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2620 (2) UI"1'Y 017 CUPERI'1110 INSPECTIOC RECORD (Office COPY) ' 2620 10700 N. De Anza Blvd. Bld.. l13 2nd F1. PEPdII'I' 1,10. SANITARY DIST. N0. LOT 1d0. ADDRESS iRemodel Int. Four Phase PROJECT OWNER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL Buildi_nv2 Date Insp. Electrical - - Power Pole Plumbing, - - Underground Mcchanica.l - Rough Miring //, 'z Temp. Gas/Elect. Halls Solar Ceiling Fire Sprinkler Fixtures Int/Ext _ Sin llotors Grounding Mise. Temp. Power _ Other _ __ _ FINAL. INSPECTIONS Not Approved _ Date Insp. r,a.s _ — PLUMBING Electric L Date Insp. Plumbing - - Backflow Mechanical - Underground Solar Underfloor _ Pool Partial. Rough Grading Rough Complete • 11.1-anninp Solar Rough Fire Dept. Water & Insulation _ Health Dept. "fain Drain Building R/of/S Drain Other Gas Other BUILDING Not Approved Date Insp. I'ad Certification MECHANICAL Foundation Date Insp. Pre-Gunite Underfloor S.N. Slab-Membrane Ducts & Insulation Bond Beam Fire Dampers _ Underfloor Girders Fireplace Floor Steel Grease Duct & hood Tiedowns One flour Shaft Diaphrams Condensate Drain Seismic Bracing hquipment Anchorage_ llalls-Panels Flues & Comb. Air Frame Lath Not Approved Wallboards Int/Ext. Firewalls Other Not Approved BUILDING y • ELECTRICAL PLUMBING • MECHANICAL MISCELLANEOUS APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY I BUILDING PROJECT (DEN (FAPPLICATION & PERMIT IC TION PE MIT e aulLolNc A00 E 5 D , ILDING-ELECTRICAL-PLUMBING-MECHANICAL 620 OWNER PLAN CHECK VALIDATION "AM OTY. ELECTRIC PERMIT FEE e PRary NOMERAcrons OUTLETS-SWITCHES-RECEP 5.00/1.00 Lt. NO ILIGHTING FIXTURES 5.00/1.00 DDRESCTOR'a APPLIANCES-RESIDENTIAL 4.00 CONTRA PHONE IPANELS 5.00 DATE OF APPLICATION ARCHITECT SIGNS 6.DD PLAN CHECK FEE P. NO. OR ENGINEEfl ' Lie.NO. SIGNS TRANS. 3.00 ' ARCH,OR ENG. PERMIT VALIDATION ADDRESS _ SPECIAL CIRCUIT 5.00 _ ^ _ ZIP TEMP.METER OR POLE INS. 15.00 /�� (/��/��{.(�(J APPLICANTS ESS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 /E w o o LICENSED CONTRACTORS Df:CLARATION PAIS <u W I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUAN E N<w (commencing with Section 7000)of Division 3 of the Business and MECH H w 2 Professions Code,and my license is in full force and effect. OCT 2 8 1982 Z 0 m - License Class Lie.Number �i Q m Date 'Contractor UILYBIWIlLOPWRERMF 2 w ¢ OWNER-BUILDER DECLARATION INFORMATION IT ° MISC.- R OORD 06 w h I hereby affirm that 1 am exempt from❑se ConlraCloi s License VALUATION $/FT. ai Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00 Code:Any city or county which requires a permit to construct alter, 2a ¢C improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR.. LIC.NO. ELEC. I requires the applicant for such permit to file a signed statement that - TOTAL (0 PERMIT TO,J� r Z s- he is licensed 9(compursuant en the provisions of the Contractor's License r Law(Chapter 9(commeneing with Section 7000)of Division 3of the Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE H O the basis for the alleged exemption.Any violation ol'Sectlon 7031.5 STORIES TYPE CONSTR. u ; § by any applicant fora permit subjects tileapplicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 �� of not more than five hundred Dollars( S00o. : ❑ I,as owner of tile my employees property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.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,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 docs such work FIXTURES-PER TRAP 4.00 $0.FT.FLOOR AREA TOTAL ACREAGE • himself or Ihrough his own employees,provided that such improve- �•� �� meets are not intended or offered forsalc.If,however.the building GAS-EA.SYSTEM-1 4.00 or improvement is sold within one year of completion, the.owner- GAS-EA.SYSTEM.OVER 4(EA.) 1.00 BUILDING USE builder will have the burden of proving that he did not build or im- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 2000 y ❑ 1,as Owner of the property,am"elusively contracting with ❑ - 2 ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. - 5.00 • ASSESSORS PARCEL NO. to Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves(hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 7.00 contracts for such projects with a contractorlx)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. .BA .for this WATER HEATER W/VVAID 4.00 'reason Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPFNSATION DFCLARATIO WATER TREATIOGIVUWP, 4,00 I hereby affirm that 1 have a certificate of consent to self-insure, or ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,leb.C.). City Of Cupertino Policy No. Company O ❑ Certihed copy is hereby furnished FIRE SPRINK ENERGY T Td Z Z ❑ Certified Copy is filed.with the city inspection division. MISC.- REFER TO ORD. ryJ1J�l-ILMI Applicant Y N❑ v O ❑ ~ w PERMIT ISSUANCE 6.00 -' FLOOD ZONE Lu CIiRTI FIO0 OF EXP-MIION PROM WORKERS' La ' W �_ CCOMPENSATIONN INSURANCE: PLG.CONTR. LIC.NO. pLG. _ CL o (This section need not•be completed if the permit is for one TOTAL �a Y[I -� 7) Z hundred do11ars($100)or aSSJ U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL f mm it is issued,I shall not employ any person in any anner so as to U 0 become subject to the Workers*Compensation Laws of California. BUILDING 7 j4" y Dale Applicant ALTER OR ADD TO MECH. 4.00 � } W NOTICE: TO,APPLICANT: If,after making this Certificate of 17x- L.. Z emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE L.1 such provisions or this permit shall be decreed revoked. If AIR HANDLING UNIT ITO 10=r-F.M.) 3.00 3- '- CONSTRUCTIONLENDINGAGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE J36 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the performance of tileMICROFILM work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC 16 � 1 certify that I have read this application and state that the above VENTILATION F NGLE) 3.00 40 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. . r ,000 B.T.U.) 4.00 6 hereby authorize representatives of this city to enter upon the BOILER-CO 1 EE FEE 5CH. MECHANICAL �© above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- O er 100000 T TO ORD. Cupertino against liabilities,judgments, costs and expenses which L3 CONST.TAX mayi any wa a rue a ai said City in consequence of the PERMIT ISSUANCE 3.00 gr I of this rn i. MECH.CONT. MECH. 4 ye, _/O ZI- TOTAL TOTAL �u9 36 ignatum o1'Applicant/Contractor (late[' OFFICE COPY- -