4077 C1T'i 017' ,CUPERT'1NO INSPECTIOI: RECORD (Office Copy)
4077 _ 7518 Dumas Drive_
PEPJIIT N0. SANITARY DIST. N0. LOT i10. ADU1:Ii55
Addition Gene Smith
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Ruildinr Date Insp.
E] ectrical Power Pole
11lumhinr, Underground
'Icchnnical Rau 'h burin
'1'emI. Cas/I'.lcct. TaI s
Solnr Ceiling
Fire Snrinkler Fixtures Int/Ext
Sign Hotors
Grounding
Misc. Temp. Power
Other
FINAL. II751'ECTIONS Not Approved
Date Insp.
:s _
PLUMBINGElectric Date Insp.
Plumbin , Backflo�:
Mechanical Underground
Solar Underfloor
Pool Partial Rou^.h
Grad ing Rough Complete • S T'
Planning Solar Rough
. Fire Dept. Water & Insulation
Health 'Dept. Main Drain
Puildin R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Lnsp.
Pad Certification MECHANICAL
Foundation -Z(-SC3 Date Insp.
Pre-Gunite Underfloor S.M.
Slab-ilembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders �j.2.q u� Fireplace _
Floor Steel Grease Duct & Hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
llalls-Panels Flues & Comb. Air
Frame Other
].nth IU-17- Not Approved
Ilallboards In /Ext.
Firewalls
Other
Not Apnroved
0
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
. BUILDING PROJECT I DENTIFICfW PERMIT NUMBER
BUILDING APPLICATION & PE•IT
N DDREss I
ad, BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME
DTV. ELECTRIC PERMIT FEE
- Z
Q P_ fa//n /Z n 7�J
IWCONTRACTOR'$ U
NAME UTLETS-SWITCHES-RECEP 5.00/1.00 �-
t �, (s�u�rvo LIGHTING FIXTURES 5.00/1.00 ^VT L �i7/3
f,ONTR ACTOR'S
ADDRESS PPLIANCES-RESIDENTIAL 4.00 '
� PRONE PANELS 5.00
2. DATE OF APPLICATION
ARCwT ILT PLAN CHECK FEE P.C.NO.
On SIGNS 6.00
ENGINCEO
uc.No. SIGNS TRANS. 3.00
an
CH,On ENG. PERMIT VALIDAT ION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP EMP.METER INS. 15.00
APPLICANT'S 94+
ADDREss MOTORSSEE FEE SCH.
SERVICE G s 10.00
0 0 o LICENSED CONTRACTORS DECLARATION
a u u I hereby affirm that I am licensed under provisions of Chapter 9 city ot Cupertino
a w (commencing with Section 71X)0)of Division 3 of the Business and L T.CE PAGE MECH.
i I'rofcssions Code, d my licasse is in full fnr f ® ❑
z o "Pj - License CI ss L1c.Number
r��+ Datc Contractor
0 N _ J.
wa OWNIi R-BUILDER DECLARATION BUILDING PERMIT
o d D N. MISC.- REFER TO ORD INFORMATION
E
; LL r '1 hereby.Ilion [flat 1 am exempt limn the Corr License VALUATION
F u o Law for the following reason,(Sec,7031.5,Business and Plot esslmn PERMIT ISSUANCE 6-00 02 � S/FT.
y
vi Code:Any city or county which requires permit to construct.'u leer, s;)w v V
O improve,demolish,or repair any structure,prior to its issuanc0.also ELEC.CONTR. LIC.NQ ELEC. (/V
o u requires the applicant for such permit to file a signed statement that TOTAL
u m he is licensed pursuant to tile PERMIT TO e provisions of the Contractor's License �- ^ kFJ
La Law(Chapter 9(commencing with Section 7000)of Division 3 of the TDC7/ d /
s E o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ''e.
re I- the basis for the alleged exemption.Any violation ol'Section 7031.5 STORIES TYPE CONSTR.
