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8603 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY _ BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER i {� .BUILDINGAPPLICATION & PERMIT AOOR SS7��� IAT 10 BU LDINGn{�0 -ELECTRICAL-PLUMBING-MECHANICAL l7 JS MV 0 ER's "AME 1- DeAnaa Group, A CBLLf0uLfl QTy, ELECTRIC PERMIT FEE PLAN CHECK VALIDATION Ltd. Partnership PHONE - NBM[RACTGRs UTLETS-SWITCHES-RECEP 10.00/1.00 The Alden 8 LIc.N., 465640 LIGHTING FIXTURES 10.00/1.00 CONTR ACTOR's 411 Sorel Ave,Ste. 410 PPLIANCES-RESIDENTIAL 4.00 ADDFLss San Mateo a 4402^G" 15 -1 B1 PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER alderon-Nakamura= "G C013712 SIGNS TRANS. 3.00 nooaies ENG. 2070 Business Ctr. #220 SPECIAL CIRCUIT 5.00 41 FERMI {qN Ca. zip EMP.METER OR POLE INS. 20.00 r -pie AADDRESS PPLICANT'S 411 Sorel Ave, Ste. 410 MOTORS SEE FEE SCH. QUL 291985 91985 San Mateo. Ca. 94402 SERVICECHANGE 20.00 �s o o LICENSED CON'T'RACTORS DECLARATION TEMP.POLE 30.00 fishy Of Crperfir0 Q U u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE w G w (commenting with Section 7000)of Division 3 of the Business and SO ELECT. PLC. MECH. F w z Professions Code,and my license Is in full(arcs,and".1"t. 1 ❑ ❑ ❑ 0 O m - License CI' ._$-..__Lic.Nw1"., 4 F D Uute"c Comractor M e E BUILDING PERMIT ¢ ¢o a OWNER-BUILDER UIiCLARA ON INFORMATION K ;w y I hereby affirm that I am exempt from the Contractor's License MISC.- I REFER TO ORD w VALUATION $/FT. u o a Law for the following reason.(Sec.7031.5,Business and Professions _ y PERMIT ISSUANCE 10.00 Code:Any city or county which structure permit foconstraanc alter, 2 ¢ ¢ oimprove, or repair any structure,prior issuance,also ELEC.CONTE. LIC.NO. ELEC. w F. o¢ requires the applicant for such permit to file a signed statement that TOTAL d w m U. he is licensed pursuant to the provisions of the Contractor's License PERMIT TO v Law(Chapter 9(commencingwith Section 7000)ofDiv¢ion 3 of the z o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ F o the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. ate _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of nut mom than five hundred dollars($500).1: ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sal, (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 F IXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE ® himself or through his own employees,provided that such""prove- Trials are not intended or offered for rale.If,however.the building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00 or improvement is sold within one year of completion, the owner- GAS-EASYSTEM OVER 4 IEA ) 2.00 builder will have the burden of proving that hu did not build or inn- . - . - BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON PB Omer ❑ I,as owner of 0a property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of properly who builds or impro es thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts forsuch projects with a COntractodsl l icensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ Iamsemptund,r Sec. .B.6P.C.f(,rlhir WATER HEATER W/VENT 6.00 11.10. Owner Date WATER SYSTEM 5.00 A C.o T ACC,FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, z roa certificate of Workers'Compensation Instituter,or a certified ZONING ENG.SITE NO. py thereof(Sec 3800,L:b.C.). s PolicyNO._y/a qI .d ❑ Cetlil'Rd't 1bY 0 rni hMf.' ^� I ' oOy7(Cetlil lifted Is Cd h,th the Cil ins cation division. FIRESPRINK ENERGY T-24 ZOr Appl2ant ��./>, YI y p MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ (; CC T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 - FLOODZONE A.L.UL. 111 > CO\h PI!NSATION INSURANCE PLG.CONTE. LIC.140. PLG. CL o (This section need not be Completed if the pernit is for one TOTAL Y❑ N❑ Y❑ N❑ D Z hundred dollar'IS 100)or less.) U O 1 certify that in the perf.rinanvc of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person in any manner .as to become subject to the Workers'Compensation Laws of California. a Dal, Applicant BUILDING } ALTER OR ADD TO MECH. 5.00 m NOTICE TO APPLICANT': If,after making this C,,Frwmc of Ex- J F Z emption,you should become subject to it,,Workefs'Conlpensalion APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE C7 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 101 M.) 4.00 CONSTRUCTION LENDING AGENsC`Y! AIR HANDLING UNIT(OVER IQOOOO.