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13311POST T ARD NEAR FRONT OF BUILDING CITY OF CUPERTINO� INSPECTION DIVISION JOB INSPECTION RECORD 10055 N. PORTAL AVE JOB ADDRESS UNIT# S • 13�T# ' OWNER DR. WEBB CONTRACTOR HDI CONSTRUCTION PERMIT NUMBER YPERMIT EXPIRATION -^" PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM CAULED INSPECTION. A INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATIONr� �-� S0� it -LAST LIFER - PREGUNITE PwL�; }i V W/' PERMIT VALIDATION l��CI�CI�'rlkRp - /% ISSUANCE) E� POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL BLD . ELECT. PLG. MECH. ❑ ❑ 00 NOTPOURFLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERM I,7 INFORMA710 WOOD FLOOR VALUAT19 $/F T. PLUMBING 'rti/"� MECHANICAL ELECTRICAL phi FRAMING INSULATION - TORIES TYPE CONSTR. OCC.GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO, FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM 1 p� /D )T 7 RES IND BUILDINGUSEUSEPB Omer ❑ 1:1 El ED Q APPLY NO ROOFING UNTIL ABOVE HAS B SIGNED ROUGH ASSESSORS PARCEL NO, PLUMBING GAS TEST TRACT N0, PARCEL NO. MECHANICAL ELECTRICAL e- '-$- FINALS DATE INSP. AOC DATE ACC FILE NO. FRAMING p.- SAN # INSULATION PLUMBING ' ZONING . ENG. SITE NO. GAS FIRE SPRINK Y [:] NQ ENERGY PPE Y ❑ NF] MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FLOOD ZONE Y❑ N� A.L. u. c. v0 No LATH—EXTERIOR FIRE DEPT. II to SHEETROCK 0-3-4,"1 GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING�I�^' ,. SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS JELECTRIC PLAN CHECK FEE GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE r OCCUPANCY OF BUILDING IS NOT PERMITTEU ON FIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, P� ONE WORKING DAY BEFORE REQUIRED INSPECTION. z 'PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - I ELECTRIC PLUMBING MECHANICAL CONST. ONST. TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. I TOTAL . OFFICE COPY APPLICANT TO FILL IN IrSRMATION WITHIN RED LINES - U'&iALL POINT PEN ONLY 'BUILDING PROJECT IDENTIFICATION APPLICATION & RMIT PERMIT NUMBER - '~ I pp,pESgg }9AC O /, BUILDING - ELECTRICAL- PLUMBING - MECHANICAL 13311 OWNER'S /J , //r•� ,NAME.i1e 4Wabb . �/ WWF_ QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE- p ( NOM RACTDRS UTLETS-SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00CONTRA CTORsADDRESS Rr�A� p.e� PPLIANCES- RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION OR "ITE ENGINEER LIC. NO PANELS(OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP / APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE .20.00 C-- LICENSED CONTRACTORS D17CLARATION I hereby affirm thus I am licensed under provisions of Chapter 9 (commencing with Se tion 7000) of Division 3 of the Business and Professions Code, y license is in full fore License Cla Lie. Nu her ' Date Can � 019SUANCE DATE BLDG. ELECT. f- ! " - PLG. MECH. ❑ ❑ a BUILDINGINFORMATION Js 1.. INFORMATION OWNIER-BUILDER DIE . ATION I hereby affirm that I am exempt from the Contractor's License tssand Professions Law forthe foll Dreamily eq iresa Poirot requiresit to consuance, also Code: Any city Dr noun pair any structure, improve, demolish, or repair any structure, prior n its issuance, also prior requires the applicant for such permit to file a signed statement Ilial he is licensed pursuant the provisions of the Contractor's License r b, MISC.- REFER TO ORD yqL fl7lPN O-V-iJ / $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. UC. NO. ELEC. TOTAL PER TO QTY. PLUMBING PERMIT FEE en of Division 3 of the (Chapter 9 (commencing with Section is exempt and Business and Professions Code) or that he isexempt Business STORIES TYPE CONSTR. edict 70 the for lbs alleged exemption. Any vapplicn of Section malty by any applicant for permit dollars tire applicant toacivil penally any a of not more than live hundred dollars (my ALTER-DRAIN-WATER(EA.) 5.00 employees ❑ Las owner at the property, or my employees with re is not their Sole compensation, will da the work, and [he structure is not BACK FLOW PROTECT. DEVICE 4,00 OCC. GROUP RES. UNITS ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR, 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 through his own employees, provided that such Improve- mentsarenetintendedorofferedforsale. If, however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SVSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion, the owner - builder will have the burden of proving (]let he did not build or int- builder prove 1, asnerof theJ. ❑ 1, as owner of the property, am exclusively contracting with - EA. SYSTEM -OVER 4 IEA.) 2.00 - BUILDING USE RES IND CON PS Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 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.8. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts forsuch projects with aconlractots) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under See... BAP.