0913 C11'Y OF CUPERTINO INSPECTIOI: RECORD (Office Copy)
-Y v 0913 10430 Cherry Tree Lane
PI:PJIIT NO. SANITARY DIST. 170. LOT 1,10. ADDRESS ----
Plumbing Steward 253-4202
PROJECT 01-INER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Buildine _ Date Insp.
Electrical Power Pole _
Plumbing 9-22-81 Underground
Mechanical Rou ;h Wiring
Temp. Cas/Elect. Ila 1 s
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Notors
Grounding
Hisc. Temp. Power
Other
FINAL. INSPECTIONS Not ApProved
Date Insp.
s PLUMBING
Electric
Plnmbin , Date Insp.
Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
Planninp Solar Rough
Fire Dept. Water & Insulation _
Health Dept. Main Drain
Building R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
1'ad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane 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
Ilalls-Panels Flues & Comb. Air
Frame Other
bath Not Approved
Wallboards Int/Ext.
Firewalls
Other
Not Approved
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN IN.FORMATION'WITHIN RED LINES - USE BALL POINT P LY
it. - ,
BUILDING PROJECT IDENTIFICATION PERMIr NUMBER
T _ ADDRESS APPLICATION & PERMIT O (�1
ADDRESS r a7 I
BUILDING-,,ELECTRICAL-PLUMBING-MECHANICAL
.- -. _. - -. .-_
OW ER'S ✓ _ PLAN CHECK VALIDATION
" Me •• QTY. ELECTRIC PERMIT FEE -
o e
CONT.AA_R
t NAMF �-A OUTLETS-SWITCHES-RECEP 5.00/1.00
uc.No. LIGHTING FIXTURES 5.00/1.00 -
C,ONTRACTOR'S - gpPL IANCES-RESIDENTIAL 4.00 -
AOORE55
vHONE PANELS 5.00 GATE OF APPLICATION
ARCHITECT _ SIGNS6.00 PLAN CHECK�FEE P.G NO.
OR CUPERTIND
ENGINEER ,
• uc.No. SIGNS TRANS. 3.Do
ARCH.On ENG. t N ^ SPECIAL CIRCUIT , - 5.00 PERMIT VALIDATI ON
ADDRESS 13lYJ1
�! zIP TEMP.METER OR POLEJNS. 15.00 -•
APPLICANT'S MOTORS- SEE FEE SCH.
ADDRESS
� I- � SERVICE CHANGE 10.00
1
o o LICENSED CONTRACTORS DECLARATION
c v v . •I hereby affirm that I am licensed under provisions OLChapter 9 _ ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. .PLG. MECH.
Professions Cod_ H. license is in full for�e gndeffceb ❑
R,� z L L71 LO .
z 0 n - License Class Lic.Number
0 y F Date Contractor C ie - -
- - r BUILDING PERMIT
¢ ¢ ae at OWNER-BUILDER DECLARATION INFORMATION,
Q:
LL r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
g PERMIT ISSUANCE -vnLunnoN
H u o J Law turtle follor c reason.(Sec.7031.5,Business and Professions 6.00 r
m Code:Any mulish coup pair any structur e p riort tois issuance,
,also
2ea Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0., ELEC.
O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a
W m u. he Is licensed pnranam to the provisions Of the Contractor's License `
La . 'Law(Chapter9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
i 0
the basis for the alleged exemption.Any violation of Section 703 LS STORIES TYPE CONSTR.
w. by any applicant forapermit subjects the applicant to a civil penalty . ALTER DRAIN&'VENT-WATER'(EA.)'q.00 '
of not more than five hundred dollars(5500))', - -
❑ I,as owner of the property,ogmy employees 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,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 does such work FIXTURES-PER TRAP 4.00 s0.FT FLOOR AREA TOTAL ACREAGE
himself re through his own employees.Provided that such improve-
ments rroellenot intended oroffered emploforsalrovided find suhebuilding GAS-EA.SVSTEM-l1NC.40UTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BuaOWG USE
builder will have the burden of proving that he did not build or im- RES iND CON PB Other
prove for purpose of sale.). - - IND USTRIAL WASTE INTER. 2.0.00 '
❑ I,as owner of the property,am exclusively contracting with El El El ❑ ❑
- 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 of property who builds or improves thereon,and who - LAWN SPR W KLERS-OVER 5(EA.) 1.00
contracts for such projects will,a contractors)licensed pursmnt to' LAWN
EA.200ft/8.00 TRACT NO, PARCEL NO.
the Contractor's License Law.
❑ 1 am exempt under Sec. ,B.&,.C.for this WATER HEATER W/VENT ,4.00
reason
Date- Ovoml - WATER SYSTEM 4.00 ACC.DATE ALO.FILE NO,
WORKERS'COMreNSA'r1UN DECLARATION WATER TREATING EQUIP. 4.00
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.
coPYyhBteP e a C. y_l/ ��„ '
Polic 0100// Y�TL(-�
O ❑ edified copy S ie byfurnislted. RE SPRINK ENERGY T-24
Z
.Z Certified cypy is filed with the city inspection division. MISC.'- - REFER TO ORD. y [] N❑ v Q N❑ -
0 A 'cunt /�
Q: y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU - COMPENSATION INSURANCE PLG.CONTR. -uc.NO. PLG.
(L o (This section need not be completed if,the permit is for one - IOTA Y E] N❑ Y ❑ N❑
Z .hundred dollars(8100)or less.)
U O Lcertify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any manner so as to
O W become subject to lire Workers'Compensation Laws of California ' BUILDING
Date Applicant ALTER OR ADD TO MECH. 4.00
} feta NOTICE TO APPLICANT: If,oiler making this Certificate of Ex- ..
L.. ? emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of lire 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
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC EEE
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.L HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name r
Lender's Address
HEATING UNIT(OVER 100,000 B.T.U.)7.50 rMECHANII
RIC
.I certify that I have read this application and state lhat,t6e above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city ai,d county BOILER-COMP I3 H.P.Or 100,000 B.T.U.) 4.00 ING
ordinances and stale laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. CAL
above-mentioned property for inspection purposes. -
(We) agree to save. Indemnify-and keep harmless the'City of MISC.- REFER TO ORD. -
Cupertino against liabyl its,judgments, casts and expenses'which PERMIT ISSUANCE 3.00 .TAX
in any ay, aw a against said City in consequence of the
granog Off, s r - MECH CONT. 'LIC.NO. MECH.
TOTAL T p L
tura App scant/Contractor /Y
OFFICE COPY - i