4340 CITY OF CUPERTINO IP.SP!;CTIOII RECORD (Office Copy)
4340 _ 11621 Regnart Canyon Drive
PI:PJIIT NO. SANITARY DIST. NO. LOT ]10. ADDIIESS
Remodel Foundation George Luchessi
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buildinr, Date Insp.
Electrical Power Pole
Plumhfnr, Under -,round
Nochanical Rough Wiring
'I'enr. Gas/I,lcct. hails
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sinn Notors
Grounding _
Misc. Temp. Power
Other
FINAL, INSPECTIONS Not Approved
Date Insp.
(,;s _
Electric PLUMBING
Date Insp.
Plnmbin , Backfloc;
Mechanical Underground
Solar Underfloor
Pool Partial Rough
C,rarling Rough Complete
• Plannin Solar rough
Fire Dept. Water & Insulation
Health Dept. 'lain Drain
Buildin R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
I'ad Certification MECHANICAL
Foundation Kew - ° - Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
1"loo; Steel Grease Duct & hood
Tiedowns One Hour Shaft
Diaphrams Condensate. Drain
Seismic Bracing Equipment Anchorage
halls-Panels Flues & Comb. Air
Frame Other
Lnth Not Approved
Wallboards Int/Ext.
Firewalls
Other
Not Approved
�ovU-� -Gvt�roUTo � Rark .T �a(C L-z�`f I/
APPLICANT TO FILL IN IN F ORMAT ION WITHIN RED LINES - USE BALL POINT PEN ONLY
- T BUILDING PROJECT IDENTIFICATION E IT,NUMBER
9D RESS APPLICATION & PERMIT' /� ry /� O
ADDRESS BUILDING—ELECTRICAL—PLUMBING—MECHANICAL ` 34
hr nD r -
rva NER'S // '•,- , PLAN�CH ECK VALIDATION
P.O
P. LGfG DTV. 'ELECTRIC PERMIT FEE It
CONTRACTOR' /� b !�
NAME _ OUTLETS-SWITCHES-RECEP 5.00/1.00
- LIC,NO, LIGHTING FIXTURES 5.00/1:00
CONTRACTORS
ADDRESSPPLIANCES-RESIDENTIAL . 4.00 - P
ADDRESS
PHONE - PANELS 5.00 ATE OF P ucATION
ARCHITECT - - p�A1r P,C.NO.
on SIGNS 6.00 if
C
ENGINEER I - V
- 3.00
uc.Na. � SIGNS TRANS.
AENG. ffM ATION
ADDRESS
- SPECIAL CIRCUIT '5.00 y�y\Il
ziP TEMP.METER OR POLE-INS. 15.00 - CItY
APPLICANT'S
ADDDRESSDRESSMOTORS, SEE FEE SCH.
SERVICE CHANGE 10.001,\\J//
o o, . .•- LICENSED CONTRACTORS DECLARATION
Q i W I hereby aMo. Ihat'l am licensed under provisions of Chapter
9 - ISSUANCE DATE
a w (commencing with Section 7000)of Division 3 of the Business and . BL G. ELECT. PLG. MECH.
H m w Professions Code,and my license is in 1"11 force and effect.
• z o m - License,Class - Lia Nulnber -
2 y- o Datc Contractor
< m H
¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT
'.
a o,> O INFORMATION
X'g -y I hereby affirm 0wgl and exempt 031.5 the Clnt"ctlrifessions ' MISC.— - REFER TO ORD
LLo Law for the following reason.lSuc.7031 S,Busincssand Professions - VALUATION $/FT.
I- - g - PERMIT-ISSUANCE 6.00, ,
Code:Any mo or county whiny structure permit Inconstruct,,also -
toQ'¢ 0 IlnptOVe,de1nOI15I1,Or repair any stf.Ctllr0.p111!to IB Iss11811CL',0150 ELEC.CONTR. - LIC.NO. ELEC.
