Loading...
1374 (2) CITY OF CUPEP,TI.IO II:SPECTIOi? RECOP.D (Office Copy) XX 1374 20377 Clay St. PFR. IIT N0. SA\ITARY DIST. NO. LOT NO. ADDRESS Plmb.i Keller 297-8107 PROJECT OLTNER JOB SITE PHONF NO. Date ELECTRICAL Building Date Insp . Electrical Power Pole Plumbin_ 2-22-82 Underground ttechanical Rough Giiring Tamp. Gas/Elect. ['a11s Solar Ceiling Fire Snrinkler Fi:ctures Int/E:;t Sion Motors Grounding :disc. Temp . Power Other FINAL INSPECTIONS Not Approved Date Insp. Gas Electric PLIPIBIVG Plumbing Backflow Date Insp . ?techanical Underground Solar Uncle-floor P001 Partial Rough gradin �~ lanninc Sough Complete ' Solar Sough Fire Dent. Water & insulation Health DeDt. Main Drain Building R/of/S Drain Other Gas Other STRUCTURAL Not ADDroved Date Insp. Pad Certification `IECHANTICdL Foundation. Date Insp. Pre-Gunite Underfloor S.M. Slab-?fembrane 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 i.?ails-Panels Flues & Comb . Air Frame Other Lath Not Approved [lallboards Int/Ext . Firewalls Other 0 Not ADnroved BUILDING ELECTRICAL PLUMBING ElE CIT-hN I CAL HISCELLANEOtiS APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES - USE BALL POINT PEN ONLY " . + BUILD[NG PROJECT I DENTI FICATION PE MIT R . a-11mNOAPPLICATION & PERMIT - 1' "�_�, A 4 a00RE55 `7 � ` BUILDING=ELECTRICAL_PLUMBING—MECHANICAL O NEE' PLAN CHECK VALIDATION I' nme QTY. ELECTRIC PERMIT FEE 0 CONTE O NAME 'j OUTLETS-SWITCHES-RECEP 5.00/1.00 LIGHTING FIXTURES 5.00/1.00 - CONTRACTOR'S ADDRESS _ APPLIANCES-RESIDENTIAL 4.00 ..P RON K, PANELS' 5.00 aRCHI CT4 M41' DATE OF APPLICATION OR - - SIGNS - - 6,00 PLAN CHECK FEE P.C.NO. ENGINEER uc.No. SIGNS TRANS. 3.00' ADDRESS END. SPECIAL CIRCUIT, 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 15.00 h APPLICANTS TE MOTORS SE SCH. P ,SERVICE CH - 10.00 00 LICENSED CONTRACTORS DECLARATION rtu I hereby affirm that I`am licensed under provisions of Chapter 9, R ((( H 2 1St ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and _ - . BLDGELECT. PLG. MECH. H G z Professions C �e, y license is in full fo '•gyld ,. ❑ ❑ Z, z w W License Clas 'Luc.Numbe ❑ r — � r Date Contractor (• - - . a m a OWNER- „ BUILDING PERMIT _ m w BUILDER DECLARATION i ° a - MISC.— REFER TO ORD INFORMATION Is ; u w I hereby affirm that I am exempt from the Contractor's License r u O ¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00 VALUATION $/FT. m � Code:Any city or county which requirosa permit mconslrucLalicq EE 2 Q 0 improve,demolish,Or repair any structure,prior to its issuance,also ELEC_CONTR. L C.NO. ELEC. u A. requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License HZQ Law(Chapter 9(commencing with Section 7000)of Dlvision3 oftlte v�- ��. . 4 O Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE /04 H p the basis for the alleged exemption.Any violation of5ection 7031.5 STOHIES -TYPECONSTR. by any applicant for a permit subjects the applicant too civilpenalty ALTER-DRAIN -WATER (EA.14.00 of not more than five hundred dollars(S500).): D I,as owner with the property,or my employees wwages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation,will the work,and the structure a is not intended or offered for Sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CONE. 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 SD.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. - 40, mentsarenotintendedoroffered for sale.It,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 4,00 or improvement is sold within one year or completion,the owner. GAS EASYSTEM-OVER 4 IEA.) 1,00 BUILDING USE builder will have the burden of proving that he did not build or im- - . prove for purpose of the RES. IND CON PB Omer ❑ ❑ El 1:1 licensed owner of the property,um exclusively contracting with licensedd 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 town owner of property whhbuildso o builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 7.00 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. - ❑ I am exempt under See, ,BARC.for thus WATER HEATER W/VENT 4.00 ' reason Date Owner - WATER SYSTEM ' 4.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm that 1 have a certificate of consent to self-insure, Orpayce)rttiificcaatte of Worrkkers)Compensation Insurance,ora,ce�rtifi/4•d ZONING ENG.SITE NO. PoGdtYmNVCbrrypeo.CJ. 1(�Y TJ • - 0 ❑ Cer[illed Copy is helnhy famished. FIRE SPRINK ENERGVT 24.- 0 Z �''Certified p is filed,with ilia city Inspection division. H O ApTcant -/ MISC.- REFER TO ORD. y ❑ N❑ v ❑ rv❑ Cr W _ CERTIFICATEOF EXEMPTION FROM WORKERS'' PERMIT ISSUANCE 6.00 — FLOOD ZONE A.LUC. LU > COMPENSATIONINSURANCE PLG.CONTR. LIC.NO. PLG. M O (This section need not be completed if the permit is for ones TOTAL , v❑ N❑ V❑ N[3 IQ hundred dollars($.100)or less.) /� 00 I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to Q W become subject to the Workers'Compensation Laws of California. d Date ApplicantALTER OR ADD TO MECH. q,00 BUILDING } N NOTICE TO APPLICANT'. If,after making this CeUi(iErF of lix Fz 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)OODC.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.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,Cc.C.). - HEATING UNIT ITO 100,000 B.T.U.) 4.00 Lender's Name HEATING UNIT(OVER 100,000 B._T.U.)7.50 Lender's Address - ELECTRIC VI certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 - information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction,'and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 hereby authorize representatives of this city to enter upon [he BOILER-COMP,IOver 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and,keep harmless the City of MISC.- REFER TO ORD. - - Cupertino against liabilities,judgments, Costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX any way a came against said City in consequence of the rand of pe it. ' MECH.CONT. LIC,NO. MECH. TOTAL TOTAL ignatureo Applicant Contractor OFFICE COPY r