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that thus, is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). H EATING UN IT ITO 100,000 B.T.U.) 8.00 Lender's Name-Bank of A1aer iCa, P-n- HEATING UNIT(OVER 100,000 B.T.U.19.50 Lender's Address-B03F18O;pe'16-� - ELECTRIC I certify that l have read this application and the above VENTILATION FAN (SINGLE) 4.00 v• information is correct, 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction. and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorise representatives of this city to enter upon lire BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL ubuvt-mentioned property for re,pFetlon purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against iia 1 ities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any ay a rue ag mst said City in consequence of the grunting off I pn L MECH.CONT. LIC.NO. MECH. 5/�1/85T°TAT. TOTAL Signature of pDleant/Contractor Date INSPECTOR COPY POST THIS CARD NEAR FRONT OF BUILDING' CITY CIF CUPERTINOR o* , INSPECTION DIVISION JOB INSPECTION RECORD Q' p J! JOB ADDRESS v 45 TeQxQ G UNIT# LOT#, /0 OWNER sup. CONTRACTOR , PFR UT NU416ER 860 PERMIT EXPIRATION PERMIT EXPIRES IF WORK 1 IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INRECTOR INSPECTION ECORD FOUNDATION- F jQoal/ `gyp' UFER c t L [ PREGUNITE f-,y or,,r PERMIT VALIDATION I;JU 2 9X9$5 B G E E T. PL w MECH• POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED I c9 iK-k Wer pct UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bu LDING ERMIT INFORMATION WOOD FLOOR VALUATION $/FT, I ERMIT TO y. PLUMBING MECHANICAL ELECTRICAL FRAMING I NSU LATI ON STORIES 1 TYPE CONSTR. OCC- GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO-FT: FLOOR AR EA f ` TOTALACREAGE DIAPHRAGM UIBUILDING USE RES/ IND CON P8 O[ther Ell 11 El El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH f r PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ACC. DATE ACC FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING 1 p -( SAN # 1 TONING ENG. SITE NO. INSULATION p- PLUMBING A , GAS FIRE SPRINK rp N[] ENERGY 7.24 r 0 N ME A IC L /Y CDVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HE TIN FLOOD ZONE Y No A.L.uc. Y I NoLJ LATH-INTERIOR ELECTRICAL - ' 3r LATH-EXTERIOR FIRE DEPT. SHEETROCK _ GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDINGSHEARc •. ,G EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS. SEISMIC FEENOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDJOCCUPANCY OCCUPANCYOFBUILDING ISNOTPERMITTEDUNTILBUILDINGFINAL ISSIGNEDBYBUILDINGINSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, Imo-- ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING MECHANICAL; CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL I OFFICE COPY 91 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY 3_i 0 Z Z tr L2 W > d Z UO LL V f 4 BUI 1CCATION PERMIT NUMBER LDING PROJECT I DENTI APPLICATION &PERMIT BUILDING — ELECTRICAL— PLUMBING — MECHANICALPIAN O LD1NG .S LOT 10k.A' DMESS DeAnza Group, A CaliforniaQr, Ltd. Partnership PHONE 415/571-1 ELECTRIC PERMIT FEE 81 CHECK VALIDATION CONTRACTOR'S NAME OUTLETS -SWITCHES - R ECEP 10.0011.00 The Alden Company LIC.NO. 465640 LIGHTING FIXTURES 10.0011.00 DATE OF APPLICATION CONTRACTOR'S 11 Borel Ave,Ste. 410 ADDRESS San Mateo, Ca.94402HDN,+15/571-14 ILkPPLIANCES - RESIDENTIAL 4.00 1 IPANELS 10,00 ARCHITECT OR ENGINEtalderon-NakamurgC.NO. 0013712 PANELS (OVER 200 AMP) 20.00 ALAN CHECK FEE P.C. NO. ISIGNS TRANS. 