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3559 4362 4400 20734-41 CELESTE CI R 3559, 4362, 4400 F DE ANZA PROPERTIES SCANNED BOX # 783 i f CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE -7 - 7 - C,BLDG. /PERMIT NO. �S i THE BLDG. LOCATED AT D 7 OWNED BY /7 Q a 2--1L) f d IDf 0' //` p I HAS BEEN COMPLETEDI FOR USE AS / r ` P;L'T/EREDI , In / / S r. J BUILDING INSPECTOR � • y� w CITY OI' CUPERTINO INSPEGTIOI! RECORD (Office Copy) , • i 3559 _ ;'1 - Rldpg 20734 - 41 Celeste Circle PEP.IIIT NO. SANITARY DIST. NO. LOT NO. ADD RI?tiff Const. 8-Units DeAnza Properties PROJECT OWNER JOB SITE PI1014E NO. PERMIT ISSUED nate ELECTRICAL Ru i1d'ine _ 5/11/83 Date Insp. Electrical Power Pule I'lumhiny Underground -- -- Ilcclianical Rauh Wiring Temp. Cas/Elect. !Tails Solar Ceiling Fire Sprinkler Fixtures int/Ext Sign tlotors Ground-ing ilisc• Temp_ Power Other _ FINAL INSPECTIONS Not Approved Date Insp. s 3 - 1 PLUMBINGElectric Date Insp. Plumbing - Backflow _ Mechanical - - Underground _ Solar Underfloor Pool Partial Roughp-/fi g Grading Rough Complete /10 17r3 Planning Solar Rough Eire Dept. Water & Insulation _ Ileaith Dept. "lain Drain /h- /e_,�r3 Building - - R'/of/S Drain Other •! . Cas Other BUILDING Not Approved Date Insp. 1'ad Certification MECHANICAL Foundati.nn Pre--unite Date Insp. Underfloor S.M. Slab-Membrane Ducts & Insulation -.00 31 Bond Ream Fire Dampers Underfloor Girders Fireplace Floor Steel iedowns Grease Duct & hood DOne (lour Shaft iaphrams °p 2 Condensate Drain Seismic Ilracinl S�n.ear I-1 ��— Equipment Anchorage_ (falls-Panels Flues & Comb. Air Frame. Other Lath Not Approved Ilallboar n 7VEx Firewalls Co (,- cto-To- 3`repS--nzoe/ &Otey r n 1 Not Approved Fu�uQ jVa.el� 3'� �I�� C�1u� �vlcd) t �( -Aik f a s1 G Ff S(6uC oq �Et•A r1.u ati a44 Dl?tOn.. A.-O Qo Vex BUILDING * y` (ic6T weT COW T az�te�mJ(¢r C( ELECTRICAL PLUMBING i MECHANICAL MISCELLANEOUS -APPLICANT TO FILLIN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY l` - - PERMIT BER -� op- DENTI FICATION - ION & PERMIT (�'l 35:59 ING—ELECTRICAL—'PLUMBING-MECHANICAL- PLAN CHECK.VALIDATION QTY. ELECTRIC PERMIT FEE'UTLETS-SWITCHES--RECEP. 5.00/1:00 LIC.No. LIGHTING FIXTURES 5.00/1:00 - CONTRACTORS offs AONTRA - PPLIANCES-RESIDENTIAL 4.00 C ,PHONE PANELS 5.00 DIATE'OF APPLICATION ARCHITECT SIGNS ' '� 6.0U PLAN CHECK,FEE P.C.N OR �� ENGI fl, // o. - -'SIGNS TRANS. 3_:00 W. CH,OR ENG." PERM VALID 1 ADDRESS SPECIAL CIRCUIT- 5.00 '/yy /�j�yy ZIP EMP.METER 08 POLE INS. ' 15.00 jo } , ADDRESS Ts - MOTORS SEE FEE.SCH. ' v - S AOOTEs6 � f ERVICE CHANGE- - 10.00. Woo ICENSED CONTRA OR ECLARATIO AJ1,/tIp/C;/ f.P/M�'W Q u,W 7 hrrebm y.affuthat I:am I6mcd under provisions of Chapter N z' (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE 4 A BLDG. ELECT. PLG: MECH. r o i Professions Code,and my license is in full force and effect. z OL;s— License Clan Lic.Number -0- 1 El ❑ 2,a, F-,w Data Contractor - H• �f J - MEme rt J OWNER-BUILDER DECLARATION' ' - - - 1 BUILDING'PERMIT X;;'G I.hereby affirm that I am Exempt.from the Contractor's License MISC.- 'REFER TO ORD' INFORMATION me me ,oa .Law for the following mason.