1184 CITY OF CUPERTINO INSPECTION RECORD (Office Copy)
1184 19447 Pruneridge Ave.
• PERIM NO. SANITARY DIST. NO. LOT N0. ADDRESS
Docutel Installation Hewlett-Packard
PROJECT OIdNER JOB SITE PHONE NO.
Date ELECTRICAL
Building 10-16-81 Date Insp.
Electrical 10-16-81 Power Pole
Plumbing Underground
Mechanical P.ough WiringTemp. Gas/Elect. i•la s
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other
FINAL INSPECTIONS Not Approved
Date Insp.
Gas PLUMBING
Electric A z 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 Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane 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
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION P R UMBER
BaILDING APPLICATION & PERMIT 1184
Aoo s
JW, azz DeeBUILDING -ELECTRICAL-PLUMBING-MECHANICAL
'R' PLAN CHECK VALIDATION
" OTV. ELECTRIC PERMIT FEE
DNE
CONTRACTORS '7i0 UTLETS-SWITCHES-RECEP 5.00/1.00 a
NAME
Lie NO. LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PRONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLANCHECK FEE P.C.NO.
OR
ENGINEER
LIC,NO SIGNS TRANS. 3.00 �//�
ARCH.OR ENG. SPECIAL CIRCUIT 5,00 pci PERMIT VALIDATION
ADDRESS
ZIP TEMP. METER OR POLE INS. 15.00
APPLI Ts MOTORS SEE FEE SCH.
ADDREDDRESSS
SERVICE CHANG10.00
woo LICENSED CONTRACTORS DECLARATION ' '/ J cilparym
a v v I hereby affinn that I am licensed tinder provisions of Chapter 9 ISSUANCE DATE
I Or u (commebemg wrib Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F H i Professions Cod anJ 60 SO is in full fa e n eff GI. ❑ ❑
z Ov, LicenS6Class Lia Number - 7(0
O = F w Dale S6 Class Contractor _
BUILDING PERMIT
¢ ¢w¢ OWNIi R-p UILDER DECLA RA N INFORMATION
O R RTO ORD
w3 u H I hereby affirm that I am exempt from lite Contractors License MISC.- TIQIj $/FT.
a, .. o a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00
Code:Any city or county which requiresa permit to construct,alter,
QQ Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEQ / d
IS rululres lire applicant for such permit to file a signed Statement that TOTAL PERMIT TO
a w m be is licensed pursuant to the provisions Of tire Contractor's License
FiQ
Law(Chapter 9(commencing with Section 7000)of Division3 of the
E 3 a Business and Professions Code)or that he isexempt therefrom and DTV. PLUMBING PERMIT FEE
till,basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
dam 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 Itundad dollars(S500).):
❑ 1,as Owner of tile property,or my employees with wages as BACK F LOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole clempensatimr,will do the work,..it lire sfracture is not
intended or offered for sale (See. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code,The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 50,FT,FLOOR AREA TOTAL ACREAGE
himself a of intended
his own employees,Provided that such improve-
ment ore not intendeJ o,employees.pre.ovided
that
the building GAS-EA.SVSTEM-1 INC.40UT LETS 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 burden of proving th . . .
at he did not build or ire- RES IND COG PB Omer
prove for purpose of'cdc r INDUSTRIAL WASTE INTER. 20.00 Fy
❑ 1,as owner of the property,din exclusively contracting with 1:1tr ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code'Ihe Contractor's License Law does not apply
to an owner of property who builds or improves tllercon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts forsuch projects with a contraclotts)licensed pudsom" SEWER-SANITARY-STORM EA.2001t/8.00 TRACT NO. PARCEL NO.
the Contractor's License Low.
❑ 1 dm cxcmPI undcrScc. .BAP C.fol this WATER HEATER W/VENT 4.00
Cason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO,
WORK I:RS'COMPI'NSA I ION DECLARATION WATER TREATING EQUIP. 4.00
Ihereby affinn flat I have a certificate ofcotHent to sclGinmre, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance ora certified
copy the r,,S5D�fJJ,�S,�,v.�� 800,Lab.C.).y�lp�l��
Polity Nrµ:Y .InpanY Y J
O ❑ Certifil,d copy is hereby(yrnizhal FIRE SPRINK ENERGY T-24
Z 2 �Certif••� cglpy filed•❑A'e,Ith the city nspection division. Misc.- REFER TO ORD, y ❑ IN❑ y ❑ N❑
O Appuount-i,Ss�`� QI/b
rn Cf RI'l l'IG1 i IiX1iMPT10N PROM N'ORKIiRS, PERMIT ISSUANCE 6.00 FLOOOZONE A.L.0 c.
LU - COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
C 0 (This section need not be completed it lire permit is for one TOTAL Y❑ IN Y ❑ N❑
D 2 hundred dollars(S 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 P mit is issued.I shall not employ any person in any manner so as to
O 0 become subject tothe Workers'Compensation Laws of California. .a 00
Dam ApplicantBUILDING
} W NOTICE TO APPLICANT: IL afar making this Certificate of Ex- ALTER OR ADD TO MECH. 4.00
F 2 emotion,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U " such provisions or this permit shall be devoted rcvukcd. AIR HANDLING UNIT(TO 10,000 C.F.M.) 3.00
CONST RUC TION LI!NDING AGENCY AIR HANDLING 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
(lie performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ CA HEATING UNIT(TO 100,000 B.T.U.) 4.00 _
Lenders Name HEATING UNIT(OV ER 100,000 B.T.U.)7.50 ELECTRIC ..�ss
Lender's Arkin, V I O
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
,information is correct.1 agree to comply will,all city and callboy BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
Ninunces and state lows relating to building construction, and
Defy authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU1 SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to wave, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX "
may in any way acc ue against Said City in consequence of the PERMIT ISSUANCE 3.00
gran ing al this pertnl MECH.CONT. LIC.NO. MECH. I f
�, TOTAL TOTAL /{�a�T
.Ignature Applicant/COntmctor. Dole
OFFICE COPY Ai