2859 (2) CI.I'Y OC CUPERT'1NO INSPECTION RECORD (OEfice Copy)
22_859 101 RI Bonny Dr_ _____-_
PCPSIIT N0. SANITARY DIST. 110. LOT 1,10. ADDRESS
Water system Marris Waxman
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Bui]dinr _ _ Date Insp.
Electrical Power Pole__
Plumhinr 12-6-82 Underground --
Ncchani_cal Rough Wiring
'Temp. Gns/17,1cct. _ [lall.s _---
Solar Ceilin
Fire S rinkler Fixtures Int/Ext _
Si ,n - Motors
Grounding
Misc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
PLUMBING
!S].ectri-c; Date Insp.
Plumbing /a/s-d7 Backflow _
Nechanical Underground
Solar Underfloor
pool Partial Rough
• Grading Rough Complete
1'lanni.ng Solar Rough _
Fire Dept. Water & man /
Health Dept. 'lain Drain
Building R/of/S Drain _
Other Gas
Other _
BUILDING Not Approved
Date Insp. 4
Pad Certification MECHANICAL Foundation Date Insp.
Pre-Gunite $
or S.
f.i'oM.
Slab-Membrane UnderDucts 8:- InsulatiUrideon
Bond Beam rf. Girders Fire Dampers
FlooSteel
Fireplace _
oor Steel Grease Duct & hood
Tiedowns ----
Diaphrams a One (tour Shaf t
Condensate Drain
Seismic Bracing Condensate
Anchorage
al.ls-Panels Flues & Comb. Air
Frame Other
Lnth Not Approved .K '
oards" Int/P.xt'
FirewallsPyy of+�.� O aw A
Firewalls ,g
Other
Not Approved
Oh. � �i�c ,�cerc�c7l. lGt�tls.�
U� YJILdCsr/aC. .�/'
�22 •.i�-C- mA� Cs�s�ic
"APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
MI R
BUILDING PROJECT I DENTIFICATION P- APPLICATION & PERMIT
oOILOIrvc - n Q C 9
A.���� � ��G BUILDING—ELECTRICAL—PLUMBING—MECHANICAL GoJ
OWNER'S - PLAN CHECK VALIDATION
NAME
�r*'n.�I QTY. ELECTRIC PERMIT FEE
///4tu_4,' GV MONLp(�(T6Z�I
NAMERAcrORs UTLETS-SWITCHES-RECEP 5.00/1.00
LIC.NO, LIGHTING FIXTURES 5.00/1.00
ADDRESS roes PPLIANCES-RESIDENTIAL 4.00 -
PHONE PANELS 5.00 DATE OF APPLICATION
AARRCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
ENGINEER
Lie.NO. SIGNS TRANS. 3.00
Ao09ESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00
ADDRESS
Sn�
A - MOTORS SEE FEE SCH.
ORE
SERVICE CHANGE 10.00 /
C o o LICENSED CONTRACTORS DECLARATION
¢ U v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
z w (commencing with Section 7000)of Division 3 of the Business and
a y BLDG. ELECT. I PLG. MECH.
F N z Professions Code,and my license is in full force and effect ❑ 1:1
❑o z m o License Class Lie.Number
Date Contractor
BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
a ¢O a. o INFORMATION
w g y I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
F Is U.o J Law far the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6 00 VALUATION SIFT.
Fw0E Code:Any city orcounty which requires a permit to construct.alter,
¢ ¢ a o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. ,LIC.NO. ELEC.
wO , requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO .
m he is licensed pursuant to the provisions of the Contractor's License
F z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the PLV/Yd/-V a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
fi o
C-
Z H$ by basis for the alleged exemption.Any violation t to action malty STORIES TYPE CONSTR.
i ; � by any applicant fora permit subjects S500).licam toacivil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(5500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,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 F IXTUR ES-PER TRAP 4.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
.meats are not intended Or Offered for sale If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
ar improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA ) 100 BUILDING USE
builder will have the burden of proving that h . . .
e did not build or im- RES IND CON P6 Deter
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 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 IEA.) 1.00
contracts for such projects with a contractor(&)licensed purstmnt to
the Contmolor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,BAP.C.lie this WATER HEATER-W/VENT 4.00
reason
WATER SYSTEMro ACL.DATE ACC.FILE NO.A 1W
WORKF-RS'COMPRNSATION DEC LA RAI'IZ WATER TREATING EQUIP. 0
I hereby affirm that 1 have a certificate of Consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified DEG 6 ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No Company
O ❑ Certified Copy is hereby furnished. Pift, FRI FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC,- REF RTO
❑ N❑ Y ❑ ME]
PERMIT ISSUANCE 6.00 FLOODZONE A.L.UC.
fr —
CERTIFICATE OF FAX IOTIPROM WORKERS'
W COMPENSATION INSURANCEiftiro PLG.CONTR. LIC.NO. PLG. C) 't? Y❑ N❑ Y ❑ N❑
LD Z (This section need not he complete) if the permit is for one TOTAL V
hundred
cert dollars(5100)pe less.l
U O 1 certify that h the to iii,loance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
0 )- mit is issued,1 shall not rkers' any person in any manner so is to
O W Date sabjecuothe Wlicant'Compensaliun Laws of Calilumia. BUILDING
IL Date Applicant ALTER OR ADD TO MECH. 4.00
F. to NOTICE;'TO APPLICANT: If,after making this Certificate sa Ex-
L.. ? emvision you should Labor
e, you to tire Workers'Cco poly with
APPLIANCE 4.00 PLAN CHECK
provisions iof ons or Labor Codc, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 3.00
CONSTRUC'T'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that there is a Construction lending agency]or EXHAUST HOOD(WITH DUCT) 2.00 -
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). I HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
LendAddress
I certify that 1 have read this application and stove that the above VENTILATION FAN (SINGLE) 3,00
• information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.
) 4.00 ��
hereby mlthoriae representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property 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 coaxer,Hence of the
granting of this permit MECH.CONT. LIC.NO. MECH.
�/ TOTAL TOTAL
/1 Signature of Applicant/CDaaeC
OFFICE COPY