHONE CONTRACTOR'S NAME „ _ OUTLETS-SWITCHES RECEP' 5.00/1.00 DS� ��EGIR/CgCLIc•NoC/02�a�3/ LIGHTING FIXTURES 5.0011.00 � ADDRESS on's _ PPLIANCES-RESIDENTIAL 4.00 CONTRA �'� /J/'meq ,/ V/e PHONE AC7/ /'P4(O _ PANELS 5.00 DATE OF APPLICATION: .ARCHITECT SIGNS - _ 6.00 PLAN CHECK.FEE P.C.NO. OR ENGINEER uTRANS.- - c.ND. SIGNS TRANS. .3:00 ARCH.OR ENGPERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 . ZIP TEMP.METER OR POLE INS. 15:00 APPLICANTS MOTORS: SEE FEE'SCH. •�. ADDRESS' s[¢�• /f�. ICO J" �y YBS4 SERVICE�CHANGE 10.00 '.02 LICENSED CONTRACTORS.DECLARATION ' r U w I hembyaffirn that I am licensed under provisions o(Chapter 9 ISSUANCE DATE (commencing with Section 7000)of Division 3'of the Business and w,<v� LOG, 'E T. PL❑G. MECH. s oM Professions Cod m license .nt full r .2 ypd cl. :m al License class y Lm.Number,if(a o�,H w DateContractor' Q y f J a A OWNER-BUILDER DECLARATION BUILDING PERMIT E a i u - INFORMATION - w ; 1 hereby affirm that],am exempt from the Contractor's License MISC.- REFER TO ORD LL OG - VALUATION SIFT. Law for the following reason:(Sec 4031:3,Business and Professions - �y'ug Code:Any city or county whichrequresa permit loconstruU,alter, PERMIT ISSUANCE X6.00 Q> ELEC.CONTR. LIC.N0. ,Q 0' improve,demolish,or repair any structure,prior to its issuance.also ELEC ' d CoC LL requiresthe applicant for such permit to file a signed statement that TOTAL �.0 y he is licensed.pursuant to the provisions of the Contractor's License BS IY -PERM T TO, Fi > Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe Business and:Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE m;I- $ the basis for the alleged exemption.Any violation of Section 0031.5 _ STORIES TYPE CONSTR. d ; by any applicant fora permit subjects the applicant 1.acivil penalty ALTER-DRAIN -WATER (EA.)'4,00 of not more.than Ove hundred dollars(SSOO).1: ❑ 1.as owner of the property,,Fmyemployecstrac wages as BACK FLOW,PROTECT. DEVICE 2.00 OCC GROUP - AES!UNITS their sole compensation,will do the work,and.thc aructareis not intended or offered for sale(Sec. 70441`.Business and Professions DRAINS-FLOOR,ROOF,,AREA,COND. 4.00 Code:The Cofitomtoi s License Law does not apply to an owner of -' propertywho'builds or improves thereon,and who dues such work FIXTURES-PER.TRAP 4.00 SO.FT.FLOOR AR EA TOTALACREAGE himself or Through his own employees,provided that such improve • menus arc!not intended or offered for sale.I f,howecr the building GAS-EA.SYSTEM-/ INC.4.OUTLETS 4.00 or improvement is sold within one yearof complelmn,the owner- GAS'-EA.SYSTEM-OVER 4 (EA.) builder will have the burden of proving that he Eid not Build or.im- prove"1,aso Der of sale:). - - INDUSTRIAL WASTE.INTER. '0 IQ' .. O oar ❑ d as owner of the property,he exclusively contracting with 20:00 EVI licensed contractors'TheC Contractor's the Project(Se 7044,Business LAWN SPRINKLERS-1 INC,5 V.Bt 5.00 AS6E550R RCELNO. and Professions Codeprope The Conrado,s improves th docs.and ho to encu forofpropertys ho with aildsoacrons6ecensed ponaratin LAWN SPRINKLERS-OVER,5(EA.) 1,00 contracts actor's h projects with a conlracfods)licensed pursuant In the Contractor's Sic. - SEWER-SANITARY-STORM EA.200ft/8.00 TRACTNO. PARCEL NO: resort am exempt under Sec: .B.&P.C.for this WATER,HEATER W/VENT 4.00 Dote Owner WATER'.SYSTEM 4.00 .ACC.DATE ACC.FILE N0, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 _ I hereby affirm that.I.have,a certificate of consem to sal Finsure, ,r itcertificete'of Workeis'Compensation Insurance:or 3 certified - ZONING ENG.SITE NO. 'opythereof(Sce.3800,Lab C).,/�f QG6ia'?� PohccyyJJJJo. Company O fYCertilied copy is hereby furnished.' FIRE SPRWK ENERGY TZa Z Z ❑ Certified Cop fled"wIt 11 the city inspection division. . 0 Applicant �. MISC.- REFER TO ORD. 'Y N� Y❑ NO ='T CERTIFICATE OF EXEMPTION FROM WORKERS' 'PERMIT ISSUANCE 6.00 FLOOD ZONE A.L-U.C. W`?. COMPENSATION INSURANCE PLO.CONTR. LIC.NO. PLG. 110 hundred section need or be completed it the permit is'1'or One TOTAL Y,� NE] V F] N� U O' 'hundred dollars(5100)ar less.) I certify that o'the performance of the work for which this per- OTY MECHANICAL PERMIT FEE SUMMARY LL !- mf Is issued,I shall not employ any.person in any manner so as to F.EE� _ O W. become subject to.the Workers'Compensation Laws of Cali1'umia. IS. Date' Applicant - - ALTER OR ADD"TO'MECH, q,00 BUILDING } Z NOTICE TO APPLICANT: If,after;making this.Certificate of Ex- F-. emption,you should become subject to The Workers'Compensation APPLIANCE 4.00 PLAN CHECK suchpprovisions io the hisLabor pe Code„you must forthwith comply with - '.FEE U such provisions,,this permit shell be deeme4revoked. AIR,HANDLING UNIT(TO tOpODGF,M) 3:00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE I hereby affirm that.Ihem is a:consmuctmn lending agency for EXHAUST'HOOD(WITH DUCT) 2.00 the performance of the work for which this permit is issucj(Sec.' MICROFIt 3097 Civ.C.). - HEATING UNIT(TO.100,000B.T.U:1 4:00 Lender's Name Lender's Address HEATI NG UNIT(OVER"100,000 B.T.U:)7150 ELECTRI Lcertify'(hatlhave read this application and st kdhat Clie above VENTILATION PAN (SINGLE) 3:00 - information Is correct I'agree'to comply with.all city and'cdunsy' fiO1LER-COME' PLUMBIN ordinances and State laws relating to building construction. and (3 H.P.or IO0,000B-T.U.) 4.00 hereby authorise representatives of this city to enter ulmn the BOILER-COMP'IOve.:t00,0p0 BTU)SEE FEE SCR. above-mentioned property-for inspection purposes MECHANI (We-).agree to save, indemnify and keep harmless the City of MISC.- REFER TO-0RD. Capertn,against habdities:.judgments; costs and expensCs which PERMIT ISSUANCE CONST.T may ut an way accrue against said City in consequence of the .3.00 grainingp�iSpernnt MECH.CONT. "LIQ NO. MECH.�C ��L / // �¢ TOTAL TOTA Signature of ApplicmllC,ntracror Date OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.