2315 CITY OF CUPERTLNO INSPECTION RECORD (Office Copy)
2315 _...----
PFPdIIT ND. ',ANITARY DIST. NO. LOT NO. ADDRESS
Fire Sprinkler Vallco Fashion Park
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buildine _ 12-6-82 Date Insp.
Electrical Power Pole
Plumhinr Underground
Mechanical RauFF',h Wiring
'Temp. Gas/Elect. ITa1l.s ---
Solar Ceiling
Tire Sprinkler Fixtures Int/Ext _
Sign Hotors
Grounding
misc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved
Date Insp.
Ars PLUMBING
Electric Date Insp.
Plnmbin , Backflow _
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
PlnnSoler Rough
Fire De t. Mater & Insulation
Health Dept. Plain Drain
Building R/of/S Drain _
Other Gas _
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
T:i.edowns One (lour Shaft
Di.aphrams Condensate Drain
Seismic Bracing Equipment Anchorage _
Unl..ls-Panels Flues & Comb. Air
Frame Other
Lnth Not Approved
Uall.boards Int/Ext.
Firewalls
Other
Not Approved
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN R,ED-LINES - USE BALL POINT PEN ONL
BUI LDI,NG PROJECT I DENTI FICATION PE U BER
BUuowc APPLICATION & PERMIT 2315 r�� C
ADDRESS (� `j �J
_'CC Sin BUILDI Ivi ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - - PLAN CHECK VALIDATION
"(^ME L OTY. ELECTRIC PERMIT FEE
IS �^ , PHDNE
CONTfl ACTOR'
ry mE Cn4ri kirivill OUTLETS-SWITCHES-RECEP 5.00/1.00
III uC.No. LIGHTING FIXTURES 5.00/1.00
ADDRESsioRs P;-enrovlT APPLIANCES-RESIDENTIAL 4.00
PHONEPANELS'. .5.00 DATE OF APPLICATION
ARRCHITECT - SIGNS 6.00 TLAN-CHECK FEE P.C.NO.
ENGINEER L
J LIC.No. SIGNS TRANS. 3.00
AARCH,OR DCRESSENG. SPECIALCIRCUIT - 5.00 PERMIT VALIDATION
5 ZIP ITEMP.METER OR POLE INS. 15.00
APPLICANT'S
ADDRESS
MOTORS SEE FEE SCH.
41Me Q SERVICE CHANGE 10.00
o o LICENSED CONTRACTORS DECLA RA ION ( Q
a v w I hereby affirm Ilial I am licensed under provisions of Clul 9 ISSUANCE DATE
y a (commencing will,Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H w i Professions CoJy a� my license ll
is in full lore �aM1M1gqJ effect. ❑ ❑ ❑
0 i w O I.icens' s�.,yf.�Liv.Numbe !;.. .
T
r j Uate Z Contractor.- 11[1N
P
Y a CO - ILDING PERMIT
¢ ¢ a
OWNER-BUILDER DECLARATION,
u a a v INFORMATION
w ; 1 y 1 hereby uHirm Ilial I am exempt from the Contractor's License MISC.- REFER TO ORD
r u o J Law I'nr the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 6.00 VAL ,Jyq rte SIFT.
Zm>N Code',Any city orcounty whichreuiresapertnitloconstrucl,:titer, c2 �,/"D -{/'
¢ a O improve,demolish,ci repair any stiuc(um,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
n'wDLL reRnlre$the applicant for Snch permit to fde..Shelf stalemenl that TOTAL ,CII T TO
$m he is licensed pursuant to the provisions of the Contractor's License
rZ > Law(Chapter 9(Commencing with Section 7000)ot'Division 3 of life ���5` �n/�(�K
¢ a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ 1-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 _ by any applicant for a permit subjects the applicant to a civil penally gLTER-DRAIN -WATER (EA.) 4.80
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS.
their site compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code'rhe Contractor's 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 BD.FT FLOOR AREA TOTAL ACREAGE
himself Or through his own employees. .I .provided.that such improve
or nts improv net intended or within
rone year
(completion the the o nee- GAS-EA.SVSTEM-1INC.40UTLETS 4.00
or improvement will have
is e b within one year of completion, the owner-
builder -EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or in). RES IND CON PB Other
prove fors owner of sale.).' INDUSTRIAL WASTE INTER. 20.00
❑ 1.d as owner of the property,he exclusively contra,ling wish ❑ El ❑ � ❑
licensed comruc(ors to construct the project ISec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B., 5.00 ASSESSORS PARCEL NO:
an I Profess, Code:The Contractor's License Law does col apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) . 1.00
contracts for such projects-with a contruclons)licensed pursuant to SEWER-SANITARY-STORM EA. 200it/8.00 `
lire Contractors Llc,me Law. TRACT NO. PARCEL NO.
reas❑on I am exempt under Sec. ,B.&Il C.fur this WATER HEATER W/VENT 4.00
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKIE RS'COMPENSA'f ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm (hal I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a calcified
copy thereof(Sec.3800,Lab.C.l. '
Policy No. Company
O ❑ Certified copy is hereby furnished.
FIRE SPRINK ENERGY T14
z Z ❑ Certified copy is riled with the city inspection division. MISC.- REFER TO ORD. o N[] Y ❑ 111O Applicant Y
c w CliRTII:ICATI:OP EXEMPTION 17ROM WORKI:RS• PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
ku COhIPI' ON fil INSURANCE PLG.CONTR. LIC.NO. PLG. Y N V
Z Il'It is section need not be completed if the permit is for one - TOTAL N
hundred dollars IS 100)or less.)
U O :I cattily Haut in the performance of the work for which Ibis per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P 11 is issued,I shall not employ any person in any manner vt is to
0Ubecome suhject to theMorkso'Compansalion Laws of CaliforniaUJ ale / �
DApplicant BUILDING d/
} m NO 'Ha "f0 APPLICANT'. If,after making this Certificate of Ex.
UJ ALTER OR ADD TO MECH. 4,00
� ? emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK -7 4-0
provisions of the Labor Code, you must forthwith comply will' GHJ _
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 3.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 109MC.F.M.) 5.00 SEISMIC FEE sans
I hereby affirm flat (here 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name H EATI NG U N IT(OV ER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
1 certify that I have read this application and state(hal the above VENTILATION FAN (SINGLE) 3.00
oordinances carred.1 agree to comply with all city and,aunty BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING
fo... res and slate laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP to.,I00,000 RTU(SEE FEE SCH. MECHANICAL
abovatnentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City CI ' MISC.- 'R FER TO ORD.
Cupertino against liabilities,judgments, costs and ,xpensex which P
ERMIT-ISSUANCE 3.00 CONST.TAX
city in any way accrue vine, said City in consequence of Jm
granting of is panni,. NT. LIC.NO. MECH, 3
11. Z _ TOTAL TOTAL G 41,
tgnutu¢o Applicant ConanIo Dnte
OFFICE COPY