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1484 CITY OF CUPEP.TINO IIISPECTION RECORD (Office Copy) PEPIIIT NO. SANITARY DIST. NO. LOT NO. ADDRESS PROJECT OWNER JOB SITE PHONE NO. Date ELECTRICAL Buildine Date Insp. Electrical Power Pole Plumbing Underground Mechanical P.ough Wiring Temp. Gas/Elect. 1a is Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sign Motors Grounding Misc. Temp. Power Other FINAL I17SPECTIONS Not Approved Date Insp. Gam.s PLUMBING Electric Date Insp. Plumbing Backflow ?techanical Underground Solar Underfloor Pool Partial Rough Grading Rough Complete Planning Solar Rough Fire Dent. Water & Insulation Health Dept. Main Drain Building R/of/S Drain Other Gas Other STRUCTURAL Not Approved Date Insp. Pad Certification MECHANICAL Foundation X14 _ )�g� Date Insp. Pre-Gunite Underfloor S.M. Slab-ifembrane Ducts & Insulation Bond Beam Fire Dampers Underfloor Girders Fireplace Floor Steel Grease Duct & Hood Tiedowns One Hour Shaft Diaphrams Condensate Drain Seismic Bracing Equipment Anchorage Halls-Panels Flues & Comb. Air Frame Other Lath Not Approved Wallboards Int/Ext. Firewalls Other Not Approved 4 BUILDING ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS i CITY OF CUPERTINO INSPECTION RECORD (Office Copy) ?i �rC�4�ZA C1 C5' W,- PEP11IT NO. SANITARY DIST. NO. LOT NO. ADDRESS PROJECT OFINER JOB SITE PHONE NO. Date ELECTRICAL Building Date Insp. Electrical Power Pole Plumbing Underground Mechanical Rough Wiring Temp. Gas/Elect. FIa s Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sign Motors Grounding Misc. Temp. Power Other FINAL INSPECTIONS Not Approved Date Insp. Gas PLUMBING Electric Date Insp. Plumbing Backflow Mechanical Underground Solar Underfloor Pool Partial Rough Grading Rough Complete Planning _"` Solar Rough Fire Dept. Water & Insulation Health Dept. Main Drain Building R/of/S Drain Other Gas Other STRUCTURAL Not Approved Date Insp. Pad Certification MECHANICAL Foundation �4 7 Date Insp. Pre-Gunite Underfloor S.M. Slab-Ilembrane Ducts & Insulation Bond Beam Fire Dampers Underfloor Girders Fireplace Floor Steel Grease Duct & Hood T.iedocros One Hour Shaft Diaphrams Condensate Drain Seismic Bracing Equipment Anchorage Malls-Panels Flues & Comb. Air Frame Other Lath Not Approved Wallboards Int/Ext. Firewalls • Other r Not Approved BUILDING ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS CITY OF CUPERTINO INSPECTION RECORD (Office Copy) • PEP11IT NO. SANITARY DIST. NO. LOT NO. ADDRESS PROJECT OWNER JOB SITE PHONE NO. Date ELECTRICAL Building Date Insp. Electrical Power Pole Plumbing Underground ttechanical P. ugh Wiring Temp. Gas/Elect. ( oMalls Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sian Motors Grounding Misc. Temp. Power _ Other FINAL INSPECTIONS Not Approved Date Insp. Gas PLUMBING Electric Date Insp. Plumbing Backflow :techanical Underground Solar Underfloor Pool Partial Rough grading Rough Complete Planning Solar Rough Fire Dent. Water & Insulation Health Dept. Main Drain Building R/of/S Drain Other Gas Other STRUCTURAL Not Approved Date Insp. Pad Certification MECHANICAL Foundation /Z-) / Date Insp. Pre-Gunite Underfloor S. i. Slab-Membrane Ducts & Insulation Bond Beam Fire Dampers Underfloor Girders Fireplace Floor Steel Grease Duct & Hood T.iedooms One Hour Shaft Diaphrams Condensate Drain Seismic Bracing Equipment Anchorage [Malls-Panels Flues & Comb. Air Frame Other Lath Not Approved Uallboards Int/Ext. Firewalls .Other Not Approved BUILDING �i- ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS T APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY , BUILDING PROJECT I DENTI FICATI ON PER IT M R GILDINGaa�jolit LA APPLICATION 1484 AooRESs BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME �� . O OTY. ELECTRIC PERMIT FEE UNE ! ! C CONTRACTOR III b OUTLETS-SWITCHES-RECEP 5.00/1.00 /947 M NA""��//�� --D a "C.NO3 /gAr s LIGHTING FIXTURES 5.00/1.00 G NTRACTORS APPLIANCES-RESIDENTIAL 4.00 A D 55 _ 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.OR ENG. SPECIAL CIRCUIT / 5.00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER ORJWLE INS. G 15.00 APPLICANTS MOTORS SEE E SCH. AOORESS SERVICE CHANGE 0.00 F w o o LICENSED CONTRACTORS DECLARATION LJ E, 1 hereby ufl'irnr that 1 up licensed under four ions of Chapter 9 ISSUANCE DATE m G W (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. 