— USE BALL POINT PEN ONLY .. BUILDINGPROJECT IDENTIFICATION PERMITNUMBER BUILDING APPLICATION & PERMIT 4141 ADDRESS _ - D7 s^ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL . OWNERS - -- .PLAN CHECK.VALIDATION NAME DTY. ELECTRIC PERMIT FEE CONTRACTOR'S NAME � �., / UTLETS.SWITCHES.-RECEP 5.00/1.00 LIGHTING FIXTURES ,5.00/1.00 SV AONFESS DNrflgcroRS APPLIANCES-RESIDENTIAL 4.00 . C - - p_ J PHONEZ872 PANELS 5.00 m DATE OF.APPLICATION OgtHliECi SIGNS 6.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC'NO. SIGNS TRANS. 3:00 AARCH.OR DDRESS ENG. $PECIALDIRCUIT 5.00 PERMIT VALIDATION .(. ZIP EMP.:METER OR POLE INS.: 15.00' APPLICANT Ns MOTORS) SEE FEE'SCH: ADDRESS �^ / p T.J(f.Y A6A- 71 SERVICECHANGE - -10.00 woo o LICENSED CONTRACTORS DECLARATION 111 Fez w I hereby.affirm that I am licensed under provisions of Chapter9 - ISSUANCE DATE < (commencing with.Section 7000fop Division 3 of the Business and 'BLDG. EC PLG. MECH. r;D i Professions Cod e,p Amy license Is ire full forr,�yid/effept3 ' Z O m License Class_e = Lic.Number L! S/ - El E 1 . q.H w Dale to � Contmctor _ <1es I BU -DING PERMIT ¢ ¢w u OWNER-BUILDER DECLARATION FORMATION W m 31LL 1 hereby affirm Ihat 1 sum the Contractors License MISC.— REFER TO ORD F w;y� Lawfo%thefollowmg reason.(See,7031.5,Business and Professions PERM1T ISSUANCE 600 VALUATION f W Code:Any city or county which requlresapennit to construct,alter, ¢ 4¢ Improve,demolish,or mpair any structure..prior to Its Issuance,also ELEC.CONTR. LIC.NOl. a. A,,o¢ requires the;applicant forsuch permit to file.a signed statemendtlial x 13� TOTAL. �(p W Ira p he Is licensed pursuaa'lo the provisions of the Contractor's License - PERMIT TO Law(Chapter9(commencing with Section 7000)of Division 3 ofthe > a:zD Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING'PERMIT FEE ¢H•$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant too civil penalty; of nos more than five hundred dollars($5001.); ALTER-DRAIN&VENT-WATER'(EA.) 4.00. `❑ I,as owner of the'prdperly,or employees with wages us BACK FLOW PROTECT.DEVICE 2.00 their sole compensation,will do the work,and the structure is not -0CC.GROUP 'RES.UNITS intended or offered for Ole (Sec. 7044, Business and Professions DRAINS-FLOOR;ROOF,'AREA;-0OND. 4100 Code:Thee,Contractor's License Law.does not apply to an owner of propertywho'tiwldsor'improves thereon,and who does such.work FIXTURES-PER TRAP 4.00 SQ• FLROOR AREA TOTAL ACREAGE` ,himself or through his own employees-provided that such improve. - - - ' ments arenot 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 owncr- bullder will have the burden of proving that he did not build or ire- GAS-EA,SYSTEM-.OVER 4(EA.) 1.00 BUIL NG USE prove for purpose oriole.). -INDUSTRIAL WASTE IN ❑,RES I❑ - ON 'a Out, 1,aI,.WnCr of the;Property,.;am.exclusively contracting will,` TER. 20.00 licensed com Octore,Wconslrucl the project(See. 7044;,Businesv, LAWN SPRINKLERS- 1 INC5 :00 g55ES50R RCEL NO... and Profession Code:The Contractor's License Law docs not apply V.B.. -. to an ownerof Progeny who builds or improves lhcreott and who LAWN'SPRINKLERS-OVER:5(EA.) 1,00 ' contracts for such projects with a contractorls)licensed pursuant to the Contractor's License Law.. SEWER-SANITARY,STORM -EA..200ft/8.00 TRACT NO: PARCEL NO. l�nl um exempt order Sec. ,B,&P.C.for this ,vWATER HEATER W/VENT 4,00 Date Owner - WATER SYSTEM. 4,00 ACC.,DATE ACC.FILENO. WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 4.00 •- I hereby..affirm that I'have.a certificate'ofconsend mself-insure: ora.certificate of:Workers'Compensation Insurance,or a cerfried ZONING ENG.SITE NO. Copy thereof(Sec.3800, pony ) POIic No. Company . U 0 Certified copy is hereby furnished. Z Z ❑ Cttlifie�'-GaP n filed with the city in'pectitlp�dlvisi0a. -FIRE SPgINK: ' ENERGY P24 FO Applicant d`�jl//2' - - MISC.- REFER TO ORD. Y [:] N� Y ❑. N� . '.�.y CERTIFICATEOFEXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE .A.L.U.C., LU > COMPENSATION INSURANCE PLG.CONT, . LIC.NO. PLO. 1 O (This SecNdn need.not be'completed:if the permit Win,one TOTAL Y N O. Y ❑ N � Z hundred dollars IS 100)or less.l U 0 1 certify that,in the perfprmance olahe work for which thk per. QTY MECHANICAL PERMIT FEE FEE SUMMARY UL U mit Is isstied,d'shall mol employ any person in any mann r so as to O.w. bevomesubject to the Workers'Compensation Laws of California. .6 Date Applicant, ALTER OR ADD TO MECH: 4,00 BUILDING' } OL NOTICE?O AP Applicant. after making this Certificate of6x- remp!ion,you should become subject to the Workers'Compensation qpp LIANCE 4'.00 provisions of the Labor Code, 'PLAN CHECK ' p -,you forthwith comply with. FEE U such provisions or this permit shall tit•deemed revoked. 'AIR HANDLING'.UNIT(TO 10,000C F.M.) 3.00 -" CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVERIO,000C:EM.) 5.00 SEISMIC FEE I hereby:afrum 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,CivC)_ HEATING UNIT(TO-100,000 B.T.U.)- 4.00 - Lender's Name Lenders'Addrers HEATING UNIT(OVER 100,000 B.T:U.)7.50 ELECTRIC I certify that have mad this application and slate that th•above VENTILATION FAN (SINGLE) '3.00 • information is:correct. I agree 10 comply with all City and county - - PLUMBING ordinances and,stale laws relating to building construction. and BOILER-COMP(3 H.P.or.100,000 B.T.U.) 4.00 8 reby aull nuc representatives of this city. to enter upon the g01LER-COMP IOver 100,000 ETU1.BEE'FEE SCH: -. above-mentioned properly for inspection purposes. - MECHANICAL' (We):agree to save; indemnify•and keep harimcss the City or misc.- REFER TO'ORD. 