8604 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
I�r.T ,I BUILDING 'JQ>G,Z LOT 9 APPLICATION & PERMIT 8604
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
PLAN 3OWN 'SPLAN CHECK VALIDATION
NAME DeAIIza Group, A Californi QTY. ELECTRIC PERMIT FEE
Ltd. P PHONE4151571-148
NAME acToa's OUTLETS-SWITCHES-RECEP 10.00/1.00
The Alden COBI LIC.NO. 465640 ILIGHTING FIXTURES 10.00/1.00
CONTRACTOR's
ADDRESS
411 Borel Ave,Ste. 410 PPLIANCES-RESIDENTIAL 4.00
NREu
San Mateo Ca 94402GNE 1 PANELS„, 10.00 DATE OF APPLICATION
ORRCMITECi PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINES
alderon-Nak$murlxND C013712 SIGNS TRANS. 3.00 r
ARCH.aR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADORESS 2070 Business Ctr. #220 q� .
Irvine Ca. ZIP EMP.METER OR POLE INS. 20.00 P-Qu
APPLICANT
Ts 411 Borel Ave, Ste. 410 MOTORS SEE FEE SCH. 'JUL
San Mateo Ca. 94402 SERVICE CHANGE 20.00 2 9 1985
wO o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
city �F rtr___,•
a it u I hereby affirm that 1 am licensed alder provisions of Chapter 9 9UrNCSD
H z °' (Commencing with Section 7000)of Division 3 of the Business and
¢ vAi SLOG. ELECT. PLC. MECH.
I-.w z 1'Infessiunx Code,.0d my license Ls in full force e f•c. ❑ ❑ ❑
Z o m - License CP.L�:���ne Lia.Nambe,
o z r D Dated/_.71/3Z_Contractor
a Y BUILDING PERMIT
¢ ¢ ¢ OWNBR-BUILDER DFCLARA'I'ION
R 0 i v INFORMATION
w ; y I hereby affirm that I am exempt from Ole Contractor's License MISC.- REFER TO ORD
.. 0el Law for the following mdson.ISec.]031.5,Business and Professions VALU ION $/FT.
H _ PERMIT ISSUANCE 10.00
Ew 4 Code:Any city or county which rcyuiresapermit toconslrucLulleq 0
ac ¢ ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
FeO u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m w he is licensed 9pursuant(commencing the provisions of Ole Contractor's License
F z > Law(Cha nd Prosionvde)with Section is 00)exempt
o and
E 4 o the
Business and he alleged
Come)or that he Isexgmpt echo 70 and QTY. PLUMBING PERMIT FEE
¢ I- $ the basis for the alleged exemption.Any vapplicn of Sect ion malty STORIES TYPE CONSTR.
a3 _
by any applicant tore permit doilatslite 55000.licam Toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred Dollars 15500).1:
❑ I,as owner of tic pmperty,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole eompenution,will Jo the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor x License Law does not apply to in owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLUOR AREA TOTAL ACREAGE
• himselfor through his own employees,provided that such improve-
ments are not intended.,offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement Is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200
builder will have the burden of proving That h - . - . .
e did not build or im- BUILDING USE
R IND CON PB Other
prove for purpose of,ale.). INDUSTRIAL WASTE INTER. 30.00
❑ L as owner of the m.perly,and rojectiv Se contracting with
licensed contractors In construct the project La 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cole:The Contractor's License Law does apply
co tr owner of property who builds to improves used a and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such censeprojectswith a contranorts)licensed pursuant In
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I:un exempt under Sec. ,D.&Y.C.lin this WATER HEATER W/VENT 6.00
reJSnn
Owner Date WATER SYSTEM 5.00
ACC.OA E ACF FILE NO.
WORKERSICOMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that ['have a certificate of consent to self-insure,
or u certificate of Workers'Couipensation Insurance,or a certified / % ZONING ENG.SITE NO.
copy thereof(Sec 3800,Lab.Cf). �♦ / / / /
Policy No, p���99 , .den
Q ❑ Ccrtit Plfip)T.�� a fuml ,r I / FIRE SPRINK ENERGY T 2
z Z (Certified copy s d 1 wit the city inspection Division. MISC.- REFER TO ORD.
H O Applicant V N V N
cc CERTIFIC'ATI i OP 1.X9MP N FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.e.
