2500 GI'I'Y 01' CUPERT'INO IIISPECTIOI' RI,CORD (OEfice Copy) -
2500 _ One Results Way_ _
l'EPJuT N0. SANITARY DISI. NO. TO—TM07 ADDRESS
Mezzanine Floor Measurex
PROJECT OWNER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Buildine — 10-29-82 Date Insp.
Electrical Power Pole
I'Lumhing Underground — -
--
flechnni.cal Rough Wiring _
Tenl). (;ns/Elect. Ilaf.7.s _
Solar Coiling
Fire Sprinkler Fixtures int/Ext _
Sign Notors
Grounding
Llisc. Temp. Power _
Other
FINAL. IIISI'ECTIOGS Not Approved _
Date Insp.
r "S -- PLUMBING
Electric Date Insp.
I'Limbin , Backflow _
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
•
I'Lanning, Solar Rough
Fire Dept. Mater & Insulation
health Dept.
Main Drain
Building R/of/S Drain _
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification HECIIANICAL
Foundation —
PDate Insp.
re-Gunite
Underfloor S.M.
Slab-flemhrane Ducts & Insulation
Band Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
T_iedowns One flour Shaft _
Di.aphrams Condensate Drain
Seismic Bracing Equipment Anchorage _
11a1.Is-Panels Flues & Comb. Air
Frame Other
Jath
Not Approved
allboards Int/Ext.
Firewalls
Other _
Not Approved
APPLICANT TO FILL IN,INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY '
• BU I LDING PROJECT I DENTIFICATI ON - PERMI Nu
BUILDING - - APPLICATION & PERMIT - OO
POOR 5
U ` BUILDING-- ELECTRICAL-PLUMBING-MECHANICAL
OW E 'a " PLAN CHECK VALIDATION
"ante CITY. r ELECTRIC PERMIT FEE `
PHONE
oN RAcraes OUTLETS-SWITCHES;RECEP 5.00/1.00
NAME
,QM - r-49a Lt7-1 Py ' LIGHTINGFIXTURES 5.00/1.00 '
uc.No
CONTRACTOR5 S"T'I S/y`) O�� APPLIANCES—RESIDENTIAL 4.00 '
6��CaMMcnGe PHorvE ZyJ�-01� PANELS . 5.00
DATE OF APPLICATION
ARCHITECT - SIGNS 600 PLAN CHECK FEE P.C.NO.
OR .
ENGINEER
LIC,. c.No. SIGNS TRANS.- 3.00 '
ARCH.OR ENG. .. PERMIT VALIDATION
ADDRESS '• SPECIAL CIRCUIT 5.00
TIP EMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH. �`�U`
ADDRESS
SERVICE CHANGE 10.00
o o LICENSED CONTRACTORS DECLARATION- L]r6/A''/�
rt U H I hereby affirm that I am licensed under provisions of Chapter 9 _ _a/V r DATE
Icunhmencing with Section,70001 of Division 3 of the Business mrd
¢ n 1 _ - FLECT MECH.
.r O i Professions code' 1 m license is in full fore• t c f'-4 _
y ❑ ❑ o
z O y License C ass �!Lic.Number C
g m� � Date O• Cnntracmr_ e -Gp1x� "
i BUILDING PERMIT
m ¢ ¢ OWN1i R-BUI LDE It DECLARATION
X
g u m 1 hereby affirm that 1 am exempt from the Contractor's License
MISC.- " REFER TO ORD INFORMATION
F LL o j Law far the following reason.(See.7031.5,Businessanci Professions PERMIT ISSUANCE 6.00
VAL S/FT.
Code:Any city or county which requires a permit to construct,altar,
ce ¢ ¢ 0 improve,Jere lish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIG.NO. ELEC.
a W'm a .....mics the applicant for such paint it to file a signed statement to Lal TDTAL MI
z ¢ he is licensed pursuant In the provisions of the Contractor's License
i
Law(Chapter (commencing the with Section the Contractor's
License
Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
Sc ca the basis for the alleged exemption.Any violin ion ofSect ion 7031.5 p ECONSTR.