Ate - by any applicant for a Permit subjects the applicant to a civil penalty gLTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(S500).):
❑ I,as owner of the property,or my employees with wages as UNITS
BACKFLOW PROTECT. DEVICE 2,00 OCC.GROUP RES.
their sole comlenstnion,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 4.p0
Cade:The Contractor's License law docs not apply to an owner of
property who builds or improves thereon,and who docs such walk FIXTURES-PER TRAP 4.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,Provide)that u¢h ibuildi.-
ments.renotintcnded oroffered
m.lbrsalo It.l.owet,no the building GAS-EA.SYSTEM-11NC.4OUTLETS 4,p0
or in.prwid to t is utlJ within one year of completion.tile owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1,00
builder will have the burden oC proving IhW he diA not build orinn BUILDING USE
prove for purpose of sale INDUSTRIAL WASTE INTER. 20.00 RES IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ 11
licensed contractors to construct the project IS.c. 7044, Bu)IrCsS 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 or improves thereon,and who LAWN SPR IN KLERS-OV ER 5(EA.) 1,00
contracts for such projects with a contractors)Iicenwd pursuant to
the Contmmor's License Law, SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT NO. PARCEL NO.
❑ tutu exempt under Sec.-,B&P.C.for this
reason WATER HEATER W/VENT 4,00
Dale Owner WATER SYSTEM 4.00 ACC.DATE ACG FILE NO.
WORK ERS'CO.MPENSATION DECLARATION WATER TREATING EQUIP, 4.00
I hereby affirm that I have a certificate of canunt to self-insure,
or a ccnilicate of workers'Compensation Insurance in,a ceniFied ZONING . ENG.SITE NO.
ropy Ihcruaf •' ,Iab.CJ.CF ,/
Policy No. Company t/A7( f11A70
O ❑ Certified copy is hereby fu msh d.
ZZx
F ❑ CernfiJ� NJPwitl. Irinjp� tun. FIRE SPRINK ENERGY TH4
ApplicanZJ
MISC.- REFERTOORD. YE] NE] YD NE
ir N CER TI IsICAI'li OP Ii X1iM1'1'[ON FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD zorvE AL.ac.
CL 0 Y1hi.s section need hot be completed INSURANCE
tire
i 1lpernlit Ix for one PLG.GONTR, LIC.NO. TOTAL Y❑ NE] Y ❑ IN El
Da o
Z) 2 hundred dollar IS 100)or less.)
U O 1 eerily that in the performance of the walk fnr which this mer- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
IL 1- mit L issued,I shall not employ any person in any manner so as to
U become subject to the workers Compensation Laws of California.
Do Date Applicant ALTER OR ADD TO MECH. 4.0p BUILDING
} w NOTICE '1'O APPLICANT: If,after making this Certificate of Ex.
Z emption,you should become subject to the Worker,'Compensat Tun APPLIANCE 4.00 PLAN CHECK
provisions at the Labor Code, you must forthwith comply with FEE
U such prnvismusor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLI (O 1 F.M.) 5.00 SEISMIC FEE l 7 S
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.CJ. HEATING UNI •fMU.) 4.00
Lender's Name
Linder',Address HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC /7
certify that l lmvere.d this application and slate 0mt the uMwc VENTILATION FAN (SINGLE) 3.00
ordinances is correct. I agree to comply with all oily and county PLUMBING
ordinances and stove luso, relating to building cmit,anion,mly BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorlrc representatives of the, city to enter upon the BOILER-COMP (over 100,000 BTUI SEE FEE SCH. MECHANICAL o'V
above-mentioned ancJ property for inspection Vurpous. `.
(we) agree to suvc, indemnify and keep h.rmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and c.,Nses which
may or .gy way accrue gairst said/City in consequence of the PERMIT ISSUANCE 300 Jct fP CONST.TAX
gmnTipg of this per mit.
/ / MECK CONT. LIC.NO. MECH.
wgiY/,/&.LL! yAni�F/i -e/ TOTAL
TOTAL 7 [!=
Slgnalurpo ppl mlCOntractot � 1
OFFICE COPY
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