1135CT 1'Y 017 CUP17111INO III SPECTIOP RECORD (office'Copy)
/ 1135 6660 John Drive
PI;Pd1IT No. SANITARY DIST. N0.
. Reroof
PROJECT
PERMIT ISSUED
Building.
Electrical
plumbing,
Ifechnnica.l
Tcmp. Gns/17,lect.
Solar
Fire Snrinkler
FINAL INSPECTIONS
LOT NO. ADDRESS
S. Merchant 255-2713
OWNER JOB SITE PHONE NO.
Date II ELECTRICAL
BUILDING
Date
Pad Certification
Insp.
Foundati.nn
_
Pre-Gunite
Slab-1lembrane
--
Bond Beam
Underfloor Girders
Floor Steel
Tledowns
Di.aphrams
Seismic Bracing
_
11al.ls-Panels
Frame
1,n t h
11allboards Int/Ext.
Pirewalls
Other
Not Approved
0
d
Date
Power Pole
Insp.
Underground
_
Rou ;h Wiring
Walls
--
Ceiling
Fixtures int/Ext
Notors
Grounding
Temp. Power
Other
_
Not Approved
PLUMBING
Date
Backflow
Insp.
Underground
_
Underfloor
Partial P.ouIzh
Rough Complete
Solar Rough
Water & Insulation
Main Drain
R/of/S Drain
Gas
Other
Not Approved
11ECIIANICAL
Date
Underfloor S.M.
Insp.
Ducts & Insulation
_
Fire Dampers
Fireplace
Grease Duct & hood
One (lour Shaft
Condensate Drain
Equipment Anchorage
Flues & Comb. Air
Other
Not Approved
A+.'PLICANT TO FILL IN INFORMATION WITHIN -RED LINES - USE BALL-POINT PEN ONL�1
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
P R BER
.1 �1
mLOINc
ADDRESS
i
Co 3o r lvL- .
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
_
-
I lKJ �
0 ER'S
NAME
M 4 (�
as V \ \ -C PMONE
___ ___
- - - - ' -- -
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
'
NAMERACTORs
UTLETS- SWITCHES -RECEP 5.00/1.00
LIGHTING FIXTURES 5.00/1.00
- LC.NO.
_ -
CONAessTOR's -
APPLIANCES - RESIDENTIAL 4.00
PANELS 5.00
' PHONE
DATE OF APPLICATION
ARRCHITECT -
ENGINEER
" sec. No.
SIGNS ' '6.00
PLAN CHECK FEE P. C. NO.
SIGNS TRANS.. - - 3.00
ADD RESS ENG. ..
SPECIAL CIRCUIT -5.00
PERMIT VALIDATION
EMP. METER OR POLE INS. 15.00
ZIP
'
APPLICANT
ADDRESS -
- MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00 - -
-
.f
LICENSED CONT RACTORS DECLARATION
Y
-
1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing wi[h,5ection 7000) of Division 3 of the Easiness and
Professions Code, and my license is in full force and effect
License Class Lic. Number
ISSUANCE DATE -
- -
BLDG.
ELECT.
❑
PLG. MECH.
❑ ❑ .
Date Contractor
1
- OWNER -b UIL111iR DECLARATION
1 hereby` iffirn that I am exmnpl from the Contractor's License
Law for the following reason. (Sec. 7031.5, Businessand Professions
-Code: Any city or county which requiresa permit to construct, alter,
BUILDING PERMIT
INFORMATION
MISC.- '' ''REFER.TO ORD
_
I PERMIT ISSUANCE 6.00
VALUATION
/ oO0
$/FT.
-
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL'
Improve, demolish, or repair any structure, prior to Its Issuance, alio
requires the applicant for such permit to file a signed statement fiat
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 I'rrsl'essim,s Codd or that he is exempt therefrom and
PERMIT T0. -
pp
,Qe400,i M1�S
OTY. PLUMBING PERMIT FEE
the basis for the alleged exemption. Any violation of Section 7031.5
STORIES
TYPE CONSTR.
by any applicant for a pernit subjects the applicant to a civil penalty
Of not more than five hundred dollars (5500).1:
ALTER -DRAIN -WATER (EA.) 4.00
❑ 1, as owner of the properly, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 2,00
-OCC. GROUP
RES. UNITS
_ DRAINS -FLOOR, ROOF, AREA,CON D. 4.00
-
intended or offered for all (Sic. 7044, business and Professions
Code: The Contac rr's License Law does not apply to an owner of
Property who builds or improves thereon, and who does such work"
himself' or through his own employees, provided that such improve-
mprove•mentsarcnotintendedmofferedforsale. IL however, the building
ments an not intended moffelred for sale.
