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6543 (2) „ CI F CUPERTINO INSPECTION RECORD (OFFICE COPY) • � � RvIIT �-- , - PERMIT ISSUED DATE ELECTRICAL DATE INSP: uuilcTin S h.k.ectrical Plumbinjq Power Pole FecnaanicaI � r un 1'e a5 ecOR Ugh Wlrin o ar Walls - lre Sprinkler el In Sign ii=res int/Ext tors Misc. Grounding - e Power utner FINAL INSPECTIONS DATE INSP, Not .Approved Gas Electric key ' um - 4- � FS PLUMB`IIG�'7” 'DATE T�iSP. Imechanical ar Backflow, _ ,o rgroun i o �, oor Planning Partial u ug oR -i - Fire t• ete eat t. Solar u ul ing !�- water ' nst atlon Other Ma Draln o rale Other ✓ , BUILDING DATE gip. of Approved . o Pad Certification oun tion-Irb 2-lG ©I(o' �� . z INSP. Slab-membrane Underfloor S.M. Bond Bearn M—Ets-TInsulation Undertloor Girders kire 1—lMers Floor tee Face le owns grease ct lood I91ap rams e Hour Shaft -- Seismec racl1ngCondensate Drain Walls-Panels _ - fi' iii' ent Anchorage — �'x' - ues Q UF Ali, - — tfi- - l- t e — ----- --- -- oar Int/Ext. Rot re s lith1� er et rove �r nuil,viivu ELECMICAL PLUMBING MECHANICAL M4ISCBLLANEOUS APPLICANT TO FILL IN.IN ION WITHIN RED LINES - USE B POINT PEN ONLY PERMIT NUMBER BUILDING PROJECT IDENTI FICATIO APPLICATION & PERM --' 6543^ omLmrvc Vh U{ Y ADDRESS _ / 071 INSa//�� K= BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNEq's 40 - ,PLAN CHECK VALIDATION NAMEp., „. .ELECTRIC PERMIT FEE CONTRACTORS NAME NAME UTLETS-SWITCHES-RECEP 5.00/100 I Lm.No. LIGHTING FIXTURES 5.00/1.00 CODREAcrogs ADDRESS . PPLIANCES-RESIDENTIAL 4.00 / PHONEi _ !' PANELS- 5.00 'DATE OF APPLICATION . ARCHITECT SIGNS - 6.00 PLAN CHECK FEEP.C.NO, = OR V, ENGINEER -LIC.No. SIGNS TRANS. 3.00 ARCH.off END - SPECIAL•CIRCUIT S.00 - PERMIT VALIDATION ADDRESS 71P ' EMP.METER OR POLE INS. 15.00 APPLICANT'Sj MOTORS -, SEE FEE SCH. S' ADDRESS - �, - •� SERVICE CHANGE 10.00 / S� w o a LICENSED CONTRACTORS DECLARATION PA / a i W -hereby affirm,that I am licensed under provisions of Chapter 9, - °' 155 DATE (commencing with Section 7000)of Division 3 of the Business and BkD E PLG. MECH. ID r F.D Li"oProfessionsla Code,and my license into full force and efl'ecL' ❑ ❑ 20 License Class Ccin Number - 2 2 -� Dom Contractor � - r ¢ yE� ¢ ¢ w a OWN F-R-BUILDER DECLARATION ay O 'PERMITx.'T,; v _ - "INFORMATION S ;n r I hereby..Iffom that 1 am exempt from.lhe Conlmclor's License MISC.- REFER TO ORD r u o a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 6.00 VALUATION $/FT. w Code:Any city or county which requiersapermit t0 Construct.alter, f�f.r jam a, ¢ Q D Improve,demolish,or repair any structure,prior tO lis Issuance,810 ELEC CONTR, LIC.NO. ELEC. , " DLL requires the applicant for such permit to file a signed statement that TOTAL / /T PERMIT TO he is licensed pursuant tothe provisions of the Contractor's License t1000161 ' H 2 Law(Chapter 9(commencing,wilh Section Division of the a Business and professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE? rc r D the basis for the alleged exemption.Any violation ofSeclion 70313' ;^v STORIES TYPE CONST d ;� by any applicant lot a permit subjects the applicant to acivil penally ALTER-DRAIN&VENT-WATER (EA.) 400 of not more than live hundred dollars(5500).): - J_A /WC. ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00, OCC.GROUP RES.urvtTS their sole compensation,will do the work,and the structure is not intended or offered for Is(Sec, 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONE: 4.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves themon,and who does such work - FIXTURES-PER TRAP 4.00 SO FT.FLOOR AREA TOTAL ACREAGE himselfor through his own employees,provided that such improve. / p mems are not intended or offered for sale.If,however,the building ' s'' GAS-EA.SYSTEM-1INC.4 OUTLETS 4,00 , or improvement is sold within one year of completion,(he owner. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE buB r will have the buNen of proving Thal he diJ not build or im- 1f for purpose al'sale.)., INDUSTRIAL WASTE INTER. 20.00 RES ' IND cory PB other I,as owner of the property,am exclusively contracting with X.- d contractors Da construct 1he'project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. ' 5.00 ASSESSORS PARCEL NO.' and Professions Code:The Contractor's License Law docs 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 contraclods)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ 1 am exc t under Sec. .B.&P.C.for this. WATER HEATER W/VENT .4.00 w (i Oon a ` \ oner, Ume WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION ' WATER TREATING EQUIP. '4.00 1 hereby affirm that I have a ce Compensation of consent to a certified or a certificate of Workers'CompensationInsurance,feent ora certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). 0 Policy No. Company. U ❑ Cerlified copy is hereby furnished. FIRE SPRINK ENERGY T-T4 Z Z ❑ Certified copy is filed with the city inspection division. MISC- REFER TO ORD. ' '� Applicant - Y N� Y C] NE] ~ va PERMIT ISSUANCE 6.00 LU - CERTI FICI OP EXRMPTIFROM WORKIiRS' FLOOD ZONE A.L.U.C. W > CO _ COMPIi NSATION INSURANCE URANCE PLG.cONTa. LIC.NO. PLG. n' 0 (This section need Imt be Completed if the permit is for one TOTAL v❑ N� V ❑ NE] U O hundred dollars($100)or less.) 'b - - I certify that in the performance of the work for which This per. h $. `pj0 `,'sky� 't'f' 'l`J" FEg`SOMIII tL DTV. r r, MECHANICAL PERMIT _ FEE mit is issued,I shall not employ any person in any manner so as(o s - - O w become subject to the Workers'Compensation Laws of California. �' - _A y Date Applicant ALTER 08 ADD TO MECH. 4.00 BUILDING S yj(� } W NOTICE TO APPLICANT: If,after making this Certificate Of Ex. . F ? eruption,you should become subject to the Workers'Compensation t:'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=C.F.M.) 5.00 SEISMIC FEE CIA I hereby affirm (hat them is.a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 - Ibe performance of The work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name HEATINGUNIT(OVER 100,000 B.T.U.17.50 Lender's Address - " ELECTRIC I certify,that l 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 countyPLUMBING 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(Over 100,0000TU)SEE FEE SCH. MECHANICAL abovomentioned properly for inspection purposes, (We) a e m save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cuperlin against liabilities,judgmen casts and expenses which - CONST.TAX may in n way ace ug st ity in consequence of the PERMIT ISSUANCE 3.00 gmnli O is MECH.CONT. LIC.NO. MECH. p k /' Sdi roTAL. TOTAL''^ /�• bigitinflum ol, ppi a /Commctor Date OFFICE COPY