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7139• O Z z / O' cc rA LU 5 CL Z) z 0 LL U W } N F � 'A" 0 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDING PROJECT I DENTI FICATI ON APPLICATION & PERMIT BUILDING- ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER i� n 7139 / 1. 139 EURGRNG ADDRESS /O6co Ql eqi �'� ��V !� c OWNER'S NAME 1 �I✓ PHONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ' TORST CONTRACTORS V-1319�3ol0p ELnPNf OUTLETS -SWITCHES -RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 LIcNo DATE OF APPLICATION PLAN CHECK FEE P.C. NO. eAoNTHACTOR5 DDflss PHONE 9JO. i ARCHrtECi Ov ENGINEER LIc. No. PLIANCES-RESIDENTIAL 4.00 ANELS 6.00 SIGN$ 6.00 IS GNS TRANS. 3.00 ARCH, OR END•5A0 ADDRESS SPECIAL CIRCUIT PERMIT VALIDATION TEMP. METER OR POLE INS. 15.00 ZIP /�({({-- APPLICANT ADDR E55 MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION I hereby athre, [far I am Ilcensed under provisions of Chapter 9 (commencing with Sectinn 7000) of Division 3 of the Business and Profcssinns Code, and n, license is in full force jy1J� - 4n b License Sl:µy,r /�� Lia Re'., ,Q! V - Uate_ /G Commcmr �gg� I OWNER -BUILDER DECLn RATION I hereby affirm that I am eSec.7 from the Contractor's Pr fescion, Professions Law for the following reason: (Sec.7iresa Busmes to construct, Code: Any city or County which requires a permit to Construct., also improve, demolish, or repair any to f, prior its issuance, also ISSUANCE DATE BLDG. ❑ ELECT. ❑ 1 PLG. MECH, CK ❑ BUILDING PERMIT INFORMATION MISC.- REFER TO ORD VALUATION S/FT. PERMIT ISSUANCE 6.00 ELEC. CONTR. LIC. NO. ELEC. n requires the applicant for such permit to Ole a signet sctmr'x i that permit to the provisions of the Contmvision License he is licensed 9 (commencing Law lsusithe es,aptcr9(leWon, Code) or Section is exempt therefo and ness' :cod 11 he alleged xempt or that he in exempt cation 70 and ❑hc basis for the alleged exemption. Any violation of Section ]031.5 TOTAL PERMIT TO �^n QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 4.00 by any applicant for a permit subjects the applicant toa civil penally of not more than five hundred dollars fS500).): BACK FLOW PROTECT- DEVICE 2.00 OCC. GROUP RES, UNITS - ❑ I, as owner of the property, or my employees with wages as their sale compensation, will do (he work, and the structure is riot DO nded or offered for sale (Sec. 7044. Business and Professions DRAINS -FLOOR, ROOF, AREA, COND. 4.00 Code'. The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who does such work FIXTURES - PER TRAP 4.00 50. FT. FLOOR Afl EA TOTAL ACREAGE himself or through his own employees, provided that such improve- mentsarenotintendedorofferedl'n, sale. If, however. the building GAS - EA. SYSTEM - I INC.4 S 4.00 or improvement is sold within Co. year of completion, the owner- builder will have the burden of proving that he did not build or int- prove brpurlins, or ml,.). ❑ h as owner of the property, am exclusively cont..ding with licensed contractors to construct the project (Sec. 7044, Business GAS - EA. SYSTEM -OVER EA. 1.00 BUILDING USE RES IND CON PB Other � � � � ❑ _ INDUS TRIAL WASTE LAWN SPRINKLERS- .B. 5.00 ASSESSORS PARCEL NO. and Professions Code: 1'he Cont...furs License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - OXM nlructos) licensed pursuant to ,Detracts I'or such projects with a curl Ole Contractor's License law. EA. 200ft/ SEWER-SANITARY-STO 8.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 4.00 Cl I am exempt under Sec.-, HAP.C. for this reason Owner, Date WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. WORKS RS'COMPP-NSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' oupe tint Insuntncu, y a eeH ificd colic thcrwdl Scc. 380(1, Lab'( :.).