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3210C.fTY OF :I:1'1N0 I11SPECTI01: RECORD (Offi COPY) s 3 d, �0/0 i' Aaoa - P1;RTIIT NO. SANITARY DIST. NO. LOT NO.� AD1)RI:SS PROJECT I1NER PERMIT ISSUED B u i I di.nr f;].ec tr ical P 111 MI.) inil Nechan ical Teri. Gas/F.Icct. Solar Fire Sprinkler Sip.n Hisc. FINAL INSPECTIONS Date r,,:.s Date g -/ - r3 Power Po l.e _ Under ,r.ound a-��-F3 Rough 1 -firing halls Ceiling -/7-,? Fixtures Int flotors Grounding_ _Temp. Power Other rj N D, Not Approved Insp. f:].ectric Plumbin , � a�83 Nechanical Solar _aa Q3 Pool Gradin., Planning Fira Dept. Health Dept. 5uildin 3 Other BUILDING Date Vad Certification Insp. Foundation Pre-Gunite Slab-1-fembrane Bond Beam Underfloor Girders Floor Steel Tiedowns Diaphrams Seismic Bracing halls -Panels F rame �. Lnth Uallboards Int/f.xt. Firewalls Other Not Approved JOB SITE PHONE NO. Date I Insp. PLUMBING Date Backflow Insp. Under ,round Underfloor Partial hough - Rough Complete Solar Rough Water & Insulation Main Drain R/of/S Drain Gas Other Not Approved t•fLCHANICAL Date Underfloor S.M. Insp. Ducts & Insulation Fire Dampers Fircplac:e Grease Duct & hood One hour Shaft Condensate Drain Elquipment Anchorage- nchorageFlues Flues& Comb. Air Other Not Approved Pg n7'i9 c /L pu GW f cP c? 37.83 06rl5 /ZoQC- QCT E� / f- or 3� CA C3cT 3,� �p� rto�r�s' ��IShi c 83�( P.'� ScTe sf�s�c 4-i3.F3� �9 5 g,8,�i.0 �Pc,��, N- rc-9 z ELECTRICAL PLUMBING IIECHANICAL MISCELLANEOUS CITY OF (UPERTII BUILDING DEPARTMENT AnAlk Certificate NO. _. 598- - ; THIS IS TO CERTIFY that the (description of building or structure). Existing Building (Interior Remodel): ----------------------------7---------- -------------------------------------------------------------A.P_1 E._CQ10jua-----------------_-------------------------------------- ------------------------------------------------------------------------•------------------------------------------------------------------------- Erected on Lot No___________________________________________Block No. Addition--___1Dt£rigx_ Remodpj--------------------------.Fire Zone ------ III----- Street No. ___10460__Bandley Drive_________ _____ ___ Occ. Group B-2 --------------------------------------------- Owner ........ Apple_•Computer------------------------------ Use Zone Architect .... Eu.,zixaumezta.1--PZauning_&_liasaaxch.I=------------------------------------------------------------------ Contrac4or __:_K,O, Swanson_&_ Co. Inc - ------- ----- - -----------------------••-------------------------------------.._..------...---...-------------- Building Permit No. _3062 ..... ------------------------- Plan No- ---------------------------------------------------_-_---- has been inspected and the following occupancy thereof is hereby authorized. OCCUPANCIES I Max. Allowable Floor Loads per sq. ft. Basement- ----------------- - ---=------=------....-------- o -------------------------------------------------------------------------- ---------------•--------------------------------------------- st fl.00r------ Exp.stacg_ 51,ab_ an_ Gx4ste---------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------- 2ndfloor ------------------------------------ ------------------------------- -------------------------------------------------------------•-------------------- ------------------------------------------------------------- 3rd floor ----------------------------------------------------- --------------------------------------------------------------------------------- -------------------------------------------------------------- 4thfloor ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- ------------------------------------------------------------- Add floors as necessary _____________________________ ------------------------------------------------------------------------------ - - - - -- ------------------------------------------------------------- ROOfExisting---------------------------------------------------- 20��/Ft_-_Live_ Load------------------------------- City of CUPERTINO----------------- JunP._19.................. 