6093 CITYOF CUPERTINO INSPECTION Pmcm
(OFFICE":.COPS
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gKU-J U" OWNhK
PE T*ISSUED ELECTRICAL DATE INSP:
lli -cam-Y�"'r"',r• °' t
ect 'Ica._
—
i Power Pole
Fre Hanaca Underground
Ko!gn wiring
o lar
ar a s
l reest° Ti cT r _ ; : Ceiling
ixtures Int/Ext
N16tors
Misc. ;k row
ower
other
FINAL INSPFGTIUNS� DATE INSP. of rove
Gas
E c- is M
pTtunZi" x « PLUMBING DATE IA'SP.
,g , �.
Underground
ran�g.g M �} oor
Partialoug _
r g ti phi y" ou lete
e t m ti s r ` -
1U mg ,-.,-,. Y ' a Water ' insulation
Olt ,, 45 -- --
tt eb- r --
BUILDING. DATF INSP:' Not AppFov=e `
Pad Certification
1 M ELECTRICAL DATE INSP.
Pre.;
, y�-� �
a cane : ,, �,. ,.` ,�,,,,� � Underfloor S:M.
limon ..:; . am cts insulation —
Un oor irdets.,, „ .e..;r,Ln, lre - afllpeTS —
mr tee lire- lP ace — —
Tip s „ s �,, —
5 rm "s Y
Grcieea..swDour�ct r
Hood.o .
D
t
et innsate� aazi
Wa `Yane r = ra eeuMent Anc o _
-
sFlues,Comb. Air
atfi'- DtTier-- ----
pa96f . rove
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A(OPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
[ BUILDING PROJECT IDENTIFICATION APPLICATION 8t PERMIT PERMI ER
TNUM�A„1
-�. !Boone (� -. -..-...-.__,.BUILDING ,.
�• -I `, ^BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
093
OWNER'S / x PLAN CHECK VALI DATION
NAME. `-` " - - TY. • ELECTRIC,P. RMIT FEE - '
y^ _14Q .. -`�T oNE '1 ,...-.= ...� a. ,^!R v xro`y'•x'rr *A a I":4 d+,
NArvinAcroRs C._.:: ,,,:_i.; UTLETS-SWITCHES-RECEP 5.00/1.00 '•
iNAME. ..,.-.���..�_.-.� "-.
e,,z. e)h61 c.101 LIC.NO. LIGHTING FIXTURES 5.00/1.00
CONTRACTOR
CONTREAS"" w_ --; ;,•-„•-••ms„µ ..,,� ;a; ... ,r.,, ,:APPLIANCES-RESIDENTIAL 4.00
SS'-' /' •] ".`
2 6
I ZLI-L ' iy d 0LP110NE 2-57-` PANELS 5.00 DATE OF APPLICATION' "y
ARCHITECT - ... .. PLAN CHECK FEE P.C:NO:'- 1
NR ,.,_..... ...... .........-...,r...,,,.,.,.,„,,.._..�_._... SIGNS.'. 6.00
ENGINEER ' ' 1
TIC.NO, SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALIDATION
ANOREss--"" :- _;' .�,^-�""'^".:�'""„`^"...:. SPECIAL CIRCUIT 5.00 • `
ZIP EMP.METER OR POLE INS. 15.00 - -
APPLICANT'S - "
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
0 0 o CIGFNSF.DLOIVTR7(CTORS•bEItAR'ATION
<v w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE'
w (commencingwith Section 7000)of Division 3 of the Business and
G m BLDG. ELECT. PLG; MECH.
0 z 1'rofessiom,COJe,- ' iice isristlripall TffoeC"•"'
Z o m - Liconse Class Lic.Numbe�-7 '2 6 - ❑ ❑ ❑ .❑
2u - Date Contractor (y Q✓t__4e•• '
-..: a:::. _ . _» ;.i•'#. BUIL',DIN °PERMIT'
¢'¢Oa U' OWNF.R-BIIILDI:R DECLARATION ,A;Q. ,xINFQRM TION
w ; LL N I hereby affirm that I am exempt from the Contr rotor's License MISC.- REFER TO ORD
VALUATION $/FT.
F'u o J Cod for.the following reQsop. .Sg};,,Z,Q�3,Lr,vJ}5 y(y/,I ypgQJ'rafesalons PERMIT ISSUANCE 6.00
w m Code:AnY city or wugty wh11!1!£yw(L4NgL'CfWy(1B,(Lopst�upt,alter, - �6���y'9•,�/
2 ¢00 improve,demolish,or repair any structure,prior URS Issuance,also ELEC.CONTR LIC.NO. ELEC. r-,Y
a wO u requires the applicant for such permit 0 file a signed statement that TOTAL PERMIT TO
m he H licensed punuan4-to-0rc•prrwiehmrof+HfrCbntmcta's License
Law(Chapter 9(commencing with Section 7000)of Division 3 orthc 4tY s:'T. A ". x �P- -9 T 'k'y NAyv
gip Business and Prol'esslons Code)or that Ire is exempt therefrom and QTY, .4 vT�'7a '„�1PI.UMBING PERMITS q,,�•glsA w•ysEfs''
H o (ho basis for the alleged exemption.Any violation of Section 7031.5 C,t a 4.v T ,. s :,, .�`ri ° STORIES TYPE CONSTR.
