0574 (2) CITY OF CUPERT'INO IUSPECTIOP RECORD (Office Copy)
I �
0574 10401 Prunetree
PEPJIIT NO. SANITARY DIST. NO. LOT rill. ADDRESS
• 10401 Prunetree Mr. MacDonald
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buildin 6-29-81 Date Insp.
Electrical Power Pole
Plumhinr Underground
"echanical Rough Hiring _
Temp. Gas/Elect. Uaiils
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Uotors
Grounding
fuse. - Temp. Power
Other
FINAL INSPECTIONS Not Apyroved
Date Insp.
Ans PLUMBING
Electric Date Insp.
Plumbing Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
•
Pinnninp Solar Rough
Fire Dept. plater & Insulation
Health Dept. Main Drain
Building R/of/S Drain
Other Gas
Other
BALDING 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 _
Tiedowns One (lour Shaft
Diaphrams Condensate Drain
Seismic Bracing; Equipment Anchorage
halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Ualiboards Int/Ext.
Firewalls
Other
Not Approved
BUILDING
ELECTRICAL
PLUMBING
•
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL. POINT PIffNLY
eI BU I LDING PROJECT IDENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 0 5'l4
ADDRESS L
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
"AME DTV. ELECTRIC PERMIT FEE
CONTRA Tons OUTLETS-SWITCHES-RECEP 5.00/1.00
AME ry�
I ///✓ A0111,10 LIC.No , 2^ LIGHTING FIXTURES 5.00/1.00
CONTRACTORS //�E� PPLIANCES-RESIDENTIAL 4.00
ADDRESS ) 1 ('
PHONE �17PANELS 5.00 DATE OF APPLICATION
ARCHITECT6DD PLAN CHECK FEE P.C.NO.
OR SIGNS .
ENGINEER LIC.c.No. SIGNS TRANS.
ARCH.ORENG. SPECIAL CIRCUIT P 5.00 PERMIT VALIDATION
ADDRESS
zIP TEMP.METER L INS. 15.00
APPLICANT'S MOTORS
ADDRESS E E SCH.
SERVICE CHANGE 10.00
y/c
o o LICENSED CONTRACTORS DECLARATION
¢ W H I hereby affirm that am censetinder I lid drovisions of Chapter 9 ISSUANCE DATE
Na V U p
a y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F N z Professions C a ty license is in foil force a d IfecL ^ ❑ ❑ ❑
z o o - License Class Lic.Numhv P 4
o z F Dace Contractor �jf�p�/wrl
ca
a Y "' "- BUILDING PERMIT
¢ a, w a OWNER-BUILDER DECLARA'r10N INFORMATION
oar' MISC.- REFER TO ORD
w3 u I hereby affirm that 1 am exempt from the Contractor s License VALUATION
H LL o a Law for the following reason.(See.7031.5.Businessland Professions PERMIT ISSUANCE 6.00
Code:Any city or County which requiresa permit to construct,alter. % s
EE improve, or repair any structure,prior to its issuance,also ELEC.GONTR. LIC.NO. ,LEC.
- D ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m" he is licensed pursuant to the provisions of the Contractor's License o - �
)
Law(Chapter 9lcommencing with Section 7000)of Division 3 of the /�(:Rd�F /�
a Business and Professions Code)or that he is exempt therefrom and OTV- PLUMBING PERMIT FEE
$ t O STORIES TYPE CONSTR.
¢ H the basis for the alleged exemption.Any violation of Section 703
malty
i ; � by any applicant hafor ive hundred
subjects the applicumtoacivil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not more then five hundred dollars 1my em:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.uwTs
their sole compensation,will do the work,and the structure r nut
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:'The Contractor's License law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 so.FT FLOOR AREA TOTAL ACREAGE
. himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 4.00
ments are not intended or offered I'or sale,If,however,the budding
or improvement is sold within one year of completion.the owner. GAS-EA.SYSTEM-OVER 4(EA.1 1.00 BUILDING USE
builder will have the burden of proving that he did not build or int- RES MD CON RB Orae,
prove for purpose of sale.). I NDUSTR IAL WASTE INTER. 20.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed Contractors to construct the project(See. 7044,Businesv LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
aEd Professions Code:The Contractor's License Law does nut 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 eonlractonsl licensed pursuant to
SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Contractors License Law.
IT I am exempt under See. .B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Late OwnCr WATER SYSTEM 4.00 Acc.DATE _ACC.FILE No,
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate ofconsent to sell'-insure. ZONING ENG.SITE NO.
or a cert it icatc of Workcrs'Compc2LJ 5orc,gsur.ulye v'ertified
copy thereof(Sec.3800,bell ++CC 1l�� ( -% aA
policy No. Company
O ❑ Certified Copy isherehy fumishcd. P/-(N FIRESPRINK ENERGY T-24
Z Z qi1 Certified copy is bled with pt�lltt``` city inspection division. MISC.- REFER TO ORD.
O Applicant X 4; tI/E,�f�a- C�77K� Y ❑ N❑ Y ❑ N❑
fY - Cft I'IFICA"I'Ii OF EXEMPTION FROM WORKIiRS, PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
W > COA1PENSATION'INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y ❑ N❑
CL o This section need not be completed if the permit is I'or one TOTAL
0 Z hundreddollani(S100)orlessJ
U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not entploY any person in any manner se,as to
OO become subject to the Workers'Compensation Lawsof California. BUILDING 3.4,11)naw Applicant ALTEWOR ADD TO MECH. 4.00
} CdA NOTICE TO APPLICANT: If,after making this Certificate of 1:x-
'
Z emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provision, 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.NL) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 5.00 SEISMIC FEE .SZ
I herchy 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(See. HEATING UNIT (TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Civ.CJ.
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I certify that l hzveread thisapplicatimu and state that the above VENTILATION PAN (SINGLE) 3.00'
• ordinances n correct I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state lows relating to building const ruI'd co and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property I'or inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liahilitius,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against said City in consequence of the
grant got ECH.
this permit. MECH.CONT. LIC.NO. M ,
»t o 1J Ed? � orAt. TOTAL :3 3.
Signuturc of Applicant( ontructor
Data
OFFICE COPY