1 19.83... 9 BUILDING.OFFICIAL Tkis-certificate must be posted and permanently maintained in a conspicuous place at or clns_e to the entrance of the building or structure referred to above. i' APPLICANT TO. FILL IN INFORMATION WITHIN RED LINES - USE BALL_ POINT PEN ONLY 1`M OFFICE COPY ErUI LDI NG PROJECT I DENTI FIPER APPLICATION & P MW - BUILDING -ELECTRICAL PLUMBING' -MECHANICAL _ ' §062 BUILDING ADD 55 - ' ' -- O ER'S NAME A z ^- 7 A QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION _ o ,/G//�/ /�^i L DATE OF APPLICATION CONTRACTOR'S NAME OUTLETS -SWITCHES - RECEP 5.00/1.00 � '"J; 16 LIC. NO.3,F LIGHTING FIXTURES- 5.00/1.00 CO TRACTORS PPLIANCES- RESIDENTIAL 4.00 .73 9 k&-,57 e, -ONE PANELS 5.00 ARCHITECT^ ,� 6.00 OR �/�� SIGNS ., ENGINEER LIC. NO. SIGNS TRANS. 3.00 PLAN CHECK FEE P.C. NO. ARC H. OR ENG.SPECIAL CIRCUIT 5.00 ADDRESS zrP EMP. METER OR POLE INS. 15.00 PERMIT VALIDATION , AMOTORS SEE FEE SCH: ADDDREDRESSS S ' SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 - mmencing with Section 7000) Of Division 3 of the Business and, - ,Kfessions Cod d y license is in full fo ce t f cl ill Class Numbe Ka ISSUANCE"DATE BLDG- ELECT. PLG. MECH. e Contractor BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License MISC. - REFER TO ORD Law for the following reason. (Sec. 703 1.5, Business'and Professions PERMIT ISSUANCE 6.00 Code: Any city -or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also ELEC. CONTR. LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that TOTAL he is licensed pursuant to the provisions of the Contractor's License VALUATION / ! j �Q O, �P 0 $/FT. PERMIT TO , Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE STORIES' TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant toa civil penalty ALTER -DRAIN & VENT -WATER (EA.) 4,00 of not more Chari five hundred dollars (5500).): ❑ 1, 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 is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS -FLOOR, ROOF, AR EA,COND. 4.00 Code: The Contractor's License Law does not apply to an owner of OCC. GROUP ' RES. UNITS _ property who builds or improves, thereon, and who does such work FIXTURES - PER TRAP 4.00 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 SO. FT. FLOOR AREA I •- TOTAL ACREAGE or 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 lie did not build or owner - prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ 1, as owner of the property, ani exclusively contracting with BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ licensed contractors to construct the project (Sec. 7044, Business LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 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 ASSESSORS PARCEL NO. �� contracts for such projects with a contractor(s) licensed pursuant to . the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/8.00 arte+ TRACT NO. PARCEL NO. ❑ I am exempt under Sec. B.&P.C. for this WATER HEATER W/V ENT 4.00 reason Date Owner WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. WA•T.ER'TREATINGEQU,IP. 4.00 WORK ERS'COMPENSATIONDECLARATION 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 thereo 0 La Policy No FIRE SPRINK Y ❑ • N ❑ ENERGY T-24 Y ❑ N❑ I g..,Certifie py is r urnished. ❑ Certifi i city inspection division. Applicant MISC. - REFER TO ORD. CERTIFICATE OF EXEdkT.14 FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This section' need not bei completed if the permit is for one Y ❑ "N ❑ Y ❑ N ❑ PLG. CONTR., LIC. NO. - PLG. TOTAL hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mit is issued, 1 shall not employ any person in any manner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING �! d' become subject to the Workers' Compensation Laws of California. Date Applicant - ALTER OR ADD TO MECH. 4,00 NOTICE -TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE 4.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10)000C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT (OVER 10,000C.F.M.) 5.00 SEISMIC FEE T°Z' 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.)