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3560 4363 4399 20743-50 CELESTE CI R 3560, 4363, 4399 F DE ANZA FORGE SCANNED BOX # 783 CERTIFICATE OF COMPLETION r BUILDING INSPECTOR'S OFFICE /CITYOFCUPERTINO I DATE 1 . 19 U y BLDG. PERMIT NO.. �T U THE BLDG. LOCATED AT OWNED BY ���J In 2d hlr7PC HAS BEEN ICOAL(ALTERED)PLETE 1 FOR USE AS Al �P C d 1w I 157 lu r BUILDING INSPECTOR ' V CITY 01" CUPI'.R1iNO IIISPFCTIOV RECORD (Office .Copy) ~ 35(,0 _ Lot 1 - Bldg. 12 20743-_50 Celeste Circle Pl;Rru-r ND. SANITARY DIST. NO. LOT HO. ADDRESS Const. 8 Units DeAnza Properties PROJECT OWNER JOB SITE PHONE NO. PERMIT ISSUED nate ELECTRICAL Bui]dinr 5/11/83 Date Insp. Electrical Power Pule I'iumhing Under ,round -- - Mechanical Roui;h Miring Temp. Cas/Eicct. Walls --- Solar Ceiling Fire S rinkler Fixtures Int/Ext Sign Motors Grounding Misc. Temp. Power Other FINAL INSPECTIONS Not Approved Date I sp. PLUMBING El.eC.tri.c ClAr Tic I'lumbing e1. q Backflow Date. Insp. Mechanical _ G-y Underground _ Solar Underfloor Pool Partial Rough Planning Grading Rough Com Tete D-y7 43 ng Solar Rough Fire De t. (dater & Insulation Health Dept. 'fain Drain 1./?"� Duildin ,2-2 - R/of/S Drain _ Other Gas, a -/- �( Other BUILDING Not Approved Date Insp. 6/c Pad Certification lfEG11ANICAL Foundation -643 Date Insp. Pre-Gunite Underfloor S.M. 3Z Q — Ducts 6 Insulation rr-3Y Y3 Bond Beamer Fire Dampers Underfloor =irders / Fireplace Floor Steel Crease Duct & hood Tedowns One Hour Shaft S --`— eismiamsc Condensate Drain Seismic 8racin{; � ----- '�- �_ f:gjipment Anchgrage 6falls-l'ancls Flues & Comb. Air Frame D f e _ Other Lnth Not Approved Ifallboards n 1;xt " �* o�Z Firewalls crtTo- 3fep Slee Other �oak Not A? roved lLovD• y Cctc, 7. . /s 6.`'9 .c,�L'� o(. /�Q / O / r 8 3 / BUILDING 1-d wet S v uT�- IL- ( S Vdyew 0 y tq uat s ELECTRICAL PLUMBING 11ECHANICAL MISCELLANEOUS APPLICANT TO FILL IN INFORMATION WITHINR4ED ll ES - USE BALL POINT PEN ONLY ftq J.A UILDINGPROJECT IDENTIFICATION _ PERMIr NUM ssATION.& PERMIT3JIJODING —ELECTRICAL—.PLUMBING-MECHANICALPLAN CHECK'VALIDATION- TV. ELECTRICPERMIT • FEE- PHAAOO CTOR .S UT,LETS-SWITCHES-RECEP 5.00/1.00 LIC.No: LIGHTING FIXTURES 5.00/1.00 ADDRESS - APPLIANCES-RESIDENTIAL - 4;00 CONTRAS ' PHONE PANELS' X5.00 DATE OF APPLICATION 'ARCHITECTSIGNS B.pp PLAN CHECK FEE P.C.NO. OR ENGIN c.No. SIGNSTRANS. 3.00 ' A H.OR ENG. ' ER bVALID I 'ADDRESS - SPECIAL CIRCUIT 5.00 I nnnyyy ZIP TEMP.IMETER OR'.POLE INS. 15:00 ASMOTORS -x'SEE'F.EESCH. ADDRESS - � � . 6147 d, 2XA!0 if SERVICE CHANGE 10.00 °w-o.o /LICENSED CONNIKA414S DECLARAL90N ¢u u 1'hereby affrrn that I am licensed:under provisions of Chapter 9 r 0 DS z Professions Code and mo llc°ew is in full`force and effect. ss and BLDG. ELECT.I fLTE z is PErT F Z Y PLG. MECX. - z O 1/', — License Claes Lic Number Q ❑ ❑ oz —O• ' Date F.as�.J . . -";5 ar W s ..OWNER-BUILDER DECLARATION - BUILDING PERMIT XJ LL.,N. I hereby affirm.that l am exempt from the Contractors License MISC. - 'REFER TO ORO INFORMATION o•er Law.for the following reason.