6401 CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
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cr OWNER
PERMIT ISSUED DATE
u�T3—ngg f� "ELECTRICAL DATE INSP,'
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Electrical
Power Pole
anica
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'IeTrp Gas ec u irui
Solar Walls
Fire ren c er ei in
Sign ixtures Int/Ext
Misc. torsro�d' g
r ower
FINAL INSPECTIONS uther
DATE INSP, Not .Approved
Gas
Electric
um - PLUMBING DATE INSP.
-e anica
•o ar Backflow
goo r un
Gra in er oor
P.Lannin arti ou 6-Igo-P
ire pt. Rougho ete
�eaith Dept, Solar RouLTh
m in ater ' ns ation
er
ain
o sin
Gas
BUILDING ter
DATE INSP, of Approved
Pad Certification
oun anon ELECTRICAL
Pre-Gunite DATE INSP.
slab-Mbm5rane Underfloor S.M.
Bond eam Ducts & Insation
u
Underfloor Girders ire an ers
Floor Steel ireace
ie owns urease Duct o0
D3,aphrms a Hour Shaft
3eismec Bracing ensateam
Frame
ane s �tuippmment Amirchorage
Flues $Comb. Air
Wat er
alinar nt xt, of rove
Pirewalls
other
Net Approve
BUILDING
ELECTRICAL
PLUMBING
DECHMI CAL
MrSCELLANEOUS
APPLICANT TO,.FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
r
BUILDING PROJECT IDENTIFICATION ... -„ PERMIT NUMBER
BUILDING APPLICATION & PERMIT 6401 01
ADDRESS L} I
I Q r BUILDING�t-ELECTRICAL-
gPLUMBING-MECHANICAL
rvaMERS 3 ' T 4t�W F9)i ` PLAN CHECK VALIDATION
DTV. '"{ELECTRIC{PERMLTG'?-,�.' r. v FEE. yyrtrt /�J/y�[//� /S�
a.n
PITON S �L" F. ': b� dRn fi `�++ U -�` V / /-�
CONTRACTORS �y�
NAME UTLETS-SWITCHES-RECEP 5.00/100 �GY
ILIGHTING FIXTURES 5.00/1= '
CONTRACTORaPPLIANCES-RESIDENTIAL 4.00 '
ADDRESS - ,. .
PHONE " PANELS ' ' 5.00 . DATE OF APPLICATION
ARCHITECT - SIGNS- 6.00 PLAN CHECK FEE P.C.NO.
OR.,
ENGINEER
LIC.No SIGNS TRANS. 3.00 '
ADDRESS ENG , SPECIAL CIRCUIT, 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00 '
APPLICANT s MOTORS :-+ SEE FEE SCH.
ADDRESS .
SERVICE CHANGE 10.00
00 0 LICENSED CONI RACTORS DECLARATION
a
UI hemhy affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w a w (mmmencmg with Section 7000)of Division 3 of the Business and - . BLDG. ELECT. PLC. MECH.
F n Z Professions s wJ&_my license is in full mb fur���IR ,sI�I�. - ❑ ❑ Cl
Z
i w o License Class_ �_Cic.Number=l Lw�
w r w Date_ Contractor ._.
a S, w u OWNER-BUILDER DECLARATION UILDINO PERMIT
d ' ' MISC.- REFER TO ORD It-NRK
ATION
X ; LL I- Thereby al1'imi that I am exempt from the Contractor's License VALUATION
a. O j Law for the following reason.(Sec.703 L5,Business and Professions - $/FT.
H - PERMIT ISSUANCE
Code:Any city or county which requires a permit TO construct,alter, 6.00 ARA ,1
EE p improve,demolish,or repair any structure„prior to its issuance,also ELEC.CONTR. LIG.NO. ELEC. Ili
4
y w m u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he Is licensed pursuant to the provisions of the Contractor's License
i
Law(Chapter 9(commencing with Section 7000)ofDNlslon 3 ofth- '1: v � rc,.ik g 'I
iQo Business and Professions Code)or that ho isexempt therefrom and QTgRVC .v' },. .�4 PLUMBING PERMIT {+$ 1 r,��FEE�B O�r��s'^"•�m�'G �vT eQ
BE I-m the basis for the alleged teem phon,Any violation of Section 7031 5 A'� STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty, ALTER-DRAIN -WATER (EA.) 4.00
of nut more than five hundred dollars(8500).):
❑ I,as owner of the property,Or my enmloyees 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,AR EA,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 FIXTURES-PER TRAP4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- {
.cuts ore not intended or offered for sale.11,however,the building GAS-EA.SYSTEM-1 I NC.4 OUTLETS 4,00
or improvement is sold within One year of completion,the owner-
builder will have the burden of proving ilial he did not build or im. GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
pmve for purpose of sale.). - - RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting'with INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
licensed contractors IN 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(EA.) 1.00
Contracts for such projects with a contructons)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/8.00 - TRACT NO. PARCEL NO.
O I am exempt under See.on BAP.C.for this WATER HEATER W/VENT 4.00
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKF:RS'COMYIENSATION DECLARATION WATER TREATING EQUIP. 4.00 '
1 hereby affirm that I have a certificate of consent to sclfainsume - - '
or a certificate of Workers'Compensation Insurance.or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab C,),
Policy No. Company S7 ?.Flu L
O' ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-Z4
Z Z Is fit illi(+h- c' lion division.
p Appfc;untL � or MISC- REFER TO ORD. v ❑ N❑ Y ❑ N❑
CC `-
LU to CERTIPICATEOPE%IEMPTIFROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u.C.
W > COMI'I:NSATION INSURANCE I PLG.CONTR. LIC.NO. PLG.
1 Cl IThrs secUan need not he completed if the permit is for on TOTAL O v❑ N❑ v ❑ N❑
Z:) Z hundred dollars IS 100)or less.) - -
U O - 1 certify that In the performance of the work for which this per. a _I'hyr i(Y , T' n {2' k• } s tlF,EESl,1MMA_RY
QTY: c MECHANICAIj'P,ERMIT „N 3� FEED F >~
W I- mit Is Issued,I shall not employ any person in any manner so as t ?,'J 5 {, •} '" 'C4'f� ,}.ry
L) become so b)ect to the Worke m'Compensation Laws of Califon la.
O 0.
an Dns ApplicaALTER OR ADD TO MECH. 4.00nt - BUILDING
} rNOT'CIE TO APPLICANT: If,after making this Certificate of Ex-
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 deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSI'RUCTIONLIENDINGAGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 5.00 SEISMIC FEE a�
I 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
.. Lenders Name HEATING UNIT(OVER 100,000 B.T.U.17.50
Lender's Address ELECTRIC
1 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 BOILER-CORM(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING Q
ordinances and state laws relating to building construction, and
hereby*authorise representatives of this city to enter upon thealboveauthored property for inspection purposes. BOILER-COMP IOYR 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby*
(We) a c 10 save, indemnify and keep harmless the City of MISC.- REFER TO ORD. ,
Cupertino inst liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may 11 in any ay,accrue against said City in consequence of the
[I is eland MECH.CONT. LIC.NO. MECH.
. .. TOTAL
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Si azure o p icant/Con or Uele 'v$
OFFICE COPY