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0263 C.I'FY OF CL'PERT'LNO IUSPECTIOb RECORD (Office Copy) 0263 20075 Forest Ave. P1:Pd1IT NO. SANITARY DIST. NO. LOT NO. ADDRESS Plumbing Dlask PROJECT OWNER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL Bui]dtnr Date Insp. El.ectrLcal Power Pole _ I'Lumhing - - Under ,round Mechanical RouFF;h Wiring Temp. Gas/Elect. 11alls Solar Ceiling__ Fire S12rin.kler Fixtures Int/Ext Sign ilotors Grounding Hisc. Temp. Power Other FINAL INSPECTIONS Not Approved Date Insp. (,2s _ PLUMBING Electric Date Insp. Plumbing Backflow Mechanical Underground Solar Underfloor Pool Partial Rou ,h Gradinp Rough Complete • 11Yannin Solar Rough Fire Det. Water & Insulation Health Dept. Main Drain Building R/of/S Drain Other Gas Other BUILDING Not Approved Date Insp. Pad Certification MECHANICAL Foundation Date Insp. Pre-Gunite Underfloor S.M. Slab-Membrane Ducts & Insulation Bond Beam Fire Dampers _ Underfloor Girders Fireplace Floor Steel Grease Duct & hood Tiedowns One Hour Shaft Di.aphrams Condensate Drain Seismic Bracing Equipment Anchorage_ 11alls-Panels Plugs & Comb. Air Frame Other Lath Not Approved 11allboards Int F.xt. Firewalls Other Not Approved AFPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 02639=5 D = BUILDING-ELECTRICAL-PLUMBING -MECHANICAL PLAN CHECK VALIDATION Me vfloNE QTY. ELECTRIC PERMIT FEE NOMaERAc.oRs UTLETS-SWITCHES-RECEP 5.00/1.00 Ic.N . LIGHTING FIXTURES 5.00/1.00 CONTE AOTOR's ADDRESS PPLIANCES-RESIDENTIAL 4.00 ADDRESS �t HON 1 PANELS 5.00 DATE OF APPLICATION -401 ORCHrt T SIGNS 6.00 PLAN CHECK FEE P.0.NO. ENGINEER LIC,NO, SIGNS TRANS. 3.00 ARCHOR ADDRESS ENG SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 15.00 APPLICANT'$ ADDRFS5 MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 0 0 o LICENSED CONTRACTORS DECLARATION N d a U Lbs I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE h a c (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH. H o i Porre.License C C Ih liters,is in full fuu x o 0 - Liana Clas _ s,i Numbs 0 w - D Date Contractor ¢ m BUILDING PERMIT ¢ w a OW'NF,R-IIUILDF.R DECLARATION K ;LL v, I hereby affirm that 1 em exempt from the Contactor i License MISC.- REFER TO ORD INFORMATION H m o g few for th<following reason,(Sec.703 1,5,Business and Professies ons PERMIT ISSUANCE B VALOATION 5/FT. Code:Anycityorcounty which requira permit to construct.alter. or ¢ improve,demolish,or repair any'stnature,prior to its issuanc0.also ELEC.CONTR. LIC.NO. ELEG - D or requires the applicant for such permit to file a signed statement that TOTA.L PERMIT TO w$m he is licensed pursuant to the provisions of the Contractors Licensez a Law(Chapter 9(cnmmenciag with Section 7000)of Division 3 of the i o Business and Professions Code)or that he is exempt therefrmn and QTY. PLUMBING PERMIT FEE w F 0 the basis for the alleged exemption.Any violation of Scerion 7031.5 STORIES TYPE CONSTR. a3 _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00 of not more then five hundred dollars($500R.) ❑ I,as owner of the property,or my employ,%,with wages as BACK F LOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS their Sale compensation,will do the work,and the structure is not intended or offered for rule (Sec. 7044, Business .,,it Profcssimu DRAINS-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 flocs such work F IXTUR ES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employers,Pe.If,ho that such improve- mcntsarenotinrandedoroffereoyees,provided ed that r.such building 'GAS-EA.SYSTEM-11NC.40UTLETS 4.00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE builder will have the burden of proving that he did not build or iso- RES IND CON PB One, prove for purpose of sale,). INDUSTRIAL W ASTE INTER. 20.00 ❑ I,as owner of the property',am exclusively contracting with licensed contractors to construct the project IScc. 7044,BusinessLAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Profession%Code:The Contactor'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 Couloacturlsl licensed Pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ I um exempt under Sec. ,B.&P.C.for Ills WATER HEATER W/VENT 4.0 reason Date Owner WATER SY 4.00 ACC,DATE ACC.FILE NO. WORKERS'COMPE-NSATION DECLARATION WATERi7RF.*WERTjN0 4.00 I hereby affirm that I have a certificate ufconsent to self-insure. or�+ay cjeyrtiyfi{c�ate of Workers Compensation Insurance,or a ccrtificd ZONING ENG.SITE NO. O q-.Cera9ed copy Is hereby furnished, .6` FIRE SPRINK ENERGY T]4 z Z Cet ynifed dad with the city inspection division. o_ ApplicanMISC. - _ ' REFER TO ORD. v N� v NN[:]~ PERMIT ISSUANCE Du CIiRTIPICCOIIPE fAiI N INSPROMN'ORK8R5' 6,00 FLOOD ZONE A.L.l1c. W � COMPIiNSA'I'ION INSURANCE PLG.CONTR. LIC.NO. PLG. /� T CL Z (This section need not be completed if the permit is.for one TOTAL/0,00 y❑ No Y El N� hundred dollars IS 100)or I.,) U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE W F mit is issued, I strait not employ any Poison in any mmnncrso us to FEE SUMMARY O w become Subject to the Workers Compensation Laws of Calitornia.' d Date Applicant BUILDING } rn NOT[CI! 'f0 APPLICANT: If,after making this Certificate of fix- ALTER OR ADD TO MECH. 4.00 F ? emption,you should bcoame subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith 'amply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1QOW 1CF.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE I hereby affirm that were is u construction leading agency for EXHAUST HOOD(WITH DUCT) 2.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Cis'.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name Lender's AddreHEATI NG UNIT(OV ER 100,000 B.T.U.)7.50 ELECTRIC ss I certify that I have read this application and state that the above V ENTI LATION FAN (SINGLE) 3.00 information is correct. I agree to comply'with all city and county PLUMBING ordinances and state laws relating to building ciao ruction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 hereby authariee representatives of this city to enter upon the BOILER-COMP (Oven 100,000 BTUI SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgnwms, costs and expenses which CONST.TAX may in any ay accrue against said City in consequence of the PERMIT ISSUANCE 3.00 n tin t I pmnut' MECH.CONT. LIG NO. MECH. TOTAL TOTAL nthincWFApplicant/Contractor Date VV JJJ OFFICE COPY