0252 CITY 01' CUPERl'iNO INSP E,CTIOV RECORD (Office .Copy)
,. 20712 Carden P1are-c-t____
PEMIT No. SANITARY DIST. NO. LOT NO. ADDRESS
isElectrical & 14echanical Garden View Terrare
PROJECT OUNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buildinc ' _ Date insp.
Electrical Power Pole _
I'Lumhinr Underground
Mechanical 5-13-81 P.ough Wiring
• •Temp. Gas/Eicct. Ual
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other _
FINAL. INSPECTIONS Not Approved
Date Insp.
PLUMBING
Electric Date Insp.
Plumbing Backflow _
!lechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
I'Lanning Solar Rough
Fire Dept. Water & Insulation
Health Dept. *fain 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-I(embrane Ducts & Insulation
Mond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood _
Tiedowns One (lour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
halls-Panels Flues & Comb. Air
Frame Other
bath Not Approved
• Ilallboards Int Ext .
Firewalls
Other
Not Approved
_.APAICANT TO FILL IN INFORMATION WITHIN RED LINES - LISE.BALL POINT PEN ONLY rA
PERMIT NU
BUILDING PROJECT IDENTI FICAT]ON APPLICATION & PERMIT 252
111111x1 "62
Joon�ss
"Crflay BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK VALIDATION
NA E OTY. ELECTRIC PERMIT FEE
CONTRACTORS
-SWITCHES-RECEP 5.00/1.00
,(L•L•v u �� "�
c.no � 0 LIGHTING FIXTURES 5.00/1.00
CONTRACTOR PPLIANCES-RESIDENTIAL 4.00
A1
ADDRESS
1/ s VWCNE p--.a�"n' PANELS 5.00 PATE OF APPLICATION
ARCHITECT SIGNS
ENGINEER 6.DO PLAN CHECK FEE P.C.NO.
OR
I uc.No. SIGNS TRANS. 3.00
ARCH Ess END' "SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
2,P rrEMP.METER OR POLE INS. 15.00 -
APrucANr's - MOTORS SEE FEE SCH:
e DPRE59 �J(4A7-3.3gt,ry Zo _A V.
SERVICE CHANGE 10.00
o /i.3
F o o LICENSLD CONTRACTORS DECLARA'f10N ,O' -
< u w I hereby affirm that 1 am licensed under provisions of Chapter 9 'Cj ISSUANCE ATE/
N z (commencing with Section 71X10)of Division 3 of the Business and
a BLDG. ELECT. PLG. MECH.
r O z Professions Cod d my license is in full fu a V feI Q
o i`� o Licen Class Lic.Number H -- 0 � El ❑
Daluf_1� Contractors s �,
a Y F MA
2 n a OWNER-BUILDER DECLARATION BUILDING PERMIT
INFORMATION
wy I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
FLLoj
Law for the following reason.(Sec.7031.5,Business and Prof•scions PERMIT ISSUANCE 600
VALUATION S/FT.
Code:Any city or county which reyuiH,Sa permit tocomaruct alter,
S ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. _ ELEC. //
Om recryires rhea licanl forsueh
pP permit to file 1 signed statement Ilett TOTAL PERMIT TO
n w he is licensed pursuant to the provisions of the Contractor's Liknse
FiQ Law(Chapter 9(commencing with Section 70001of Division 3 of the
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.1,4.00 '
of not store than five hundred dollars(55001.):
C 1,as owner of the proPcry,or my employees with wages as BACK F LOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and thdstructure is not
intended or offered for sale (Sec. 7614, Business and Professions 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 docs such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own em Pio yccs,Provided that such ibuildi e-
menlsore not intended onthpoffered lot salei-mideowever,the building GAS-EA.SYSTEM-1INC.4OUTLETS 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 int- RES IND CON PB Omer
prove for purpose ale.).of sINDUSTRIAL WASTE INTER. 20.00
❑ 1,as owner of the property,am exclusively contracting with ❑' ❑ ❑ ❑ ❑
licenmd contractors to construct the project(Sec. 7044, Rosiness LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO
and Professions Coda: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 contmetems)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200f1/8.00 TRACT NO. PARCEL NO.
C I am exempt under Sec. .B.&BC.for This WATER HEATER W/VENT 4,00
reason
Date OwLe, WATER SYSTEM 4.00 ACCIDATE ACC.FILE NO,
WORKERS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of consent 1D self-insure.
or a certificate of Workers'Compensation Issuance,or a Certified ZONING ENG.SITE NO.
copy thereaf(Sec.3810,Lab.C.).
Policy No Company ,
O ❑ Certified copy is hereby furnished. RE SPRINK ENERGY T34
Z 2 O Cerif opY i�Gled with the city inspection division.
O Applicant ��9.(@1ZF�I- misc.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
CC CERTIFIC\TEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A1.UX
LU > COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG
d ('Phis Section need not be completed if the permit is for one TOTAL Y❑ N❑ v❑ N❑
2 hundred dollan(S[DO)or less.)
CJ O 1 Certify that in the performance of the work for which this Par- OTY MECHANICAL PERMIT FEE FEE SUMMARY
mit is issued,1 shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
Date Applicant ALTER OR ADD TO MECH. 4'-00 BUILDING
NOTICE TO APPLICANT: If,atter making this Certificate of I!x-
? emption,you should become subject to the Workers'Compensation 'APPLIANCE 4.00 PLAN CHECK
To
ovisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit strait b /OO
e deemed revoked. AIR HANDLING UNIT(TO 10DC.F.M.) 3.00
CONSTRUCTION LENDING AGENCY'. AIR HANDLING UNIT(OVER 10,000C.F.M.) 5.00 'SEISMIC FEE -
I hereby affiRL thin there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the 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 H EATI NG UNIT(O V ER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC- �/
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
. ordinances u correct. I agree tcomply with all city and county PLUMBING
ordinances and slate laws relati m OILFA-
ng building construction, and BCOMP(3 H.P.or 100,000 B.T.U_) 4.00 -i
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 7
00
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs Ind expenses whichPERMIT ISSUANCE 3.00 _ CONST.TAX ,
may in any way Iccme against said City in ttmsetluence of the
grantingofthis permit. MECH.CONT, LIC.NO.
---FECH.
TAL7' 0Q TOTAL
Signature of Applicant/Contractor Dam
\ OFFICE COPY
'z_ .