./I/��e MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name (� Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)7.50 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. ordinances and state laws relating to building construction, and PLUMBING BOILER -COMP (3 H.P. or 100;000 6.T.U.) 4.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon.the above-mentioned property for inspection purposes. MISC. REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in an way accrue ag ' st said City in consequence of the PERMIT ISSUANCE 3.00 grand g tl}jg per ' MECH. CONT. LIC. NO. MECH. . TOTAL TOTAL Si na ure o Apphca o act oDat.01. 1`M OFFICE COPY �APPLICANT'TO'FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY zl- O Z Z I C) � � W _ ao Z) Z Uo_ L U O w. CL .E0 I"' Z i' BUI LDI NG -PROJECT I DENTI FIC )N BUILDING / APPLICATION.& PL... -JIT BUILDING - ELECTRIADDRESS CAL- PLUMBING -MECHANICAL PC 552O PLAN CHECK VALIDATION OWNER'S -, NAME QTY. ELECTRIC PERMIT FEE. PHONE NT A OR' NA V OUTLETS -.SWITCHES - RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 LIC. NO. - IrCNNTRAC'TOR's DATE OF APPLICATION �y.-� ESS D c.i. i . PHONE ^%�p• APPLIANCES -,RESIDENTIAL 4.00 PANELS 5.00 ARCHI E OR ENGINEER , ' Llc. nlo. . SIGNS 600 PLAN CHECK FEE . P.C.'NO. SIGNS TRANS. 3.00 AARCH. OR DDRESS ENG. ZIP SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ' - TEMP. METER OR POLE INS. 15.00 APPLICANT'S ADDRESS � 3 %'L�✓- MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 - L ENSED CONTR CTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions ofChapter,9 (commencing with Section 7000) of Division 3 of the Business anq Professions Code m license is in full fort nd effect. ` Number License Cla Lic. NumberEK ISSUANCE DATE , BLDG. El ELECT. F-1 PLG. MECH. Date Contractor BUILDING PERMIT OWNER= UILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and ProfessionsPERMIT Code: Any city or county which requires a permit to construct, alter, improve, demolish, or.repair any structure, prior to its issuance, also requires the.applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License INFORMATION MISC. - REFER TO ORD VALUATION $/FT. ISSUANCE 6.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO - QTY. = PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of not more than five hundred dollars (5500).): - ALTER -DRAIN &VENT -WATER (EA.) 4.00 ❑ I, as owner of the property, or my employees with wages as their -sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044„Business and Professions Code:; The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP. RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 4.00 FIXTURES - PER TRAP 4.00 �• SO. FT. FLOOR AREA TOTALACREAGE GAS- EA. SYSTEM = 1 INC.4 OUTLETS 4.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or owner prove for purpose ofsale.). - ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 20.00 licensed contractors to construct the project (Sec. 7044, Business 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 - 1 INC 5 V.B. 5.00 ASSESSORS, PARCEL NO. 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/8.00slTRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,BAP.C. for this reason WATER HEATER W/VENT 4.00 Date Owner WATER SYSTEM 4.00ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 4.00 WORK ERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self-instye. or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.C.). Policy No. ' Company FIRE SPRINK Y NO ENERGY T-24 Y ❑ No ❑ Certified copy is hereby furnished. ❑ Certified copy is Filed - with the city inspection division: Applicant MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This section need not be completed if the permit isfor one Y [:]'❑ N N Y [:]❑ PLG.CONTR. ❑C. NO. PLG.(gyp p� TOTAL /O hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mit is issued, shall not employ any person in any tan"er so as t'o QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become bje IteWorkerm a' of i rnia. a Date Applicant NO P LICANT: I , af[e ma ng his Certificaf of Ex- ALTER OR ADD TO MECH. 4.00 APPLIANCE 4.00 PLAN CHECK empt. n, you should become subject to the Workers':Con ensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 3.00 AIR HANDLING UNIT(OVER 10,000C.F.M.) 5.