0914 (2) CITY OF CUPERTINO INSPECTION RECORD (Office Copy)
0914 _ 7450 Fallen Leaf_ Lane
PI;RIII'r N0. SANITARY DIST. 140. LOT NO. ADDRESS
Plumbing Jackson 252-8303
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Building Date Insp.
M ectrical Power Pole _
Plumhinr 9-1-81 Underground
Mechanical P.ou ;h Wiring _
Temp. Cas/Elect. flails
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other
FINAL INSPECTIONS Not Approved
Date Insp.
Cos PLUMBING
Electric Date Insp-
Plumbing Backflow _
Mechanical Underground -------
Solar
____Solar Underfloor
Pool Partial Rough
Cradin Rough Complete
1'lannin Solar Rough
Fire Dept. 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-Membrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tfedowns One Hour Shaft__ _
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
halls-Panels Flues & Comb. Air
Frame Other
Lnth Not Approved
Wallboards Int/E:xt .
Firewalls
Other
Not A2proved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POI ONLY
yTu
BUILDING PROJECT IDENTIFICATION APPLICATION PERMIT NUMBER
& PERMIT 091 4
uuOlxc
• REss
ILDING — ELECTRICAL—PLUMBING—MECHANICAL
PLAN CHECK VALIDATION
NAME TY ELECTRIC PERMIT FEE
x NERACTOR's UTLETS-SWITCHES-RECEP 5.00/1.00
it,.xti. LIGHTING FIXTURES 5.00/1.00
C(NTRACTGRs PPLIANCES-RESIDENTIAL• 4.00
ooRE s
PHO PANELS 5.00 GATE OF APPLICATION
OR
SIGNS 6.00 PLAN CHECK FEEP.C.NO.
ENGINEER
uc.No. SIGNS TRANS. 3.00
ADORESS ExG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00
Ares
ADDRESS MOTORS SEE FEE SCH. .
ADDRESS
SERVICE CHANGE
atm z 95,11
o o LICENSED CON'I'RACfORS DECLARATION , t.7
2 v I hereby a(Rrm final 1 am IiccnwJ under pnrvisions of Chapter 9 - ISSUANCE DATE
y-, i (commencing with Section 7000)of Division 3 of the Business and
BLDG. ELECT. PLG. MECH.
F m i Professions CoJOLI (cense is In toll to Gt. ❑ El Ela i w o License CWss Lie Number
� Dole Contractor
a Y 1D BUILDING PERMIT
Eon u OWNFR-BUILDER DECLARATION INFORMATION
iAxu ; LL y I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
F LL o j Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 6-00 VALUATION SIFT.
Code:Any city or county which requires a permit to construct,alter. _
or a: 0improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO.. ELEC.
es
LL mqulln the vppbcart for such permit m Nle a signed statement that TOTAL PERMIT TO
K
m he is licensed punuant to the provisions of the Contractor's License
F a, r Law(Chapter 9(comn ing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and PLUMBING PERMIT FEE
or =0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 by any applicant for a permil subjects the applicant to a civil perahy
ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars(55000.)
:
I,as•owner of the property,or my employees with wages asBACK F LOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their wle compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 1044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such workFIXTURES-PER TRAP •4.00 SQ.Pr.PLIMR AREA TOTALACREAGE
himself or thrugh his own employees,provided that such improve-ments are not intended or offered for sale.l(,however,the buildingGAS-EA.SYSTEM-11NC.4OUTLETS 4.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did nm build or ins- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
'Post,for purpose nf,wle.l' INDUSTRIAL WAS TE INTER, 20.00 RES INo CON PB othnr
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed eoutracton to construe, the prinoo(Sec. 7044, Business LAWN SPRINKLERS- 1 INC.5 V.B. 5.00 ASSESSORS PARCEL NO.
and professions Code.'I lie Cnnlremnr',s License Luw docs not apply
to an owner e.1pro,perty who builds or improves thereon,vnd who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 -
contracts forsueh Projects with a contractors)licensed'Dpnuant to ,
the Cmu,actor's'Liccfi,Co.. SEWER-SANITARY-STORM EA, 200ft/8.00 TRACT NO. PARCEL NO.
❑ l um exempt under Sec---D&P.C.for this WATER HEATER W/VENT 4,00
on
reas
ma
Date Owner WATER SYSTEM 4.00 ACGDATE ACC FILE NO.
WORKERS-compENSATION DECORATION WATER TREATING EQUIP, 4.00
1 hereby affirm that I have a certificate of consent to self insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
ropy t1)er�yl S b C L
Policy iKu.al�
Q ❑ Certified copy is herebyhunishcd. FIRE sPRINK ENERGY T 24
Z Z can Dililllropy filed with the city inspection division. MISC.- REFER TO ORD. Y N Y N
1-- O Vfif7li Pf�= ❑ ❑ ❑ ❑
CCN CERTIFICCI'1?OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE .6.00 FLOOD ZONE A.L.U.C.
ANCE
PLG
O. ❑ 1'I'his section needHottroy beTcoOmpleted lit the Permit is for arse PLG.CONTR. LIC.NO. TOTAL Y❑ N❑ v ❑ N
Z) Z hundred J011anfS 1001 or less.)
U O 1 certify that in the performance of the work for which this per- DT-Y. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, Pshall not employ any person in any manner so as In
O w become subjenCalifornia,
to the Workers'Compensation Laws of Californi
Date Applicant BUILDING
es.
ALTER OR ADD TO MECH. 4.00
} w NOTICE i TO APP should
be NT: U.after making this rs'Cocate anon
TEx-
Z cmvision you the L lb become Co e, you
m the Wrthwith comply witn APPLIANCE 4.00 PLAN CHECK
provisions io the Labor mit sit you must forthwith comply with FEE
U omit provisions m this permit shall h deemed revoked. AIR HANDLING UNIT TO 10,000GF.M.) 3.00
s CONS'('RUCFION LENDING AGENCY AIR HANDLING UNff(OVER 10=C.EM05.00 SEISMIC FEE
I hereby affirm that there is u construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance o1' fire work fur which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3,00
information is corroo. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-OONP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authurirn representatives of this city to enter upon the
above-mentioned property for inspection purposes. - BOILER-COMP (Over 100,000 BTU(BEE FEE SCH. MECHANICAL
(we) agree to save, indemnify and keep harmless the City of MISC.- ,REFER TO ORD.
Lupe Nino agai t Ilabilitia,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
io pe. iccrme against v C'y in consequence of the
Ping t i r L MECH.CONT. LIC.NO. MECH,
TOTAL TOTAL
at rs o pphcanl/Contractor c
OFFICE COPY