6933 CITY OF CUPERTINO INSPECTION RECORD
(OFFICE: COPY)
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PERMIT ISSUED DATE "ELECTRICAL DATE INSP.'
ui ink
Electrical
`Plumbing Power Pole
meechianicalr un
Temp as ec u irin
Solar Jvalls
ire Sprinkler 1 In
Sign gRres nt/Ext
tors
Misc. roan ing
Temp Power
er C e —J go o S I"
FINAL INSPECTIONS DATE INSP. ot . rove
Gas
ectric
Plumbing
FUMING DATE INSP.
mechanical
-
o ar Backflow
lool Underground
Irading Undertloor
Planning Partial oug
ire a t. ou Tete
F e Tt e t. Solar Vu
Zh
9N.Cling ater Insulation
a�
o ain
Lias
Other
BUILDING DATE INSP, Not Approved
Pad Certification
oun ation ELECTRICAL DATE INSP.
Pre-Gunite
Slab-14embrane Underfloor S.M.
Beam Ducts & Insulation
c e oor i rerc�s ire ampers
Floor Steel Firelace
ie owns reasse wct & Hood
Dia li��ram"s -- ---- ��—$h—
tieismec�in Condensate Drain
s- ane sm en
_ t Anchorage
rame y_ 1- ues 4 UDMI). Air--
ME—
rat - er
a oar int/MFT. _ of d
rove --
#irewa s -
Ot�.ier
Net Approved ( U
(U'tf .N-..r to cttCaM P' / sfo{Kw��pf �Ge�iYyUf y,l� \Q ) - .
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BUILDING
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ELECf�R/i,CAL
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PLUMBING
MECHANICAL
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MISCELLANEOUS
'•APPJJCANT TO FILL IN INFORMATION,WI.THIN RED LINES USE BALL POINT PEN ONLY' '
PERMITNUMBER
BUILDING PROJECT IDENTIFICATION _
f a ILOING APPLICATION 8i PERMIT
ADOREss "v c 6933
�Q BUILDING -•ELECTRICAL=PLUMBING-MECHANICAL
wNF.R'S CC PLAN CHECK VALIDATION
O
" E ••- OT ELECTRIC ERMIT -
PHONE
c
FACT R'sUTLETS'-SWITCHES'RECEP 5.00/1.00q.
• (' p Lie,N ILIGHTING •
,FIXTURES , _ 5.00I1.00 ' -
NTRACT a pPCIANCES-RESIDENTIAL ' 4.00 .
DDREss /fJ/'j
Q PHONE .�/)(y J PANELS 5-00 DATE OF APPLICATION'
ARCHITEC 1 SIGNS - 6A0 PLAN CHECK FEE PC.NO.
OR ///��. 1 .. l 5
E NG I NE ERI n
J / uc,NO. s SIGNS'TRANS 3.00
ARLN.ORE " $PEGIALGIRCUIT. PERMIT VALIDATION
ADDRESS \/�
J n^/ .,zIP , EMP.METER OR POLEINS. 15.00
Y"
APPL CANT - MOTORS " SEE FEE SCH.
ADDRESS - -
I SERVICE CHANGE'' '+ 10.00
.Foo LICENSED CONTRACTORS DECLARATION-,
,
Q'u 1- 1 hereby affirm that 1 am licensed under provisions of Chapter 9 - r
ISSUANCE DATE
w a N (commencing with Section 7000)of Division 3 of.the Business and - BLDG. ELECT. PLG. MECH.
Professions Cod nd my license is in full for f'
z
,z o w - License Class Lm Numbe „ ❑ -❑ ❑
0 -
¢ ¢ are— Contractor
OWNER-BUILDER DECLARATION v ILDIN PERMIT
INFORMATION
w 3 LL w 1 hereby affirm that I am exempt from the Contract s.License MISC REFER TO ORD - -��
LL o¢ Law for the following reason.(Sec.7031.5,Bus ness and Profssions - PERMIT ISSUANCE fnr�� VALUATION11-i S/FT.
H -I Code.Any city or county which requires a permit to condom",alter, B 00 %/O' OO O
¢ a:Q 0O Improve,demolish,or repair any structure,prior to its Issuance aIxR ELEC.CONTR ..� LIC.NO. ELEC
o ¢ requires the applicant for such permit to file a signed statement that p; ` TOTgL +t�
K m" Ile is licensed pursuant to the provisions of the Contractor's License' , �4y'0 O�fwEfl TO;1
FZQ'. Law(Chapter 9(commencmgwith Section 7000) lDrviaion3of(he v J`cr/�
4 o Business and Professmns Code)or thabhe is exempt therefrom and QTY. Pgg.L.UMBING PERMIT FEE
¢F e the basis for the alleged exemption:Any violation of Section 71 5 . :. ::P,a _ STORIES TYPE CONSTR.'
