0924111
L
0924 _
PI:PdtI'r N0.
CITY OF CUPERTINO INSPECTIOL' RECORD (Office Copy) lU
_ 7914 Festival Ct. _
SANITARY DIST. NO. LOT td0. ADDRESS
Paul Pulsipher 446-0950
PROJECT OUNER JOB SITE PHONE NO.
PERMIT ISSUED Date II ELECTRICAL
;1inr
trical
Plumhirig
techanical
Temp. Gas/
volar
Fire
Sip.,n
FINAL INSPECTIONS
BUILDING
Date Insp.
Pad Certification
Foundation
Pre-Gunite
Slab-Hembrane
Bond Beam
Underfloor Girders
Floor Steel
Tiedowns
Diaphrams
Seismic Bracing
11alls-Panels
Frame
Lath
Uallboards Int/Ext.
Firewalls
Other
Date I i.nsp.
Power Pole
Underground
P.ou�h Wiring
lalls
Ceiling
Fixtures Int/Ext
tlotors
Grounding
Temp. Power _
Other
Not Approved
PLUMBING
Date
Backflow
Insp.
Underground
Underfloor
Partial Rough
Rough Complete
_
Solar Rough
Water & Insulation
_
'lain Drain
R/of/S Drain
Gas .
Other
Not Approved
HECHANiCAL
Date
Underfloor S.M.
Insp.
Ducts & Insulation
Fire Dampers
Fireplace
Crease Duct & Hood
_
One Hour Shaft
Condensate Drain
_
Equipment Anchorage
Flues & Comb. Air
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEVLY
OFFICE COPY
BUILDING PROJECT I DENTIFICATION
APPLICATION
BUILDING — ELECTRICAL— PLUMBING— MECHANICAL`
PERMIT NUMBER
0�]�A
J LF
BUILDING n
ADDRESSq1 q c_S?i!/,9L (� T
r7
OWNER'S
NAME t
;01' ,PULS%i% lff7te PHONE777 D9SC
Ory ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
NAMERACTORs -
UTLETS- SWITCHES -RECEP 5.00/1.00
uc. No.
LIGHTING FIXTURES 5.00/1.00
ADDRESS TORS
PPLIANCES- RESIDENTIAL 4.00
PANELS 5.00
PHONE
DATE OF APPLICATION,
ORRLHITECi
SIGNS 6,80
PLAN CHECK FEE P.0. NO.
ENGINEER
LIC.ND.
-
SIGNS TRANS. - 3.00
ADDRESS saes
SPECIAL CIRCUIT 5.WPERMIT
VALIDATION
TEMP. METER OR POLE INS. 15.00
zm
(�✓////mix
APPULANTS
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
J
LICENSED CONTRACTORS DECLARATION
I hereby affirm Ihar I am licensed under provisiotn of Ch apt er 9
[m mmencing with Section 7000) of Division 3 of the [Inside, and
Professions Code, and my license is in full force and effect.
Class Lic. Number
BUA/NCE DATE
BLDG_ ELECT. PLG. MECH.
❑ ❑ LiLicense
Date Contractor
OWNER -BUILDER DECLARA'IFION
I hereby collo that I am exempt from the Contractor's License
Low fortheity or countawhichn. requires a Perminess t tocndtrct.altr.
Code: Any countywhichreguirum Permit oconstructa
BUILDING PERMIT
INFORMATION
MISC.— REFER TO ORD
PERMIT ISSUANCE 6.00
'
VALUATION
$/FT.
ELEC. CONTR. LIC. NO. ELEC.
TOTAL
molishcoo
improve, demolish, or repair any strueturt, prior nu its issuance, also
also
Rgnires the applicant for such penuil t0 Elle a Signed statement thal
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 ofilm
/
PERMIT TO
(tininess and Professions Code) or Hurt Ile is exempt therefrom and
DTV. PLUMBING PERMIT FEE
the basis for the alleged exemption. Any violation of Section ]031.5
by any applicant for a permit objects the upplicanl to u civil penalty
of not mom than live hundred dollars (5500T).
STORIES
TYPE CONSTR.