'Cupertino against liabilities.judgments; costs and expenses which TAX may,m any'way Accrue Against Said City in consequvnce or the PERMIT ISSUANCE "' 3100 CONST. '- granting of Jpje/.r/�/1.: - MECH.CONT. _ LIC.NO. MECH. - 9 tam"renn'y �¢ TOTAL TOTAL M 5pbeanl/Contractor Date �� S, . OFFICE.COPY . APPLICANT TO FILLIN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NGPROJECT I DENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS - 414 D BUILDING- ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME - _ CITY. ELECTRICPERMIT .FEE - NE CONTRACT5142S NgmE." UTLETS-SWITCHES-RECEP 5.00/1.00 �( qua LIGHTING FIXTURES 5.00/1.00 cc_ _ - CONTRACTORS . APPLIANCES-RESIDENTIAL 4(00 - ADDRESS ST—IHONE PANELS 5.00 DATE OF APPLICATION ARCHITECT - SIGNS B.00 PLAN CHECK FEE P.C.NO. OR ENGINEERe Lia NO SIGNS TRANS. - 3.00 ADDRESS ENG.. SPECIAL.CIRCUIT 5100 I'PERMIT,VALILlAT10N _ ZIP TEMP.METER,OR POLE INS.. 15.00 APPLICANTS - MOTORS ADDREsa P SEE FEE SCH.JIq'Q O f pp SERVICE CHANGE 10.00, w'o'o LICENSEDCONTR ORS DECLARATION Fi�:w hereby affirra that 1'am,licensed under provisions of Chapter9' - ,ISSUANCE DATE C (commencing with;Section 7000)Of Division 3 of the Business and, BLDG. ELECT. PLG. MECH. 0,2 Pro@ssions CoijgagQ,�ny license is in full'for�,q)ad r� a: 0$$'— License Class:l.-L�_Llc Num her X(o �, $"N.I-w Date a�- i.-'ii G.t Contractor El -J�� 'B CDING PERMIT 0 W. u - OWNER-BUILDER DECLARATION' N z: FORMATION �;;LL t; I'..hereby affirm.lhat I am exempt from the Contractors License MISQ— - REFER TO OR (' H.w0J Law for the,following reason.(Sec:7031.5.Businessand Professions PERMIT ISSUANCE 5:00 VALUATION, _ $jFT. - as as f Code Any cityor county which requiresa permit toconxlrucLolle,, Q Q Q D Improve,demolish,or repair any structure.I prior t0 115 Issuance.also ELEC.CONTR UC.N0, ELEC: '//�//^ p 0'4 'requires the applicant for such permit to file a signed statement that I? TOTAL /v 6 w 2 w lie is licensed pursuant to the provisions of the Contractors License: LO - .PERMIT TO 'Law(Chapter.9(commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or tha(,lie is exempt therefrom and OTY. PLUMBING PERMIT FEE 6H�.- the bash;for the alleged exemption.Any violation of Section703L5 .STORIES TYPE CONSTR. by anyapplicant for a permit subjects the applicant to a civil penalty.' of not more than five hundred dollars(SSOO).): ALTER-DRAIN&VENT-WATER (EA.) 4= ❑ A.as owner of the progeny,or my employee s wilKwsgcs as BACK FLOW PROTECT.DEVICE 2.00 . .00C.GROUP RES.UNITS - 'their sale:compensation,will do'the work,.and the stracture is not intended or offered for sale(Sec. 7044. Business and Professions DRAINS-FLOOR AREA,COND. 4:00 ` Code:The Contractor's License law does not apply to an owner,of; property who builds O or improves thereon,and who Bull such work FIXTURES-PER TRAP 1" 4,00 SFT.FLOOR AREA TOTAL ACREAGE • "himself or through his own employees provided that such improve. ments are not intended ar offered for sale.If,however,the building GAS-EA.SYSTEM-11 INC.4 OUTLETS 4:00 or improvement D sold'withm onl y ar&fcompletion,the owner- GAS-EA.SYSTEM-:OVER.4(EA.)builder will'.have the burden.of proving that he did not build or im- 4:00 . BUILDING USE prove for purpose of solea. INDUSTRIAL WASTE INTER. - FES IND C PB Cuba, - ❑ d e.owner of the protruct pm.exclusively,ecS 'o contracting with - 20:00 ❑ E: 13 .ceased contractorstoconstruct Contractor's the project ISec does not apply LAWN SPRINKLERS:-1 INO5 V.B. 5.00 ASSESSO RCEL NO. and Professions Code.The Conbuildsr s License Law does not apply . properly. P , to,an.owner ofwho builds int roves thereon.and who, LAWN SPRINKLERS-.OVER'51EA.1 7.Q0 contracts for such project;with aconlmctons).licensed'.pursuanrlo - theComractocsLicenselaw: SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. maxim �nlam exempt under Scc. ,B.kP,C..Ibr 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 Iiheraby affirm that I'fiave a certificdrt of consent to sell-insure or a certificate of.Workers'Compensation Insurance,ca.. , rtified- ZONING ENG.SITE NO. Po fiyhereof ISec.3800 Pab.Y ���.l.vr„ Polly o. Com, an /�-yag� 1l4, 0, Certified copy is hereby furnished. ' FIRE SPR INK ENERGY T-p4 Z Z ❑ Certified c. is filed wHh the city .inspection division. FO APPhcu"nt- Rr'q/D MISC.- REFER TO ORD. y'[] N[_ vt❑ N� � N ' CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 8.00 FLOOD ZONE A.L.U.C. W COMPENSATION INSURANCE ` PLG.CONTR. ILO (This section need not}be completed if the LIC.N0. PLG_. D Z p permit is for(one TOTAL Y'❑ N 00 hundred dollars 100)at less.) I certify'that in the performance of the work for which this per- QTY FEE SUMMARY LLL 1= .ml(is issued,l:shall not employ any Personm any manner sD us to MECHANICAL PERMIT FEE" O W became subject to the Workers:Compensation Laws of CSlifomia. C -Date Applicant ALTER OR ADD TO MECH. 4,00 BUILDING } 2 NOTICE.TO.APPLICANT:.,If,ufter'makingahisCerlificme of Ex. _ emption,you should became subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK 'provisions of the Labor.Code, you must'forthwith comply with FEE 'U such provisions orchis permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r-F,.M.) ,3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOJ]ODGF.M.) 5.00 SEISMIC FEE' 1 hereby,affirm that there is a construction lending agency for EXHAUST HOOD(WITH,DUCT) 2:00 file performance,of the work for which this permit is.issued(Sec. 3097,CN.C.). .. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM Lender's Name Lender's Address - HEATING.UNIT,(OVER 100,000 B.T.U.)7.50 ELECTRIC" Icertifythat.Iha%N!mad this application and state that theabove VENTILATION FAN (SINGLE) 3.00 " . 'information iso correct I agree to comply Willi all city and county BOILER-COMP PLUMBING ordinances and state laws.relating to building Construction, and (3 H.P:or 100,000 B.T.U.)-0.00' hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree ro'save, indemnify:and•keep harmless the City of MISC.-' REFER TO ORD. Cupertino against Babilities,judgments, Costs and expen'ses'whieh. may in any way accrue against said City in eonsegneace of the I PERMIT.ISSUANCE 3,pp CONST..TAX. granting Of this rmit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature of Applic ntluonlreclor Date OFFICE COPY: - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL- POINT PEN ONLY .. UI LDI NG PROJECT IDENTIFICATION. PERMIT NUMBER B ;BUILDING - APPLICATION &.PERMIT 4 „4 4 ,. ADDRESS T T � ,72 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S( PLAN CHECK VALIDATION ' NAME. QTY, - ELECTRIC PERMIT FEE . �GRN�!'r PHONE CONTRACTOR'S NAmE:.AFY_ _ UTLETS-SWITCHES-RECEP 5.00/1100 /..