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORK f RS'COMPF-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 en r copy (hereof fSec. Lab.LL /1 _ �f - ZONING ENG. SITE NO. • Policy Company ❑ Certifiedcopyis hereby furnished. Cerlific c py d w 1 c y spa 'on division. O plic rat/ FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ MtSC. - REFER TO ORD. CERTIF-IC 1'E F' EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. ENSATION INSURANCE. (This section need not be completed if the permit is for one PLG. CONTR. LIC. NO. PLG. TOTAL v ❑ N ❑ Y ❑ N ❑ hundred dollars IS 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 OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING -7C become subject to the Workers' Compensation Laws of California. Date ApplicantALTER NOTICE TO APPLICANT: II', after making this Certificate of nix- OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you trust forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10MC.F.M.) 4,00 AIR HANDLING UNIT (OVER 10MIC.F.M.) 6.00 SEISMIC FEE p a 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, CN.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address H EATING UNIT 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 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 PLUMBING gOILER•COMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon trio above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. Cupertino against liabilities, judgments, costs and expenses whish may in any way accrue against said City in course uence, of the PERMIT ISSUANCE 10.00 CONST. TAX gra in f 1, Ic ni MECH. CONT. LIC. NO. MECH. TOTAL TOTAL /7 ( G 6�•`• Sign ore Applicant/Contractor ate U OFFICE COPY APPLICANT TO FILL IN IN&WATION WITHIN RED LINES — US,6,RALL POINT PEN ONLY I LDING PROJECT I DENT[ FI -T] ON APPLICATION & MIT BUILDING — ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER -- 13875 pBU �B01o1115i'•� O0 SxS O / l� OWNER'S - NAME CITY, ELECTRIC PERMIT FEE PLAN CHECK VALIDATION N- Ir PHONE CONTRACTORS NAME OUTLETS-SWITCHES-RECEP 10,00/1.00 (n1 / to ) UC.No.V6,9 J0 DATE OF APPLICATION LIGHTING FIXTURES 10.00/1.00 DDREScroRs As OOREsq y Q '}I C D V t PHONE AIC '� / �Vp PPLIANCES- RESIDENTIAL 4.00 PANELS - 10.00 ARCHITECT OR ENGINEER LIC. rvo. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO, ISIGNS TRANS. 3.00 ARCH. Ess ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 .P APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 Da6o nPrf;, AL Ave P. r — .4 LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 {commencing with Section 7000) of Division 3 of the Business and Professions Code and 1py license is in full fort ark effect License Class �1 L Lic. Number O L o sl 0 j•;{y- -.IS UA E DATE BLDG. a EL CL. `) 0 PLG., MECH. ails' Date Contractor OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Professions Law for the ityfollowing reason. (hrequires a Business to Code: Any city or county which requirese permit to construct, also improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file o signed statementisLithat he is licensed pursuant to the provisions of the Contractor's License BUILDING PERMIT INFORMATION MISC.— REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL P IT TO , DTV. 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 CRIES TYPE TR. the basis for the alleged exemption. Any violation of Section 7031,5 byanyapplicant for a permit subjects the applicant to a civil penally of not more than five hundred dollms (S500)J: ALTER -DRAIN & VENT -WATER (EA.F 5,00 O 1, as owner of the properly, or my employees with wages as (heir sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS intended or offered for sale (Sec. 7044, Business and Professions 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 through his own employees, provided that such improve - meats are not intended or offered for sale. I L however, the building . �) F IXTURES - PER TRAP 5.00 /I 0 50, FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SYSTEM-l1NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner builder will have the burden of proving that h e did not build or im- prove for purpose of sale.), ❑ 1, as owner of the property, am exclusively contracting with . .. GAS - EASYSTEM •OVER 4 (EA) 200 BUILDING USE RES MD CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: T'he Contractor's License Low does but apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contractsforsuchcenprojects Lwith acnnlmctorts)licensed pursuant to the tracts for s s License Law. SEWER -SANITARY -STORM EA. 200f1/10.00 TRACT NO. PARCEL NO, ❑ I am exempt under Sec.—, B &P.C. for this reason , WATER HEATER W/VENT 6.00 0 0 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COAIPENSATION DECLARATION I hereby affirm that I have a certfficate of consent to self -insure. or a certificate ofWorkers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab .C.). E %N A Policy No, Company FIRE SPRINK Y❑ N❑ ENERGY T$4 Y❑ IN Car( triedcopy is hereby furnished. Certified copy is filed with the city inspection division. Apllicant MISC.- REFER TO ORD. CER7'IFICATIi OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 /O •i FLOOD ZONE a. U.C. PLG. CONTR.LIC NO. N 2 Q PLG. / OC TOTAL p '� COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N ❑ hundred dollars ($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 QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Dale ApplicantALTER . . OR ADD TO MECH500 NOTICE TO APPLICANT: If, after making this Cerlil'icale of Ex- emption, you should become subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 1000041F.M.) 4.00 FEE AIR HANDLING UNIT (OVER 10MIC.RM.) 6.00 SEISMIC FEE 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.). MICROFILM ' HEATING UNIT (TO 100,000 B.T.U.) 6.