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C 8134 (2)APPLICANT TO FILL ININFORMATION WITHIN RED''LINES -'0SE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT ' PLUMBING - MECHANICAL PERMIT NUMBER 81'34 BUILDINRr ApJJNEA'S pDCtae_,V_-BUILDING=ELECTRICAL- 0 NEERR'SS NnME HONE738 DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION NAMECONT OUTLETS UTLETS-SWITCHES -RECEP 10.00/1.00 LIGHTINGTIXTURES- 10.00/1.00 - LIC. No. CONTRACTORS ADDRESS APPLIANCES, RESIDENTIAL 4.00 PANELS - - 10.00 - PHONE. I. - DATE OF APPLICATION - ARCHITECT I OR //��� ENGINEER A.: ���5 No. u'E'G uc. PANELS (OVER 200 AMP) 20.00 PLAN CH K FEE P.C. N0. SIGNS TRANS. 3.00 ARCH, Oil ENG. ,' AooREss qq /vim n T !-' / �' J".'r^ ,. zIP 9� SPECIAL CIRCUIT _ 5.00 - PEJV 6 DATION r`,,. n - APR J 1985 City of Cupertino ,. EMP. METER OR POLE INS. 20.00 ADDRESSr's :a - ADDRESS�T7 A/J - 3U MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 . LICENSED CONTRACTORS DECLARATION TEMP.. POLE . 30.00 I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code; and my license is in fill[ force End efl'ecL License Class Lic. Number ISSUANCE DATE BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ Date Contractor - OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professions Code Any city or county which requiresapermit to construct, alter, BUILDING PERMIT - INFORMATION MISC. - REFER TO ORD 'PERMIT ISSUANCE 1000 ' . .VALUATION ELEC. CONTR. -LIC. NO. ELETC. TOTAL- s - • • ' DTV. PLUMBING PERMIT ' - FEE improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file signed shGenlent that lie Is licensed pursuant t0 the provisions of the Coutractor s License Law (Chapter 9(commencing with Section 7000) of Division 3 ofthe Business and I'm(cssiona Cole) or that he is exempt therefrom and -J V pERMIT.TO �i'�. ..I _ the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant too civil penally of not more than five hundred dollars (S5001J:' STORIES TYPE CONSTR. ALTER-DRAIN&VENT-WATER IEA.) 5.00 ❑ 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 4.00 OCC. GROUP RES. UNITS - DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: Tile Contractor's License Law does not apply to an owner of - FIXTURES - PER TRAP 5.00 GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mems are not intended or offered for sale. If, however, the building So. FT. FLOOR AREA TOTAL ACREAGE ` or Improvement is sold within one year of completion, the owner- builder will have the burden of proving But he dill not build or im- prove for purpose ofsale.). .. L ID 1, as owner of the property, am exclusively contracting with GAS EASYSTEM OVER 4 IEA1 200 - . -.. BUILDING USE RES IND o PB Omer ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. .30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Cude: 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 AtESESSORIS PARCEL NO. contracts for such projects with a contraetorfs) licensed pursuant to tile CR ntrac[of icense Luw. tan cd n race. ,li.&P.C. fix lilt. reason SEWER -SANITARY -STORM EA. 200ft/10.00 - - TRACT NO, PARCELING,❑ ' WATER HEATER W/VENT 6.00 Owoer I e WATER SYSTEM 5.00 / C Acc: OnrE ACC. FILE NO. WATER TREATING EQUIP, 5.00. WOR ERS'A MP_17EN ON DI: LAR Ic I hereby affirm that I have a certificate of consem to %elf -insure. ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certified copy Ihome f (Sec. 3800, Lab C.). Policy No. Company MISC.- REFER TO ORD. ❑ Cerlifned copy is hereby furnished. - ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPRINK Y ❑ N ❑ ENERGY T 24 Y ❑ IN E] CFRT'IFICA"FE OP EXEMPTION I^Rohl WORKERS' COMPENSATION INSURANCE - (This seetiun need not be completed if the permit is for one -PERMIT ISSUANCE 10.00 - FLOODZONE Y [:]N[_Y A. L. U.C. [:3 NE] PLG. CONTR. LIC. N0. PLG.