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4989CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) 7 ADDS FR FINAL INSPECTIONS DATE_ I INSP...., Gas Q ELECTRICAL DATE JINSP: Power Pole AVu 31 IYl1.UL - L ,- a s P4 a 7-�, L 2-i si v i Q, 15 E� E CERTIFICATE OF COMPLETION BUILDINGINSPECTOR'S OFFICE CITY OF CUPERTINO DATE5-IR 191?—1-- BLDG. PERMIT NO. �/ a THE BLDG. LOCATED AT 2 0 9! 6 A/ 0 h B S T l' A OWNED BY C ST 9 Iv ,p /r HAS BEEN (COMPLETED) FOR USE AS Sy P t /T S C (ALTERED) � X �- BUILDING INSPECTOR ,T^%PPL•ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI FICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL4989 PERMIT NUMBER BUILDING ADDRESS ©� E-%pat�(C SLl OWNER'S v�e.& itC-p[i NAM` T �)r� y'f (i LJ PHorvE 73L/:6_`770 - QTY. ELECTRIC PERMIT FEE PLAN CHECKVALIDATION DATE OF APPLICATION CONTRACTORS N E HJT- 1. Un. NO.,Z.Z 00.1 OUTLETS - SWITCHES -RECEP 5.00/1.00 .� 17 LIGHTING FIXTURES 5.00/1.00 v_ CONTRACTOR'S A.2D.Ess fQ] ��jj/ IQ T v� PRONE �i(� !S� APPLIANCES - RESIDENTIAL 4.00 PANELS 5.00 -0 AARRCHITECT ENGINEER LIC, NO. SIGNS 6.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 AADDRESS eNa ZIP SPECIALCIRCUIT 5.00 PERMIT VALIDATION NCE TE Pity B1L/�ryF� I I -TE MEp�CtIM. `_' LJ�• LIQ `\ rrEMP. METER OR POLE INS. 15.00 ADDRESSTs MOTORS SE . SERVICE CHANGE 10.00 LICENSED CON' 1' RACTORS DECLARATION I hereby ftin.. that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and I'rul'esslons Code my license is in full lu� License Inss Lic. Number /s Uate Contractor _ - OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Constructor's License Lawfor the followingreason, (Sec.70315,erantlocand Professions Code: Any mulish coon pair any structure p prior t omnstracL, also improve, demolish, or repair any structure, prior n in issuance, also requires the applicant for such permit to file a signed statement that ha is licensed pursuant en the provision of the ) of Division License Section is exempt theefoofthe Law(ChapterProfessions Business and Professions Code) or that he is exempt therefrom and the basis for tan alleged corruption. Any violation of Section malty by any applicant for o permit subjects the applicant mncivil penalty five hundred dollars (my em): of not more owner ❑ I. as owner of the property, a my , and t ces with wages as will (S the work, and the structure not their sole r offered far intended or ontra J for sale feeLaw doe Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and, who docs stch work himself or through his own employees, providd that such improve- memsarenotintendedorofferedfarsole. If, however, the building or improvement is sold within one year of completion, the owncr- builder will have the burden of proving that he did not build or inn- Prove for purpose ofs:dc.f ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions COLL: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractons) licensed pursuant to the Contractor's License law, ❑ l am exempt ander See B.ABC. far this reason FEB 1C)AA rity of Pupart On BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE 6.00 VALUATION - /9006 / $/FT. ELEC. CONTR. ❑C. NQ ELEC. x000 TOTAL C7 O PERMIT TO /�Vra-4/O.Q IAIPRO QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTA, ALTER -DRAIN & VENT -WATER IEA.) 4.00 BACK F LOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 4.00 ' FIXTURES - PER TRAP 4.00 GAS - EA. SYSTEM -1'I NC. It OUTLETS 4.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA.. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE RES IND CON PB Omer INDUSTRIAL WASTE INTER. 20.00 LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. LAWN SPR IN KLERS - OV ER 5 (EA.) 1.00 SEWER-SANITA EA. 200ft/8.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT - 4.00 Date Owner WORM i RS'COMPENSATION DECLARA NON 1 hereby InCrm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Seo. 3800, Lab.C.)... Policy No: Company a- WATER SY AA ( + a tt 4.00 ACG DATE ACC, FILE N0. WATER TREATING EQUIP, 4.00 _ Cifil nf CII ZONING ENG. SITE NO, O..Perfinbcd copy is hereby furnished. Certifi copy n file 'th a city i ton division. APNmam / CIi R" PICA'I PION FROM WORKERS' COMP(NSAI'ION INSURANCE (This section need not be completed if the punnil iv for one hundred dollars IS 100) or le") I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Worken' Compensation Laws of California. Dam APPLICANT NOTICFi 'PO APPLI(CANT If, attar making this Certificate of fix- ce"tion, you should become subject to the workers' Compensation provisions of the Labor COLIC, you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). - Leader's Name Lender's Address I certify that I have read this application and state that the above information is correct, I agree to comply with all city and eouNy .ordinances and state laws relating to building constntetinn. and hereby authorize representatives of this City tO cmcr upon the bovc-ntuntinned property for inspection purpose.MECHANICAL fWe) agree tD save, indemnify and keep harmless the Cliy of Cupertino against liabilities, judgments, costs and expenses whc ,'I y way accrue a Inst smdty in consequence of the gra got tiv�+t //L / /1/✓L XVf FIRE SPRINK v N ENERGY T 24 v No MISC. - REFER TO ORD. PERMIT ISSUANCE 6.00 �t- FLOODZONE ' YE] N E] A.L.U.C. Y � NE] PLG CONTR. LIC. NO. PLG. TOTAL 3 8 �✓ QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING /O xsb ALTER OR. ADD TO MECH. 4,00 APPLIANCE 4.00 PLAN CHECK FEE 0� AIR HANDLING UNIT (TO 10=CF.M.) 3.00 3 R AIR HANDLING UNIT (OVER 10MOC.EM.)5.00 SEISMIC FEE .- EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM HEATING UNIT (TO 100000 BTU) 400 , . . . . HEATI NG UNIT (OVER 100,000 B.T.U.)7.50 ELECTRIC 3g✓ / VENTILATION FAN (SINGLE) 3.00 ` ILER-CI�P. or 100,000 B.T.U.1 4.00 PLUMBING p ;B01 LER-COMP (Over 100,000 BTU( SEE FEE SCR.a S9 REFER TO ORD. RMIT ISSpCONST. 3.00 J -j TAX MECH. CONT. CIM Of CUpGI 1111U TOTAL (!" o/ TOTAL ,2/6sJ i a t re of Applicant/COntracmr Dan OFFICE COPY