6867 CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
PERMIT ISSUED DATE ELECTRICAL DATE INSP.'
PinE
rncal
Plumbinjz Power Pole
Mchan:Lcal Underzround
Tenp Gas/Elec Rough ann
Solar Walls
Fire SpHO erei in —
�— Fixt res Int/Ext
Rotors
Misc. Grounding
e ower
Other
FINAL INSPECTIONS DATE INSP, Not .Approved
Gas
Electric
Plumbing - - "PLUMBING DATE INSP.
Mechanicai
o ar Backflow
•.00 r un
Grading r oor
Planning Partialu
Fire Dept. u ete
health Dept. ar ou
l3mg 2 iK pater ', insulation
uther mn Drain
oDrain
as
Wi
er
BUILDING DATE INSP. Not rove
Pad Certification
oun ation ELECTRICAL
re- ite DATE INSP.
a - e rare Underfloor 'S:M.
Bond Beam cts nsu ation
Underfloor Girders Fire ers
oor Steel 11lace
ie owns Grease Duct & Ho-o-T-
131aphrams a Hour t
3eismecBracing Mdensate TH7ain
Wills anels ui ment An mora e
Frame ues , om r
at
er
.a oar nt t e
=ewa is
Other
Net rove
civ z Lz. 6
SIC �ocK « u ti-to -�{
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
�( amLOING APPLICATION & PERMIT
PE55
r BUILDING- ELECTRICAL-PLUMBING-MECHANICAL 6 67
..NCR S PLAN CHECK VALIDATION
NANE ,/•C� /I�r o CITY. ELECTRIC PERMIT FEE
G •_ItT-G PHONE
NAmE�R+ACTovs �Lry��/� UTLETS-SWITCHES-RECEP 5.00/1.00
SUN N r�� LIC.NO.{y`f 2_ 3 LIGHTING FIXTURES 5.00/1.00
CONTRACTORS Cf}'w1 A5&(_ PPLIANCES-RESIDENTIAL 4.00
/ ADDRESS DD Vl/ -•� r�,
�t 1,L V. PHONES (4•-5{� PANELS 5.00 . DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE D.C.NO.
OR SIGNS 6.00
ENGINEER
' LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE-INS. 15.00
ADDRESS
S
AMOTORS SEE FEE SCH. /)
URE
SERVICE CHANGE 10.00
r o o LICENSIiD CONTRACTORS DECLARATION -
a I hereby affirm 111-1 I am licensed under provisions of Chapter 9 -
2 i ISSU CE DATE
(commencing with Suction 7000)of Division 3 of Business and
m i Professions Code. my license is r full fore e e
BLDG. CT. PLG.' MECH.
z o m - License Cl 1-ic.Number
a y r [)are_izN �S Contractor �-
¢ Q w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
E o A ° INFORMATION
X ;LL N 1 hereby affirm ilial 1 an exempt from the Contractor's License MISC.- REFER TO ORD
I. o j. Law Iirr the following reason.(See,7031.5,Business Professions VALUATION S/FT.
r - g PERMIT ISSUANCE 6.00 ^r�Z 7�mtl
Code:Any euros countywhichany structurep prior
ttoconsuancalter. d Jv
¢ e,¢ 0 improve,demolish,or repair any structure,use,prior 10 its issuance,also ELEC.CONTR. LIC.rv0. ELEC.
u o¢ rmluires the applicant for such permit to file a signed statement that TOTAL
d w m LL he is licensed pursuant to the provisions of the Contractor's License P TO
r z r Laos(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢F m tire basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
Ate _ by any applicantm ]or a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not ore ive than fhundred dollars(S500T):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE
their sole compensation,will do the work,and the structure is not 2.00 OCC.GROUP RES.UNITS
emended or offered for sale(See. 7044, Business and ProfessionsDRAINS-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.PT FLOOR AREA TOTAL ACREAGE
• himself or through h
mis own employees,provided that such Improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or ivrproventent is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
prove for porpoec nfsale.). c
IN DUSTRIAL WASTE INTER.' 20.00 RES IND CON PB Oe.
❑ I,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 or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant to
the Contractors License Law, SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 4.00
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO,
WORK ERS'COMPCNSATION DECLARATION WATER TREATING EQUIP. 4.00 '
I hereby affirm that 1 have a certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
cupy thercnl'(Sec.3800,LaDC.).
I'olicY No; C tpany
❑ �•Hflic 0 •ruby fu ihed. FIRE SPRINK ENERGY T 24
z 1C Certif' Is tiled 11 0 slR:ction division.
H Applicant _ —4 MISC.- REFER TO ORD, v � N� w.� m�
= N C-RI'114CATF:OFIiX EM PTION F ROM WOR K E R S' PERMIT ISSUANCE 6.00
FLOOD ZONE A.L.t1.G.
CL COM PIiNSA1'ION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL ❑ 1'fhin section necA not be completed if the permit is for one TOTAL v❑ N� Y N�
2 hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE SUMMARY
LL F 'mit is issued, I shall not employ any person in any manner so as to FEE
U become subject to the Workers'Compensation Laws of California.
ED
n Date ICAND:nt ALTER OR ADD TO MECH. 4,00 BUILDING
} w NOTICE'f0 AYPLICANI': If,after making this Cutlificatc of Ex-
F Z emptlon,you should become subject to the Workers'Compensation APPLIANCE
4.00 PLAN CHECK
such pons io the Labor Code, you muss forthwith comply with FEE
U such provisions or this permit shall bedeemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M) 3.00
CONSTRUCHON L17NDING AGENCY - AIR HANDLING UNIT(OVER 10=CF.M.) 5.00 SEISMIC FEE R S�
I hereby affirm that Dcr6 is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of Zhu work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Addmss HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
I certify that 1 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
ordinances and state laws relating to building construction,and BOILER-DOW(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorite representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
(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 a wa accrue against Said City in consequence of the PERMIT ISSUANCE 3.00
grantin f h •rail . , MECH. LIC.NO. MECH.
\X,
C,1,2
,2 $ TOTAL - TOTAL
S' to fApplicant/Contractor ate
OFFICECOPY