- TOTAL 1.11ors fS l 001 or less.I I certify that in the performance of thework for which this per' mit is issued, I shall not employ any person in any In:umer so as to OTY. - MECHANICAL PERMIT FEE FEE SUMMARY BUILDING J become %uhuct to the Workers' Comproonien Laws of Caldonfo.- D:dE • Applicant No'ria"'I'O APPLICANT. If, after making this Certilw:ne of lix. ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=11F.M.) 4.00 PLAN CHECK FEE elnption, you should hocome 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 1OVER 10=C.F.M.) 6.00 SEISMIC FEE- CONSTRUCTION LENDING AGENCY I 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.L ' MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 NamC Lender's Name Lender's NAddress- H EATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 I certify that 1 have read this application and state that OIe above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING .. BOILER-COMP13 H.P. Or 100,000 B.T.U.) 6.00 hereby authorize representatives of.this city to enter upon .filo above-mentioned property for inspection purposes. BOILER -COMP (Over 100,000 BTUI 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 wa accrue against said City in consequence of the misc.- REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX - _ grand i s per IL' - ' f-----'- `/-L4 %. MECH. CONT. LIC. NO. MECH. TOTAL TOTAL SLa?.�I/^iSYZ 'al col ppircanl/Contra orL, � /tea U('(A'/ V fewliI . OFFICE COPY •' POST THIS CARD NEAR FRONT OF BU,ILDING CITY'OFCUPERTINO '-PFR M IT NUMBER "INSPECTION DIVISION P? 134 JOB INSPECTION RECORDqwr ,•.`. / ,�, .///''' 1 -.. ' PERMIT EXPIRATION JOB ADDRESS•&�_ ' AL PERMIT EXPIRES IF WORK.-• OWNER "� L `CONTRACTOR IS-.NOT'.STARTED; WITHIN,r .80, 1DAYS OF PERMIT•'ISSU r� .. 180 DAYS FRONV • .L CA ED INSPECTION.' INS ECTION DATE INSPECTOR -' INSPECTION ECOR - FOUNDATION. S � . ,' y..f.e� � UF.ER,.N _: �, PREGUNITE...; t .. . -' y /�,., 1 y, PERMI ,r'VAL IUATION 11 SSUANCe GATE POUR NO CONCRETE UNTIL ABOVE HAS BEENSIGNED.. UNDERGROUND /SLAB" PLUMBING.• • ELECTRICALUP 1 MECHANICAL' _ - 5... �S ���,�/,—,r,;)�L B ELECT, PLG. MECH. 11.1 40A DO NOTPOUR FLOOR UNTIL ABOVE HAS'BEEN SIGNED �9-T'T ;'Y'`i'rTGL[ Vw�C,`(lr �l" ''' �'/LI' `• BUILDING PERMIT k, •INFORMATION WOOD FLOOR PLUMBING "• 'i - - TNI •$/FT. r . •1. .,••S MECHANICAL ELECTRICAL'- - -' t.... .. � PERM,r . J�-(' �. }T - FRAMING".: '. Y.-. ' t - - INSULATION " - STORIES E •H,VPCONSTR.,j , - .. OCC. GROUP -, RES.UNITS•- PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _ ROOF - a• �, T. FLOORREA 50. GA 'TOTALACR'EAGE- DIAPHRAGM BUILT IN, USE • p •' .:�• �' ' RES' IND PB. O�M1er' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ''. •. .. 'ROUGH-- -- •. •.._... .. . .. .Assess H byARCEL Nor. PLUMBING. ' GAS TEST •5 •• .. TRACT NO. '. - ;PARCEL NO. MECHANICAL - - _ - ELECTRICAL - ^ FINALS - DATE INSP.. ACC. DATE , .' . ACC. FILE NO.. FRAMING,Wd• f C p t/:: SAN # -' - .. -�' IN SULATI O, '. •; -' PLUMBING V 20NING . .'ENc. SITE No. - ;"• ,'...• IGAS MECHANICAL �• — FIRESPRINK - "o' ENERGY T 201 . ' `'� NC: COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL -• FLOODZONB A.L.U. C. - _�� . I "'�❑ NO _ °'❑ -NO ' LATH—EXTERIOR• . FIRE DEPT. '' :•a SHEETROCK Y •- GRADE .,.N •FEE. SUMMARY'' SHEAR INTERIOR,' -'BUILDING - sulLpwc. • A'. „P r„ , ry SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS !- - _ ELECTRIC ' - _ PLAN CHECK. FEE Y .. GAS t NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUI LDING FINAL IS SIGNED BY BUI LDING INSPECTOR. ,MICROFILM-' t" ARRANGE FOR INSPECTION BY PHONING 252-4505, o�' ' ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING..-:,, MECHANICAL Z SEE''PERMIT FOR EXPIRATION DATE.- !+ ' '^t CONST.,TAX IMPORTANT!' PLEASE.READ REVERSE SIDE BEFORE":' TOTAL CALLING FOR FINAL INSPECTION:. ` .;� �;;� �. 