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3558 20644-51 CELESTE CIR 3558 F DE ANZA PROPERTIES SCANNED BOX # 783 CT'ry Or CUPERTINO INSPYCTIOV RECORD (Office Copy), 4 3558 #1 Bldg. 1 20644-51 Celeste Circle Pl:pjli,r Ro-. SANITARY DIST. Fo LOT i0ADDRESS Unit Const. DeAnza Properties PROJECT OWNER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL B1 Date Insp. 1:1 ectr Lcal 1'8 731L Power Pole. P Lumbilig— Under ,round Mechanical !jough Wiring Temp. Cas/Elect. 11aE17s-- Solar Ceiling Fire Sprinkler Fixtures, int/Ext Sign Motors Grounding_ disc. Temp. Power Other FINAL INSPECTIONS E2LIUruved Date In P. PLUMBING Electric UAJ/71 I'Limbin Date Insp. Backflow Mechanical 114-Y Underground Y -7;jt' Solar Pool Underfloor Partial Rough Grading Rough Complete --t3 planning Solar Pough Fire De t. Water & Insulation Health De t. 'I in Drain -* By i I d ing 0 Other L,4� Dig 3 2,-& T/of/S Drain Gas*c P 1 �4CcCC7. cJti17' 7483 Other BUILDING Not Approved Date Insp. 0/< p.,, P/- /7 Pad Certification �fj *Foundation IILCHANICA�(,74-2�7 Dale Insp. Pre-Gunite Underfloor S.H. Slab-flembrane Ducts- & Insulation -2-.Ax-f�' Bond Beam a Fire Danpers Under I 1oo?-f,rrders Fireplace 11-If-f3 Floor Steel (;tease Duct & Heed fiedowns One Hour Shaft Diiphrams, Co—ndensaue —Dr�—in--- Seismic Braci Walis-Panels 1"j%rjLtiipMenC Anchorage Frame Flues & Comb. Air Lath r-- I`1-1�j Other Lac - of Approved T- 11al I boa rds?fn37/Ex t. Firewalls Ocher 77q��—in _ed Not A, roved. 0 A-, .090 BUILDING ,I ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS 't APPLICANT TO FILL IN INFORMATION WITHIN RED.LINES - USE BALL POINT PEN ONLY . BUILDING PROJECT IDENTIFICATION PERMI NUMBER d TION & PERMIT C G Q AD REss ING—•ELECTRICAL—PLUMBING'—MECHANICAL J�1V yr DIN NERa PLAN CHECK VALIDATION " E TY. ELECTRIC PERMIT FEE PHONE CONTRACT.fl'S - NA PUTLETS-SWITCHES-RECEP 5.00/1.00 LIC.No, LIGHTING FIXTURES 5.00!1.00 ADDRESS CONTRACTORS oR's A - APPLIANCES'-RESIDENTIAL 4.00 ' PHONE PANELS .5.00 DATE OF APPLICATION ARCHITECT SIGNS - 6.00 PLAN CHECKFEE P.C.NO. ENGINEE .. b. SIGNS TRANS. - .3.00 GP ' ARCH RENG. PERMIT VALIDATION 'ADDRESS+ - SPECIALCIRCUIT 5.00 ZIP TEMP..METEROR'POLE INS. - 15.00 APORESSPLICANs ' MOTORS SEE'FEE SCH. ADOREss SERVICE CHANGE. ,10.00 � > 'w o o LICENSEDthat I a T CT S DECLARAT .�. ,Q u u I hereby.affirm that I am licensed under Provisions o(Chapter 9 N E T P IN,4 a' (commencing with Section•700G)of Division 3 of the Business and BLDG. ECT, PW. 'MECH: ,H,D z Professions Code,and my license is in.full force and effect. ❑ El _❑ o`Oz. c License Class' ,Lie.Number— Date, r m,H; Date' Contractor. W 4 OWNER-BUILDER DECLARATION I BUILDING PERMIT INFORMATION u 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFERTO ORD ` VALUATION $/FT. in I Law for the following reason.(Sec 703 iras. Businessend Professions y�a��Q Code Any.cily,or coumywhiny regmresap riot toconst Lt .also PERMIT ISSUANCE- 6.00 ac ¢'Q O Improve,demolish or repair any seructurc.priar to its issuance.also ELEC:CONTR. - LIG NO. ELEC. ir D a r<9 ones the'aPPlicant for such permit to file a signed slakmcnl Ihul TOTAL. PERMIT TO x,m U. he Is licim d,pursuant to the provisions of the Contractor's License /J A LaW.(Chapter9(commcluing with SecIRm70GO)of Dsv,skm3ol'Ihe a Business and Profenions Code)or that he isexempt therefrom and OTY. PLUMBING.PERMIT ,FEE • 4I ¢,r D' the basisfor the aIle eJ ezem tion.An violation of Section 7031.5 ' 6 P Y . ' STORIES TYPE CONSTR: i ;$ by any applicant for v peril'doll.. $5 0).): mR ro u civil penalty - Is at licas I nnivcfeu-tt ndrc subjects 0)d: ALTER'-DRAIN&VENT-WATER (EA!1'4.00 ❑ I.aa`owner of the,Prciperty,'or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 their Sale compensation,will'.do the work,and the structure is not OCC.GROUP RES,UNITS Intended or offered for sale(Sea 7044; Business and Professions - DRAWS-FLOOR,'ROOF,AREA,COND. 4.00 / Code:The Contractor's License Lawdoesnot apply to an owner of - - pruperty who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 sD.PT.FLooR AREA TOTAL ACREAGE • himself or through his own offered fors provided that sucicibuildi g or ets mc,notimprovement is Sold w thin on your o If, p levee)the ow building GAS-EA.SYSTEM•1 INC.4OUTLETS 4.00 /M �• or Improvement is Sold within one year of completion,the owner GAS-EA.SYSTEM-OVER4(EA.) 1.00 IN BUILDING USE builsdeer will have the burden.of proving that he did not build or im- .pro for purpose of sale.). - RE$�(ND ,CON PB Other I,as owner of the property,am exclusively.contracting Willi INDUSTRIAL WASTE INTER. 20,00 r!a/ 1 '1 El 11 can d contractors to construct the project(See..7044,Business LAWN SPRINKLERS-1 INC 5'VB. 5.00 LJ ASSESSORS PARCEL NO. and Professions Code.The Contractor's License Law does not apply n �y to an owner of:property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) •1,00 a(�d rlO� y ,I .Contracts for such projects with a contractonad licensed pumuant to 00!(( ! C the Contractor's L n -Law. SEWER-SANITARY-STORM EA..200ft/8.00 TRACT NO. PAIfCECNO. ❑ lame mptu de Be : ,B.S.PC' for lis WATER NEATER WIVE 4 ,00 // ' Date Dale Ow _ _ WATER SYSTEM' 4.00 ACC.DATE ACC.FILE NO. ORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. '4.00 ^ �� Ihereby off.that I have a certificate of consent to self-insure. or a cortifcate of Workers Compensation Insurance:or a certified .ENG.SITE NO. copy)hereof(Sec 3800;Lab.C.). Policy No Company - - 0 ❑ 'Certified copy is hereby furnished. FIRESPRINK� ENERGYT29 Z,:2 ❑ Certified copy is filed ;with the city inspection division. _O Applicant - MISC.- REFER TO ORD. - y cr N CERTIFICATE OF EXEMPTION FROM WORKERS' - PERMIT ISSUANCE 6.00 FLOOD ZONE -'Cr i CL-� COMPENSATION INSURANCE PLG.CONTR. .LIC.NO. - PLG. - - Z (This section need not be completed.if the p,nmt is for one TOTAL Y hundred 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'SUM MARV. LL.U . mil is issued,I shall not employ any Porion in any manner so as to 0 W become subject to the Workers'Compensation Laws of California. Date' ApplE : I . } 2 NOTICE-TO T,.It.after making this Certificate TO MECH. 4= BUILDING' licate of Ex- �._ emption;youshould becomesubject to the Workers'Compensation, APPLIANCE 4.00 ` PLAN CHECK provisions of the Labor Code: you must forthwith Comply with 'U such provisions or this permit shall be deemed.revoked. . AIR HANDLING UNITFEE CONSTRUCTION 3.00 CONSTRUCTION LENDING AGENCY ' AIR HANDLING UNIT(OVER 10=C:FM.) 5.00 -SEISMICFEE. I hereby affirm that there la a construction landing agency for EXHAUST HOOD(WITH DUCT) , 2.00 the performance of the work for which this permit is.issued(Sec, - MICROFILM .3097,Civ.C.L HEATING.UNIT(70 100,000 B,T.U.)