(Sec.703115,Business and Professions PERMIT ISSUANCE 6:00 VALUATION as Code.Any city cr county which reyuiresa permit to construct.alter, /Ja Z¢Q'C Improve demolish,or repair any structure..prior to its IasUaace,also ELEC:CONTP. - LIQ NOty ELEC. O ¢ requires the applleant for such permit to file'a signed statement Dial TOTAL W m''� he is licensed',pursuant to the provisions of the Contraom's License PERMITTO Law(Chapter 9(commencing with Section 7000)of Division 3 of.the - ) Fez o Business and Professions Code)or that he`is exempt therefrom and OTY. PLUMBING,PERMIT FEE' ✓ / ¢} 8 the basis for the alleged exemption.Any violation of Section 7031.5. _ STORIES TYPE CONSTR., n 3 — by any applicant for a permit subjects the applicant m a civil penalty - w: of not more than five hundred dollars lS500).): ALTER-DRAIN III VENT-WATER IEA.) 4:00' o✓a ❑ [.as owner of the property or my employees with wages ass BACK F LOW-PROTECT.DEVICE 2!00 AVOW 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 DRAIN$-FLOOR,ROOF,AREA;GOND. 4100 ;F—/ J/ Code The Contractor's license Law does'not apply to an owner of - - (/ - property who buildsor improves thereon..and who does such work FIXTURES•PER TRAP 4100 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. - mems are not intended or offered for sale If however,the building GAS EA.SYSTEM-1'INC.40UTLETS 4;00 �. or Improvement is sold within one year of completion the owner- GAS EA SYSTEM—OVER 4(EA'.) budm der will have the burden of pro g that he did not build or Im- 1.00 BUILDING USE prove for purpose of sale). RES IND CON PS Other sd 1 as owner of the property am exclusivelycontre'ting with INDUSTRIAL WASTE INTER. 20.00' �� ❑' Ifeemc contractors to construct the project tSee 7044.Business LAWN SPRINKLERS-I.INC 5 V.B.. 5.00 and Professions Code:The Contractor's License Law doesnot apply - ASSESSORS PARCE O. to an owner of property who builds or improves thereon.and who LAWN.SPRINKLERS,;OVEfl 5 IEA:) 1.00 c'ontri cis'for such projects with a cantraetons)licensed pursuant to WWf�g the Contractor's L en Law. SEWER-SANITARY-STORM EA.'.200fI/8:00 TRACT No. PARCEL NO. ❑ lam xemp i do $ec. ,B.&P. ..fo Otis WATER HEATER,W/VENT 4.00 , rca o 'Date f WATER SYSTEM 4,00 VW ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER'TREATING EQUIP. 4.00 �+ I hereby affirm that 1 have a certificate ofconsent to.+x'14insure. ' ora certificate of Workers'Compensation Insurance.oracertified ZONING ENG;SITE NO. copy thereof(See.3800,Lab,C.). - TIT) I Policy No. Company _ ysiilg/ '0 ❑ Certified copy is hereby furnished. Z Z ❑ Certified copy is fled with the city inspection division. I. FIRE SPRINK 'ENERGY-T 24 0 Applicant MISC..- REFER TO ORD. YylvN _] I rX .No, � N CERTIFICATE Or EXEMPTION FROM WORKERS' PERMIT ISSUANCE -6.00 FLOODZONE . teaiter.+ W > COMPENSATION INSURANCE. PLG:corvrR. uc..No. PLG: CL O (This section need not becompletedif the pernit'is for one TOTAL "EJ _164� D Z hurdreddollars(SIGO).,less.) U O 1 certify that In the performance of the work for which this per- CITY. FEE SUMMARY LL'F• mu Is Issued,I shall not employ any person:in,any niamler so.as to MECHANICAL PERMIT FEE' O become subject to the Workers Compensation Laws of California. - 0 0 Date Applicant ALTER'OR ADD TO MECH. =4.00 BUILDING a� } 2 NOTICE TO APPLICANT: If,after tomaking thisWorkers' rsrCompe ofEx- L.