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8613CANT TO EIUII... o(ri W,O 0 Lu r aN Z O H 02 o Ic6 y 4 a O a U w u 0 QJ W Kamm a X p w m N r 2 ¢ CCtyro Lu r toa FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Lal NG PROJECT I DENTI FICATION APPLICATION &PERMIT BUILDING -- ELECTRICAL— PLUMBING — MECHANICAL PERMITNUMBER 8613 INAILOINy LOT 2 Do Ess- PLAN 1 NAMEAS I}eAnZa Group,A CaliforniaPLAN Ltd. PartnershipPHONE415/571-I QTY. ELECTRIC PERMIT FEE 81 CHECK VALIDATION CTOR•s NAME NAME OUTLETS -SWITCHES- RECEP 10.0011.00 LIGHTING FIXTURES 10.00/1.00TheAldenCompanyLIQNo. 465640 SsraRs 411 Sorel Ave,Ste. 410ADDRE APPLIANCES - RESIDENTIAL 4,00 1 PANELS 10.00SanMateo, Ca.94402PHor4l5/571-14 DATE OF APPLICATION ARCHITECTPANELS ORENOIN1611 alderon-NakamuraLIC.NO, C013712 OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 AEN` 2070 Business, Ctr. #220ADDRESSESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20,00Irvine, Ca. ztP92715 5 S' ADDRESSTS 411 Borel Ave, Ste. 410. MOTORS SEE FEE SCH, SERVICE CHANGE 20.00Sa,n Mateo, Ca. 94402 OrJUL LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 1 hereby affirm that I am licensed under provisions of Chapt 9 commencing with Section 7000) of Division 3 of th Business nd Professions Cade nd my license is in full force, qe License I Lic. Number FFO F Date Contractor ISSU NEE T n B D PL MECH. BUILD,ING,PERMIT INFORMATIONOWNER -BUILDER DECLARATION 1 hereby affirmMISC. m that [ am exempt from the Contractor's License Law for the fallowing reason. (See. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that pursuant to Ing with Se ti of the Contractor's LicenseheisUccnsc( ChapterLaw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he is exempt therefrom and REFER TO ORD VALUATION d" SIFT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO CITY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ALTER DRAIN &VENT -WATER (EA.} 5,00 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC GROUP RES. -UNITS 1DRAINS -FLOOR, ROOF, AREA,COND. 5.00 Code: The Contractor's License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mems are not intended or offered for sale. If, however, the, building FIXTUR ES - PER TRAP 5.00 9 SQ. FT. FL OR AREA TOTAL ACREAGE GAS- EA. SYSTEM -1 1NC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- prove for purpose of.sale.). 1, as owner of the property, am exclusively contracting with GAS EA. SYSTEM -OVER 4 (EA,} 2.00 B 1LDING USE E IND CON PB Other INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6,00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 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 ASSESSORS PARCEL NO. contracts forsuch projects with'a cantracior(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft110,D0 TRACT NO. PARCEL NO. f am exempt under Sec. BAP.C. for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC. DAT ACC. FILE NO. WATER TREATING EQUIP, 5.00WORKERYCOMPENSATIONDECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, b.0 ). Policy No. f}drpl an , Thk Aiden GeHiq)-aftyCcrtrledcopyibfurniis'fi Certified copy s 1e a city inspection division. Applicant So' FROM( FIRE SPRINK Y N ENERGY T-24 Y N MISC. - REFER TO ORD. CERT'IFICAT F E PfION WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENS TION INSURANCE This section need- not be completed if the permit is for one Y N V E] N QTY. MECHANICAL PERMIT FEE FEE.SUMMARY hundred dollars (S 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 BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 JAPPLIANCE 5.00 PLAN CHECKemption, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY FEEAIRHANDLINGUNIT (TO 10A00C.F.M.) 4.00 AIR HANDLINGUNIT(OVER IO,0OOC-FM.) 6.00 SEISMIC FEE 1hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance af'the work for which this permit is issued (Sec. 3097,Civ.C.). Bank of AmericaLender's Name MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8,00 HEATING UNIT (OV100,000 B.T.U.)9.50 ELECTRICLender's Address f certify that I have read this application an sae at the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county ordinances and stale .laws relating to building construction, and PLUMBING BOILER-OOfV>P(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICALherebyauthorizerepresentativesofthiscitytoenteruponthe above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX We) agree to a indemnify and keep harmless lite City of Cupertino agai I ;b hiesK j encs, costs and expenses which may in any caid City in consequence of the granting of thi a it 