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6799 CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) 1v9�_ b12�eU �Pvc�• LOT NO.— PROJECT UWNhK P/ ��fGhN L7�f rtJ PERMIT ISSUED DATE ELECTRICAL DATE INSP. Building-- ectrica Plumbing Power Pole Mechanical r un emp as ec ugg firing >,Za )olar Walls Fire rU er Ceiling ign ixtures Int/Ext motors Misc. round Tenp Power Uther FINAL INSPECTIONS DATE INSP, Not .Approved Gan Electric Pru_mBing PLUMBING DATE INSP. mechanical o ar Backflow 6)01 Underm ur in oor Planning arti ouRy Fire Dept. u ete health Dept. Solar Rough ilding Water '& Insulation erMain Drain 77,57=ain Gas fther BUILDING DATE INSP, Not rove Pad Certification oun anon `ELECTRICAL DATE INSP. re- rte Slab-Yenbrane Underfloor S.M. Bond earn Ducts & insulation Underfloor Girders ers Floor Fireplace ie owns - rease Duct 4 Hood Frams a our Shaft smec Bracing Condensate Drain _ Walls-Panels ujEMent Anchorage Frame (5L4, Flues 4 COMb. Air LaT— t 1 -- `"7lWoar int/Ext. of prove rewalls Other Net proved BUILDING ' ELECTRICAL PLUMBING • MECHANICAL MISCELLANEOUS Sr PLICANT TO FILL IN INFOR WITHIN RED LINES - USE BA T PEN ONLY PERMIT NUMBER BUILDING PROJECT IDENTI FICATIO APPLICATION $! PERMI Poaowc - 6799 7 9 9 a D Es r E 'V /l .1� {�'/ / vlJl�yJ O BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNEP'B Yr . 'i.IY Y PLAN CHECK VALIDATION 'NAME 01 OTyV�: i - ELECTRIC-PERMIT D PHONE -coNTPa Ps IOUTLETS-SWITCHES-RECEP 5.00/100 s - r4p(Mt: LIGHTING FIXTURES 5.00/1.00 rorvTRACTGPs - APPLIANCES-RESIDENTIAL 4.00 ^' ��.)QOPEss ,Lr r,O,QOX, a PXO ^ � PANELS 5.00 DATE OF APPLICATION ARRCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO. ' ENGI NEEP ' LIC.No. SIGNS TRANS. 3.00 ADDRESS Ervc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.,METER OR POLE INS. 15.00 (� ASMOTORS SEE FEE SCH. `f 1 t ADDRESS I SERVICE CHANGE 10.00 0 3� woo LICENSED,CONT'RACT'ORS DECLARATION _ a u t I hereby affirm (hat I am licensed under provisions of Chapter 9 - ISSUANCE DATE .m<v'i (commencing with Section 7000)of Division 3 of the Business and BLOG.' ELECT, PLG. MECH. F w z I'rol'essions C and my license is in full foe z iccnse Class Lie.Number_ p (,�` ❑, ❑ N'-so o ate-"- �u Contractor LL� 5 a m s 1 �'� x,� BUILOILN PERMIT -arm that I am exempt DECLARATION - �.r INFOMM.TION MISC.- EFERTO ORD $/F7 w;LL w I hereby affirm that I am exempt from the Contractor s License i t -VALUATION F u_o J Lawlor the following reason.(Sea 7031.5,Businessand Professions PERMIT ISSUANCE)fU'I 6.00 r I L 1 Code Any city or county which requlresa permit reconstruct,alter, /' - R ¢ 40 Improve,demolish,or repmr any structure,prior(o Ila Issuance,also ELEC.CONTR LIC.NO. p p EL44 6/ d IL itO¢ regwres the appbcant fur such is ro file a signed sla[emant that CItV OI Cape(TOTAL / PER TO w esu- he is licensed punumd to the provisions of the Contractor's License /fss.,�5�� Irxx}� �Y�t�g(tIno Law.(Chapter 9(commenemgwlth Section 7000)ofDvision 3 of(he rsF t i t /.(/%63f@3d r1Ks'TS�MOdo iao Business and Professions Code)or that he rs exempt therefrom and OTiV 4",�i d ,k,0,LlUMBING`PE_RMITF A, a x JFiEE - ¢F.p Iht 60514 far IIIC allCged eRempllen.Aey viel3HOe Of SCC(IOn 7D3 LS t _ " , t lr - STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty, ALTER-DRAIN -WATER (EA.14.00 " of not more than five hundred dollars(5500).1: - ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not iiaeaded or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon;and who does such work FIXTUR ES--PER TRAP 4.00 s0.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- - memsamnotintendedorofferedforsale.If,however,the building IGAS-EA.SYSTEM-1 INC.4 OUTLETS 4,00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 1.00 BUILDINGUSE builder will have the burden of proving that he did not build or im . RES IND CON - PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ I,as owner of like property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS+ L INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00 reason Owner _Dale WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have a certificate of consent to salf�hrxUm, ZONING or a certificate of Workers'Compensation Insurance,or a certifiCJ ENG.SITE NO. '\/ copy thereof(Sec 3800,Lsh.C.j. - Policy Na. Copany 0 ❑ Cerlif dcop Is helebmyfurnished. - FIRE SPR INK ENERGY T-24 ❑ Cert'icd c 1• w'Ih iliaily i s on division. Zpx Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑. N❑ Fy PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. CC Ts CE FICATE OF EXEMPTION FROM WORKERS' LLI _ 'TT O US ION INSURANCE PLG.CONTR. LIC.NO. PLG. (L 13 IT section need not be 'completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ Z hundred'dollars(S 100)or less.) v '._ 0 O 1 certify that in the performance of the work for which this per QTY'; , .;MECHANICAL PERMIT FEE ' FEE SUMMARY LL I- roll Is Issued,I shall not,employ any person in any manner sG as to q U become subject to the Workers'Compensation Laws of Cid iforri a an 0 w BUILDING Sf7 Date Applicant; ALTER OR ADD TO MECH. 4.00 } w NOTICE TO APPLICANTAf. her making this Certificate of Ex- -� F Z eruption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT TO 10=CF.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCTI '2.00 / the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM 3097,Civ.CJ. - Lender's Nam HEATING UNIT(OVER 100,000 B.T.U.P.50 ELECTRIC Lender's Addf� ress 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 in1'on...Dun is correct.1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.of 100,000 B.T.U.) 4.00 hereby authorize representatives of (his city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL I abovc-mentioned property for inspection purposes. (We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cup noIII liabilities,judgments, casts and expenses which CONST.TAX m• in a way accrue against id ity in nsequpppnee of the PERMIT ISSUANCE 3.00 grntmg rhispermiL // MECH.CONT. 'LIC.NO. MECH. / TOTAL TOTAL ij S2=of Applicant/Contractor Date. OFFICE COPY s ,.