3,00 qARCORENG. 2070 $11SZABSS Ctx'. 22OADDRESS SPECIALCIRCUIT S,DD PERM ION TEMP. METER OR POLE INS. 20,00Irvine, Ca. ZIP 92715 q pJULy1x175ADORESS411Borel •Ave, .Ste. 410 MOTORS SEE FEE SCH. SERVICE CHANGE 20.00SanMateo, Ca. 94402 City of t pettinoLICENSEDCONTRACTORSDECLARATIONTEMP, POLE 30.00 1 hereby affirm that I am licensed under provisions of Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code, . d my license is in full force @t r4tD 51-3 5 Lin, Number JLicenseCl551-3-1-7857- Date Contractor ISSUANCE DATE ELECT. W-1 PLG. MECH. BUILDING PERMIT INFORMATIONOWNER -BUILDER DECLARA l0N 1 hereby affirm that I am exempt from the Contractors License Law for the following reason. (Sec. 7031.5, BusutessandProfessions Code: Any city or county which requiresa permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to Cde a signed statement that he is licensed pursuant to the provisions of the Contractor's License Lew (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 MISC. — REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION S/FT. J- J !/ ELEC. CONTR. LIC. NO, EIEC. TOTAL QTY. PLUMBING PERMIT FEE PERMIT TO STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN &VENT -WATER (EA.) 5.00 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 DRAINS -FLOOR, ROOF, AREA, CONO. 5.00 OCC. GROUP RES. UNITS Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building FIXTURES -PER TRAP 5.00 SO. FT. FLOOR AREA TOTALACREAGE GAS- EA.SYSTEM-1 1NC.4OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that lie.did not build or im- prove for purpose of sale.).R I, as owner of the property, am exclusively Contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon. and who GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE ISO CON PB Other ASSESSORS PARCEL NO, INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -1 INC 5 V.B. 6.00 H/ LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft110.OD TRACT NO. PARCEL NO. lam exempt under Sec. B.&P.C. for this WATER HEATER WIVENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC. Dr ACC - FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP: 5,00 1 hereby affirm .that [ have a certificate or consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.C.). Policy No. Th n A 1 rinf'ntprQ$fq any FIRE SPRINK Y E] N ENERGY T-24 Y N EXCenitied co y'S by F rni5hed, A pp Certified p i I ith [he city inspection division. MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE 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 (S 100) or less.) 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 BUILDING become subject to the Workers' Compensation Laws of California. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- 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 beAcemed revoked, FEEAIRHANDLING -UNIT (TO 10=CF.M.) 4.00 AIR HANDLING UNIT (OVER 10=CFM.) 6.00 SEISMIC FEECONSTRUCTIONLENDINGAGENCY 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. Liv. c.). endWAmerica, Bank of AiP.O. Lender's Name MICROFILM HEATING UNIT (TO 100,000 S.T.U.) 6,00 00 B.T.U.)9.50HEATINGUNIT (OVER 1000 ELECTRICLender's Address i I' 1 certify that I have read this application and state at 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 PLUMBINGBOILER- COMP (3 N.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. MISC-- REFER TO ORD. we) agree to sav inand keep harmless the City of Cupertino agains li i sties, ' dgments, costs and expenses which may in any a a rue a ' st said City in consequence of the granting of t I. CONST. TAXPERMITISSUANCE10.00 MECH. CONT. LIC. NO. FMEH5/31/85 TOTAL Signature of liplic t/Contractor Date OFFICE COPY