4097 CITY 01' CL'1,171,11NO INSPECTI01 RECORD (Office Copy)
4097 10310 Stonydale
PI:PJIIT MO. SANITARY DIST. NO. LUT ,57 ADDIU:SS
Addition Henerickson
PROJECT OWNER JOB SITE PHONE NO.
PER*SIT ISSUED Date PLECTRICAL
Buildinr
Date Insp.
Electrical Power Pole
I'iumhinr Underground
llcchnnical P.ou ch Wirin
Temp. Gas/I,lcct. aI i `
Solnr Ceiling
Fire Sprinkler Fixtures Int/Ext
Sir.n Motors
Grounding
Hisc. Temp. Power
Other _
FINAL INSPECTIONS Not Approved
Date Insp.
s
PLUMBING
Electric Date i
nsp.
Plumbin , Backfloc7
!lechanical Underground
Solar 4tUnderfloor /
Pool Partial Rough a f-,93
C,rarling Rough Complete
• Plannin , Solar Rough
Fire Dent. Water & Insulation
Health Dept. 'lain Drain
BuildingR/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date I Insp.
Pad Certification MECHANICAL
Foundation �n y3 � ( _ Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation
Bond Bean Fire Danpers
Underfloor Girders 10'1 - 7 Fireplace
floor Steel Crease Duct & hood
Tiedowns One (lour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
Ualls-Panels Flues & Comb. Air
Frame Other
],nth Not Approved
llallboards Int/Ext.
Firewalls
Other
Not Apnroved
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN-ONLY,
BUILDING PROJECT I DENTI FICATION .-., .PERMITNUMBER,
"I APPLICATION & PERMIT f/ej1 /`j�E /!/J
-N[
ADDRESS
"JlD V 1 IDV 1
BUILDING-' ELECTRICAL-PLUMBING -MECHANI
OWNER'S - - _ PLAN CHEC 'ALIOATI
N-=� - OTY. ELECTRIC PERMIT FEE'+
J sa 3z
CONTRACTORS '
NAME Cl JOUTLETS�-SWITCHES-PIECED 5.00/1.00 3.r
il/T�/y6C.No. LIGHTING FIXTURES 5.00/1.00 T
foNrRAcroRs
ESS , e,& 4:1, APPLIANCES-RESIDENTIAL' 4.00 pQ�
AO H
:X PHONE PANELS 5.00 pAT LICATICINE
.TIURIECT SIGNS 6.00 PLAN CH E
OR
ENGINEER -
` LC.No: - SIGNS TRANS. 3.00
ARC
ENG, 'PE _
ADDRESS OR SPECIAL CIRCUIT 5.00
--i,p EMP.METER OR POLE INS. ' 15.00 ('I
APPLICANTS MOTORS. SEE FEE SCH. b
SERVICE CHANGE 10.00
0 0 0' LICENSED CON'1'RAC'1'ORS DECLARATION ' FAID
a v u I hereby affirm lEi t 1 am licensed under provisions of.Chapter 9 I ISSUANCE DATE',
y a w, (co nunencing'with Section 7000)of Division 3 of the Business and B ELE L L 1,NVCH.
H z ' I'rol'essions Code, my license is in,lull I'nrce J of=c1� / I
z o w- Licen 'Cl. Lir.N1 FJ
O m r Du1�_- („� Contac '
'a'Y _ - Cit of Cu ertino • . cul ING ERMIT
E Ie- w u OWNER-BUILDIiR P LA RATION _ ' .-. I INFORMATION
w ;LL N 1 hereby affirm that I am exvm from tie Contractor's License _ MISC.- REFER TO ORD VALUATION $/FT.
ea u.o¢ Law forthe following reason, 7031.5,Business and Professions - PERMIT ISSUANCE 6.00
Code:Any city or county which requires a permit to construct,alter. -
¢ 2¢ 20 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. , LIC.NO. ELEC. -
0¢ requires the applicant for such permit to file a signed dalement Thal TOTAL PERMIT Tp
m pursuant Is licensed puumi[ki site provisions of fire Contractor's License - - - V YV
Hi >
Law(Chapter 9(commencing with Section.7000)6fDivision 3 of the
¢ Business and Professions Code)or that he isexempl'therefrom and CITY. PLUMBING PERMIT FEE ' I
. ¢ gym the basis for tire alleged exemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR.