+ 4.00 I:endeds Namc - Lender's Address - HEATING UNIT(OVER100;000 B.T.Ui17.60 ELECTRIC I Certify that I have read,this application and state that the above VENTILATION FAN (SINGLE) 3.00 'information is correct I agree.to Comply with all city and.county - - - - - PLUMBING Ordinances and state laws relating to building construction. and BOILER-COMP(J H.P.or 100,000 B.T.U.) 4.00 - �' Inrcby au[hpriic representatives of This city to enter upon Ilte BOILER 100,000.BTU1'SEE'FEE SCH. — abovnmentionedproperty for inspection purposes. MECHANICAL - (We) agree to save indemnify and keep harmless thefity'of MISC.- REFER TO ORD. Cupertino against liabilities,judgments,'costs and expenses which - In y;m anyway ae again at-vid City in Consequence of the PERMIT ISSUANCE 3.00 CONST.TAX' gir tin ofthfo is P it MECH:CONT. ;LIC.NO. MECH. - - 'L , TOTAL b Si Sure of Applicant Contractor vte - TOTAL OFFICE COPY - APPLICANT TO FILL IN INFORMATI WI HIN RE I S - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIF A ION 'PERMIT NUMBER BUILDING, APPCIC ION & PERMIT' r °°DRE ` 4395 7 J°, ILD - RICAL—PLUMBING—MECHANICAL V awrvE 's -- - - - --- --- - ----- — -- .PLAN CHECK VALIDATION NA.as)` _ OTV. ELECTRIC.PERMIT FEE _ HONE PAID CONTPACTOR_5 NAME � UTLETS,-SWITCH ES'-RECEP 6.00/,1.00 3019a3 LIGHTING FIXTURES 5.00/1.00 SEP f-OrvTRAci°qs PPLIANCES-,RESIDENTIAL. 4.00 "°°AE C1yhy� of Cupertino O ° 9— PANELS 5.00 DATE OF APPLICATION ORTECs PLAN CHECK FEES P.C.NO, oR. •�(L SIGNS 6.00 END I NEER Lm,NO. SIGNS TRANS. <3.00 ARCH OR ENG. - PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 ZIP EMP._METER:OR.POLE INS. . 15.00 �J/^ ADDRES r$ MOTORS, . SEE FEE SCH. ECJ/ ADDRESS (FF//j(__vA /—LALALLL SERVICE CHANGE 10.00 IC w O LICENSED CONTRACTORS DECLARATION Q u u I hereby.affirtn that am licensed under provisions of Chapter ISSUANCE DATE N<'vwi (commencing with Section 7000)of Division 3 of the Businessand BLDG. ELECT. PLG.. C .F z Professions Cod ,and my license is.in full to - o Z-- at - Lleentt Cldss Lie,.Number O!'_w Date �Contramo a a:'� BUILDING.P,ERMI ic m w ¢ BUILDER DECL RATIO X0�o - MISC.- -REFER TO ORD I INFORMATION ;, r I hereby affirm than am exempt from the Contractor. License sw u IA I Code Anh 2il11or Imam which re ueason.(Sce. 0ileia•Brmlto mnsusiness and PwfLsalters VALUATION S/FT. w LL s y y y q p PERMIT ISSUANCE 6.00 > ELEC:CONTR, LIQ NO. C Q,¢O improve;demolish,or repmr any structure;prior Its issuance.also (ELEC: w 'O to requires the applicant for such permit to:file a signed statement that TOTAL A.w"m w he is licensed pursuant to the provisions of the Contractors License PERMIT TO vii Law(Chapter 9(commencing with Section 70000ofDivision 3oflhe i z ss Business imil Ti afessions Code)or that he is exempttherefrom and DTV. PLUMBING PERMIT FEE IcHom the basis for the alleged exemption..Any Violation of$ection 7031.5 STORIES TYPE CONSTR. sa the any applicant for a perran subjects the applicant toa Evil penalty , ofnotmom than fivehundied dollars(S500).): ALTER-DRAIN'III VENT-WATER (EA.)�4.00 ❑ I:as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE' their sole compensation,wilt do the work,and the structure.is not '2:00 OCC.GROUP RES.UNITS intended oroffeoed for sale(Sec. 7044;.Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4:00 -Code:The Contractor's License.Law does not apply,to en owner of properly who,builds Or lmprobes thereon,and who dues such work FIXTURES.-PER TRAP 4.00 ',aQ.FTlFLDOR AREA TOTAL ACREAGE himrself othro.gM1 his own employees provided that such'improve- memsarenonintended or offered for sale l 0 however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or Improvement Is sold within one year of completion,the owner. _ builder,wdl haJeflic.burden of proving.that he did not build or.im- GAS-EA.SYSTEM-OVER 4 (EA.)- 1,00 BUILOIN uSE' prove for 1,as weer of the.)pro INDUSTRIAL WASTE INTER. � 20.00 ❑ ,RES I❑ G ❑ ;Other❑ ❑ 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project'(Sec. 7094.Business LAWN'SPRINKLERS-1 INC 5 V.8. 5.00 AsgEgso P gCEL No. and Professions Code:The Contractor's License:Law does not apply 'to an owner of properly who builds or improves fhercon-and who LAWN'SPRINKLERS-OVER 5(EA.) 1.00 1 contracts for such projects with Cali licensed prirsuant In ' .the Contractor's License Law. _ SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.. ❑ tam exemptundesSec. ,B.&P.Cfor osis rea on WATER HEATER W/VENT 4.00 Date - Owner - WATER SYSTEM 14,00 Ace,:DATE Ace:FILE No. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00. 1 hereby affirm that I have a certificate of consent to'elf-insule.' or a.certificate of Workers'CompensationInsurance;or a certified ZONING ENG.SITE NO. copy.thercuf(Secr3800,.Lab.C.). - Policy No.- Company _ - O ❑ Certified co y is hereby,turn ed Z,2 1•� Certified y Is, Belled ih` cl im,dwimon. �FIRESPRINK ENERGY T-p 'P O AD.L.I t M /C�^ -gaczi�, IMISC. REFER TO ORD. E) E. C1E N Y N OCT CERTIFICATE OF EXEMP'I'ION'FROM WORK ERS' PERMIT ISSUANCE'. 6.00 W > COMPENSATION INSURANCE .PLG PLDoO ZONE A.L.u.c. IlL CONTR. uC.NG. .PLG. �' (This section need not be corn pleted Il the.permit is for one - TOTAL Y,[] N�. _ Y� N� 'U O hundred dollars 15100)or leis.I I certify.thxtinthe performance of the work for which this.per, Q7:y FEE SUMMARY ILF mit is Issued,I shall not employ an MECHANICAL PERMIT FEE O p y ypersnminuny mm�ncrso as O w become subject to the Workers'Compensation Lawsof Cali forma. to} Date, CAN ALTER OR ADD TO MECH.. 4.00 BUILDING to NOTICE TO APPLICANT: If,aper making(his Certificate if Ex I- ? emption,you should become subject to the WorkcrsCompensation APPLIANCE provlslons of the Labor Code. you most forthwith comply with 4.00 PLAN CHECK U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10=CLF.M) 3.00 FEE ' CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C-EM.)+5.00 o SEISMIC FEE 1 hereby affirm that there-is.a construction lending agency rer '. EXHAUST HOOD(WITH DUCT) 2,00 the performance of the work for which this permit is isionsI(Sec. - - 3097.Civ.C.). HEATING'UNIT(T0.100,000..B.T.U.) '4.00 MICROFILM- ' Lender's Name Lender's Adores HEATING UNIT(OVER 100,000 B.T.U:)7.50 ELECTRIC I certify Ila1,I have read the;application and nate that Clic above VENTILATION FAN (SINGLE) 3,00 information,.is correct I agree,to comply with all city,and county ordinances,and state laws-relating to budding construction. and BOILER-COMP(3 H.P.or100,0008T.U:) 4:00 PLUMBING ha-by authorize representatives ti city to enter upon the BOILER-COMP IO propertyfor inspection purposes - IOVp1 lo0.GGOBTU)SEE'F,EESCH. MECHANICAL (We) agree to save, indemnify and:keep'hannless the City of MISC:- REFER TO ORD. Cupertino against liabilities,judgments, coats and expenses which' .may in any ..Y2 against said Cty•in'I .y c- I of the .PERMIT ISSUANCE 3.00 CONST.TAX gianli0 (Ihis permi MECH.CONT. LIC.NO. MECH. �I�Y�Y1s TOTAJ.