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3672 CITY Op CUPERTINO INSPECTIOI! RECORD (Office Copy) • 3672 One Results Way PEPJIIT 110. SANITARY DIST. NO. LOT 110. ADDRESS Mezz. Floor (renewal,)' _Tleasurex i' PROJECT OWNER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL Bui]dinr, 6/14/33 Date Insp. Electrical Power Pole Piumhinr, Under -,round Mechanical Rough Wirin 'Temp. Cas/IRlcct. Ilal7.s Solar Ceiling Fire Sprinkler Fixtures Int/Ext Si .,n Notors' Grounding Ilisc. Temp. Power Other FINAL. INSPECTIONS Not Approved Date Insp. Gzs _ PLUMBING Electric Date Insp. Plumbin , Backflow Mechanical Underground Solar Underfloor Pool Partial Rough Grading Rough Complete Planninp Solar Rough Fire De t. Water & Insulation Health Dept. Main Drain Building R/of/S Drain Other Gas . Other BUILDING Not Approved Date Insp. Pad Certification MECHANICAL Foundation Date Insp. Pre-Gunite Underfloor S.M. Slab-Ilembrane Ducts & Insulation _ Bond Beam Fire Dampers Underfloor Girders Fireplace Floor Steel Grease Duct & Hood Tiedowns One Hour Shaft Diaphrams Condensate Drain Seismic )tracing Equipment Anchorage_ halls-Panels Flues & Comb. Air Frame Other Lath Not Approved Wallboards In Firewalls Other Not Approved APPLICANT TO FILL' IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTIFICATION PE IT APPLICATION NUMBER BUILDING & PERMIT ADDRESS 3 U d/1PE X�c'S'Ci L 7J' G'U'•4 BUILDING —ELECTRICAL—PLUMBING—MECHANICA OWNER'S PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT -FEE C SI 14`1iF' ProNE CONT ACTOR$ NAME UTLETS-SWITCHES-RECEP 5.00/1.00 /l�'r�� LIC Np. ILIGHTING FIXTURES. 5.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 - A�D�RyE'SS/�� (f4)I LLM(��•.d• PHONE LJ(�� PANELS 5.00 - DATE OF APPLICATION ARCHITECT SIGNS 16.00 PLAN CHECK FEE P.C.NO, ENGINEER 08 Lic.NO. SIGNS TRANS. 3.00 AARCH OR DDRESS ENG SPECIALCIRCUIT S.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 15;00 APPLICANTS ADDR MOTORS Ess SEE FEE SCH. , 1 SERVICECHANGE 10.00 l r NSED CONTRACTOR$DECLARATIONo o LICIi wF u u I otePi affirm that I am licensed tinder nwlf the of CMI ler 9 ¢. y P P ISSUANCE DATE H D i ICOIIIfuenChtg with Section 700e i of Division 3 of the 1lusiness and BL G. ELECT P MECH. D IA Professions Code 1 t Icenc rs m u fore d e feel .F y e flit r+�p ,f Pz F Licenses �!_Lic.Nwnber.,Y U� " y DalP GOntNLlnr �� ¢ ¢ws<¢ OWNFR-BUILDFR DECLARA'NON BUILD( N w ;'A i y I hereby affirm that I am exempt from lire Contractor's License MISC.— REFER TO ORD H LL o ¢ Law for the following reason.(Sec.7031.5,Business and l'roPoseinns PERMIT ISSUANCE' 6AO 'vnwnnoN $/FT. Code:Any oily or county which requires a permit to cord....idler, ELEC.CONTR. LIC.NO. ,e ¢ ¢ 0o improve,demolish,or repair any structure,prior to its issuance,also ELEC. D¢ requires the applicant for such permit to file a signed statement that TDTAL .4/ (a/ wm w he is licensed pursuant to the provisions of the Contractor's PERMIT TO License . rz > Law(Chapter 9(commencing with Seclion 7000)of Division 3 of the ¢ Business and Professions Code)or that hCG.vCJ /I/EZ Z. Fz , e is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ F the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES - TYPE CONSTR. a � by any applicant for a pemtit subjects the applicant to it civil penalty ALTER:DRAIN&VENT-WATER (EA.) 4.00 of not more than five hundred dollies(S500i) - ❑ I,as owner of me