W CO�II'f\$p710N IN URANCE PLG.CONTE. LIC.NO. PLG. V� N� V� N�
a ('this section eed not be completed if the parent is for one TOTAL _
h e n dred dollars IS 100)or less,)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
U a Date Applicant BUILDING
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
FZ enORion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONS1'RUCfION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE Q�
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 .mow
the performance of the work 1'or which this permit is issued(Sec. MICROFILM
3097,CieC.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name Bank of America, P. HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address Ttn. O. ELECTRIC
I certify that l hzve«adthisapplicationand tel ,Tlhe A, VENTILATION FAN (SINGLE) 4.00
iolormation is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP(Over l00.000BTU)SEE FEE SCH. MECHANICAL
(We) agree to sa e, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino agents fibilines,judgments, costs and expenses which PERMIT ISSUANCE 10.001CONST.TAX
may in any a a crus ag est said City in consequence of the
grunting nl' nit. ! MECH.CONT. LIC.NO. MECH.
5/31/85 TOTAL TOTAL 0 ,
Signnturu or pplic r /Cont, Dam
INSPECTOR COPY
O
72
F0
CC 0LU
a
O Z
Uo_
IL }'
Ow
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
mss_ BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
PERMITNUMBER
0n.00l°ING LOT 9
4.4 PLAN 3
NAMERS
DeAnza Group, A Californi
Ltd. Partnership PHDNE 415/571-
QTY. ELECTRIC PERMIT FEE
481
PLAN CHECK VALIDATION
CONTRACTOR'S
19AME UTLETS-SWITCHES-RECEP 10.0011.00
The Alden Company L.c,No, 465640
DATE OF APPLICATION
LIGHTING FIXTURES 10,0011.00
r-ONTRACTOR'S 11 Borel Ave Ste. 410ADDRESS
San Mateo, Ca.9440Zo,,E415/571-1
APPLIANCES - RESIDENTIAL 4.00
81 PANELS 10.00
ARCHITECT
DR
ENGINEEta l der on-Nakamur&.ND, C013712
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE
t_
TZ7RU__
ISIGNSTRANS. 3.00
ARCH. OR ENG. 2070 Business CLr. 220ADDRESS
Irvine, Ca. ZrP 92715
SPECIAL CIRCUIT 5.DD PERMI uOATION
E'
rJULLJ 2919 85
1[y or (
ISSUANCE DATED
EMP, METER OR POLE INS, 20.00
APPLICA
Ts Borel Ave, Ste. 410
San Mateo, Ca. 94402
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
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 Code, a my license is in full force f c4oLicenseClsLic. Number
Date Contractor _4114 -
TEMP. POLE 30.00
LDG. ELECT. PLG, MECH.
BUILDING PERMIT
INFORMATIONOWNER -BUILDER DECLARATION
1 hereby affirm that [ am exempt From the Contractor's License
Law for the following reason. (Sec. 7031.5, Business and Professions
Code: Any city or counly 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 ed pursuant to the provisions of the Contractors License
Misc. - REFER TO ORD
V U TION SIFT.
PERMIT ISSUANCE 10.00
ELEC. CONTR, LIC. NO. ELEC.
TOTAL PERMIT TO
QTY. PLUMBING PERMIT FEE
Law (Chapter 9 (commencing with Section 7000) ofDivision 3 of theCh
Business and Professions Code) or that he is exempt therefrom and
rYrfJl
7
STORIES E CO)4 TR. the basis for the alleged exemption, Any violation of5ection 7031.5
by any applicant fora permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).): 1TY Y/ ALTER -DRAIN &VENT WATER IEA.} 5.00
employees with wages asasowner
at
the property, or my .
andthetheirsolecompensation, will do the work, and the structure isnot
BACK F LOW PROTECT. DEVICE 4.00 OCG. GROUP RE NITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00intendedorofferedforsale (Sec. 7044, Business and Professions
Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who docs such work
improve-
mentsarenorough
ntendeownffered
oes,
provided
hothat
ver,
thimprove-
ments are not intended or offered forsale- If, however, the building
IFIXTURES - PER TRAP 5.00 so FT. FL RARER
Q
TOTALACREAGE
GAS-EA.SYSTEM-1 6.00
or improvement is sold -within one year of completion, the owner-
builder will have the burden of proving that he did not build or im
prove for purpose of sale.).
as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractors License Law does not apply
to an owner of property who builds or improves thereon. and who
GAS EA. SYSTEM OVER 4 (EA.) 2.00 BUILDING USE
IND CON PS Orher
X ASSESSORS PARCEL NO.
