1243 (2) CITY OF CUPERTINO INSPECTION RECORD (Office Copy)
1243 861 Lonna Lane /
_P_ERMIT NO. SANITARY DIST. N0. LOT NO. ADDRESS
Hot Water Heater Steve Ou
PROJECT OWNER JOB SITE PHONE NO.
Date ELECTRICAL
Building Date Insp.
Electrical Power Pole
Plumbing - -_RT Underground
Mechanical P.ough Wiring
Temp. Cas/Elect. Walls
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other
FINAL INSPECTIONS Not Approved
Date Insp.
Ge s
Electric PLU11BING
Plumbing Date Insp.
Mechanical Backflow
Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
Planning Solar Rough
Fire Dept. Water & Insulation
Health Dept. Main Drain
Building R/of/S Drain
Other Gas
Other
STRUCTURAL Not Approved
Date Insp.
Pad Certification PI.
Foundation MECHANIC
Pre-Gunite Underfloor S.M. Date Insp.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & Hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Braceling Equipment Anchorage
Tlalls-Pans Flues & Comb. Air
Frame Other
Lath Not Approved
ilallboards Int/Ext.
Firewalls
Other
�;lot Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
es BUILDING PROJECT IDENTIFICATION RMrt a ER
BUADORES I G`t
LGING APPLICATION & PERMIT q rj q
LQY-1 y1� LQn BUILDING-ELECTRICAL_PLUMBING -MECHANICAL
OWNER'S - - _
PLAN CHECK VALIDATION
NAME
DTV. ELECTRIC PERMIT FEE
Q.VE �1-t.. PHONE
/ ERACTOR S OUTLETS-SWITCHES-RECEP 5.00/1.00
LIC.No. LIGHTING FIXTURES 5.00/1.00
CONTRACT.
-
ADDRESS
DAPPLIANCES-RESIDENTIAL 4.00
CO
PHONE PANELS 5.00 DATE OF APPLICATION
ORRCHITECT - SIGNS 6.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO SIGNS TRANS. 3.00
A-CH.OR ENG - SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
ADDRZIP EMP.METER OR POLE INS. 15.00
ADDRESS MOTORS SEE FEE SCH.
ADDRESS
. ' SERVICE CHANGE 10.00
'02 LICENSEiD CONTRACTORS DECLARATION gx!,z�
< U W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H (commencing with Section 7000)of Division 3 of the Business and
y Q y BLDG. ELECT. PLG. MECH.
R z Professions Code,and my license is in.l all force and effect -
_ o
' 0. W License Class Lic.Number El- ❑
Date Contractor
Or¢'y E - BUILDING PERMIT
4 OWNER-BUILDER UECLA RATION ' I
F. o d.O - INFORMATION
X
g; •y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
L.
O 4 Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
,- - g PERMIT ISSUANCE 6.00
Cope:Anye,d city Or County which structure permit tocomatmct,alter,
Or improve,Juanoish;of repuii uny structure,prior to its issuance,also ELEC.LDNrR: LIG N0. ELEC.
La
w m u requires the applicant For such permit to file n signal statement that - - TOTAL PERMIT TO
be is licensed pursuant to the provisions of the Contractor's License
H.z<
Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the 1/
f 4 D Business and Professions Code)or tial he is exempt therefrom and OTV. PLUMBING PERMIT FEE G .
X 1- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i;$ by any applicant fora un re dollars life applicant penalty , ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred property,
o (my employees
❑ Las owner at the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sole r offered
ion,will(S the work,and the structure is not
intended or offered for Luce(Sec. 7044, Business and Professions - DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law doesnot apply to an owner of
property who builds or improves thereonrcon,and who docs such work FIXTURE PgR TRAP 4.00 Ead.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees, f,ed that such improve-
meats are not intended or offered for sale.le.if,however,the building GAS-EA.S 1 C.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA. V TEM- �' .) 1.00 BUILDING USE
builder will have the burden of proving that lie did not build or im- RES IND CON PB Omer
prove for purpose of soled. INDUSTfl A I TER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ 1.d as owner of the properly,am exclusively contracting with
licensed colons od to The
the project(Sec.7044,Business LAWN SPRINKLERS- V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's 1-lepra Law Joos not apply
to tr owner of properly wWitt,a co t r improves thereon.and who LAWN SPRI OVER 5 IEA.) 1.00
contracts for such License
is with a contractions)licensed pursuant to
the Contractor's Licunu Law. SEWER-SANITARYORM EA.200ft/6.00 TRACT No. PARCEL No.
❑ lam exempt under Sec..,B.&P.C.forda, WATER HEATER W/VENT 4.00 nn
reason
Date Owner WATER SYSTEM 4,00 ACC.DATE ACC.FILE NO.
W'ORKERS'COMPEiNSAT10N DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a Certificate of consent to self-insure. ZONING ENG.SITE NO,
of a certificate of Workeri Compensation Insurance,or a certified
copy thereof(See.3800,Lab.C.).
Policy No. Company '
Q ❑ Certified copy is hereby fury ish cd. FIRE SPRINK ENERGY T-24
Z p p❑plicamtifie o py is file) a l • ty nspecbon Division. MISC.- REFER TO ORD. Y C] NQ Y [:] N❑
� Exy
Lo CE RTWICATF OF EXEMP"PION FR MM W KERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.L.
W COMPCNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not he completed if the permit is for one TOTAL 10 Y[:JN❑ v E] NEI
- _
Z) Z hundred dollars IS 100)or less.)
UO 1 certify that 'm D®perk.... ce of the work for which this Per. OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 Shull not enmioY any Person in uny manner so us In
U become subject to the Warkers'Compensation Laws ol'California.
y Dae ApPhc°ntALTER OR ADD.TO MECH. 4.00 BUILDING
} m NOTICE TO APPLICANT: IL after making this CCrtificate of E.-
Z emp ion,you should hecoom subject tO the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such Provisions of this permit s1a11 be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE � .
I hereby affirm that there is i.consHuction leading agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I certify that l 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
ordinances and nate laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 4.00
liereby uuthorine 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, iiWemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,costs and expenses which - r CONST.TAX
may in any way accrue agains id City in consequence of the PERMIT ISSUANCE 3.00
gmn. gof this Per il. MECH.LONT. LIC.NO. MECH. -�
r o-a g TOTAL TOTAL O 3�
Signature of Applicant/Contractor I Dale
lit
OFFICE COPY