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CITY OF CUPERTINO INSPECTION RECORD \../
(OFFICE COPY)
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PERMIT ISSUED DATE ELECTRICAL , DATE INSP.'
ui n
ctrl
Plumbing Power'Pole
mechanical r1round
e as ec 4H Wiring
Solar a s
Fire Sprinkler Leeilin ,
Sign - ixtures int/hxt
tors
Misc. rouezn
e ower
Other
FINAL INSPECTIONS DATE. INSP. Not Approved
Gas
ectric
Flum-bing PLUMBING DATE INSP.
-Mechanical
Solar Backflow •
oo r un
r in oor
Planning Partialou
Fire tu affLete
Health Dept. Solar Rough
i �n ater ' insulation
er Drain
oDrain
as
Mer
BUILDING DATE INSP. Not Approved
Pad Certification
Foundation ELECTRICAL DATE INSP.
re- unite
slab-Membrane Underfloor S.M.
Bond Beam MRT7=nsulation
Uridertloor Girders Fire Dampers
Floor Steel Fireplace
ie s Grease Duct 4 Hood
rams 'MeTour eismec racin a- - on ensate ain
s- ane s Equipment Anora e
rame ues a Comb. Air
a
Other
�allboar Int/Ext. T 77of rove
��irewa s •
Other
Net rove
BUfMING I
ELECTRICAL
PLUMBING
MECHANICAL
M'IISCELLANEOUS
r
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
s, , BU LDING PROJECT.I DENTI FICATION PERMIT NUMBER -
mLDING - . . I APPLICATION & PERMIT
ADDRESSAp
• 715 3
BUILDING —ELECTRICAL—yP..,,JLUMBING—MECHANICAL
NAME - $ J,anilvlt PLAN CHECK VALIDATION
'EL ECTRIC„r;PERMIT FEE /�
E ✓ .; PAID.
CONTRACTOR'S �(
N
AME IJ UTLETS-SWITCHES-RECEP 5.00/1.00 f�
LIC.No. sJfO LIGHTING FIXTURES 5.00/1.00 •FEB 155
_ pPLIANCES-RESIDENTIAL 4.00
. 1aN PHDry ` 1 PANELS . 5.00 T N
RSIGNS. 6.00 PL N H K FE P.C.NO.
F.NGINEER 1..
LIC.NO. SIGNS TRANS. 3.00
nooe'Ess ENG. SPECIAL CIRCUIT��1�E• LK 5.00 O PER MIT VALIDATION
ZIP rrEMP.METER OR POLE INS. 15.00
APPLICANT s
ADDRESS 41M
MOTORS � SEE FEE SCH.o
0 +
' SERVICE CHANGE
NGE 10.00
0
Foo LICENSED CONTRACTORS DECLARATION
a U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCPOATE
yaw (commencing with Suction 7000)of Division 3 of the Business and I T. PLG. MCH
0 w z I'rofesrion-Cn - nit m��cvnse is in full f`y cryldleffegls
o i m W License Cl ass Lic.Num be �.Sr5.
Dale_ -'�(�_Cnntractor
- BU MDI NG�ERM11
Iz rt w OWNF?R-BUILDER DECLARATION -
wi.LL w I hereby affirm Olat I am exempt from OIc Conimclor'S License MISC.— - REFER TQ RD ••�^, 1NFORMATLON
r a_04 Law for the following reason.(Sec.703 1.5,Business and Professions •PERMIT ISSUANCEVALUATION S/FT.
Cale:Any cityor county which requires a permit to construct,Shut, as
.?/��
re Q Q 2O Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. rxJ
ce requires the applicant for such permit to file a.signed statement that TOTAL . pE IT O
e w m" he is licensed pursuant to tire provisions of the Contractor's License I -
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
14 o Business and Professions Code)or that he is exempt therefrom and GTY PLUMBING PyE,.RM IT FEE
Ie H m the basis for the alleged exemption.Any ululation of Section 7031:5 4 5 t ,` $ ' yg�`, ; y STORIES TYPE CON R.
