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5303 (2) CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) PERMITNO. ADDRESS LOT NO. P & p� 6� V MMR PERMIT ISSUED DATE ELECTRICAL DATE INSP.= ui ink ¢ €lectrical Plumbing Power Pole Mechanical �+. er oun e as ec oug . firing . . oar Walls Fire Sprinkler eiin ? ixF tures nt xt otors Misc. Croundin emp ower utner FINAL INSPECTIONS DATE INSP, Not Approved Gas Electric 8 Plumbing +, - /_gy . PLUMBING DATE INSP. Mechanical Wolar Backflow o Underground Grading eITnde boor Planning Partial Fire pt, ou o Tete f�ealt t. o ar ough ui ater ' Insulation t er �n rain R/oF79 rain as t er . BUILDING DATE INSP, Not Approved Pad Certification oun ation ELECTRICAL DATE INSP. re- rte Slab-Nierffirane Underfloor S.M. Bond earn DFH7771nsulatlon Underfloor Girders ire ers Floor teel Fireplace ie owns brease Duct ,Z Hood is rams One Hour Shaft eismec Bracing 76—HEF—sate brain a1V l�-ME s E5uilxnent Anchorage Frame Flues 4 Comb. Air t t er oars n xt. .�-) Not Approved Firewalls Other et rove Pin ems_ _ P Al- a -d APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT.PEN ONLY` BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ADM1mNG APPLICATION & PERMIT' - 0 o110 BUILDING—ELECTRICAL-PLUMBING'—MECHANICAL 1Nf32opGt WsvW. nWNE 'S Aume',r, - - - PLAN CHECK VALIDATION i-� ^OLSy.19,(' OTY. ELECTRIC PERMIT FEE _ �1 1. PHONE s' T PAIL) �. ! p 'TL.ETS-SWITCHES'-RECEP 5.00/1.00 NV`V ^ IOIJc�-C' � LIC.*NO. (J3, LIGHTING FIXTURES 5-BGn-DD MAR 301984 co4NTRncTOR•s{'� i A,,.��]2r�. [? PPLIANCES—RESIDENTIAL 4.00 n�D-s-3 QO41' Flnryr✓L.Y .. 1'{� PHONE � —SQ') PANELS 5:00 ON . ORCHITEcr - SIGNS - 6.00 ' P C C P.C.NQ ENGINEER,' uc.No. j ISIGNS TRANS. 3.00 ' ARCH,OR ENG: $PECIAL CIRCUIT 'S.00 - PERMIT VALIDATION ADDRESS nap iEMP..METER OR POLE INS. '15.00 APPLICANT'S - " ADOREss " MOTORS' SEE FEE SCH. SERVICE CHANGE '10.00 w o o LICENSED CONTRACTORS DECLARATION Fa ..I hereby affum'that I am licensed under provisions of Chapter 9 t ¢ (commencing wilhction 7000)of Division 3 of the BusiOess and D ISSUANCE PAGE M LH Fyi Professions Code„Keel myrlicense is in full fo e '^ ❑ z4 O T — LicenscC asst' Lic.Numbnr ” m r� Dated/-+—�(—�Cnnlructor' 11 p Q v (� wa OWNER-BUILDER DECLARATION MAR a+ o '�"'�� - BUILDING PERMIT w 3 LL G .I hereby affirm that Pam exempt from the Contracor's License M IS6:- DEFER TO ORol INFORMATION LL04 Law for thb Collowin6 reason.(Sec.7031.5,Businessund Professions PERMIT ISVALUATION $/FT. L Code:Any city or county which requiresapefmitto construct,alfeq 6.00 �� ELEC.CONTE. LIC.NO. //sx/i/ U ac rc ¢ � improve,demolish,or repair any structure,prior to its issuance,also ELEC. / —O u requires the applicant for such permit to file a signed statement that TOTAL u w m he is licensed (ozo nt to the provisions of the Contractor's License PER TO r z a Law(Chapter 9(commencing with Section 7000)of Divisipn3 oRhe - 4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE leHm the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES JYPE CONSTR. aim by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN (EA.14.00 of not more than five hundred dollars($500).): ' ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 their sole compensation,will d0 the work,and the structure is not OCL.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:'The Contractor's License Law does not apply to an owner of - property who builds or improvesthereon,and who does such work FIXTURES-PER TRAP- ' - �. himself or through his own employees:provided that such improve. 4.00SQ.ET.FLOOR AREA TOTAL ACREAGE ments are not intended or offered forsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00 or improvement is sold within one year of completion,the r ownie- l BUILDING USE builder will have the burden of proving that he did not build w - GAS-EA.SYSTEM-OVER 4(EA.) 1.06 Prove for Purpose ofsale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON. PB Omer ' ❑ 1,as owner of the property,am exclusively contracting with - .,1:1 - . - O licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner or property who builds or'improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ,contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. - PARCEL NO. `e❑nl am exempt under Sea ' ,B.&P.C.for this : WATER HEATER W/VENT - 4',Op Owner - - Dale WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATIONWATER TREATINGEQUIP. - 4,00 I hereby affirm that I have a certificate of consent to self-insure,' n/ or certificate of Workers'Compensation Insuranccgr a certified ZONING ENG.SITE NO. V� copy fner`� OS' - FfN(.�. . P is - O Ce ilii v creby Lr fished. > FIRE$PRINK ENERGY Z Cerlif d rs filed �ly mspochon division. - - 1 24 . H O ApPiicum _ MISC.- REFER TO ORD. Y� . N Y ❑ No 1 PERMIT.ISSUANCE FLOOD ZONE A.A.u.c. LUW FIC OMPE ATION INS FROM WO FIRS' ! 6.00 CLO COMPENSATION INSURANCE. PLG.CONTE. LIC.NO. " PLG. Z (This section need not be completed if the permit is for one - TOTAL Y N Y[:] NC] hundred dollars($100)or less.)' U O I certify that in the performance of tie work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY IL F mil is issued,1 shall not employ any person in any manner sun as h) OW become subject to the Workers'Compensation Laws of California y DateApplicam " ALTER OR ADD TO MECH. , q,00 - BUILDING >_ NO TICK TO APPLICANT: If,after making this Certificate of Ex- F _ emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK U puck visions oln the [.shot Code, you must forthwith comply with - provision this pe.rout shall he deemed revoked. AIR HANDLING UNIT(TOFEE'10p00C.F.M3 -3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.RM.) 5.00 SEISMIC FEE. I hereby affum.[hat there is a construction lending agency for EXHAUST HOOD(WITH.. 2.00 the perforelanee'of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100' .TU) 4.00 Lender's Name . . - ` Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC ' I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 �' information n correct. I agree to comply with all city and county BOILER-OOMP(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING .' hereby aces ori state laws ativesn8 to building construction, and above- inti authorize representatives of This city to enter upon the BOILER-COMP (Ova,100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (We) agree.to save, indemnify and keep harmless the City of MISC.- EFER TO ORD: - Cupertino' anst liabilities,judgments, costs and expenses which CONST.TAX mayaiIva accrue rust S"city in consequence.of the PERMIT ISSUANCE 3.00granfis ern'itMECH.CONT. '• l .lam. •g ' MECH.TDT TOTAL Applicin/Contractor Date OFFICE Qta1