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0266 CITY OF CUI'ERTINO INSPECTSOI! RECORD (Office Copy) 0266 10581 John Way PERitIT PIO. SANITARY DIST. NO. LOT NO. ADDRESS . Appliance John Norden 253-7971 PROJECT 01-INER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL Building Date insp. Electrical Power Pole Plumbing Underground Ilechanical _ 6-1-81 Routh Wiring Temp. Gas/Elect. hails Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sign ll tors Grounding Hisc. Temp. Power Other__ FINAL IIISPECTIONS Not Approved Date Insp. r'e_s PLUMBING Electric Date Insp. Plumbing Backfloio 'lechanical Underground Solar Underfloor Pool Partial Rough Grading Rough Complete • PYanni.ng Solar Rough Fire Dept. Water & Insulation Health Dept. Main Drain Bui.ldin R/of/S Drain Other Gas Other BUILDING Not Approved Date Insp. Pad Certification MECHANICAL FoundationDate Insp. I Pre-Gunite Underfloor S.M. Slab-Membrane Ducts & Insulation Bond Beam Fire Dampers Underfloor Girders Fireplace Floor Steel Grease Duct & flood Tiedowns One Hour Shaft Diaphrams Condensate Drain Seismic Bracing Eilnipment Anchorage halls-Panels Flues & Comb. Air Frame Other Lath Not Approved 11allboards Int/Ext. Firewalls Other Not Approved it APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NumeER BUILDING APPLICATION & PERMIT O �^ AD E55 V BUILDING-ELECTRICAL-PLUMBING-MECHANICAL _ OWNER'S "" PLAN CHECK VALIDATION NAME �1OTY. ELECTRIC PERMIT FEE o A) - PHON (5-3-7921 , CONTERACTORS UTLETS-SWITCHES-RECEP 5.00/1.00 NAIVE 'm.NG S, 21LIGHTING FIXTURES 5.00/1.00 - ADDRESS oRs .cul. _ APPLIANCES-RESIDENTIAL 4.00 /2 t'l r PHONE , O PANELS ` 5.00 DATE OF APPLICATION ARCHITECT, SIGNS,. 6.00 PLAN CHECK FEE P.C.N0: OR , ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH.DR ENG. SPECIAL CIRCUIT -5:00 PERMIT VALIDATION ADDREss- iIP. - EMP.,METER.OR POLE INS. 15.00 - APPUCANT's -' ADDRESS MOTORS SEE FEE SCH. _ - - SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION to a'u 1 hereby affirm that I am licensed under rovisionsof Clia ler9 YY_/ ¢- Y P P ISSUANCE w (commencing with Section 70001 of Division 3 of the Business and - ¢ RLDG. ELECT. PLG. MECH. Hwi I'rofessiC Co' Co'C Liis in full for a e�_- ❑ ❑ ❑ I`h/-I/�I 'o i m G License C ass Lic.Number - Date Contractor i.¢ x f - BUILDING PERMIT ¢ ¢ w a- �' OWNIiRBUICDER DECLARATION - INFORMATION dao• ° MISC.- REFER TO ORD w H I hereby affirm that I am exempt,from the Contractor's License y VALUATION $/FT. a. 0 ¢ Law for the following mason,(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00. f NNJ Cade:Any city or county which requires o permit 1.Construct,after, M Q 4 0 improve,demolish,Dr repair any structure,prior to its issuance,also ELEC:CONTR.' , LIC.NO. ELEC. ' y iL O LL' requires the applicant for such permit to file a signed statement that /• TOTAL PERMIT TO se S he is licensed pursuant to the provisions of the Contractors License ' H z r Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe PPG/,9Nt�.� a Business and Professions'Code)or that he is exempt tberefonn and DTV. PLUMBING PERMIT FEE T = the basis for the alleged exemption.Any violation of Section 7031.5 _ STORIES TYPE CONSTR. .w by any applicant for a pefmil subjects the applicant to a civil penalty. ALTER-DRAIN& VENT-WATER (EA.) 4.00 of not more than five hundred dollars(5500).): C] 1,as owner of the properly,or my employ.,willi wages as BACK FLOW PROTECT:DEVICE 2,00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, 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 does such work FIXTURES-PER TRAP 4.00 $O.FT.FLOOR AREA TOTAL ACREAGE himself rethroughointended own employees, le.IL hd that such improve- mentsar1 his or employees, ees,or lalf,however,the building GAS-EA.SYSTEM-1'INC.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 LOON PB Omer ,prove for 1.as ownerose olf the p INDUSTRIAL WASTE INTER.- 20.00 C] � E ❑ L as owner of the property,he exclusively contracting with licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS-.1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Use does nor.apply to an owner of property who builds or improves thereon,and who LAWN SPR IN RS`OVER 5(EA.) 1,00 ' - contracts for such projects with a contractor(s)licensed pursuant to ' SEWER-SANT t/8.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. .BAP.C.for this - ,"Son WgTER EAR W/BJUH 4,00 , - s Date Owner WATER SHVSTTEVENTMal 4.00 ACC.DATE ACC.FILE NO. t 'I WORKERS'CONIPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I heathy affirm that I have a certificate of Consunl to sel Plnsom,. u1 - - ZONING or a certificate of Workers'Compensation Insurance,or a certified - ENG.SITE NO. copy thereof Sec. 900,Lab.C.I r'� Policy N mpany.L.J=d, U 0 ❑ Cyy'ftifled copy is hereby firnished. - FIRE SPRINK ENERGY T-24 z Z 21('erlifi'd c y' i fit J w'h the city i,I pec Ion')v`ki n. MISC.- REFER TO ORD. O Applicant -�LLFj- Y E] N� V❑ NE] to PERMIT ISSUANCE 6.00 LU CE R'1'1 FJ CA'f TION PROM WORKERS' FLOOD ZONE AT.U.C. W COMPI7NSA7'IONINSURANCF r PLG.CONTR. - LIC'.N0. PLG. CL 0 (This section need not Abe Completed if the permit is for one TOTAL Y .NY ❑ NE] Z) Z hundred dollm(S 100)or less.)' 0 O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. '� 0- Dare Applicant - ALTER OR ADD TO MECH. 4.00 BUILDING ' } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- F ? emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Cade, you must forthwith comPlY with ;FEE such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC,FEE- I hereby affirm that 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.L' HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Nome HEATING UNIT(OVER 100,000 B.T.U.)7.50 Lender's Address - ELECTRIC - I certify that I have read this application and slate that lire above VENTILATION FAN (SINGLE) 3.00 information is correct. I agree to comply with all city and county - .PLUMBING ordinances and slate laws relatingtobuilding Constriction, and BOILER-COMP H.P.or100,000B.T.U.) 4.00 7, '- acreeof this purposes authorize representatives ec this city es enter upon 'the above--mentioned property forinspection BOILER-COMP (Ovm 100,000 BTU)SEE FEE SCH. MECHANICAL •- '7 '�� ' . (We) agree to save, indemnify and keep harmless the City of MISC.- .REFER TO ORD. Cupertino against liabilities,judgments, Costs and expenses which PERMIT ISSUANCE 3.00 s. CONST.TAX mccruay in any way ."Re against said City in C. Sq.. a of the ) - gra ingofthis per mit / MECH.CONT. LIC.NO. I MECH. , TOTAL TOTAL 7-- Signature of Appman Conhudnr Btu /"(L�y-T / - OFFICE COPY