///�sI//�yys , sigt�"rlfre Or Apillicani,,Contractor Date ,g�yXfy�{! TOTAL OFFICE COPY �O APPLICANT TO FILL'IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN'ONLY ' BUILDING PROJECT IDENTIFICATION PERMIT NUMBER 9yIL ,NG. APPLICATION& PERMIT p � BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 4 NERS 1 - - - - -------- -. PLAN CHECK VALIDATION NAME /E //�� OTV: ELECTRIC PERMIT FEE ,® A` 4 02,4 I VHGNI: ' PAID CONTRACTOR S V OUTLETS-SWITCHES-'RECEP '5.00/1.00 167,4007,A ALUM LOC.NO: Ste 7 O LIGHTING FIXTURES 5.00/1.00 EP 2 31983 CONTRACTOR'r PPLIANCES-RESIDENTIAL 4.00 AGGRESS �.sfA O �Lr C YNON6 'j'. / PANELS 5.00 ERB)CATION - OR R lied SIGNS •. - B-� - C FEE ..C.NO. ENGINEER Lie.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. - - ERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5.00 - •ZIP .EMP METER OR POLE INS. 15.00 / ADDRESS rs MOTORS SEE FEE SCH. /0 6-O AA ja4'.L. +tot ' Cv SERVICE CHANGE10.00 0.,¢2i F 00 LICENSED CONTRACTORS DECLARATION - a u U I hereby,affsrin that l'am licensed under provisions of Chapter - 155UANLE DATE w (commencing with Section 7000)of Division 3 of the Business and F'J i Professions Code nd ]cense Is In full for •Yed. O - BLDG. ELECT. L MECH. z oi,"n. Lloen las - ' s Gc,Numbcr� 6 Y _ ' El, y'f w Date Contractor M M wl6 OWNER-BUILDER DECLARATION - BUILDING RMIT 'x °;LLh 1 hereby affirm that I am exempt from the Contractors Llccnse MISC.— REFER TO ORD INFORMATION F,.,;yj Law for the following reason.(Sec.7031.5,Basins..nd Professions PERMIT ISSUANCE .6.00 VALUATION SIFT. Code Anycilyor County which requiresa permit reconstruct.ulter. Q Q Q 2 Improve,demolish or repair any Structure.prior tO its imuap e,-41W ELEC.CONTR. LIC.NO. i '0-LL requires the.applicant forsuch permit to flea signed statement that - TOTAL - W$)M he.is licensed pursuant to the provisions of the Contractors License PERMIT TO p zr Law(Chapter.9(commencing with Section 7000)of Division 3 oftne f s o Business andToafessioris Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE it the bast.for the alleged exemption Any violation of Section 7031.5 STORIEST E CONSTR. by any applicant for a permit subjects the applicant tea civil penalty afoot more than rive hundred'dollars(5500rl1 - ALTER-DRAIN&VENT-_WATER (EA.),4,00 ❑ I..as owner of the property,or my employees wish wa nsgas.. BACK FLOW PROTECT. DEVICE 2'00 their sole compeation,will the work,and the structure isnot - OCC.GROUP RES,UNITS Intended or offered for sale-(See. 7044, Business and Professidns, DRAINS-FLOORROOF. Code:The C , ,AREA,COND. 4.00'ontractors License Law;does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP -im4.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- - i� menusarenoYintcndedoroffered for sale:If,nmwever,Hue linildmg GAS-EA.SYSTEM i.11NC:4 OUTLETS 4.00 or improvement Is sold withinore year of contpletlon.the owner GAS-EA.SYSTEM-OVER 4'builder will have the burden of proving that he diener build lir im- '(EA.) 1.00 BUILDINGLSE• prove far purpose of sale.). INDUSTRIAL'WASTE INTER. 20.00 RES IND 'CON PB: Omer ❑ 1,.as owner of the property;am exclusively contracting with '� '� )' licensed contractors to constructthe project(Sec 7044,Business - LAWN$PR IN KCE RS- 1 INC 5 V!B. '.5.00 ASSESSORSPARC EL NO: and Professions Code:.The Contractor's License Law does not apply - townownerofproperty'who builds'or improves 0terebn.and who LAWNSPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to - - e. the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. - IMason l4m ezempi under Sec. 0&P:C.Oir.rfiis WATER HEATER'W/VENT 4.00 0 Data Owner_ _ 1NATER SYSTEM, - 4;00 ACC,DATE ACC:FILE NO. WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP, 4.00 I hereby affirm that 1 have a certificate of consent to self-insure. _ or:a certificate of.Workcn'Compensation Insurance.or a certifiedZONING ENG.SITE NO. copy thereof(Sec.3800;Lab.C.I Policy No: Company /--J AC�/}AA - 09 Certified copy is hereby furnished. z'Z if Certified'copy is filed',with the city inspection division. - FIRE SPRINK , ENERGY T_24 F`.O Applicant . MISC:- FERTO ORD. Y � N❑' YEl' NEI er T - CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00PLOOD ZONE - - A.I.:O.C. LU > COMPENSATION INSURANCE'- ' PLG.CONTR. PLG: 1 a •(This section need not be.complcled if the Permit is for one 'TOTA' YN� Y No 0 Z h nil •d'd011ars 15 100)or less.) - () O ('certify that In the performance of the work for which this per- LL FEE MECHANICAL PERMIT LL /- mit Is Issled,.l shall not employ any person in any mann•r so as to T FEE ' U beco ec t th Workers'C to on a s Cal' ruse.. - y Date 54� �qy Appham'�yy�1Cyn, ALTER OR ADD TO MECH. 4,00 BUILDING } W NOTICE OT�PPLICANT: It.a reT-r making this Certificate of Ei- - Z. eruption,,you should become subject In the Wurkers'COmpenssfoll APPLIANCE 4:00 PLAN CHECK' Provisions of lite Labor Code; you must forthwith:comply Mill U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M:) 3.00 FEE CONSTRUCTION LENDING AGENCY ' AIR HANDLING UNIT(OVER 1Op00 C.F.M.) 500 SEISMIC FEE ].hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 ' the perlormanee.of the work for which this permit is issued(Sec - LeaMICROFILM Lender's Name CN.C). � - � HEATING UNIT(TO 100,000 B.T.U.) 4:00 . Lender's Address HEATING UNIT(OVER.100,0000J.U.)7.50 .ELECTRIC 1 certify that I h read this application and stat that the above VENTILATI FAN (SINGLE) 3.00 mdinancI. s a estate 1 agree Jo comply with all city and county BOILER' PLUMBING mdmames and state laws.relating to building onstruetion. and -COMP(3 H:P.Or 100,000 B.T.U.) 4:00 Hereby authorize representatives of this'city-to enter...... ni! BOILER- above-mentioned Property for inspection purposes COMP IOverr OD,000'BTUI BEE FEESCH. MECHANICAL (We) agree to save, indemnify and keep harmless petlmnmty of MISC.- REFER TO ORD. Cupertino against liabilities.judgments,,costs d xs Ciwhich, CONST.TAX PERMIT ISSUANCE Orm may in any way'decrue against Said City inconsequence of the; PCE 3:00 grantingofthispll. MECHi CO LIC.NO. MECH. . ^j'# at a of pplicant(Contractur', [))are TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTIFICATION PERMIT NUMBER gapRESG [ APPLICATION &PERMIT C U�� 3-(co BUILDING-ELECTRICAL-PLUMBING_.MECHANIC U wNE 'a' ll PLAN CHECK VALIDATION- " " QTY. ELECTRIC PERMIT FEE - . Pro.'