► [' R C cN LIGHTING FIXTURES 78.00/1:00, CONTR AcroflTi ADDRESS PPLIANCES-RESIDENTIAL 4.00 ' ADDRESS Q J(a PHOruE Q PANELS - 5.00 DATE OF APPLICATION A OHDECT _ SIGNS B.00 - PLAN CHECK FEE P.C.NO. OR IENGINEER LIC.rvo. SIGNS TRANS. 3:00 ARCH.OR ENG. PERMIT VALIDATION - ADDAESS SPECIAL CIRCUIT 5.00" ZIP TEMP.,METER'OR POLE INS. ADDRESS - MOTORS ,SEE�FEE SCH. ASS ✓. ' V/m SERVICE CHANGE ` 10.00 ✓��/ ,-02 LICENSEDCONTRA ORSDECLARATIOr4 "Q Zu Thereby affirm that I amt licensed under.provisions of Chapte") - ISSUANCE DATE' a (Commencing with Section 7000)of Division 3 of the Business and _ f 7 2. Professions CO I my,license is m.fulL fttr}'.pyld f - BLDG. E C PLG. .MECH. 2 OLicense Class LI humber L/ /S/.; Z, z t;w Dete_'2Conttactor a V � - 'BUI ING'PERMIT ¢ ¢w-u OWNER+BUILDER DECLARATION u'x';6,� I hereby affirm That I am�eiempt from'lhc Conlrucmrs License MISC.— REFER TO ORD I ORMATION r LOat Law forthe.following mwon.(Sec 7031.5:Businmand ProfessionsPERMIT ISSUANCE 6.00 VALUATION? $/FT. � wm.,� Code.Anycity.or County.which egmrcsu permit tocrnstruct alter. ¢ a> O improve,demolish,or repair any structure,prior 10 Its issuance,also ELEC.CONT y q CIL.NO. ELEC. // w o{, requires the'appllcant for such permit to file a signed statement that. E `�D��t��3 TOTAL W m;N, he is licensed pursuant to the provisions of the Contractor s License PERMIT TO H i'.> Law(Chapter.9(commencingwsth Section 7000)of Division 3o fl he 'a Business and Professions Code)or that heir ciempt therefrom and DTV,: PLUMBING PERMIT FEE s4o ¢ I—.$ the basis'for,lhe alleged exemption:Any violation of Section 7031.5 STORIES TYPE CONSTR. n;_ by any applicant for permit subjects the applicant to a civil penalty of not mom than five hundred doll..(S500).): ALTER-DRAIN&VENT-WATER (EA.) IL00 - ❑ h as owner of thu'property.or my employees with:wages 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 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 sueh work. FIXTURES-TER TRAP 4.00 SWFT.FLOOR AREA 'TOTAL ACREAGE •• himself or'through his awn employees,provided that such improve- meets ore not intended or offeredfor sale.If.howeeC the budding GAS-,EA.SYSTEM-I INCAOUTLETS 4:00 or improvement is sold within one year.of completion, the owner-' GAS—EA.SYSTEM-OVER 4(EA.) 1.00 aulLow USE budder will have the burden of proving that he did dol build or ins- provefor purpose crude,). INDUSTRIAL.WASTE,INTER. AES IND PB - Other ❑ L'as owner of the property,am exclusively contracting with 20.00 �" 1 Imensed'conttactors'to construct the project ISee.7044.Business ' LAWN SPRINKLERS-11NC5 V.B. 5:00 ASSFSSO P CEL NO. and Professions Code:The Contractors License.Law docs not apply; - - toanowner.oLproperty who builds or-improves thereon.and who LAWN SPRINKLERS-OVER:'5(EA'.) 1.00 contrads'foi such projects with r omiractnt(,)'licen.,ren rsuanl to - - the Contmctor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCELNW ❑ lam exempt under Sec: ,B.&.P.C..lor this reason " 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 ' Ihereby affirm that E have a certificate of consentto self-insure: or a certificate of Workers'Comatuewtion Insurance,or,certified. ZONING. ENG.SITE N0: , copy ahercof(Sce.3800,'Lub.C.).�yg 9GLY9J2 .• ' PolicJ'bl Company /I .0 �Certified copy Is hereby fumished. - - FIRE$PRINK ENERGY T�pC Z 2 ❑ Certified�y2y�iI •d. with Ilia city Inspection division. Applicant Y L �• MISC. REFER TO:ORD. y � NQ Y❑ ..N 1- O .• Iry CERTIFICATE OFEXEMPTION URNCWORKERS' PERMIT'ISSUANCE 6:00 FLOOD ZONE A.L.U.C. ' . . W'> COMPENSATION INSURANCE '� PLG.CONTR. CIL.NO. ',pLO. a 01 (This section need not be.complcbd if the permit is for one TOTAL YO N❑ V'� N❑ U2hundred dollars(SIGO)or less:) . I certify that;In the performance of the work for which'this,per-' QT,r MECHANICAL'PERMIT FEE SUMMARY W F• our Is issued,1 shall not employ any person in any manner so is to FEE' O W become subjectao the Workers'Compensation Lawsol Caldornio: _ y Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING } M NOTICE TO APPLICANT: If,.Slier.making.this Certirwe.of Fx- -�'? , errlption,you.should become subject to the Workers'Compensation APPLIANCE 4.00 provisions of the Labor Code. you muni forthwith comply with PLAN CHECK U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.FJVU '.3.00 FEE CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER,J0=C.F.M.).5.00 SEISMIC FEE, 1 hereby affirm that-there:is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the performance oPlhe work forwhichahis'permit is issued(Sec. - 3097,Civ.C.): HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM Lender's Name Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U)7.50 ELECTRIC. 1 certify that l have read this application oil state that the above VENTILATION FAN.(SINGLE) 3:00 • I lel) information is correct I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction.'and BOILER-COMP(3 H.P.Or 100,000 B.T.U.)'4.00 - hereby aulhorize Rpmsentatives of this City 10C" upon tie , abov>mentioneo pe property'.for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE,FEE SC H. MECHANICAL (We) agree to Save, indemnify and keeps harmless the Cily,ol' 'MISC,- REFER.TO'0 D. - CuperUno against liabilities,judgments.ccsls,and expenses which, may in sny'way aarue against said City,'in consequence CONST.TAX of the - PERMIT.ISSUANCE 3.00 _ Starting of lh' u. MECH.CONT, LIC:NO, MECH. .//( '/.'� //` Q ¢ - TOTAL TOTAL rr n Slgnaturc of ApphcantjContractor Date OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDING PROJECT I DENTI FICATION ,bv PERMITVNUMBER -aUIL.ING APPLICATION"& PERMIT _ 4145 'ADD.ESS - " ����Vz ,4'2 BUILDING-ELECTRICAL-PLUMBING-.MECHANICAL OWNEW5 I5 p �/ AA �— _ PLAN CHECK VALIDATION' NAME_ /�Q--]Q/I--QTV: ELECTRIC PERMIT FEE. - • DA_ Q PHONE NAMERAcrogs1 / _l UTLETS:SWITCHES-RECEP 5.00/1.00164Y2 r� m G uC;Noel LIGHTING FIXTURES 5.00/1.00 CONTRACTORS ADORE - APPLIANCES.