0866 CITY OP CUPERT'INO INSP ECTIOL' RECORD (Office Copy)
0866 _ 7465 Dumas Dr_.
PER11I'I N0. SANITARY DIST. NO. LOT NO. ADDRhSS
Ilechanical W.E. LaFrentz 253-3035
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buij in Date Insp.
Electrical Power Pole
Plumbing Underground
ifechanical 8-12-81 Rou��g� h Viring
_
'i'emp. Gas/I'slcct. falls
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Ifotors _
Grounding
hist. Temp. Power
Other
FINAL. INSPECTIONS Not Approved
Date Insp.
PLUMBING
Electric Date Insp.
Plumbin , Backflow
!techanical Underground
Solar Underfloor
Pool Partial Rough r
Grading Rough Complete
PL-inning Solar Rough
Fire Dept. Water & Insulation
Health Dept. "gain Drain
BuildingR/of/S Drain
Other Gas
Other _
BUILDIiIG Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.N.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace _
Floor Steel Urease Duct & Hood _
Tiedowns One flour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext.
Firewalls
Other
Not Approved
A
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT P NLY
fel•
BU LDI NG PROJECT I DENTI FI CATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 06
ADDRESS ( v
BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 8
OWNER'S PLAN CHECK VALIDATION
"AM TY. ELECTRIC PERMIT FEE
r•� p E 7-- -\ r
N°NT " T a ; UTLETS-SWITCHES-RECEP 5.00/1.00
uC.NO. LIGHTING FIXTURES 5.00/1.00
f, NTRACTOR' 7
A /� �y0(�/ _APPLIANCES-RESIDENTIAL 4.00
77; J sOP PRONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 600 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.NO. SIGNS TRANS. 3.00
Hol cress ENG' SPECIAL CIRCUIT 5,130 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00
ADDRESS
NT 5
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
o o LICENSED CONTRACTORS DECLARATION
rt U U I hereby affirm that I am licensed under provisions of Chapter 9 1 1. vr, LuPERIIN0ISSUANCE DATE
H G Icmomr,r fog with Section 7000)of Division 3 Of the RuSiners and BLDG. ELECT, PLG, MECH.
H o Professions Code Tnd my license is in full(arra and Cfe't. ,wy
z o h - Li en CI
LIE', /,t IN
4 y t w Dote W-2Contmcto
a x f BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
¢ a ca - INFORMATION
ww I hereby affirm that I am exempt from the Contractor's License MISC.- _ REFER TO ORD
H LL o a Law for the following reason,(Sec.7031.5.Bmart,,and Pmfcsvunx PERMIT ISSUANCE 6 00 vAwnnDN S/FT.
at Code'Any city or county which TNuires a permit m conslnmL alter
R2 G IO improve,demolish,or repair any structure,prior to its issuance,'also ELEC.CONTE. LIC.NO. ELEC
- o u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m m he is licensed pursuant to the provisions of the Contractor's License
HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ - the basis for the alleged exemption.Any violation of Scetion 7031.5 STORIES TYPE CONSTR,
a ; _ by any applicant for a permit.subjects the applicant to acivilovoidty ALTER-DRAIN -WATER (EA.) 4,00
of not more than five hundred dollars(5500).1:
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 2.00 OCG 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
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 TOTALACREAGE
himself or through his own employees.provide)that such impmve-
himstsare through
ot or offered fornemployee side.provided that sthebwlding GAS-EA.SVSTEM-11NC.40UTLETS 4.00
or'improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did t build or im-
provefor purpose ofsale,). INDUSTRIAL WASTE INTER. 20.00 RES IND CON PB other
(3I,as owner of the property,am exclusively comracliog 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 taw docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1,00
comtraEB for such projects with a contrachms)licensed pursuant to
the Coutreemr's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exempt under See. .B.AP.C.for this j WATER HEATER IA/VENT 4.00
reason
Date e Owner WATER SYSTEM 4.00 ACC.OATE ACG FILE NO,
WORKERs'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that 1 have a certificate of con,wnt 1.elf-insures,
or R certificate of Workcrs Cotnpcnmtion Insurmlec,or u crrtil'i,d ZONING ENG.SITE NO.
copy thereof f5ec,3800,Lrb.0 I /} s
Policy No. Cnmpany.C�/
0 ❑ Certified copy is hemby for lshed. FIRE SPRINK ENERGY T-24
Z 2 74 Certifie p rs filed w tl the cit Inspection division.
O MISC.- REFER TO ORD.
Applicant \ - Y ❑ N❑ Y ❑ N❑
� N CERTIFICATE OF EXENIP7'ION FROM ORKERS' PERMIT-ISSUANCE 6.00 FLOOD ZONE A.L.u,D,
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. pLG
11 . ❑ ❑N r ❑ N❑
O (This season need not be completed if the permit iz for one TOTAL r
2 hundred dollar,(S 100)or less.)
U O I certify that in the perfomtana+of the work for which this Per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mil is issued,1 shall not employ any person in any manner so as to
become subject m the Workers Compensation Laws of California.
0- Dxtc Applicant ALTER OR ADD TO MECH. 4,00 BUILDING
} m NOTICE 'TO APPLICANT. If,after making this Certificate of I,
Hz emptfon,you should become subject to the Workers*Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the tabor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deuntvd revoked. AIR HANDLING UNIT(TO 10)100C.F.IA) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 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). HEATING UNIT(TO 100,000
Lender's Names HEATI NG UNIT ER 100,000 B.T.U.17.50
Lender's Address ELECTRIC
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00
information is correct I agree to comply with all city and county BOILER-CONP(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING
^swore, and state laws relating m building constnletlon, and
by aulhorim representatives of this city to enter upon the BOILER-COMP (Over 100.000BTU)SEE FEESCH. MECHANICAL Q�
..ave-mentioned property for inspection purpous.
(We) agree to save, imden,nlfy and keep hannle, the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may i ny way accrue against said City in consequence of the
grwtC Ill'zpe,inil, MECH,CONT. LIC.NO. MECH.
sigmamro o app seam Conl t r 'Date I L a2 /�o� TorgL,e D TOTAL ..
FFICE COPY/ / 'w
i