a.;m by any applicant for a permit subjects the applicant toa civil penally, ALTER-DRAIN (EA.) i'
of not more to..five hundred d.1ars($500)J: of Cl IDBf.i(10 -
. ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE
their sole colnpensatiOn,-u411Jil gio aook"aW-!hal tum is not 2.00 OCC.GROUP RES.UNITS
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 4.00
Code:The Contractors License Law does not apply to an owner of '
/ property who builds Or Improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SG.FT,FLOOR AREA TOTALACREAGE
himself or through ids Blue'eml4rdyees;rylrmadgntllht-Sfsdh imp rave. GAS-EA.SYSTEM-I INC.4 OUTLETS"4.00
sy menu are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner-
bufferGAS-EA.SYSTEM-OVER 4(EA.) 1,00 - BUILDING USE
will have the.gNrQppdjQ ��•+d.a,ianaCbuild or im-
proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 20.00 RES IND -CON PR ower
❑ I,as owner of the property,am exclusively contracting with C3 El 1:10 Ellicensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Codc:The @onaeb8sdeba not apply
• to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsueh projects with it contractors)licensed pursuant to -
the Contractor'sLicense Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ .I,'om exempt under Sj;¢.- .,..,,.-,,,`.. B.&2C,.formic ..._ WATER HEATER W/VENT 4.00 -
reason
Owner Date WATER SYSTEM 4.00 ACC.GATE ACC,FILE N0.
WORK BRS'COMPENSATION'DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that [,have a certificate ofc.nSe.t a0"Ibinsure, ZONING or u certificate of Workers:.folnpoasWiirwdiruranaq-or a certified ENG.SITE NO.
copy Nen"Of(Sec. 800 La IC.).r`1
.. Policy No _j_ PauY' y�L�14-1�
O ❑ Certified co y' Icrehy furnished
Z Z ❑ Certified p 's flied WBIi'l6 "�frispection division. _ FIRESPRINK ENEHGYT-24
APPlicvm t - MISC.- REFER TO ORD. Y❑ N❑ Y❑ N❑
~-rn cnS• _ PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. •
LU -. &k.ttTJFLCCO'E ° :ANCA,:=�_ .
W COMPENSATION be completed if
PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y❑ N❑
CL O f flus lion need not be Lomple[cJ If the permit is for one TOTAL
Z hundred Hollar,(S1OD_y�r 11e��xss�,4 - -
V O I rely that in the penance.I C work for which Ibis per p 'x �+r 7" "'" vrv""` 1f to µ+'Vi'x FEE SUMMARY
- mit Is Issued,I shall not employ any person In any manner so as to QT,�Y.- `$ MECHANICAL'IPERMIT ' FEE
ir
LL V become subject to the Workers'Compensation Laws of California T ` ` m a' T ..
n Date-ApPillM..+.-....�••..•* - -••--- gLTER ORADD TO MECH. 4.00 BUILDING as-
} 411 NfTfICl:;TO API'tICA'llT:'tf,'^JRtI'M1lakitl$'tt83"C•FI1tYealf:`uf tx-
H Z emption,you should become subject to the Workers'Compensation APPLIANCE - 4.00 PLAN CHECK _
_ provisions of the Labor Code,'you nnist forthwith comply with FEE .
CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO I0J=C.F.NI) , 3-00
"CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,13MC.flb1) 5.00 SEISMIC FEE
I hereby aflhltr'that'TIIHN'bTC1fI1St1'dL9T6rfTeBMBp'agericy Tur EXHAUST HOOD(WITH DUCT) 2.00
the performance of The work for which this Permit is issued(See. MICROFILM'.
3097,CmC L HEATING UNIT(TO 100,000 B.T.U.) 4-00
lender's Name
dress HEATI NG UNIT ER 100,000 B.T.U.P.50
Lender's Address ELECTRIC
I certify that I have mad this application and state(hat the above VENTILATION FAN (SINGLE) 3.00
information is cpsmctf rapi,t••q� mnly XAt-y1LWY.OnJ.county BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating:to building construction, and
hereby 11thoed representatives of this city to enter upon the BOILER-COMP Water 100,000 BTU)SEE FEE SCH. MECHANICAL
above-rnentioncd propertyerepresentatives
of chi purposes.
(We):agrce t0"SllOP,`1ftCPMYRIy`k'h'�"Yc'e'ep'Barmleis the City of MISC.- REFER TO ORD.
Cu a rti e,winsl liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3•W CONST.TAX
may in any way acerae against said C ty in consequence of the
gmntin8 this peimlt .� -,i- MECH.CONE ' LIC.NO. MOTAL.
Signature of Apphcam nlractor Date
- -' OFFICE COPY -