1063 C I I I UP GUPP.RTINO iNSPECTIOC RF.UUKD 10tfice Uopy)
WN
1063
PI:md1IT NO. SANITARY DIST. 140. LOT NO. ADDRESS
1 Helmut Kramer-- 252-5866
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Bui]di.nso, 9-18-81 bate Insp.
Electrical ]'ower Pole
Plumbing Under round
14 chnnical Rough Hirin
Teme. Cas/Elect. flails _
Solnr Ceiling
Tire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other
FINAL INSPECTIONS Not Approved
Date Insp.
n. s PLUMBING
Electric Date Insp.
Plumbing Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading
Rough Complete
Planning Solar Rough
Fire Dent. Plater & Insulation
Health Dept. Main Drain
Building R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Hembrane Ducts & Insulation _
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext.
Firewalls
Other
Not A2proved
•
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY-
BUI LDI NO PROJECT I DENTI FICATION - PERM I NU B
BUILDING . - APPLICATION & PERMIT 063
L' ao0 1 x21 1� NN J
Q BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
wNER'S PLAN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT 'FEE
�� 4I� �✓YJ/moi/VHONE`-'+JG Jar
eNIRW NAME AcroRs _ OUTLETS=SWITCH ES!RECEP- 5.00/1.00
LIC.NO. ILIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S - APPLIANCES-RESIDENTIAL, 4.00
1IT90F, CUPERTINO PRONE PANELSf 5.00 DATE OF APPLICATION
ARCH��ITTJEC•TI 1 p SIGNS 6.00 PLAN CHECK FEE P.C.NO.'
4ilAeegy V -�O1 LIc.NO. SIGNS TRANS, 3.00
ARC"
OR ENG. _ SPECIALCIRCUIT 5,00 PERMIT VALIDATION
AIO ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00 yr
o o LICENSED CONTRACTORS DECLARATION - 7 (/ /
a zI•j 1 hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE PATE
w
(commencing'wlth Section 7000)of Division 3 of the Business and BLDG-' ELECT.. PLG. MECH.
F z Professions Code,and my license is in full force and effect.
❑ ❑ ❑ -
" o z m G License Class Lic.Number—
P,
-
Date Contractor
H,H~J
a x s BUILDING PERMIT
¢ ¢ a� OWNER-BUILDER DECLARATION - -
¢ w o INFORMATION
K
o e r I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
3 u y LUATION $/FT.
F _ oJ Law for the following reason.(Sec. uires a,Businessand Professions PERMIT ISSUANCE - 6.00
3w � P Code:Any city or county which requiresapermit toconstruct,a also N
¢ , a O' improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.`
i 0 u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w m y he is licensed pursuant to the provisions of lite Contractor's License ,
tzr Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
rc r,o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TVPECONSTR.-
i 3 m by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500h.)
ALTER-DRAIN -WATER (EA.) 4.00
❑ I,as owner of the property,or my employees with wages asBACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 -
Coder The Contractor's License Law does not apply to an owner of -
property who builds or Improves thereon,and who docs such work FIXTURES-PER TRAP. 4.00 SO,FT.FLOOR AREA TOTAUACREAGE
himself or through his own employees,piovided that such improve-. .r
ments are not intended or offered forsale.If,however,the building GAS-EA.SYSTEM-I-INC.4OUTLET$ 4.00.
or improvement is sold,within one year of completion, - . -OVER 4 (EA.) ,00 BUILDING USE
the owner- GAS EASYSTEM - 1 -
builder will have the burden of proving that lie did no[build or int- RES INCON PB Other
prove for purpose of sale.). INDUSTRIAL'WASTE INTER. 20,00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I 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 Mention.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
' contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA,2001tiSLOO TRACT NO. PARCEL NO.•
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT - 4.00 -
reason
D Owner WATER SYSTEM 4.00 ACC.DATE 'ACC.FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 ,
I hereby affirm that I have a certificate of consent to self-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'y}ensation Insurance,or,�iyertified
copy ihereo (Sec.3800,Lah.C/T/ 41/1/0 '
Policy No heir mpa v /- -
O ❑ Certifie yRby Rlniiled. FIRE SPRINK ENERGY T.24'
Z Z \ f❑ Cerll' p S f d i' i city-sryretton division. MISC.- REFER TO ORD. F] ❑N V ❑
O pplV N❑
i w \/
~ rnPERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u.c.
� C' TI FICCOM E EXEMPTION FROM WORKERS'
W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
Z (This Section need not be completed if the permit is for one TOTAL Y E] NE] Y.❑ Is E]
hundred dollars($100)or leas.)
U O 1 certify that in the performance of the work for which this per, OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL 17 nils is issued, I shall not employ any person in any ma mTr so as to
U become subject to the Workers Compensation Laws of California.
0 y Date ApplicantBUILDING
ALTER OR ADD TO MECH. ,4,00
} N NOTICE TO APPLICANT: IL after making this Certificate of Ex. -
�'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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.), ,3.00
CONSTRUCTION LENDING AGENCY AIREANOLING UNIT(OVER I0AOOC.F.M.) 5.00 SEISMIC FEE
I herebyaffirmthat 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. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Civ.CJ.
Lender's Name HEATING UNIT(OV ER 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 andstatelaws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.1 4.00 '
.. hereby authorize representatives of this city to enter upon she BOILER-COMP IOver 100,000 BTUI SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
MEC
Perrin° a St liabi'lies,j ud6ments, costs and expenses which CONST.TAX
int In -y Sec,
ce at
tr amst'said City in consequence of the PERMIT ISSUANCE „3.00
mi MECH.CONT. LIC.NO.
gran ' er - H.
TOTAL
p
�7��/• TOTAL
+Sute of Applicant Contractor
On Ve
OFFICE COPY