4449C.JTI' 01' CUI'F.ItTIND INSPECTIOt. RECORD (Office Copy)
4449 862 Ferngrove
PI:PjIIT 190. SANITARY DIST. NO. LOT 140• ADDI:I`.55
Repair Shower Pan Fitzgerald
PROJECT OUNER JOB SITE P11014E
PERMIT ISSUED Date II ELECTRICAL
FINAL INSPECTIONS
BUILDING
Date I Insp.
Pad Certification
Foundation
P -re -Duni to
Slab -I lembrane
Bond Beam
Underf.lnor Girders
Floor Steel
Tiedowns
Diaphrams
`seismic Bracing; o
halls -Panels
Lnth i I"
llallboards Int/F.xt.
Firewalls
Other
_ 0 Not P
IBa
PLUMBING
Date I Insp.
Rough Complete ovJe-
Solar Rough
Water & Insulation
'lain Drain
Other
Not Appr
MECHANICAL
Date
Underfloor S.M.
Insp.
Ducts & Insulation
Fire Dampers
Fireplace
Grease Duct & flood
One flour Shaft
Condensate Drain
Equipment Anchorage
Flues & Comb. Air �-
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' . BU I LDING PROJECT I DENTIFICATI ON
APPLICATION & PERMITADDRESS
BUILDING - ELECTRICAL -PLUMBING - MECHANICAL
PERMIT NUMBER
AAA n -
BUILDING
OWNER'S
PLAN CHECK VALIDATION
NAME
QTY. ELECTRIC PERMIT FEE
JI/ HONe' -;r- 7-f'
.
NAMERa°°R {{
st t% -/u6/aa c. No.
UTLETS- SWITCHES -RECEP 5.00/1.00
LIGHTING FIXTURES 5.00/1.00
CONTRACTORS
CONTRA
PPLIANCES- RESIDENTIAL 4.00
E � O{ -a
DATE OF APPLICATION
PANELS 5-00
ORRCRITECT
ENGINEER
LIC. NO.
SIGNS 6�
PLAN CHECK FEE
.C. NO.
-
SIGNS TRANS. 3.00
ARCH,ORENG. RESSSPECIAL
CIRCUIT '5.00
PERMIT VALIDATION
EMP. METER OR POLE INS. 15.00
ZIP
�p
J
ADRESS ANT
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
p
• AI/O1`
LICENSED CONTRACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
rofessioro Code, an y licenLise is u Nfull are a e ep.
LicenseCL c. umber
E DATE
LD PLG. MECH.
ale heContractor
OWNER-BUILDCR DECLARAT ON
1 hereby affirm that I am exempt from the Contractor's License
Law for the following reason, (Sec. 7031.5. Buslnessund Professions
Code: Anycity orcounty whichrequiresapcmtif toconstn¢l, alter,
ly 01 PERMIT
I INFORMATION
MISC. - REFER TO ORD
pERMIT ISSUANCE 600_
VALUATION
$/FT.
ELEC. CONTR. LIC, NO.
ELEC.
TOTAL
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such pemtil to file a signed statement that
he is licensed pursuant to the pruvisions of the Comrtetor'r License-
Law (Chapter 9(commencing with Section 7000) of Division 3 oflhe
Business and Professions Code( or that he is exempt therefrom and
300
PERMIT TO
�D
QTY. PLUMBING PERMIT FEE
STORIES
TYPE CONS R.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects lire applicant Dra civilpanalty
of not more than the hundred dollar, I S500).):
ALTER -DRAIN (EA.)
❑ 1, as Owner of the property, or or, employers with wages as
(heir sole compensation, will do the work. and the structure is not
BACK FLOW PROTECT. DEVICE 2.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. slim
-mended or offered for role (Sec 7044. Business and Professions
Code The Contractors License Law does not apply to an owner of
FIXTURES - PER TRAP 4.00
-
GAS - EA. SYSTEM -1 INC.4 OUTLETS 4.00
SO, FT. FLOOR AREA
TOTAL ACREAGE
properly who builds or improves thereon, and who docs such work
himself or through his own em ployecc provided that such impmvc
memsarenotintendedorofferedforsale.ifhowever. lire building
or bnprovemem is sold within one year of completion, the Posner -
builder will have the burden of proving that h did not build or im-
prose for purpose of sale. ).