ALTER -DRAIN & VENT -WATER (EA.) 4.00
❑ 1, as owner of the properly. or my employees with wages as
mcir sole compensation, will do the work, and the Stn¢tum is not
BACK FLOW PROTECT. DEVICE 2.00
occ. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 4.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License law does not apply to an owner of
'
FIXTURES - PER TRAP 4.00
GAS - EA. SYSTEM - 1 1 NC. 4 OUTLETS 4.00
properly who builds or improves thereon, and who dues such work
himself or through his own employees, provided that such improve-
ments are not intended or offered for sale. If, however, the building
Sp_ FT, FLOOR AREA
TOTAL ACREAGE
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving than he did not build or ins-
GAS - EA. SYSTEM - OVER 4 IEA.) 1.00
BUILDING USE '
prove for purpose of salc.).
❑ I, as owner of the property, am exclusively contracting with
RES IND CON PB other
❑ ❑ ❑ ❑ ❑
.
INDUSTRIAL WASTE INTER2000
licensed contractors to construct the project (Sec. 7044, Business
andProfessions Code:'rhe Contractor's License Law dims not apply
to an owner of property 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 u connractono licensed pucnmm lis
the Contractor's License Law.
.
❑ 1 an, exempt under Sec,B&P. C. for this
reason
SEWER -SANITARY -STORM EA. 200ft/8.00
TRACT NO.
PARCEL NO.
-
WATER HEATER W/VENT 4,00
Dane — — ter
WATER SYSTEM 4.00
ACC, DATE
ACC, FILE No.
WORKERS'COMPENSA'IION I IECLARAI]ON
WATER TREATING EQUIP. 4.00
I hereby affirm that 1 have a certificate ofcom,em to self -insure.
ZONING
ENG�SITE NO.
or a eerlificate of Workers' Cum Pcnution Itnurance. or a certified
copy thereof (See. 3800, lab.C.).
'
Policy No. Company
❑ Certified copy is hereby Iurnlslmd'
❑ Ce NiOed copy is filed with the city inspection division.
Applicant
FIRE SPRINK
v❑ N
ENERGY T 24
Y❑ N❑
MISC.- REFER TO ORD,
CERTIFICATE 01° Exi mprION 17ROAI W'ORAIiRS'
COb1PIiNSAI'10N INSURANCE
(This section need not be completed If the permit Is for One
PERMIT ISSUANCE 6.1x)
FLOOD ZONE
Y ❑ N
A. L. u.C.
Y ❑ N❑
PLG. CONTR. LIC. NO.
PLG.
TOTAL
hundred dollars IS 100) orless l
I certify that in the performance of the work for which this per.
mit is issued, I shall not employ any person in any manner.w as to
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
become subject to the Workers Compensation Laws of California.
OR ADD TO MECH., q,p0
Date ApplicantALTER
BUILDING
p
a0 �57J
NOTICE TO APPLICANT: If, after making this Cenificme of Iix-
APPLIANCE 4.00
PLAN CHECK
FEE
moption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10=11F.M.) 3.00
AIR HANDLING UNIT (OVER 10=C.F.NL) 5.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending ugeney for
the perfonnanee of the work for which this permit is issued (Sec.
3097, Civ CA � -
EXHAUST HOOD (WITH DUCT) 2.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Address
HEATING UNIT (OVER 100,000 B.T.U.)7.50
ELECTRIC
VENTILATION FAN (SINGLE) 3.D0
I certify that l have read this application and store Huai lheubove
information is correct 1 agree to comply with all city and county
ordinances and talc laws rclatinµ to building construction, and
PLUMBING
BOILER-CQVP(3 H.P. or 100,000 B.T.U.) 4.00
hereby
hereby enthorim representatives of this city to enter upon the
mauthored property for inspection purposes r .
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
MISC. - REFER TO ORD.
(we) agree to save, indemnify and keep'hnnolem the City of
CONST. TAX
Cupertino against liabilities, judgments, costs and expenses which
may T any way accrue against mid City in co nog'case of the
grangof this perm ^ /
VX
PERMIT ISSUANCE 3.00
MECH. CONT. LIC. NO.
MECH.
TOTAL
TOTAL
�
Signature Plicant/Contract Date
OFFICE COPY