5999 CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
PI T-N6.
PERMIT ISSUED DATE 'ELECTRICAL DATE INSP.'
ui in
ctrica
Plumbing Power Pole
Mechanical anr un
Temp as ec Roughparing
Solar walls
Fire Sprinkler Ceiling
bign iixtures Int/Ext
otors
Misc. noun in
emp ower
Other
FINAL INSPECTIONS DATE INSP, Not Approved
Gas
ectric
Plumbing PLUMBING DATE INSP.
Mec ianT�ica
AmZ
o ar Backflow
�01 r un
in oor
Planning Partial ou
ire Dept. u� ete
Health t. Solar t2ugh
Building Water 'k Insulation
Othey Main Fain
77,67Maim
Gas _
Other
BUILDING DATE INSP. Not rove
Pad Certification
Foundation ELECTRICAL DATE ?NSP.
re- rte
Slab-Membrane Underfloor S.M.
on cts nsu ation
Undertloor Girders Fire Dampers
Floor Steel Fireplace
Downs rease Duct 4 Hood
is ran One Hour Shaft
eismecracin Condensate aim
Val s- ane s ui ent Anchorage
rame Fluesr
atOther
oar nt xt. of rove
NMrewalls
er
Not Approved
MLDING-
ELECTRICAL
PLUMBING
AWL
MECHANICAL
'MCELLANEOUs
. .APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
\,x BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING Q APPLICATION 5999
ADDRESS 'J'
./,pai �/f �� BUILDING-ELECTRICAL-PLUMBING-MECyy��HANICAL
NAMELPNNL�(/�J'7, OWn/ CTR, O G2T/es7 I:'ir # `�� SAA P 'y PLAN CHECK VALIDATION
/a OT5yYX ,E,LTECTRIC,,FERMIT11i FEE S.: -
C PHONE �+ ?
CONTRACTORS
j/ UTLETS-SWITCHES-RECEP 5.00I100
EYu LIC.ND.G j6�Zel� LIGHTING FIXTURES 5.00/1.00
COry ACTORS f.. I
ADD/DRESS [,,.�}J"e.., IZ£D x �A• PPLIANCES-RESIDENTIAL 4.00
Y I�'t '; 1 f PHDNE 3�g'3 'i PANELS 5.00 DATE OF APPLICATION
AARRCHITECT SIGNS 6.00 PLAN CHECK FEE .C.NO,
ENGINEER
LIc.ND. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS 1- SPECIAL CIRCUIT •5.00
ZIP EMP.METER OR POLE INS. 15.00 ^ /
APPLICANT s MOTORS SEE FEE SCH,
ADDRESS
SERVICE CHANGE 10.00
w00 LICENSED CONTRACTORS DECLARATION
a v D 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(comfnane ing with Section 7000)of Division 3 of the Business and
Ci< - I V BLDG. ELECT. .PLG. MECH.
r y z Professions Code,a99J r�ayy,,license is in full foreJ�,agqd effect� - ❑ ❑ ❑
z 0.-
Z
�,- Licen Class_5./1�Lie.Number�T- G�+)
9 z r w Uate .p OLi Contmmor
a x I cit' Of CUP BUILDING+PERMIT;- "'
¢ ¢ w ¢ OWNER-BUILDER DECLARATION "rk
U INFORINATPON, •'
X 3 LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
F w04 Law for lire following reason.(See.7031.5,Business and Professions PERMIT ISSUANCE `6.00 VALUATION S/FT.
gw0� Code'.Any City or county which requires a permit to construct,alter, _ D
1 Plop
ac ¢¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a wO¢ requires the applicant for Such permit to file a signed statement that TOTAL PERMIT TO
m m he is licensed pursuant to the provisions of the Contractor'.%License
rz > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe IL
a Business and Professions Code)or that he is exempt therefrom and OTEY:`;, PLUMBING PERMIT FEE
¢ H o the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
ogre by any applicant for a permit subjects the applicant loa civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars($500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE, 2.00 OCC.GROUP REB.UNITS
sole compensation,will do the work,and lire structure is not
intended or offered for sale(Sec. 71144, Business anciTrofessions 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,unit who does such work FIXTURES•PER TRAP 4.00 SQ.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
mems are not intended or offered for Salo.If,however,the building GAS-EA.SYSTEM-111NC.40UTLETS 4,00
or improvement is sold within one year of completion,the owner. GAS•EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
provefor.purposeofsale.). INDUSTRIAL WASTE INTER. E IND CDN PB Omer
O 1,as owner of the property,am exclusively contracting with 20.00 1:1 El O 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 properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec..,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Owner Dale WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO,
WORK F.RS'COMPENSATION 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 ENO.SITE NO.
copy Cher ISec.3 00,Lab.C1� �•NI 7 �'I
Policy No. Company G�
0 ❑ Cetlllied copy ishemby furnished. FIRESPRINK ENERGY T-24
Z Z ' ❑ Ccmifie cop is Bled v'th the City inspection division. MISC.- REFER TO ORD.
O Applicant Y N Y 0 N�
'~ H 4 PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
!r CI:R'I'I PIC ATI;OF fI FROM WORKERS'
CL �_ COMPENSATION ore INSURANCE PLG.CONTR. CIO.NO. PLG. y� N� Y N�
1 Cl (This section Mrs S10 not ss. completed if the permit is for one TOTAL
L) Z hundredfy that inI 00)or perforJ
U O I certify That in the performance of the work for which 1I'S per OTV,-g#£ ` ,s`M ECHANICALiPERMI+T :"le" ''1 FEE' ,,EPEE SUMMARY+o
LL F mit is Issued,I Shall not employ any person In any manner so as to S a - s ms
Ow become subject to the Workers'Compensalion Laws of California.
Applicant ALTER OR ADD TO MECH. 4,00 BUILDING
IL Date
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
,F Z emption,you should become subject to the Workers'Compensation APPLIANCE- 4.00 PLAN CHECK �•
provisions of the Labor Code, you most forthwith comply with FEE
- U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10ADC.F.M.) 3.00
CONSTRUCTION LENDINGAGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 5.00 SEISMIC FEE lOEliv
I herehy affirm that there is a construction lending agency for EXHAUST HOOD,(WITH DUCT)' 2.00 -
the performance of the work I'or which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.17.50
Lender's Address - ELECTRIC
I rcuready that I have read this application and slate that i .bole VENTILATION FAN (SINGLE) 3.00
information n coater. I agree to comply with all nest and COBRIy PLUMBING
ordinances and slam laws relating to building construction, and BOILER.COMP(3 H.P.Or 100,000 4.00
hereby authorize PCPresen SdVCS of this city to enter Spurt the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-me Nionetl property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino ainst liabilities,jud s, costs and expenses which PERMIT ISSUANCE .3.00 . CONST.TAX
may in n way a Lou agai S City in consequence of the
grant; o hisp f. ♦ MECH.CONT. - - U0.N0. TOTAL
�) 1- TOTAL
SigMECH
naureo p I Contractor Date'
OFFICE COPY