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6729 CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) E� 10699 :4 �/J�a,aAL) Q�/v7ro�� Via® PERDIIT ISSUED DATE ELECTRICAL DATE INSP.' ui in ectnca Plumbing Power Pole MecTicaioun e as ec ouer lirin bolar Nalls ` Fire rin:lere— in 1 fixtures nt xt otors Misc. Grounding e ower Uther FINAL INSPECTIONS DATE INSP, Not Approved Gas Electric in PLUMBING DATE INSP. tiicga'.. Solar Backflow :)ol UndergrounT 'mT;rading Under±loor ann�n artia ou ire e t. Rougho ete ea t ept. o ar Rough �uiTdur -i -p tater ' nsulation era� Drain o ain Gas Dther BUILDING DATE INSP. Not Approved Pad Certification oun ation ELECTRICAL DATE INSP. re- unite Slab-NL-mbrane Underfloor S.M. Bond eam UTHT-77nsulation Undertloor Girders Fire D ers Floor Steel ire ace ie owns Grease Duct 4 Hood is rams e Hour a f t eismec bracing t-o-n-de—nsate Drain Walls-Panels Equipment Anc ®rage rame ues 4 Uomb. Air at tther. .dmWa oar Int/Ext. of rove irewa is t er ee rove APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER PDICDING 4-Dr-r APPLICATION & PERMIT 6729 ADORES$t^ 7�/ LgWOO BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNEH'S PLAN CHECK VALIDATION NAME _ QTY. ELECTRIC PERMIT FEE NONE To NAME G UTLETS-SWITCHES-RECEP 5.00/1.00 NAME UC NOm LIGHTING FIXTURES 5.00/1.00 CO IROIs'S ADDDREESS ss PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 5.00 DATE OF APPLICATION ARCHITECT SIGNS 6.00 PLAN CHECK FEEP.C.NO. OR ENGINEER LIC.ND. SIGNS TRANS. 3.00 ARCH,OR ENG. SPECIALCIRCUIT S,QQ PERMIT VALIDATION ADDRESS 71P FEMP.METER OR POLE INS. 15.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS - D SERVICE CHANGE 10.00 �1�1 Oo LICENSE 1)CONTRACTORS DECLARATION - O /I hereby affirm that I am licensed under provisions of Chapter 9 IS ISSUANCE DATE N rt N (commencing with Section 7000)of Division 3 of the Rosiness and BLDGA ELECT. PLG. MECH. F N z Professions Code,and niy license is in full force and effect Lj y q z o m - License Class Lic.Number ❑ C(peRB ❑ Q ow Datc Contractor II (��sT s w e OWNER-BUILDER DECLARATION lOU l 'i BUILDING PERMIT y ;. o A o _ MISC.- REFER TO ORD INFORMATION" X 3 I- 1 hereby allirm that I am exempt from the Contractor's License VALUATION S/FT. H Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE Uty 0} IIRP.r6.00 Code:Any city or county which re,evesa permit toconstruct alter, / A Q¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. V ELEC. O u- requires the applicant for such permit to file a signed statement thatTOTAL �. PERMIT TO a w m u- he is licensed pursant uto the provisions of the Contr.¢tnr's License rii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ gym the basis for the alleged exemption.Any violation of5eclion 7031.5 STORIES TYPE CONSTR. Ate _ by any applicant for a permit subjects the applicant toaaivil penalty ALTER-DRAIN -WATER (EA.) 4.00 of nal more than five hundred dallars($500).): ❑ I,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 Ole work,and the structure is not intended or offered lot sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 FIXTURES-PER TRAP 4.00 50.FT,FLOOR AREA TOTAL ACREAGE • liinsself or Ihrough his own employees,provided that such improve mens are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00 or improveme I is sold within one year of completion, . .1 1.00 BUILDING USE the owner- GAS-EASYSTEM-OVER 4 IEA builder will have the burden of proving that he did not huild or ins- RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ I,asowner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors Io c l,,Dull the project(See 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 A554SBORS PARCEL NO. and Professions Code:The Contractor's License law dues not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts I'or such projects with a contrumoRJ license(]pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/8.00 TRACT NO, PARCEL NO. ❑ lumexemptunderS¢. ,B.&P.C.far this WATER HEATER W/VENT 4.00 le"n l-��-��- ---- Owner .1//,y Darn WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORK hi RS'COMPENSA'TION DECLARATION WATER TREATING EQUIP, 4.00 I hereby affirm that l have acertificaleofennsent loself-insure. 20NING END.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 Z ❑ Certified copy is filed with the city inspection division. MISC - REFER TO ORD. Y❑ N❑ v ❑ N[_Applicam F- - PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u.C. CL CER'I'1 PICAI'Ii 01:EXEMPTION FROM WORKERS' W >_ COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG. CL O (Phis section need not be completed if Ila permit is for one TOTAL Y❑ N❑ v ❑ N❑ Z hundred dollars($100)or less.) - U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE,SUMMARY,.: U_ F- mit is issued.I shall not employ any person in any manner so as to Ow become subject to the Workers Compensation Laws of California. BUILDING Q64, Date ApplicantLTER OR ADD TO MECH. 4.00 } to NOTICE '10 APPLICANT': If,after making this Certificate of Ex- ~ Z caption,you should become subject to tire !APPLIANCE e Workers'Compensation 4.00 PLAN CHECK 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 10A00C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE c3� 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the performance e-1'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 UN IT(OVER 100,000 B.T.U.17.50 ELECTRIC vZ I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 information is correct.1 agree do comply with all city and county PLUMBING ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.1 4.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (Wo) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00 ,.orfi 4Of this permit. MECH.CONT. LIC.NO. MECH. 7��.GX pr y- /C/II/5v TOTAL TOTAL � Signature of Applicant/Contracor D.16 OFFICECOPV