5308 CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
530 21745 Collin sworth
PEIMT_i Swimming Pool George Yano
PT= OWNET—
PERMIT ISSUED DATE ELECTRICAL DATE INSP:
>_n
ecFI" trFa
Plumbing Power Pole
Fehaanical under im
Temp as ec oug irking
Solar ells . 4.
Fire rin er Ceiling .
Sign Fixtures Int/Ext
otors
Misc. roun ui .
6
"Temp ower
Other
FINAL INSPECTIONS DATE-_: .,INSP_._ Not .Approved
Gas
Electric
PlumbingPLUMBING DATE INSP.
e anic
. a
o ar "Backflow
)o r un
ra mg er oor
Planning Partial 0
Fire wept. MIFTE pl.ete
Hea1tT ems— solar ugh
water ' ns ation
Other
o am
Gas 1�.9
.,Other
er
BUILDING DATE INSP. Not rove
Pad Certification
oun =tion ELECTRICAL DATE INSP.
re- rte
Slab-N16ribrane V, Underfloor S.M.
To—nd-73mnDTHFTnsu ation
Underfloor Girders Fire Dampers
Floor Steel ire ace
ieowns Urease JJuct & Hood
is rams a our haft
ehsmecracing Condensate Drain
ails-F•anne s ui ment Anchorage
Frame 111UeS 4 Comb. r
at ter
woars Int/Ext. of rove
irewa s
Other
Net Approved
BUILDING
It
•
ELECTRICAL
is
PLUMBING
•
waimICAL
I
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
Ir. BUI LDI NG PROJECT I DENTI P16ATION - - PERMIT NUMBER
`I .1L.aNG - - "APPLICATION &PERMIT
F�RE55
i1 SA CO�G�A��SW&#rN BUILDING ELECTRICAL-PLUMBING-MECHANICAL 5308
OWNER'S'
NVW
k11 xy ae qw Ttv Vy PLAN CHECK VALIDATIO
.. �' �4• ��MAP,
,•� G75YA 6, 'aa 1` !,' ELECTRICGPERMITx ,"!'t'v�'ta.'y"a,FEEtirt SZ /) - /
M �/yJ J .
tC NTRACTOR'5 l
ME - e OUTLETS SWITCHES RECEP 5.00/100
I FEf14mr- �! =2a S8L LIGHTING FIXTURES 5.00/1.00
f,0rvTRACTOR'S
7HE /Lp APPLIANCES-RESIDENTIAL 4.00
77 S6.1 'PRO I-� PANELS 5.00 DATE OF APPLICATION
ORC TECT SIGNS' 6.00 PLAN CHECK FEE P.C.NO.
ENc ER ua SIGNS TRANS. 3.00HIIIH '
Ara.& $TNo� • '., SPEC IALCIRCUIT 5.00 PER MITVALIDATION
A,VN�iJY\ zIP r EMP.METER OR POLE INS. 15.00
' A%We GW
a MOTORS .SEE FEE SCH. �'J
SERVICE CHANGE j {/
woo LICENSED CONTRACTORS,DECLARATION
m'v I hereby aflirin that 1 am licensed under provisions of Cha ter9 E R
w a m (commenc ng with S n 7000)of Division 3 of the Business and d BL L T. E MECH.
r y z Professions CAl,�iI-ri license is in full f ff
z 0 y' License lyss -_ Lic.N _
9,N d Dale ► ennl City ot,Cuoer ino .
¢ W w ¢. OWNER R-BUILDER DE LARATION - F.B -D O", IT
a O'u MISC.- REFER TO ORD
.' ";'IMA
NFORTION
w 3 LL h Thereby affirm that I am exempt from the Contractor's License
LL O ¢ Lew for the following reason.(Sec.703 1.5,Business and Professions - VALUATION $/FT.
r _ in Code:Any cityorcounty which requiresa permit toconstruct,alter, PERMIT ISSUANCE 6.00
Roc Q improve,demolish,m repair any ahuc[are,prior to its issuance,also ELEC.CONTR. /bpLIC.NO. ELEC. .l n / G OQ0
0, requires the applicant for such permit to file a signed statement[hat TOTAL OLA/
a w m U.w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
F z a
Law(Chapter9(commencing with Section 7000)of Division 3 of the
4 D
Business and Professions Code)or that he is exempt therefrom and OTV:*„.� °PLUMBING"PERMIT^ ' 'FSEs°^
¢ s- the basis for the alleged exemption.Any violation of Section 7031.5 'STORIES TYPE CONSTR.
a3 � by any applicant lora permit subjects the applicant macivil penalty ALTER-DRAIN&VENT-WATER (EA..).4,00
' of not more than five hundred dollars(8500).):
'❑ 1,as owner of the property,or my employees with wagesas 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 (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 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 gG,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided iiia[such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1 INCA OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.). RES IND CON', - PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 El ❑ ❑ ❑ 11
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 SPRINKLERS- (EA) 1.00
contracts for such projects with a contractorls)licensed pursuant to - '
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/6.00 TRACT NO. PARCEL NO.
0 lam exempt under Sec. ',BAP.C.for this
re WATER HEATEFAPREY9 4.00
Owner I Date WATER SYSTEM 1984 4AO ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATI RR
4.00
hereby affirm that I have a c Ific e f uo crit In set -
r rt k s d ZONING ENG.SITE NO.
Policy No e , Cm.).
GAF 00 L_ -
' Policy No. Company' '
O -❑ Certified 'opylsherebyfurnished. - '
FIRE SPR INK ENERGY T24
Z 2 ❑ Ce is d t lh ec diWslon.
� O APplica MISC.- REFER TO ORD. v0 rv❑ v ❑ rvEI
CE TIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.LU.c.'
IL O COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. / r v NE] v N�
= Z (This section need not be completed if the permit is for one TOTAL fe
hundred dollars(S 100)or less.) - -
I certify that in the performance of the work for which This per, OTv3 .„"r"= s*MECHANICAL-�P,ERMIT "a; wFEE;S *;:'F,EtSUMM;6,Y,
0 O
LL F mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation laws of California.
a Date Applicant ALTER OR ADD TO MECH. 4.00 - BUILDING
} m NOTICE TO APPLICANT: If,alter making this Certificate of Ex-
? emption,you should became 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 10,000CF.M.) 3.00
CONSTRUCTIONLENDING AGENCY AIR HANDLING UNIT(OVER 10p00GEMJ 5.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of[he work.for which t s perms . issued(Sec. MICROFILM
3097,Civ.C.L I HEATING'UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name �a HEATINGUNIT(OVE 1 OB.T.U.17.50
Lender's Address ELECTRIC'
I certify that 1 have read this application and stale that the above VENTILATION FAN I 3.00
information is correct.1 agree to comply with all city and county PLUMBING !
ordinances and slate laws relating to building construction,and BUILER• 13 rt O B.T.U.) 4.00 oZb
hereby authorize representatives of (his city to enter upon the BOILER=COMP veil T FEE SCH. MECHANICAL
shove-mentioned property for inspection purposes.
.(We) agree to save, indemnify and keep harmless the City of MISC.'- - REFER TO ORD.
Cupertino against loch ittes, gments, costs and expenses which 'pERM1T ISSUA - 3.00 CONST.TAX
I 'n ny way accrue a i !'said City in n en of the
n f[ ermit MECH.CONT. LIC.NO. MECH. p/
TOTAL
o e,n,' 141 7A
Sign are p on teens/Cclor to � t TOTAL,t,� �
" 'OFFICE COPY '