property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.capuP RES.UNITS their sole compensation,will do the work,and the structure is nut intended or offered for sale (Sec. 7044. Business Cul 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 docs such work FIXTURES-PER TRAP 4.00 sD.Fr.aooR AREA TOTAL ACREAGE himself or t......gh his own mnployees,Provided'Ihat such improve- memsarenotmumdedorofferedforSade:If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS,4:00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM OVER 4 (EA ) 1.00 BUILDING USE builder will have the burden of proving that h . - . e did not build or no RES IND CON PB' pmhr prove fm purpose of they .r - ,., INDUSTRIAL WAS TE INTER. 20.00 ❑ ❑ ,❑ 1:1 ❑- ❑ I,as owner of the property,am exclusi vely,contracting wi dt licensed contractors to construct the project(Sec. 7044,Business'' LAWN SPRINKLERS- 1 INC 5 V.8. 5.00 ASSESSORS PARCEL NO. and Professions Codu:The Contractor's License Luw does not apply to an Owner of property who builds of TIProveS thercon,:ad who ` LAWN SPRINKLERS-OVER 5-(EA.) 1,00 conlraos for such projects with a contactons)licensed pursuant In The Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,B.&P.C.for'this • WATER HEATER W/VENT q,Op - - reason ' Dam Owner. WATER SYSTEM 4.00 ACC.DATE ACC.FILE N0. WORK IS RS'COMPF NSATION DECLARAIION WATER TREATING EQUIP, 4.00 I hereby affirm that I have a certificate of consent In self-insure, ZONING ENG.SITE NO. or a certificate of Workers' m Compensation Iurunee,or a certified copy Cher• I(S}3800,Ll,C,) /� , Policy NX—Company O Certified copy is hereby fumshed' FIRE SPRINK ENERGY T 24 Z 2 A❑1 ant_t )c y is a —svYy th Ty inspection division. MISC.- REFER TO ORD. v N v N Ir ~ rn\ - - PERMIT ISSUANCE 6.00 Lu CIiR"FIlICATIi SA ION ON FROM WORKERS' PERMIT zorvB A.L.u.c. W 2! COMPENSATION INSURANCE . .. PLG.CONTR. LIC.NO. PLG. CL Cl 1 'FFlux section need not be completed if the pennit Is for one TOTAL' Y❑ N❑ Y ❑ N❑ hundred dollars(S 100)or less r U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued, I shall not employ any person in;my mamter so as t0 O W become subject to lire Workers Compensation Laws of Culimmin. a Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING 0L(—"A` } 0NOTICE TO APPLICANT: If,after making this Certificate of fix- F 2 eioption,you Should become subject to the Workers'Cuntpens,nion APPLIANCE 4.00 PLAN CHECK - - prwisions or the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 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 3097,CivC.). ' HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name HEAT]NG UN IT IOVER 100,000 B.T.U.)7.50 Lender's Address - ELECTRIC I certify that I have read this application and sate that lire ahove VENTILATION FAN (SINGLE) 3.00 information is correct I agree to comply with all city and county PLUMBING - ordinances and-state laws relating In building construction, and ty BOILER-COMP(3 H.P.or 100,0008.T.U.) 4.00, hereby authorize representatives of this city enter enter upon the BOILER-COMP (Over 100,000 BTU(SEE FEE SCH. MECHANICAL ubuve-nue Monad property for inspection purpos z (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 fully in Any way aecrue agnins said Cily m ronseq ucnw of (hu gryylylg of t lilt permit. ' MECH.CONT. LIC.NO. MECH. _ TOTAL TOTAL f'dS Signature of Applrounticentractor Date OFFICE COPY ,