6138 CITY OF CUPERTINO INSPECTION RECORD V
(OFFICE COPY)
PER4IT O. sf�✓mss Creek �l✓� O.
5hell DiPROJECI I tR
PERMIT ISSUED DATE ELECTRICAL DATE INSP.
Ful In
ctric
Plumbing 85 Power Pole
Mcnanical r un ,
Teas ec u grin _
Solar a s
Fire Sprinkler Ue3.iing
Sign ixtures int/Ext
FEE—Ors
Misc. Grounding
e ower
er -y
FINAL INSPECTIONS DATE INSP. Not ApprOVea
Gas
Electric
Plumbing - — PLUMBING DATE INSP.
mcnanlcar—
Solar Backflow -
0o r un
Grading r oor
F.Lann3ng 1jartialou _ _S —
Fire t. u o -1eTe
Health t. oar RougH
lIn al ater ', ns anon
T
eF .0 In _ aln
773— 75 ain
Gas
Other
BUILDING DATE INSP Not Approved
Pad Certification
oun atlon ELECTRICAL
re- unite �TE P
Slab-Membrane zT Underfloor S.M.
Bond eam Ducts nsu atlon
Lhiderfloor Girders ire ers
Floor Steel Fireplace
le owns Grease Wct & Hood
Diaphrams One Hour Shaft
elsmecracln condensate Drain
ams-- ane s ul ment Anc orae
rame Rues
rn r
Lath ter
Wa . oar int/Ext. of Approved
•1-rrewaiis
'St ems"
Net Approved
APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECTIDENTIFICATI ON vERMIT NUMBER
BUILDING APPLICATION & PERMIT (��1 /
P _;[, aooREss
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S Iv�Vµt�1yy PLAN CHECK VALIDATION
NAME O r L CLj . pNONEy����
T*, x ".'r ELECTRIC PERMIT '70
. GD rRaLTDR B 3 2 - U-'
OUTLETS-SWITCHES-RECEP 5.00/1.00 d/
LIGHTING FIXTURES 5.00/1.00 ! ��
.ADDRESS ons APPLIANCES-RESIDENTIAL 4.00
CONTRA ���.� 70.7
Q� I�yJ7/IINO. 7•••a 6J PANELS 5.88 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR - SIGNS 6.00
ENciNEER ,qC r• .
' uc.NoSIGNS TRANS. 3.00
ARCH.OR ENG. PERNPVjPyIf2ATION
ADDRESS ItJf?I)', '(.� 1cij . SPECIALCIRCUIT -5.00 f+fH'► DD
t A �1
. ( • ZI 110 ITEMP.METER OR POLE INS. 15.00
APPLICANT'SI �L�,., 1 y /� 1
ADDRESS JL/ E'✓h llA. �'71p TJ ♦JQIJ�b MOTORS SEE FEE SCH. J '
a C 19
SERVICE CHANGE 10.00
uo o ICCOTRCRSDLARATION
. u City O ap5o�
o
. I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w¢m (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r w z Professions Code,,nd my licenm is in full fmdc( ❑ ❑
oi w o 'License Class_�T Lic.Numberp'(�[_ -
0 Date_�•'�h Contractor -' ,.../
•� Q w a' owrleR-RuaDeR DECLARA'r174L'�e"'9• A' ' BUI LDING;PERMIT
U
- INFORMATION
K
3 n m I hereby affirm that 1 am exempt from the Contractors License MISC.- REFER TO OR
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