0978 GI'fly OF CU IT1NO INSPECTIOt! RECORD (OfficCopy)
0978 _ io123:11: Wol£,_.Rsir-_-S.gac�lE213A
PCPdIIT NO. SANITARY DIST No. LOT NO. ADDRESS
Remodel Kramer_ Shoes
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buildi.nr 9-9-81 Date Insp.
Electrical Power Po_te
Plumbing Underground — --
MechanTcal 9-1-81 Rough Wiring
Temp. Cas/lilect. _ Walis
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other
FINAL. INSPECTIONS Not Approved
Date Insp.
r"s PLUMBING
Electric
Date Insp.
Plumbing Backflow _
!techanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
Planning Solar Rough
Fire Dept. 0-F-2 6later & Insulation
Health Dept. / Main Drain
Buildin. - - R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification 11ECIIANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext .
Firewalls
Other
Not Approved
s
• BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ON
BUILDING PROJECT I DENTI FIC T NUMBER
noo° 014_3 , G(/OLfE 7 APPLICATION & PE T 0978 9 7 8
O N _ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .J 11
EP PLAN CHECK VALIDATION
1 NAME CITY. ELECTRIC PERMIT FEE
A!4;L S �1 PHCNE
CONTRACTORS ��
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
�•
�. / L^.fuc.No LIGHTING FIXTURES 5.00/1.00
. DRESS Das PPLIANCES-RESIDENTIAL 4.00
ACoaess )_
• C �' PANELS 5.00 DATE OF APPLICATION
A HIT �' SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGI E
sec.No. SIGNS TRANS. 3.00
ARCH. ENG. 9/L,�/A:� SPECIALCIRCUIT 5,OQ PERMIT VALIDATION
ACHE55 99��11
" /) jam zIFEMP.METER OR POLE INS. 15.00
A uESS MOTORS SEE FEE SCH, n
ADOREss
SERVICE CHANGE 10.00 /
D o o LICENSED CONTRACTORS DECLARATION
a v v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
Hw (commencing with Section 7000)of Division 3 of the Business and
¢ n BLDG. ELECT. PLG. MECH.
H D i Professions Code, nd my license is in full force i sd a eat.
z D r� - License rC Lie.Numb 0 0 El
Q m r Date Contractor I
f BUILDING PERMIT
a e w ¢ WNER-BUILDF,R DECLARA I -- INFORMATION
oAU MISC.- REFER TO ORD
Axe ; LL h I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
uo¢ Law for the following reason. 703L5,Business Professions PERMIT ISSUANCE 6.00
Code:Any city orcounly which requires:I�rerrad to construct,alter,
2 ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
D , requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w'$ he is licensed pursuant Io the provisions of the Contractor's License
i
La.(Chapter 9(commencing with Section 7000)of Division 3 of the
¢ Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n -; by any applicant fora permitsubjects the applicant loacivil penalty ALTER-DRAIN -WATER (EA.) 4.00
I
of not more than five hundred dollars($5000.):
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2,00 G.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 `� �•�a
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 SO.FT.PLOOR AREA TOTACACREAGE
hlmseh re ofoughrote his own employees,provided that such improve.
mems are not intended or employees, lrJfed that such
building GAS-EA.SYSTEM-1INC.4OUTLETS 4.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that Ire did not build or int RES IND CN PB oma,
prove for purpose of sale.). INDUSTR ASTE INTER. 20.00 �❑
❑ 1,as owner of the property,am exclusively contracting withEl 0
licensed contractors to construct the project(Sec. 7044,Business LAWN SP,13.1 K S-1 INC 5 V.B. 5,00 ASSESSORS PARCEL NO.
and Professions Code: [he Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWNS LE VER 5 (EA.) 1.00
contracts for such projects with a contractorls)licensed pursuant In
the Contractor's License Law, SEWER-SANITARY'-ST EA.200ft/8.00 TRACT NO, PARCEL NO.
❑ l am exempt under Sao.-,BAP.C.lot this WATER EATE NT q,QQ
reason
Data Owner WATER M 4.00 PCC.DATE ACC,FILE NO.
W'ORKIIRS'COMI'liNSAT10N DECLARATION WATER TRE NG EQUIP. 4.00
1 hereby affirm flat I have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certiEeJ
copy thereof(Sec.3800,La • /l I
Policy N Companyny-
Q ❑ Certified
ified copy is hereby.ffur ed. FIRE$PRINK ENERGY T-24
-�yJ
Z 2 ❑ Certi ' d t ,is ilr ity
nt sp 'Yo Irvision. -
O, Applica (t/g/j� -�s-- MISC. REFER TO ORD. Y N Y N
� y CERTIPI CATE OF EXI MPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.0 C.
LU > COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG
CL Z( 'this Section need not be conmleod if the permit is I'or on ❑e TOTAL Y NE] Y 0 N[]
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per. CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
Ow become subject to the Workers'Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING �'�b. A
rd
} N NOTICE: TO APPLICANT: If,after making this Certificate of Ex-
2 emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONST'RUC'TION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOC.F.M.) 5.00 SEISMIC FEE Yp
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,CN.C.). ._ HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name r 00,000 B.T.U.)7.50�- HEATING UNIT(OV ER 1
Lender's Address - ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
ordinances is rotatel I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000B.T.U,) 4.00 PLUMBING
ordinances and state laws relating to building lConstruction,citand cand
hereby authorize representatives of this city to enter upon the BOILER-COMP love,100,000BTUISEE FEESCH. MECHANICAL
above-mentioned property for inspection,purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against linhil iti ,judgments, costs and expenses which CONST.TAX
may in a ay ace against said City in consequence of the PERMIT ISSUANCE 3.00
granting - per MECH.CONT. LIC.NO, MECH.
I T°T"` TOTAL 'J4/ ,70
Sijin.fumntTcrunt'acto, Date
OFFICE COPY