- - •Mph • ❑ Certili,d copy is hereby furnished. T- ❑ Certified copy is filed with the city inspection division' Applicant ZONING ENG. SITE NO. FwESPRIrvK v ❑ NE] ENERGY TQ4 v NE] MISC. - REFER TO ORD. CERI'IFICATF OF EXEMPTION FROM WORKERS' _ PERMIT ISSUANCE 6.00 FLOODZONE A.L.u.C. PLG, CONTR. LIC. NO.PLG. ''II TOTAL /V .. COMPENSATION INSURANCE I'I his secs ion need not b, complete) if the permit is for one r❑ N❑ V� N� OTY. MECHANICAL PERMIT FEE - FEE SUMMARY hundmd 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 become subject to the Workers' Compensation Laws of Califomio. Date Applicant BUILDING` ALTER OR ADD TO MECH. 4.00 NOTICI'- "I'O APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to tire Workers' Compensation Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked APPLIANCE 4.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10MC.F.M.) 3.00 AIR HANDLING UNIT (OVER IQMC.F.M.)5.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM 1 hereby affirm tut there is a construction lending agency for tic perl'annance of the work for which this permit is issued fSec. 3097. Civ.C). HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATI NG UNIT (OVER 100,000 B.T.U.)7.50 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 VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby uuthorite representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino mss liabilities, judgments, costs and expenses which may any wa accrue against said City in cons uenee r the Snort,o1 this nut. ` AAt ! t.4 S 1 MISC. - REFER TO ORD. CONST. TAX TOTAL PERMIT ISSUANCE 3.00 MECH. CONT. LIQ NO. MECH. TOTAL Signatu pl:amt/C I Date OFFICECOPY • O Z z / O' cc rA LU 5 CL Z) z 0 LL U W } N F � 'A" 0 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDING PROJECT I DENTI FICATI ON APPLICATION & PERMIT BUILDING- ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER i� n 7139 / 1. 139 EURGRNG ADDRESS /O6co Ql eqi �'� ��V !� c OWNER'S NAME 1 �I✓ PHONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ' TORST CONTRACTORS V-1319�3ol0p ELnPNf OUTLETS -SWITCHES -RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 LIcNo DATE OF APPLICATION PLAN CHECK FEE P.C. NO. eAoNTHACTOR5 DDflss PHONE 9JO. i ARCHrtECi Ov ENGINEER LIc. No. PLIANCES-RESIDENTIAL 4.00 ANELS 6.00 SIGN$ 6.00 IS GNS TRANS. 3.00 ARCH, OR END•5A0 ADDRESS SPECIAL CIRCUIT PERMIT VALIDATION TEMP. METER OR POLE INS. 15.00 ZIP /�({({-- APPLICANT ADDR E55 MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION I hereby athre, [far I am Ilcensed under provisions of Chapter 9 (commencing with Sectinn 7000) of Division 3 of the Business and Profcssinns Code, and n, license is in full force jy1J� - 4n b License Sl:µy,r /�� Lia Re'., ,Q! V - Uate_ /G Commcmr �gg� I OWNER -BUILDER DECLn RATION I hereby affirm that I am eSec.7 from the Contractor's Pr fescion, Professions Law for the following reason: (Sec.7iresa Busmes to construct, Code: Any city or County which requires a permit to Construct., also improve, demolish, or repair any to f, prior its issuance, also ISSUANCE DATE BLDG. ❑ ELECT. ❑ 1 PLG. MECH, CK ❑ BUILDING PERMIT INFORMATION MISC.- REFER TO ORD VALUATION S/FT. PERMIT ISSUANCE 6.00 ELEC. CONTR. LIC. NO. ELEC. n requires the applicant for such permit to Ole a signet sctmr'x i that permit to the provisions of the Contmvision License he is licensed 9 (commencing Law lsusithe es,aptcr9(leWon, Code) or Section is exempt therefo and ness' :cod 11 he alleged xempt or that he in exempt cation 70 and ❑hc basis for the alleged exemption. Any violation of Section ]031.5 TOTAL PERMIT TO �^n QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 4.00 by any applicant for a permit subjects the applicant toa civil penally of not more than five hundred dollars fS500).): BACK FLOW PROTECT- DEVICE 2.00 OCC. GROUP RES, UNITS - ❑ I, as owner of the property, or my employees with wages as their sale compensation, will do (he work, and the structure is riot DO nded or offered for sale (Sec. 7044. Business and Professions DRAINS -FLOOR, ROOF, AREA, COND. 4.00 Code'. The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who does such work FIXTURES - PER TRAP 4.00 50. FT. FLOOR Afl EA TOTAL ACREAGE himself or through his own employees, provided that such improve- mentsarenotintendedorofferedl'n, sale. If, however. the building