-ONE .. CONTR TORS UTLET SSW ITCI HES'-RECEP 5.00/1•.00 ggqqcccc rvamF/' ra A No. 37 LIGHTING FIXTURES' 5.00/1`.00 ,DDTRR�-A'/CSTOR's PPLIANCES-RESIDENTIAL 4.00 ADORER b p IA& PHONE. h)'3- 6-1 Z3 PANELS 5.00 DATE OF APPLICATION 'ARCHITECT ( - SIGNS: 6.00 PLAN CHECK FEE P.C.NO. r �oNGmEER uc.NO, SIGNS TRANS. •.3.00 ARCHEOR ENG SPECIALCIRCUIT • 5.00 - rPERMIT VALI DATION ` nv TEMPl METER OR POLE+INS. 15100 APPLICANT S . ADDREOGRESMOTORS SEE FEE SCH. O SERVICE CHANGE '10.00 1 Dori LICENSED CONTRACTORS DECLARATION 0IN u' 1 hereby affirm that 1 am under rovumnsof{ha ter 9 ' ¢ y P P ISSUANCE O TE I- Zi ('ommemmng;with Section 70001 of Division 3 of the Business'and m ¢a, SLOG. ELECT. PLO. NX F a.2 Professions Co y d m -license Sin fulls - ridsofteu� a, O N License Class Lie.Number JJ3 IO m F 0 Date lip Contractor- < xsem: .BUILDING PERMIT tc o M6 OWNER-BUILDER DECLARATION. - X 3:wt I-hereby'af`I that I am exempt from the Contractor's.License MISC.- REFER TO ORD INFORMATION w LLw< Law for the following reason.(Sec.7031:5,Business and Professions PERMIT'ISSUANCE 6.00 VALUATION B/FT: W> Code:Any city or county which requiresa perenutoconslruct,alter, a, A ¢Q improve,demolish:or repair any structure,prior to Its tssuanCt',also ELEC.CONTR. LIC.NO. TE LEC D.LL requires the applicant for.such permit,to file.a signed statement that TOTAL x m he is licensed'pursuent to thoprovisi"ns of the Conlmetor>License 'PERMIT T r'ii Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the ¢ Business'.and ProNmions Codehor that•he'is exempt therefrom and QTY. PLUMBING PERMIT FEE •,¢,F�, the basis for the alleged exemlion'An violation'of Sect ion 7031.5 - B p h 'STORIES TVPECONSTR. by any applicant fora hundred dollars the applicant toacivil penalty of not more than Ove hundred'.tlollors(55001.11 ALTER-DRAIN'&:V ENT-WATER+(EA.) 4:00 ❑ h asowner of the property,or my employees with wages as BACKFLOW PROTECTDEVICE 200' their.sole compensation,will do the work,and . .the structure is not OCC.GROUP RES.UNITS intended or:offered for sale (Sec: 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND..4.00 Code:The Contractor's License Law does or apply to an owner.of properly who builds or improves thereon,and who dues such work FIXTURES'-PER TRAP 4.00 50:FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees.provided that such improve- _ 'mems are not intended or offered for sale.i f however,the building 'GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or improvement is sold`withm one year of completion.the owner- GAS-EA.SYSTEM.-OVER.4(EA.) 1;00 builder will have the burden of proving that he did not build or im BU14PIVII USE :prove for purpose of sale): INDUSTRIALWASTE INTERi RES IND oN +PB; Omer ❑ ,I,as ovener,ol'the property,.am exclusively ontracting,with , 20.00 _.❑ licensed contractors to'comtruct the project(Sec 7044,Business LAWN'SPRINKLERS-1 INC 5V:8. 5.00 ASSESS RSP PARCEL NO: end Professions Code'The Contractor's license Law does not apply - to an owner of property who builds or'improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts Tor such.Projeds with a contracmn s)licensed pursuant m -- the Contractor's License Law. _ SEWER-SANITARY+STORM EA.200ft/8.00 - TRACT NO. .PARCEL NO. ❑ 15m exempt under Sec. -.6.6P.C.furrhis reason WATER'HEATER.W/VENT '4.00 Date Owner WATER SYSTEM' 1 4.00 ACC.,DATE ACC.,FILE NO. WORKERS'COMPENSATION DECLARATION .WATER TREATING EQUIP, , 4.00 1 hereby'affirm,that I have a certificate ofe"nsent to self-insure. or a Certificatc.of Workers Compensation:lnsurance,or,a':certified! ZONING ,ENG,SITE NO. copy thereaf(Sec.3800;Lab.C.). - Policy No. Company - U❑ Certified copy I.he ab fpp rnished. 1FIRE BPRINK ..ENERGY 744 .Z Z Certified y is O ith t inspection division. F O A Plicanl L MISC.--. REFER TO ORD. Y [-] N[-] - Y E] 140 il: y CERTIFICATE OF EXEMPTION.FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.c. LU 2 COMPENSATION INSURANCE PLG.CONT"- LIC NO PLG. 'd o tThis;section need not be'completed if the;Permit is for ane TOTAL V a N� Y NE] Z hundreddollxrs(SIDO)OLlese.). U O 1 certity,that in the performance of the work.for which:this per. QTY MECHANICAL PERMIT, FEE FEE SUMMARY .LL F . mit is issued,1 shall notemploy,any person'in any manner.so as tu. O W become subject to the Workers'Compensation Laws of California.: Uetc ' Applicant'. ALTER OR ADD TO MECH.' 4.00 BUILDING - >wW NOT ICE'TO APPLICANT:.If;after makingthis Certificate of Ex. Z emption.you should become subject to the Workers'Compensation APPLIANCE la4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with suchprovisions or this permit shall be deemccizavbked. AIR HANDLING UNIT(TO 10A00C.F.M.) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.EM.)'5.00 SEISMIC FEE I hereby affirm that there is a constructionlending agency to, EXHAUST HOOD(WITH DUCT) 3.00 4?- .the performance'of-the-work for which:this permir,is issued ISec. MICROFILM i" - 3097 Civ.C.). HEATING UNIT(70"100,000 B.T.U';) 4.00 2� Lender's Name - HEATING UNIT(OVER B. . TUJ7.50. Lender's Address ELECTRIC ' I certify that I have read this application and state that the above 'VENTILATION FAN (SINGLE) 3.00 Z _ :informincin.is correct I agree to comply with all city and county BOILER- - PLUMBING'. Ordinances and state laws.relating to building const ",tion,and COMP(3 H.P.orn100,000 B.T.U.) 4.00 hereby authorize representatives of this city to enter upon the BB OIL (Over 100,000 BTU)SEE FEE SCH. above-mentioned Property for inspection purposes: MECHANICAL (We),agree,losavc. indemnifyte,and keep:haso, the City of MISC.- REFER TO ORD. Cupediuo'againsfliabilities,judgments,costs and expenses which .TAX- may in any way accrue against said City:.in consequence ofthe ` PERMIT ISSUANCE E: , CONST. - gra ling of this perD��fi MECH::CONT. LIC.NO. MECH: '.= TOTAL ?s TOTA'C bi nature of Ant/Contto racr Date u OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE-BALL POINT PEN ONLY ~ BUILDING PROJECT IDENTIFICATION MBER BUILDING 1 APPLICATION'&PERMIT A3 ES6 _ _ _- 9V48'63 it / . �3 - � BUILDING—ELECTRICAL—PLUMBING=MECHANICAL -, AWNER'S PLAN CHECK VALIDATION 'NAM QTY. ELECTRIC PERMIT FEE • Q - CONTRACTOR'S PHONE NA � UTLETS-SWITCHES-RECEP 5.00/1.00 sec.No�3 LIGHTING FIXTURES 5.00/1:00 , CONTRACTORS APPLIANCES.-RESIDENTIAL 4.00 ADDRESS —PANELS 5.00" DATE OF APPLICATION ARCHITECTon SIGNS - - 6.