1 :•., '� 'r: ' -, - OFFICE COPY, - 46ANT TO FILLIN INFORMATION WITHIN RED LINES= USE BALL POINT,PEN ONLY BUi LOI NG PROJECT I DENTI FICATION b - - • ' APPILICATION &PERMIT BUILDING' -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER , O 1 %� 3; 0 I ff oILOINc . aoDREss _6 //�� ��ll 230J-Tcve2t'5 6e,PA'/,JL•'A�' OWNER'5. NAME � p �/�I � 71" tC lA�/R L1'21471"1/4� J/T1i42.E QTY. � ELECTRIC PERMIT " ' FEE PLAN CHECK VALIDATION Q yG/ ' DATE OF APPLICATION. C TRgCTOfl'S - NAmE &�K!t;r� uC.No, - UTLETS-SWITCHES'-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR -- a0o RE5s / �' � / / e �N'b" PHONE�Y6 SC/I APPLIANCES - RESIDENTIAL 4.00 PANELS _ '10.00 ARCHITECT OR INEE �/ / NRH[ 4� iluc. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECKFEE - P.C. NO. - • SIGNS TRANS: 3.00 aRCH.eRENG,.. ADDRESS Q b 737 4ItC�rifN /G v -C ' iS1?' �}- ZIP ftp//?- ) " SK SPECIALCIRCUIT' 5.00 PERMIT VALIDATION, , e TEMP. METER OR POLE INS. „ 20.00 . ATS AD11RE- - MOTORS SEE FEE SCH. ' . ' - SERVICE CHANGE - 20.00 LICENSED CON TRACTORS DECLARATION .'TEMP. POLE'. 30.00 1 hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 .[the Business and Professions CoJ nd my license is in full fora y� r,[[eCy License Clas Li- Number '7J 7th •' T5 MSU7NCE DATE B 'EL' CT PLG. MECH. \ n ❑ Datc_2�Ff Contract. OW 9. to ii*eplfr�s/��fe�q�.. OWN 1;R -B UI LD 1;R DEC LA RA' I' IOPr�C a A4 I hereby affirm that I son, exempt from the iress.mor's.Licensu Code:Law Any Citylowevooltng son.(S c. requires Code: Any city of county which requires a permit to construct, after, a permit essend Pr ifiesliumisCt,altr, to Its issuance. thatalso improve, he applicant Or for su any Smit ture,ofi . signed requires the applicant frr such permit ns file a signed statement that he is to Inc provisions of the Contractor's License -BUILDING RMIT INFORMATION - A $/FT D00 _ MISC.'-' REFER TO ORD PERMIT ISSUANCE 10.00 ELEC: CONTR... LIC. NO. ELEC. TOTAL PER TO Chauttl 9(copursuant Law (Chapter 9 (commencing with Section I, clo Of Division.. CHIP 3 Rosiness and Professions Gloc) or Olay he is therefrom and QTY. PLUMBING PERMIT FEE ' tionof the basis❑v the alleged exntiption. Any violation of Section 703 L5 _ STORIES T PE CONSTR. by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollars ($500).): 1 - ALTER-DRAIN&VENT-WATER(EA.) 5.00 ❑ I, as owner ofthe property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP .RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 - 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,:md who docs such work himself or through his own employees, provided that such improve. mentsarenot intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SO.FT. FLOORAREA TOTAL ACREAGE - ' GAS - EA. SYSTEM -1 INC. 4 OUTLETS 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 ofsale.). - ❑ L as owner of the property, exclusively contracting with - . .. GAS EASYSTEM -OVER 4 (EA) 200 BUILDIN USE RES IN O PB Onon INDUSTRIAL WASTE INTER. 30.00 he licensed contractors to construct the project (Sec. 70449 Business o License law docs not apply to owner of property who builds to Professions Code: ty who improves and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSE550 P HC EL NO. tr tr rased p. contracts for such projects with a contractor(s) licensed pursuvnt to the CDnVBCtOis License Law. SEWER -SANITARY -STORM EA. 20011/10.00 TRACT NO. PARCEL NO. O tont exempt under Sec. ,B.&P.C. for this ' WATER HEATER W/VE T 6.00 reason Owner Date WATER SYSTEM SAO ACC.DATE ACC. FILE NO. WATER TREATING EQUIP. -5.00 WORKERS'COMPENSATION DECLARATION - I hereby affirm that 1 have a certificate ofcorlsem to sell -Cone. or a cer ��t�-py �4yy� nsation Insurance, or certified - ZONING ENG. SITE NO. 'a .WJVeiJ' ApyNtJ VLt.r� P cy Company ❑ Cerlilledcopy is hereby furnished' ❑ Ceoi py. file vitt he cit inspection division. AppliCHot. �` ___ FIRE SPR INK YM N ❑ ENERGY T-24 . v ❑ NE] MISC. - REFER TO ORD. CIiR'I PICA'PI'.017 EXEMP'T'ION FROM WORKERS' PERMIT'ISSUANCE 10.00 FLOOD ZONE I A.L.u.G. COMPENSATION INSURANCE (This section need not be completed if the permit is for one V N V ❑ N PLG. CONTR. LIC. NO. PLG. TOTAL hundred dollars IS 100) or leof _ I•certRy 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 FEESUMMARY- BUILDING S '^ become subject m the Workers' Compensation Lrovs of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of lis1. ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE emptier, you should become subject to the Workers' Compensalion provisions of the Labor Cade, you must foRhwiOl comply with such provisions or this permit shall be deemed revoked AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that Iherc i9 a co stroction 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.) .8.00 Lender's Name Lender's AddleName .50 HEATING UNIT (OVER 100,000 B.T.U.19 ELECTRIC 1 certify that I have read Ibis applicmicn and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree rat comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER-COMP13 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE 9CH. MECHANICAL hereby authorize representatives of this city IT enter upon the above-mentioned property for inspection purposes: (We) agree Io save, indemnify and keep hu nn less the City of MISC. - REFER TO ORD. _ Cupertino against liabilities, judgments, costs and expenses which may in any way accrue a ITS said City in consequence of the - PERMITISSUANCE 10.00 CONST. TAX gran 'ago this ermit.26 ��' MECH. CONT. LIC. NO. MECH. TOTAL I TOTAL QSV OQ�r Signature of Appli rat/ nlracto ate- OFFICE COPY OFFICE CORY, ;"`� t -'� e , •+ ..G POST THIS CARD NEAR FRONT OF.BUILDING _ + CITY IPF.RNIIT NUMBER .0 .OF.:CUPERTINO"- ' 83 INSPECTION DIVISION JOB INSPECTION RECORD..;. ' r . .. tI •' >.+-: PERMIT EXPIRATION nn/� C"^^ 26 S�UEYls l�CI + JOB ADDRESS UNIT# LOT#- ' PERMIT EXPIRES IF WORK OWNER =CONTRACTOR IS NOT STARTED WITHIN lb.0 OAVS OF.PER MIT ISSU-,:. FROM•' CE OR 180 DAYS- _ STCALLEDINSPECTION. - INSPECTION ' DATE INSPEC OR ' -- - INSPECTION RECORD - . FOUNDATION, - - 3 YI!�:i�'. U^"� t�•"ca.N. - UFER-..'... PREGUNITE - PERMIT VALIDATION (_ }�'y':,�', • - �'4 "'>. Ci �re-Gi��'�- ISSUANCE: DATE ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING < w. :. • '�. ELECTRICAL MECHANICAL' - - �L_� LD ELE r. PL N` c . DO,NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ` _ " eul DwO .ERMI7- .INFORMATION _ WOOD FLOOR, • " VALUATION-$/FT. i �. �:.�' . PLUMBING ;°�r'. • - MECHANICAL, ELECTRICAL' . .. ' ., I PERMIT 0 _ v .a,?• rt J� _ FRAMING _ INSULATION' - -STORIES - TYPE CONS OCC, GROUP RES. UNITS , PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED" ' " I,•- SO. Fr. FLOOR AREA TOTAL ACREAGE .ROOF " DIAPHRAGM - P BUILDING USE , 'RES' -CON - - _ IND PB' Otlim •�� EN, ❑ -APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED . .' ROUGH `. _7 ASSESSORS PMICEL.NO. - ' PLUMBING. GAS TEST �' � TRACT NO. PARCEL NO. ,- .. r MECHANICAL i ELECTRICAL • 2, FINALS DATE INSP.' D" Acc.nrE-' pcc. FILE No. - FRAMING . WyL(.✓, -�, g SAN#• _ -zoNG INSULATION PLUMBING+ ENG' ENSITE No. GAS ., - - MECHANICAL 'FIRE SPRINK• ENERGNT24 ., ' COVER, NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING` _ - LATH-INTERIOR ELECTRICAL 2S FLOOD ZONE �[]" N� A.L.U.Q v I], N❑ LATH-EXTERIOR FIRE DEPT. I 'i 7j• SHEETROCK �' " GRADE - . FEE SUMMARY ' SHEAR INTERIOR - BUILDING - .S% (�� - � BUILDING •�" SHEAR.EXTERIOR .- f .. -, .TEMPORARY FIREWALLS ELECTRIC PLAN CHECK - FEE ' '• GAS y NO TAPE OR PLASTERANTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE' . OCCUPANCY-OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM AR,RANGE FOR4-INSPECTION BY PHONING 252-4505,- ELECTRIC' F-� ONE WORKING DAY BEFORE REQUIRED -1NSPECTION. PLUMBING ; O PLEASE GIVE JOB ADDRESS, WHEN PHONING: MECHANICAL z, --SEE PERMIT FOR EXPIRATION DATE;' CONST: TAX �Y •,` IMPORTANT! TOTAL ''PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ' OFFICE CORY, ;"`� t -'� e , •+ ..G L. F. OFFICE CORY, ;"`� t -'� e , •+