a ; _ by any applicant for a permil subjects Elie applicant ma civil penalty ALTER-DRAIN -WATER (EA.)•4.80
of not more than five hundred dollars(S500).):
Cl I,as owner of the properly,or my rq loy,e,vi 11, wage,as BACK FLOW PROTECT:DEVICE 2,00. - occ.GROUP EES.UNITS
their sole cola pensution,will do the work,and the slnm Wre o not .
intended or offered for sale (Sec. 7044, Business and Professi.ns DRAINS_FLOOR,ROOF,AREA,COND.,4.00 'v
Code.The Contractor's License Law does riot apply to an owner of
property who builds or improves thereon,and who docs such work a FIXTURES'-,PER TRAP , -4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own entpinfor E PmIf,cd that,atilt im Pnavc ,. -intended RE hisow offered for pi.lf,ho that suer building GAS-EA.SYSTEM-'11NC.40UTLETS 4.00
or improvement is sold within one year of completion, the ownerGAS'-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RE IND CON PB Omer
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 20.00
❑ I,as owner of the property,u exclusively contracting with . El El .ElI lcc,ewd contractors to construct the olled(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. .5.00 ASS ESSOR S P AN CE L NO.
mid Professions Code:The Contractor's License Law does nOLapply -
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with o contractor(a)licensed pursuant m
the Contractors License Law. - SEWER-SANITARY-STORM EA.2001t/6.00 TRACT NO. .PARCEL No.
❑ 1.atoexcn[p(under Sea ;B.&P.C.ubgOlis' WATER HEATER W/VENT 4.00
Reason
Dae - Owner WATER.SYSTEM 4.00 ACC.OATE ACC.FILE NO.
N'ORKIiRS'C011PliNSAT10N DECLA RA('ION WATER TREATING EQUIP. 4.00 •' -
hereby affirm tint I have a cerlifjcate of consent to self-insure.
or if certificate of Workers'Cnnipensat on Insurance,on a certified ZONING ENO,.SITE NO,
reo
copy(hef f5ec.3800,Lub,C.l.
policy erf CO,La '
O ❑ Ec here fu . . FIRE-SPRINK ENERGY T 24
Z Z .Certs ' .co is •d illi- thea division' . MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O PRI'ant _ Y _ N •..V N
111.
CC Lo• CB CATE OF EXCM PTION FROM WORKERS' PERMIT ISS 6 6.00 FLOOD ZONE A.L.0 c.
EU > COMPENSAT'ION INSURANCE - PLG.CONTE. LIC.NO. PLG. _
G' O` (I IRS s ction need not be completed Yf the permit is for one TOTAL v❑ N❑ V❑ N❑-
D Z IIn ni red dollars(S I00)of less.) -
U O 1 certify Owl in the perbirniance„Of the work for whichthis per- CITY. MECHANICAL PERMIT FEE' "FEE SUMMARY '
LL F- mil Is issued, I shall not employ any person a
n iny mmnnerso as to
Ow become subject to the Workers Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
.} ID
W NOTICE TO APPLICANT: If,ufter.mal m,this Cerliticme of His- .
h 2 eniption,you should become subject to the Workers'Conipensalion APPLIANCE 4.00 PLAN CHECK
pnWisions of the Lahor'Coin, You mull furtliwith mmply.wlill FEE
U such provisions or this permit shall be deenad revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
_ - CONSTRUCI'iONLENDINCAGENCY ANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
hereby affirm that Ibere is a construction lending agency for - EXHAUST HOOD(WITH DUCT). 2.00 .-
the performance of situ work far which this permil is I,aMrod(Sec. MICROFILM
3007.Civ.C.r - H NIT(TO 100,000 B.T.U.) 4.00 -
Lender's Name
Lender's Address - l i HE TING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRICev
p I certify(hat have read this application and slate that the above I N FAN (SINGLE) t .3.00 /
lnfnnimtion n mrrcetl I agree to comply with allcity and county PLUMBING
ink...natioces ms star laws re (I,c in building construction,and... and OILER-COMPI3 H.P.Or 100,000 B.T.U.) 4.00
'hereby authorise representatives of.this city to enter upon the . ,BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indmnnify and keep bar less the City o1' MISC.- REFER TO ORD.
Cupertino againsl Iltibilitle, iii nems, cosls a expen,cE wit sI, -'PERMIT ISSUANCE - 3.00 CONST,TAX ,.
nr t anY wu :acr c :i id'Ci ly in nscqucnc• of Ila
R?,""
ig of lhl •r - �D v+ ECH.CONT. - LIC.NO, MECH. TOTAL 2z
Xn Iic.0 D; • I ' l
` - OFFICE COPY - - .