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13371337 �! PERMIT 110. CITY OE CUPERTINO INSPECTION RECORD (Office Copy) JU 7515 Kirwin 9 SANITARY DIST. NO. LOT NO. ADDRESS " Slodki PROJECT OWNER Date Building 11-20-81 Electrical Plumbing Mechanical Temp. Gas/Elect. Solar Fire Sorinkler Sign Misc. FINAL INSPECTIONS Date Insp. Electric Plumbing Mechanical Pool •Grading Planning .Fire Dept. Health Dept. Building Other STRUCTURAL Date Insp. Pad Certification Foundation Pre-Gunite Slab -Membrane Bond Beam Underfloor Girders Floor Steel Tiedowns Diaphrams Seismic Bracing [Malls -Panels Frame Lath Wallboards Int/Ext. Firewalls -•Other Not Approved v .N�:, JOB SITE PHONE NO. ELECTRICAL Date Insp. Power Pole Underground P .ouggh [Tiring falls Ceiling Fixtures Int/Ext Motors Grounding Temp. Power Other Not Approved P=B ING Date Insp. Backflow Underground Underfloor Partial Rough Rough Complete Solar Rough Water & Insulation ".fain Drain R/of/S Drain Other Not Approved MECHANICAL Date Insp. Underfloor S.M. Ducts & Insulation Fire Dampers Fireplace Grease Duct & flood One Hour Shaft Condensate Drain Equipment Anchorage Flues & Comb. Air Other Not Approved APPLICANT TO"FILL IN INFORMATION WITHIN RED LINES-, USE BALL POINT PEN ONLY eU1LDING PROJECT IDENTIFICATION -APPLICATION & PERMIT ' PERMIT NU ER am S 1 OGRESS ' BUILDING - ELECTRICAL- PLUMBING - MECHANICAL. PLAN CHECK VALIDATION' OWNERS NAMEOTY. ELECTRIC PERMIT FEE ' PHONE t I CONTRACTORStOUTLETS-SWITCHES -RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 LIC. rvo. 11 - DATE OF APPLICATION ' ADDRESS ADTORs Lt B 6F..NE� �� APPLIANCES -RESIDENTIAL 4.00 PANELS 5.00 ARCHITECTSIGNS. OR ENGINEER LIC. No, 6.00 PLAN CHECK FEE P.C. NO. ' SIGNS TRANS. � � 3.00 ARCH. OR ENG, ADDRESS - - SPECIAL CIRC -5.00 PERMIT VALIDATION EMP. METER ORP 15.00 Mb - _ ZIP APPLICANT s ADDRESS MOTORS SCH. SERVICE CHANG = j), 10.00 - 99 . -LICENSED CONTRACTORS DECLARATION 1 hereby affirm that Dam licensed under provisionsof Chapter.9 (commencing with Section 7000) of Division 3 of the Business and Professions Co(Ify a=l my I se Is In full fore and effect. License Qass _ 1-ic. Number ISSUANCE DATE - BLDG. ELECT. PLG. MECH. - Date N no, � I q BI Contractor BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION. - 1 hereby collo that 1 am exempt from the Contractor's License Low for the following my which .ichec. 70315, Basin eseund Professions also alter, Code: Any mulish eau my nrequiters permit riot toconstruct,issuance, improve, demolish, or repair any Structure, prior to its issuance, also requires the applicant for such pemtit to files signed statement Li ase the provisions of the Contractor's License he is licensed 9 (commencing Law (Chapter 9 (commencing wish Section is exempt xe of Division 3 of the It stress ees and Professions Code) or Ilett he is therefrom and '' MISC.'- REFER TO ORD VALUATION �� (". 141 `-/ 7 S/FT. PERMIT ISSUANCE 6.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO GTV. PLUMBING PERMIT FEE STORIES,; TYPE CONSTR. the basis for the alleged exemption. Any violation of Section tion of any malty by et on.rticant fora hundred dollars $5000.he licunLlaia civil penalty of not more than five hundreJ Anllare (EE00).1', , ALTER -GRAIN & VENT -WATER (EA.) 4.00 - - VENT-WATER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK F LOW PROTECT. DEV ICE 2.