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.NO. SIGNS TRANS. 3.00. _ ARCH.OR ENG. PERMIT, ALIDATION ADDRESS SPECIAL CIRCUIT. - 5.00. - ZIP EMP.METER OR POLE INS. 15.00 ,�Q APPLICANT'S - MOTORS SEE FEE SCH. T I ADDRESS - - SERVICE CHANGE - 10.00 Woo LICENSED CONTRACTORS DECLARATION y\ Q,Zw Thereby afflnn that I am licensed under provisions of Chapter 9 'IS UA TE nam (commencing-with Section 7000poLDivision 3 of the Business'and _ F 7 as ProfessionsC BLDG: EL .. L.G. E rrdr,an i licence is m full fo an4 fT t;-�- ❑ .❑ ❑ 2 i y ursi Licen Cla (L.�� Lic.Number _ pate��Contractor H�H.J BUILDING PERMIT/ a ac E J a w•a • OWN ER-BUILDER'DECLARA'TION, - 0,A. u - -INFORMATION LL E, 1 herebyaffirmthat I am exempt from the Contractors License MISC.— REFER TO ORD - w IA the 'VALUATION' $/FT. Cal PERMIT Lawfornycitylowingnty which a: mito construct, Professions PERMIT ISSUANCE 6-OD f w>2 Code:Any coolish cor n pair any structure permit riot owns Ilee:also - 2 ¢ al0 Improve;demolish,orrcpaioany structure, [o its issuance:also ,EIEC.CONTR. LIC.NO. ELEC. XD," requires.the applicant for such permit to file a signed statement that TOTAL PERMIT TO R ay he Is licensed pursuant to the provisions of the Contractor's License r i> Law(Chap[er9(commencingwith Section J000)of Division3ofthL, Business and Profession$Cod.)0,that he is exempt herefrom and QTY. - PLUMBINGPERMIT FEE H ca the oasis for the alleged exemption.Any violation ol'Seclion 7031.5' ST RIES' TYPE CONSTR. n;119 by any;applicant fora permitsub)ects.the applicant toaciyilptnalty " • of not more than five hundred dollars($500).1: ALTER-DRAIN&VENT-WATER (EA.);4..00 ❑`I,as owner of.the property,,oimy:employees withwagesas BACK FLOW PROTECT.DEVICE 2.00 Iheir,sole compensation,will do the,work,and the structure is not. OCC.GROUP RES.UNITS intended or offered for.sale (Sec. 7044,.Business and,ProfessionsDRAINS'-FLOOR,'ROOF;AREA,COND:'4.00. Code:Tire Contractor's License Law does not apply to an owner of property.who builds'or improves thereon,and-who does suchwork FIXTURES-PER TRAP 4.00 SBFT.FLOOR AREA TOTAL ACREAGE . himself or through his own employees,provided that such improve. - - memsarenotintendedoroffered for sale.If,however the building GAS-EA.SYSTEM-11NC.4OUTLETS 4.00 or Improvement is sold wnhirTone year of Cnmplation the owner budder wilrhave the burden of proving[hat he did not build or im- GAS-EA.,SYSTEM-OVER.4,(EA:) 1.00 BUI LOING 5E prove for purpose of seta): INDUSTRIAL WASTE INTER. RES IND' o ve omar .❑" I ccoiwnei of the property,he project Se contracting with 20.00 E El 11 ❑ ❑' anlicd Pro colons Code:The construct the project(Sec.7044,Business LAWN SPR INKLERS- 1 INC 5 V:B. 5.00 'ASSESSO RCEL NO. end Professions Code:The Contractor's License Low docs not apply to an owner of property who builds or improves thereon,and.who LAWN SPRINKLERS-OVER'5(EA:) 1.00 contracts for such projects with'a contractor(s)licensed Pursiiint.to '- - theContracmr'sLicenselaw. SEWER-SANITARY-STORM EA..200108.00 TRACT NO. PARCEL NO. - ❑ I am exempt'under Sea ,B.&P,C.for this reason /VENT WATER HEATER W 4.00 Dale OwnerWATER SYSTEM 4.00 ACC.DATE ACC.FILE No. _ WORKERS'COMPENSATION DECLARATION WATER TREATING.EQUIP. 4.00 I hereby if firm that JChase certificate of 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. Company' - O ❑ CertltiedeopylshetebyfuMshed. FIRE SPRINK ENERGY.Za Z;Z IB�Certified c�yr.js filed it the mly mspeanun'Jlvision. O .Ay(plicani A �r--ms MISC,- REFER'TO ORD: y N v N 2,N CERTIFICATES OF EXEMPTION FROM WORKERS.' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L❑.U.c. ❑ LU > COMPENSATION INSURANCE PLG:CONTR:„ d a] 'LICI.NO. .PLG. (This section need not be completed lif-t11C penia t is for one ” TDTAL Y O, N0 Y 0 NE CJ O hundred delta.IS]00)or less.) _ I certify that in[he performance of the work for hichlhir,p`r- OTY. MECHANICAL'PERMIT FEE SUMMARY LL f mat Is issued.i shall.no,employ any person in any manner.so as tis FEE O U become subject lothe Workers Compensation Laws of California. LUDate -Applicant - - .BUILDING NOTICE TO APPLICANT:.IL after making this Certificate of Ex. ALTER OR ADD TO MECH. 4.00 F Z emptmn,YOU Slto0ld become subject to the Workers Compcasa[ion APPLIANCE' 4'.00 provisions•of the Labor lode.,you t I'or[h Ith comply with PLAN CHECK. min V such,provisions or this permit shall,he deemed revoked. - " AIR HANDLING UNIT(TO 1O=C.F,M-) 3.00 FEE t CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER.l0,000CEM.I 5:00 SEISMIC FEE I hereby affimr-[hal theta isa construction leading agency for EXHAUST HOOD.(WITH DUCT) 2.00 the performance of the workCi ;for which this.permit is issued(See. MICROFILM 3097, v.C.).. _ 1HEATING UNIT(TO,100,000 B.T.U.) 4.00 3 Z! Lender's Name Lender's Address- HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC I certify thallhave read thisappLLntion and st Lethal the above VENTILATION FAN (SINGLE) 3.00 information is.correct I agree[D comply with all city and:county "PLUMBING -ordinances and state laws relating to building corolr.,tion,.and SOILER-COMPOH.P.Or100,000B.T.U.) 4.00 hereby authorae rcprescnlatives of this city. to enter upon the / above-mentioned property for inspection purposes. BOI LER-COMP IOvar 100,000 BTU1 SEE FEE$CHI MECHANICAL- Save. L. (We) agree In Save.,indemnif REFER TO�ORD. y and keep hannlcss the City cot MISC.- - Cupertino against Imbllitms„judgments, costs.and exp nus wllich - CONST:TAX' I may in'any way, accrue'against'sa!&City in consequimce of the PERMIT ISSUANCE - 3!00 gran hnPC.'t/ p .. /� 1/ MECH.CONT. LIQ NO, q,ECH: SIBw[ure of App�nl/Commdor Date TOTAL f/✓n[/k/ • OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY PERMIT MBER BUILDING PROJECT'IDENTIFICATION - APPLICATION H/ 4 o PERMIT A O6 A BU I LOING ns ,� fr EO I� -3 Z C.• BUILDING--ELECTRICAL-PLUMBING-MECHANIC • ' 'OWNERS - - -- - - --- ----- - -- - '---' ;PLAN CHECK VALIDATION .e -PNONE 0TY. ELECTRIC PERMIT FEE - i� S �' CONTRACTOR' 'N ME/ I^/`w UTLETS-SWITCHES-RECEP 5.00I1.00 1rAJIV\ I LIC.No.2f- 37S LIGHTING FIXTURES 5.00/1.00 AcrOs ADDRES ' APPLIANCES-RESIDENTIAL 4.00 qe P / 44NE PANELS 5.00 _ GATE APPLICATION " agenrtecr SIGNS 6.00 PLAN CHECKK FEE P.C.NO. ENGINEER LIC.NO. SIGNS.TRANS. 3.00 ARCH.OR ENG PERMIT VALIDATION ADDRESS SPECIAL-0IRCUIT 5.00 ZIP TEMP.METER:08 POLE,INS. 15.00 APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 w ¢2 O'2 LICENSED CONTRACTORS DECLARATION. VE i"t; I hereby,afftrm that I amlicensed'under provisions of Chapter 9 ..ISS CE <v lcommeneing with Section'70001 of Division 3 of the'Business and BLDG. ELECT. G. E F O i' Rofessions Coda,app wwRcense Is in fullfo 'c' Rd'• ect. Z'0 o S-. -Licca Cl Ci Gt/ Lie.Numtier w E w D. ,(> -Contractor - ¢Q rc¢ OWNER-BUILDER DECLARATION BUILDING PERMIT - A o.d °. - INFORMATION x g;a I hereby;affirm thaCl lira exempt from the Contract s.License .. MISC..