0921 (2) CITY 017 CUPFdtTINO IIJSPECTIOC RECORD (Office Copy)
0921 _ 874 E. Estates Dr.
PERMIT NO. SANITARY DIST. NO. LOT NO. ADDRESS
Plumbing Edward Schairer 725-0329
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Building Date Insp._
E] ectrical Power Pole
Plumbing 8-14-81 Underground --
Mechanical Rough Wiring
Temp. Cas/l;lcct. flails
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Notors
Grounding
misc. Temp. Power _
Other
FINAL, INSPECTIONS Not Approved
Date Insp.
Cos — PLUMBING
Electric Date Insp.
Plumbing Backflow _
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Crading Rough Complete
•
Planning Solar Rough
Fire De t. Water & Insulation _
Health Dept . *lain 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-Hembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & HoodFiedowns One Hour Shaft _
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
Ual.ls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext.
Firewalls
Other
Not Approved
LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BIBU I LDING PROJECT IDENTIFICATION PE "UMBER
LB LM APPLICATION & PERMIT 0921
ADDRESS
T74 G r�T !}� �� yJ R BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
"AME DTV. ELECTRIC PERMIT FEE
CDIUAzb 5ertaf2'oR �ZSo3=9
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 5-00/1.00
Lie.No. LIGHTING FIXTURES 5.00/1.00
ADORE SS
ADDna APPLIANCES-RESIDENTIAL 4.00
PRONE PANELS 5.00 DATE OF APPLICATION
ORRCHITECT SIGNS 6,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNSTRAig � 3.00
AARCH,OR DDRESS ENG. SPECIAL CI IT�3 5,00 PERMIT VALIDATION
ZIP EMP,METE R ROLE I I 15.00
ADDRESSTs MOTORS p C9 SEE FEE SCH.
SERVICE CHGE 10.00 p
0 0 o LICENSIi1)CON'T'RACTORS DECLARATION
rt i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a A (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
o-m i Professions Code,and my license is in full force and effect. ❑
z o License ClassLic.Number
4 H w Date Contractor
Q y f J
tc a OWNER-BUILDER DECLARATION BUILDING PERMIT
a o v INFORMATION
m3:.LL I- I hereby affirm that 1 an exempt from the Conlmctor'a License MISC.- REFER TO ORD
LL o a Law for the following reason.(Sec.7031.5.Businessand Professions VALUATION 5/FT.
_ PERMIT ISSUANCE 6.00
Code:Any city or county which requirese permit m construct aper.
QQ ¢ 0 improve,demolish,Dl Rplllr any SVOClllrf,prior t0It51SapllnCQ aI50 EI-EC.CONTR. LIC.NO. ELEC.
To - D u 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 Contractors License
FZQ
Law(Chapter 9(commencingwith Section 7000)ofDivisioR 3 o1the �L UKdi Al C,
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
m H ca the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR.
so
A by any applicant for a permit subjects the applicant to a civil penalty
of n of more than five hundred dollars(S500).): 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 ProfessionsDRAINS-FLOOR,ROOF,AR EA,CON D. 4.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs Such work FIXTURES-PER TRAP 4.00 - sD.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such ins building
meim are not is sold or within
year
o if,howetion the building GAS-EA.SYSTEM-1INC.O OUTLETS 4.00
or improvement Is sob within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.)
builder will have the burden of proving that he did not build or Ino- 1.00 RUtLDING uSE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. RES IND CON RB Other
❑ I,as owner of the property,am exclusively contracting with 20.00
licensed contractors To Construct the project(Sec. 7044,BusinessLAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:'I'lie Contractor's License Law does not apply
to an owner of property who builds or ilnproves thercon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for Such projects with a contructorts)licensed pinstant to
telt Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCEL NO.
A I air exempt order See. Z..i.&P.C.for this WATER HEATERW/VENT 4.00
\/ reason
X Date _ _ ""'°rte- WATER SYSTEM 4-00 ACC.DATE ACC.FILE No.
WORK17RS'COMPIINSA'I[ON DECLARATION WATER TREATING EQUIP. 4.00
I hereby aflirm that I h:ne a cerlificac of.....Seth to neiGin,uR,
or a certificate of Workers'Compensation Insurance.or a ccrllflcd ZONING ENG.SITE NO.
copy thereof(See.3800,Lida C.).
Policy No. Company
(] ❑ CertilieJ copy is hereby tarnished' FIRE$PRINK ENERGY TY4
Z Z ❑ Certified copy u filed will, the city inspcctiun division.
O Applicant !misc.. REFER TO ORD. v N Y ❑ NE]
jr y CER1IPICA'f1i 01'EXEMP"1'ION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u,c.
W > C041-NSAT'ION INSURANCE PLG.CONTR. LIC.N0. PLG.
d O This section need nm he completed if the permit is for one TOTAL /Q do Y E] NEI Y[:] N�
Z hundred dollars Is 100)or less.)
U O I Ecrtify that in file performance of the work for which this Per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- not is issued, I shall not employ any person in unY manner so un to
0 become subject to the Workers'Compensul ion Laws of California.
d Date. Applicant ALTER OR ADD TO MECH. q,pp BUILDING
} m NOTICE TO APPLICANT: If,after making this Cerlificale of Ex-
Z eruption,you should beconne Subject to the Workers'Compcmation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be dccmcd revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)000C.F-M.) 5.00 SEISMIC FEE
I hereby affirm that there is a construction leading agency lot EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
I certify that I have read this application and state that The Abu,, VENTILATION FAN (SINGLE) 3.00
information is
correct. I agree to comply with all city and county PLUMBING Qs (/-j7
ordinances and state laws relating to building lconstruction.citynco andmy BOILER-COMP I3 H.P.or 100,000 B.T.U.1 4.00
hereby amt III representatives of this City to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to Save, indemnify and keep taintless The City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, coats and expenses which PERMIT ISSUANCE CONST.TAX
may in any way accrue against said City in consequence of the 3.00
grant f This permit. MECH.COST. LIC.NO. MECH.
rOTAL TOTAL
Signature of Applicant/Contractor Date
OFFICE COPY