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1293 r a— . ' CITY OF CUPEP.TINO ILISPECTIOLi RECORD (Office Copy) 1293 10700 N. neAnza Blvd. PERMIT NO. SANITARY DIST. 110. LOT NO. ADDRESS Remodel Four Phase 9U, -3 255-0900 Ext: 2037 PROJECT OWNER JOB SITE PHONE NO. Date "' " ELECTRICAL Building 11-2 -81 Date Insp. Electrical 11-23-81 Power Pole Plumbing Underground IlechanicalP.ou h Wiring Temp. Gas/Elect. a s Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sipn Motors Grounding Misc. Temp. Power Other FINAL INSPECTIONS Not Approved Date Insp. Elle e PLU11B ING Electric Date Insp. Plumbing Backflow Mechanical Underground Solar Underfloor • Pool Partial Rough Grading Rough Complete Planning Solar Rough Fire Dent. Water & Insulation Health Dept. *-Iain Drain Building R/of/S Drain Other Gas Other STRUCTURAL Not Approved �. Date Insp. Pad 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 T.iedowns One Hour Shaft Diaphrams Condensate Drain i Seismic Bracing Equipment Anchorage Walls-Panels Flues & Comb. Air Frames 1->i 0/ Other Latham Not Approved Wallboards Int Ext. Firewalls • Other Not Approved BUILDING +, ELECTRICAL • PLUMBING MECHANICAL MISCELLANEOUS APPLICANT TO-FILL IN-INFORMATION WITHIN RED LINES -_USE BALL POINT PEN Y PERMIT NUMBER A BUILDING PROJECT IDENTIFICATION ' APPLICATION & PERMIT BUILDING yJ ADDRESS 1� J J /oQ ;D" 204-Y•�w BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I GwNER'S - PLAN CHECK VALIDATION S "AME QTY. ELECTRIC PERMIT FEE. I. ZS -0.�o0 ONE CONraacroRs OUTLETS'-SWITCHES;RECEP '.5.00/1.00 ChB` NAME IC.NO. LIGHTING FIXTURES 5.00/1.00 (J71 AD - APPLIANCES-RESIDENTIAL 4.00 CONTRACTOR DRRAcTRAC roR's_ DRESS PHONE ` PANELS. 5.00 DATE OF APPLICATION ARCHITECT SIGNS 6:00 PLAN CHECK FEE P.C.NO. OR ' ENGINEER , ilc.NO. SIGNS TRANS. 3.00 ' AARC OORIESS 'OR ENG. SPECIAL CIRCUIT � Q •5.6D 1 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. nIh5.00 APPUCHNTSADRESS MOTORS - ecl V,40AWICH. - SERVICE CHANGE ^^ wo O LICENSED CONTRACTORS DECLARATION a u U I hereby affirm that 1 am licensed under provisions of Chapter 9 -'ISSUANCE DATE G y' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLO. M H- H w i Professions Code,and my license is in full force and effect El 9? o w - License Co.-Lic.Number O F'ca Dale - Contractor . ¢ x s dBUILDING PERMIT ¢ a, ¢ ¢ r OWNER-BUILDER DECLARATION C - - INFORMATION w ° REFER TO ORD F 3 u6.w I hereby afOrm that I am exempt from the Contractor's License MISC.- VALUATION r a-0 ¢ Law forthe following reason. 7031.5,Business and Professions PERMIT ISSUANCE 6.00- Code:Any city or county which requires permit to construct,alter, le a ¢ 2' improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELECa. . J-/� DLL requires the applicant for Such permit to file a signed statement that TOTAL 3Z e PERMIT TO w $ he is licensed pursuant to the provisions of the Contractor's License , HZ > Law(Chapter 9(commemciagwith Section 7000)of Division 3 ofthe ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ' ¢ O STORIES TYPE CONSTR. ¢ H o the basis for the alleged exemption.Any violation of Section nam by any applicant fora permit subjects the applicant tell civil penally malty '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 wages as BACK FLOW PROTECT. DEVICE 2.00 ace.GROUP RES.uNrrs their sole compensation,'will do the work,and the.stmcture is not intended or offered for sole (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO,FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS a EA.SYSTEM-1 INC.4 OUTLETS 4.00 t or improvement is sold within one year of completion, . .) 1.00 BUILDING USE v RES IND ' CON PB Other the owner- GAS-EASYSTEM-OVER 4(EA - pro "no builder will have the burden of proving that he did t build or im- move for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 131,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ - 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 m improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 _ contracts for such projects with a c(.ntradons)licensed pursuant to the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/6.00 - TRACT No.- PARCEL N0. - - \ ❑ I am exemptumder Sec.' ,B.&P .for fid WATER HEATER W/VENT 4.00 n ' reaso Date D oC OwWATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION .. WATER TREATING EQUIP. - 4.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). ' Policy No. Company - -- � 0 CiCertiOedcopy is hereby furnished. - FIRE SPRINK -ENERGY T-24 Z Z ❑ Certified.'copy is Filed with the city hhspeclion division. - O Applicant MISC.- REFER TO ORD. Y ❑ IN Y ❑ N❑ rutPERMIT ISSUANCE 6.00 FLOOD ZONE A.L.UG. LU - CERTIFICATE EXEMPTION FROM WORKERS' lJJ > COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. - IL tio O (This seen Reed not be completed If file permit is for one TOTAL Y[:] N❑ Y ❑ N❑ � Z hundred dollars(S 100)or le"O U Or I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U hecolne subject to the Workers'Compunsution Laws of California. _ O n Date Applicant ALTER OR ADD TO MECH. 4,00 BUILDING >_ m NOTICE TO APPLICANT: If,after making this Certificate of Ex- - r Z emption,you should become subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK / p provisions of the Labor Code, you must forthwith Comply with - ' FEE L (Ol U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT.(OVER 10MC.F.M.) 5.00 1 SEISMIC FEE 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 HEATI NG UN IT(OV ER 100,000 B.T.U.P.50 ELECTRIC 3a Lender's Address 1 edify that l have read this application and state that the above VENTILATION FAN (SINGLE) ,3.00 - - '. information is correct. I agree to Comply with all city and county PLUMBING s ordinances and state lawrelating to building construction, and , BOILER-COMPI3 H.P.or 100,000 B.T.U.1'4.00 hereby authorize,representatives of this city to enter upon the BOILER-COMP.IOver 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection put posep h (We) agree to save, indemnify and keearmless the City of MISC.- REFER TO ORD. Cupertino agolre[ liabilities,judgments, casts and expenses which CONST.TAX may in any way'accrue against said City in consequence of the PERMIT ISSUANCE 3.00 - fSi, ,rCf'AFpIicaru/C of t ' ern I. MECH.CONT. LIG NO. MECH. C 043( . TOTAL TOTAL onUactor Date OFFICE COPY �- t