a.3m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN'&VENT-WATER,IEA.) 4.00 '
of not more Aran five hundred dollars(5500).): a
❑ has owner of the property,or my employees with wages asBACK FLOW PROTECT.DEVICE . . 2.00 OCC.GROUP - RES.UNITS
their sole compensation;will do the work,and the Simeon.is not
'intended or offered Yor 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 4.00SO,FT.FLOOR AREA TOTALACREAGE
.�� himself or through his own employees;provided that such improve- -
mentsare not intended orofferedfor Sale.'If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS'4.00
an improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA:)'- ' 1.00 BuaowG USE
builder will ho,c0s,burden of proving that he dud not build or Im- - RES IND CDN PB Omar
prove for purpose of sale.). - INDUSTRIAL WASTEINTER. 20.00
❑ 1,as owner or the property,am exclusively contracting with - ❑ ❑ ❑ ❑ ❑
licensed,comractors to constrdct the project(Sec,7044,Business' - LAWN SPRINKLERS-1,1 NC 5'V.B. . - 5.00 : ASSESSORS PARCEL NO.
and Professions Codc:.The Contractor's License Law does not apply - -to an owner Of property who builds or improves thereon,and who LAWN SPRINKLERS:OVER 5(EA.) 1.00
rontracts for such projects with a contmctor(S)licensed Important
the Contractor's License Law. SEWERSANITARYSTORM EA.200ftaoo TRACT NO. PARCEL NO.
❑ ,B.
I am exempt under.Sec. &P.C.for INS WATER HEATER W/VENT c 4.00
reason
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
.,R'oRKERS'COMPENSATION DECLARATION WATER TREATING EQUIP- 4.00 = - '
'1 hereby affirm That I have a certificate of consent self-ins re;' - ) ZONING ' ENG.SITE NO.
or a certificate of Workers'Cumpe v t n 1 Pertce P c r Bed _ " _
copy thereof(S ,, 3800,Lab.C.). [//{qQ4 "
Policy No. Company � I/I
❑ Certified copy skier y Rw.th. FIRE SPRINK ENERGY T-P4-
z Z ❑ Certifie c y is a with`.the.city inspection division: r :REFER TO ORD.Applicant MISC. Y❑ .N❑ Y❑ ry❑
~ rn7E " ' PERMIT ISSUANCE' 6.00 FLOOD ZONE A.L.u.c.
cc: Cli I ATE F :MPT'ION FROM WORKERS'. ,
_ COMPENSATION I NSURANCE PLG.CONTR: _ LIC.ND,.. 'PLG.' -
d O '(This Section need nal be completed if the permit is for one TOTAL• Y❑ N❑ Y El
(This
Z hundredfi that IS 100)pe less.) - TRY,. M CHANI6AL
V O 1.certify that h the performance Of the work for which this per- PERMIT FEE FEE SU MARY
,LL F rut is Issued,1 shall not employ any person in any manner so as to
L) hccome subject to the Workers Compensation Laws of California r - - [[X-115-
0 Ed Date •- Applicant '4:00 BUILDING ALTER OR ADD TO'MECH. - 71
}.rn NOTICE TO APPLICANT: If,after making this Certificate of Ex- '
r2, 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 '
U such provisions or this permit shall be dreamed revoked. AIR HANDLING UNIT(TO io 0wr-F.ML) 3.00
• CONSTRUCT'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10M)C.RM.15.00 SEISMIC FEE
'70
• •I=hereby affirm;that there rs a construction tenting agency,far • EXHAUST HOOD-IWITH DUCT) 2.00
the perfomnmr�c;of the work for which this permit is issued(Sec. MICROFILM
3097,CwC).- HEATING.UNIT 170100,000 B.T.UT, 4.00
Lender's Name HEATING UNIT IDV ER 100,000 B.T.U.)7.50
' Lender's Address ELECTRIC
Icerlify that have real this application and state that th-a .
aove VENTILATION FAN (SINGLE) ., 3.00 - -
information is correct 1 agree to cotnply with all'nty and'County PLUMBING r
ordmencce-and state laws relating to building constructlon,`and BOILER-COMP 13 H.P.or 1000008T.U.)-4.00
hereby authorize represenlatives,of•this-city to enter upon'the - BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. - - -
` (We ' fee to sae demnify and-keep harmless the,City of MIS
'- REFER TO ORD.
Caper' against b' ies,judgments,.costs and expenses which CONST.TAX
may ac a against said Cdy 'n cons uenee of•the PERMIT ISSUANCE - 300 ,
IRS f r I "• MECH.CONT LIC N0. - MECH _ r�(T - #¢ '70
s TOTAL TOTAL •' d `ter
, ig alum o Apphca t(GOnlraClOr Da[e, 'I n & , `�
', - V OFFICECOPY - - a+e•s `