5637 CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
IOloG�PERMIT 9-!A
ADDFhsb
96vedd=L1 UYK i 1tir aUru
PERMIT ISSUED DATE ELECTRICAL DATE INSP.'
ui�'Tdin
ctrica
Plumbing — Power Pole
mechanicaler tm
STS
e as ec ou _ffi
Solar Walis
Fire SprUMTe—r --- ei_ zn
Sign res Int/Ext
otors _
Misc. Gunding
1re�2 P—ower
Other
FINAL INSPECtIONS DATE INSP, Not rove
Gas
Electric
um manPLUMBING DATE INSP.
ica
Wolar Backflow
Pool Underground
Gradmg Undertloor
Planning arti ou
ire a t, u o ete
eat a t, aru 1
Building - Water *4 Insulation
et�T r main
17-517=aIn
Gas
Other
BUILDING DATE IN%P. Not Approved
Pad Certification
oun anon ELECTRICAL DATE INSP.
re- unite
gaU-Ye- rane Underfloor S.M.
Bond Beam cts nsu ation
Undeftloor it ersire ers
Floor tee ire ace
ie owns 6rease Duct 4 Hood
rem— e our t
eismec racin Condensate rain
s- ane s ui ment Anchorage
Frame Flues om . Air
.a ter
aiiboarLs lnt/Ext. Not Approved
crew s
Other
Wet Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Pti
BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING 'APPLICATION & PERMIT '
ADDRESS t
/06�-• _ /.� BUILDING -:ELECTRICAL-PLUMBING-MECHANICAL ,5637
DwrvEn'S F•s + PLAN CHECK VALIDATION
NA n_ yQ ��5692aQTV1 Si'^'t As a 1ELECTRICjPERMITaRi6ln �.'.«a,��%E(}' -
1061, . .:?G UI{y�kiNE '
CONTRACTORS OUTLETS-SWITCHES-RECEP 5.00/100
NA
No. LIGHTING FIXTURES 5.00/1.00 n
CONTRACTOR'S. APPLIANCES-RESIDENTIAL 4.00
• ADDRESS ,
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO. SIGNS TRANS.- 3.00
ARCH.OR ENO. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
.. "'ZIP EMP.METER OR POLE INS. 15.00
•,.4 APPLICANTS MOTORSSEE FEE SCH. S
ADDHLSS
SERVICE CHAN 10.00 %(/�
h w o o'•LICENSED CONTRACTORS DECLARATION -
u I hereby of firm That I an licensed under provisions of Chapter 9 ISSUANCE DA E
m ,w , (commencing with Section 7000)of Division 3 of the Business and juL 11 1w BLDG. ELECT. PLG. MECH.
"D¢ Professions Code,and my license is in full force and effect: n ❑ ❑
Z o.. La Class Lm Nu...be, - ,v. ,'.
o ze H w na(E Contractor City of Cupertino
BUI��s.QI�V�1,II��ERMl
OWN)R BUILDER DLCLARAI ION 41QX'ION
oa o i MISC ., REFER TO ORD
�,�u r I hereby.(firm that I am exempt from the C tractor s'Licenae _ VALUATION SIFT.
r-u-0 j_ Law for the following mason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE '6.00 i q uf A
Codc Any city oreounly which requireso permit lnconsl ruct,aller, .n
o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC:NO. ELEC. l' pv
O a, requires the applicant for such permit to file a signed samment that I TOTAL Z PERMIT TO
'6 m he is licensed pursuant to the provisions of the Contractors License
w -
rzrLaw(Chapter 9(ecturn eog with Suction 7000)offrvidiur 3 oftht
< Business and I'mlesa ons Code)or Out he s exempt therefrom and QTY- ' PLUMBING PERMIT'n+• 5 FEE O c G
f p the basis for the alleged exemption.Any violation of Section 7031.5 - ^N''#' STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN -WATER (EA.) 4.00
of nut more than five hundred dollar.,($500).)'.
❑ I,as owner of the Property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC,GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
'intended or offered for salt(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:'fhe Contractor's LiceP,c I.Pw does nut apply to an twice of - t
property who builds or improves thereon,and who does such work u FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
',ruentsare not intended or offered for sale,Ifhowever,thebulldfng GAS-EA.SVSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion,the owner GAS-EP..SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
P.vcfor purpose ofsale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON PB Omer
(a I,as owner of the p,o,rty,con exclusively contracting with '❑. ❑' ❑ ❑ ❑
'licensed cuntracton'to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contact'for such project,will,5 umtr:mtots)licensed Pursuant to
the Comractor's License L.w. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCELNO.
❑ IanexcrnPu.. Sec. - ,B.&PC.f..this WATER HEATER W/VENT 4.00
nasoI- - _ q
OwnL � x Dille11";,A WATER SYSTEM 4.00 - ACC.OATE • ACC.FILE NO.-
WURKIiRS'COMPIiNSA'1'ION DECLARATION WATER TREATING EQUIP. - 4.00
I hereby allirm thin I not a cerlificutu of consent to s,[Finour, - ZONING ENG.SITE NO.
- or a certificate of Workers'Compensation insurance,'or a-certified
copy thereof(Sec.3800.Luh.C.). -
Policy No. Company -
O' ❑ Certified copy is;hereby furnished. FIRE SPHINK ENERGY T 24
Z Z O Certified copy Is riled with the city inspection division. MISC REFER TO ORD.
O Applicant ! V❑ N❑ Y.❑ N❑
' N CIiR'I'119CA'I'Ii UI*IrIiMYI'ION FROM'WORKIiRS• PERMIT ISSUANCE 6.00 FLOOD ZONE, A.L.U.C.
W �_ COMPENSATION INSURANCE PLG.CONTR. - UC.NO. PLG..
CL o (I III, ,vection prod not he Completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z- hundred dnllars(810ol unless.)
L) O I certify that in the performance of the work for which this per-r
MECHANICALPERMIT " FEE- ='FEE SUMIMARY
LL P mit is issued, I shall nut employ any.person in any mariner so as to
U beeomesubjert P.The Workers'Compensation Laws al'Cal:fonia. - fi0-0 :
O w pate npplicuhs - BUILDING
u ALTER OR ADD TO MECH. '4.00
} N NOTICE TO APPI,ICANI If,after making this Certificate of fix- _
F Z eniptieP.you should become subject to the Warkeri CompensationAPPLIANCE 4.00 PLAN CHECK
pnrvisions of the Lebon Cnde,,ym, mus( forthwith Comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 -
CONS"fRUCPION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEEI hereby affirm that there is a cosmclion lending agency forEXHAUST HOOD(WITH DUCT)- 2.00 '
the performance III the work for which this permit is issued(Sec. MICROFILM
3097,Civ,C.L HEATING UNIT(TO 100,000 B.T.U.) 4.00 .
Lenders Name, I
Oil-
H EATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC o�
1 cosily Orabl have read this application and suit that the above VENTILATION FAN (SINGLE) - 3.00
irinamation is correct. I agree to comply with all city and county BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances' and state laws'RIPting to building construction, and
hereby authorize representatives of this city to enter upon the
/ above-mentioned property for inspection purposes. BOILER-COMP(Over t00,D008TU)SEE FEE SCRMECHANICAL
. '
(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 CONST.TAX
may in any way acerni,.Bi inst said City in consequence of the
f his permit. MECH.CONT. LIC.NO. MECH. .�`
TOTAL 'rA0 lA1'L Y
ignatere oforificant tractor Date -
OFFICECOPY