0394 (2) - CITY 01' CUPERI'INO INSPECTIOV RECORD (Office Copy)
O394 10750 Farallme-D=,_
PI:PJIIT N0. SANITARY DISI. NO. LOT MO. ADDRESS
'. Reroof Irvine Frish 257-0274
PROJECT OWNER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Building 5-22-81 Date Insp.
Electrical Power Pole
Plumbing Underground
Mechanical Rou ;h Wiring
TOT-111. Cas/Elect. alis
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other _
FINAL INSPECTIONS Not Approved
Date Insp.
r"s PLUMBING
Flectric Date Insp.
Plnmbin • Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
Planning Solar P,ou ,h
.- Fire Dept. Water & Insulation
health Dept. Main Drain
Buildin R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification 11ECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Hembrane Ducts & Insulation _
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One (lour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int Ext.
Firewalls
Other
Not Approved
S�
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONQA
-BUI LDI NG PROJECT I DENTI FICATION IT NUMBER
BUILDING APPLICATION & PERMIT f 0394
AOOREss BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 1,
O`�So T-c�Glla^e. `�v e ___
OWNER - PLAN CHECK VALIDATION
"A;� OTY. ELECTRIC PERMIT FEE
rVLY�G PHDN S9"CO
NOMTER„Ac.°;s 7��•rJ OUTLETS-SWITCHES-RECEP
LIC.ND.
5.00/1.00
J J ILIGHTING FIXTURES 5.00/1-00
CONTRACTORS /� (��,11�(1I�+ PPLIANCES=RESIDENTIAL 4.00
AOO/E/7Z 'OC.- J4 A AgE-1�3
'/•J+`��lJ� PHON PANELS5.00 DATE OF APPLICATION
ARCHITECTF
ECT SIGNS 600 PLAN CHECK EE - P.0.NO,
ENGINEER
ua NO. SIGNS TRANS. i 3.00
ARC'L ON END SPECIAL CIRCUIT � 5.00 PERMIT VALIDATION
ADDRZIP TEMP.METER OR POLE I M 15.00
ADDRESS PPLICANis MOTORS LaEE SCH.
ADDRESS
SERVICE CHANGE N 0.00
ami G
Foo LICENSED CONTRACTORS DECLARATION it � �- /
a i Pu I hereby affirm that 1 am licensed under provisions of Chap Wr 9 y ISSUA CE DAT
h a (commencing with Section 7000)of Division 3 of the Business and BLDG_ ELECT" PLG. MECH.
F °a Prolessions Code,an Incense is in full to a elf O ❑ ❑ ❑
¢ o — License la Lic.Number Y
o m t w Date Contnclor,L
a a. i BUILDING PERMIT
a OWNER-BUILDER DECLARATION
ELL U INFORMATION
K
;LE y I hereby affirm that I am exempt from the Contractor's Licensee MISC.— REFER TO ORD
VALUATION $/FT.
F u o g Ww for the following maven.(Sec.7031.5,Business and Pm&csiuns PERMIT ISSUANCE 6,00 I' 0
OG PERMIT
Code'.Any city or county which requires a permit to connmc l,alter. /^µCC �Ih�
Ii ¢
40 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. V' I J O VVo s `�O
wD u requires the applicant for such permit to IIIc a signed statement Thal - TOTAL PERMIT TO
$ he is licensed portant to the provisions of the Contractor's License
F z Q Law,(Chapter 9(commencinCwith Section 7000).&Dish..3 ofthe
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation o(Section 7031.5 57TORIES TYPE CONSTR.
ca by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00
fn ot more than five hundred dollars(551 OLL
❑ 1,as than
of,he property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GHOUP RES.uNlts
their sole compensation,will do the work,and the structure n not
intended or offered,for Nil, (Sec. 7044, Blniness and Ptotessinns DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Cod" rhe Contractors License Law does not apply to in owner ut
property who builds Dr improve.ill ere.n,.Ed who due,such work FIXTURES-PER TRAP 4.00 5D FT.FLOOR AREA TOTAL ACREAGE
himself re through de own employees.provided Ihat such improve-
ments arenot ln,ended or Offered for nemployee,,provided
113,such
building GAS-EA'.SVSTEM-I IINC.4OUTLETS 4.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose ofsalv.). - INDUSTRIAL WASTE INTER. 2000 RES IND CON PB Otte,
❑ 1,as owner of the property,am exm .
clusively co
mnin,with ❑ ❑ ❑ ❑ ❑
licensed contactors to consume, the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:'['he Contractor's License Law dopy not aliply
to an owner of property who builds or improves thcrcon-and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such pinjch,with a eontaetoto licensed punuanl to
the Contractor'sLicense Law. SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT NO. "PARCEL NO.
❑ I am exempt under Sec._,B,&P,C,for this WATER HEATER W/VENT 4,00 '
reason
Dat Owner WATER SYSTEM 4.00 ACG DATE ACO.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby allirm that I have a`certifeale of consent to self-inslua, - ZONING ENG.SITE NO.,
or a certfleute of Welker,Compensation InllraaeO,or a certified
copy thereof(Sec.3800,Lob C.). pp s
Policy lxonl T� Company- C
O ❑ Certified copy Is hereby furnished" u
z Z 9Cenified opy is fi -d h the city impaction division. t, FIRE SPRINK ENERGY T.]4
O Applicant Lie" \ IMISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑'
CC �+ PERMIT ISSUANCE 6.00
LU — CERTIFICCOI IPE EXEMPTION FLOOD ZONE A.L.0 C.
IL 1 CONIPEN'SATION INSURANCE. PLG.CONTR. LIC.NO, PLG.
1 O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
2 hundred dollars(S 100)or less.)
U O 1 certify that in the performance o1'the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
O Ubecome subject to the Worker Ccon,imn,ion Laws of Ca1i(ornia. ,
Date—Applicant BUILDING
} N NOTICE TO APPLICNT: Jr,after making this Cern&,,,,of Ex- ALTER OR ADD TO MECH. 4.00
♦— Z empnon,you should become subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE ♦ c�-ysf LU
.0 such prm,isions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.NL) 3.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10.000C.EM) 5.00 SEISMIC FEE
I hereby affirm that ,here is a construction lending agency fur EXHAUST HOOD (WITH DUCT) 2,00
the performance of the work for which ,his permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I Certify that l have read this application and nam,hal the above VENTILATION FAN (SINGLE) 3,00
information n corral I agree,o comply with all city and county PLUMBING
ordinances and sine laws relating to building connrumion, and BOILER-CONS(3 H.P.or 100,000 B.T.U.1 4.00
hereby authuri e fepfeseniltives of this city to enter upon tc BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. _ MECHANICAL
a hove-mentioned pro petty for inspection pulposus.
(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 ANCE 300 CONST.TAX
may in any way accrue against said City in consequence of the
granting of this permit. MECH.CONT. LIQ NO. MECH.
OTA' TOTAL (93 �
Signature of pplicant/Contractor Date
OFFICE COPY