• _ cmvision you t should,become subject to the Workers Compensation with gppLIANCE '4.00 PLAN CHECK provisions of the Libor Code; you must dine ke tmnplY with FEE C,) such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10,000C.F:M) 3.00 ' CONSTRUCTION LENDING AGENCY. AIR HANDLINGUNIT(OVER 10 CF-K) 5.00 SEISMIC FEE e� 9 I hereby affirm that'there,:is a construction lending agency for EXHAUST HOOD (WITH DUCT)' - .2.00 the performance of the work for which.th'is permit is.issued(See: - MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name Lender's Address - HEATI NG UNIT(OV ER 100,000 B.T.U.)7;50 ELECTRIC I certify that l have mad this application andstate that the above VENTILATION FAN'(SINGLE) 3:00 mformationlis correct I agreeito comply with.ill city and county PLUMBING ordinances:and stale laws relating to building H unstruction;and BOILER-COMP(3 or 100,000 B.T.U.)'4:00 hereby authorize representatives of this city to enter upon the 'abovrmentioned property'for inspection purposes. BOILER-COMP VOJir l00 poo BTUI SEE F.EE SCH. MECHANICAL (We) agree to save indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities"judgments, costs'.Snd asperses which CONST.TAX granting in any way aeon against said City in consequence of the PERMIT-ISSUANCE * '3.00 granting of this perl�l MECH.CONTE -A 3- , LIC.NO. MECH. \ TOTAL Uigpslumof Applicant/ nntracto etc TOTAL OFFICE COPY APPLICANT,.TO'FILL IN INFORMATION WITH IN.•RED WES -,USE BALL POINT PEN ONLY' BUILDING'PROJECT IDENTIFICATION PERMIT.NUMSER. BUILDING AL APPLICATION-& PERMIT .�' REBa 'cltdrC .Gti BUILDING-.ELECTRICAL-PLUMBING-MECHANICAL _;; 4.363 N PLAN CHEC N y NAME '/a DTV. ELECTRIC PERMIT FEE' /S!,AA /1A ! PHONE Q _ NAMERAcroR's Pa UTLETS-SWITCHES-RECEP 5.00/1.00 SEP 231983 - ht A* j9 PL•h IC.NO. �jO /O LIGHTING FIXTURES 5.00/1.00 CONTRACTOR'S.TDB's. Fa PPLIANCES-RESIDENTIAL 4.00 City of Cupertino 10 q 9 O OL A'.� PHONE R• PANELS 5:00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR SIGNS 6.00 . 'ENGINEER - LIC.NO, SIGNS TRANS.' 3.00 ARCH,OR ENG. P MIT VA (DATION ADDRESS ' SPECIAL CIRCUIT 5.00 ZIP EMP.METER 08 POLE.INS. 15.00 ^� APPLICANT'S MOTORS SEE,FEE SCH. ADDRESS + 0 Y 0. / /A 1A L Atic C SERVICE CHANGE" 10.00 asi F o a LICENSED CONTRACTORS DECLARATION - a i�• I hereby from that I am licensedunder provisions of Chapter9 - ,C.a h mmemm�g with Section,70001 of Division 3 of IheBusiness'and ISSUANCE DATE {co BLDG. ELECT.Pro(eSSI005 GydeGtl� yjlGense 1570(1111(n/ge yYl<(f``Cn a PL MECH.. c 0.w o, 'License M F w Dat. �' on0acmr _ ¢x a a. OWNER-BUILDER UCCLARATION - BUILDINGPERMIT INFORMATION � - x g w y. 1 hereby affirm that I am exempt from ills Contractors License MISC. REFER TO I, D J Law for the following raasoor(Sec 70315 Busm ssand Professions VALUATION 7 S/FT. er, PERMIT 6.00 Improve, d mulish,or nip which structure permit to to st ante,also ¢ QQO, rmuireshe applicant for sucrepair h p♦mit.turt'pai sin dslalemont.a15O ELEC.CONTR: LIC.NO. ELEC. a. O¢ requires the applicant for such proviso to fide a signet actor's ntalmt 11 TOTAL - PERMIT T0- K eoi w he rs lieensed'.pursuent to the provisions of the Conor utor s License Ria Law(Chapter.9(commencing with Section 7000)ol Division 3 of the fz a Business and Professions Code)or.thal he is exempt they fromland OTY: PLUMBING PERMIT FEE ¢ I- 'he the basis for The alleged exemption Any.violation of Section'7031.5 _ STORIES PE CONSTR. >'',; _ by anyepplicanlfor a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00 