= REFER TO ORD �,u w :. law forthe followmgreason.(Se 7031.5.Business and Professions PERMIT ISSUANCE VALUATION � w �. Code^Any city or county whichregmresaperinittoonstruct;alto,' - - '6.00 a, improve,demolish.or repair any structure,porn.to its.iasuonce,also ELECTpONTR: 'LIC.NO. ELEC. - oto¢ :requires the applicant for such,permit to file a signed statement that TOTAL x'm' he Is licensed pursuant to the,provisions of the Contractor'slicensc _ - PERMIT TO rzi APPLICANT'TO FILL IN INFORMATION WITHIN REDILINES , USE BALL POINT-PEN ONLY / r FICATION /j:BU - PE BER . y• BUICDING�PROJECT IDENTI PERMIT NUMBER BUILDING _ _ APPLICATION:& PERMIT 1 ' .nDORE5sa06S9 "�/ELDING ELECTRICAL PLUMBING-MECHANICAL 4151 OWNER-3 - --� PLAN.CHECKVALIDATION NAME GTY: ELECTRIC PERMIT FEE j�&�.NZ/�'/*vR.aNe . .?p& 'CONTRACTOR'S -: NAME OUTLETS,-SWITCHES-RECEP ''5.00/1.00. , E✓� �LC /�t/'-+tire,c:No.C/0��.?� LIGHTING FIXTURES 5.00/1,00', ADDRESSCONTRAA CToeayL ' rr� - PPLIANCES'-RESIDENTIAL .; 4.00 gmO �] lrL CVv PHON j',7-,:14 D PANELS' ... 5:00, �"'� :DATE OF APPLICATION ARCHITECT - , PLAN CHECK,FEE P.C.NO. OR -_ SIGNS 6.00 . ENGINEER _ - _ _ LIC.NO. SIGNSTRANS: 3.00 ARCH:OR ENG. - "PERMIT VALIDATION' 'ADDRESS - SPECIAL CIRCUIT - 5.00'. ZIP TEMP.METER OR POLE INS. "15.00', AODREPPLIC . -�p MOTORS ' - SEE FEE;SCH. - VIPC_ � JR T E SERVICE CHANGE - -10.00 "•y� (/ o•a iI I �'�d ,r - Flo o. LICENSED CONTRACTORS DECLARATION - Q� 1 hereby:affirm that Lam licensed under provisions of Chapter 9 - ¢•w - a ISSUANCE DATE ,q< d. (commencing g-with Section 7000) in full for, a the Business and ' r D i Professions CodQeg;p�Id my treatise u m full(or, ayd f(�et .' - � ,BLDG: EL T.. PLG. MECH. i Ony— Lloease ClassLll�pA L C Number�(o 'Y'Z2.3 — _ O�::F,w Date —�.r-6'T "Contractor 13 Is M.4 ' OWNER- BUILDING'PERMIT,, BUILDER DECLARATION - 6;a MISQ.- REFER T' ,INFORMATIONS X g w w I hereby aSho that I am exempt-from ilia Contractors License OiORD u 0. law for'he'Show reason.(Sec 7031 $;BuaiOe5a a0d PIOI'e{sion5 VALUATION $/FT, ,g ',PERMIT ISSUANCE 6:00 Cade Andemo.r county which egwresepermit to construct;al[eq a 010 Ove demo" orrcpairyany structure prior;[.Its Issuance;also ELEC.CONTR:- NO.p .ELEC. n w o�W req us he t S pp_.at for such permtl[D Ole a signed sletemmri shit /J a/ ITOTAL PERMIT TO X m It rs licensed.pursuant talhe pronvons of the Contractor's License _ F i.Q Lew(Chaptec9(Commencing with Section 70001 ofDlvision3of ftir _ s i,D Busmen and.Professions Code)'.or that he is ekempLtherefrom olid GTY. 'PLUMBING PERMIT FEE z ' a r.0 the barn for alleged ekemption Any violation ofSecti.n7031.5 STORIES TVPE.CONSTfl: e.u ;,§ by any aPPhead,for permit sub)ecis ehe'eppiicant[oa civil penally of not more than flue hundreddollars ALTER-DRAIN -WATER'(EA:) 4i00 ❑ I,as"Camp.,,,.(the prop"city or myeinpioyees with wagesaS BACK FLOW PROTECT.DEVICE 2.00 . (herr solecompensalion,wllPdo the work,.entl the structure is not OCC.GROUP - RES UNITS intended`.,offered for Sale(Sec. 7044 Business and".Professions' DRAINS-FLOORROOFAREA,COND. 4.00 Code The Contractor's License Law does not apply,to an owner of ,ROOF,AREA,- - ' properly who builds or improves thereon,and who does Such:work FIXTURES-PER TRAP 4.00 himself or through his own employees'provided that such Improve. - ' Sa FT.'FLOOR AREA TOTAL ACREAGE ments are not intended or offered for Sale.IL-however.the building: GAS EA.SYSTEM 1 1NC.4',OUTLETS,4.00 men . or improvet is sold within one yeur.ofcoroplefon„the owner. _ builder will.hSvedhe':burden'of ,.vire that lye did not build or im. GAS=.EA.SYSTEM-'OVER 4 (EA.) ,1;00 P 8 ._ BUILDI USE prove I,asfor uo derose ofshee p - . � INDUSTRIAL WASTE INTER. ❑ I❑ ❑ o❑r ❑ d as owner rs to Construct he roje6l'ively contracting with -- 20.00 licensed dantractois to construct the pro)edv(Sce 7044:Business. LAWN SPR IN KLERS-S7INC 5 V.B. 5.00 and Professions Code.The Contractor's License.Law dos not apply ASSESSOr P RCELNO: to,5n owner'of property,who tiuilds or improves thereon.and who LAWNISPRINKLERS-DYER 5'IEA:) 9.00 contracts for such projects with a contractortsllicensed pursuant to - the Contrector'sLicense'Law. SEWERSANITARVSTORM EA.200ft/8.00 TRACT NO: PARCEL NO. l am_ exempt under,$ce. ,B&P.G.(or'diis reason WATER HEATER W/VENT- 4.00 -Dale - _ - Owner. WATER SYSTEM - '4.00 - ACC.DATE ACC.FILE NO; ' WORKER S'COMPENSATION DECLARATION WATER TREATINGEGUIP,:. 4.00 �� I h,mby{affum,thm I have a certificate of eumsent.to roll'insure. .. .: .. :ZONING aqa ce hereof leof Workere'Compensalitin Insurance;uoa certified ENG.SITE.NO. CO thereof(Sec 3800,I:ati.C.)ix�// POL�/cy�nNo: Company fila 9�r�q32 0, I/�.ertTrwdIcome Is hereby ff rnished. , zZ, ❑ Cerci 1. y d'with'the.city. Inspection-division. FIRESPRINK ENE PONT]4' � O Applicant �1 MISC:- REFER%TO ORD. K0 NEI v ❑ NEIjr•y CERTIFICATE OF EXEMPTION FROM,WORKERS'. -PERMIT ISSUANCE= - 6.00 - Ujl. COMPENSATION INSURANCE'_ PLGrC_ONTR:' FLOOD:ZONE LIC.'.. PLG :),z Z 11L to (This section'need not bea.completed if the pennibis for o-e ' -TOTAL - Y-� N O. V O , hundred d.11am($100)o less.). - 1 certify that in[he performance oI the work for which this per- OT 'FEESUMMARV r-• mil n inued,.I shall not em to an MECHANICAL,PERMIT' . LL p. y Y persomin any manner so is to ,FEE O.W, Date subjec,to tAWorkers:Compensaliop laws of California: - C.W Date Applicant Certificate A LTEFLOFFADD:TO MECH. - 4:00 BUILDING } In' NOTICE TO APPLICANT. I(,after to the ork rs!Co Compensation ion _ _ f.- ? empbon,yof the L become subject roust forrkeri Commensal ion APPLIANCE 4.00 — pr.viv.ns of the Labor'Cooe, you must forlliwdh'comply with ' PLAN�CH ECK'-. U such provisions or this permit shall be deemed'revoked. - AlWHANDLING UNIT ITO AO,OOD O.F.N1:) 300 -FEE- , CONSTRUCTION LENDING AGENCY, AIR HANDLING UNIT(OVER IO,000GRM.1.5.00 . 'SEISMIC'F EE - I hereby,affirm that there,is a construetion'leuding agency for EXHAUST HOOD(WITH.DUCTI. the p rformance,of the work for which this permit.is issued(Sec: . .3097 Civ C:)., To UNIT(T0100,000 B.T.U.)' 4.00 MICROFILM Lenders Name -Lenders AdelPOSS HEATING.UNIT(OVER''100,000 B.T.LLM50 ELECTRIC I certify that LluI read this application and et.ic that the above VENTILATION'FAN (SINGLE) 300 • information Is correct I agree to comply with,all city nd.county BOILER PLUMBING' ordinances and':'state laws relating to budding construction. and COMP(3 H.P.Dr 100;000 B T.U.) 4.00. hereby aulhoriie representatives of this,city to enter upon the BOILER. abovem nUonedl property.for inspection purposes. COMP(Over IOO,DOOBTU)SEE.FEE,SCH. MECHANICAL - (We)agreeAtor save;.indemnify and keep harmlus the citywf MISC.