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4624 r CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) /� �Z Y� e2iOU rfIv lq N� i Trzpp*f+ Cnn lP a�r� �c�rz f �n•15 — PERMIT ISSUED DATE "ELECTRICAL DATE INSP: Fin 3 5� trl ca S/ d PlumbingPower Pole ' anica er oun e as ec ouL iron o araal ills . SprinklerirCeiling 1 ixtures Int/Ext rotors Misc. Groundin e - ower Other FINAL INSPECTIONS DATE INSP, Not .Approved Gas Electric Plumbing "PLUMBING DATE INSP. . etc�ianica. o ar Backflow 'wool JndeE oun Gradinger oor Planning Partialou Fire Dept. Rougg=offplete Health Dept. Solar Rough ui. in ater ' insulation t erainF� Drain o ain Gas Other BUILDING DATE INSP, Not Approved Pad Certification oun ation ELECTRICAL DATE INSP. reunite Slab- Underfloor S.M. on eam cts 4 insulation Underfloor it ers Fire Dampers Floor Steel Fire lace ie owns ureasectxh�, ood Diaphrams McMoourShaft eismec Bracing Condensate Drain Va-1 s- ane' s ui mentAnc a e or rame - p Flues om r at t er n1lboards( TnVExt. Not Approved Firewalls Other , z Not Approved ocl•� uta s �'�' 3-'1-�1-�G l BUILDING ELECTRICAL PLUMBING • MECHANICAL MIISCELLANEOUS APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY UILDING PROJECT IDENTI FICATION PERMIT NUMBER B ` n BUILDING APPLICATION & PERMIT /� C /� ADDRESS Y U `7 C•70a r BUILDING-'ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION �N NAME CITY• ELECTRIC PERMIT FEE ' • F&u it Mae ONE cONTRACTOR's 'NAME / OUTLETS-SWITCHES-RECEP 5.00/1.00 LIC.No. LIGHTING FIXTURES •5.0011.00 �- CONTRACTOR'spp LIANCES-RESIDENTIAL 4:00 ADDRESS PHONE PANELS' 5.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR SIGNS 6.00 ENGINEER LIC.NO, SIGNS TRANS. 3.00 ARC HE55 ENG. SPECIAL DIRriU 1T 5.00 PERMIT VALIDATION z,P EMP.METE LE INS.- 15.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS L./ SERVIC A G19� - 10.00 PAI �(1'� D o O_ LICENSED CONTRACTORS DECLARATION /�//" ¢ u I hereby affirm that I am licensed under provisions of Chapter 9 N 3 I DATE w < w (commencing with Section 7000)of Division 3 of the Business and BL G. ELE i. PLG. MECH. w• Ai z Professions Code,and my license Is In full force and effect - z o m- License Class Lic.Number- 0 umber - - t�/ C O ver a Date Contractor _ a x s - - BU LDING PERMIT ¢ ¢ w ¢ OWNER-BUILDER DECLARATION INFORMATION K a ° - MISC.- REFER TO ORD X LL H I hereby affirm that 1 am exempt from lire Contractor's License' VALUATION - $/FT. r LL04 Law for the following reason.(Sec.7031.5.Business Professions PERMIT ISSUANCE 6.00 Code:Any city Directory which requires a permit to constmcl,alter, ¢ ¢ Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ri ELEC. u requires the applicant for such permit to file a signed statement that TOTAL/6 PERMIT TO K he is licensed pursuant to the provisions of the Contractor's License ` Law(Chapter 9(eommencingwilh Section 7000)of Division 3 of lire •�/f LpSV.edT ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE CN C ¢ r o the basis for the alleged exemption'.Any violation of Section 7031.$ +STORIES TYPE CONSTR. d ;m by any applicant for a permitsubjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 4.00 of not more than five hundred dollars($500).): ' ❑ I,as owner of the properly,or my employees with wages asBACKFLOW PROTECT.DEV ICE 2.00 ace.-GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,'ROOF,AR EA,CONE). 4.00 ' Code:The Contractor's License Law does not apply to an owner of - Property who builds or improves thereon,and who dues such work FIXTURES,PER TRAP 4,00 50.FT.PLooR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ..cuts are not intended or offered for sale.If,however,the building GAS or 4.00 or improvement is sold within one year of completion, the owner- GAS-EASYSTEM-OVER 4(EA.) 100 BUILDING USE builder will have the burden of proving that did not build or if,-- . . - RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑ ❑ .I,as owner of the properly;Grit exclusively contracting with licensed contractors to construct the project ISec, 1044,Business LAWN SPRINKLERS-I 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 poncerS with a eontractodsl licensed pursuant to the Contractor's License Law. - SEWER-SANITARY-STORM-EA. 200ft/8.00 TRACT NO. PARCEL NO. _ ❑ lamexem t I d Se B.&P.C.lbrthis WATER HEATER W/VENT 4.00 PC Date � s ow erWATER SYSTEM 4.00 ACC,DATE ACC.FILE No, WORK ERTCOMPENSATIONDECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm that 1 have a certificate of 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 0 ❑' Certifiedcopyisherebyfumislted. FIRE SPRINK ENERGY T 24 .Z_ Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. C) Applicant Y❑ N❑ Y ❑ N❑ ~ rn r PERMIT ISSUANCE 6.00 FLOODZONE A.L.000 CC 1 CERTIFICA MPENEAF-MPTINSU FROM WORKERS' UJ COMPENSATION INSURANCE PLG.CONTR. •• LIC.NO. PLG, Y❑ N❑ Y ❑ N 1 O (This section need not be completed if the pennit Is foi one TOTAL D Z hundred dollars($100)or less.) - U O 1 certify that in the performance o4 the work for which()'is pery QTY. MECHANICAL PERMIT FEE FEE SUMMARY UL F not Is issued, I shall not employ any person in any manner so as to U become subject to fit,Workers'Compensation Laws of California. GG ' i Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING �Od } to 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 FEE CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 5.00 SEISMIC FEE 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name _ Lender's Address HEATING UNIT(OV ER 100,000 B_.T.U.)7.50 ELECTRIC I Certify that l h.sC,C.d this application and state that the above VENTILATION'FAN (SINGLE) 3.00 . Information is correct.I agree to comply with all city and county . BOILER-COMP.(3 H.P,or 100,000 B.T.U.) 4.00 PLUMBING ordinances and state laws relating to building Construction, and hereby authorize representatives of this.city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. .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 PERMIT ISSUANCE 3.00 CONST.TAX may in any way accrue against said City In consequence of the granting of fir' perm' MECH.DONT. LIG NO. MECH. ' I Ilt��/ //�/�/ TOTAL TOTAL 30-2 Signa licant/Contmcto-r - T Date OFFICE COPY '. '