6171 A C� OF CUPERTINO INSPECTION RECORf
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S0810-lt7o Jev. Co.
PERMIT ISSUED DATE ELECTRICAL DATE INSP.
ui n —
ctrnca �
Plumbin
e�Tic animal Punder uncl
e as ec UuWiring —
o ar Ivalls
Fire Sprinkler ei in
31Kn _ i=res Int/Ext
Motors
Misc. GroundinA
Te ower
Other
FINAL INSPECTIONS DATE INSP, Not.Approved
Gas
Electric
1
um in , PLUMBING, DATE INSP.
-Mechanical
.o ar Backflow
goo r un
r oor
anninRy PartialouR i
Fire Dept. - q- G cRough leten
eat t. bolar �111
ui in pc cv( t r a ( e4 v 2 K1 Mnater - zs l.S
er a�n ys=
O alIl 3
as L_
Other
BUILDING DATE INSP. Not rove .
Pad Certification 1 Fe. RAS Foundation ® / s^� ELE F22 � G p�
3 w CTRI DATE INSP.
Pre-Gunite
slab-Membrane de oo
Bond earn cts ns anon
Underfloor i rs ireers
Floor tee it . ace
ie owns rease wct & Hood
is rams a our ' t
eismecracin _ Condensate a3.n
Walls-Panels uesment ��e
Frame Xc,!
Lath Other
=ka oar Int/Ext. footApprove27
rer s I O s
� � &
e S F 14t: yi. g y 3
k N 0 -r-y 3
Flr sTQ�� cue,v� 6— 7-as `
3fr 6'—l8 x��-✓ ��
Sh� Qoc�SctcW-n4vs _3sC(60x,s 1-1gb i < SrA a/,rGfGn�a-a e3/rsIY6-
APPLICVkNTeTO FILL IN INF TION WITHIN RED LINES- US POINT PEN ONLY
BUJ,LUINGPROJECT'IDENTIFICww PERMIT NUMBER
apILOING APPLICATION & PER
a
BUILDING-ELECTRICAL-PLUMBING.-MECHANICAL 6171
PLAN CHECK VALIDATION
NAME QTV. .'ELECTIC
Tv r V(J+ PXONE ��� fS u
NAMERacroRs O UTLETS-SWITCHES-RECEP 500/1.00
Sa S-3
LIC,NO, LIGHTING FIXTURES 5.00/1.00 '
ADDRESS oRs PPLIANCES-RESIDENTIAL - 4.00
PHONE PANELS " 5.00 DATE OF APPLICATION `
RCHITECT _ PLAN CHECK FEE P.C.NO.
E R C38� SIGNS 6.00
P GIN '
• G AyiG L Q„ SIGNS TRANS.' ' 3.00 -
+ aPCH.OR ENG. PERMIT VALIDATION
aoOREss T ���=Qr' SPECIAL CIRCUIT 5.00
700 4C• 1 - Szonp /� - EMP.METER OR POLE INS. 15.00.
APPLICANT J y.-J:" Fr�A
aooREss � ) - MOTORS SEE FEE SCH. 1
00 VA H SERVICE CHANGE 10,00
o o LICENSED CONTRACTORS DECLARATION v4IS
¢U U I hereby affirm that I ant licensed under provisions of Chapter 9 ISSUANCE GATE
y ¢i commencing with Section 7000)of Division,3 of the Business and t-BLA 4 ECT. PLG. . MECH.
F w Professions Code,and my license is in full force and effect ,j{:f 0 El 11 ❑
c, i m o License Class Lia Number
rw Date-Contractor
a r - „'BUILDING;PERMIT
¢ ¢ w u OWNER-BUILDER DECLARATION k'+o1N FORMATION, '
x 3 at,w I hereby at Ihat I am exempt from the Con Harbor's License MISC.- REFER TO ORD -
u O a Law for[he following reason.(Sec.7031.5,Business and Professions VALUATION WET.
ra _ PERMIT ISSUANCE 6.00 )
Code:Any city of county which requiresa permit construct,alter, y?'dad 000
rt¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
an
iL D ¢ requires the applicant for such permit to file a signed statement that TOTAL
a w m" he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the
4 0
Business and Professions Code)or that he is exempt therefrom and QTV.,,r 3 7 ,PLUMBING PERMIT ., FEE'
•-¢ r m Ilse basis for the alleged exemption Any violation of Section 7031.5 "•' .. „ ' " "" .' . ' 4°', TORIES ' TYPE C NSTR.
La ; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER DRAIN&VENT-WATER (EA.) 4.00 / ./jt
of not more than five hundred dollars($500).): - '�• V /V
❑ 1;as owner of the property,or my employees with wagesas BACK FLOW PROTECT.DEVICE 2.00 DCC.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 ;L-,`
property
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 SG:FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
me ntsare not intended orofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 7.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
proveTorPurposeofsale.). RES IND CON PB Olhx,
❑ .1,as owner of the properly,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑ ,
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 -
conCreelsforsu projects with
withacontrf
uctorts)licenced pursuant
License
the Contractor's License LSEWERSANITARYSTORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam lander Sec. e.&P.C,for alis WATER HEATER W/VENT 4,00
' reason
Own Date - WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
.WORK ERS'COMPEN.ATI N DECLARATION WATER'TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate of consont to self-mar e, ZONING ENG.SITE NO
Car a certificate of Workers'Compensation Insurance,or a certified ..!,
' copy lhereof(Sec.3800,L'
INo. m
0Certified y' reby fn d. FIRESPRINK ENERGY T-24
01
ertifi is r tle cit ins ection divi.ion.
F O' APplican MISC.- REFER TO ORD. Y❑ N❑ Y ❑ INC]
� N TIFICATE OF TMP NFROM WORKERS, PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU COMPENSATI INSURANCE: PLG.CONTE LIC.NO. pLG.
CL 0 (This section need not be completed if the permit is for one TOTAL Y E] N[] Y E) NEI
hundred dollars IS 100)or less.)
V O m ¢ se
I certify that in ole performance of the work for which this per, t ; " ? . E SUMMARY „
QTY. MECHANICAL PERMIT-_ )t F.EE, FE
{'o-
IL H mil is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
GO Date - Applicant ALTER OR ADD TO MECH. 4.00 BUILDING,
} to NOTICE 'f0 APPLICANT: If,after..king this Certificate of F.-
1 F ? emption,you should become 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 3.00
... aG
coNsreucnoNLENDING AGENCY AIR HANDLING UNIT(OVER 10,000GEM.) 5.00 SEISMIC FEE �S-
I hereby affirm thut'there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit Is Issued(Sea MICROFILM
3097,Civ.C.). - r HEATING UNIT(TO 100,000 B.T.U.) 4,00
Lender's Name HEAT[NG UN IT(OV ER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I celtify lhal(have read this application and sWtc that the above VENTILATION FAN (SINGLE) 3.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby aull '.e represematives of this city to enter upon the BOILER-COMP (Ovir 100,000 BTU)SEE FEE SCH. MECHANICAL
above-m a ned propert crllion purposes,
( agree to s indemnify and keep harmless the City of MISC.- 'REFER TO ORD.
C lino agains ilities, 'udgme Is, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX- '
Y w Cit itcpp�y s O
``fit`^11 .CONT. LIC.NO. MECH.
. TOTAL TOTAL33�.
.Sig azure o -a ontractor Date
OFFICE COPY '