A,i _ 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 hundred dollars(3500).):
_ ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 ace.GR
their sole compensation,will Jo the work,and the structure is not UP RES.UNITS,{p
intended or offered for sale (Sec. 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 flicreon,and who doe's such work FIXTURES-PER TRAP 4.00 SD.FT FLOORAREA TOTAL ACREAGE
himself re through his own employees,provided that such improve ADD `—• e
memsare Got intended d ed or employees,
for eesule.Iided that suhcmproog GAS-EA.SVSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion, the owner- GAS,-EA.SYSTEM-OVER 4'(EA.) 1.00 BUILDING USE
builder will have the burden of proving that hu did not build or int- ` RES IND CDN PB Ohao,
prove for purpose ofsale.). INDUSTRIAL WASTE INTER - - 20.00 ^/
❑ I,as owner of the property,am exclusively contracting with . 11 [l ❑' ❑ ❑
licensed contractors to construct the project ISec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:T he Contractor's License Law floes Pot apply
to an owner of property who huilds or inhproves thereon;and who LAWN SPRINKLERS-OVER 5 (EA.) 1,00 �,e.. G3
contracts forsuch projectswith a conloctons)licensed Pursuant In SEWER-SANITARY-STORM EA.200ft/6.00
the Contractor's License Law. TRACT NO. PARCEL NO,
❑ tum exempt under Sea .Bt for this WATER HEATER W/VENT 4,00 �-
r.sCn
Dam Ownar WATER SYSTEM ' 4,00 -ACC.DATE ACC.FILE N0,
WORK ERS'COMPENSATION DFCLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of consent to self-insure, --
or a certificate of Workers'Contpensatiun Insurance,or a certified _ ZONING ENG.SITE NO.
copy thereSe BOO,Lab.-.L
PoIicY mPan
Y—
Q ❑ Cerifiedco yis heresy funtished. FIRESPRINK ENERGY T$4
- Z z 0 Cert tied Is file"�will the 'y ntspedvm division. MISC.- REFER TO ORD.
O APPIicu tA-IPA f v N❑ Y ❑• N
~ w - PERMIT ISSUANCE " 6.00
LU - CF.RTIPICCOII F SATION]ON NSPRONIW'OR 1125' FLOOD ZONE
W >_ COMPENSATION INSURANCE? PLG.CONTR. LIC.N0: PLG.,
4' O (This welt ein need not be conhpleted it the pennil is for ane TOTAL Y❑ ^'p'—+iTJ
:) z hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which tills per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
,LL F mit is issued,I shall not employ any person in any manner so as lO
O w become subject to the Workers'Compensation Laws of California.
y Datc Applicant - ALTER OR ADD TO MECH.' 4.00 BUILDING 7L-)
} N NOTICE '1'O APPLICANT'. If,after making this Cerlifieme.17E.7 /
z' emplion,you should become subject In Ilse Workers'Cormansal ion APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, youmostfurthwilh comply with -
U such provisions or obis permit shell be deemed revoked. AIR HANDLING UNIT(TO 1(=C.F.M.) 3.00 FEE 00 (T3
CONSTRUCTION LENDING AGENCY .AIR HANDLING UNIT(OVER 10PMC.EM.) 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
3097,Civ CA ' HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)7:50
Lender's Address - ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city laid calmly PLUMBING '
ordinances and out, haws Willing to building consrumion, anfl BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 .
above- authorize property natives ec this city es enter upon the BOILER-COMP (over 100,000 BTU)SEE FEE SCH: MECHANICAL
hereby
above-mentioned property forinsp of this
purposes.
- (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
III any way acenle ago' .said City in cansoyucnci of the '.
gra ods prondl MECH.CONT. LIC.NO. - MECH.
>tf '/e-zp TOTAL TOTAL
tgnitum of Applicant Contractor Date "
Y - '+ OFFICE COPY