11 r D i'{, Professions CsO y license Is in full force.13c V11 ❑ ❑ ❑ C, i m o License Class_ Lia Number 7 Duro- ��),-�Contmctor _ < y I J BUILDING PERMIT rt w OWNIi R-Ii UILDIiR DECLARATION INFORMATION X LL I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD u. 0¢ Law for the following reason.(Sec.70J1.5.Businessand Professions PERMIT ISSUANCE 6.00 val,UnnOry S/FT. Code:Any city or county which requires a permit to construct,ulteq ac ¢ Q p improve,demolish,or repair any'structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. (� L O LL Mquires the applicant for such permit to file a sighted statement that TOTAta U / � PERMIT TO u w m he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 70000of Division 3 of the C >� a PLUMBING PERMIT FEE Business and Professions Coded or that he is exempt therefrom and QTY. r o the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR. i ; m by any applicant for a permit subjects lire applicant Ina civil penalty ALTER-DRAIN -WATER IEA.) 4.DD of not more than five hundred dollars 15500).): ❑ 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 nr offered for sale (Sec 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Cnntmetor's License Law does not apply 1.an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 4.00 So,FT PLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that Such improve- mentsare not intended oroffered for sale.If.however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 4,00 or improvement is sold within one year of completion,the owner- builder .) 1.00 BUILDING uSE GAS-EASYSTEM-OVER 4 IEA "r will have the burden of proving that he did not build or Int- RES IND CON PB Orhu, prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 Cl I,as owner of the property,ant exclusively contracting with 1:1 El El El El licensed contractors to construct the project(Sec. 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 improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 nmtracts for such projects with E contractor(s)licensed pursuant to the Com mcmr's License law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00 reason patesoOwner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKIIRS'COMPI'NSAI ION D17CLARAI ICON WATER TREATING EQUIP. 4.00 I hereby atfrm that 1 Imre a certificate of Consent to self-irourc. TONING ENG.SITE NO. or a certificate of Workers'Compensation lnsumnte,or a certified copy thereofa00,I`BC Iuly No. ( Coml,auY_ _ Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 2 Z Z g-Cwtified copy is Edd w i�i� city inspection division. REFER TO ORD. Applicanty/,�$1L-'� MISC.- V N� V ❑ N� f- - '�" - PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. CC - CIi R1'IFICATI:OIs FXIiMPTICIN FROM WORKERS' IL >_ COMI'RNSATION INSURANCE PLG.CONTE. sec.NO. PLG. v N� Y N� CL O (This section need not be gontpleted if the permit is for one TOTAL :) Z hundred dollars($100)or les.) U O I certify that in thevperformance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY IL H mit is issued,I shall not employ any person in any manner so m'to (] w become subject tri the Workers Compensation Low,of Culifomia' BUILDING Date Applicant ALTER OR ADD TO MECH. 4.00 } N NOTICE.TO APPLICANT': If.after making this Certificate of Ex- F ? emption,you should become subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this PWlnit shall be deemed revoked. AIR HANDLING UNIT ITO 10=C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE 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(Sec. MICROFILM 3007,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name HEATI NG UN IT(OVER 100,000 B.T.U.P.50 ELECTRIC s- Lender's Address I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 iroormmlon is correct.I agree to comply will all city and countyBOILER-COMP13 H.P.or 100,000 B.T.U.) 4.00 PLUMBING ordinance, and state laws relating ,, building construction, and ,hereby authori a representatives of this city to enter Inion the BOILER-COMP (Over 100,000 STU)SEE FEE SCH. -MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may n y way ccruegadnst said City in co4lueretc of the PERMIT ISSUANCE 3.00 Nmnt!g a mil MECH.CONT. LIC.NO. MECH. TOTAL TOTAL e OFFICE COPY