(Sec.70315;Business and Professions - PERMIT ISSUANCE VALUATION SIFT. V,ICode-Ar it or count whichm lyresa — 6.00 Ari y y y permit to construct.alter, C a:a.,0 improve,demolish,or repair any structure,prior to its issuance.also ELEC.CONTR. LIC.NO. ELEC!' to r0.a requires the applicant for such permit to rile a signed statement that - - TE w�m_N he is licensed poison",to the provisions of the Contractor's License n 'PE///R���MIT TO _ Q Law(Cnap[er9(commeneing with Section 7000)of Dwision3o(the f i3O Busmess.and'Professions Code):or that he is exempt therefrom and QTY. - PLUMBING PERMIT FEE. fYYXff rrrAAA�1��f.Q J Y M v�� the basis for the alleged exemption Any violation of5ection 7031.5' STORIES TYPE CONSTR] by anyapplicant'for It permit subjects the applicant toa'ivil penalty of not more than five hundred dollars(S500).): ALTER-DRAIN IEA.1.4.00 614 ❑ L as owner of theproperty;or my employe with wages as BACK FLOW PROTECT.DEVICE � • then sole.compe"ration.Will do the work,and the structure is net 2.00 OCC.GROUP RES.UNITS intended or offered for sale(Ser 7044, Business and.Professions. DRAINS-FLOOR,ROOF,AREA,COND. 4.00 y Code The:Contractor's License Law does not apply town owner of (! property who builds or improves thereon,and.who doessucldwork FIXTURES-PER-TRAP ' 4.00 60.FT,FLOORA RA TOTAL CLRECGE meatshimself re through his own ff.m&fws Provided that such improve. - mentsarenorintcndedor immldf r.-p ILhowee c buildin,improve. GAS-EA.SYSTEM-3-INC.4OUTLETS.4.00 or Improvement Is sold within one year.1 completion.the owner budder will have the burden of Proving that.he did not build or im- GAS-EA.SYSTEM.-OVER 4(EA.) 1.00 BUILDING USE pro forpurpose of sale). INDUSTRIAL WASTE INTER. 20.00 RES' IND' CDN PB Other- as owner owner of the property.am exclusively contracting with ❑ ❑ 0 - 11. 1' a sed contractors to construct the pmject(Sec 7044,Business, LAWN SPRINKLERS.-1 INC 5 V.B. 5.01) - ASSESSORS PARCEL NO., and Professions Cade.The Contractor's License Law does not apply � _/� to an owner So property,who glides tr improves thereon.and who LAWN SPRINKLERS-'OVER$(EA:) 1:00 contracts forsuch projects within ontmctons)licensed puinrangto the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/6:00 TRACT NO' PARCEL NO. re wn am xempn -r Sec: B&P. '.for his WATER HEATER W/VENT 4.00 Date O" __ WgTER SYSTEM -4.00 'AW.DATE .ACC.FILE NO. OR KERS'COMPENSATION DECLARATION WATER TREATING EQUIP, '4.00 I hereby,affirm that Phave a certificate orconsent to self-insure.. - or a certificatelof Workers'Compensation Insurance,or a certified _ZONING ENG.SITE NO. copy,thereo((Sae 3800 Lab.C). J9D r� Policy No: Company i- 'Q ❑ Certified copy is hereby..furnished' - FIRE 6PRINK: ENERGY T-24'z Z ❑ C61ified copy is filed with the city'in[peclion division. MISC.- REFER TO ORD. .� O Applicant' - No v N[:] Cr W CERTIFICATE OF EXEMPTION FROM WORKI!RS' PERMIT ISSUANCE 6.00 - FLOOD ZONE' jMllrl 'W COMPENSATION INSURANCE PLG.CONTR. LICf NO. PLG. G' (This section need not be completed if the permit is for'one _ TOTAL v� ,LB•--q�, Z hundred dalars(S100)or less.). . . U'O 1 certify'.that in the performance of the work forwh -hdhisper' 'OTY MECHANICAL PERMIT FEE FEE,SUMMARY LL 6 in is issued;I.shall net employ any person.in any marine,sous to - ' U becortie subject to the Workers'.Compcnsation Laws of C Illurnia. U is Date 'Applicant- ALTPLIC. R OR ADD TO MECH. q',q0 BUILDING /mW }..N Data TO APPLICANT: If,after making This Certificate of Ex- - �;Z emption,you should become subject to the Workeri