-RESIDENTIAL 4:00 =o S g7jHONE 'PANELS', 5:00 . O DATE OFAPPLICATION ARCHITECT ' PLAN CHECK FEE P,C.NO.. OR SIGNS- 6.00. _ ENGINEER ' - uc:No. SIGNS TRANS. _ 3:00' AARCH.OR DDRESS ENG. SPECIAL CIRCUIT - 5,00 - PERMIT VALIDATION ZIP JTEMP.METER OR POLE INS. '15:00 APPLICANT'S ADDRESS MOTORS / - SEE FEE SCH. G ✓O 4.V OSS SERVICE CHANGE 10.00 w'o o LICENSED CONTRACTORS'DECLARATION _ .7 Q;i,w I hereby affirm that lam licensed under provisions of Chapter 9 - - ISSU CE DATE H.a (com rencing�with Section 7000)oCDi uion'3 of the Businessand IBLDG. E PLG. MECH. H:o i Professions Code my'license is in dull forsy•,qn d c1 Z O L - License lass y Lic Numlxr.i7/T/ � O I In L w Date Contractor El El El a I BUILDING PERMIT ¢ ¢w,u OWNER-BUILDER DECLARATION x;d+ I hereby affirm That I,am exempt from the Contractor's License MISC. REFER TO ORD -. INFORMATION I to - - VALUATION SIFT, Fu0a ldwfor thefollowmg mason.(SeC 7031.5;Business and Professions PERMIT ISSUANCE Code.Any city or county which requimsa permit to construct,alter., 6:00' . Q Q,a.2 improve,demolish,or repair any struclloc,prior to its Issuance,'also ELEC.C TR. LIC,NO. ELEC. /� 0'M re quires the applicant for such permit to(le a signed.statement'that 5' '� Q �/� TOTAL /"' 3 PERMIT TO ' W$'.y he 6licensed pursuant to the provisions of,the Contractors License r Z.> Law(Chapter 9(commencingwith Section'7000)of Divisiun3 fthe, - f.iQo 'Business and Professions.Code):.,that-he is exempt therefrom'and OTV. PLUMBING.PERMIT 'FEE ¢'t-�i the basis for the,alleged exemption.Any'violalion of Section 7031.5 - STORIES TYPE CONSTR. n ; _ by any applicantfor a permltsubjects the applicant to acivil penalty, ALTER-DRAIN -WATERt(EA:) q,00 of not mare than five hundred dollars($500).): ❑, I:as owner of the property,or my employees with wages as. BACKFLOW PROTECT. DEVICE 2.00 their sole compensation,will do the work,and:the structure is not OCC.GROUP ,RES.UNITS Intended or offered'for sale (Sec. 7044„Business and P,ofessi.ns DRAINS-FLOOR;ROOF,AREA,CONDO 4.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon:and who docs such.work FIXTURES-PER TRAP 4.00 •himself or through his own employees,providedSO.FT.FLOOR AREA TOTAL'ACREAGE .that such improve E mens are not intended or offered for sale.If,however.thelbvilding GAS=EA-SYSTEM-I INC.4 OUTLETS 4:00 or improvement Is sold within one year of completion,the owner. budder will have the burden bfproving that he did not build or im. - GAS-,EA..SYSTEM-OVER 4(EA.) -1;00 .BuaotN u5E prove.1.as owner of sale.) INDUSTRIAL WASTE INTER. 'Q lO` b0 oQr. ❑ f apowner of the ro art am -xclusi4el 20.00 P P Y exclusively h� licensed cions Cod :The Cal.. theproect(Sc does not apply LAWN SPRINKLERS-1 INC 5V.8. 5.00 ASSESSOR PARCEL No. and Professions property ty Contractor r improF'Lvw does ran apply - [o tr owner o[ich projects wtio builds or improves thereon.andwho LAWN SPRINKLERS!-OVER 5(EA.), 1,00 the Contract siah penjecL with a contmcton sl licensed.pursuanl.ui the Contractors Liecnsolaw. - SEWER-SANITARY-STORM EA..200ft/6.00 -TRACT No. PARCEL No. lasso;limixemptunder Sec. ,B.&B6 for this WATER HEATER 4;00 ' Date Owner WATER SYSTEM4'.00 ACC.',DATE, ACC.FILE NO. WORKERS'COMPF-NSATION DECLARATION - WATER TREATING EQUIP, 4.00 1 hereby affirm that I have a ccrlificam of consent m sell-insure: - or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. Pollthereof lSec.3500,Lpab.y Al",, ,�?2 Policyy LjJJo. Can an /e. Q �2ertified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z 2 ❑ Cerlifies�o y is 01edd io with the city inspection divisn. FO Applicarf .Y��Nc7 MISC.- - REFER TO ORD. Y[] N� r0 N[ - CERTIFICATEOFEXEMPTIONFROMWORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.LLC. W > (This section need nON ba cromplUCd RANC'If theePCrmi1 is for one PLG.:CONTq. LIC.NO. TOTAL �� N� Y N� ao D 2 hundred dollar,($100)or less.) U 0 I certify that In the performance or the work for.which this per. QTY. MECHANICAL PERMIT FEE. 'FEE SUMMARY LL f- Imt is.issued.I"shall not employ any person or any manner so as:to O W become subjecLto the Workers Compensation Laws of California. to Date—Applicant - - ALTER OR ADD TO MECH. 4.00 BUILDING } N NOTICE TO.AP If,after making this Certificate of Ex- I- ? emption,you should become subjec[,to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions..of the Labor Code, you;musl forthwith comply with U such provisions ortl ls'permit shall be deemed rea.ked. AIR HANDLING UNIT ITO 10=CF--K) 3(30 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p0DC.EM.)5.00 SEISMIC FEE.' 1 hereby affirm that them is..a construction lending agency for - EXHAUST HOOD(WITH DUCT) 2.00 the97performance of the work for which[his permit is issued(See. MICROFILM 30 ,Civ.Ci), HEATING UNIT(TO`700,000 B.T:U.) 4:00 Lender's Name - Leader's Addle HEATING UNIT(OVER 100,000 B.T.U.)7:50 ELECTRIC Pertify tha(i have read this application and state that Oto above VENTILATION FAN"'(SINGLE) 3._00 • in Contain", is'eomec[ I.me,tocomply with all city and County - PLUMBING Ordinances and:state lawsT luting [o buildin,.cousloaclion. and BOILER-OOIVP(3 H.P.or100,0008.T:U:) 4:00 her by uthoriae rcpt ntativcs of [his'city. to enter upon the BOILER-COMP IOve.100pOB BTUI SEE FEE SCH. abovL mentioned property'for:inspection purposes. MECHANICAL .