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Name Lender's Address 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 I VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER-COMP(3 H. Por100,000B.T.U.) 6.00 BOILER -COMP (Over 100,000BTUISEE FEESCH. MECHANICAL liareby authorize representatives of this city to enter upon the above-mentioned property for inspection pumascs. MISC. - REFER TO ORD. (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 TAX PERMIT ISSUANCE 10.001CONST. grunting of this permit. l %—li % MECH. CONT, LIC. NO. MECH. TOTAL TOTAL Signature of Applicant/Con tractor Date OFFICE COPY APPLICANT TO FILL IN I RMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI TION - APPLICATION & MIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 8864 aD,LD,„G BUILDING A . F OWNER'S NAM CITY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE CONTRACTORS E _ 9LIC No. UTLETS- SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 - CON eAC DRS NJ PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 E vHON DATE OF APPLICATION ARCHITECT �T�s� OR�t+l =,.. � ENGINEER LIC. No PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEEP.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG. ! SPECIAL CIRCUIT 5,00 PERMIT VALIDATION -+rrEMP. METER OR POLE INS. 20.00 ZIP SOPPY �� CI OISsr)q E ADDRESSTS ' MOTORS /, 00 �� SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 / TEMP. POLE 30.00 (commencing with Section 7000) of Division 3 of the Business and Professimss Codsr^an license isNfullfore;�7pyejJ'eQyr Licens Class (r- BLDG. ELEC PLG. MECH. ❑ ❑ ❑ onract Date ContractoL,QyA�❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's s License Law: Anycity a'count which e. requires a perminess t Docnd Professions Code: Any city or county which requirese permit toconstruct, alter, BUILDING PERMIT INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION S/FT. ELEC, CONTR. LIC. N0. - ELEC. �f TOTAL improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed smthat he is licensed pursuant to the provisions of the Contractor'sor's License Law (Chapter 9 (commencing with Section of Division 3 of the Business and Professions Code) or that he is therefrom and is exempt PERMIT TO CITY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation tion ooff Section malty applicant fora permits ubjeclstheapplicam too civil penalty by Great : of not more than five hundred dollars lmy STORIES TYPE CONSTR. ALTER-DRAIN-WATER(EA.) 5.00 ❑ Las owner at the property, or my employees with wages as em their sole compensation, will Jo the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 DCC. GROUP RES. UNITS intended of offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of DRAINS -FLOOR, ROOF, AREA,COND. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00 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. merits are not intended or offered for sale. If,howeveq the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or im. prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other INDUSTRIAL WASTE INTER. 30.00 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. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts lot such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ lam exempt under Sec.-, B.&P.C. for this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM - 5.00 ACC.DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKF-RS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate ofconsent to setGinsure, ZONING ENG. SITE NO, or a Certificate of Workers' Compensation Insurance, or a certified copy theregf (fqy', aACo pang ).CR �9 Z� /(,i Policy e ry BC0, L.b. _ ❑ Certified copy is hereby furnished. e copy Is filed s' lh the citinspection div' ion. st y FIRE SPRINK Y N ENERGY T 24 Y NEIApplin MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CER'TIF'ICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This Section need not he Completed if the permit is for one FLOOD ZONE Y 0 N A.L.u.C. Y [:] N PLG.CONTR. LIC. NO, PLG. TOTAL hundred dollars is 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 OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE 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 HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ.C.). EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's AJArcss HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC O(7 VENTILATION FAN (SINGLE) 4.00 1 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 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 hereby entimrid representatives ec this city es enter upon the above-mentioned property forinsp ofth i purposes. BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL (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 ling of this permit. . �3-8 misc.- REFER TO ORD. pERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL ature of Applicant/Contraclor Date OFFICE COPY