5/31/85 PERMIT ISSUANCE 10.00 MECH. CONT, LIC. NO. MECH, TOTAL TOTAL Signature of Applican Data OFFICE COPY W POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERVIT NUMBER r n INSPECTION DIVISION L 61 t3 JOB INSPECT IO RECORD Ioil, PERMIT EXPIRATION JOB ADORES UNI OT# t - PERMIT EXPIRES IF WORK I, OWNER CONTRACTOR IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 160 DAYS FROM LAST CALLED INSPECTION. INSP! TIONiINSP CTOR INSPECTION RECORD FOUNDATION.S,$(,, ( UFER PREGUNITE PERMIT VALIDATION PAID,. JUL g POUR NO CONCRETE UNTIL ABOVE HAS BEEN S[GNED UNDERG_ ROUND / SL 19$5 _ PLUMBING ELECTRICAL CIti s DAT9- BL G ELECT., .f' MECFf. MECHANICAL 00 NOT POUR FLOUR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL P IT O ELECTRICAL FRAMING STORIES TYPE CONSTR, INSULATION OCC. GROUP RES. UNITS. IPLACENOSUBFLOORUNTILABOVEHASBEENSIGNED LLROOF SO. FT. F.LOQR AREA TOTAL'ACREAGE DIAPHRAGM ZV _ r BUILDING USE E IND CON PB Other F-1• Fl 0 El APPLY NO R00 ING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO, ROUGH 7ZI iPLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL ELECTRICAL -s FIN S DATE INSP, ACC. DATE C. FILE NO. FRAMING SAN # ZONING ENG, SITE NO. IN ULATIO PiUMBING GA FIRE SPRINK C] N[3 ENERGY T-24 Y E NE:l ME HA AL- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED H NG FLOOD ZONE Y0 N A. L.U.C. Y N LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS ELECTRIC PLAN CHECK FEE GAS SEISMIC FEENOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDIOCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBYBUILDING INSPECTOR. MICROFILM ARRANGE FOR 1NSPECTION'BY PHONING 252-4505, ELECTRIC PLUMBINGoONEWORKINGDAYBEFOREREQUIREDINSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. Z SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST. TAX IMPORTANT! v- PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LD1 NG PROJECT 1 DENTI FICATI ON PERMIT NUMBER isUI LDING APPLICATION & PERMIT �A� nooREss LOT 20 b � 4 . P BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNERS'- - - - I I -- , PLAN CHECK VALIDATION AME . DeAnza Group, A California CITY. ELECTRIC PERMIT FEE HONEA1q,Jq71-1 al CONTRACTORS NAME UTLETS-SWITCHES-RECEP 10.00/1.00 T6 Alden flowipany 41C.No. 4fiSfi4n LIGHTING FIXTURES 10.00/1.00 CONTRp�TORS PPLIANCES-RESIDENTIAL 4.00 { ADDRESS 411 Sorel Ave,Ste. 410 ] RCHITECT PHO PANELS 10.00 DATE OF APPLICATION 4 APLAN CHECK FEE P.0 NO. on PANELS (OVER 200 AMP( 20.00 ENGINEER iIC.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. VALIDATION S ADDRESS 2070 Bueineee Ctr. 6220 SPECIAL CIRCUIT 5.00 PERMIT PAID Z,R EMP. METER OR POLE INS. 20.00 Avv LICANT'S q y Aoo4REss 411 Sorel Ave, Ste. 410 MOTORS SEE FEE SCH. JUL q y 1985 4 an SERVICE CHANGE 20.00 0 0 0 •LICENSFT;CONTRACTORS DECLARATION RATION TEMP.POLE - 30.00 f/x�I a u U I herebyaffirm that I am licensed under provisions of Cha ter 9 Lady of E DATE ono ' p p ISSUANCE DATE y G i (commencing with Section 7000)of Division 3 of the Business' end BLDG. ELECT. PLG. MECH. H y i I'rofessiuns Code,pnJ my license is in full force and f c. z o m License Cla _ Lia Number_ 9 yH � Date ��jl�B�Contmetor � � � L `a m BUILDING PERMIT IF w OWNI>R-BUILDIiR UECLA RATION INFORMATION w0.LL w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION $/FT. re u, Law for the following reason.(Sec.7031.5,Busine,Sand Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct.alter, IS 0improve,demolish,or repair any structure,prior to its issuance,also ELEG.GONTR. LIC.N0. ELEC. 0 A LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License za Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Business and ProOssiuns Code)or that he is exempt therefrom andQTV. PLUMBING PERMIT FEE r // IS I- the basis for the alleged exemption.Any violation of Section703L5 STORIES TYPE CONSTR. e. 3 m by any applicant for a permit subjects the applicant Ina civil penalty ALTER-DRAIN& VENT-WATER IEA.) 5.00 of not mon:than five hundred dollars(5500).1: D 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 ocC.cRouP S. NI 5 their sole cunfpensation,will do the work,and the structure a not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractors License Law docs not apply loan owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SOFT.kjoll AREA TOTAL ACREAGE himself or through his own employees,Provided that such improve- mim,are not intended or offered for all,It,however,the bmWing GAS-EA.SYSTEM-I1NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200 builder will have the burden of proving that he did not build OR in,- - . - . . - B 1LDING USE Prove for purpose orale.). IINDP CDN Pe Omer ❑ 1,as owner of th . . e property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project (Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'I lie 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 for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO PARCEL NO. ❑ Ium uxempt under Sec B.