(We) agree to save, tndemnify'and keep harmless theeCity of MISC.,- REFER TO ORD. - Cupertino,against liabilities.juugments, costs and.expenses which may in any Way accrue against said City in consequener,of the "PERMIT ISSUANCE 3.00 CONST.TAX" grantlng is pe�y�} MECH.CONT. LIC.NO_ MECH. 6trrt- TOTAL TOTAL Signature of Applicant/(ontmetor Uate r, OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION PERMIT NUMBER. aDnOiNc - G'rLE9/e C-/Q� APPLICATIONS& PERMIT ADORES _ CTRICAL—PLUMBING:—MECHANICAL 4148 1TQ a173O OWNER'S PLAN.CHECK VALIDATION- ' NAME CITY. ELECTRIC PERMIT .FEE ANza P'eoR.. PH.N - fA S' CONTRACTOR'S NAIL? ' . . / OUTLETS-SWITCHES-RE EP 501.0000 7� E / C/CtyLuc.No.e`/5,plLIGHTING FIXTURES 1 1311-6 'CONTRACTOR'S APPLIANCES,-RESIDENTIAL .4.00 POOR Eos �„ /OY Se, VHONE •�O PANELS 5.00 S� DATE OF APPLICATION ARONITECT PLAN CHECK FEE P.C.NO, OR SIGNS 6.00 ENGINEER . im.No. SIGNS TRANS. 3.00' AARH.09DDRESS ENO SPECIAL CIRCUIT 5.00 " PERMIT VALIDATION'. .Zip EMP,METER'OR POLE INS. 15.00 AAooREs5 �Ppoc5MOTORS SEE FEE SCH. r t7 ' e'yDy-5/1 00 •'�S� SERVICE CHANGE 10.00 .Fioo LICENSED CONTRACTORS DECLARATION <.z w I hereby.aff(rrti th.t am licensed under provisions of Chapter 9 ISSUANCE DATE Immmeoeing with Section]000)of;Division 3 of the Business and - BLDG; LE T. PLG. I.MECM. H o- Professions my license is in full for dy�ffj , OLLicenseClasss L(c Number �� - o zq,.H w Date /- //- Oss Contractor H w._ TT/� 7` ¢ M.F - ILDING PERMIT ¢ ,,w¢ OWNER-BUILDER DECLARATION - o4o MISC.— REFER TO ORD . INFORMATION wg , u I hereby affirm that I.am exempt from the Controctoh License v.o Law for.the following reason.(Sec.7031.5;Bueinesssnd Processions VALUATION B/FT.. g PERMIT ISSUANCE 6.00 - S W.� CodL Any city are unty wM1ich requltesa permit tovonstruct.alter, „ Or Q,¢0 - imprOve.dCn101ish.Or repairarlY structure'.prior to its issuance.also ELEG CONTR. LIC NQ {LE0. ,O LL requires,the gpplmant for such permit to file a signed statement[bat S��I•�Q a`�3�3 40TAL /[p PERMIT TO ce he a licensed pursuant to the provisions of-the Contractor's License .�,. l rix w( he ter 9too mmarming with Section 7000)ol-Division 3 of the srv/f/,�f'i/ J ¢ Business and Profesvons,Coda)or that he is exempt therefrom and. MBING PERMIT FEE ¢,�_o the basis for,IheallegedeKcmption.Any violation ofCITU. PLU .Section7031.5 STORIES TYPE CONSTR. aS`g.m by.. aPPlicantforapemtit subjects the applicant to a civil Penally ofnotmorethbnfive hundred dollanlS500).): - ALTER-DRAIN&VENT-WATER (EA.) 4.00 ❑ 1.as:owner of the property,.,my employees with wages as BACKFLOW PROTECTDEVICE - 2:00 theie .sole compensation,will do the work.and.the structure is not OCC.GROUP, RES.UNITS 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 owner of - property who builds or improves thereon,and who does such work F.I XTUR ES-PER TRAP 4.00 see FT.FLOOR AREA TOTAL ACREAGE' • himself or through his awn employees provided that such improve- ments are not intended or offered Tor sale.If,howver:the building) GAS-EA.SYSTEM-I INC.4 OUTLETS .4.00 or improvement Is Sold within one year of completion,the Owncr GAS-EA.SYSTEM-OVER'4(EA.) 1.00 BUIL01G SE builder.will have the.burden:of proving that he did not build or im- provefor purposeofsale.). INDUSTRIAL'WASTE.INTER. . 20.00 'O �O C a Other ❑ I,as.owner of the properly.am exclusively contracting.with licensed contractors to construct the project(Sec 7044..Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 'ABBECELNO.. and Professions Code:The Contractor's license Law d.es not apply 55D to an owner of properly,who builds or improves ihcreon.and who LAWN SPRINKLERS-OVER 5(EA:) 1.00 contracts rot such projects with contractorol licensed pursuantro the Contractor's License Law. SEWER-SANITARY-STORM EA..200ft/8.00 TRACT NOI PARCELNO. re❑n lain exempt under Sec. ,B.&P.C.ter this WATER HEATER W/VENT 4.00 'Date - Owner WATER SYSTEM '4.00 .ACF DATE ACC.:FILE NO. WORKERS'COMPENSATKNDECLARATION WATER TREATING:ECUIP. 4.00 1 hereby affirm that I have a certificate of consent to wif-nsure. or a certificate:of Workers'Compensation.Insurance.or a certified ZONING ENG.SITE NO. copy'thereof(Sec.9C. vati.Y.)'/� Policyy�JJit Com an /U�' Z �Certificd copy is hereby.furnished. , Z'rZ ❑ -Certified c p Isflpd with the city inspection division. FIRE SPRINK ENERGY T34 'F O Applicant - _4� MISC:- REFER TO ORD. Y F] N Y ❑ N[ "y CERTff KATE OI°EXEMPTION FROM WORKERS' 'PERMIT ISSUANCE .6.00 - FLOOD ZONE A.C.U,C. Lai COMPENSATIONINSURANCE PLa CONTR. LIC.NO. PLG, - 'a'�p (This section need'not rbc completed if the permit is-fur one TOTAL Y C] NY C] N�. 0 Z hundred della (S10G)or less.) - - U'O I certify that in the performance,at.the work forwhich this per. DTy. FEESOMMARK 'I- 'emit Is I,shell,not employ any MECHANICAL PERMIT FEE LL P Y Y Person in any mu nnerso to O W become subject)o the Workers'Compensation Laws of California.ia Is. Date Applicant ALTER OR ADD TOMECH. 4:00 BUILDING }'Z' NOTICE TO.APPLICANT: If,after making this.Certificate'of Ex- (- - emption,you should become subject to the Workers'Conpensation APPLIANCE 4:00 PLAN CHECK provisions,of the•Labor Code„you must forthwith comply with U . such provisions or this permit shall.be'deemad revoked. AIR HANDLING UNIT(TO 110MC.F.M.) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER-10=11F.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. MICROFILM 3097.nder's am HEATING UNIT'(TO 100,000 B.T.U.) 4.00 Lender's Name Lender's'Address HEATINGUNIT(OVER100,000_B.T.U.)7.50 ELECTRIC I certify that 1 have read,this application and state that the above VENTILATION FAN (SINGLE) 3.00 information is-correct 1 agree to comply with allcnly and county BOILER-COMP PLUMBING - - ordinances and state laws relating (3 H.P .to building construction. and ,or 100000 B.T.U.) 4.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE'FEE BCH. above-mentioned property fonins ,,,two.Purposes MECHANICAL .(We).agree to save:;indemnify and keep harmless lite City.1' - 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 grantin Of erm' . wt:H.CONT.. •LIC.NO. MECH. g����//— �¢ TOTAL TOTAL / Signatureo Appbcant/Contract., .Date �IO OFFICE COPY "`CCC APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN.ONLY BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER GUILONG APPLICATION &PERMIT p q (� ADDRESS0-3'14 '1 4"95/9- 0 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 4 I _E9 OWNERS - --- - - -- - -- - - � - --- --' ---- ^'- PLAN CHECK VALIDATION > • NAME QTY. ELECTRIC PERMIT FEEPNONE CONTRACTORS NAME / UTLETS-:SWITCHES-PIECED 5.00/1.00 L C/aQUn7�. uc.noC/D��/�/1 LIGHTING'FIXTURES 5:00/1:00 ADDRESS DDREDRs APPLIANCES,-RESIDENTIAL 4.00 CONTRACTOR'S SSS EYO yrl PHONE: Q f6 PANELS 5.00 -�� DATE OF APPLICATION ARCHITECT - PLAN CHECK FEE P.F.NO. OR - SIGNS 6.00 , ENGINEER LIC NG. SIGNS TRANS . 