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2475- CITY of CUPERTINO 0 INSPECTIOL' RECORD (Offic Copy) 1 �s- . Rou ,h Com lete / - I -later & Insulation Main Drain PUPdI 'r NO. SANITARY DIST. NO. LOT N0. ADI ,SS Other Renair Not Approved y>ary Campbell 446-6143 PROJECT OWNER JOB SITE P11014E NO. PERMIT ISSUED Date ELECTRICAL Buildinc //9➢211 Date I Insp. Plumbing Mechanical Temp. Cas/hlect. Solar Aire Sprinkler Sign FINAL. INSPECTIONS BUILDING Date Insp. Pad Certification Foundation Pre-Gunite Slab -Membrane Bond Beam Underfloor Girders _ Floor Steel Tiedowns Diaphrams Seismic Bracing Valls-Panels Frame Lath walls r Ll - Po ro WI flotors Grounding Temp. Power Other Not Anoroved PLUMBING Date Backflow Insp. Underground _ Underfloor _ Partial Rough Rou ,h Com lete / - I -later & Insulation Main Drain R/of/S Drain Gas . Other Not Approved MECHANICAL Date Underfloor S.M. Insp. Ducts & Insulation Fire Dampers _ Fireplace Crease Duct & flood One flour Shaft Condensate Drain Equipment Anchorage Flues & Comb. Air Other Not Approved 0 BUILDING • ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY _I BUILDING PROJECT APPLICATION &PE T BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER X475 BUILDING ADOREss _20/( --` r OWNER'S ' "AME _ PHONE - QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION - CONTRA ORS _ C a uc. No. J OUTLETS-SWITCHES -RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 nooRessTOR� I PPLIANCES-RESIDENTIAL• 4,00 / PHONE 3 / PANELS " 5.00 DATE OF APPLICATION _ ARCHITECT ENGINEER LIC. NO. SIGNS B.0O PLAN CHECK FEE P.C. NO. ' SIGNS TRANS. 3.00 ARCHESS RENO ' SPECIALCIRCUIT 4 - '5.00 PERMIT VALIDATION . I ZIP TEMP. METER OR POLE INS. 15.00 APPLICANT ESS r$ MOTORS ' SEE FEE SCH. SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION qISSUANCE I hereby affirm that I am licensed under provisions of Chapter') (commencing with Section 7000) of Division 3 Of the Business and 510115 COdC,. R my license is in full for and effect. License Licau ' I ss' Lic. Num her DATE - - - B DG. J ELECT. ❑ PLG. MECH. ❑ Dote Contractor -`- BUILDING PERMIT INFORMATION OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Professions Business to Law for the following rey which Code. Any city or county which reyuiresa permit to constnmq alter, improve, demolish, or repair any structure, prior l0 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 ofthe Business and Professions Code) or that he is exempt therefrom and MISC.- REFER TO ORD PERMIT ISSUANCE 6.00 VxAAL_U_.A�TIOSN. 7` U v V $/FT. ELEC. CONTR. LIC. N0. ELEC. TOTAL PERMIT TO rr�� �L_ I1 � /-' OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects ilia applicant toa civil penalty of not more than five hundred dollars ($500).1: I gLTER-DRAIN&VENT-WATER (EA.)4.00 L- ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and tile structure is not BACK FLOW PROTECT. DEVICE 2.00 OCC. GROUP RES. UNITS DRAWS -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 ' SO. FT. FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who docs such work himselfor through his own employees, provided that such improve. meats are not intended or offered for sale. If, however, the building GAS - EA. SYSTEM -1 INC.4 OUTLETS 4.00 or Improvement is sold within one year of completion, the owner - builder builder will have the. burden of proving that h e did not build or im- prove 1, as ownerose of the.). ❑ I, as owner of the property, am exclusively contracting with . .. - EASYSTEM -OVER 4 IEA) 100 BUILDING USE RES IND CON PB orM1ar ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 20.00 licensed contractors to construct the project (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 LAWN SPRINKLERS - 1 INC 5 V.B. 5.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. . contracts for such projects with a contractons) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/8.00 TRACT NO, PARCEL NO. ❑ I am exempt under Sec.., BAP.C. for this reason WATER HEATER W/VENT 4.00 Date Owner WATER SYSTEM 4.00 ACC. DATE ACC, FILE NO, WATER TREATING EQUIP. 4.00 WORKERS'CODIPENSAI'ION DECLARATION 1 hereby affirm that I have a certificate of consent to salf-insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE N0. copy thereof (Sec. 8 0, Lab.C.)51 .L (, Policy N mpany f M_.(_-.0 Certified copy is hereby furnished. I p Cer' py is filet pection division. MISC.- REFER TO ORD. FIRE SPRINK v ❑ N ❑ ENERGY T24 v N ❑ ❑ CERJ.IF CATS 01: EXEMPTION OM WORKERS' PERMIT ISSUANCE 6.00 - FLOOD20NE A, L.U.C. COMPENSATION INSURANCE fThis section need not be completed if the permit is for one PLG. CONTR. LIC. NO. PLC. da TOTAL �0 Y ❑ N Y ❑ N ❑ hundred dollars IS 100) or less.) 1 certify that in the performance of the work for which this per mit is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY 'BUILDING .� 446S� become subject to the Workeri COmpensal ion Laws of California. Date ApplicantALTER OR ADD TO MECH. 4.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE 4.00 AIR HANDLING UNIT (TO 10,000C.F.M.) 3.00 PLAN CHECK FEE 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 be deemed revoked. AIR HANDLING UNIT (OVER 10MC.EM.)5.00 SEISMIC FEE ,S"$ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) - 2.00 the 3097LCv.C.jnce of the work for which this permit is issued (Sec, MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name HEATING UN IT 100,000 B.T.U.)7.50 ELECTRIC "Lender's Address VENTILATION FAN (SINGLE) 3.00 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING / BOILER- COMP (3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP (Over 100,000 BTU) SEE FEE $dH. MECHANICAL hereby authoto, representatives of this city to enter upon the above mentioned property for inspection purpoxs. " MISC. - REFER TO ORD. PERMIT ISSUANCE 3.00 CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may any way accrue against said City in consequence of fila g In this permit I MECH. CONT. LIC. NO. - MECH. TOTAL TOTAL -ter Slg a Of APPe innn 't Da OFFICE COPY