, requires the applicant for such permit to file a signed statement that - TOTAL PER
TO
¢ w Fe u.w he is licensed pursuant to the provisions of the C.riticror's License
rz>-
Law(Chapter 9(commencing with Section 7000)of Division 3 of the -
14 a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT - FEE jhA )A
¢ H $ the basis for the alleged exemption,Any violation of Section 7031.5 - STORIES I TYPE CO TR.
by'any applicn't for a permit subjects[be applicant to a civil penalty gLTER6DRAIN&VENT-WATER (EA.) 4.00
- of not more than five hundred dollars IS500).1', - -
❑ I,as owner of the pmperty,or my employees with wagcs'as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,an'
the structure is not
'intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code:'fh.Contractor's Irmo'Law docs not apply to an owner of ,
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP - 4.00 So.IT.FLOOR AREA TOTAL-ACREAGE
himself or through his own employees,provided that such improve-
Rents arc not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
or improvement is sold within one ye5r of completion, the Owner. GAS-EA SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE builder will have the burden of proving that he did.nlr huilA 1r im - IND CON. PB olbar
prove for purpose ofsale.). ' INDUSTRIAL WASTE INTER. 20.00
❑ has owner of the property,am exclusively conlmning with ❑ ❑ ❑ ❑
licensed contractors to am irtct the project lStc-7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. .5.00 A ASSESSORS PARCEL NO.
and Professions Cod e:The Contmetor's Liccmc Law does not apply -
to an owner of property who builds or in.proves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) - i m '
contracts for such projects with h anmr,¢lor I licensed purRIad
' the Contractor's License Law. SEWER-SANITARY-STORM EA.2001 TRACT NO. PARCEL NO,
Cl I am exempt under '• ,B.&P.C.li. I TER HEATER W/VENT 4,pp -
rlaSml
1)°re TER SYSTEM 4:00 ACC.DATE ACC FILE NO.
WORK IiR("COMI'IiNSA'1'ION'Db`Ci.A ON WATER TREATING EQUIP. 4.00 j
I berehy affirm that I have a ctrl ificxt of nn:cnt In sell'-Insure. ZONING
- or a certificate of Workers'Compensation Insurance,or a certified 1 ENG.SITE NO,
copy thereoffSec.3800,Lab.C.) -
Policy N1. Company
0 U CeRih,d copy is hereby Ranxin,d. FIRE SPR INK ENERGY T-Z4
Z Z ❑ Certified-copy is filed with the city Rspccton division. MISC.-, REFER TO ORD.O Applicant Y ❑ N❑ Y ❑ N❑
va .PERMIT ISSUANCE 6.00
� — CIiRTIPICAI"I'01'IiXIiMPT10N1'ROMWORKCRS' ,FLOODZONE A.L.UO.
W > COMPIiNSA'I'ION INSURANCE PLG.CONTR. "CIC.NO.
Cl
IThis section need nor be completed if the permit is lin one - TOTAL V❑ N❑ Y ❑ ry❑ '
hundred dollars($100)or less.)
U
01 certity.that In the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL.� ndlt is issued,I shall not....ploy any person in any ma ones sn'"s r) _
0 Ubecome subject to the Workers Compensal ion Laws of Cahlo nia. - -
C. Datc Applicant
ALTER OR ADD TO MECH. 400
} y NOTICE 'f0 APPLICANT: If,after,making this Certificate of Ex- . r
F Z emplion,you should became subject to the Workeo'(7ompensation '.APPLIANCE 4.00 PLAN CHECK
provisions of tehLabor Cade, you oust forthwith comply with FEE
U such provisions or this permit shall be,deemed revoked - AIR HANDLING UNIT(TO 10=11F.M.) 3.00 �•
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
1°°hereby afl'irin that there is a construction kidding xgency,for EXHAUST HOOD (WITH DUCT), 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097;Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name H EATING UNIT(OV ER 100,000 B.T.U.)7.50
Lender'sAddress ELECTRIC
I CcTlily that l have read this applicationand stale that the above VENTILATION FAN (SINGLE) 3.00
information n correct. i agree tog to lY with all city and county .PLUMBING
ordinances and state laws reluto cool building construction,co aril BOILER-COMP 13 H.P.or 100,0006.T.U.I 4.00
hereby above-mentioned
reproseNuriveserlons uip es aster .poli-tido BOILER-COMP IOvn, 100,000BTU)SEE FEE SCH. MECHANICAL
herebymentioned property for hnsp of inn purposes: -
(We) a e to save, indcmni a keep harmless the City of MISC.- _ REFER TO ORD.
Cupeain alnsr liabilities,'sties,Ju Is cost and expenses which CONST.TAX
may in y way "'Erne again. .Id .ity nmserum.ce al' the PERMIT ISSUANCE CE 3.00
grant' 'this permit MECH.CONT, LIC.NO. - MECH, /
TOTAL
Signature PC- Co x.113 'TOTAL /
- — ' - OFFICE COPY -