CompensationLIANCE '4100PLANCHECK pro rsions,of the labor Code. you must forthwith comply withsuch provisions or this permirshall tie deemed revoked HANDLING UNIT(TO 1041MCF.M:) 3.00 - FEE CONSTRUCTION.LENDING AGENCY HANDLING UNIT(OVER IQOOOC.FM.15.00 SEISMIC FEEI hereby affirm that there is a construction'landmg agency (orAUST,.HOOD:,(WITH DUCT) 2.00the performdnce o('the workiforwhich Ihis'permit,is Issuad(Sea - - MICROFILM 3097,CIv.C.). TING UNIT ITO 100,000''B:T.U:) 4.00Li:nder's Name Lender'sAddress TINGUNIT(OVER 100,000 B.T.U.)7.50ELECTRIC Lcertify that)have mad this application and state that the aboveTILATION FAN (SINGL_E) 3.013infoMotion is correct 1 agree to comply with'all ity and count) ER COMP PLUMBING ordinances and state laws relating to budding constructs n, and (3 H,P..or 100,000 B.T.U.) 4,00hereby authorimr presentativesof thismy to einT tip in theLER-COMP'IOvar 100,000 BTU)SEE FEE SCH,above mentioned prof rty for inspect)m purposesMECHANICAL (We),agree to,save indemriify.und keep:Immiless the'City of .- REFER TO ORD.Cupertino against hag Mies,judgments,costs and expenses whichmay in any way,'i eme against Said City inconsequence of the: MIT ISSUANCE 3.00 CONST.TAX ptlpgOfih er II, LIQ NO. MECH.TOTAL TOTALrSi ore of plicanl/ConjConractur r - OFFICE COPY. - ' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUIL DI NG PROJECT I DENTI FICATION APPLICATION &'PERMIT PERMIT,NUMBER DI - . aLDING 36'Z •- DOR L�aTC L' GA. P 'BUILDING'-ELECTRICA -P4362 LUMBING-MECHANICAL ER'S - - - - - _- - -- _ - PLAN CHECK VALIDATION NAMe OTY. ELECTRIC PERMIT FEE_' - AJ C Q PHONE _ coNrRAcroR's AME UTLETS.-SWITCHES-RECEP' 5.00/1.00 r NaNt► Pttig /I uc•No.'ASIC e>D LIGHTINGFIXTURES 5.00/1.00 DDRESS oR's ADDRESS - JAPPLIANCES-RESIDENTIAL 4.001.9 - r�1 s'') g. !D •gy 0 vi PHONE' Vro-�/�J PANELS - 5.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR . SIGNS •6.00 - ENGINEER uc No, SIGNS TRANS. 3.00 :ARCH.OR ENG - PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 PAID .. ZIP EMP,METER OR POLE INS. 15.00 - APPLICANTS ADDRESS - MOTORS SEE FEE SCH. ,. . JG C:0 �/I�'t�►l V t GAP SERVICE CHANGE - 10.00 SEP 2 3 19P') ' .. a oo LICENSED CONTRACTORS DECLARATION }sI .y a is j I herebyaffum,that I am licensed under provisions of Chapter 9 .City of Cupertino ¢ Z w P P ISSUANCE DATE . (commencing with Se ny li ease i in nlfullsion 3 of the Business and G¢ > •BLDG. ELECT. "'PLG. ,MECH. H i Professions Codr 8p,rlY,licen Li .Numb fora as�Cefycl, QI 2 z rS m 'License lass f� Contractor ractor 4 F,A� J,. DatcCnntraclo/ a mBUILDING PERMIT E rt w u OWNER-BUILDER DECLARATION z 3 n,HA. 1 hereby,affirm1that'I am exempt from the Contractor's License _ MISC..- REFER TO ORD INFORMATION ww0 J Lew forthe following reason.(Sec:7031.5.Businessand Professions PERMIT ISSUANCE'. 6.00. VALUATION S/FT. fH>E Code:Any city or county which requiresa permit toconstruct,alter. a:ea ¢O. .improve,demolish,or repair any structure.prior to its issuance,also ELEC.CONTR. 'LIC.NO.- ELECT i m OG LL' reyuires the applicant for such permit to rile'a signed statement that TOTAL % m " he is licensed pursuant to the provisions ofAhe Contractors License PERMIT TO s- Low.