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4393 CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) 4�- C> ��b>�rr� — Aflt�r nod A �-��- PEWIT ISSUED DATE "ELECTRICAL DATE INSP.' Wing �. lcal in B Power Pole anica er oun Te-Fp- as ec 7 WiTing 4t; ` o ar Walls Fire rin erei�— 6ign Pixtures Int/Ext otors Misc. (,rounding e ower Uther FINAL INSPECTIONS DATE INSP, Not .Approved Gas Electric -!12,44 Plumbing -a_ PLUMBING DATE INSP. Mechanical �� ar Backflow. �o r gun Grading er oor H -may Planning arta ou vireept, Rougho ete Healt t. o ar ou �Building Water '4 Insulation t er oDrain as t er BUILDING DATE INS.p, of Approved Pad Certification To—un—la—non _ L(-Fj�tELECTRICAL DATE INSP. re- unite la - rane Underfloor S.M. NWo n earn cts Insulation Undertloor Girders 7J— ireers ire ace Tied wns Grease Duct & Hood isUne ' our Shaft eismec racing Condensate aur Walls-panels ui ment Anc ora e ram,' aK A-h% Flues m r �.�t �`I l� Other llboardsn xt. Not prove Firewalls ter iNs0c .9 ? ioW iw wgrrssIPA Not Approved 'CITY OF CUPERTINO P.G.a E. COPY GAS SERVICE NOTICE, To You are hereby authorized to connect the GAS service for Owner or Tenant 'At- New AtNew Service No. of Meters l Reconnect 'No. of Add. Meters Move Service - Mo'�ve/�M/e�ter PLUMBING INSPECTOR OFHCE CITY OF CUPERTINO COPY COPY GAS SERVICE NOTIC'E To You are hereby authorized to connect the GAS service for Owner or Tenant At •� ��a `� /�i�e1Liv��-Y New Service No. of Meters Reconnect No. of Add. Meters Move Service Move Meter pA PLUMBING INSPECTOR �YJ50G1?1 ©„ r APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY PERMIT NUMBER ' . BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT r BUILDING . A�QQZ4 4893 „j GrC Cee✓Lerr. - BUILDING=ELECTRICAL—PLUMBING—MECHANICAL i � OwNERZ PLAN CHECK VALIDATION "AME r/r `� TY. ELECTRIC PERMIT FEE x}7}1 P171� PHONE /t�l�I CONTRACTORS UTLETS-SWITCHES-RECEP 5.00/1.00 AME LIC.NO. 41 LIGHTING FIXTURES 5.00/1.00 CONTRACTORS PP,LIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS S.00 DATE OF APPLICATION OR SIGNS 6.00 PLAN CHECK FEE P.C.NO. ENGINEER .LIC.NO. SIGNS TRANS. 3.00 AD7MDCH SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 15.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS �/)',��, SERVICE CHANGE 10.00 o o LICENSED CONTRACTORS DECLARATION In `n 14 -{(y a u w I hereby affirm that I am licensed under provisions of Chapter 9 Is E DATE m a tcomntrnnng with Section ]000)of Division 3 of the Business and BLDG. E L fMEC�1. . H 0.z Professions Cola and my license is in full force and effect. City flftnperfino o0 w -umn.se Clasc Lic.Number H r Dale Contractor aN a OW'NIi R-BUILUIiR DECLARATION BUIL [�1Jf?IRO X s Le U - INFORMATION wo A H I hereby affrn that 1 am exempt from the Contractor's Licence MISC•— REFER TO ORD 3 uVALUATION $/FT. F LL o 5 Law for the folcity or county which (Sec.7031.5,tl anincssundmuct.salons —PERMIT ISSUANCE 6,00 Code: e,Anyymolish county structure, ermiuots issuucLaalso 4 improve,demolish,or repair any ctrucfuro,prior In its issuanca,also ELEC.CONTE, LIC.NO'. ELEC. / Q`= [� PERMIT TO O u requires the applicant for such permit to file a signed statement that TOTAL tom he is licensed pursuant to the provixions of fhc Contractors License A(/t� HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe i o business and Professions Code)-or that he is exempt therefrom andQTY. PLUMBING PERMIT FEE IS I- the basis(or the alleged exemption.Any siolmion of Section]071:5 7 STORIES TYPE CONSTR. by any applicant for a permit subjects the uppllwnr to civil penalty ALTER-DRAIN -WATER (EA.) 4.00 - of not mom than five hundred dollars(55001): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 200 OCC.GROUP .RES.UNITS their sole compensation,will do the work,and the structure Is not tended or offered for vole(Sec.x7044, Business and I'rofcsmm DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Contractor's License Law dols not apply to an owner of property who builds or improves thcrcon,and who does such work FIXTURES-PER TRAP 4.00 1A so.