3.00 ADDRSS End' SPECIAL.CIRCUIT '5.00 PERMIT VALIDATION za, TEMP.METER,OR POL'E'INS. 15.00 AMOTORS SEE.FEE SCH. SO• �ti' l ADDRESS DREsa p ay SERVICE CHANGE 10.00 w'o`o .LICENSED CONTRACTORS DECLARATION ' ¢.0 I-.hereby affirm that l am licensed under provisions of Chapler.9 ISSUANCE DATE Gay (commencing with Section 7000)of Division 3 of the Business and H ]'i •Professions C n " .Ii cense is in Tull for' nil • u. -FLOG ELE PLG. MECH. a,O${'- License Class Lie.Number - ❑ ,g,,y L7w Date.f-y/!_ _Contractor ¢m¢ a OWNER-BUILDER DECLARATION ( BUI INGPERMIT °'-O MISC.- _ ;REFER TO ORD IN ORMATION. X ; ';G I hereby affirm.that I am exempt from Contractor'slicense, - u O j law for the followingreason.($eci 7031.5,Budnessand Professions' VALUATION- SOFT. PERMIT ISSUANCE 6.00 S W Code Any.city,or county which requires a permit to construct,alter. Q Q s- improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. )A 'LIC.aNO.. CLEC. O.LL regwms the applicant for such permit to file aligned statement that L���� V TOTAL-� e w�'y tills licensed.pursuant)to the provisions of the Contort tors License V PERMIT.TO r i:a Use(Chapter 9(commencingwlth SectionJ000)of Division3.1 the " 4 D Business and Professions Code)'outhxlhe isexemprthcrcfrom and QTY. PLUMBING PERMIT FEE Ie. h,$ the basis for the alleged exemption.:Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant fora permit dollars theSS applicant too civil penalty ALTER-DRAIN III VENT-WATER(EA:) 4.00 of not more than five the preddty,or em1: ' ❑ I as .net a("the property;or my employees wilh.wagev as BACK FLOW PROTECT.DEVICE , 2.00 their sole comss pention,will do the work..and the st rectum is not OCC.GROUP. RES.UNITS intended or offered for sale(Sec. 7044. BusinessandProfessions 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 dors such work FIXTURES-PER TRAP 4.00 SO,F7.FLOOR AREA TOTAL ACREAGE • himself or through his own employees provided that such improvo mens are not intended or offend for sale.I C.however.the budding GAS-EA.SYSTEM '1JNC:4 OUTLETS 4.00 cr Improvement Is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER'4(EA.) '1".00 builder will have the burden of proving that he did not build or im- BUILDING USE prove 1.aso nee of sale.). - INDUSTRIAL WASTE INTER. O IN❑p o i O Other, ❑ 1,as owner of the property am exclusively contacting with. 20:00 licensed contraetors•tD:construct the,project(Sec. 7044.Business' LAWN SPRINKLERS- 1 INC 5 V.B.- 5.00 ASSEssOR3 RCEL NO. and Professions Code:The Contractor's license Law does not apply - -to an owner of.propeny who builds or improves thereon.and who LAWN SPRINKLERS-OVER'5(EA.) 1.00 Contractsfor such projects with a commcomsl.hcensed pur,u=t to the Contractor's License Law. SEWER-SANITARYSTORM, EA.200ft/8.00 TRACT NO, PARCEL NO. ❑ lam exempt under Sec..,B.&F.C.,for this reason WATER HEATER W/VENT Date Owner WATER SYSTEM 4.00 .. AM.-DATE .ACC.FILE NO. - WORKERS'COMPENSATION DECLARATION WATER TREATING,EQUIP. .. 4.00 I hereby affirm that I have a certificate of consentlo lei.insure. Or a certificate of Workers'Compensation'.Insurance,or a certified' - ZONING ,ENG.SITE N0. copy thereof(Sec:.3800-Lab C.). - - E N Policy No. Company 96G/9z2- O Q"Cerifted copy is hereby fumishcd. Z.Z: i❑ Ceitiflcd„yO�yflled with the city "inspection division.' x FIRE SPRINK ENERGY T 24 F-• Q" AVplic.m e, B• MISC.- REFER TO ORD. - - Y ❑ N Y p N[ W CERTIFICATE OF EXEMPTION FROM WORKERS'. PERMIT ISSUANCE. _ 6.00 LU COMPENSATION'.INSURANCE PLG:CONTR. 'FLOOD ZONE A.L.U.C. O. O LIC. PLG. (This declion nerd nok'be completed'if the p mut is liar one TOTAL U O hundrcdfy that 15100)pe lcssa I certify that m the performance of tion inhe a y rias%Iua this.Per' QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL.0 ,Colt is Issued(.F:shall not employ any person in any manner so a,On, O,w become subject to the Workers-Compenseaon Caws of California: :Q; Applicant. ., ALTER OR,ADD TO MECH: 4,00 BUILDING " ' } va Date NOTICE-TO'AP Applicant T:,IC.after making this C rtill ne.oPEz F'2 emption.�,you should become subject to the Workers Compensation APPLIANCE 4.00 .PLAN CHECK provisions-of thelabor Code, you mustjforthwuh comply with C) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO'10=11F.M.) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNITJOVFA10=C.EM.) 5:00 SEISMIC FEE - 1 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;CN.C.), HEATING UNIT(TO 100,000 B.T.U.) 4:00 Lender's Name Lender's'Address HEATING UNIT(OVER 100,000 B.T.U.17.50 ELECTRIC, . ,Z;D I certify that l have readthis application and sure that the above VENTILATIONTFAN•(SINGLE) '3.00 i formation is coerce[ I agree to comply with all city and'county - PLUMBING ordinances and state laws,relating to building construction, and 801LER;CONP(3H.P.611GO,000.8,T.U.) 4.00 hereby authorize representatives of this city To enter upon the above mens oned property for inspe non.purposes: BOILER-COMP IOver IOO.000 BTU)SEE FEE BCH. .MECHANICAL '(We) agree to sac indemnify and keep harmless the Cit of MISC.- ,Cu ,Cupertino against liabilities,judgments. y. - REF ER TO ORD. P g 3 t said ,corns and expenses which PERMIT ISSUANCE CONST.TAX may m any way'acme against said City in center expense of theid, - 3:00 :granting of this tit Gam( MECHi'CONi. LIC:NO. MECH. �.Li lSignalure of pphc IJContractor Date. TOTAL: G OFFICE COPY - .APPLICANT TO. FILL IN INFORMATION WITHIN RED LINES - USE BALI. POINT PEN ONLY FICATION APPLICATION&PERMIT - BUILDING PERMIT NUMBER BUILDING PROJECT I DENTI �� 5� P ADORESS�O/J� ESl� G/2_ .BUILDING -ELECTRICAL-PLUMBING -MECHANICAL :OWNERS / - - --- -- - ----- ----' -- — PLAN CHECK VALIDATION NAM//E-�,y. �Js-yp {^/�,/ QTY. ELECTRIC PERMIT FEE Ce 11A `T ( AGO PHGNE 3 `fA _ . 