aim by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN (EA.),4.00
of not more than five hundred dollars(1500).): - - )
❑ I,asowner of the.property,or my employees '
wages as BACK FLOW PROTECT.DEVICE 2 OCC.GROUP RES.UNITS
their Sale compensation,will Jo the work;and the structure is not
intended or offered for Sale(Sec. 7044, Business.and Professions DRAINS-FLOOR,ROOF,AREA,COND. .00
Code:The Contractor's License Law does not apply to an owner of - -
property Saha builds or improves thereon,and Saha docs such work FIXTURES-PER TRAP 4.00
mSO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
entsarenotintendedorofl'creel for sale.'I F,however,lire building GAS-EA.SYSTEM-l TS 4.00
or improvement is sold within one year of completion,the owner,
builder will have the burden of proving that he didnotbuild or int- GAS-EA.SYSTEM-OVER 4 A.) 1.00 BUILDING USE
prove for purpose ofsaleJ. INDUSTRIAL•WASTE INT flE5 IND • C PB orhar
1] I,as owner of the property,am exclusively contracting with El ❑ ❑
licensed'contractors 1. construct•the project(Sec.7044,Business LAWN SPRINKLERS-JA
C 5 V.B. 5.00 ASSESS PARCEL NO.
and Professions Code:Thm
Tire Cmnctor's License La does not apply
to air owner of property who builds of improves(hereon,and who LAWN SPRINKLERS OVER 5(EA.) 1.00
contmets for such projects with a conlrachms)licensed pursuant to
the Contractor's License Law. SEWER-SANITA -STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑. lam exempt under Sec: ,B.&P.C.for this WATER HEA RW/VENT 4,00
canon
' Owner Date WATER SV EM 4,00 ,ACC.DATE ACC.FILE NO.
4 WORKERS;COMPENSATION DECLARATION WATE REATING EQUIP. 4.00
P I hereby affirm that I have a certificate of consent to self-insure, •
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
'.„ copy Iher of(Sec 3 00,Lai)C.)
Policy N ! Cut Pant
O"• ❑ Cernfiedcopy is reby fu nn shed' FIRESPRINK ENERGY T-24
Z Z 'A❑1 Cerkif -file h the city inspection'division. MISC. REFER TO ORD. Y
O ❑ N❑ Y ❑ N❑ -'
~ w
,CC Cl IR TI I'ICA'I'C OF E%li PERMIT ISSUANCE 6.00
PTION I° )M WORKERS" FLOOD ZONE A.L.uc.
L COMPENSAT NINSU NCE PLG.CONTR. LIC.NO. PLG.
d O' (This xcli'm need not he core if the permit is for one TOTAL Y❑ N❑ Y❑ No
0 Z hundred dollars IS 100)or less.)
V O . I certify that in the performance of the work for which this per f A re ''" '$' i.+yL row^ a
OTVE Tn� gMECHANICAL,PERMIT�)b " ` aFEE 14EE SUMMARY
Il L) . all Is Issued,I tosinillthe W employ any person in any mxmmr so as to k r71'qa. ^+ ) •4a , § g _ +w'+^
O ED become subject to the Workers'Compensation Laws of California
C. Dat° APPhcant ALTER OR ADD TO MECH. 4.00 BUILDING
} ED NOTICE TO APPLICANT': If,after making this Certificate of Ex-
-I.— ? emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Cade, 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
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
US performance of the work for which this permit is issued(Sec. MICROFILM
3097,0,C.). � � .. HEATING UNIT(TO 100,000B.T.U.) 4.00 '
Lender's Name ` HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I + I certify that l baveread this application and state that theabove VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county� BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING I mdinances and Mute laws relating to building construction, and
I
triz, representatives of.this city to upon the BOILER-COMP IOver t0o,0008TUhSEE FEE SCH. MECHANICAL
ned property for inspection purposes.e to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
ainsl liabilities,judgments, Costs and expenses which9 00 q CONST.TAX
way a against said City in consequence of the PERMIT ISSUANCE- L.'s rail. MECH.CONT. LIC.NO. MECH.TOTAL / Rci,r?''#;T ,`R r' DYL I ant/Contractor Date - # ,G gTpALCV 9p
OFFICE COPY ,. T%