1652 (2) CITY 01' CUPERMIO I:,SPECTION RECORD (Office Copy)
• 1652 10700 N. DeAnza
PER3IIT NO. SANITARY DIST. N0. LOT ?0. ADDRESS
F �w'w /�,� Four Phase Corp. 365-8513
PROD CT_ 01:TIER JOB SITE PHO_',E NO.
Date ELECTRICe?L
Buildinp 4-1-82 Date Insp.
Electrical Power Pole
Plumbing Underground
:!echanical P.o! ?-Iiring -iZ-QZ
Temp. Gas/Fleet. Falls
Sola Ceiling
Pine Sprinkler Fixtures Int/Ext
Sign cfotors
Grounding
A[isc• Temp . Power
Other
FINAL INSPECTIONS Not AnDrcved
Date Insp.
as
Electric
PLUMBING
Plumbing Date Insp .
aechanical Backflow
Solar Underground
Underfloor
• Pool Partial Roush
Grading Rouph Complete
Planning Solar Rough
Fire Dent . Water S. Insulation
Health DeDt . ?lain Drain
Building R/of/S Drain
Other Gas
Other _
STRUCTURAL No[ Aonroved
Date Insp.
Pad Certification. `!ECHANICAL
Foundation Date Inso.
Pre-Gunite Underfloor S .M.
Slab-"embrane Ducts & Insulation
Bond Beam Fire Damners
Underfloor. Girders Fireplace
Floor Steel Grease Duct a Hood
T_iedomns One Hour Shaft
Dianhrams Condensate Drain
Seismic Bracing Equipment Anchorage
alls-Panels Flues & Comb . Air
Frame $ .� Z_ $Z OF Other
Lath —� Not Ann roved
?'al.lboards Int/Ext.
Firewalls
Other
Not Approved
'APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONL
i_ PER M ER
BUILDING PROJECT IDENTIFICATION
9OILDING APPLICATION & PERMIT 1652
AooREss /�.T� - v
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK VALIDATION
• � I1. �rj CITY. ELECTRIC PERMIT FEE '
wr`1 PHONE
CONTRACTOR'5
NAME• UTLETS-SWITCHES-RECEP 5.00/1.00
WIL�IK-4•. lr uc.Na ^ LIGHTING FIXTURES 5.00/1.00
CONTRACTOR's - �J APPLIANCES-RESIDENTIAL 4.00
ADORE / 6-si
•y�ar.a�{--•�1GG PHONE 2&`_gql PANELS 5.00 DATE OF APPLICATION
ARCHITECT - SIGNS, 6•.QD PLAN CHECK FEE P.C.NO,
OR
ENGINEER -
LIC.NO. SIGNS TRANS. 3.00 A �•
ARCH
ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANT'Sy MOTORS SEE FEE SCH.
ADOREsg _� As
Si'� iLf SERVICE CHANGE .10.00
Woo rirL
LICENSED CONTRACTORS DECLARATION OF CUP
Q'i W I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
¢ (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
F Professions Cod a d Psy.liccnsc is in full c•' f•II ^ ')'1 _,❑ ❑ ❑ ❑
z o 6'i Li<en CI Lic.Nwt
o z - Date Contract
r
¢ y s BUILDING PERMIT
¢ ¢ m ¢ OWNF RBUILUER UIiCLARATION INFORMATION
A 0 Z " MISC.- REFER TO ORD
w 3 ,y I hereby affirm that I am exempt from the Contractof s License VALUATION $/FT.
Fa- 0 Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 6.00 OP
Code:Any city or county which requires a permit to Construct,alter,
C ¢ Q improve,demolish,or repair any structure,prior to its issuance,also' ELEC.CONTR. LIC.NO. ELEC. v V
requires the applicant for such permit to file a signed statement that TOTgL PERMIT TO
whe is licensed pursuant to the provisions of the Contractor's License
Fzi Law(Chapter 9(commencing with Section 7000)of Division 3afthe
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
S s¢-p the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
au ; m by any applicant for a permit subjects tire applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars(S5000.)
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not
Intended or offered far Sale (Sec. 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.PT.FLOOR AREA TOTAL ACREAGE
. nneoty are not hrough
ownemployees,for sale,
If,
however,the
improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
menu are not intended or offered foe sale.If,ed that s the building,
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM OVER 4 IEA) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im - . RES NO CON PB Omer
.
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 2000
❑ I,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 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. .B.&P.C.for tits WATER HEATER W/VENT 4.00
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
w'ORKERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of consent to sell-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or C rtifieJ
Fathere f 5<c.3 0 ,�1.�kj?A .�,, s L
Fare Y e n I� (j'
O ❑ Cerd cyyyyyy..rs��her mashed. I"FILE FIRE SPRINK ENERGY T-24
Z Z ❑ d4ropy'is le the cry inspection division. -
Applir o ��-�� MISC.- REFER TO ORD. v❑ N❑ Y ❑ N❑
~ PERMIT ISSUANCE 6.00
Cr CERTIFICATE COM F EXEMPTION[CNS FROM WORKERS' FLOOD ZONE A.L.U.C.
CL _ COMPENSATION INSURANCE if hot PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y ❑ N❑
1 O Idle section need not be completed if the permit is for ane TOTAL
� Z hundred dollars l5100)or lcssJ
U O 1 certify that in the performance of she work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
U. h- mit is issued.1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Lows of California. .TD
D. Datc Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of F.x-
F Z emption,you should become subject to the Workers'Conpensation APPLIANCE 4.00 PLAN CHECK 9j
provisions of the Labor Code, you must forthwith comply with FEE pZ --
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 10,000C.F.M.) 5.00 SEISMIC FEE
1 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,CY.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
II certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county PLUMBING
n. ordinances and state laws relating to building construction- an J BOILER-COMP(3 H.P.or100,000B.T.U.) 4.00
hereby authorise representatives of this city IO enter upon rite BOILER-COMP Over 100.000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpc -
(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
may in any way accrue against said City in Consequence of It PERMIT ISSUANCE 3.00
g
an Ingo is permit. MECH.CONT. LIC.NO. MECH. �7
- TOTAL TOTAL
Si lure ol'ApplicantlComracmr, Uate '
1/� OFFICE COPY