1280 (2) r '^ CITY OF CUPERTINO INSPECTION RECORD (Office Copy)
1280 1046 Bubb Rd.
PEP11IT NO. SANITARY DIST. NO. LOT NO. ADDRESS
Repair Roof Jan H. Yammas
PROJECT OWNER JOB SITE PHONE NO.
Date ELECTRICAL
Building 11-5- 1 Date Insp.
Electrical Power Pole
PlumbingUnderground
Mechanical Rough Wiring
Temp. Gas/Elect. iTala
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
_ Other
FINAL INSPECTIONS Not Approved
Date Insp.
Gas PLIMBING
Electric
Plumbing Backflow Date Insp.
Mechanical Underground
Solar Underfloor
Pool Partial Rough
• Grading Rough Complete
Planning Solar Rough
Fire Dept. Water & Insulation
Health Dept. *lain Drain
Building R/of/S Drain
Other Gas
Other
STRUCTURAL Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Itembrane 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
Slalls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Wallboards Int/Ext.
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
..,. BUILDING PROJECT I DENTIFICATION PEIT E
BUILDING APPLICATION & PERMIT Q,O
AOGRESS tJ
O 6 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - - - PLAN CHECK VALIDATION
"AM - OTY. ELECTRIC PERMIT FEE
A�//f�jJ/-JpJIONE
2NT[RACTORS OUTLETS-SWITCHES-RECEP 5.00/1.00
LIE.No. LIGHTING FIXTURES 5.00/1.00
CONTRACTORS
ADDRESS PPLIANCES-RESIDENTIA 04.00
ADDRESS
PRONE PANELS 5.00 DATE OF APPLICATION
ORE
RRCHITECT SIGNS a 6.00 PLAN CHECK FEE P,C.NO,
ENGINEER
Llc.No. SIGNS TRANS. w 3.00
AARCH,OR DDRESS ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zap EMP.METER OR POLE _ 15.00
ADDRESS
S .
AMOTORS SEE FEE SCH.
DRE
SERVICE CHANGE 10.00 Ls_
Foo LICENSED CONTRACTORS DECLARATION
U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE
DATE
in
Q,w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. ALC. MECH.
1. D i ,PTofessions Code,and my license is in full force and effect ❑ ❑ El
o= License Class Lic.Number
2 z H w Date Contractor '
BUILDING PERMIT
¢ ¢ � OWNER-BUILDER DECLARATION INFORMATION
w0 A . I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
3 u ,A VALUATION $/FT.
F u.o a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00
0improve,demolish,or repair any structure,prior to its issuance,also ELEC.COB�
Y � E Code'.Any city or county which requiresa permit to construct,after.
n-D
ce at a D CONTR. LIC.NO. ELEC.
i DLL requires the applicant for such permit to file a signed statement that TOTAL MIT TO ,
whe is licensed pursuant en the provisions of the Contractor's License -----
Law
r Law(Chand drowsiest Codeng )or Section is 00)exempt
Division of the
H a- Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢H D the basis for the alleged exemption.Any violation tto aclinn malty STORIES TYPE CONSTR.
i ;$ by any applicant fora permit subjectsthe$500).licant tuacivil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(5500)J:
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 2.00 OCC.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
Code:The 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 S0.FT,FLOOR AREA TOTAL ACREAGE
himself re through his own employees,for sale.Provided that such improve
mems a re notinthhis or empldforrovided that such
building GAS-EA.SVSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA) 100 BUILDING USE
builder will have the burden of proving that h . . .
e did not build or im' RES IND CON P9 Omar
prove for purpose ofsah.). - INDUSTRIAL WASTE INTER. 20.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:'I he Contructur's License Law does not 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 contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/6.00 TRACT NO. PARCEL NO.
C] I am exempt tinder Sec. ,B.&P.C.I..this WATER HEATER W/VENT 4.00
IS.
son
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK F-RS'COM PENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that 1 have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or o certified _
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certifie Is her f FIRE SPRINK ENERGY T24
❑ Ce ed py i li w' t ly ins ection division. MISC.- REFER TO ORD.
O Applicant' r❑ N❑ Y ❑ N❑ "
efIlIFICATECIF I3XIS ION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.II.C.
W > COMPF.NSA ON INSURANCE PLG.CONTR. LIQ N0. PLG.
CL 0 (This section need not be fompleted if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
:) Z hundred dollars($100)or lees)
U O I certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mil is issued,I shall not employ any person in any manner so as to
U. become subject to the Workers'Compensation Laws of California. t�
ED Dutc Applicant ALTER OR ADD TO MECH. q,00 BUILDING �q
} (ail NOTICE TO APPLICANT: If,after making this Certificate of Ex-
emption,you should become subject to the Workers'Compensmion - APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE
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,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC -
I certify that I have read this application and state tlml Ote above VENTI LATION FAN (SINGLE) 3.00
information n correct.1 agree to comply with all city and county PLUMBING `
ordinances and state laws relating to building construction, and BOILEfl-COMP(3 H.P.or 100,0008.T.U.) 4.00
hereby authorize representatives of this city tien1L•r upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
ahove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino inst liabilities,judgments, osts and expenses which CONST.TAX
may if y way accrue a 'ns said ly in consequence of the PERMIT ISSUANCE 3.00
gr' ago his perm' MECH.CONT. LIC.NO. TOTAL �O
TOTAL , 00
ature of App¢antjC nor Uam
OFFICE COPY >