&P.C,fill this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 cG.D TE ACC.FILE NO. WORKERS'COMPIENSATION DECLARAT ION WATER TREATING EQUIP, 5.00 1 hereby utfirm ilia, 1 have a certificate of consent TO self-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy flureof(Sce.3800,Lnb.C.). I , / /! I. 1 Policy No pE+Qq$ ,m am ❑ Ccr11},M{d1'YI �' 'b) Iurl i. A f I FIRESPRINK ENERGYT24 Z Z }j Certified copy - le with c city' inspection divisimt. O A man, MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ Cr = CEIYI'1 FICA'f. i)1. Y'f ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.O.C. LU > COMPENS/TION INSURANCE PLG.CONTR. LIC.NO. PLG. CL Z( This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y EJN❑ hundred dollars(51001 ar less.) U O 1 certify that In the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued, I Shull not employ any person in any manner so as to O w become subject to she Workers'Compensati"n Laws ofCulifionia. BUILDING CL Date APpl,ca"' ALTER OR ADD TO MECH. 5.00 } w NOTICE TO APPLICANT: If,after making this Certificate of lox- _ Z_ eruption,you should become subject to the WorkerC Com Pensation APPLIANCE 5.00 PLAN CHECK x provisions of the Labor Code, you rand forthwith comply with FEE U such provisions or,his permit shall be deemed revoked. AIR HANDLING UNIT(TO 10J10DC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00QEM.) 6.00 SEISMIC FEE I hereby ofl'ium that there is a construction lending agency fill EXHAUST HOOD (WITH DUCT) 5.00 ,he performance of the work for which this permit is issued(See. MICROFILM 3097.Ci+.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Rank ofAmericaR 0, ELECTRIC Lender's Address +.-- +on n_- HEATING UNIT(OVER l00,000B.T.U.)B.50 s -nvn rov ca Iresult,rmatio that correct. rcadmisopcomplyn it It theounty VENTILATION FAN (SINGLE) 4.00 4 ordinances n correct I agree to comely with all city and count)' PLUMBING ordinances end state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL ubovemtentioned Property for inspection Purposes. (we) agree to save indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino agai I' b'ities,jud• ents, costs and expenses which CONST.TAX may in any r c e agai,s said City in consequence of the PERMIT ISSUANCE 10.00 G granting of t it m It MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature of Ap tic t onta .,/ Dae INSPECTOR COPY CANT TO EIUII... o(ri W,O 0 Lu r aN Z O H 02 o Ic6 y 4 a O a U w u 0 QJ W Kamm a X p w m N r 2 ¢ CCtyro Lu r toa FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Lal NG PROJECT I DENTI FICATION APPLICATION &PERMIT BUILDING -- ELECTRICAL— PLUMBING — MECHANICAL PERMITNUMBER 8613 INAILOINy LOT 2 Do Ess- PLAN 1 NAMEAS I}eAnZa Group,A CaliforniaPLAN Ltd. PartnershipPHONE415/571-I QTY. ELECTRIC PERMIT FEE 81 CHECK VALIDATION CTOR•s NAME NAME OUTLETS -SWITCHES- RECEP 10.0011.00 LIGHTING FIXTURES 10.00/1.00TheAldenCompanyLIQNo. 465640 SsraRs 411 Sorel Ave,Ste. 410ADDRE APPLIANCES - RESIDENTIAL 4,00 1 PANELS 10.00SanMateo, Ca.94402PHor4l5/571-14 DATE OF APPLICATION ARCHITECTPANELS ORENOIN1611 alderon-NakamuraLIC.NO, C013712 OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 AEN` 2070 Business, Ctr. #220ADDRESSESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20,00Irvine, Ca. ztP92715 5 S' ADDRESSTS 411 Borel Ave, Ste. 410. MOTORS SEE FEE SCH, SERVICE CHANGE 20.00Sa,n Mateo, Ca. 94402 OrJUL LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 1 hereby affirm that I am licensed under provisions of Chapt 9 commencing with Section 7000) of Division 3 of th Business nd Professions Cade nd my license is in full force, qe License I Lic. Number FFO F Date Contractor ISSU NEE T n B D PL MECH. BUILD,ING,PERMIT INFORMATIONOWNER -BUILDER DECLARATION 1 hereby affirmMISC. m that [ am exempt from the Contractor's License Law for the fallowing reason. (See. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that pursuant to Ing with Se ti of the Contractor's LicenseheisUccnsc( ChapterLaw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or that he is exempt therefrom and REFER TO ORD VALUATION d" SIFT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO CITY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ALTER DRAIN &VENT -WATER (EA.