GAS - EA. SYSTEM - I INC.4 S 4.00 or improvement is sold within Co. year of completion, the owner- builder will have the burden of proving that he did not build or int- prove brpurlins, or ml,.). ❑ h as owner of the property, am exclusively cont..ding with licensed contractors to construct the project (Sec. 7044, Business GAS - EA. SYSTEM -OVER EA. 1.00 BUILDING USE RES IND CON PB Other � � � � ❑ _ INDUS TRIAL WASTE LAWN SPRINKLERS- .B. 5.00 ASSESSORS PARCEL NO. and Professions Code: 1'he Cont...furs License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - OXM nlructos) licensed pursuant to ,Detracts I'or such projects with a curl Ole Contractor's License law. EA. 200ft/ SEWER-SANITARY-STO 8.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 4.00 Cl I am exempt under Sec.-, HAP.C. for this reason Owner, Date WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. WORKS RS'COMPP-NSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' oupe tint Insuntncu, y a eeH ificd colic thcrwdl Scc. 380(1, Lab'( :.).- - •Mph • ❑ Certili,d copy is hereby furnished. T- ❑ Certified copy is filed with the city inspection division' Applicant ZONING ENG. SITE NO. FwESPRIrvK v ❑ NE] ENERGY TQ4 v NE] MISC. - REFER TO ORD. CERI'IFICATF OF EXEMPTION FROM WORKERS' _ PERMIT ISSUANCE 6.00 FLOODZONE A.L.u.C. PLG, CONTR. LIC. NO.PLG. ''II TOTAL /V .. COMPENSATION INSURANCE I'I his secs ion need not b, complete) if the permit is for one r❑ N❑ V� N� OTY. MECHANICAL PERMIT FEE - FEE SUMMARY hundmd 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 become subject to the Workers' Compensation Laws of Califomio. Date Applicant BUILDING` ALTER OR ADD TO MECH. 4.00 NOTICI'- "I'O APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to tire Workers' Compensation Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked APPLIANCE 4.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10MC.F.M.) 3.00 AIR HANDLING UNIT (OVER IQMC.F.M.)5.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM 1 hereby affirm tut there is a construction lending agency for tic perl'annance of the work for which this permit is issued fSec. 3097. Civ.C). HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATI NG UNIT (OVER 100,000 B.T.U.)7.50 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 VENTILATION FAN (SINGLE) 3.00 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby uuthorite representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino mss liabilities, judgments, costs and expenses which may any wa accrue against said City in cons uenee r the Snort,o1 this nut. ` AAt ! t.4 S 1 MISC. - REFER TO ORD. CONST. TAX TOTAL PERMIT ISSUANCE 3.00 MECH. CONT. LIQ NO. MECH. TOTAL Signatu pl:amt/C I Date OFFICECOPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON & PERMIT PERMIT NUMBER BmWINGAPPLICATION - ADDRESS/O600 P_I ey I cT"713.9 BUILDING —ELECTRICAL— PLUMBING —MECHANICAL OWNER PLAN CHECK VALIDATION NAME /y��� r✓ II` .ONE 9,40 QTY. ELECTRIC PERMIT FEE corvrnncran'S OUTLETS -SWITCHES -RECEP 5.00/1,00 ZIr-(31980(09 (%�if,t08 IF LI.. No. ' LIGHTING FIXTURES 5.00/1.00 r,ON TRACTOR'S - ADDRESS APPLIANCES -RESIDENTIAL 4.00 PANELS 5.00 / PHONE 9 -it. DATE OF APPLICATION ARCHITECTSIGNS OR ENGINEER • Lie, NO. Q.QQ PLAN CHECK FEE P.C. NO, SIGNS TRANS. 3.00 ARCH OnADDHESS ENG. SPECIAL CIRCUIT rj,QQ PERMIT VALIDATION TEMP. METER OR POLE INS. 15.00 ZIP APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 �(� /"41 i/ is+ LICENSE 1) CONTRACTORS DECLARATION I hereby affamn that I am licensed under provisions Of Chapter 9 Icommrncing with Section 7000) of Division 3 of the Business and Prof"cions C'ode,,nA my license is in full force A, Liccnsc Cl � Lia.Numbe S7JC1 �! 