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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