} 5,00 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC GROUP RES. -UNITS 1DRAINS -FLOOR, ROOF, AREA,COND. 5.00 Code: The Contractor's License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mems are not intended or offered for sale. If, however, the, building FIXTUR ES - PER TRAP 5.00 9 SQ. FT. FL OR AREA TOTAL ACREAGE GAS- EA. SYSTEM -1 1NC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- prove for purpose of.sale.). 1, as owner of the property, am exclusively contracting with GAS EA. SYSTEM -OVER 4 (EA,} 2.00 B 1LDING USE E IND CON PB Other INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6,00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 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 ASSESSORS PARCEL NO. contracts forsuch projects with'a cantracior(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft110,D0 TRACT NO. PARCEL NO. f am exempt under Sec. BAP.C. for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC. DAT ACC. FILE NO. WATER TREATING EQUIP, 5.00WORKERYCOMPENSATIONDECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, b.0 ). Policy No. f}drpl an , Thk Aiden GeHiq)-aftyCcrtrledcopyibfurniis'fi Certified copy s 1e a city inspection division. Applicant So' FROM( FIRE SPRINK Y N ENERGY T-24 Y N MISC. - REFER TO ORD. CERT'IFICAT F E PfION WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENS TION INSURANCE This section need- not be completed if the permit is for one Y N V E] N QTY. MECHANICAL PERMIT FEE FEE.SUMMARY hundred dollars (S 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 BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 JAPPLIANCE 5.00 PLAN CHECKemption, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY FEEAIRHANDLINGUNIT (TO 10A00C.F.M.) 4.00 AIR HANDLINGUNIT(OVER IO,0OOC-FM.) 6.00 SEISMIC FEE 1hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance af'the work for which this permit is issued (Sec. 3097,Civ.C.). Bank of AmericaLender's Name MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8,00 HEATING UNIT (OV100,000 B.T.U.)9.50 ELECTRICLender's Address f certify that I have read this application an sae at the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county ordinances and stale .laws relating to building construction, and PLUMBING BOILER-OOfV>P(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICALherebyauthorizerepresentativesofthiscitytoenteruponthe above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX We) agree to a indemnify and keep harmless lite City of Cupertino agai I ;b hiesK j encs, costs and expenses which may in any caid City in consequence of the granting of thi a it 5/31/85 PERMIT ISSUANCE 10.00 MECH. CONT, LIC. NO. MECH, TOTAL TOTAL Signature of Applican Data OFFICE COPY W POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERVIT NUMBER r n INSPECTION DIVISION L 61 t3 JOB INSPECT IO RECORD Ioil, PERMIT EXPIRATION JOB ADORES UNI OT# t - PERMIT EXPIRES IF WORK I, OWNER CONTRACTOR IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 160 DAYS FROM LAST CALLED INSPECTION. INSP! TIONiINSP CTOR INSPECTION RECORD FOUNDATION.S,$(,, ( UFER PREGUNITE PERMIT VALIDATION PAID,. JUL g POUR NO CONCRETE UNTIL ABOVE HAS BEEN S[GNED UNDERG_ ROUND / SL 19$5 _ PLUMBING ELECTRICAL CIti s DAT9- BL G ELECT., .f' MECFf. MECHANICAL 00 NOT POUR FLOUR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL P IT O ELECTRICAL FRAMING STORIES TYPE CONSTR, INSULATION OCC. GROUP RES. UNITS. IPLACENOSUBFLOORUNTILABOVEHASBEENSIGNED LLROOF SO. FT. F.LOQR AREA TOTAL'ACREAGE DIAPHRAGM ZV _ r BUILDING USE E IND CON PB Other F-1• Fl 0 El APPLY NO R00 ING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO, ROUGH 7ZI iPLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL ELECTRICAL -s FIN S DATE INSP, ACC. DATE C. FILE NO. FRAMING SAN # ZONING ENG, SITE NO. IN ULATIO PiUMBING GA FIRE SPRINK C] N[3 ENERGY T-24 Y E NE:l ME HA AL- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED H NG FLOOD ZONE Y0 N A. L.U.C. Y N LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS ELECTRIC PLAN CHECK FEE GAS SEISMIC FEENOTAPEORPLASTERUNTILABOVEHASBEENSIGNEDIOCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBYBUILDING INSPECTOR. MICROFILM ARRANGE FOR 1NSPECTION'BY PHONING 252-4505, ELECTRIC PLUMBINGoONEWORKINGDAYBEFOREREQUIREDINSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. Z SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST. TAX IMPORTANT! v- PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY