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C9209POST THIS CARD NEAR FRONT .,,,CITY bF .CUPERTINO „• INSPECTION DIVISION JOB INSPECTION ��ff hh,,pp•• CC��B r ryA JOB ADDRESS IXOSO�� `-'�°n J CRI'), Yv" OWNER J e_ Kia r) cONTRACTOn OF BUILDING . RECORD - 'UUNIIT# , LOT 4f SeIIy. ;/PFRMITN M3ER PERMIT EXPIRATION 'pERM1T•'EXPIRES IF'WORK IS NOT STARTED WITHIN -'ISO DAYS ORPERMIT ISSU- ANCE OR 180 DAYS FROM :BLAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION LIFER PREGUNITE vePl�wA TION .�' AUG 16 1985 Of CDp2rtIRU. CIL' W ISSUANCE NCF. DATE POUR NO CONCRETE UNTIL -ABOVE HAS BEEN SIGNED Ih , �' Or � s.t- � r +- : J ��� �-�(s �wf (IST UNDERGROUND/SLAB PLUMBINGyEI M p - i-� ELECTRICAL MECHANICAL BLDG I ELECT. PLG. .MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED /!-, 1-4- 6/c 4 L -J LO .IJ BUILDING PERMIT INFORMATION WOOD FLOOR ALUATION $IFT. PLUMBING - DLu.Lv.f ,Vti MECHANICAL ELECTRICAL ''PERMIT TO ? FRAMING INSULATION I, DRIES TYPE CONSTR. rt0 IC OCC. ROUP RE.S UNITS ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO. FT, FLOOR AREA TOTAL ACREAGE I DIAPHRAGM-' _ BUILDING USE Hes IND 'ON, PB om., ❑ ❑ ❑ • ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH AS5ESSORSPARCELNO. PLUMBING WIF. GAS TEST .. KI 16 'TRACT N0. PARCEL NO. MECHANICAL -- ELECTRICAL � � FINALS ' DATE INSP. ' ACC.DATE ACC. FILE NO, FRAMING SAN # INSULATION PLUMBING ZONING ENG. SITE NO, . GAS - " MECHANICAL FIRE SPRINK Y ❑ N ❑ ENERGY T ZA Y ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR -. 'ELECTRICAL (/ . FLOOD ZONE v ❑ "❑ A.L.U.C. v ❑ N❑ LATH—EXTERIOR - - - FIRE DEPT. 77 SHEETROCK.. - GRADE FEE SUMMARY SHEAR INTERIORBUILDING - BUILDING SHEAR EXTERIOR W alry! Iy-3 ,TEMPORARY APPROVAL FIREWALLS ELECTRIC 'PLAN CHECK FEE ` GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM . ARRANGE FOR INSPECTION BY PHONING 252-4505, i0�ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN PHONING. r - SEE PERMIT FOR EXPIRATION DATE = ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE :CALLING FOR FINAL INSPECTION., TOTAL OFFICECOPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 9209 ^ O ^ 9 G 9 BUNTING ADDRESS S. OWNER'S AME /y 1 /•S �PNONEdJ.7 oiy OTY, ELECTRIC PERMIT FEE PLAN CHECK VALIDATION _ 3 NAMERAcroRs OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 LIC. NO. CNRACDRRAOrOFs AD - PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION OgcNlrecr ENGINEER Lec. NOP, PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENO. ADDRESS SPECIAL CIRCUIT 5.00 PERMIT IDATION /g 1ARY EMP. METER OR POLE INS. 20.00 ZIP AUG 161985 A ADDRESS oREss MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 4 OC'1 LICENSED CONTRACTORS DECLARATION TEMP. POLE 30,00 I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE 7 &gitino (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect License: Class Lic. Number BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ ❑ Date Carriacou- ' OWthat I m DERexam DECLARATION 1 hereby affirm that I um exempt from the Contractor's License a, Ifusin to and Professions Law for 11m following reason. (See. 703requires Code: An cit or count which re uiresa Anycity y q pe -or toots issuance, improve, demolish, or repair su any structure, prior to its issuancet also also requires elle applicant sua t t the provispermiions Irl t t a Contlactor'1sL i use he is licensed pursuant to the provisions o 700 Contractor's License Law (Chapterand Po.comm Cod)cing or Section is exempt the of o of the Business and Professions Code) or that he is exempt ehc and BUILDING PERMIT INFORMATION , MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION q $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL OTY. PLUMBING PERMIT FEE PERMIT TO Re -M d b aL �-J7e 4 ion 70 thebasisthea ora ermit subjetsthon. Anyeaplicnt tSection 703L5 by any applicant fora undecsubjecr, the applicant ooacivil penalty of net more than five hundreJ dollars ($500).): STORIES TYPE CONSTR. ALTER-DRAIN-WATER(EA.) 5.00 ' ❑ I, as owner of the property, or my empluyces with wages as their sole compensation, will do the work, and the st ruceure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ROOF, AREA,CON D. 5.00 intended or offered for sale (See. 7044, Business and ProfessionsDRAINS-FLOOR, Code: The Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 GAS-EA.SYSTEM-11NC.40UTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- menis 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 that he did not build or ins- GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). ❑ I, as owner of [lie property, am exclusively contracting with RES IND CON PB Other 0 0 0 0 0 INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: 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 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contractors) licensed pursuant m the Contractor'sfoS License Law. / ❑ I am exempt under Sec. ,BAP.C. to, this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT N0. PARCEL NO.. WATER HEATER W/VENT 6.00 O.ncr 1 5 Date - - WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSATION D17CLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, ora certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, L E.C.). Policy Nn. Company ❑ Certified copy is hereby furnished. EI Certified copy is fled with the city inspection division. Applicant MISC. - REFER TO ORD. FIRE SPgINK Y E] No ENERGY T-ZO Y ❑ NF] CERTIFICATE 01: EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPI!NSATION INSURANCE (This' section need not be completed if the permit is for are Y E] N[_ Y [3 NE] PLG. CONTR. LIF NO. PLG. TOTAL hundred dollars ($100) or less.) I certify that in the performance of He work for which this per- Mit is issued, I shall not employ any person in any manner se, as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after nmkiag this Certificate of Ex- ALTER OR ADD TO MECH. 5,00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE emption, 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 AIR HANDLING UNIT (OVER 10=C.FM.) 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 Hun work 1'or which this permit is issued (Sec. 3097, Civ.C.L MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address H EATI NG U N IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE) 4,00 - 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 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 000 BTU) SEE FEE SCH 100, . MECHANICAL -'hereby authorize 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 MISC. - REFER TO ORD. Cupertino against In 'lis' s, ju gm nts, costs and expenses which may inway C e gal s City in consequence of the I gr nispe g h PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT, LIC. NO, MECH. TOTAL TOTAL Eign tureof Applicant/Contractor Date OFFICE COPY 2 POST THIS CARD NEAR FRONT .,,,CITY bF .CUPERTINO „• INSPECTION DIVISION JOB INSPECTION ��ff hh,,pp•• CC��B r ryA JOB ADDRESS IXOSO�� `-'�°n J CRI'), Yv" OWNER J e_ Kia r) cONTRACTOn OF BUILDING . RECORD - 'UUNIIT# , LOT 4f SeIIy. ;/PFRMITN M3ER PERMIT EXPIRATION 'pERM1T•'EXPIRES IF'WORK IS NOT STARTED WITHIN -'ISO DAYS ORPERMIT ISSU- ANCE OR 180 DAYS FROM :BLAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION LIFER PREGUNITE vePl�wA TION .�' AUG 16 1985 Of CDp2rtIRU. CIL' W ISSUANCE NCF. DATE POUR NO CONCRETE UNTIL -ABOVE HAS BEEN SIGNED Ih , �' Or � s.t- � r +- : J ��� �-�(s �wf (IST UNDERGROUND/SLAB PLUMBINGyEI M p - i-� ELECTRICAL MECHANICAL BLDG I ELECT. PLG. .MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED /!-, 1-4- 6/c 4 L -J LO .IJ BUILDING PERMIT INFORMATION WOOD FLOOR ALUATION $IFT. PLUMBING - DLu.Lv.f ,Vti MECHANICAL ELECTRICAL ''PERMIT TO ? FRAMING INSULATION I, DRIES TYPE CONSTR. rt0 IC OCC. ROUP RE.S UNITS ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO. FT, FLOOR AREA TOTAL ACREAGE I DIAPHRAGM-' _ BUILDING USE Hes IND 'ON, PB om., ❑ ❑ ❑ • ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH AS5ESSORSPARCELNO. PLUMBING WIF. GAS TEST .. KI 16 'TRACT N0. PARCEL NO. MECHANICAL -- ELECTRICAL � � FINALS ' DATE INSP. ' ACC.DATE ACC. FILE NO, FRAMING SAN # INSULATION PLUMBING ZONING ENG. SITE NO, . GAS - " MECHANICAL FIRE SPRINK Y ❑ N ❑ ENERGY T ZA Y ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR -. 'ELECTRICAL (/ . FLOOD ZONE v ❑ "❑ A.L.U.C. v ❑ N❑ LATH—EXTERIOR - - - FIRE DEPT. 77 SHEETROCK.. - GRADE FEE SUMMARY SHEAR INTERIORBUILDING - BUILDING SHEAR EXTERIOR W alry! Iy-3 ,TEMPORARY APPROVAL FIREWALLS ELECTRIC 'PLAN CHECK FEE ` GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM . ARRANGE FOR INSPECTION BY PHONING 252-4505, i0�ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN PHONING. r - SEE PERMIT FOR EXPIRATION DATE = ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE :CALLING FOR FINAL INSPECTION., TOTAL OFFICECOPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 9209 ^ O ^ 9 G 9 BUNTING ADDRESS S. OWNER'S AME /y 1 /•S �PNONEdJ.7 oiy OTY, ELECTRIC PERMIT FEE PLAN CHECK VALIDATION _ 3 NAMERAcroRs OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 