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1346 II �' u'• CITY OF CUPERTINO INSPECTION RECORD (Office Copy) 1346 10700 N. De Anza Blvd. ,PEP11IT NO. SANITARY DIST. NO. LOT NO. ADDRESS Remodel Four Phase 255-0900 Ext: 2037 PROJECT OWNER JOB SITE PHONE NO. Date ELECTRICAL Building 12-15-81 Date Insp. Electrical 12-15-81 Power Pole Plumbing ' Underground Mechanical P.ou h Wirin Temp. Cas/Elect. Ta s Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sigm Motors Grounding Misc. Temp. Power Other FINAL INSPECTIONS Not Approved Date Insp. Gas Electric 1 / / - 82 PLUMBING Plumbing Date Insp. Backflow Mechanical Underground Solar' Underfloor • Pool Grading Partial Rough Rough Complete Planning Solar Rough Fire Dept. Water & Insulation Health Dept. 'lain Drain _Building R/of/S Drain Other Gas Other STRUCTURAL Not Approved Date Insp. Pad Certification MECHANICAL ECHANICAL Pre-Gunite Date Insp. Underfloor S.M. Slab-Membrane Band Beam Ducts & Insulation Underfloor Girders Fire DampersFireplace Floor Steel eedowns Grease Duct & Hood Tiaphrams One Hour Shaft Seismic Condensate Drain Seismic Bracing Equipment Anchorage Fram Flues-& Comb. Air e 4 =` Com. /n 'a p/ Other Lath Not Approved Wallboards Int/Ext. Firewalls Other Not Approved BUILDING ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUR LDI NO PROJECT I DENTIFICATION PERMIT u B DING APPLICATION & PERMIT 346 DDRIN / , oO - lJ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S 3 PLAN CHECK VALIDATION NAVE �� 'ems ti OTY. ELECTRIC PERMIT FEE S PH.HEZ�� DQ �. DGNTrACTorI OUTLETS-SWITCHES-RECEP 5.00/1.00 NA E U - Lic.No. LIGHTING FIXTURES 5.00/1,00 eONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 5.00 DATE OF APPLICATION ARCHITECT 6.00 PLAN CHECK FEE P.C.NO. OR SIGNS ENGINEER 3.00 uc,rvo. SIGNS TRANS, ARCH.OR ENG, 5.00 - PERMIT VALIDATION.,, ADDRESS - SPECIALCIRCUIT ZIP EMP.METER OR POLE INS. 15.00 APPLICANT'S MOTORS MOTORS SEE FEE SCH0.00 / Z/ ADDRESS ' SERVICE CHANGE 10.00 w o o LICENSED CONTRACTORS DECLARATION a u u I hereby uffinn thin 1 am licensed under provisions of Ch.pter 9 - ISSUANCE DATE y< W (commencing with Section 7000)of Division 3 of the Business and BLDG. LECT. PLG. MECH. H �z Professions Cade,and my license is in full force and effect. ❑ z O `,J, - License Class Lic.Number - 9 u H Date Contractor ie4 OWNER.BUILDER DECLARATION BUILDING PERMIT O REFER TO ORD INFORMATION w3 A y 1 hereby affirm that I am exempt from the Contractor's License MISC.- - VALUATION SIFT. HuOa, Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00 M L/ OOp1 Code:Any city or county whichrequiresa permit toconstruct,altef, N IO ,e a¢ Improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC. y o I., - O u requires the applicant for such permit to file a signets statement that TOTAL /' �� PERMIT TO E: $w he is licensed pursuant to the provisions of Cm Contractor's License .H i> Law(Chapter 9(commencing with Section 7000)ofDlvision 3 ofthe ' a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE Q $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN& VENT-WATER (EA.) 4.00 .Fact more than Ove hundred dollars(5500).): ❑ Las owner of the properly,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 intended or Offered for sale(Sea 7044, Business and Professions DRAIN OND. 4.00 ' Code:The Contractor's License Law does not apply to an owner of property who builds or,improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 . so.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve GAS-EA. -16 UTLETS 4.00 ., mems arc nut intended Or offered for sale.IL however,the building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON Pa Omer prove for purpose of sale.).- INDUSTRIAL TER. 20.00 ID ❑ 1,as owner of the property,am exclusively contracting with _ licensed contractors t0 construct the project(See. 7044,Business LAWN$PRINK -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 ihcreon,and who LAWN SPRINKLERS-OVER 5(EA.) too contracts for such projects with a contructndsl licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/6.00 TRACT NO. PARCEL NO. ❑ lam,exempt under Sec:_.BAP-C for this WATER HEATER W/VENT 4.00 'reason Date - Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have a certificate o-consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24 Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. y � N� 1:1 ry� Applicant CCLO CER1 'IFICATfi OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 6.OD FLOOD ZONE W > COMPENSATION INSURANC17 PLG.CONTR. LIC.NO. PLG. Y 0 N� Y N CL a (This section need not be completed if the permit is for one - TOTAL =) 2 hundred dollars(S 100)or less') U O 1 certify that in the performance of the work for which this per OTV MECHANICAL PERMIT FEE FEE SUMMARY LL P mit is issued.I shall not employ any person in any manner so as to O w become subject to tlic Workers'Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 4.00 sv } W NOTICE TO APPLICANT: If,after making this Certificate of E.. � ? empllon,you should become subject to the Workers Conmensation APPLIANCE 4.00 PLAN CHECK ?( 73 provisions of the labor Code, you must forthwith comply with FEE ✓ " U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOC.EM.) 5.00 SEISMIC FEE s'D 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 3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name _ HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC D O Lender's Address I certify that l have read this application and state that lhehbove VENTILATIONFAN (SINGLE) 3.00 `• information is correct I agree to comply with all city and county PI3 H.P.or PLUMBING ordinances and slate laws relating to building construction, and BOILER-COM100,000 B.T.U.) 4.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (0Yer IDD,000BTU)SEEFEESCH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX �,g y ' any way accrue against said City in onsn ence of the PERMIT ISSUANCE 3.00 gof[hi. ni1L MECH.CONT. LIC.NO. MECH.C//Z7TGTAL TOTAL nature Of Apphcanll onlmdor OFFICE COPY