6097 CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
PE&�NO. 10791 E. Estate Dr.
PKWhui iVindowe PAY. & Mrs. Song
PERMIT ISSUED DATE ELECTRICAL DATE INSP.'
ui in
Rrica
Plumbin Power Pole
anica mi un
rolre-Ear asec
Fire Sprinkler ei in
1 ixtures Int/Ext
Misc. torsroan mg
142 Power
Uther
FINAL INSPECTIONS DATE INSP, ot . rove
Gas
Electric
Plumbingl. PLUMBING DATE INSP.
• anica So ar Backflow
PoolUnderRrou—n���
Urading oor
Planninja Partial RouLyh
ire t. ugGompleze
health Solar u
Otherg Water '& ns ation
ther
in . ain
o rain
Gas
Other
BUILDING
DATE INSP. of APproved
Pad Certification
mm =tion ELECTRICAL
re- unite DATE INSP.
Slab-NleubraneUnderfloor 'S:M.
r5neam cts & InslHation
Undertloor Girders ire an ers
Floor tee ire ace
ie owns cease ct 60
Seismeams e our Shaft
eismec racin ensate ain
Walls-Pan—els ui ment An lora e
came ues on Air
•at t er
wallboards nt xt, of prove
Firewalls
other
Net Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BNPERMIT NUMBERILDING PROJECT IDENTI FICATION APPLICATION & PERMIT
'
11' BVILOING
BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 6097
PLAN CHECK VALIDATION
NAME '^f �/I OTY. ELECTRIC PERMIT FEE
�•lI SOV PHONE
••kAMEvncrORS UTLETS-SWITCHES-RECEP 5.00/1.00 cell-trcNLIGHTING FIXTURES 5.00/1.00
ACTORS PPLIANCES-RESIDENTIAL 4.00
PHON J PANELS 5.00 DATE OF APPLICATION
ICT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
ENGINEER ��_.
LIC.No. SIGNS TRANS. 3.00
ADDRESS sell _-- SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00
APPLICANT'S
ADDRESS �,�--- MOTORS SEE FEE SCH. G Q
SERVICE CHANGE 10.00
oIF z
Foo LICENSED CON'1'RACfORS DECLARATION
a u 1 hereby affirm that I am licensed under provisions ofchapter 9
y a N (commencing with Section 7000)of Division 3 of the Business and ISSUANCE GATE
B G LE PLG. MECH.
r y z Professions Code,f��sIII]]]'d my license is in full r 0 - El 1:1 Lice e C a _ Lic Number Lim c.
Contractor
¢ ¢ w a OWNER-BUILDER DECLARATION BUILDING PERMIT
w °A ,�- - MISC.- REFER TO ORD INFORMATION
� I hereby affirm that I am exempt from the ContraerorA License vA UN
Law $/FT.
F u o j Law for the fallowing reason,(See.7031.5,Businessand Professions PERMIT ISSUANCE 6.00
f m Code:Any city or county which requiresa permit toconstruct,alter. -
¢ ¢ 0 0 improve,demolish,or repair any structure,prior In its issuance,also ELEC.CONTR. LIC.NO. ELEC.
¢ tell vires the applicant for such pemrit to file a signed statement that TOTAL
a w m he is licensed pursuant t0 file provisions Of the Contractor's License / PERMIT TO
ri>
Law(Chapter 9(commeneing with Section 7000)olDivision 3otitle
4 o Business and Professions Code)or that lie is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a 3 _ by any applicant far a permit subjects the applicant toll civil penalty
of not none than five hundred dollars($500).): 1ALTER-DRAIN&VENT-WATER (EA.) 4.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE
their Side compensation,will do the work,and the structure is not 2.QQ OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 4.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such'in
prove-
mentsare not intended orofferedfor Sale.If,however,the building - GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
or improvement is sold within one year of completion, the owner- GAS-EA .
builder will[lave th .SYSTEM-OVER 4(EA.) 1.00e burden of proving that he did not build or im- BUILDING USE
prove lor 1,aso neer al'rale.). • INDUSTRIAL WASTE INTER. 20.00 t I❑ ❑ry O Other❑
❑ Las owner of the properly,he exclusively contracting with
licensed crions ods to construct the project(Sea 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. '5.00 ASSESSORS PARCEL NO.
unA Profusions GtJm'1'he 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 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT NO. PARCEL NO.
❑ lura exempt under Sec..,B.&p.C.for thin. WATER HEATER W/VENT 4.00
Owner Date WATER SYSTEM 4.00
ACG DATE ACC.FILE NO.
WORK liRs'coMPliNsnl'[ON DECLARATIONWATER TREATING EQUIP. 4.00
1 herchy affirm that I have a certificaze of consent to xif-insore,
or a certificate of Workers Compensation Inssssssppppp1NrrNrr{{•1nce,or certified ZONING ENG.SITE NO.
copy thcrcoftSec. Cco L.b,an,
Policy No. Company v`ol
❑ C •d co yis hereby til •d. FIRESPRINK ENERGY T.74
z z ❑ C rtifi J fled til c city inspection division.
F O Applic:m MISC.- REFER TO ORD. Y ED N❑ Y 0 N�
jr W TR'I'IIIC 'I"Oh li XEMPITON PROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD 20NE A.L.U.C.
CL O
W CO PISNSATION INSURANINSURANCEPLG.CONTR. LIC.NO.
:) Z (This section need not'le completed if tire PLG.
e permit is for one TOTAL v rv�
hundred dollars l5100)or less.) TOTAL 0 N
U O 1 certify that in the performance of the work]or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U" mit is issued,1 shall not employ any person in any manner sat as to
U W become subject to the Workers'Compensation Laws of California.
CL I NOI Nm - ALTER OR ADD TO MECH. 4.00 BUILDING '2
} W Date Ii 'f) APPLICANT: If,after making this Certificate 4d Ex- �f
F ? emption,you should become subject to the Workers'Compensation APPLIANCE ro4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with T
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10J=GF.PA) 3.00 FEE
CONSTRUCTION LENDING AGENCY, AIR HANDLING UNIT(OVER IQOOQF.M_) 5.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2,00
the is.Cance of the work for which this permit is issued(Sec. MICROFILM
30nder.C's .C.). HEATING UNIT ITO 100,000 B.T.U.) 4.00
Lender's Name '
Lender's Addrra HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
I certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00
Information is correct.1 agree in comply with all'city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOI LER-COMP(Ova,IOOODO BTUI SEE FEE SCH. MECHANICAL
bort
agree to Save, indemnify and keep harmless the City of MISC. REFER TO ORD.
against liabilities,judgments, costs and expenses which CONST.TAX
ECH
ny way accrue against mid City in conseque^nce of the PERMIT ISSUANCE 3.00
is e_.I. ' � O YLIC.NO. MOTALA ¢ant/Contmc Date TOTAL
OFFICECOPV