1864 COPY 01' CUPF.Rl'1NO IIISPFGTIOt' RECORD (Office Copy)
1864 20596 Cleo Ave.
PERMIT N0. SANITARY DIST. NO. LOT NO. ADORF'SS
Repair & Elect. State of Calif Dept. of Transp. 272-2362
PROJECT 01•INER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buildlnr _ 5-13-82 Date Insp.
Electrical 5-13-82 Power Pole
Plumping Underground
Mechanical Rough Wiring _
Temp. Cas/FIcct. halls
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Hotors
Grounding
Misc. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved
Date Insp.
r"?s _
PLUMBING
Electric
Date Insp.
Plumbing
Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
Planning Solar Rough
Fire Dept. Water & Insulation
Health Dept. Main Drain
Buildin R/of/S Drain
Other Gas
(ether _
BUILDING Not Approved
Date Insp.
Fad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation _
Bond Beam _ Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic liracinl; Equipment Anchorage_
halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Wallboards Int/F.xt.
Firewalls
Other
Not Approved
BUILDING
u�
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY
P,P BUILDING PROJECT IDENTIFICATION PERMIT N Ma
BILDING
` APPLICATION & PERMIT
ADDRESS
CF VLBUILDING-ELECTRICAL-PLUMBING -MECHANICAL U
4
NAME
NE / PLAN CHECK VALIDATION
1 kaa- ' e.IZrv.
ELECTRIC PERMIT FEE
PHONE r S'� b
CONTRACTOR'
'NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
CONTRAC D% 1;"o LI C.No.Z�iQSj 6 / LIGHTING FIXTURES 5.00/1.00
R'S S -
Aoo,RE.Es/s/ '�,(ti gS/Lz- PPLIANCES-RESIDE L A 4.00
{� ' (� T�yr PRONE 2 Z3 72 Y
'W •Z PANELS ! 6.00 DATE OF APPLICATION
ARCMRECT
ENGINEER SIGNS T B.QQ PLAN CHECK FEEP.C.NO.
R. LIC.NO. SIGNS TRAN .� 3.00
AENG. -
ADDRESS SPECIAL CIR Y (/7Z�l 5.00 PERMIT VALIDATION
APPLICANT'S
"PP EMP.METER PO S` i1 15.00
aooREss � MOTORS S EE SCH.
o nti SERVICE CHANGE 10.00
Foo LICENSED CONTRACTORS DECLARATION
Q o u I hereby affirm that I am licensed under provisions of Chu pier 9
,HA n (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
F Professions C.JQ%qappd my license is in full force and eIT BLDG. ELECT. PLG. MECH.
Z z m Ltcensellass �L 'Li,.Neher
6
,A W Date [[J�-t3 L Contractor (��,•Krsz..f _ �I. ❑ ❑
¢ w u .OWNER-BUILDER DECLARATION' BUILDING PERMIT
u y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
Fu.O ¢ Law for the following reaaom($ec.703 L5,BusioCssand Professions VALUATION E/FT.
IN � J Code:Any city or county which requiresu permitmepnstnlct,alter, PERMIT ISSUANCE 6.00 /
or re ¢0improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR'. LIC.NO. ELEC. / (/"r/
i o u requires the applicant for such permit to file a signed statement that TOTAL 6
w he is Ilcenaed pursuant[O the pmvl5ions of IhC Contmc[oi 5 LicetoPERMIT TO
FZa Luw(Chap[er9(commencingwith Section 7000)ofDivision3 of till' /X�4/R r C�.L'�r
Business and Professions Code)or that he is exempt therefrom mid OTv. PLUMBING PERMIT FEE ,p
¢ r the basis for the alleged exemption.Any violation of Section 7031,5 STORIES TYPE CONSTR.
n3 � by any applicant forapemllt subjects the upplicom toacivil penalty
gLTER-DRAIN&VENT-
of not more than five hundred dollars(5500).1: WATER (EA.) 4,00
❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.
their sole compensation,will Jo the work,and Ole structure is not DEVICE 2.00 OCC.GROUP / RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 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 FIXTURES-PER TRAP 4.00 - SQ FT.FLOOR AREA TOTAL ACREAGE
Novell or through his own employees,provided that such improve.
mints are not intended or offered for sale.If,however,the building GAS.EA.SYSTEM-1 INC.4 OUTLETS 4.00
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- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON PS Omer
❑ I,as owner of the property,am exclusively contracting with
he project(Sec.7044, Business LAWN SPRINKLERS-1 INC 5 V.B.
licensed contractors to construct t 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License El 0
Law does nut apply
to an owner of property who builds or improves fiction,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contraciorls)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA, 200ft/8.00 TRACT NO. PARCEL NO.
re❑n l am exempt under Sec..,B.&P.C.for this WATER HEATER W/VENT
4.00
Dale
Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COM PENSATION DhCLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that Thave a certificate of consent to sel Gins.re,
or a certificate of Workers'Compensation Insurance or a certitiid ZONING ENG.SITE N1.
copy thereof( cc 3 ab.0-).A/
Policy No/ any 'JCg - ONOLsdw.r
Certified copy is hereby furnished.
Z Z Certified cgpy Is tied with the oily inspection Division. FIRE SPRINK ENERGY TQ4
H O ApPlicant6.y{7�1}.f�•�JG(I�,p S- MISC.- - REFER TO ORD. Y E) NE] Y E] NEI
O: y CERTIFICATE OF-EXEMPTION P ROM WORK RS' PERMIT ISSUANCE. 6.00 FLOOD ZONE q.L.u.C.
W 1 COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG.
0' O (This section need not he Completed if the permit is for one TOTAL Y N C] Y F] N
::) Z' hundred dollars(S 100)or Ics,
U O 1 certify that in the performance of the work for which this per-
LL U mil is issued,1 shall not employ any person in any manner so as to DTV. MECHANICAL PERMIT FEE FEE SUMMARY
O W become subject to the Workers'Compensation Laws of California.
Q. DateNOT Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Cade, you must forthwith comply with -
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000QF.M.) 3.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE r77
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
Lend is Nam - HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct 1 agree to comply with all oily and county - PLUMBING
information
and state laws relating to Comply
with l cittrudio o and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the
above-mentinned property for inspection purposes. BOILER-QOMP (Quer 100,000 BTUI SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against IiabiI a, judgments, costs and expenses which CONST.TAX
may to y way ac a inst said City in consequence of the PERMIT ISSUANCE CE 3.00
gra f t per I� MECH.CONT. - LIC.NO, MECH. ��
TOTAL TOTAL #r '�7
Signature of App moat/Contractor Date
OFFICE COPY