8619 (2)POST THIS CARD NEAR FRONT OF BUILDING
r: -CITY OF CUPERTINO .
INSPECTION_DIVISION
JOB INSPECTION RECORD
JOB ADDRESS W UNIT# L
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OWNER ' CONTRACTOR . (lid" U.
PERMIT NUMBER
Q
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLEDINSPECTION.
INSPECTION DAT INSPECTOR INSPECTION RECOPD
FOUNDATION r
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Ids
PREGUNITE
PERMIT VALIDATION
PAID
AUG 1 3 CQ
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POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
MECHANICAL
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI DING RMIT '
1 FORM TION
WOOD FLOOR VALUATION
77'
srFT.
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
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STORIES " TYPE CONSTR.
A 0
FRAMING
INSULATION
OCC. GROUP,
J
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
50. FT.LPOORAREA
rJ`...
TOTAL ACREAGE
DIAPHRAGM_Ito^[ BUILDING USE
RES IND CON PB Other
e El 0
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO.
ROUGH '
y PLUMBI NG
GAS TEST !
MECHANICAL //
TRA//CT NO
ATE
PARCEL NO.
ELECTRICAL f S-Q FINALS DATE INSP.
ACC.OATE ACC. FILE NO.
FRAMING 1' rf-s— SAN # r1-72:2 ZONING ENG. SITE NO.
INSULATION PLUMBING
GAS / i
FIRE SPA INK
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ENERGY T•24
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MEC A AL
COVER NO.WORK UNTIL ABOVE HAS BEEN SIGNED HE TIN
FLOOD ZONE
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A. L. U.C.
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LATH -INTERIOR EL CT ICAL f_
LATH -EXTERIOR FI EPT.
SHEETROCK - y GRADE FEE SUMMARY
SHEAR INTERIOR I( I qKy BUILDING ., b
BUILDING
SHEAR EXTERIOR p- TEMPORARY APP OVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEE f fNOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDOCCUPANCY
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL 1SSIGNE BY BUILDING INSPECTOR. MICROFILM
Y
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION._Yrr
ELECTRIC
PLUMBING
MECHANICAL
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CONST. TAX.
TOA
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
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BUI Lt)I NG PROJECT I DENTI FICATI NN
APPLICATION & PERMIT
BUILDING - PLUMBING - MECHANICAL
PERMIT NUMBER
6 9
DUItDING
ADDFLES$
Y LOT 14ELECTRICAL-$
OWNERS
I)eAnza GrO1117, A Cali forma
Ltd. PartnershipPHONE 415/571-1
QTY. ELECTRIC PERMIT FEE
81
PLAN CHECK VALIDATION
CONTRACTOR'S
NAME OUTLETS -SWITCHES- RECEP 10.0011.00
The Alden Company LIC.NO. 465640 LIGHTING FIXTURES 10.00/1.00
DATE OF APPLICATION
CUNTRA-aFt's 411 Borel Ave,Ste, 410
ADDRE5s
San Mateo, Ca.9440Z.O,415/571-14
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT
ORENGIN'Calderon-Nakamur 0013712Ic. N0.
PANELS (OVER 200 AMP) 20.00
PLANCHECK,FEE
to p1, Ipv
P.C. NO.
SIGNS TRANS. 3.00
ADDRESS ENG. 2070 Business Ctr. 220 SPECIALCIRCUIT 5.00 PERMIT VALIDATION
I=MP. METER OR POLE INS. 20,00Irvine, Ca. ZtP 92715 R
APPLICANT'S
ADDRESS
411 Borel Ave, Ste. 410 MOTORS SEE FEESCH,
SERVICE CHANGE 20.00SanMateo, Ca. 94402 C)fyt( rl '!)0
LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00
1 hereby affirm that I am licensed under provisions of Chapter 9
commencing with Section 7000) of Division 3 of the Busine s and
Professions Code, d in license is in full force,a t
License CL s Lic. Number 4 V
ISSUANCE DATE
B ELECT. PLG. MECH,
Date J Contractor A/ MITBUILDIRMATIINFORMATIONOWNER -BUILDER DECLARATION
hereby aaffirmMISC. affirm that 1 am exempt from the Contractor's License
Law for the, following reason. (Sec, 7031.5, Business and Professions
Cade: Any city or county which requires a permit to construct, alter,
improve, demolish, or repair any strueture, prior to its issuance, also
requires the applicant for such permit 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
REFER TO ORD
VALUATION IFT.
PERMIT ISSUANCE 10.00
ELEC, CONTR, LIC. NO.
E LEC.
TOTAL PERMIT TO
VQTY. PLUMBING PERMIT FEE
STORIES TYPE CONS R. the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applieant to a civil penalty
of not more than five hundred dollars ($500).): ALTER -DRAIN &VENT -WATER (EA.) 5,00
1? 1, 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
BACK FLOW PROTECT. DEVICE 4.00 DCCiR%UP R. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or thmugh his own employees, provided that sueh improve-
ments are not intended or offered for sale. If, however, the building
f/
FIXTURES - PER TRAP 5.00 sa FT. FL0 RAREA
Vv
TOTAL ACREAGE
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6,00
or improvement is sold within one year of completion, the owner-
proving that he did not build or im- builder will have the burden of pro
prove for purpose of sale.).
El 1, as owner of the property, am exclusively contracting with
GAS - EASYSTEM -OVER 4 (EA) 200 BUILDING USE
IND CON Pe Other
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
and Professions Cade: 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. 6.00 ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for such projects with a contraclor(s) licensed pursuant to
the Contractor's License Law.
LJI am exempt under Sec. B.&P.C, for this
reason
SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO.
w
PARCEL NO,
WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC. DAT ACC. FILE N0.
WATER TREATING EQUIP. 5.00WORKERS'COMPENSATION 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 (See. 3800, L b.C.),
Policy No. j ny
ZONING ENG, SITE NO.
Sig 17
FIRESPRINK
Y N
ENERGY T-24
Y N
Certi to top is a e6y f is a
X Cert(fied co - th the city inspection division.
AppGcant MISC. - REFER TO ORD.
CERTIFICATE O EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10.00 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
Y N Y N
QTY. MECHANICAL PERMIT FEE FEE SUMMARY
hundred dollars ($100) or tens.}
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
become subject to the Workers' Compensal ion Laws of California.
Date Applicant BUILDING
ALTER OR ADD TO MECH. 5,00
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
APPLIANCE 5.00 PLAN CHECKemption, 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.
FEEAIRHANDLINGUNIT (TO 10000C-F.M.) 4.00
AIR HANDLING UNIT (OVER 10PIMC.F,M,) 6.00 SEISMIC FEE D % CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5,00
the performance of the work for which, this permit is issued (Sec.
3097,Civ.C.).
Lender's Name Bank of America P.O.
Lender's Address
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT (OV ER100,000B,T.U.)9.50 ELECTRIC
I certify that I have read this application and state 91 the above VENTILATION FAN (SINGLE) 4.00
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 B.T.U.) 6.00
BOILER COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICALherebyauthorizerepresentativesofthiscitytoenteruponthe
above-mentioned property for inspection purposes.
M15C, - REFER TOORD.
Cupertino
We) agJhy nd keep harmless the City of
deof ts, costs and expenses which'
may in ana int s City in consequence of the
granting of
5/31/85
CONST. TAX
PERMIT ISSUANCE 10.00
MECH.CONT. LIC. NO, MECH.
TOTAL
TOTAL Ft j
Signature oon actor Date
OFFICE COPY