(Chapter 9(commencing with Section 7000)o(Division 3 of the fz o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING'PERMIT FEE 2 F$ the basis for thealleged exemption..Any violation or Section 7031.5 STORI S TYPE ONSTR. hyanyapplicant foru permit subjects the applicant to a civil penally , ALTER-DRAIN&HENT-WATER (EA.)ofnot'more then,five hundred dollars(5500),): ' ❑ I as.owner oflhe: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 DDD>GRDUP R 5.UNITS - intended bt offered for suh,(Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 4.00 Code:The Contractor's4icense Law does not apply to an owner of property who builds or improves thereon,and who does such work F,IXTUR ES-PER TRAPhimsel4.00 so:Pr.FLooR AREA TOTAL ACREAGE nertir or through his own employorsale:I f,h that r,t h builove- - - orimprovementisSoldwithinred oneyearof,completio ttheo owner, GAS-EA.SYSTEM-11NC.4'OUTLETS 4.00 or improvement will have rs sold within one year hat he did of the owner "GAS-.EA.SYSTEM-OVER 4 IEA.) 1,00 .. BUILDING USE builder will have the burden of proving ilial he did not build or im- provefor purposeofsale.). INDUSTRIALWASTE IN RES IND CON PS Dole, ❑ 1.�as owner aLthe pioperty,ameselusively camracting with 20.00 E] ❑ El I--]' ❑ licensed contractors to construct the project(Sec. 7044,Business LAWNSPRINKLERS-1,INC,5''ViB. 5.00 ASSESSORSPARCEL NO. and Professions Code:The Contractor's License Law does not apply - -to an owner of properly who',builds or improves thereon.and who LAWN'SPRINKLERS,OVER 5'(EA.) 1,00 contracts(orsuch projects with a contractons)licensed pursuant to - - theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/8.00 ,TRACT NO. PARCEL NO. _ Lam exemptunder Sec.-.B.&P.C.lot this ..Son WATER.HEATER'W/VENT q,00 Dam - Owner WATER SYSTEM 4.00 AM.GATE ACC.,FILE N0. WORKERTCOMPENSATION DECLARATION: WATER TREATING EQUIP. 4.00 1 hereby affirm that I have a certificate of consent to self-insure. , 'or'a certificate of Workersf Compensation Insurance.or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Iab.C.), Fi��rn►ti Policy.No, - ' Company O [A Certified copy is hereby famished FIRE SPRINK ENERGY T-24 Z'Z Certified copy is-filed-with the city. inspection division. F:O Apvlicam MISC.- REFER TO ORD. y� NE] Y❑ N[] X'T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT-ISSUANCE- 6.00 FL00020NE 'A.L.u.C. LU > COMPENSATION'INSURANCE PLG.CONTR, `uC.NO. - PLG, CL O (This section-need not be+completed if the permit.is for one TOT.L l�r Y O, N� Y-13 'N El -Z)Z hundred dollars IS 100)or Is.J U O 1 certify that in the performance of the work for which this per. OTV. FEE SUMMARY MECHANICAL PERMIT LL f mu Is issued,1 Shallow employ any person i any muonc,,.as to FEE U bcco- = "c t the Workers'.Bpnl?' '� a of Cvlifornia. '� y. Data ` Applicam ALTER'ORADD TO MECH. 4,00 BUILDING } res 'NOT E TO APPLICANT: If,after making this Certiftcme of Ex- F Z emption;you should become subject to the Workers'Compensation APPLIANCE - 400 PLAN CHECK provisions,of the Labor Code: you.must forthwith comply with . U such provisions or this permit:shall he deemed,revoked. AIR HANDLING UNIT(TO 101ACCRM) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 14000CFNL) 5.00 'SEISMIC FEE I hereby affirm that.there is a construction lending agency,for EXHAUST HOOD(WITWDUCT) 2.00 the performance of the work for which this permit is issued'(Sce. - MICROFILM .3097:Civ.C.). MCONT, G UNIT(TO 100,000 B:T.U.) 4.00 Lenders Name - Lenders'Address GUNITIOVER100,0008.T:U-)7.50 ELECTRIC