2100 C11'Y 01' CUPERTINO INSPECTIOV RECORD (Office Copy)
2100 21899 T.indy Lane,......_
PEP11IT NO. SANITARY DISI. N0. LOT N0. ADDRESS
v
:• Pool & Retaining Wall Chuck Hunner
PROJECT Oi•@IER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Building 6-22-82 Date Insp.
Electrical 6-22-82 flower Pole.
I'Iumbing 6-22-62 Underground
Hechnnieal 6-22-62 P.ou ;h 1•lirin _
'Temp. Cas/I,lcct. flails
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Ilisc. Temp. Power _
Other
FINAL. 114SPECTIONS Not Approved
Date Insp.
r r,s PLUMBING
Electric Date Insp,.'
P�
Plitmbin , Backflow _
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Crading Rough Complete
Planning, Solar Rough
Fire Dept. Water & Insulation
Health Dept. *lain Drain
Building R/of/S Drain
Other Gas
(ether _
BUILDING Not Approved
Date Insp.
I`ad Certification MECHANICAL
Foundation Date Insp.
Pre-Gun ite Underfloor S.M.
Slab-Hembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & flood
Tiedowns One flour Shaft_
Diaphrams Condensate Drain
Seismic Bracini> Equipment Anchorage
Walls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Wallboards Int/Ext.
Firewalls
Other
Not Approved
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BUILDING '
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
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APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY ' �-
BUILDING PROJECT IDENTIFICATION PERMIT u
BUILDING APPLICATION & PERMIT OO
ADD 55
Wzz"Y'al BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
ER'S - PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
PHON
NAMER CTORS UTLETS-SWITCHES•RECEP 5.00/1.00
T M1 ��^1J • FQ c.No kt�3-4 LIGHTING FIXTURES 5.00/1.00
r-ONTRACTORS PPLIANCES-RESIDENTIAL• 4.00
ADDRESS
3� n' 5 ��. ^IN PHONE Q 1 PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P,C.
�[ p
/ E � Q " i uc.No. ��(p� SIGNS TRANS. 3.00 -
AARCH,OR DDRESS ENG, SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00
AS - MOTORS SEE FEE SCH.
ADDRESS
p .
tIS2-•Zte
� 01"'LL SERVICE CHANGE 10.00 ¢
° a CITY OF CUPERTIN
F o o LICENSED CONTRACTORS DECLARATION _ ll
Be I hereby affirm That I am licensed under provisions of Chapter 9 OCJ 4 L ISSUANCE DATE
H < (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. 1 PLG. MECH.
r D Professions Cod¢,and m license is in full fore iRd eft L 11 IN 2 2, 1982
z i 2 G License Cla s Lie.Number 5 u
o Date�Contructor
xf � fP"�'^'�%t' - BUILDING PERMIT
K arw OWNIiR-BUILDIiR UIiCLARATION _ INFORMATION
X ; u- H 1 hereby affirm that I am exempt from the Contractors License MISC.- ER TO ORD
r a.ow VALUATION $/FT.
e Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00
as Code:Any city or county which requires a permit to construct,alter, /{p
IS Q FO improv4 demolish,Or repair any sVUClure,prior to its issuance,x150 ELEC.CONTE. LIC NO. ELEC. �0
i °Be requires the applicant for Such permit to file a signed Statement that TOTAL L� PERM T TO
w $ he is licensed pursuant to the provisions of the Contractor's License f � /�M�
H I > Law(Cha and
Professions
Code)a,Section is exempt
theron 3 of the I//+IIT
a Ist
Business and Professions Code)or Thal he is exempt echo 70 and DTV. PLUMBING PERMIT FEE
¢'� ° the
nyaporthea ora exemption,Any'The applica o to aclium malty STORIES NS
by any applicant fora undreddollars($50).): annoacivil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(5500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 DLL.GROUP RES.UNITS
their Sole compensation,will do the work,and the Structure is not
intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO,FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve.
mon is are nut intended or offered fill sale.If,however,the building GAS-EA.SYSTEM•.11NC.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 purpose
the burden of proving that he did not build or im- RES IND CON PB Omer
prove for purpose of stheJ' INDUSTRIAL WASTE INTER. 20.00
5 ❑ d as owner of the property,am exclusively.7044,Bu with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct to�'s License
(Sec.7044•Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORSP CEL NO.
and Professions Code:The Contractor's License Law does not apply �P
to anowner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 rJ .rT��
contracts for such projects with a amlructorl s)licensed pursuant to Mftm
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT No. PARCEL No.
❑ l am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKF-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of consent to set-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONI ENG.SITE NO.
Q � copy thereof(See.3800,Lob,C. ^ � O w
Policy No. ComPan y +-AJta�P+
❑ Certified copy is hereby l'with Mile %ci i.1 1y/A FIII!•eImRK
Z ❑ Certified copy is fled with the nny mspectidl Ilvlsl MISC.- REFER TO ORD. .�y�-1 -NIbJ
O Applicant - LJ ,.CI
� y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE Y. --
LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLO:
(LCl (This section need not be complcjed if The permit is for one TOTAL p26 V❑ N
D 2 hundred dollars($100)or less:)
U O I certify that in the performance of Du work for which this per, GTV MECHANICAL PERMIT r 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'CompensationLaws'of Calibonia.
Uate Applicam - BUILDING 0
LU ALTER OR ADD TO MECH. 4 -
z emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK Q
provisions of the Labor Code;you must forthwith comply with FEE
(.7 such provisionsor this permit shall be decmed.revoked. AIR HANDLING UNIT(TO 10MCF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 5.00 SEISMIC FEE 3 '
I hereby affirm that there is a construction lending agency]or EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. - HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Cw.CJ.
Lender's Name HEATING UNIT IOV ER 100,000 B.T.U.)7.50
Lender's Address - ELECTRIC 7. ..i
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct I agree no comply with all city and county PLUMBING
iordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOve;100,000 BTU)SEE FEE SCH. MECHANICAL ry
above-mentioned property for inspection purposes. / ✓
k (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 VZO 0 CONST.TAX
may in any way accrue against Said City in con uq Renee of the
ranlio ofit rail. ^, MECH.CONT. LIC.NO. MECH.
!M TOTAL 7 0� TOTAL 'r-3 F`Y
Signature of Appanl/Cnntraclor Date r /
OFFICE COPY