of not.more than five hundred'dollars(S50o.): C) 1. as'owner of the property,or my employees with wagesas BACK'F LOW PROTECT.DEVICE their sole compensation,,will do the work,nmd the structure is not 2.00 OCCGROUP RES.UNITS intended,or,offered for sale (Sec. 7044, Business',and 11rofessims, DRAINS-FLOOR;ROOF,AREA;COND. 4,00 Code:The Contractor's.License Law docs not apply.to so owner of property,who builds or improves Ihereon and who docs such work FIXTURES-PER TRAP .4.00 .Himself or through, is own employees provided that such'ouprow. b0:FT,FLOOR AREA TOTAL ACREAGE �. .mens are not imendedocoffered foesale.If,howcer.Mlle building GAS-EA.SYSTEM-11NC.40UTLETS 4.00 P or Improvement Is sold within one year.pf completion the owner GAS-EA.SYSTEM-OVER 4.(EA.) 'builder will have the burden of proving that he did not build or im- 1,00 BUILDING USE prove for purpose of silt.):- INDUSTRIALWASTE.INTER. RES IND CON ' PB' Other ❑ Lasowner of the property,am exclusively contracting with 20.00 El .� licensed:contractors to construct the project(Sec.7044,Business LAWN,SPRIN KLERS-1 ING5 V:B. '5.00 ASSESSORS PARCELNO: El El El 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 acontraclorls)licensed pursuant to the Contractor's License taw. SEWERSANITARV-STORM EA.200ft/8.00 1 TRACT NO. PARCEL NO. 'rea❑sonl um rxcmpt undegSec. .B.&P.C.for ibis WATERHEATERW/VENT 4,00 �• Date Owner WA 4.00 • • ACC.GATE ACC FILE NO. woRKERs1.COMPENSATION DECLARATION WATER TREATING EQUIP.. 4.00 I hereby affirm that I have a cerlificale of-consent to sellsinsure. ora certificate of Worken"Coinpenwtion Insurance,or a certified ZONING ENG.SITE NO. copy thereof(See.3800.Lab.C.). )CM L'�RN Policy Noan : Compy O ❑ Certified copy is hereby lurnlshd. FIRE SPRINK ENERGY T44 Z'.Z � Certified.copy is filed will, the city inspl Dun division. F-p Applicant - MISC. REFER TO ORD. y � N� r� N� - Lt.V CERTIFICATE OF EXEMPTION FROM WORKERS' QHOOD ISSUANCE 6.00 L00020NE A.L.U.C: LU > COMPENSATIONS INSURANCE 'LIC.NO. ,yLG, CL D (This section'need not be,completed if.the pctmil'is for oneTOTAL V.� N� V �. ry� � Z hundred dollars IS 100)or less) U O I Certify that the.performance It the work for Iu 91 this.per. MECHANICAL PERMIT FEE A FEE SUMMARY LL U� mit ,s!aimed,I shall not mploy,any person in ary n..nmr sous to. bL o Ito Warkc;l'C rpor io -aw fCalifornia, y Date • Appl tom ' BUILDING ' } w NOTE TO APPLICANT ILS Lr maks sIC of Ex- R ADD TO MECH. 4:00Z emption,you shouldbecome subject to the Workers CompensationCE ,4.00 PLANCHECK. provisions o('the Labor Code, you must forthwith wmply with - such provisions orthis permit shall h deemed revoked. DLING.UNIT(TO.10,ODOOF.II ,3.00 FEE CONSTRUCTIOMLENDINGAGENCY DLING UNIT(OVER 1O=C FM.1.5.00 SEISMICaFEEI hereoy.affiml that there-is a cunsirucbon Isndmg agency forT HOOD(WITH,DUCT) 2.00 the performance of the workfor which this permit (',issued(Sec. 3097 CN.C.). HEATING'UNIT(TO100,000B.T.0.) 4.00 MICROFILM ' Lender's Name Cmcr's Address HEATING.UNIT(OVER 100,000 B.T.U)7.50 ELECTRIC I certify that I have,cad this uppll ationand state thaClhe above VENTILATION FAN (SINGLE) _ 3.00 intormallom is correct 1 agree to comply With all sty and County. - PLUMBING L71� ordimccs and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 hereby authortae representatives or Ih is city to enter upon the above-mentioned property for inspection purposes. BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL ' (We) agree io eve.:indemnify and keep harmless the City of .MISC.