-. REFER;TO ORD. Cupertino against liabilities,.judgments eo,Ss,nd a-pcmce hich - may many ay accrue against said City;in:cons quence of'.ihc PERMIT ISSUANCE . 3!00 I” CONST:TAX - glanlingofih per il. MECH:CONT LIC.NO.. ,MECH. SlgnetunConerac[or' Date Ir - TOTAL - TOTAL • - - OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY N ^PERMIT.NUMBER BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT - '4154 . ap_pRESS / qq I •. BUILDING —ELECTRICAL—PLUMBING_MECHANICAL OWNER'S --- _ — -- - - — ----- PLAN CHECKVALIDATION NAME a-/��`}•��t'.y�./ CITY. ELECTRIC PERMIT FEE ' . vede; z / /lD PHONE- 7" _ -. NAMERacroR's UTLETS-SWITCHES-RECEP .5.00/1.00 L ADORE 1iC.N lot LIGHTING FIXTURES 5.00/1.00 m OTRAcroR's - - PPLIANCES-RESIDENTIAL 4.00 as ADSS dn HONE: PANELS 5.00' DATE OF APPLICATION. ARCHITECT PLAN CHECK FEE P.C.NO. OR SIGNS 6.00 ENGINEER' LIC.NC. SIGNS TRANS. 3.00 _ AARCH.OR DDRESS ENG: SPECIAL CIRCUIT 5.00 PERMIT VALIDATION - ZIP- TEMP.METER'OR'POLE':INS. 15.00 APPLICANT'S - - aoDRegs - MOTORS'' SEE FEE SCH. .1' S/qfj SERVICE-CHANGE 10.00 Q w 0.2 LICENSED CONTRACTORS DECLARATION I hereby,affirm that'I am licensed:under provisions of Chapter 9 I- z e- '(commencing with Section 7000)of Dbision'3bf the Business and ISSUANCE DATE. r:N i Professions CO my license Is In full far' 'yyJnJf( �S - - _ .BLDG. E'E :PLG. MECH. o i m c L¢ense Class��j� �LIc Number ..� ,❑ El 11 F W F J Date Contractor M i"W a OWNER-BUILDER DECLARATION - BUI DING PERMIT X ; u MISC.— REFERTOORD INFORMATION '_y 1 hereby affirm that I am exempt from the Contractor's License r ,pj Law for the following reason. Sec.7031.5.Business and Professions PERMIT ISSUANCE 6.00 VALUATION g/FT, _ 1- Code.Any city or county which regmres4 permit to construct alter, - ¢ ¢ ¢p Improve,demolish,or repair any structure,prior to its Issuance.also ELEC.CONT, LIC:NO. ELEC. A0¢ requirestheapplreantfor suchpermitto offileto signedstatement cnse L Q��3�3 TOTAL �TO K.m.'• re a es the p applicant to uc provisions of the Comsigned czar s License W'ryw Fin Lawless andr9lcommenCngsvilh Secthat is 00)exempt therefoof the , sac Business end Professionssxempt or that he is exempt therefrom and CITU. PLUMBING PERMIT FEE ¢ F.o the bays for alleged exemption.AnyvinlSlion o(Sedion 7031.5 STORIES TYPE CONSTR. vi;m by any applicant for a permit subjects the applicant Ica civil penally ofnotmore than five hundred dollars($500)1; ALTER-DRAIN -WATER (EA.) 4.00 ❑ 1,as owner of:the property,or my employees with wages as ^' BACK FLOW PROTECT.DEVICE '2.00 their sole compensation,will,do the work,and the structure is not OCC:GROUP RES.UNITS intendedorOffered for sale(Sec. 7044, Business and.Professions DRAINS--FLOOR,ROOF,AREA,CON D. 4.00 Code:The Contractor's:License Law do.not apply to an owner of properly who builds:or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 so,.PT:aaoR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsare.not intended or offered for sale.l f:however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS'4.00 or Improvement Is sold within one year of completion!the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1,00 builder will have the burden:of proving that he did.not build or im- BUILDING USE prove for purpose of sale.). RES, IND '^ O PB. Olhar. ❑ has owner Of.the property am exclusively contracting with INDUSTRIAL WASTE INTER: 20.00 E El ❑. licensed contractors to construct the prnjnet'(Se-..,7044.Business LAWMSPR INKLERS-1 INC 5 V.B. 5.00 A55E55OR 0 11 and Professions Code:The Contractor's License Law does not apply - PARCEL NO. - to an owner of property whobuilds or-improves thereon.and who LAWN,SPRINKLERS-OVER 5(EA.) .1,00 contracts forsuch projects with a contractOns)licensed Pursuant tis - - -, the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO: PARCELNO. leave" WATER um exempt under Sec. f. .B.&P. .far this WATER'HEATER WIVE NT 4.00 Date Owner' WATERSYSTEM 4.00 AM.DATE ACC.FILE NO. WORKERS'CONIPENSATiON DECLARATION WATER TREATING EQUIP. 4:00 - 1 hereby,affirms that I have a certificate of consent to sell'-insure. or a certificate of Workers:Compensation Insurance,or a certified ZONING ENGCSITE NO: copy thereof(See.3800 Lab.C.l. g�/f 7'1 ' O Policy No. Company ertified copy is botchy fur iahed. _ Z Z ❑ Certifiepp,.�� I s1ed"with the city inspecbon;divisiori - FIRESPRINK 'ENERGY T-24 Applicant clr0- MISC.- REFER TO ORD, r� n)❑. v'❑ No F.O PERMIT.,ISSUANCE CERTIFICATE OI^IiXEMPTION FROM WORKERS' 6.00 FLOOD ZONE A.L.ILC. LU COMPENSATION INSURANCE PLG.CONTR. ❑O.NO. PLG 1 (This section need not be completed if the permit is for on TOTAL Y 0 N❑ Y.❑ ..NO Z hundred dollars IS 100)or less.) - - U O I certify that in the.performance of the work for which this per- CITY MECHANICAL PERMIT FEE SUMMARY LL Fl in is issued,1 Shall not employ any person in any manner so us to FEE O w, become subject to the Workers'Compensation Laws of California. _ CL Date Applicant ALTER OR ADD TO MECW 4:00 BUILDING. } m' NOTICE you APPLICANT:become IP,after making this rs'Co pe of ion - L.. Z.' emption,you should becomesubjectto the Worker-Compensation APPLIANCE - 4.00 proexions of,the Labor Code, you must forthwith comply with PLAN'CHECK U such provisions or this peanut shell be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.)' 3.00 FEE' - CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00CRM.)..5.00 SEISMIC.FEE ' 1 hereby,affirm',that dhereis a construction-lending agency.for EXHAUST HOOD(WITH DUCT( -2:QQ dna performance-.of the work for whichthis permit is'issued ISec' MICROFILM 3097,Giv.l;.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lende`r's Name Lender'sAddress .HEATING UNIT(OVER 100,000 B:T.U.)7.50 ELECTRIC I certify that I have read this application and Sale that the above VENTILATION FAN (SINGLE) 3.00 . .information is correct I agree to Comply:with all city and county mdummoes and stale laws relating to building construction. and BOILER-COMP(3H.P.'Or100;0006T.U.) 4:00 PLUMBING 'hereby authorize representatives of this city to enter upon the, BOILER- above-mentioned'property for.inspection purposes. COMP(Oval 100,000 RTU)SEE FEE SCH. MECHANICAL (We) agree to.save. Indemnify .,itkeep Cupertino the City of M_ ISL.