5303 CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
PERMITNO. ADDRESS LOT NO.
P & p� 6�
V MMR
PERMIT ISSUED DATE ELECTRICAL DATE INSP.=
ui ink ¢
€lectrical
Plumbing Power Pole
Mechanical �+. er oun
e as ec oug . firing . .
oar Walls
Fire Sprinkler eiin
? ixF tures nt xt
otors
Misc. Croundin
emp ower
utner
FINAL INSPECTIONS DATE INSP, Not Approved
Gas
Electric 8
Plumbing +, - /_gy . PLUMBING DATE INSP.
Mechanical
Wolar Backflow
o Underground
Grading eITnde boor
Planning Partial
Fire pt, ou o Tete
f�ealt t. o ar ough
ui ater ' Insulation
t er �n rain
R/oF79 rain
as
t er .
BUILDING DATE INSP, Not Approved
Pad Certification
oun ation ELECTRICAL DATE INSP.
re- rte
Slab-Nierffirane Underfloor S.M.
Bond earn DFH7771nsulatlon
Underfloor Girders ire ers
Floor teel Fireplace
ie owns brease Duct ,Z Hood
is rams One Hour Shaft
eismec Bracing 76—HEF—sate brain
a1V l�-ME s E5uilxnent Anchorage
Frame Flues 4 Comb. Air
t t er
oars n xt. .�-) Not Approved
Firewalls
Other
et rove
Pin ems_ _ P Al- a -d
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT.PEN ONLY`
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ADM1mNG APPLICATION & PERMIT' - 0
o110 BUILDING—ELECTRICAL-PLUMBING'—MECHANICAL
1Nf32opGt WsvW.
nWNE 'S Aume',r, - - - PLAN CHECK VALIDATION
i-� ^OLSy.19,(' OTY. ELECTRIC PERMIT FEE _
�1 1. PHONE s' T PAIL)
�. ! p 'TL.ETS-SWITCHES'-RECEP 5.00/1.00
NV`V ^ IOIJc�-C' � LIC.*NO. (J3, LIGHTING FIXTURES 5-BGn-DD MAR 301984
co4NTRncTOR•s{'� i A,,.��]2r�. [? PPLIANCES—RESIDENTIAL 4.00
n�D-s-3 QO41' Flnryr✓L.Y ..
1'{� PHONE � —SQ') PANELS 5:00
ON .
ORCHITEcr - SIGNS - 6.00 ' P C C P.C.NQ
ENGINEER,'
uc.No. j
ISIGNS TRANS. 3.00 '
ARCH,OR ENG: $PECIAL CIRCUIT 'S.00 - PERMIT VALIDATION
ADDRESS
nap iEMP..METER OR POLE INS. '15.00
APPLICANT'S - "
ADOREss " MOTORS' SEE FEE SCH.
SERVICE CHANGE '10.00
w o o LICENSED CONTRACTORS DECLARATION
Fa ..I hereby affum'that I am licensed under provisions of Chapter 9 t
¢ (commencing wilhction 7000)of Division 3 of the BusiOess and D ISSUANCE PAGE M LH
Fyi Professions Code„Keel myrlicense is in full fo e '^ ❑
z4 O T — LicenscC asst' Lic.Numbnr ”
m r� Dated/-+—�(—�Cnnlructor' 11 p Q v (�
wa OWNER-BUILDER DECLARATION MAR a+ o '�"'�� - BUILDING PERMIT
w 3 LL G .I hereby affirm that Pam exempt from the Contracor's License
M IS6:- DEFER TO ORol INFORMATION
LL04 Law for thb Collowin6 reason.(Sec.7031.5,Businessund Professions PERMIT ISVALUATION $/FT.
L Code:Any city or county which requiresapefmitto construct,alfeq 6.00
�� ELEC.CONTE. LIC.NO. //sx/i/ U
ac rc ¢ � improve,demolish,or repair any structure,prior to its issuance,also
ELEC. /
—O u requires the applicant for such permit to file a signed statement that TOTAL
u w m he is licensed (ozo nt to the provisions of the Contractor's License PER TO
r z a Law(Chapter 9(commencing with Section 7000)of Divisipn3 oRhe -
4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
leHm the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES JYPE CONSTR.
aim by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN (EA.14.00
of not more than five hundred dollars($500).): '
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00
their sole compensation,will d0 the work,and the structure is not OCL.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:'The Contractor's License Law does not apply to an owner of -
property who builds or improvesthereon,and who does such work FIXTURES-PER TRAP- ' -
�. himself or through his own employees:provided that such improve. 4.00SQ.ET.FLOOR AREA TOTAL ACREAGE
ments are not intended or offered forsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion,the r
ownie- l BUILDING USE
builder will have the burden of proving that he did not build w -
GAS-EA.SYSTEM-OVER 4(EA.) 1.06
Prove for Purpose ofsale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON. PB Omer '
❑ 1,as owner of the property,am exclusively contracting with - .,1:1 - . - O
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner or property who builds or'improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
,contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. - PARCEL NO.
`e❑nl am exempt under Sea ' ,B.&P.C.for this : WATER HEATER W/VENT - 4',Op
Owner - - Dale WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATIONWATER TREATINGEQUIP. - 4,00
I hereby affirm that I have a certificate of consent to self-insure,'
n/
or certificate of Workers'Compensation Insuranccgr a certified ZONING ENG.SITE NO.
V� copy fner`� OS' - FfN(.�. .
P is -
O Ce ilii v creby Lr fished. > FIRE$PRINK ENERGY Z Cerlif d rs filed �ly mspochon division. - - 1 24 .
H O ApPiicum _ MISC.- REFER TO ORD. Y� . N Y ❑ No
1 PERMIT.ISSUANCE FLOOD ZONE A.A.u.c.
LUW FIC OMPE ATION INS FROM WO FIRS' ! 6.00
CLO COMPENSATION INSURANCE. PLG.CONTE. LIC.NO. " PLG.
Z (This section need not be completed if the permit is for one - TOTAL Y N Y[:] NC]
hundred dollars($100)or less.)'
U O I certify that in the performance of tie work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
IL F mil is issued,1 shall not employ any person in any manner sun as h)
OW become subject to the Workers'Compensation Laws of California
y DateApplicam " ALTER OR ADD TO MECH. , q,00 - BUILDING
>_ NO TICK TO APPLICANT: If,after making this Certificate of Ex-
F _ emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
U puck visions
oln the [.shot Code, you must forthwith comply with -
provision this pe.rout shall he deemed revoked. AIR HANDLING UNIT(TOFEE'10p00C.F.M3 -3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.RM.) 5.00 SEISMIC FEE.
I hereby affum.[hat there is a construction lending agency for EXHAUST HOOD(WITH.. 2.00
the perforelanee'of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100' .TU) 4.00
Lender's Name . . - `
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC '
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 �'
information n correct. I agree to comply with all city and county BOILER-OOMP(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING
.'
hereby
aces ori state laws ativesn8 to building construction, and
above- inti authorize representatives of This city to enter upon the BOILER-COMP (Ova,100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(We) agree.to save, indemnify and keep harmless the City of MISC.- EFER TO ORD: -
Cupertino' anst liabilities,judgments, costs and expenses which CONST.TAX
mayaiIva accrue rust S"city in consequence.of the PERMIT ISSUANCE 3.00granfis ern'itMECH.CONT. '• l .lam. •g ' MECH.TDT TOTAL
Applicin/Contractor Date
OFFICE Qta1