1884 (2) CITY 01' CUPEPT7NO INSPEGTIOC RECORD (Office Copy)
1884 10295 E. Prado Way
PEP11I'r NO. SANITARY DIST. 170. T—OTH07 ADDRESS
Spa Kurt Blickle
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Building. - - Date Insp.
Electrical Power Pole
Plumhing - - Under ,round
tIcchnnical - - Rough 1•liring _
Temp. Cas/Elect. Wails +
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Notors
Grounding
Misc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved
Date Insp.
Ga.s PLUMBING
Electric Date Insp.
Plumbing Backflow
Mechanical Underground
Solar Underfloor
pool Partial Rough
Grading Rough Complete
Planning Solar P.ou gh —
Fire Dept. Water & Insulation
Health Dept. Main Drain
Building R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
I'ad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation
Bond Beam Eire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One (tour Shaft
Di.aphrams Condensate Drain _
Seismic Bracing Equipment Anchorage
!falls-Pancls Flues & Comb. Air
Frame Other
Lath Not Approved
Uall.boards Int/Ext.
Firewalls
Other
Not Approved
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
PER IT ER
• nooDINss APPLICATION & PERMIT 1 88 n
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I lJ 11 `f
OWNER'S PLAN CHECK VALIDATION
NA E _ TY. ELECTRIC PERMIT FEE
. fiPHo
cONTRACTOR's
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
LIC.No. LIGHTING FIXTURES 5.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE 'RG NO.
OR LIC,
ENGINEER c.No. SIGNS TRANS. 3.00 /�
ARCH,OR ENG. SPECIAL CIRCUIT
5,00 PERMIT VALIDATION
ADDRESS
ZIP rrEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADORE SS
SERVICE CHANGE 10.00
wo o LICENSED CONTRACTORS DECLARATION
rt u w I henchy affirm that 1 am licensed undcf provisions of Chaplcr 9 ' CUPERTINO ISSUANCE DATE
y a 'w (commencing with Section 7000)of Division 3 of lire Business and BLDG,/ ELECT. PLG. _ MECH.
E. w z Professions Code,and my license is in full force and effect
z o oo - License Class Lie.Number -
2 zy H o Date Contractor
`a 4 BUILDING PERMIT
¢ rt w OWNIi R-BUILDIiR DECLARATION LION INFORMATION
K
; LL H I hereby affirm that I am exempt from the Contractor's License MISC.- EFER TO ORD
.. o¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE VALUATION 5/FT.
~ '^i Code:Any city or county which requiresapermittoconstruct,alter.
6.00 /f�
¢ w ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE, LIC.NO. ELEC. R/
O u requires the applicant for such permit to filo a signed statement that TOTAL PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License /.w,
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the N,P
¢ Business and Professions Ceder or that he is exempt therefrom and OTY- PLUMBING PERMIT FEE v�
¢r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTE.
by any applicant for a permit subjects the applicant lea civil penalty ALTER-DRAIN& VENT-WATER (EA-) 4.00
of not more than five hundred dollars($500).):
❑ I.as than
of the property,or my employees with wages" BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the StnlnWre is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 .0/7W
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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided trial such int Pnsve-
m �+
ents are not intended or offered for sale If,however,the buddillg GAS-EA.SYSTEM-1 ORTS 4.00
or improvement is sold within one yea of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.1 1.00 BUILDING USE
builder will have the burden of Proving that he did nm build or im-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 REs o eory ve enter
❑ 1,as owner of the property,em exclusively contracting with O ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSOHSPAHCELsl
and Professions Code:The Contractor's License Law docs not apply
to an owner of properly who builds ', improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 f�
contracts forsuch prajecta with acimtraaoos)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TE GT NO. PARCEL NO.
Ore Cont motor's License Law. pyN
❑ amcxempt un der S-c. .B.&P.C.Ior thio WATER HEATER W/VENT 4.00 /a • (0
reason
Date f WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK E RS'COMPEN'SATION DECLARATION WATER TREATING EQUIP. 4.00 1
I hereby affirm that I have a certificate of consent to self-insure. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy iz hereby lunlished. FIRE SPRINK ENERGY T$4
Z Z ❑ Certified ropy is filed with the city inspection Division. MISC.- REFER TO ORD. ❑ '�j❑
Applicant
F0 O
lr CERTIIICA'I'F 01'FXFMPI'ION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZNE
111 > CON 41- INSURANCE PLG.CONTE. LIC.NO. PLG. O p-( Y ElCL o (This section t be completed if the permit is for one need noTOTAL
:DZ hundred dollars(SI00)ar less.) v.
U O 1 certify that in lire performance of the work lin which this per' CITY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ f- mit is issued,I shall not employ any person in any Inanner,an as to
O W become subject to the Workers'Compensation Laws of California. BUILDING
Uatc Applicant ALTER OR ADD TO MECH. 4.00 -�
} y NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emptier,you should became suhjecl 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=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOMC.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 HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATING UNIT I0 VER 100,000 B.T.U.)7.50
Lenders Address ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 OD
. information is correct I agree to comply with all city aridcounty BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and stale laws relating to building construction, and
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over IO0,000BTU)SEEFEESCH. MECHANICAL '7 (}-0
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 o CONST.TAX
PERMIT ISSUANCE 3.00. -
y/I) any way accrue gains[ soil City in consequence of the L_
"agSIl g of•lhis pcnnil./1n q r/_',/7/f��f ) ECH.CONT. LIC.NO. MECH. TC'TAL
�ji�,c-r- J;/1U�(�/g N0 /7 5/J(l� TOTAL rE
Sign.URcof Applicant/Contractor Dat / �
OFFICE COPY