4861 V
CT. OF CUPERTINO INSPECTION RECORD y
a (OFFICE COPS •
49&1 2 �a l at 14—
�� AmDRESs LUI NU.
PM4 OWNER -T—
PERMIT ISSUED DA "ELECTRICAL DATE INSP.
u .Electr-Ha — —
FL-ummaPower Pole
mechanical - tfn r un
-� as ec u wiring
o ar
Walls
Fire Grin c er ei in
ixtures Int/Ext
otors
Misc. Grounding
e ower
Uther
FINAL INSPECTIONS DATE INSP, Not Approved
Gas 11-1 3 i�-s'6 ,Electric I 1-7 y- ;
"'M
m In a-I - PLUMBING DATE INSP.
aniar—
o 7ar
a o3-ar Backflow
:
1001
rground
a e
gra in r oor
Gln
Partial
ire_ t. KoUgn LaPpLete
ea 1Ti Ise t: u
Buildbther�g �1 19 ater ' Insulation
__- in Drain -7-SrG
oDrain
Other - ----
BUILDING DATE INSP. Not Approved
_
Pad Certification
Foundation ELECTRICAL DATE INSP.
Pre-Gunite
gl ba F rane , 7, - Underfloor S.M.
n amDucts 9 Insulaton _y
Under oor Girders - ire ers
Floor Steel —
eowns
iapp
Che rams r�i 7ours
SeismeBracing
�— on ensate ainwa-u -
s- ane s -- - - ui ent brae --__ -
Frame 3-!?- F ues 4 Comb. Air -"-'-
at _ trier — .
boar nt xt
,;: li: •;els 3` J of rovecT-- __ --- ---
Aet rove L
I� �I��� �hd e�e �G,ll✓�J-(=+1-�fY'�F�FI��,✓
R•" Kri-t-tu ArmI II rVreLCC2
V rIL-L- Um iixara %p Ft I11V we, v 11V0 - UOC UHLL r11V tr 1 CIV UIVL e
-71
f? L eU I LYIIVO 0hOkCTIDENT(FICA •IPERMIT NUMBER
1LOING APPLICATION VFF�1..ri
a ADDREea a,` ID �n1BOW a BUILDING -ELECTRICAL-PLUMBING-MECHANICAL4861
.ate NeMEN IG►� f. r• y,, �FI"V CI irite'Titzi, CA
PLAN CHECK VALIDATION
RE NyTnt.IT12 fobs r ts�f.e�f �d�tr ,
bHONE27-137,
1,,,' .1St111.1xkpr. x„
ONTRACTORa
ME p S UTLETS-SWITCHES-RECEP 5.0017.00 0FN -
eC) Nuc.No.3�'t/03 ' LIGHTING FIXTURES 5.00/1.00
CONTRADDREACTOR S �WJA/TjC o0Z a. APPLIANCES-RESIDENTIAL 4.00
1005 fflIS/ TLAA61 "PHON` / 3 f� PANELS 5.00 DATE OF APPLICATION
ARCHITECT LAN CHECK FEEP.C. O.
d PP� SIGNS 6.00
ENGINEER
tic.No. (217 SIGNS TRANS. 3.00
ARCH.OR ENO. SGL SPECIAL CIRCUIT 5.00
e DPERMIT VALIDATION
ADDRESS �a��JJ � e
iSiiqWD 6L CkP TEMP.METER OR POLE INS. 15.00 J
APPLICANT'
ADDRESS a a56s 'DRQ MOTORS EESCH. ,52 U
,�� 1 E�
SAI.) C;,4A*P-A G gs06f SERVICE CHANGE 10.00 SEP 1 ten/ �•�
�o o LICENSER CONTkACTORS OECLARATION SLF 1 Z 1984j•/
a i u 1 hereby afOrm that I am licensed under provisions or Chapter 9 -ISSUANCE DATE
a (commencing with Section 7000)of Division 3 of the Business and E 8 MECH.
Professions Code,and my license is In full force and effect. 1 y O 0'8 IDD
a,i o License Class Lic.Number
,A E bale Contractor
az OWNCk.kUILREk DECLARATION ,'�s IJINA ,ce
ox 1� I hereby affirm that I am exempt from the Cnnlraclor's License MISC.- REFER TO ORD -
IL:]! VALUATION SIFT.
Fglax
wo Law for the following reason.(Sec.7031.5,Businnsend Professions PERMIT ISSUANCE B.00 �"
to 02
Code:Any city or county whlchrequiresa permit loconslrucl,alter, �•O
M
Q Improve,demolish,Or repair any structure,prior to Its Issuance,also ELEC.CONTR. UC.NO. ELEC
to A` o LL requires the applicant for such permit to Ole a signed statement that TOTAL
X w he Is licensed pursuanl to the provisions of the Contractor's License �s Sx'N _ PI:Hlytlrjp '( '
F a: r Law(Chapter 9(commencing with Section 70DO)Df Division 3 of the U �'N^+h•vv v }. �{�s �((�}' rr(+f�•.' KE
2 -o Business and Professions Code)or that he Isexempl therefromand U •r oy�'tl:�`Y(;Sy.' I` �LUM�INf'i THI171 �a� 1511EE �y_PE i
re the basis for the alleged exemption.An violation of Section 7031.5 9t'W,r.>"I+!•T- ' 1•.-'ds5^•`+W Ss4G5kd ".lA+g'+6�f8f nSAtr M STORIES' TYPE CONSTR.