- REFER TO ORD. Cup< no against liabilities:judgments, costaand expenses which - may to en :way accrue>against said City mnr conscquence of she. PERMIT ISSUANCE 3.00 CONST.TAX granting its pe L MECH.CONT. LIC.NO. MECH. . 9w— /— /e? — TOTAL TOTAL Signatue o.Applicant/Contractor Date - ^ OFFICE DOPY'' (/ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES =USE BALL POINT PEN ONLY BUI LDI NG PROJECTI DENTI FICATION. / PERMIT NUMBER WILDING _ APPLICATION & PERMIT a �+� 'ADDRESS GL� J '�0 .BUILDING—ELECTRICAL—PLUMBIN —MECHANICAL . OWNER'S - -- - - - NAME l•Ta H /� - PLAN CHECK'VALIDATION' 9 M2.47 17X`0/n _ QTY. ELECTRIC PERMIT - FEE - '/:PNONE CONTRACTORS -SWITCHES-RECEP 5.00/1.00 NAME OUTLETS 7 S /G ND.C'/02&1J1 LIGHTING.FIXTURES' - 5.00/1.00 a4� CONTRACTORS ADDS ESS - PPLIANCES-RESIDENTIAL 4100 . pPHDNE PANELS 5.00 DATEOF APPLICATION ARCHITECT .PLAN CHECK FEE P.C.NO. on SIGNS . 6.00 ENGINEER L.C.No: SIGNS TRANS. - 3:00 ARCH.OR ENG PE P JVA ION - "ADDRESS - SPECIALCIRCUIT 5.00 vJ�/ ZIP TEMP..METER OR POLE INS. •15.00 APPLICANT'S 'ADORE MOTORS y SEE'FEE'SCH. ,y`(e %e S� p SERVICE CHANGE 80.00 f lie BOO LICENSED CONTRA ORS':DECLARATION u I hereby affirm that Fam licensed under.provisions of Chapter 9' - - ¢z. ISSUANCE DATE w.¢ "(commencing.with.Section 7000)mf Division 3.of the Basin,,,and f'y'Z Professions CoQ4g qqn}}11 my licenseis In full fore a d t - BLDG. E PLG. MECH. o2�`C License Class C:l�Lia Number `: ..a yµ:W Dote s, CnnGactor OWNER-BUILDER DECLARATION BUILDINGPERMIT •Ix- o Aro j •INFORMATION ; a.y. 1 hereby affirm that I'am exempt from the Contractor's License _ MISC.,.—, - _ REFER TQORD u04 Law for the.following reason.(See.7031.5,Business and Professions - VALUATION VFT. � - - PERMIT ISSUANCE 6-00 my Code.Any city or countywhi<h regwresa permit to canstrucl:niter, ' QQ¢':C improve:demolish,onrepair any struture,prior.to its i"Icince:also ELEC.CONTlfl. LIC NO. !b-rt - y w p'i[ requires the applicant for such ptOnt110 File a Signed statement that 9Esr �C/D2��? OTAL 76 -P PERMIT TO m:w hers licensed pursuant to.the provisions of:tne Contractors License, - Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe s z:c Business and'Professions Code)or that he is exempt therefrom and DTV: PLUMBING'.PERMIT FEE - a:H the basis for the alleged exemption.Any violation of Section 7031.5 n;:$ by'any applicant for a permit subjects the applicant Its civil penalty - STORIES TYPE CONSTR. of not more than five hundred dollars($500f): ALTER-DRAIN&VENT-WATER (EA.) 4.00. ❑ 1,as ownctof lhr property,or my employeeswith'augesas. - BACK.F LOW PROTECT.DEVICE-"' their,sole compensation,will do the work,and.the structure is not 2,00 OCC'DROOP REB,UNITS intended or offared'Iijr sale(Sec. 7044, Business and Professions DRAINS-FLOOR;ROOF;:AREA,COND. 4.00. Coder The.Contractors License Law does not apply to an owner of - -- PmperlywhObuilds.or improves thereon,and whodoes inch work FIXTURES-PER TRAP 4lOO' BQ FT.FLOOR AREA TOTAL ACREAGE It or through his own employees,provided that such improvi�- mems arc nal intended or offered for sale.If,however,the building GAS-EA.SYSTEM'--0INC.4 OUTLETS"4.00 or improvement is sold within'one year of completion.the owner. - builder will have jhe burden of,proving that he did not build or im- GAS-EA,SYSTEM-OVER 4.(EAI) 1,00 - BUILOW USE prove for purpose of sale.). INDUSTRIAL WASTE:INTER. - RES IND .PB Other ❑ 1,as owner of theproperty am exclusively contmeting'with 20.00 :El ❑ ❑ licensed contmclors,ro construct the project(Sec. 7044:,Business LAWN'.SPRINKLERS:1 INC5 V:B. ;5:00 g5HE550 PARCEL NO. and Professions Coder'The Contractor's License Law does..1 apply to an owner of properly who builds or,improves thereon.and who LAWN SPRINKLERS-OVER-5(EA.) 1.00 HIS for such projectswith,a contractor(s)'licensed Toronto ro - - the Contmctor'ssLicense Law. SEWER-SANITARY-STORM EA..200ft/8.00 TRACT NO: PARCELNO. "❑ I am exemptunderSec; •,BAP.C..Iar this WATER HEATER W/VENT- reason - - 4.00 Dale Owner WATER SYSTEM . 4.00 ACC.DATE .ACC.FILE NO. WORKF;RS•COMPF.NSATION DECLARATION WATER'TREATING EQUIP. 4.00 I hereby alfirm that have a certificate of consent to self-0rvatm, - or a certificate. of Workers Compensation Insurance or a certilietl ZONING'. ENG.SITE NO.. copy thereof(Sec' 3800,Lab C.) s Polit�yy yyoo Company ry� ��Ar�.L•_ 0 fYCertified copy is hereby furnished.- - Z:Z ❑ CerlifiCd y lCd'with.the City inspection division. FIRE'SPRINK ENERGY T-24 O -Applicant __ ��is fit/o MISC.- REFER TO ORD. Y N v N 2 y 'CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE .6.00 FLoa zDraE❑ 'n:L❑.u.c. :❑ L > COMPENSATION INSURANCE PLG,CONTB, . LID.NO; p(G, _ CL O (This.section neetl not be completed.iP the permiLis for ane TOTAL Y'El N� 1 V❑ N� 7 Z handrail dollars(51001 or.less.) - ` 0 O I cerlifyo that in the performance of the work for which[bis per OTY MECHANICAL PERMIT' FEE SUMMARY LL F. 'mat is issued,I shall not employ any person in any manner was to - FEE Q.W become,subject to,the Workers%Compenulurn Laws of Caliloriiiu. y .Date Applicant 'ALTER,OR',ADD TO MECH.. 4.00 BUILDING' }W NOTICE TO APPLICANT: If,aftcumait, this Ce'"Feateof lis- . r _ empton:you should become sable,Io,he:Work rs Compensation APPLIANCE 4.00 .PLAN CHECK prowsions.or the Labor 'Code . Yen 'rnust forthwith comply with - -PEE U. such provisions orchis permit shall be deemed'revoked. AIR HANDLING'UNIT(TO IQ QF,.PA) 3.00 CONSTRUCTION LENDING,AGENCY AIR HANDLING UNIT(OVER 10,000GF,M) 5.00 SEISMIC FEE I hereby affirm that there is a.construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the performance of the work for which,lhis permit is issued(Sec. - MICROFILM. 3097,Civ.C.), - HEATING UNIT(TO 100,000 B.T.U.) 4.00 Landers Name Lender's Add.. HEATING UNIT(OVER-1or,,000 B:T:U.17.50 ,ELECTRIC - 1 xrl lylhmlhave nod this apphcaton and stale that theatiove VENTILATIONFAN(SINGLE) '300 • information is correct+l agree to coma ly with all city and county - COIVP(3 H BOILER- -'PLUMBING ordlnances,and state laws relating to building'construction, and .P.cr 100,000 B.T.U.),4,00 hereby authorize representatives of this-city:to enter'upon Ole BOILER-COMP above mentioned property for inspection purposes. (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save_indemnify andkeep harmless the Cit) of 'MISC.- REFER TO ORDI ' Cupertino against liabilities,judgments ts cosand expenses which CONST.TAX may in any way accrue'against said City.in'consequencie of the .PERMIT ISSUANCE 3:00 '. 9.rung of[ ermlr�Iiit� / /// MECH.CONT: LIC.NO. MECN. ibqy/// YMlI - ! _/j, TOTAL Srgnatureo ApplicanUConlractor Dale - TOTAL OFFICE.COPY "