- - > REFER TO ORD. - Cupertino against liabilities,ajudgments.City and a uences which CONST.TAX - may I. any way ncenle against said City in consequence of the PERMIT ISSUANCE 300 f8r�rslin6 i5 Trac Baa 1 MECH:CONT.' LIC.NO. MECH. '/i/g/y� ISP 6- TOTAL TOTAL Signature of Applualc ULIantract., Dale OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED ES - USE BALL POINT PEN ONLY BUILbING'PRbJECT IDENTIFICATION O ' - PERMIT NumeEr+ :SO APPLICATION & PERMIT '4DORE55 _ TUILD!ING—ELECTRICAL—.PLUMBING—MECHANICAL43.99 Ore.ER's. _ -- - - - -- ---- -- PLAN CHECK VALIDATION NA ELECTRIC PERMIT FEE PAID .PHONE CONTRACTORS UTLETS-SWITCHES--RECEP 5.00/1.00 SEP. 30 14Q�. i ,sec.NG 53 7 LIGHTING FIXTURES. 5:00/1:00'. CONTRACTORS - - ` ADDREss APPLIANCES PPLIANCES-RESIDENTIAL 4.00 Pit of ' vHONE � PANELS ' 5.00 'DATE OpAP I TroN ARCHrtECT t - � - SIGNS 6.00 PLAN CH CKFEE 'P,C.NO. OR ENGINEER LIC NO. SIGNS TRANS: 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT '5:00 .. ZSP rTEMP.METER OR POLE INS. 15.00. . ^L APPLICANTS , - MOTORS SEE FEE SCH. 1�o �, ') ADDRESS - \\\„/// SERVICE CHANGE 10.00' Odi 0 '- ,LICENSED CONTRACTORS DECLARATION ` ' <o s~a 1 hereby affirm thrill am licensed under provisions of Chapter 9 ISSUANCE DATE G a2 (commencing with Section 7000)of Division 3 of the Business d s-.ya Profession$C a license is in'full to n �y BLDG. ELECT. PLG. M I ,e o License s Ln.Numbs J` ll�_ _ 0 m_.w Dale Contmcmr� k + ¢ ¢ W.a I OWNER-BUILDER DECLARATION BUILDING PERMIT - MISC,— REFERTO ORD I INFORMATION. w ; I- Thereby u(firm that Fant exempt from the,Contractor's License. F u'y,'� Law for the following person.(Sec 7031'5.Businessand Professions - PERMIT ISSUANCE - VALUATION SIFT- PERMIT I Code:Any city or county which requires a permit to construct.alter, 6:00' ELEC.CONTR. LIC.NO. ¢ re a O Improve demolish,or repair any structure,prior m its issuance.also: ECEC, ' 4 ��¢ requires the applicant for such permit to_ e a.signed statement tnut. TOTAL .w rile LL he is licensed pursuant to the provisions of Elle Contraclor s License P MIT TO r-zi Law(Chapter 9(commtmcing with Section 7000)of Division 3of(he f q o Business and Professions Code),or that he is exempt tNcmfrom and OTY. PLUMBING PERMIT 'FEE X I- the basis for the alleged exemption.Any violation ofS ectioo7031.5a STORIES TYPE C NSTR: u ;,� by not fora unre subjects the applicant toacivil penalty ALTER-DRAIN_ of not more than Ove hundrtd dollars($SOW):. ' ❑ I,as owneeof ibe property,or myemployees with;wagesas BACK FLOW PROTECT.DEVICE 2.00 their,,sole compensation,will do.the work.and the structure is nos. OCL.GROUP RES.UNITS intended or offered.for sale (Sec:?0", Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Commetor i License Law does not apply to an owner of properly who builds or,improJes thtrcbn,and who do•s such awk FIXTURES-PER TRAP 4.00 'sO:FT.FLOOR AREA 'TOTAL'ACREAGE� • himself or through his own employees,provided,that Such improve - mentsare not intended orofrend t'orsale.If,however,(he.building- GAS-EA.SYSTEM-11 NC.4 OUTLETS 4.00 or improvement is sold within'one year of completion,the owner, builder will:.have the.burden of,provmg that lie did not build or im- GAS-EA.SYSTEM-OVER 4.