I certify that I have read this application and start that the aboveATION FAN (SINGLE) 3.00 information is 2nrrect.1 agree vo comply with all and county .PLUMBING ordinances ad State laws relating to building,construction. andCOMPO H.P.or 100,000 B.T.U.) 4.00 - .. :hereby authorize representatives of this city to enter upon the - above-mentioned Properly for inspection purposes -COMP IOver l00,0008TUTSEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep h unless.the City of REFER TO RD: - Cupertino,against liabilities,judgments, costs and expenses whichISSUANCE CONST.TAX may in any.way a cave against sold City in consequence of the '3.00gmI¢ing of per L ,LIC.NO. MECH. TOTAL TOTAL SglAalure of Applicant/Contractor Uate OFFICE.COPY - - APPLICANT TO FILL 1N INFORMATION WI LINES - USE BALLPOINT PEN ONLY a BUI LDI NGPROJECT IDENTIFICATION PERMIT NUMBER BUILDING ��� It _APP ICATION & PERMIT 4400 ,Aoonllss. INGggiCTRICAL—PLUMBING—MECHANICAL PLAN CHECK VALIDATION n OTY.� ELECTRIC.PERMIT FEE �fp PHONE I .O Pap. CONTRACTORS LTLETS-SWITCHES-RECEP 5.00/1.00 r NA LL GT.LI -? C.NO '3 7/ &1 ILIGHTING FIXTURES 5.00/1;.00 Cp 3 Q 1�J8� CONTRACTOR' PPL'IANCES-RESIDENTIAL 4.00 SEr AD /�//Yr X1 N/61aaN�n S S.u ' PANELS.. 5.00' DATE 410 ARCHITECT - SIGNS 6.00 PLAN E P.C.NO. OR -. ENGINEER - -LIC.NO. SIGNS.TRANS.' 3.00. -ARCH,08 ENG: 'PERMIT-VALIDATION ADDRESS SPECIALCIRCUIT 5.00 :BIP TEMP.:METER OR POLE INS. 15.00 APPUCANT's MOTORS SEE FEE SCH. . ADDRESS SERVICE CHANGE � -10.00 Woo LICENSED CONTRACTORS DECLARATION a u w I hereby affirm that l',am licensed.under In of Chapter 9 -' ISSUANCE DATE I- (commencingwuh Section 70001 of Division of the Business and a u •�� - BLDG. ELECT PLG EC . Professions in '.license rsmfull.fu n S z o Lme He Lo..Numbe o H w Date Contract di . . BUILDING PERI ¢ ¢ a O ER-BUILDER DECLARATION - c a'u INFORMATION. 'u S y Lherebyaffirm that I am exempt from:the Contractor's License MISC.— - REFER TO ORD F :o"g Lavlfor the following reason.(Sec;7031.5.Businessano Professionst PERMIT ISSUANCE '6i0U VALUATION Code,Anycity orcounty which requires a permit to construct niter, - R Q Q..0 - improve'demolish.or repair any structure.prior to IIT IStnance,also ELEC.CONTR. LIC.NO. ELEC. ' To O,, requires the applicant for such permit to file a signed statement that TOTAL. 6'x'2"w he IS licensed pursuant to the.provisions of the Contractors.License' PERMIT TO r z a apter9(commencing with Section 7000)of Division 3 of the - 4 Law(Ch _ Mi;D the bass and he alleged exempt or that he is exempt therefromono, OTY. PLUMBINDPERMIT EEE ¢ I-;o the bans for the alleged exemption:Any violation ofoaction malty STORIES TYPE CONSTR. y ;m of nanyot applicant for a permit subjects the applicant too civil penalty of not moa than five hundred dollarslS5001.h I � ALTER?DRAIN&VENT-WATER [EA.) 4.00 ❑ I.as owner of the properly or my`employees With wages as BACK FLOW PROTECT.,DEVICE 2.00 OCC,GROUP RES,UNITS, their sole compensation;will doth.work;and the structure is not - .intended or offered for sale (Sec 7044;Business'and Professions. DRAINS-FLOOR,ROOF,,AREA,COND.; 4.00' Code:The Contractor's Licensci Law does not apply to an owner:at property who builds or'improves themom and who docs such work FIXTURES-PER TRAP 4.00 BO.'FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such impro4e- -- mentsare not