No preview available
4988CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) r "' PEW41T� , %moi-rI� I�I1JnA ad #Z-- C� Gecu�e,�� ADDRFSS LOT OWNER FINAL INSPECTIONS DATE I INSP. Gas . I. re 4ELECTRICAL DATE IINSP: Power Polo' Underfloor S. ELECTRICAL DATE I INSP. o¢i HWo 1= a Z a H z 0 y w ¢ ¢ ¢ a E w u w 3 ` y F LL o 4 I w > f ¢¢4O nwm H a sio Ic o a 3 m O ZZ H O LU _ ao Uo LL F- 00 w >Z h ? A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT 1 DENT( FICATION • APPLICATION &PERMIT BUILDING—ELECTRICAL—PLUMBING—MECHANICAL PERMIT NUMBER 4988 g g `i PLAN CHECK VALIDATION DATE OF APPLICATION BUILDING ;269ADDRESs. 2o9/b lF©r,r TEk� SPR 2 NAMERS ._t� CL=�A'�rC9 ONE Cos AL rj PHONE �70 OTV- ELECTRIC PERMIT FEE NapMERnnAcr''oas Qd,� F— N P-/��K�� uc rvo t�lJ�7 OUTLETS - SWITCHES -RECEP 5.00/1.00 �--p J ° ILIGHTING FIXTURES 5.00/1.00 DDESsiDRsCONTRACTOR RK�PHONE��D :J( 5,r Fpwfia__ PPLIANCES- RESIDENTIAL 4.00 PANELS 5.00 ORRCm TECs ENGINEER LIC. NO. SIGNS 6.00 PLAN CHECK FEE P,C. NM SIGNS TRANS. 3.00 ARCH, OR ADDRESS ENG ' ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION AlP EB Ify Of CqpO@ DATE TEMP. METER OR POLE INS. 15.00 ADDRessis MOTORS SEE FEE SCH. -SERVICE CHANGE 10-00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I ion licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code h my license is in full force and eft O License tau \ Lie Number Date Contractor 9 q FEB 9 - BLDG. ELECT. PLG. MECH. City of Cupertino OWNER -BUILDER DIiCI-A RAT I hereby affirm that 1 am exempt fano the Contractor's Licence Law for the following reason, (Sec, 7031,5, Businessand Professions Code: Any city or county which requires a permit to construct. alter. Improve, demolish, Or repair any'structure, prior tU Its Issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollars ($500).1: O 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: 'the Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who dices such work himself Or through his own employees, Provided that such improve- ments are not intended or offered for sale. If, however. the building or improvement is sold within one year of completion, the owner - builder will have the hurden of Proving that hedid not build or run- Prove fors owner of sole.). ❑ L as owner of the property, he exclusively contracting with and contractors to construct the project La 7044, Business Professions and Professions Code: The Commctor i License Law docs not apply to an owner of property who builds or improves thereon, and who contracts far suelh projects with a eontractows) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. ,B.&P. C. for this reason BUILDING PERMITION INFORMATION MISC: — ' REFER TO ORD ' PERMITISSUANCE 600 VALUATION C, ` a( o $/FT. ELEC.CONTR. LIC. NO. E LEC. / / TOTAL. IP PERMIT TO OTV. PLUMBING PERMIT FEE gLTER-DRAIN&VENT-WATER IEA.)q,OQ STORIES TYPE CONSTR. BACK FLOW PROTECT. DEV ICE 2,QO OCC -GROUP RES, UNITS DRAINS -FLOOR, ROOF, AREA,COND. 4.00 FIXTURES - PER TRAP 4.00 SO, FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 4,00 GAS - EA. SYSTEM - OVER 4 (EA.) 1.00 BUILDING USE ❑ I❑ ❑N ❑ ❑ INDUSTRIAL WASTE INTER. 20.00- LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.0o SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT No. PARCEL No. WATER HEATER W/VENT 4.00 Date Owner WORKIiRS'COh1PfiNSATION DECLARATION I hereby affirm that 1 have a ccrlificate of consent m self -insure, or a certificate of Workers' Compensut ion Insurance, or a certified copy thereof (Sec. 3800, Lab,C.)- ZEJ't(I%/y Policy No. CompanyCiipprtinn ❑ Certified copy is hereby furnished. 4f,Cerof,i� copy i iIC{h with Ilu�city inspection division. Apple.: _CGS( n i-•.� WATER SYSTEM 4.00 ACG DATE ACG FILE NO. WATER TREATING � �O'4A0 ZONING ENG. SITE N0. - MISC. - REFER TO ORD. FIRESPRINK r N ENERGY T 24 v ❑ IN CERTIFICA'1'1:OP IiXEMPTION PROS? WORK HRS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars IS 100) or lett.) I certify that in the performance of the work for which this per- mit is issued, 1 shall not employ any person in any manner so as to beconm suhject to the Workers' Conhpensutiou Laws of CaIbomia. Date Applicant - NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this Permit shall he dee deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec, 3097. Civ.C.), Lender's Name Lender's Address I certify that 1 have read this application and state Unit the above information is correct. I agree m comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the Cit of City ties, judgments, costs and expenses which Cupertino against accrue Go ft way accrue against said City in consequence of the gra h got this perrili(. /% L��' PERMIT ISSUANCE 6.00 FLOOD ZONE Y ❑ N A.L.U.C. Y N[ PLG. CONTH, LIC. NO, PLG. TOTAL e�I OT,. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING _ ALTER OR ADD TO MECH. q QO APPLIANCE 4.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10,000 g Gp F.W 3.00 cl— AIR HANDLING UNIT(OVER 1Q000C. EMJ 5.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 HEATING UNIT (OVER 100,000B.T.U.)7.50 ELECTRIC v VENTILATION FAN (SINGLE) 3.00 BOILER-COMP(3 H.P. B.T.U.) 4.00 PLUMBING �p 190,11 O BOILER -COMP (Over t00,0008TU1 SEE FEE SCH. MECHANICAL CTJ MISC. - CREFER;T ORD. PERMIT ISSUAN 3.00 d — CONST. TAX MECH. CONT. by Of C p (Y Cuper pf1 WA, AL / �/ TOTAL 11.2_ a 6 h • of Applicant/Contractor Date OFFICE COPY