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5766 CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) �. AGO/ SaRATO GR -�..,vNVVR4L'' QP RKil NU. i /J�J. f 1 FFie'e- WTN 8l.a N AY 3T- 94TVEV•, Cid . P 3OWNER PERMIT ISSUED DATE "ELECTRICAL DATE INSP. Wui in ectrica t in Power Pole ' anica r oun 'lei ec ougg hang o ar � Wills i_ re pr�n er Ceiling 1 ixtures Int/Ext go-COTS Misc. Grounding eT mph er Uther FINAL INSPECTIONS DATE INSP, Not Approve Gas /-i9-F, w r ectric ce Plumbing al PLUMBING DATE INSP. o ar Backflow '00 r un bra in r oor Planning Partial Roujzh lire t. u Complete ea pt. ar uu 30_ Water at-iva a _77 er in Drain aTer__ BUILDING DATE M. P. of rove S ncl idat ,y ! Pad Certifto Iti q-z i. 1 nAL RwL 9LECt CCAw !e Io PDAT Foundation on DATE TI�SP re- ite © tel. � Qr RR$6e P 9//9/ys¢�, Mb-Mlembrane Underfloor M. Bond am Ducts & Insulanon Underfloor Girders Fire Damers _ iF"rep ace ie owns Grease Duct 50 ramso e our t eismec racin .. Condensate Drain s ,ljj e nt Anc ora e�r ,V4 .4-SDues om r_ ?uipme Lath --� �u e�,c�T-At�c� bt er �ailboards Lnt/txt.' of Approved — �rewa s _ bt er ra,v¢ kor 0 e c�! a 1� Net rove 0 ftl-(� w�L(h Vel 7'j1 -ds Mdnu4- Rud-1-j4F'C�,1� 7-Z-a BUILDING 2-2(-Brc-Mcc=1-r- stab co Oct -2 Td « F 45- tea.. co-L. �s __ ill e r T e� Peed I`( L 0�1; SOT Tww 11'2— f-i. � lC•.-u 6 � ut (WZ �V a srl fr ° w hi v e l 2 214+1 ss( z cT slab Flt -- s a:r 0911 J ar818�� 3 Pe-fC [<w �l �v ell (f T �� i+— el Tb ff 7P 'I-w-sr a e. c 0 I p 7 3-mss rr 4•a epi-.+�a i } si ELECTRIC �-�(-tri ee, i o o.,rw .e- s--• ✓ �(-yti5� IL...0 steer( 12 ,v V, .�-toe��bn 6 cr,. Aim ld a4. )p 51f Lk L 1 2ud� 'f-- tC.- dY-4 (��'�k CJ( II�V^Y f1-w C� 'e' I T f� � P4Vw Jef IgWi ✓✓ Ap cp� UUVva 7-7 uR. -pr kr fe 1 2. PLUMBING MBaiAMCAL MISCELLANEOUS APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -, USE BALL POINT PEN ONLY •\ BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER • /�' BUILDIING u • " APPLICATION & PERMIT - yr OWNER'S // BUILDING UILDING-_1ELECTRICAL_:PEPLUMBINGRMITs(I -:sMECHANICAL ECHAKhNFIECEALaMNMA-�uAw ` r- 576 6 NAMEfOUM GKPLIDAT N EECTRIC QyM00A PHONE �73 - CONTRACTORS NAIVEOUTLETS-SWITCHES-RECEP 5.00/1.00 LIC.No ;/p 3 LIGHTING FIXTURES 5.00/1.00 CONTRACTORSADDRESS PPLIANCES-RESIDENTIAL 4.00 DN&W S . PHONE PANELS 5.00 DATE OF APPLICATION JVD 4oBT SIGNS 6.BD PLAN CHECK FEE P.C.NO. dENNGINEER (� �y�r_ G, ) I/ LIC.NO /%iJ SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS '�p^voA - SPECIAL CIRCUIT 5.00 Q C.�E-1 nt V ZIP95iog TEMP.METER OR POLE INS. 15.00 APPLICANT'S MOTORS SEE FEE SCH. S ADDRESS ..AyN IDl�a�ofJ L /yjq SERVICE CHANGE' 10.00 1 ,7 0- w o o LICENSED CONTRACTORS DECLARATION PAID a u U• I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE vi G w (commencing with Section 7000)of Division 3 of the Business and B�. G. ELECT. PLG. 1. MECH. F y z Professions Codgld my license is in fall fur3,�gyl�eGfpa,�j,,, 7 Oiw Limnse Class 1_yL_Lie.Number `f- •, - - 1. '� ❑ El ,A L Date_7_3�-94 COntractorlr.r�• . y E ' T �TNN�• II,- BU.I►,pI NGIPERMIT ¢ w < OWNER-BUILD17R DECLARATION ,Of)QU FiMAT1ON w ;u N I hereby affirm That I am exempt from the Contractor,License MISC. REFER TO OR ' 1'- LL o.Qi Law for the fallowing reason.