1214 (2) • CITY OF CUPERTINO INSPECTION RECORD (Office Copy)
1214 �Qe �J 19447 Pruneridge
. PERMIT NO. SANITARY DIST. NO. LO NO. ADDRESS
Remodel Hewlett Packard
PROJECT OWNER JOB SITE PHONE NO.
Date ELECTRICAL
Building 10-21-81 Date Insp.
Electrical Power Pole
Plumbing Underground
t4echanicalP.ouggh Wiring
Temp. Gas/Elect. Wa Is
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sian Motors
Grounding
Misc. Temp. Power
_ Other
FINAL INSPECTIONS Not Approved
Date Insp.
G`'s PLUMBING
Electric Date Insp.
Plumbing Backflow
tTechanical Underground
Solar Underfloor
Pool Partial Rough
• Grading Rough Complete
Planning Solar Rough
Fire Dent. Water & Insulation
Health Dept. Main Drain
Building R/of/S Drain
Other Gas
Other
STRUCTURAL Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Hembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & Hood
Tiedooms One Hour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
Malls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Wallboards Int/Ext.
Firewalls
Other
Not Approved
BUILDING
ELECTRICAL
•
PLUMBING
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL_ POINT PEN ONLY
• BU I LD ING PROJECT I DENT[FICATI ON PER u EH
BUILOINc APPLICATION & PERMIT 1214
ADDRESS //Z,yea. Iw: BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNERS PLAN CHECK VALIDATION
/-
NAME ,�[ &C7__1 PAC1C&W -72,<- �' QTY. ELECTRIC PERMIT FEE
,y PHONE 3 I/
CONTRACTORS OUTLETS-SWITCHES-RECEP 5.00/1.00
NAME
uC.NO. LIGHTING FIXTURES 5.00/1.00
coNTRACTOR's APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS B_00 PLAN CHECK FEE P.0.N0.
OR
ENGINEER
LIC,No. SIGNS TRANS. 3.00
ARCH,OR Enc' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
zIP EMP-METER OR POLE INS. 15-00
APPLICANTg
ADORE SE MOTORS SEE FEE SCH.
5X1
L�
0
SERVICE CHANGE 10.00 4
02 Foo LICENSIiD CONTRACTORS DECLARATION
I hereby affum that I in licensed under provisions of Chapter 9 ISSUANCE DATE
ma w (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH.
F N z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
z D m - License Class Lie.Number
Q v, H w Date-Contractor _
a YBUILDING PERMIT
IY ¢ X ¢ OWNIiR-BUILDI:R DECLARATION INFORMATION
owO MISC.- REFER TO ORD
w LL H I hereby affirm that I am exempt from the Contractor s License VALUATION S/FT.
Fu0 J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00
Code:Any city or county which rcyuiresa permf it to construct,alter. D� 0
Q �QD improve,Demolish,or repair any structure,prior to its issuanceNG
.also ELEC.COTE. LINO. ELEC. (((11
-o n requires the applicant for such permit to file S signed statement that TOTAL PERMIT TO
a. wsa he is licensed pursuant to the provisi ora of the Convae tot's License
r z i
Law(Chapter 9(commencing with Sect ion 7000)of Division 3 of t he
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
o the Iasis for the alleged evemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
aby any applicant l'ofaPermit s,,hjects the applicant to a en'd"amlty gLTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars(S50OH:
❑ I,Towner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE, 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law docs not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO,FT,FLOOR AREA TOTAL ACREAGE
. himself re of rote his own employers.provided(hal such int ilding
menus are not intended ones to for cesa rr raided that s (hebuildiog GAS-EA.SVSTEM-11NC.4 OUTLETS 4.00
or improvement is sold within one year of complalon,the owner- GAS-EA.$ ,O ��amm1.00 BUILDING USE
builder will have the burden of proving that be did not build or int- RES IND CON PR Other
prove for purpose of sale.). INDUSTRIA STEINTER. 20.00 El El 1:1 El
❑ I,as..per of the property,am exclusively contracting with
licensed contractors to construct the protea(Sec. 7044,Business LAWN SPR( _ $ 1 N B. 5.00 ASSESSORS PARCEL NO.
and Profession'Code: the Contractors License Law does mol apply '
to an owner of property who builds or improves(hereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for suds projects with a contractors)licensed pursuant to
the Contractors License Law. SEWER-$ANITA EA.200ft/8.00 RFLOODZONE
PARCEL NO.
❑ tum exempt under Sea ,B.EI'.C.tilt this WATER HEATER W/VENT 4.00
v nn
Dme�- _ w�,.r WATER SYSTEM 4.00 ACC.FILE NO.
WORK ERS'COM F.. S I DECLA RA'f1ON WATER TREATING EQUIP. 4.00
1 hereby affirm that I have h certificate of consent to sell-insure, ENG.SITE NO.
or a calif Late of Workers'Compensation Insurance,or a certit'ied
copy thereof(Sec.3800,La.0.).
Policy No. ComPamy
Q ❑ Certified copy'is hereby'furnished. ENERGY T 24
Z Z D Certified copy is tiled with the city inspection division. MISC.- REFER TO ORD. Y CD N�
O Applicant .
rn CERTIFICATE OF Ii XEMPTION FRONI WORKERS, PERMIT ISSUANCE 6.00 A1.U.C.
LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLGY [] N
�- O (I[its section need not be compacted il'the permit is for one TOTAL
Z hundred dollars($100)or less.)
U O 1 certify that in the performance of 0r work for which this per. OTV MECHANICAL PERMIT FEE FEE SUMMARY
U_ F mit is issued, I shall not employ any person in any'manner so as N
Q become subject to the Workers''Compensation Laws of Calitbmia.
O BUILDING (i�0' O
LU Dutc Applicant ALTER OR ADD TO MECH. 4.00 O
} rap NOTICE. FO APPLICANT: If,after making this Certificate oIl,x-
�, Z emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK r ) Xo
provisions of the Labor Code, you must forthwith comply with FEE V qP
CJ such provisionsor this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
cONSTRUC'iION LENDING AGENCY AIR HANDLING UNIT(OVER 11000C.F.M.) 5.00 SEISMIC FEE �9
1 hereby uffinn that there is a construction landing agency for EXHAUST HOOD (WITH DUCT) 2.00
He performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.0.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
einformation is correct, I agree to comply will,all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and stale laws relating to building construction, and
hereby aulhorieo representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save. Indemnify and keep Imrniless the City til' MISC.- REFER TO ORD.
Cupertino against liahilities,judgments, costs and expenses which CONST.TAX
may in any w y a tie against ity in comwqucnce of the PERMIT ISSUANCE 3.00
gr "go' 1' / MECH.CONT. LIC.NO. MECH.
/o /� TOTAL TOTAL
I n' me p f n radpL _-. ate
bJU OFF=COPY