LIC. NO. CNRACDRRAOrOFs AD - PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION OgcNlrecr ENGINEER Lec. NOP, PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENO. ADDRESS SPECIAL CIRCUIT 5.00 PERMIT IDATION /g 1ARY EMP. METER OR POLE INS. 20.00 ZIP AUG 161985 A ADDRESS oREss MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 4 OC'1 LICENSED CONTRACTORS DECLARATION TEMP. POLE 30,00 I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE 7 &gitino (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect License: Class Lic. Number BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ ❑ Date Carriacou- ' OWthat I m DERexam DECLARATION 1 hereby affirm that I um exempt from the Contractor's License a, Ifusin to and Professions Law for 11m following reason. (See. 703requires Code: An cit or count which re uiresa Anycity y q pe -or toots issuance, improve, demolish, or repair su any structure, prior to its issuancet also also requires elle applicant sua t t the provispermiions Irl t t a Contlactor'1sL i use he is licensed pursuant to the provisions o 700 Contractor's License Law (Chapterand Po.comm Cod)cing or Section is exempt the of o of the Business and Professions Code) or that he is exempt ehc and BUILDING PERMIT INFORMATION , MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION q $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL OTY. PLUMBING PERMIT FEE PERMIT TO Re -M d b aL �-J7e 4 ion 70 thebasisthea ora ermit subjetsthon. Anyeaplicnt tSection 703L5 by any applicant fora undecsubjecr, the applicant ooacivil penalty of net more than five hundreJ dollars ($500).): STORIES TYPE CONSTR. ALTER-DRAIN-WATER(EA.) 5.00 ' ❑ I, as owner of the property, or my empluyces with wages as their sole compensation, will do the work, and the st ruceure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ROOF, AREA,CON D. 5.00 intended or offered for sale (See. 7044, Business and ProfessionsDRAINS-FLOOR, Code: The Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 GAS-EA.SYSTEM-11NC.40UTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- menis 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 that he did not build or ins- GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). ❑ I, as owner of [lie property, am exclusively contracting with RES IND CON PB Other 0 0 0 0 0 INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: 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 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contractors) licensed pursuant m the Contractor'sfoS License Law. / ❑ I am exempt under Sec. ,BAP.C. to, this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT N0. PARCEL NO.. WATER HEATER W/VENT 6.00 O.ncr 1 5 Date - - WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSATION D17CLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, ora certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, L E.C.). Policy Nn. Company ❑ Certified copy is hereby furnished. EI Certified copy is fled with the city inspection division. Applicant MISC. - REFER TO ORD. FIRE SPgINK Y E] No ENERGY T-ZO Y ❑ NF] CERTIFICATE 01: EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPI!NSATION INSURANCE (This' section need not be completed if the permit is for are Y E] N[_ Y [3 NE] PLG. CONTR. LIF NO. PLG. TOTAL hundred dollars ($100) or less.) I certify that in the performance of He work for which this per- Mit is issued, I shall not employ any person in any manner se, as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after nmkiag this Certificate of Ex- ALTER OR ADD TO MECH. 5,00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE emption, 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 AIR HANDLING UNIT (OVER 10=C.FM.) 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 Hun work 1'or which this permit is issued (Sec. 3097, Civ.C.L MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address H EATI NG U N IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE) 4,00 - 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 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 000 BTU) SEE FEE SCH 100, . MECHANICAL -'hereby authorize 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 MISC. - REFER TO ORD. Cupertino against In 'lis' s, ju gm nts, costs and expenses which may inway C e gal s City in consequence of the I gr nispe g h PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT, LIC. NO, MECH. TOTAL TOTAL Eign tureof Applicant/Contractor Date OFFICE COPY 2