-
-
FIXTURES -'PER TRAP ' 4.00
50. FT, FLOOR AREA
TOTALACR•EAGE
_
_
GAS - EA. SYSTEM -1.INC.4 OUTLETS 4.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that h e did not build or im-
prove 1. aso neeose of role.).
❑ I, as owner of the property, am exclusively contracting with❑
.
GAS - EASYSTEM -OVER 4 (EA.) 1.00
BUILDING USE
RES IND CON PR ' OIM1er
❑ ❑ -'❑ ❑,
INDUSTRIAL WASTE INTER. 20.00. '
licensed contractors to comtuct the project (Sec. 7044, business
and Professim,e Code: The Contractor's License Law Apes 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 N0.
contracts for such projects will, a contactmos) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/8.00 _
TRACT NO,
PARCEL NO.
9I taroeNempunder SPC. ,b.&P.C. for
reason L
-
WATER HEATER WIVENT' 4.00
D _
ai Owner
WATER SYSTEM:- 4.00
ACC. DATE
ACC. FILE NO.
WORK ERS'COMPENSA'rION DECLARA-1' ION'
WATER TREATING EQUIP,' 4.00
hereby affirm that I have a'certificate of consent to self -insure,
or a cer ificate of Workers' Compensation Insurance, or a certified
-'
- ZONING
ENG. SITE NO.
copy Ihereof(Sec. 3800, Lab.C.),
Policy No. Company
❑ Cmlified copy is hereby fumished.
❑ Certit'icd copy is, Filed with the city inspection division.
Applicant
FIRE
FIRE SPgINK
Y ❑ NE]
ENERGY T-24
. Y ❑ N ❑
ER TO ORD:
CIFRTIFICATE OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 6.00
FLOOD ZONE
A.L.u.C.
CONIPENSATION INSURANCE
(This section need mol hi completed if the permit is (ser one
Y ❑ N❑
Y ❑. N❑
PLG.CONTR. LIC. NO.
PLG.
TOTAL
hundred dollars (5100) or less)
I certify thin in the performance of We work for which Ibis per-
mit is issued, I Shall not employ any person in any m:umer so as to
DTV. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
171
7
become subject to the Workers Compensmion Laws of Califomla.
Date Applicant'
NOTICE '10 APPLICANT: If, after making this Certificate of lis-
•4 LTER'OR ADD TO MECH: 4.00
- APPLIANCE 4.00
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 shell be deemed revoked.
AIR HANDLING UNIT (TO 10MOC.F.M.) 3.00
AIR HANDLING UNIT (OVER 10MC.F.M.) 5.00
SEISMIC FEE
' CONSTRUCTION LENDING AGENCY
Thereby 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.
3097, Civ.C.l.
MICROFILM
'
HEATING UNIT(TO'100,000 B.T.U.)' 4.00
Lender's Name
HEATING UNIT (OVER B.T.U,)7.50
ELECTRIC
Lender's Address
VENTILATION FAN(SINGLE) 3.00
I eerily that l have read this application and stmellimocabove
nfornmion is correct. I agree In comply with all city end county
ordinances and state laws relating to building construction,, and
PLUMBING
- BOILER- cUMP 13H.P.or.100,000B.T.U.) 4,00
BOILER-COMPIOwn 100,000 BTU) SEE FEE SCH.
-MECHANICAL
-
hereby uutlmriae representatives of this city Io -clot upon the
above mentioned property for inspection purposes.
(We) agree to save, indemnify and keep ImrnlLS, the City of
MISC. - - REFER TO ORD.
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against said City in conseq Rear, of the
granjg(if j�Ill pormlt'
1 V p-Pn C.Inael.,1
PERMIT ISSUANCE 3.00
CONST. TAX
-
MECH. CONT. LIC. NO.
MECH.
TOTAL
-
TOTAL
SlBkal r1s c ofA'pPlicant/Comrator � ate
.
-' _ , OFFICE COPY -