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF,AREA, COND. 4.00 intended or offered for sole (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improve- , ments are not intended or offered lot sale. If, however, the building FIXTURES - PER TRAP 4.00 SO. FT. FLOOR AREA TOTALACREAGE GAS - EA. SYSTEM-11NC.40UTLETS 4.00 1 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or no. off theJ. prove 1, as ofoi wner ❑ as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 1.00 - BUILDING USE RES 'IND CON PB One, ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. - 20.00 licensed project(La riles odappss adPro contractors it The Contractor's and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, anti who LAWN SPR INKLER$-1.INC'5 V.B. - 5.00 ASSESSORS PARCEL NO. - LAWN SPRINKLERS -OVER 5 IEA., 1.00 - contracts fnr such projects Willa contractors) licensed punnitnt to theContrector'sLicenseLaw. SEWER -SANITARY -STORM EA. 200ft/6.00 TRACT NO. PARCEL NO. ❑ 1 am exempt tinder Sec. ,B.&P.C. for this reason - WATER HEATER W/VENT 4.00 Dare 'Owner WATER SYSTEM - 4.00 ACC.DATE ACC. FILE NO. WATER TREATING EQUIP- 4.00 WORKERS'COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to Sel4in ora certificate of Workers' Compensation Insurance. of a certifiedsure, ZONING ENG. SITE NO. copy thereof(Sec -1800,1-ab.C.I I k rUYI CI Policy No.' Company ❑ Certified copy ishercby furnished. yggqqq qq� ( y('Cenif �d copy is filed with the city idspecfionvixion. Applicant_ -a.. , , i Vuae'rWL._ FIRE SPRINK _ y ❑ N ❑ ENERGYTY9 - y ❑ N MISC.- REFER TO ORD. CER'I'I FICA 11; OF I!XEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A. L. u.c. PLG. CONTR. LIC. NO. - PLC TOTAL COMPENSATION INSURANCE (This sectidn died not be Completed if the pennit Is for one v ❑ N❑ y ❑ N❑ hundred dollars IS 100) or less.) ' I certify that in the performance of the work for which this per. mit is issued. I shall not employ any person in any manner sD as to CITY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING S -(J become subject to the Workers' Compensation laws oICalifornia. Date'Applicant NOTFE 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 Shull be deemed revoked. ALTER OR ADD TO MECH. - 4,00 ApPCIANCE - 4.00 AIR HANDLING UNIT (TO 1OJ10DC.F.M.) 3.00 PLAN CHECK FEE AIR HANDLING UNIT (OVER 10,000OF.M.) 5.00 SEISMIC FEE CONS'FRUCfION LENDING AGENCY 1' hereby affirm (iiat there is a construction lending agency for EXHAUST HOOD -WITH DUCT) 2.00 the performance of the work for which this permit is issued fSec. 3097, Cis.C.). - - MICROFILM - HEATING UNIT (TO 100,000 B.T.U.)., 4.00 HEATI NG UNIT (OVER 100,000 B.T.U.)7.50 ELECTRIC - Leder'sName Lenader's Address - VENTILATION FAN (SINGLE) - 3.00 - i certify that I have read this application and state that the above - information is correctl agree to comply with all city and county ordinances and stale laws relating to building construction, and PLUMBING BOILER -COMP(3 H.P.Or 100,000B.T.U.) 4.00 BOILER -COMP IOve, 100,000 BTU) SEE FEE SCH. MECHANICAL ,hereby authorise represcnmtivos'af this city to enter upon. the above-mentioned property I'urinspection purp(ses. _ MISC.- REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments. Costs and expenses wfuel) may in any way accrue against said City in consequence of the PERMIT ISSUANCE -3.00 grantilspf this permit. // /y OI Qom( ./` �.g �dD�B/ \ Signature of Applicant/Contra 7t- Date MECH. CONT. LIC. NO: MECH. TOTAL TOTAL OO OFFICE COPY