INDUSTRIAL WASTE INTER, 30.00
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 Hig
LAWN SPRINKLERS - OVER 5 (EA.( 1.00
contracts for such projects with a contractor(s) licensed pursuant to
the Contractor's License Law,
am exempt under See. ,B.&P.C. for this
reason
SEWERSANITARY STORM EA. 200ft/10.00 TRACT NO. PARCEL NO.
WATER HEATER WIVENT 6.00
Owner Date WATER SYSTEM 5.00 ACC. O TE ACC. FILE N0.
WATER TREATING EQUIP. 5.00WORKERS'C051PENSATION DECLARATION
1 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 thereoS C.).
Policy No.
pp,,Certifiedcopy ' h furri'[hed,
Ccrtified cop i. I it the city inspection division.
AApplicant------
FIRE SPRINK
Y N C]Y
ENERGY T-24
N MISC. - EFEA TO ORD.
CERTIFICATE OFEXEM FROM WORKERS
PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
PLG. CONTR. LIC. NO. PLG,
TOTAL
COMPENSATION IN RANGE•
This scaidn need not be eomplelcd if the permit is for one
Y N Y H
QTY. MECHANICAL PERMIT FEE FEE SUMMARY
hundred dollars (S 100) or less.)
I certify that in the performance of the work for which thus per-
mit is issued. I shall not employ any person in any manner so as to
become subject to the Workers'Compensaiion Laws of California.
Date Applicanl
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
BUILDING i{
ALTER OR ADD TO MECH. 5.00
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 10p00 C.F.Ml 4.00
AIR HANDLING UNIT (OVER 10MC.F,M,) 6.00 SEISMIC FEE DCONSTRUCTIONLENDINGAGENCY
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.). Bank of America, P.O.
Lender's Name
Lender's Addreee Ox 16UYaro_`-HEATINGII
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) B.00
UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above
information is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and
VENTILATION FAN (SINGLE) 4.00
PLUMBING
BOILER- COMPO H.P. or 100,000 B.T.U.} 6.00
BOILER -COMP { lover 100,000 BTU) SEE FEE SCH. MECHANICALherebyauthorizerepresentativesofthiscitytoenteruponthe
above-mentioned property for impcction purposes.
indemnifyWe) agree to sa , indemnify and keep harmless the City of
Cupertino ag 'n G kUdgments, costs and expenses whiehCONST.
may in any true t said City in consequence of the
granting of
5/31/85
e
MISC. REFER TO ORD.
TAXPERMITISSUANCE10.00
MECH. CONT. LIC. NO. MECH,
TOTAL OTOTAL
Signature of Applicht/ContsX16ir Date a
OFFICE COPY
J
1
POST THIS CARD NEAR FRONT OF BUILDING
r. CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS' ' P(M r/ e UNIT L T#
OW",• CONTRACTOR
PF111,11T NUMBER
860
PMMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
IN ECTION bt,,TE INSP CTOR INSPEtWdN RECORD
FOUNDATION Z
LIFER30
PREGUNITE S wvoi- /i/ e-ur-+--
PERMIT VALIDATION
JUL 2 8 1985
11SSUANCE.DATE
B O E T PL J, CH.
b. S d k-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
00 NOT POUR FLOOR UNTIL ABOVE'HAS BEEN SIGNED 1 Bul DING ERM1T
INFORMATIDN
WOOD FLOOR VALUATION
f ' `
FT.
PLUMBING
MECHANICAL
ELECTRICAL
ERM1T TO
STORrES TYPE CONSTR.
FRAMING
INSULATION
OCC, GROUP
t
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO, FT FLOOR AREA TOTALACREAGE
on—
q
BUILDING USE
S IND CON PB Oihe,
ASSESSORS PARCEL NO.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ROUGH
of ' MT f
PLUMBING p /
GAS-TEST
TRACT NO,
f
A'
PARCEL NO
MECHANICAL a
ELECTRICAL /j_ , FINALS DATE INSP.
ACC DATE ACC. F14ENO,
FRAMING _z i SAN # 7
ZONING ENG. SITE NO.
INSULATION /- I PLUMBING
GAS r3li
FIRE SPRINK
Y NE]
ENERGY T-74
v NE]
ME HA ICAL % J,r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HE TING
FLOOD ZONE
V N
A.L.U.C.
YoLJ No
LATH-INTERIOR EL CTRIC p-/
LATH-EXTERIOR FIRE
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR fd- BUILDING
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
SEISMIC FEENOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDJOCCUPANCY
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
SEE PERMIT FOR EXPI RATION DATE —
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
TOTAL f
OFFICE COPY