(EA.) 1.00 BUILDING USE prove'for,purpose of sale.). RES IND d FEE Other Ll 1,as owner of,the"property,am'exclusively contracting with INDUSTRIAL WASTE'INTER. .20.00 -� licensed contractors to'cmislrucl the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B.. 5.00 ASSE55o ARCELNO. and Professions Code:The Contractor's License Law does not apply to an owner of property,who builds or,improves thereon.and who LAWNSPRINKLERS-OVER.5'(EAJ 1'.00 DO ntracts for such protects with'a contranorl s)'ieenxed Punuuntm the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B,&P.C.for this reason WATER HEATER W/VENT 9,00 Date' Owner WATER SYSTEM 4.00 - ACC.OATE ACC.FILE NO. WORKERS'COMPENSA710N DECLARATIONq WATER TREATING EQUIP. 4.00 ;I hereby'affirm that.'have a.certificate orconsern to sclr-insu R•, or a.certificate of Workers'Compensation Insurance,or a certified - ZONING ENG.SITE NO. copy thereof(See.3800,Lab.C.)i Policy No. Company O ❑ Certified cqP is her Turn d. Z Z Certified�c is tiled Ix ity'in rasion, FIRE SPR INK ENERGY Tia jr— O A0111 l --. ., r-� -- MISC.- REFER TO ORD. Y❑ NQ Y 0 .NQ cc N CERTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A:L.U.0. W.> COMPENSATION INSURANCE' . PLG.CONTRt. -,_LIC.No. PLG: a'Z ITre dollars ISI d not be completed if the Permit u for one TOTAL - Y❑' NEI Y❑ No. � Z hundred dollars(SI00)or less.) - U'O . I certify that in the purformance of the work for which[his par- OTY; MECHANICAL PERMIT FEE FEESUMMARY LL'F- 'mit is'issued,1.shall not employ any person in any manner w as lO OW become subject to the Workers'Compensation'Laws of California. Q. Date Applicant ALTER OR ADD'TO MECH - q;Op BUILDING Z NOTICE TO APPLICANT: IL after making this Cenill ate of l .ix- - emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 provisions of the Labor Code,;you..must forthwith.comply with PLAN CHECK U suchprovisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 19000 CF.NL) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 5.00 SEISMIC FEE I hereby from that'lhere'is'a,construction lents,agency for EXHAUST HOOD(WITH DUCT) 2.00 OL'' the performance of the work for which this,pennu is issued(Sea, - - MICROFILM 3097.Civ C.): - HEATING UNIT(TO 100,000 B.T.U.) 4.00 O Lender's Name Leader's Address HEATING UNIT(OV ER 100,000 B.T.U.)7f50 ELECTRIC Icertlfy that 1 have read this application and state that Ilse above VENTILATION FAN (SINGLE 3,00 0 information Is'curmc I agree to comply with all city and county ordinances and^state laws relating to budding'constructionrund BOILER DOW(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING " hereby,aulhoriu representatives of this city to enter upon tine BOILER- aboa muntionect property for inspection purposes. COMP IOvar 100,000 BTU;SEE;FEE SCi MECHANICAL (Wetmmi ) agree o save, denfy and keep harmless the City of MISC.- REFER TO ORD. - CnPCrImD against liabilities,judgments, costsand expenses which - . CONST.TAX - may m any way meme;against:s5id City in con seyuenct of the PERMIT ISSUANCE 3.00 3.00 granting of this permit. MECH.CONT. LIC.NO. MECH. Date / TOTAL-•a�O` TOTAL � ' b - Signature of Appbcant/Contractor OFFICE COPY