4670 CITY OF CUPERTINO INSPECTION RECORD
• - (OFFICE COPY)
4670 10689 D Maplewood Road
• PERMIT NO. D �I NO—
Remodel/Elec. Property services
PROJECT OWNER
PERMIT ISSUED DATE ELECTRICAL DATE INSP.
ui ing
E e� ctrica
Plumbing Power 'Pole
Mechanical Underuound
emp Gas/Elec ou irin
Solar Walls
Fire rin c er Ceiling
ign Pixtures Int/Ext
otors
Misc. Groundin
e ower
Other
FINAL INSPECTIONS DATE INSP, Not :ApproveT
Gas
Electric - g
AM ing PLUD4BING DATE INSP.
7—cFian—iccaT
.
oar Backflow
oo er roan
Grading Mer
oor
Planning Partial Rough
Fire Dept. Rough Complete
Hea pt. Solar ou
cull in Water '6 Insulation
Other
o ain
as
,Other
BUILDING DATE INSP, Not Approved
Pad Certification
Tour =tion ELECTRICAL DATE INSP.
re- unite
1S a - m rane Underfloor S.M.
Bond eam __ Ducts nsu ation
Underfloor Girders ire D -
ers
Floor Steel ZEe ace
T"iedowns Grease nuct o0
N rams One our a -t
�eismec Brracin Condensate Drain
Walls- anels Equipment Anchorage
Frame / Plues comb. Air
3t
Other
K oar Int/Ext. of prove
Firewa s
Other
Not rove
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON
• APPLICATION & PERMIT PERMIT,NUMBER
BUILDING
ADORE T
6
O
A .4p BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER PLAN CHECK VALIDATION
NAME _ OTY. ELECTRIC PERMIT FEE
. .,ZC PHOrvE
TR c7o s
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
(.IC ND. LIGHTING FIXTURES 5.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS
6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.ORENc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
WADDREss
9 -, ZaP EMP.METER OR POLE INS- 15.00 C`
APPLICANT s MOTORS SEE FEE SCH. J
ADDRESS
o0i / `U
SERVICE CHANGE 10.00 513/ 3
Foo LICENSE iD C NTRACTORS DECLARATION
G
U8 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
N rt w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F w z Professions Code,and any license isin full fierce and effect ® ❑
z o - License Class Lie Number LEI
o z F Uatc Cornractor
M BUILDING PERMIT
a w ¢ OW'NIi R-BUILDER UECL,\RATION N N
U REF R OO D
w3 u N I hereby affirm that 1 am exempt from the Contractor's License MISC.- L A O SIFT.
.. oa Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE L"
- Code:Any city or county which requiresa permit toconstruct,alter, ,.{
W¢Q IS 0 improve,demolish,or repair any structure,prior or its issuance,also ELEC.CONTR. _ LIC.NO, ELEC n U el ll 0
D u, requires the applicant for such permit t0 DIC a signed statement that TOTAL/, ,C)e PERMIYT
X m he is licensed pursuant m the provisions of the Contractor's License a/� 4
i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
E ¢ O STORI S TYPE CONSTR.
ac o the basis for the alleged exemption.Any violation of Section 7031.5
ate _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not more than five hundred dollars(5500).):
O I,as owner of the property,car my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCG GROUP I 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
CodeThe Contractor's Licnhsc Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 sD.FT.FLOOR AREA TOTAL ACREAGE
. but or through his own employees,provided that such improve-
menu are not intended or offered for sole If.however.the building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 100 BUILDING USE
builder will have the harden of proving that he did not build . . .
or soil' REB IND CDN PB Omer
prove for purpose of sale.T INDUSTRIAL WASTE INTER. 20.00
O I,as owner of the property,am 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 Law does not apply
to an owner of property who builds or inhproves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contractsf'orsueh projects with a contractors)Licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ 1 am exempt under See.-,B&P.C.for this WATER HEATER W/VENT 4.00
hcmo
pate /1_.�Dwner `lJ. WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
% I[ON G1L
WORK RRS'coNPFNERsn10N D-�chn R,Yl'ION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate of Consem m self-inaure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thercof(See.3800,Lab.C.).
Policy No.-Com, y
Q ❑ certified Copy is hereby furnished. FIRE SPRINK ENERGY T�24
Z_ Z ❑ Certified copy is filed with tiro city inspection division. MISC.- REFER TO ORD. Y No Y N�
Applicant
F - PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
CERTIFICA'ri:01'EXEMPTION FROM WORKERS'
W _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. v N� Y N�
CL o (This section need not be completed if the permit is for one TOTAL
D Z hundred dollar,IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
OU become subject to the Workers'Compensation Laws of California. BUILDING � Q
CpV
Date Applicant ALTER OR ADD TO MECH. 4.00
} N NOTICE TO APPLICANT: 11,after making this Certificate If 1!x-
2 emption,you should become subject to the Workers m
Copensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be decnmd 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 �O
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(See. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Co.C.).
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I certify that I have read this application and slam that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree.to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building imOuct ion, and
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-nhentioned property for inspection purposes.
(We) agree•e 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 CONST.TAX
may in any way accrue against said City in consequence of filo
gradingofthhs permit. MECH.CONT. LIC.NO. MECH.
Sig /�Pl�//���` ��j• n-30-Q) TOTAL TOTAL
.;, pphcantZ.o ntractor Uete
OFFICE COPY