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3533 1. CITY OF CUPER11110 INSPECTI011 RECORD (Office Copy) 3533 _ 10105 DeAnza Boulevard PCPJII'r N(1. ",Ai`TARY DIST. 140. TO—Trio. ADURI�;SS - ----- Demolish falls Ilcl'horters PROJECT OWNER .TOB SITE PHONE NO. PERr1IT ISSUED Date ELECTRICAL BuLldi.ne. ___ 5/6/83 _ Date Insp. Electrical Power Pole PLumhing UndcrCround -- ---- rlochani.cal Rough Wiring ---__ Temp. Cas/Ficct. Ilaa....s _— Solar Ceiling Fire Sprinkler Fixtures Int/Ext _ Sir,n Motors Grounding Hist. Temp. Power _ Other FINAL. INSPECTIONS Not Approved _ Date Insp. r%5 PLUMBING Electric Date Insp. Plumb in , Backflow 'Iechanical Underground Solar Underfloor Pool Partial. Rough • C,rad i ng Rough Complete -- Pinnninf, Solar Rough Fire De t . Water & Insulation Health Dept. ?fain Drain Buildinp R/of/S Drain Other Gas Other BUILDI17G Not Approved Date Insp. Pad Certification MECHANICAL Foundation Date Insp. Pre-Gun.ite Underfloor S.M. Slab-Hembrane Ducts & Insulation Bond Beam Fire Dampers Underfloor Circlers Fireplace Floor Steel Grease Duct & Hood TLed owns One flour Shaft aphrams Condensate Drain _ Seismic Bracing; P:quipmenC Anchorage halls-Pancls Flues & Comb. Air --- — Frame Other Lath Not Approved Wallboards Int/Ext. Firewalls Other . Not Approved APPL;CANT TO FILL IN INFORMATION WITHIN RED LINES - USE-BALL POINT PEN ONLY i PER ER BUILDING PROJECT IDENTI FICATION APPLICATION & PERMIT 3533 ADORE G ADORE BUILDING-ELECTRICAL-PLUMBING -MECHANICAL I OWNER' V PLAN CHECK VALIDATION n NAME /. ,p^/� OTY. ELECTRIC PERMIT FEE CO RACTOR'S NAMES UTLETS-SWITCHES-RECEP 5.00/1.00 �ti'2h0rCuc.No, 7 LIGHTING FIXTURES 5.00/1.00 f,ONTRAc*aRs /�(` APPLIANCES-RESIDENTIAL 4.00 -�, AooR )5- /71 mf3/Jr �^ /J PHOrvE� .[.�� PANELS . 5.00 GATE OF APPLICATION ARCHITECT SIGNS 5.00 PLAN CHECK FEE P.C.NO. ENGINEER �� A10LED.No. SIGNS TRANS. 3.00 ADDRESS eNG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP EMP. METER OR POLE INS. 15.00 ADDRESS AEMOTORS SEE FEE SCH. � SERVICE CHANGE 10.00 w o o LICENSED CONTRACTORS DECLARATION 0 a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE N (commencingwith Section 70001 of Division 3 of the Business and A y L ELECT. PLG. MECH. Fez Professions Code J my license is in full to e�epd a y'. ❑ ❑ ❑ ❑ z O se- License Class J-�1 Lic.Number JJ -T 9 w r w Date Contractor I1n n v a y E MAIWffLbING PERMIT ¢ a OWNER-BUILDER DECLARATION s o d v INFORMATION w g n y I hereby afliri that I am exempt Irom the Contractor's License MISC.- REFER TO ORD IF0a Law for the following reason.(Sec.7031.5.Busihessand Professions PERMIT ISSUANCE rQYFM%ION $/FT: m re Code:Any city or county which requirasa permit iOtmutrm alter, 5.00 �C`70 ¢ Q a Q Improve,demolish.or repair any structure,prior tO its Issuance,also ELEC.CONTR. LIC.NO. ELEC. / -o ¢ requires the applicant for such permit to tile a signed statement their TOTAL A o PERMITTO a w m he is licensed pursuant to the provisions ofthe Contractor's License 'X iii Law(Chapter9(commencingwithSection 7000)ofDivision 3of'(tic yEv�/�I[,rf/, Lt�ALGJ a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE R E.o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONGER, by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00 Of not more than five hundred dollars(5500).).` ❑ 1,as owner of the property,or Or,employees with wages asBACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation.will do the work.and lire 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 FIXTUR ES-PER TRAP 4.00 SO,FT.FLOOR AREA TOTAL ACREAGE himselfre throughhis own empWyees. le.If,however,thatsuchimpnne- memsarenotinthhis or for thatthehuildimg GAS-EA.SYSTEM-1INC.4OUTLETS 4,00 or improvement is sold within one year.I'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 am RES IND CON Pa Other prove 1,Is Owner of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ d as owner of the protract and exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. does Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's s License Law does not apply coan trowner of property who buildstrimproves nsed nand who LAWN SPRINKLERS-OVER 5IEA.1 1.00 conhe Contractor's such Lice jeaswith u Contractor(s)licenseJ pursuant ro SEWER-SANITARY-STORM EA.200ft/8.00 TRACT No. PARCEL NO. the Contractor's License Law. ❑ Iain exempt ander Sec. ,B.&RC.for Nis WATER HEATER W/VENT 4,00 reason It to Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSAIION DECLARATION WATER TREATING EQUIP, 4.00 1 hereby atlirm that I have a certificate of consent to self-insure. ZONING or a certificate of Workers'Compensation l'surainer.or rtil'ied ENG.SITE NO. i copy mem�ol�5�sg��Sopppp LA,CJ4-^,`��jr Policy htG�d;l-liaJ-�In`pany�mt c u Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 z ?Ik ❑ Cert ifie c y d with m city impeclion division. a` Applicant s- �` MISC.- REFER TO ORD. Y ❑ No , Y ❑ N❑ ~ w PERMIT ISSUANCE 6.00 cc - CCR KATE OF EXEh1P ION FROM WORKERS' FLOOD ZONE A.L.0 C. W COMI'ENSA'fiON INSURANCE PLG.CONTH. LIC.NO. PLG. 1 O (This section need not be completed if the permit is I'or one TOTAL Y❑ N Y ❑ N❑ Z) Z hundred dollars IS 100)or Icss.) 0 O 1 certify that in the performance of(lie work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F unit is issued,1 shall not employ any person in any ohmner so as Io O w beco...e subject to the Worker COmpen,IiUn Laws of California. Date A licant BUILDING Sv C. pp ALTER OR ADD TO MECH. 4.00 xS(y } m NOI'ICI:TO APPLICANT': If,:dyer making this Certificate of fix F. emption,you should become subject to the Workers'Compenwtion APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must fisrthwith 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 IO,000O.F.M.) 5.00 SEISMIC FEE �Z 1 hereby affirm that then, is A construction lending agency lot EXHAUST HOOD (WITH DUCT) 2.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097.CieCJ. HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 Lender's Address ELECTRIC I certify that l have read this application and slat,that lire above VENTILATION FAN (SINGLE) 3.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, mut BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 �. hereby authorize representatives Of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned Draftily for inspection purposes. (We) agree to save, indenmify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities.judgments, Costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX may in any way accrue against said City in conseyuenee .I' the granting of his permit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL J 7 e"& Signatur Applicant/Contractor arc OFFICECOPY