❑ 1, as owner of the property, am exclusively contracting with
. .I.Go
USE
RES IND CON PB Other
❑ ❑ ❑ El , 0
INDUSTRIAL DUSTR I A L WASTE 1 NTE R: .20.00
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of prolxny who builds or improves thereon, and who
LAWN SPRINKLERS - 1 INC 5 V.B. 5.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 IEA.) 1.00
contracts for such projects with a cantractor/s) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 2001t/R,00
TRACT.NO.
PARCEL NO.
❑ l am exempt under See ,B.&P.C. ter this
reason
WATER HEATER W/VENT 4.00
Dam Owner
WATER SYSTEM 4.00
ACC. DATE
ACO, FILE No.,
WATER TREATING EQUIP, 4.00
WORK ERS'COMYEN'SA'fION DECLARATION
' 1 hereby affirm that 1 have a cenifeme of consent to self -insure.
,or a cerlificaur of Workers' Ccoh,, tion Ihairancc, or a certified
copy Ihe�e f(Sea�Q��jj}C,
Policy Rfi,
ZONING
ENG. SITE NO.
FIRE SPRINK
V NEj
ENERGY T9<
Y IN
❑ Certified copy lS hereby l urnished.
O Cenified co is filed, it11JL. ci
py ty-iwaiun Aivision.
Applicante
MISC.- REF ER TO ORD.
CI.R_TIFIC/Kr,/OF IiSE�MPTION FROM WORKERS'
PERMIT ISSUANCE 6.00
FLOODZONE
A.L.UC.
ONIPENSATION INSURANCE
(This section need not be completed if the permit is for one
Y N
Y N
PLG. CONTE. ❑C. NO.
PLG.
TOTAL
hundred dollars (S I Wo or less.)
'
I certify that in the puformanm of the work fur which this per-
mit is Road, 1 shall not employ any person in day n nncr sa u,c to
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
l0 0�
beconm subject to the Workens Compensation Laws of California.
Date Applicam
ALTER OR ADD TO MECH. 4.00
NOTICI, TO APPLICANT: If, after making this CeMM,f ,fa of Fs.
APPLIANCE 4.00
PLAN CHECK
FEE
emptiun, you should become subject In the Workers COrl,,a,atl°n
provisions of the Labor Code, you must forthwith comply with
such provisions ur this permit shall be deemed revokcd.
AIR HANDLING UNIT (TO 10=C.F.N71 3.00
AIR HANDLING UNIT (OVER 10,000C.F.M.) 5.00
SEISMIC FEE
a`(s
CONSTRUCTION LENDING AGENCY -
I hereby affirm that there is a Const°mtion lending agency for
EXHAUST HOOD (WITH DUCT) 2.00
tire pertcrritance of the work for which this permit is issued (Sec.
3097, Cie.C.h
MICROFILM
HEATINGUNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Address
H EATI NG UNIT (OV ER 100,000 B.T.U.)7.50
ELECTRIC
VENTILATION FAN (SINGLE) 3.00
Icertify that l have read this application a n d site flint the whom
informallon is Correct. I agree to comply with all city and county
lndin,ou,,, slid Slate Laws relalorg to building construction, and
PLUMBING
BQILEA-CONP 13 H.P. or 100,000 B.T.U.) 4.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby amhnrve rcprewhad,n of this city to carer upon the
abovomentioned property for inspection pu Rrow'.
(We) agree to save, indemnify and keep harem.... the Cit, of
MISC. - REFER TO ORD.
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against said City in �onuyuunce of the
PERMIT ISSUANCE 3.00
CONST. TAX
granting of this permit.
MECH. CONT. LIC. NO.
MECH.
-' _
DTA,
TOTAL
O �+
Ignamre p can Count, r Dale
OFFICE COPY