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY 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.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)7.50 - ELECTRIC I certify that I have.read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, 'and VENTILATION FAN (SINGLE) 3.00 PLUMBING Aa BOILER -COMP 13 H.P. or 100,000 B.T.U.) 4.00 gQl LER-COMP (Over 100.,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon. the above-mentioned property for inspection purposes. (we) agree to save, indemnify and keep rtes' the City'of Cupertino against Nabi ies, judgments, cos an expenses which may in any way ace a again( said C' n/n,equence of the MISC. -- REFER TO ORD. CONST.. TAX PERMIT ISSUANCE 3.00 gr ng p t ' MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Ignature of Ap i ant/Contr for Date - / OFFICE COPY Y T /4 O) Z Z �:O UJ > 6- 3- 0 0 Z UO_ LL Oa } U) F- Z-- AE „ AE APPLICANT TO FILL IN INFORMATION WITHIN HEU LINES - USE BALL NUIIv I NLIV UIVLY-,-,7�, • BUI LDI NG PROJECT I DENTI FIC )N BUILDING AD RES /O��CP. v - `APPLICATION & PL.....IT • • ,=-' BUILDING _ ELECTRICAL --PLUMBING - MECHANICAL a IBER 3210 PLAN CHECK VALIDATION - DATE OF APPLICATION OWNER'S - _ - NAME QTY. ELECTRIC PERMIT �1 PHONE 1 FEE CONTRACTOR'S •' - OUTLETS. - SWITCHES-RECEP •5.00/1.00 NAME 1512C O (C LIC. NO. ZJSD LIGHTING FIXTURES 5.00/1.00 CONTRACTOR'S APPLIANCES- RE81DENTIAL• 4.00 _S V Jco 4-I 6I W ' PHONE qIq6- b PANELS5.00 Q RCHITEC , Abp , - OR �-ll O ENGINEER uc:No. I SIGN$ 6.00 �'• SIGNSTRA'NS. 3.00 (� PLAN CHECK FEE P.C. NO. • ARCH. OR ENG.SPECIAL ADDRESS CIRCUIT S,OQ (� PERMIT VALIDATION ZIP TEMP.IMETER OR POLE INS. 15.00 - I . i APPLICANT'S G�TI 'MOTORS SEE FEE SCH. ADDRESS - 93M �Co 1% 6/ 03 - SERVICE CHANGE PAM 10.00 LICENSED CONTRACTORS DECLARATION hereby affirm that I am licensed under•provisions of Chapter 9-, (commencing with Section 7000) of Division 3 of the Business and Professions Cod an y license is in full forEn f 1. License Clas Lic. Number (J Dale -sa Contractor MAR 4 7r -t City of �t1^�'�"'^ lrI ly ISSUANCE DATE BLDG.- ❑ ELECT, �, PLG. • ❑ MECH. ❑ BUILDING PERMIT �Contractor's OWNER -BUILDER DEC I hereb affirm that I am exem om License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires permit toconstrucl, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and MISC. - REFER TO ORDyVALUATION PERMIT ISSUANCE. 6.00 ELEC. CONTR. LIC. NO. OV TOTAELEC.�96 QTY. PLUMBING PERMIT FEE INFORMATION $/FT, - PERMIT TO ELGCC-% QNL STORIES TYPE C $TR: the basis for the alleged. exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to civil penalty of not more than five hundred dollars (5500).): ALTER -DRAIN & VENT -WATER (EA.) 4.00 ❑ I, as owner of the property, or my em ployees-with -wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who, builds or improves thereon, and who does such work DRAINS -FLOOR, ROOF, AREA,COND. 4.00 F IXTURE$ - PER TRAP 4.00 So. 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.withinone year of completion, the owner- builder, will have the burden of proving that lie did not build orim prove for purpose of sale.):. ❑ 1, as owner of the property, am exclusively contracting with GAS 'EA. SYSTEM -OVER 4 (EA.) 1.00 INDUSTRIAL WASTE INTER. 20.00 USE - BUILDING USE RES •IND CON - PB Ocher ❑ ❑ ❑ . ❑ ❑ licensed contractors to construct the project (Sec. 7044, Business 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- 1 INC 5 V.B. 5.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200f t/8.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. B.&P.C. for this. reason WATER HEATER W/VENT 4.00 _ Date Owner WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 4.00 WOgKERS'COMPC-NSATION_ DECLARATION 1 hereby affirm that I have a certificate of consent.to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.C.)� PolRo. mpany �� ZONING ENG. SITE NO. _ FIRE SPRINK Y ❑ N ❑ ENERGY T-24 v ❑ N❑ rtified co ereby furnished. rtified filed with the city inspection division: ,Apt MISC. - REFER TO ORD. CE IF ATE OF EXEMPTION FROM WORKERS' PERMIT -ISSUANCE 6.00 FLOOO ZONE A.L.U.C. PLG. CONTR. LIC. NO. J PLG. TOTAL COMPENSATION INSURANCE (This section need - not be completed if the permit is, for one Y E)N ❑ Y ❑ N ❑ hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT , FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER -OR ADD TO MECH. 4.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE - 4.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions'or this permit shall be deemed revoked. FEE AIR HANDLING,UNIT (TO I0,000C.F.M.) 3.00 AIR HANDLING UNIT(OVER 10)=C.F.M.) 5.00 SEISMIC FEE CONSTRUCTION -LENDING AGENCY 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.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATING UNIT (OV ER'100,000 B.T.U.)7.50 I C ELECTRIC 3 96 Lender's Name Lender's Address Icertify that I have read this application and state that the above information is correct. I agree to comply with -all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER-COMP(3H.P.OrJ00,0006.T.U.) 4.00 BOILER -COMP (Over 100,000 BTU),SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter -upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which Inaccrue against said City in consequence of the PERMIT ISSUANCE 3.00 n1iL - MECH. CONT. •LIC. NO. - TMECH OTAL '- TOTAL Date / OFFICE COPY Ad09 �3Idd0 .T �! 1d101 18101 'ON'311 '1NOO*H03V4 ed laeiluoD/lu ay tlJoalnleu'HO3W '1!wj Jo'U!)ueJB ayl Jo a3uanbasuo3 u! p!,_I p!es ]su!e8e a.33e Arm Cue u! Cew yq!ym sasuadxa pue SIS05 'SluawBpnf 'sa!)!I!ge!I ISU!CSe' OUgjadn:) JO ,Cllr ay) Ssalµujey daall pue ,CJ!uwapu! '3nes 0) aaJSE (aM) sasodmd uog3adsu! 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'09- a: oo¢ U ~ Z w W 4 N I- N z_ z O O z H w < N ,2J a Q w 1a U x 3 w N ~_ LL O a: <0 w ¢ O a X o u W m N FZy. I C1 ¢ r_ o w 3 °D Q � z 0\ Q_ In W > t1O Z)Z 00 U_ Lu } 'a In U APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT 1 DENTI FI( )N BUILDING APPLICATION &,P -----IIT ADDRESS - BUILDINGELECTRICAL-PLUMBING -.MECHANICAL PE J MBER r� r] 2 j OWNER'S CCl/ _ - NAME CITY. ELECTRIC PERMIT FEE. PLAN CHECK VALIDATION PHONE , - CONTRACTOR'S NAME �r D.W/O Ne- LIC. NO.3106147 OUTLETS -SWITCHES - RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 ADDRESS DoR•s. - •' _ APPLIANCES - RESIDENTIAL 4.00 PANELS 5.00 ZooADDRESS / PHONE DATE OF APPLICATION ARCHITECT - OR ENGINEER' LIC. NO. SIGNS - 6.00 PLAN CHECK FEE P.C. NO.. SIGNS TRANS. 3.00 ARCH. OR ENG.SPECIAL ADDRESS - CIRCUIT rj-QQ PERMIT VALIDATION , TEMP. METER OR POLE INS. 15:00 ZIP •A ADDRESS, , MOTORS SEE FEE SCH. SERVICE CHANGE 10.00. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9_ ISS ANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Cold nd t license is in full fort ap of ec License ass Lie. Number - BLDG. ❑" ELECT. ❑ PLG. ❑ MECH. Date Contractor BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reasoA. (Sec. 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Seclioii 7031.5 INFORMATION MISC. - REFER TO ORD VALUATION $/FT.' PERMIT ISSUANCE 6.00 ELEC. CONT R. LIC. NO. ELEC. TOTAL PERMIT TO QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant toacivil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN &VENT -WATER (EA.) 4.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 4.00 intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of 1 FIXTURES -PER TRAP ' 4.00 „' SO. FT. FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who does such work 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, the owner- builder will have the burden of proving that he did not build or int prove for purpose of sale.). ❑ 1, as,owner of the property, am exclusively contracting witli GAS EA..SYSTEM -OVER 4 (EA.) 1,00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 20.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who LAWN SPR IN KLERS - 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 Contracts for such projects with a contractor(s) licensed pursuant 10 the Contractor's License Law. SEWER -SANITARY -STORM EA'. 