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- centsarenotintendedoroffcradfiorsale.If,however,the buildmg -/ GAS-EA.SVSTEM-11NC.4 OUTLETS 4.00 or improvement is wid'within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.I 1.00 BUILDING USE builder will have the burden of proving that Ile did not build or on- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON, PR oma, ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to convrmr the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and-Professions Code: I be Contractors License Law does not apply to an owner ofpro arty who builds or improves thcrcon.and who ' LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with u contractotfs)licensed pursuant to ' the Contractor's License Law SEWER-SANITARY-STORM EA.2001t/8.00 TRACT NO, PARCEL NO. ❑ 1 um exempt under Sec.—.D&r ,.for this assn i WATER HEA ENT 4,00 DateOwnL WATE S EM 4.00 ACC.DATE ACC.FILE NO. a WORK IiRS'CO>tPENSATION DI-cl ARATI N WATE dbulp. 4:00 / 1 hereby affirm that I have u certificate of consent to sal-insure, ZONING ENG.SITE NO. or a cerfificate of W'ofloms Compensation Insurance,or a certified aapy farm..ISec.3800,Wb.C.h - Policy Nn. Company 's O ❑ Crrtificd copy is hereby famished FIRE SPRINK ENERGY T24 Z•O/J A0 Certified copy is filed with the city imn�'ticn division.pplicant MISC.- REFER TO ORD. Y ❑ N❑' Y ❑ NE] CC N CIi R1'IPICA'IT OF EXEMPTON FROM WORKERS' PERMIT ISSUANCE 6.00 .FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTE. LIC.N07 PLG. oZoZ ❑ NE) v ❑ N❑ Z (This section.need not be completed if the permit is for orae TOTAL hundred dollars(S1001 or Icsc.) U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY mit is issued.I shall not employ anypcom in any nanncr.su as to become subject to the Workers'Compenvtion Laws of California. (�t Date Applicant BUILDING N NOTICE TO APPLICAKf: If,after making this Cetifcam of 8x- ALTER OR ADD TO MECH. '4.00 H Z omplion,you ahould beeonm subject to fhc Workers'Com,...uticn APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such prmision,or cis pemlit:hull be deulnud revoked AIR HANDLING UNIT(TO 10=CF.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING ER'1QWOCEM.) 5.00 SEISMIC FEE I hereby affirm that there is h c"U'U" fiun Iced a,agency for EXHAUST HOOD (WITH DUCT) 2.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.l. HEATIN `JT JFt 1A99 B.T.U.) 4.00 34 QO - Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)7.50 Lender's Address- ELECTRIC /7 I certify that I hme read this application and state liar the above V ENTIL !1( E) 3.00 Olfornation n correct. agree In comply with all city and manly - PLUMBING (f I1 INinances and state laws relating m building conn nctinn, and BOILER-CO MH.P.or 100,000 B.T.U.) 4,00 hereby xufharire rcprcmnwtives of this city to enter upon the BOILER-COMP (OA,100,000 BTU)SEE FEE SCH. MECHANICAL .hove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD. Cupertino againsf,lUf ilities,judgments,•co's and expemm which PERMIT ISSUANCE 3.00 CONST.TAX 'may in any way accrue against said City in Consequence of the — \ / gyrating oI II �,yl.- MECH.CONT. NO. MECH. X illy. (L .z/ - :25 -Y'/ orAL 7 Q o TOTAL 1ognatime of Applmant(Controctor Date, OFFICE COPY.