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5961 (2) r, CITY OF CUPERTINO INSPECTION RECORD (OFFICE COPY) D �h PEIWET NO. ADDRESS LOT N Pff�EL 49 f207T OWNER PERMff T ISSUED IVE ELECTRICAL DATE INSP.' building Electrical P15-Eing Power Pole anica r un e as ec u irin Solar Walls Fire Sprinkler Ceiling bign FixturesInt/ERF— motors Misc. Oround3ng T22 ower O er FINAL INSPECTIONS DATE INSP, of rove Gas ectric PI-um in -�-� PLUMBING DATE INSP. .Mechanical ar Backflow ,o r un r ingoor r P1annin Partialu ire Rouete eat ept, oar u Eui13in -�s- r " Insulation — Other176-777M-in " Gas —� .Other BUILDING DATE INS, P. of prove Pad Certification oun anon ELECTRICAL DATE INSP. re- ite blab-Menbrane Underfloor S.M. Bond Beam cts Insulation Uhderfloor i ersirF'ewers Floor Steel 1-irep�ace .. iedowns Grease Duct & Hood is ramsHour Shaft Eeismec racing a Condensate Drain Grails-Panels ui ent An ora e game s Si ues 4 Lomb. Air r, ter oar Int/Ext. Not Approve= Firewalls Other Not prove P APPLICANT TO FILL IN INFORMATION WITHIN REDDLINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBERAPPLICATION & PERMIT nolLOmc 5961 Aoo ss © CO} N (� 1a.90O BUILDING-ELECTRICAL-PLUMBING-MECHANICAL , ...ER'a NAME �L PLAN CHECK VALIDATION fIS(� �Q/3 QTY. ELECTRIC PERMIT FEE 'mow r(P Vim( PHONE 7 �.�V' OJ CONTRACTORS ryy `�MF UTLETS-SWITCHES-RECEP 5.00/1.00 Jf__ " •�Url I CIr M'10119LI-5Q.S 1_Ic.No.4q-q2-193 LIGHTINGFIXTURES5.00/1.00 nooeess roll's f11,(-+��Pg�L�/ PPLIANCES-RESIDENTIAL - - 4.00 i A ItY PHONE32��547 PANELS 5.00 DATE OF APPLICATION ARRCHITEL? SIGNS 6.OU PLAN CHECK FEE P.C.NO. ENGINEER. LIC.NO. SIGNSTRANS. . 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 15.00 APPLICANT S ADDRESS - MOTORS SEE FEE SCH. r � SERVICE CHANGE 10.00 9 woo LICE NSEDCONTRACfORS DECLARATION a U w 1 hereby affirm that I am licensed under provisions ol'Chapter 9 100 A ISSUANCE GATE in G m (commencing with Section 7000)of Division 3 of the Business andAUG 83 n BLDG. ELECT. PLG. MECH. r w z Professions Cod• nd my license is in Fall fore and effect.3 Zo z v_ ,o License Class Lio.Number 4'1: Date Contactor M tr(3 `su- City of-Cupertino M m s BUILDING PERMIT• F ¢ wst OWNE -BUILDER DECLARATION INFORM F 3 LL I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD w ✓� VALUATION - $/ T. H .. o j, Law far he following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00 my Code:Any city or county which requires a permit to construct.alter, s.� Q Q ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /(/1! /(p VQ J• 1MA C¢ requirearhe applicant for such permit to File a signed statement that TOTAL e PERMIT TO E re he is licensed pursuant to the provisions of he Contractor's License Fzi Law(Chapter 9(Commencingwith Section 7000)of Division 3 oftheErf�9rre. Qlfy 4¢o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE at I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONS fR. a ; by any applicant for a permit subjects the applicant to acivil penalty of not more than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 4.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW 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 F IXTUR ES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such mimprove- GAS-EA.SYSTEM-1 INCA OUTLETS 4.00 Improve- ments ure not intended or offered for Sale.If.however,the building or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4(EA) 1,00 builder will have she burden of proving that he did not build or am- - . - . BUILDING USE RES IND - -CON PB Other Prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 20.00 E]• 1 O I,as owner of she property,am exclusively contracting with 0 11 0 11 licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:1'he Contractor'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 contmctons)licensed pursuant to •' the Contractor's License Caw. •SEWER-SANITARY-STORM EA:200ft/8.00 TRACT NO. PARCEL NO. '❑ lam exempt undei Sec. ,e.&P,C.for this WATER HEATER W/VENT 4.00 maven Owner _ Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSAT10N DECLARATION WATER TREATING EQUIP. 4.00 - I hereby affirm that I have a certificate ul'consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(SIC.3 Lab.C.1.�p - Policy No.- y rn �y U4GZ • . 0 ❑ rtified c y h y fhrni •30 FIRE SPRINK ENERGY T 24 d. Z CefliF, led wit a nifeldo o 1 .vision. O Applicant s MISC.- .REFER 70 ORD. Y'Q N❑ Y❑ No c y CIi TIFICATE OFEXEMPT-ION- FROM WORK.RS' PERMIT ISSUANCE 6.00 ' FLooD zoNE A.L.U.C. IL , (This section need nloN beTcompletedl if ha-permit is for one PLC.CONTR. LIC.NO. PLCTOTAL Y❑ N� Y❑ NC] o 7) Z hundreddollars(S100)nr lcssJ U O . I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I. mil is issued.I shall not employ any person in any manner So as to O W become subject to the Workers'Compensation Laws of California. y Dam Applicant ALTER OR ADD TO MECH. 4.00 BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- F Z 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 10MOC.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.FM) 5.00 'SEISMIC FEE s� 1 hereby affirm that there is a construction lending agency for EXHAUST HO H DUCT) 2.00 the performance of the work for which this permit is issued(Sec. - MICROFILM 3097,Civ.C.L HEATING UNI 0,000 B.T.U.) 4.00 Lender's Name HEATING UNITI V R 00, OO B.T.U.)7.50 Lenders Address ELECTRIC 1 certify that I have read this application and state that the above VENT:L $ G LIE) 3.00 information is correct.1 agree to comply with all city and county BOILER-COMP13 H.P.Or 100,000 4.00 PLUMBING ordinances and state laws routing to building construction, add hereby authorise representatives of this city to enter upon the BOILER-C UI SEE FB.T.U.)EE SCH. MECHANICAL above-mentioned properly for inspection purposes, (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino again' il liabilities,judgments, costs and expenses which CONST.TAX may " an ay accrue against try in consequence of the PERMIT ISSUANCE 3.00 (3 ge, i is permit , , MECH.CONT. LIC.NO. TMECH OTAL V v Signature of Ap Ica /-on TOTAL tractor Date `� •• - OFFICE COPY . .