'Date Contractor ISSUANCE DATE BLDG. ❑ ELECT. ❑ PLG. I MECH. O BUILDING PERMIT INFORMATION s e OWNIi R-BUII.DER uCCLARA'I'ION I hereby affirm that I am exempt from the Contractor's License Law list the following reason. (Sec. 7031.5, Business and Professions Code: Any city orcountY which requires pennil toconstnwt,alt,q improve, demolish, or repair any structure. prior to its issuance. also MISC. — REFER TO ORD VALUATION S/FT. PERMIT ISSUANCE 6.00 ELEC. CONTR. LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 loom nwricing wfill Section 7000) of Division3 of the Business and Professions Code) or that hr is exempt therefrom and TOTAL PERMIT TO 71R, —�• �/f�' QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollar, ($500).), ALTER -DRAIN & VENT -WATER '(EA.) 4,00 ❑ 1, as owner of the property, or my employees with wages as sole compensation, will do the work, and fine structure is not BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 4.00 '4! intended or offered for sale (Sea 7044. Business and Professions Coda 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 thfough his own employees, provided that such improve - nam, are not imended or offered for sale. lf, however, the building FIXTURES- PER TRAP 4.00 SO, FT. FLOOR AREA TOTAL ACREAGE F GAS-EA.SYSTEM-l1NC.40UTLETS 4.00 or improvement is sold within onr year of completion, the Wow builder will have the burden Of proving that he did not build or im- prove for sownepurpose ofs,le.). Cl as owner of toe property, contracting with exclusivelye(Sec. GAS - EA. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 2000 he licensed contractors m construct the project Lo 7044, Business d and Professions Code: The Contractor's License Law docs not apply owner of who builds r im thereon, and who to ancontracts LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 LAWN SPRINKLERS -OVER 5 (EA-) 1,00 ASSESSORS PARCEL NO. ' rofproperty t Pu L wllll a Cnnt Jl:larl Y) IICCI1SCd pa Rnanl to ,hproject,us) licensed the ort actor's L License me Contractor's Liccnsc Law. SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO. PARCEL NOs O l am exempt under Sec,—, IL&P.C, for this r•nson WATER HEATER W/VENT 4,00 L Owncr Date WATER SYSTEM 4.00 ACC.DATE ACG FILE NO. WORKS RS'COMPHNSATION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby altirm that 1 hove a ccrtili.1, of consent to sell insure, or a Crtificxte of Workers' Compensation Imur`ce, ,coil ieJ ZONING ENG. SITE NO, -a citpyt creof(Sec. 3800, LAC.) Policy Nn. Company_ !Qi FIRE SPRINK Y ❑ NE]Y ENERGY T 24 ❑ NE]CERTIFICA'I'1: O Certified copy ishereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant MISC. - REFER TO ORD. OF IiXEMI'l'[ON FROM WORKERS' / PERMIT ISSUANCE 6.00 tp FLOODZONE A.L.U, C. PLG.CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE s,etwal need not be completed it the pennil Is for One v❑ N❑ V❑ NE]ffhis hundred JOBurs IS 100) or Tess.) I certify that in the performance of the work for which this IT mit n issued, I shall not employ any person in any mannerso as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the WOrkeri Compensation Laws of California. Dat" Applicant NOTICE TO APPLICANT: If, after making finis Certificate of Ex- ALTER OR ADD TO.MECH. 4.00 APPLIANCE 4.00 PLAN CHECK emption, you Should been", subject m the Wofkers' Compensation provisions Of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10OW CF.M.) 3.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 5.00 SEISMIC FEE CONS"I'RUC'I'ION LENDING AGENCY I hereby affirms that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00 the performance of the work for which this permit is issued (Sec 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 f HEATING UNIT (OVER 100,000 B.T.U.)7.50 ELECTRIC Lender's Names Lender's Addr, 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 VENTILATION FAN (SINGLE) 3.00 PLUMBING gQILER-COMP(3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,000 BTU) SEE FE E SCH. MECHANICAL hereby authorize representatives of this city to enter upon the ,hove -mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino - st liabilities, judgments, costs and expenses which may ' any wa accrue against mid City in Cone uence f file CONST. TAX PERMIT ISSUANCE 3.00 gran mgof Onisp mit. ` Z4 8S 44 I& �—� MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Signal plieanl/Contractor Date INSPECTOR COPY