(Sec.7031.5,Business and Professions VALUATION E/FT. I- - PERMIT ISSUANCE 6.00 �,�� vo Code:Any city or county which requirese permit m construct,alter, rcM¢ o improve,demolish;or repair any structure,prior to its issuance,also ELEC.CONED. LIC:N0. ELEC. G S,requires the applicant for such permit to file a signed statement that TOTALd. E lie is licensed pursuant m the provisions of the Contractor's License O n c PERMIT T zi Low(Chapter 9(commenciagwithSection 7000)nfUivision3ofte ha, - .w"'z. �aC,t' SAW a Business and Professions Code)or that he is exempt thnefrory and CITY;IT - PLUMBING PERMIT ' FEE f i o r o by basis applicant alleged exemption.Any applicant tSection malty03 1.5 STORIES TYPE CONSTR. n ;m by any applicant firs hundred tdollars the applicanttoacivil penally ^ /, / of not more than five hundredrty,or ALTER-DRAIN&VENT-WATER (EA.) 4.00 � V,V ❑ 1,as owner of the properly,or my employees with wages as ggOK FLOW PROTECT.DEVICE 2,00 OCC.GROUP RES.UNITS fair sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 4.00 Code:The Contractor's License Law does not apply to an owner of J" property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SQ.FT.FLOOR AREA TOTAL ACREAGE � himself or through his own employees,provided that such improve pp r reents are not intended or offered For sale.IL however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 4,00 O� 000 ar improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or int. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE • prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON Pe Other ❑ I,as owner of the properlypam exclusively contracting with ❑' ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Po l'essions Code:The Contractor',License Lew does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1,00 contracts for such projects with a contractor(s)licensed pursuant to mo Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ 1 a cxcmpfundcr Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00 reason 'Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION- WATER TREATING EQUIP. 4.00 1 hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO. -- .or u certificate of Workers'Compeasalion Insurance,or a certified copy ther`pj ..78Bo Lab.C.l./H-A•T/A� Ye AJ Pol/ 0 sVFk'''Y00 1 y t-•I x/72 rJ O' R Certified 'opy is ereby furnished. RE$PRINK ENERGY T y1 Z ❑ Certlfre copy fled wllll the city in,I. division. O Applicant �b MISC.- REFERTOORD. YE] N❑ Y ❑ ' N❑, Fy Lu CERTIFICATE / IA TIFROM WORKERS' PERMIT ISSUANCE6.00 FLOOD ZONE. A.L.U.C. W > COMP NSATION INSURANCE PLG.CONED. LIE.NO. - PLG. 1 O 1'1'his motion need not be completed if the permit is for one TOTAL Y❑ N Y❑ N❑ Z) Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which this per- tr ° o-. Ar.�a.• '' s' m v5' F,EE SUMMARY LL P- and¢issued,I shall not employ any person in any manner s0 as m QTY.; MECHANICAL'£'PE RMIIT`x Y' .FEE§ a sN9as.a„f, O W heconm subject t0 the Workers'Campensalion Laws of.Californlu.' Date A licant 'BUILDING: a PP ALTER OR ADD TO MECH. 4.00 } W NOTICE TO A....IdC eco IL after making(his Certificate si I>x- ♦- ? emvision you sheLbor Code,objecttoIse Workers'Ccopely with APPLIANCE' 4.00 PLAN CHECK t provisions io the Labor Code, you muss drevokh comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 GF.M) 3.00 � ` CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOO.F.M.) 5.00 'SEISMIC FEE 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(Sea - MICROFILM 3097,CYU.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 Lender's Address ELECTRIC- PecrNlytatlhavereadmis�pplicationandsuit,uml the ahove VENTILATION FAN (SINGLE). 3.00 boomation s correct 1 agree m comply with all city and county PLUMBING ordinances ad state Taws relating to building construction, and BOILER-CONP I3 H.R or400,000B.T.U.) 4.00 a �L au IOrire presentativee of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE'FEE SCH. MECHANICAL e ioncd operty forinspecl ion purposes., gree to ave, indemnify and keep hurndess the City of MISC.- REFER TO ORD. agains liabilitis,judgment,, costs and expenses wllich PERMIT ISSUANCE 3.00 CONST.TAX consequence of the\sxx of tills rmit. MECH.CONT! LIC.NO. ME . �n // • _ TOTAL TOTAL"+ ' 67�Xe of App¢ al/Contractor '' Date - OFFICE COPY