by any applicant for a permit subjects 11 se applicant los civil penally ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars(5500).): C
131.as owner of the property,Or toy employen with wages as
(heir sale compensation,will do the work,and the structure is not BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP REs.UNITS
Intended or offered for sale(Sec. 7044, Business and Professions - DRAINS-FLOOR,ROOF,AREA,COND. 4,00
Code:The Contractor s License Law don not apply to an owner of
RrOPerty who builds or Improves thereon,and who does such work FIXTURES-PER TRAP 4.QQ 6Q FL FLOOR AREA TOTAL ACREAGE
imself or through his own employees,provided 11 hat improve'
IGAS-EA.SYSTEM•I INC.4 OUTLETS 4.00
ments are not ntended ar offered fur sale.IL however,the building
or Improvement Is sold within one year of complellon,Ole owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have the burden of proving Thal he did not build or int t
po far purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON PB One,
)Y 1,as owner of 111e property,om eilckalvely contracting with ❑ ❑ ❑ ❑ i
licensed Contractors to construct the project(Sec.7044•Business LAWN SPRINKLERS-1 INC 5 V.8. 5.00 ASSESSORS PARCEL NO.
end Professions Code:The Contractors License Law does not apply
to an owner of property who builds or Improves(hereon.and who LAWN SPRINKLERS- EA.) 1.006 -3d:
contracts for such projects with a contractor(O licensed pursuant it
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 �rTTRRAACT NO. PARCEL NO.
❑ [am exempt under Sec. O.AP.C.for it LA WATER HEATS 1984 4.00 U /9 Q
ea o
�( Date WATER SYSTEM 4.00fC ACC.DATE ACC.FILE-NO.
WOkkLRS'COMPENSATIONRECLARA'1'tON WATER THEATIN01"CupertinO 4.00
1 hereby affirm Ilett I have a cerificale of consent to self-insure,
or a cerlificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO.
co
y(hereof(Sec.3800,Lob.C.). e�
C/7,f Policy No. Company i
�/ ❑ Certified copy Is hereby furnished. FIRE SPRINK ENERGY T.24
Z ❑ Certified copy is Bled wills the city Impeclion division. I
MISC.- REFER TO ORD.
r Applicant Y ❑ No v ❑ NO I
cr CHRTIFICATIi OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 6.00 i FLOOD ZONE A.L.U.C.
W,. COMPENSATION INSd If the PLG.CONTR. LIC.NO. PLG. , t Y❑ N❑ Y❑ N❑
d O (Tres section IS
not he completed if the permit Is far am TOTAL s
L) Z hundred fy that in the or 1ess.1 -fq -e - -g' Cs vfsf sy .gy
LL O I certify that h the to employ
an of Ills work far which this per. 6T1. �•1 a M€4iu�NI4•AIkPERMrI Gy 'Fd I ''iK � p��gUINMAII k
LL k- mil is issued.I ilull not employ any person to any manner w as h r. ra t ,�,{ + t,...,.•.+•.... i'k7
O W become subject to elm Workers'Compensation Laws of California. est +1- at•• t ems, .•w, 4-�!,durr ,iy�TY,K(ppja.'y(.�<,La '�yy3r. i
Dale Applicant ALTER OR ADD TO M 4.00 BUILDING 990 dm
f� NOTICE TO APPLICANT: if,after making.lhis Certificate Of Ex
Z 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 1
V such provisions of this permit shall be deemed revoked. AIR HANDLING UNI 1 WO
3.00 I
CONSTRUCTION LENDING AGENCY '
AIR HANDLING UNI ER ,M.) 8.00 SEISMIC PEE pZQ
I hereby arfirm that (hem is a constr iciton IendenR agency forEXHAUST HOOD I H T ;• 2.00 rat
the performance of the work for which(his Permit is Is1Jed(Sec. MICROFILM `If
3097,❑a.C.). HEATING UIT(T 0N , . . 4.0
Lender's Name H EATING U N IT IOV ER 100,000 B.T.U.)7.50 ELECTRIC
Lender i Address
,r.--''=-• I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00 f
` tiformation Is correct.I agree to comply with all city and county PLUMBING �3
ooOnancca and stale laws refiling Io building cunstruclion. and BOILER-COW 13 H.S.or 100,000 B.T.U.) 4.00
'Thcby..aulhoNae representatives of this city to enter upon the �/
I. above-mentioned property for inspection purpusn. 'BOILER-COMP (Over 100,000 BTlll SEE FEE SCH. MECHANICAL
"A,"y',L'.Cvi",'
tD save. Indemnify and keep haimlcts the City of Misc.- REFER TO ORD. -
st liabilities,judgments• costs and expenses which �. CONST.TAX pp M
ay seer a against said City in quence of the PERMIT ISSUANCE 3.00 1X
IF n n MECH.CONT. LIC.NO. MECH, '.•`•a%{,r�5y' ���
ica 1/ clot,,. , TOTAL%7�• s /faf.i q�
I OFFICE COPY
I
I 1
I