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4602 CITY OF CUPERTINO INSPECTION RECORD (OFFICEI COPY) n- ' • 4 a700 N �E A-N-zA— OWNER PERMIT ISSUED DATE ELECTRICAL DATE INSP. FEin cal Plumbing "Power Pole " mechanical er un Temp as ec oun Wiring Solar Walis Fire Sprinkler ei in lgn Fixtures Int/Ext Motors Misc. Gromding . . e ower Other FINAL INSPECTIONS DATE INSP. Not .Approv57 Gas Electric Pl—umbing PLUMBING DATE INSP. ec�anical o ar Backflow 00 �r��rr��.� Grading --- Underfloor PTarining Partialou Fire Dept. Rough Complete Heald Dept. z5oiar ou ui in ater ' Insulation ter in . ain o rain as Other BUILDING DATE INSP, Not rove Pad Certification oun anon ELECTRICAL DATE INSP. re- rte Slab-Membrane Underfloor S.M. Bond earn cts - nsu ation Underfloor it ersirk eD ers Floor Steel irF e dace e owns urease Duct o0 Tis rams a our Shaft Te:a racing Condensate Drain Walls-Panes ui ment Anchorage Frame Plues 4 Comb. r -7---* atTier a oar nt xt, of rove Firewalls Other et rove BUILDING 1 ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS • APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY r 1'l• PERMIT NUMBER . BUILDING PROJECT I DENTIFICATION / APPLICATION & PERMIT BUILDING t UILDING -ELECTRICAL-PLUMBING-MEMECHANICAL 4602 IO O r OWNER'S PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE - Fo k Q 111 �. DNE SS a u PAID NAMERACTons . OUTLETS-SWITCHES-RECEP 5.00/1,00 LIC.NO, LIGHTING FIXTURES 5.00/1.00 1 .Asti r-ONTRADTons r PPLIANCES-RESIDENTIAL 4.00 ADDRESS 411 a1 B� W E CAPHONE 104PI PANELS 5.00 � ICATiON ARCHITECT SIGNS Q.QQ P N CH CK FEE P.C.NO. OR EN WEER pic .t 1r rue No� SIGNS TRANS. 3.00 4RCH.OR ENG. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION ADDIVI(a sLNcm 1AR# otop OQ zRP5N III& EMP.METER OR POLE INS. 15.00 A ss S MOTORS SEE FEE SCH.SERVICECHANGE10.00 17 I ^111 Ci '09 LICENSED CONTRACTORS DECLARATION a it L, I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE N a u. (commencing with Section 7000)of Division 3 of the Rosiness and BLDG. ELECT. PLG. MECH, r w Professions Co ,and m s in full force an •fret!,./Sn ❑ z o m License Number I7-I © o o w Date, Contractor Nl�fen�c -/ ¢ se ¢ ¢ OWNER-BUILDER DECLARATION / BUILDING PERMIT ¢ u, I! INFORMATION O> " MISC.- REFER TO ORD E 3 y I hereby collo tlmt 1 am exempt from the Contractor's License VALUATION S/FT. H .. o j Law for she fallowing reason(Sec.]031.5.Business and Professions PERMIT ISSUANCE 6.00 �� v Code:Any city or county which requires s permit to construct,alter, SE , ¢0 Improve,demolish,Or repair any structure.prior to Its issuance.also ELEC.CONTR. LIC.NO. ELEC. LL requires the applicant for such permit to file a signed statement(lilt TOTAL PERMIT TO A w lie is is licensed pursuant m the provisions of the Contractor's License F i t Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe � i'�N1.fV✓ ) a Business and Professions Code)or that he is exempt therefrom and GTV. PLUMBING PERMIT FEE O STORIES TYPE CONSTR. ¢ $ the basis for the alleged exemption.Any violation of Section 7031.5 i ; � by any applicant fora permit subjects the applicant o a civil penalty. ALTER-DRAIN -WATER (EA.) 4.00 of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT..OEV ICE 2.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended Dr offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 FIXTURES-PER TRAP 4.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself or Ilmouillrote his own employees.provided that such improve. _ mems.,a not intended of employees, moie. led far building GAS-EA.SYSTEM-1INC.4OUTLETS 4.00 Or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or int- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE prove for purpose of sale.). RES IND CON PB Other ❑, Las owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 ❑ 0 0 ❑ ID 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 huilds or improves thereon.and who I LAWN SPRINKLERS-'OVER 5 (EA.) 1.00 contracts for such projects with a conlractons)licensed Pursuant to the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ tum exempt under Sec. .tl.&P.C.fir this WATER HEATER W/VENT 4.00 son Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. W'ORKF.RS'COMPE:NSA1ION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm that I have u 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 JLESTeu w/ E O ❑ Certified copy is hereby furnished. FIRE SPRINK' ENERGY T 24 Z Z ❑ Cer py is Sfiled_avph the City inspection division. MISC.- REFER TO ORD. 0 Applicant ll �\ v N v N rn PERMIT ISSUANCE 6.00 FLOODZONE A.L.0 c. CC 1 Cli RTIFICATE 1'EXEMPTION FROM WORKERS' 11J COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG, 1 O (This section need not be completed if the permit is for one TOTAL Y N v N Z) Z hundred dollars IS 100)or less.) L) O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY UL & mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Com ensation Laws of California. _ 12- W )Date Applicant p BUILDING a ALTER OR ADD TO MECH. 4.00 } N NOTICE TO APPLICANT: If,after making this Certificate sa ion ? emptio n You should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Codi, ll b must d revoked. comply with FEE - U such provisions or this permit shall be deemed revoked.' AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000OF.M.) 5.00 SEISMIC FEE 33 1 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,Cis.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC Lender's Address I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 ordinances n correct I agree to comply with all city and county PLUMBING ordinances and slate laws relating to building construction.andno, and BOILER-COMP I3 H.P.or 100,000 B.T.U.1 4.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way_accrue against said City in.consequc_nce of the PERMIT ISSUANCE 3.00 gra ng Of this per til. MECH.CONT. LIC.NO. MECH. ,q �N!", I AIM"Ift TOTAL TOTAL /3 S_ Signature A Applicant/Contracto�e OFFICE COPY -