intended or offered for.]].IL however,the building GAS-EA.SYSTEM-1'INC.4 OUTLETS 4,00 or Improvement is sold'veithin'one year of,completson, the owner- GAS.EA.SYSTEM-OVER 4(EA.) 1.00 euILDING USE budder will.have the burden of proving that lie did,not build or im- proveforpurposeofsale.). - INDUSTRIAL WASTE INTER. - RES IND c PS Omer ❑ I,as owner of the property am exclusively contracting.with 20.00 licensed contractors 10 Construct the,projecl(Sec.7044,Business LAWN SPRINKLERS-1.INC 5 V.B. 5.00 gBSE5S0 RCEL NO. and Professions Coder The Comme(or's License Law due,not apply - - toanowner'of property who builds or'impreves thereon.and who LAWN SPRINKLERS r OVER,5'(EA.) ;1;00 cpnlracts',fur such projects wilhnTontrui1ontl hcensehpursuant to - - theContractor'sLicenseLaw: SEWER=SANITARY-STORM EA:200ft/6.00 TflgCT NO.. FE the NO, ' reason am exempt under Sec. .B.&Y.C.ilbr Ibis WATER.HEATER'W/VENT 4.00 Date owner WATER SYSTEM„ 4,00 ACC,DATE ACC.'F ILE NO. WORKERS,COMPIiNSATIONUECCARATIONWATER TREATING EQUIP: 4.00 ' Thereby affirm that I have a certificate of consent to sel Ginsure• or a certificate of Workers Compensation losumnce:or asert'tied r ZONING ENG:SITE NO. copy thereof(See.3800.Lab.C.). Policy No. Company O �I. Cemfie py is hareh f misted. Z 2 �i Carl }+y _h f - th'tI yt inspection division. FIRESPRINK 'ENERGY T 24 HO Alfpficn �— r✓+'-ddr-'y MISC. -.REFER TO ORD. �' O Y N Y N .may CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT'ISSUANCE 6:00 FLOOD ZONE W > COMPENSATION INSURANCE PLG:CONTR, LIC.NO. Ip[G d O (This section need or be completed if the permit is for one TOTAL 'N� Z hundred dollars IS 100)or less.) - U O 1 certifythat'm the performance or the work for which Ihis per-. OTy/ MECHANICAL PERMIT FEESUMMARY LL U mil,is issued,I,shall not employ any person in any manner ser as to FEE O W become Subject tothe lWorkers any Laws of California, Date Applicant .. BUILDING - },Z NOTICE TO.APPLICANT,.;IL after making this Cerlificote of Ex= ALTER�ORADDTO.MECH. q,00 �'_ emptlon,you should become subject 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 UNIT(TO 10P00C.F.MI) 3.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C:flM.) 5.00 'SEISMIC FEE ' I hereby affinn that there is a construction lending agency for the.performance of the work.for which(his permitEXHAUST HOOD (WITH 2.00 3097. - MICROFILM - 3097.Civ.C.). " HEATING UNIT'(TO 100;000 B.T.U:) 4.00 - Lender's Name Lender's Address HEATING UNIT,(OVER.100,000 B.T.U.P.50 ELECTRIC , ' I certify that l have read this application and slate Thur the above VENTILATION FAN (SINGLE) 3.00 _ information.'is correct I agree 10 comply with.11city and cosinty BOI�ER•OOprP PLUMBING 'ordinances and state laws.alating to building construction, and I3 H.P.or 700,000B.T.U.) 4;00 hereby.authorize representatives of this city to enter upon.the above-mentioned property for inspection purposes. BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL f (We) agree to sac indemnify and,keep harm) w the City.of� MISC.- - REFER TO ORD. Cupertino against liabilities.judgments„costs,anit expenses which- +CONST.TAX` may Inanyway accrue.against mid City.in consequence of the, PERMIT ISSUANCE 3.00 granting of Ihis permif MECH.CONT. LIG NO. MECH. - /�}]) TOTALiE (J TOTAL �D Y`•' Signature of ApphcanllCantrnctor Date /// ' _ OFFICE COPY _