200ft/8.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. B.&P.C. for this reason WATER HEATER W/VENT 4.00 Date Owner WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 4.00 WORKERS'COMPENS'ATION DECLARATION 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.). i Policy o. Cmpany r ❑ erli(ied copy iso hereby furnished.'✓- ' ,y ✓ '� Certified C ), is J"iled with the city inspection division. Applicant�76�.j�� - FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ MISC- - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one V ❑ N❑ V ❑ N❑ hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I'shall not employ any person in any manner so as to QTY,. MECHANICAL PERMIT FEE - FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD H. 4.00 7X NOTICE TO APPLICANT: If. after making this Certificate of Ex- APPLIANC 4.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you"must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLI T 1 ,000C.F.M.) 3.00 FEE - AIR HANDLINGUNITJ.O ER1 C. F.M.)5.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST H NW151 WIM 2.00 the performance of the work for which this permit is'issued (Sec. 3097,Civ.C.). Lender's Name Lender's Address MICROFILM HEATING UNIT (TO 100,000 B.T.U.) . 4.00 ELECTRIC HEATING UNIT (OVER 100,000 B.T.U.).7.50 I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00 information is correct. I agree to comply with all city and County ordinances .and state laws relating to building construction, and PLUMBING BOILER -COMM H.P. Or 100,000B.T.U,) 4.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL a.hL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City, in consequence of the PERMIT ISSUANCE 3.00 granting i ,this permit. :. -/'(� -f3 MECH. CONT. LIC. NO. MECH. • TOTAL �i (� TOTAL .3;23 Sig ure pplicant/Contractor Date OFFICE COPY i m town FEE ry00 2 CJ C3 'NI r A 'DOCUMENTATION FORM BUII.DING LIGHTING COMPL IAP Project Title A0,ot,E COMPUTE2 I,./c• /34 IV o c cr dv- Location � t VVVN?e� r21 "� Documented by vp:r,kerfor� P, [ac.4[G. E727% T /G 4t.$i86-7-06/ Date Project Designer EP.Q /rtc, kO- Siyvr�s�7 GfLo F,�r �,; �^ Checked by Date �>AJK/NpN TASX Room Room RCR Task Areas Note sq. Ft 1J a. Sg. Ft. Total Watts Allotted Design Na. 5a. Ft. Aad: /Occ. Occ.. iTa•sk Sq. Ft.. /Sq. Ft. `,•vans Waus I �r Page Total ��5 7 Y� (5 A�.c.ow6a ocTs.G,�cv rd s� z / I /OO J •d4 S Q �Z52 3.6 A S' . 3.?.� 320 pox z z4�� I tom � �► /as /}-d S/ ' / GO t. s 37� j2p 7y- 57 y70 3z0 /07 / 9s st oFF�eE E 77s Asa G �,� zoo zu� I I�asr.s s.6 !08 B5 -0S �-'s GE.v.ofr�Cs / sss•s i z 20 y�/Z /SGro /09 ,2 zO _ ,` L-A IM. //D 5f --VS' Y� r 17s7{l.s 3.6/,2 /So S' D—*r SeN.d>�f/cam isx.s 2S`/ 4167 /// /9S S f Orricc + I97 7.5 0 Z zoo Sf OFA/G� j s7 C _f _!30 g ,-/ c E I /?s /'Z 9 9•S 9040 e-LUSE7- - /Orin "b -- 5 2 6� / 0 0-•S' ZY2 �oCJN6. J�?O: I / I /3ot I /los' +f,6 /. z Gj Z to � S 7'� O //7 N/iii V14 C L o S t-'` I -axs/( /�9 390 °-`S Dr, -c -/cam / 1 /45 10 goo 13 /s- 195' s� 2ysy pFF/C / I g7f S 3 y 97 5 00 9,r�s 2 sz ISBrs 3,� 2 98 3 00 I �r Page Total ��5 7 Y� (5 A�.c.ow6a ocTs.G,�cv rd DC3-UMENTATION FORM — LIGHTING rn"PLIANCE • PROJECTTITLE E e1*7 I.yc. -BAzu1-)e fx,'e� Room Room RCR Task Areas Note Sq, Ft. No. No. Sq. Ft. Appl. /Occ. Occ. ?ace 2 or For So. Ft. 'T al W Allotted Design /Task Sq. Ft. /Sq. Ft. Watts Watts /,22 iQ 3 s>� �-, rcME�✓ — _" — — / 4 3 $1,97 3 Z.0 /23 2S9 o .4I!=, /z¢ rid z 2 i s,� 2�7 Nl ,7'a t L , _ _ z / /, 6 '34-'o 12$- 7A9f 6 ¢ S 7L zy7 �.t(ow�(� RM —' I — I G ¢ !, to /OZ lee e PA�r L y7 iA96j sed 72o D �S zs�L GEv.O><)=/GE' I /o o /, 72- �i4ia:� <'y0 17 - 27 2- Fr=Ic-6 / !00 2,72- ,7zA-7 A- 7Z 0 _'S �FFI CC- / I l00 ,?,722 /3.2. 8, zoo �-°�C_ �frL 6c•�J. B FF/c.E I / �d D Bz.o I./ioD 5 0 4�ioo 3.6 /, z /9 6 go 9 00 40 ", R -- I I I 1�_ OF ESS/p ' ~ � 0. vd'_�U� _ gi X77 R\C,p`\' 2N'' Page Tofa� l'T CT \P I s r P4ge To W, F OF CAUE�� 7Building Total 6 9 / T3 0T --- << i _ 2 lOY- _ asp -- - - --- - - - -- - - - ----0--'- 4 -- - - ----- --- ' -