5336 CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
P� NO. —. 10230 DuD Ave.
Addition Sherman S. B bee
p=1 OWNER
PERMIT ISSUED DATE "ELECTRICAL DATE INSP.'
ui ink
r eectrica
Plumbing Power Pole
Mechanical Underund
e as ec ou' irin /U- S
o ar Walls .
Fire prin c er Nel in
�lgn fixtures Int/Ext
motors
Misc. �g
"Temp Power
Uer
FINAL INSPECTIONS DATE INSP. Not .Approved
Gas
Electric
Plumbing PLUMBING DATE INSP.
Mechanical
anica
lay Backflow
�oUnder ound P
Grading er oor
Planning Partial Rough
Fire ept. RoughComplete
Healt t. molar Rough
m in ater ' Insulation
ter W-FTFain. --
rain
Gas
Other
BUILDINGDATE INSP. of rove
Pad Certification
roun anon j - ELECTRICAL DATE INSP.
re- unite
Slab-Membrane p _mac Underfloor S.M.
Bond Beam cts nsu ation
Underfloor Girders ire Ders
Floor ire ace
ie owns Grease ct & Hood
is crams One Hour Shaft
5eismec Bracing CondensaTFTF5�in
Walls-Panels ui ment An orag_e
Frame /- Flues , Uomb. Air
t� ter
MW� oars of rove
Firewalls —
r
Piet ro -
APPLIiCANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY .
BUILDING PROJECT IDENTIFICATION
I v - APPLICATION & PERMIT
PERMIT NUMBER
a'LOING •/ADDRESS OS /` N950// BUILDING — ELECTRICAL—PLUMBING—MECHANICAL 53
3 6
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
s 141VA AI f BYB�NONE zs zz�
CONTRACTORS /�/a ! UTLETS-SWITCHES-RECEP 5.00/1.00
I'A47vAJLIC.40.wt//JJ 7JU LIGHTING FIXTURES 5.00/1.00
CONT
Ess TDns �•� 3• PPLIANCES-RESIDENTIAL 4.00
LaS72"4e PHONE —Q/ PANELS 5.00 DATE OF APPLICATION
ARCH ECT SIGNS 6 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
oDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
J)ftZ /-7SAGN IW761C Ztv TEMP.METER OR POLE INS. 15.00
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00 ^
0
,00 LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
Z w (commencing with Suction 7000)of Division 3 of the Business and
w2 Professions Coda, y license a in full force a f �1 BLDG. ELECT, PLG. MECH.
License Clan Lin. ractor
Contractor ❑ ❑ ❑ ❑
9 m Dale
¢ ¢ Q OWNER-BUILDER DECLARATION BUILDING PERMIT.,,
E: o oINFORMATION
X 3: LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
u0j Law for the following reason, 703 L5,Business Pr ofcsslons VALUATION 5/FT.
H — y PERMIT ISSUANCE g,pp ! _
Cale: e,y city lish county whiny structure permit tononsuan e,cho /_X f) OD a
¢ ¢ ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
¢ w he is licensed pursuant to the provisions or the Contractor's License q
� za Law(Chapter 9(commencing with Section 7000)of Division 3 of l he AD0iT/0,�
4 o Business and Professions Code)or that he k exempt therefrom and CITY. PLUMBING PERMIT
¢ f the basis for the alleged exemption.Any violation of Section 7031.55 TYPE CONSTR.
by any applicant l' P,.
it x pcit vobjects the applicant lax civil penally ALTER-DRAIN& VENT-WATER (EA-) 4.00
afoul more than five hundred dollars(5500).1:
❑ I,as owner of the property,of my employees with wages as BACK FLOW PROTECT. DEV ICE 2,00 P RES.UNITS
their sole compensation,will do the work,and the structure is not 8�
intended or Offered Icor 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 docs such work FIXTURES-PER TRAP 4.00 So.FT.FLOOR AREA TOTAL ACREAGE
ments are oti menhrough et own emred for els.If,
ever,the
inmldin GAS-EA.SYSTEM-11NC.4 OUTLETS 4,00
mems are not tis sold
or thin on for sale.If,however,the building
or improvement will
is e b within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1,00 BUILDING USE
builder will have the harden of proving that he did not build or ire- RES IND CON PB Other
prove for 1.aso owner
of sale.). INDUSTRIAL WASTE INTER. 20.00
ri d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑
and Professions
comtrsnod : construct Contractor's
ont the project La 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Con lmnor r License Law docs not apply
co an owner of properly who builds or improves
ensed p,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such License
with a canlmcmrtsl licensed purswnl to
the lam exempt
License Luw. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ Iron exumpl under ,tl.&flC.for this WATER HEATER W/VENT 4,00
OwwnQ ��_6AV
— Date • f WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO,
WORK ERS'COM PENSAI ION DECLARATION WATER TREATING EQUIP, 4.00
1 hereby affirm that I have a certificate of consent to set&Insure,
or a certificate ol Workers'Compensation Insurance,or a certified ZONING 'ENG.SITE NO.
copy there�Aa�y ffjj00 Labf,.). /1
Policy Nn/4JS ilei puny_�F//✓?MOAw'7
Q ❑ Certdwd copy is hereby furni hod.
Z Z •❑ CcNific s d welly I p qw division. FIRE SPRINK ENERGY T 24
♦— O APplinnt_ Ly./C./e;WS1/_6gLr /^+— MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
H CERTIFICATE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG
one :
0- Z (This section need not be completed if the permit is faro TOTAL Y 1:1N❑ Y E] N❑
hundred dollars I S 100)or less.)
U O 1 certify Thal in me performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL f— mit is issued,I shall not employ any person in any manner was to -
U become subject to the Workers'Compensation Laws of California.
O IL Date ApplicantALTER OR ADD TO MECH. q,00 BUILDING d' Y I�
>_ h NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? emphon,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 he deemed revoked. AIR HANDLING UNIT(TO 10p000F.M.) 3,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p1XICEM-) 5.00 SEISMIC FEE DZ
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,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.)- 4.00
Lender's Neese HEATING UNIT 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I Echify that I have read this appliealiun and state that the above VENTILATION FAN (SINGLE) 3.00
information fi correct. 1 ages to comply with all city and nnmty PLUMBING
ordinances and stale laws relaling to building construction.and BOILER-OCW(3H.P.or100,ODOB.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Owe 100,000 BTUI SEE FEE SCH.
hove-mentioned property for inspection puRlosos. MECHANICAL
(We) germ to save, indemnify and keep harmlev the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,cords and ex peroses which CONST.TAX
may in any way amore against Slid City in consequence of the ISSUANCE 3.00
PERMIT IS
gnntineo spermiL MECH.CONT. LIG NO. MECH. G6
TOTAL 2
Sigm
atum or Appynt Con n
1— Date TOTAL `tz0
OFFICE COPY '