'CDNTRACTOR'S "NA_MEEj UTLETS-SWITCHES','RECEP 5.00/1.00 LIC.No 6j LIGHTING-FIXTURES . 5.00/1.00 CONTRACTORS ooneuTogs - PPL'IANCES-RESIDENTIAL 4.00 1/ PHONE $ (J PANELS - 5:00 DATE OF APPLICATION _ AOR RCHITECT SIGNS B.00 PLAN CHeu,FEE P.C.NO. ENGINEER int.No. SIGNS TRANS. 3.00' ADDRESS ExG' SPECIAL CIRCUIT - 5.00. PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. - '15,00 _ aoaucaxrs MOTORS /' SEE FEE SCH, - ADDRESS T V G O •///1C V70S95. SERVICE CHANGE 10.00 F02 LICENSED CONTRACTORS DECLARATION v'W Ihereby affirm that I'am licensed under provisions of Chapter 9 . 4 (commencing with Section 7000)of Division, Of the Business and ISSUANCE DATE _ vii n H BLDG. LECT. PL❑G. MECH. a t3 Professions Cod y licenu is i, full foyefnd,ei ys - ci o .License Class Contrator �3 /J r N,F j Dare_tf— I/— Contactor . . -. MSW a OWNER.BUILDER DECLARATION B.IU0LOING PERMIT X ; e1Q— REFER TO'OFi D INFORMATION 'A'y I.hereby affirm that I am exempt from the Contractor's License MIS F _�o'J Law for,the following reason'.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE -i - 500 VALUATION S/FT. Eley'>f Code Any city or county whichreguiresa permit to construct.utter, _ - n a: <p improve,demolish,or repair any structure,prior to IIS issuance.al W' ELEC-CONTR. LIG NO. ELEC. r/1 iO.LL requires the applicant for such permit to file a signed statement that r f' TOTAL 1rL=-� X 8 a- he is licensed pursuant to the provisions of the Contractor's License PERMIT TO- Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe s,4 o Business and:Professlons Code)',or that he is exempt therefrom and CITY. PLUMBINGIPERMIT 'FEE ¢s- g the basis for the alleged exemption Any violation of Section 7031.5 STORIES TYPE CONSTR. by anyapplicant for a permitsubjects the applicant toe civilprmlty- ALTER-DRAIN -WATER"(EA.) 4,Qp of not more than five hundred dollars(5500).):- - ❑ I,is Owner of the property,or my employ us whin wages as. BACKFLOW PROTECT. -DEVICE 2.00. theiesole compensation,will do the work;Aad the structure is net OCR.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 thereom and who doer such work FIXTURES-'PER TRAP 4.00 .sv.Pr:FLOOR AREA TOTAL ACREAGE himself or through his own employees provided that euch improve. • Tents annot intended or offered for salt It,however.the;buildmg ` GAS-EA:SYSTEM-1�INC.4 OUTLETS',q.00 " or Improvement Is sold'.withimmne year of coinpletmnthe owner builder will'!have the burden.of proving that he did not build or GAS:EA.SYSTEM--OVERA(EA.) .'q-p0 suaDlN USE P, for purpose of sale.).' - - INDUSTRIAL.WASTEANTER '20.00 .RES. .IND PB Other. ❑ .1,as owner of the properly he reject(Se .7044. ing.wiss - V.B. El -❑ �ad PrTfcontrautors toeCIoConstruct ire.project(See.7044,Business LAWN SPRINKLERS.-1 INC.5 V.B. 5:00 ASSESSOR PA CEL NO.. and Professions Co perly who o improvense s therces not. who ' to an owner oGpr projects wi bacon or tor(v)iceri•renn.Nouns to LAWN SPR INKLERS,.,OVER:5(EA:) 1(00 the contracts forsach projects with a con lmaonsl'I¢cnud pctlsuanr to - the CdntreRor's License Lew. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO: PARCEL NO: ❑ 'lam exempt,under Sec..,B.&P,C.for this: WATER HEATER W/VENT 4100 reason Date Owner WATER SYSTEM 4,00 ACC,DATE -ACC.FILE NO, WORKF:RS'COMPENSATION:DECWRATION WATER TREATING EQUIP, 4.00 'I hereby affirm that I have.a certificate of consent to selhinsurn, m a certificate of Workers'Compensation Insurance,riga ccrliticil ZONING ENG.SITE NO. Policy O. (Sec. Coo nab.G.). q?44 � �.2 Policy Nr Company /din u.e O I¢Certified copy is hereby fwith the - Z 2 ❑ Ceeifie �,p 1s,filed with the city inspection division. FIRE SPRINK ENERGY T-24 � O Applicant 4a—_Vxr'a - I MISC.: REFER TO ORD. YE N❑ YE]' No �..h. .CERTIFICATE OF EXEMPTION FROM WORKERS' .PERMIT ISSUANCE 6.00 FLOOD ZONE' A.L.U.C. W COMPENSATIONINSURANCB PLG.CONTR. LIC,NO. PLG 0- 0 (This section need not be completed ifthe permit is for one - - TOTAL v❑ N� Y❑ N� 0:Z :hundred dollars IS 100)or less.) ' 0.0 I certify thapin the performance of.the work for whim this Per- CITY MECHANICAL PERMIT - FEE SUMMARY W:1= mit is issued,i shall not employ any person in any:manner so as to FEE O Ud become subject to the Workeri Compenmtion Laws of California. IL Dale - Applicant ALTER OR ADDT0 MECH. 4, BUILDING' }.H ,NOTICE TO'APPLICANT:.IL.after making Ihis.CertiBcale of Ex 00 Z emption,you should became subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK ' prossnons.of the Labor.Code, you must forthwith comply with t,7 such'provisions or this permit shall deemed revoked. AIR HANDLING UNIT(TO 110=C.F.M.) 3.00 . FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M) 5.00 SEISMIC FEE I.hereby 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.(Sic. -- - ' MICROFILM 30977Civ.C.): HEATING UNIT,(TO 100,000 B.T.U:) 4:00 Lender's Name Lenders Address HEATI NG UN IT'(OV ER 100,000 B.T.U.)7-50 ELECTRIC (.certify that'I have read this application and state that the above VENTILATION FAIN (SINGLE) 3.00 • information is.correct I agree to comply with all city and'County BOILER COMP PLUMBING ordinances and state laws_relating to building construction. and (3 H,P.or 100,000 B.T.U.) 4.00 hereby,authorize representatives of this city to enter upon the bove-mentioned property forinspection: g01 LER-COMPYOvei 100,000 BTU)SEE FEE SCH. a . purposes - MECHANICAL.' (we),agree to save,.indemnify end.keep harmless the Cit of MISC.a _ - City ' - - REFER TO ORD. amy, Cupertinoagainst liabiliaccrue es,judgments, costs and�ex pences which may�nn any way accrue ageiost said City m mnscguenceol' the PERMIT,ISSUANCE 13.00 CONST.TAX granting of In;(pa nit: //// MECH.CONT: LG.NO. MECH. TOTAL' Bignalure of Applica 1/Contractor DatC ' - TOTAL. OFFICE COPY