0229 (2) J ' CITY OF CUPERTINO INSPECTIOi? RECORD (Office Copy)
0229 7409 Rolling Dell Dr.
PEF21IT 7,10. SA2'iITARY DIST_ . NO. LOT NO• ADDRESS
Reroof J. Nendoza 996-8608
PROJECT OWNER JOB SITE PHONE N0. �
-Date ELECTRICAL
Building -5-81
Date Insp .
Electricai Power Pole
Plumbing, Underground
.1echanical Rough f-iiring,
Temp. Gas/Elect. I.Talls
Solar Ceiling,
;ire Sprinkler Fixtures Int/Ext
Sig,n i4otors
Grounding
Misc. Temp. Power
Other
FINAL. INSPECTIONS' Not Approved
Date Insp.
Gas PLUMBING
LUMBING
D
Plumbing ate insp .
SlaL Backflow
on�cal Underground
Sola- Underfloor
Pool Partial ROugh
Grading Rough Complete
P1anr.ing Solar Routh
r re Oepc . Mater c, Insulation
Health DeDt.
Main Drain
Building
Other R/ot/S Drain.
Cas
Other
ST_RUCT_U'1L Not ADnroved
Date Insp.
Pad Certification
`fECHA?'ICAC
i�oundation
Pre--unite Date insp.
Underfloor S .`!.
Slab-?!embrane Ducts c Insulation
Bo ed Beam Fire Dampers
Underfloor Girders Fireplace
rloor Steel Grease Duct 5 Hood
T;edowns
Diaphrams One Hour Shaft
Condensate Drain
Seismic Bracing r
quinment Anchorage
alls-Panels Flues L Comb . Air
Frame Other
Lath Not Approved
?7allboards Int/Est.
Firewalls
Other
Not :+noroved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BU I LDING PROJECT I DENT]FICATI ON PERMIT NUMBER
r' APPLICATION & PERMIT
ADI ADDRESS
_ 0229
ADOREss � r '
� 6sw e4 e- (n ti • � BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
O NE 'S PLAN CHECK VALIDATION
"AME OTV. - ELECTRIC PERMIT FEE '
47 A.ZF"r"ooz PHONE "9 W,4a
NOAMERacTORs - OUTLETS='SWITCHES-RECEP 5.00/1.00
LIGHTING FIXTURES 5.00/1.00
ADDRESS ORs a`r APPLIANCES--RESIDENTIAL 4.00 '
ADDRESS A 1
LJy2 L`�¢�' PRION y _> PANELS 5.00 DATE OPAPPLI CATION
ARCHITECT SIGNS - 6.00 - PLAN CHECK FEE P.C.NO.
OF
ENGINEER LIC NO SIGNS TRANS. - 3.00
ARC H.OR.ENG, PERMIT VALIDATION
ADDRESS - SPECIAL CIRCUIT 5.00
h. •- - z1P - TEMP.METER OR POLE INS. 15.00
A _ MOTORS SEE FEE SCH.
ADDRESS
pREss r, _ I////JfSG
SERVICE CHANGE 10.00
0 00 LICENSED CONTRACTORS DECLARATION -
u U I hereby affirm first 1 an,licensed under provisions of Chapter 9 _ ER ISSUANCE DATE
a z w (Lo n.Care ng with Section 7000)of Division 3 of the Business and
- BLDG. ELECT. PLG. - MECH,
w m Professions Code,a m license is in full force nd IT ct� ❑ ❑ ❑
z o m — License Lic.Number MAY
-
o m t w Date Contractor t
BUILDING PERMIT
SE
o u OWNER-BUILDGR DECLARATION. �`. INFORMATION -
F
g LL F I hereby affirm that I am exempt from lire Contractor's License MISC.— P EFER TO ORD -
Fac Law for the following reason.(Sec.7031.5,Emoressand Professions pERMIT ISSUANCE - - 600 VALUATION $/FT.
m y Code.Any city or county which requires apermino construct,alter, v�OrsD Vr'
R M < improve,demolish,or repair any St RiCture,prior to its issuance,also ELEC.CONTR. -_ LIC.NO. TE LEC.
p(
wO at requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License -
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the • - -
< Business and Professions Code)or that he is exempt therefrom and QTY. - PLUMBING PERMIT, FEE
r o the basis for the alleged exemption,Any violation of Section 7031.5S ORIES vSYPE CONSTR,
u ;°2 by any applicant for a permit subjects-the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars($5000.): -
❑ 1,as owner 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
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP_ 4,00 SO.FT.FLOOR AREA TOTALACREAGE
himself re through his own employees, le.If,provided however,
such improve-
marts
mprove ,
himself enol Enough
dor employee sale.If, that suhebuilding GAS-EA.SVSTEM-l1NC.40UTLETS 4.00
or improvement is sold within one year 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 not build or im-
RES IND CON PB Gone,
prove for Purpose of the
INDUSTRIAL WASTE INTER. 20.00
d as owner of the property,he exclusively contracting with - 0 ❑ ID 1-1
licensed contractors to The
the project(Sea,7044,Business LAWN SPRINKLERS- 1 INC 5 V_ .B. 5.00 ASSESSORS PARCEL No.
and Professions Code:The Contractor's License Law does nat apply _
to anowner Of such
with
builds r improves thereon,and who LAWN SPRINKLERS OVER 5(EA.) 7:00
tare Cocontracts for such projects with a contmc[od s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/6.00 TRACT No. PARCEL NO.
❑ tum exempt under sea ,R.&P.C.for Ibis
reason _. WATER HEATER W/VENT 4,00
, .
Date Owner' WATER SYSTEM 4.00 ACC.DATE ACC,FILE NO.
WORK ERS'COMPE.NSATION DECLARATION WATER TREATING EQUIP, 4.00
I hereby affirm that I have a certificate ofconsent to self-insure, - ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company /— •L '- -
Q ❑ Certified Copy sherebyfurnished.' FIRESPRINK ENERGY 24
Z 0/Certifi 1 copy,rS� filed with tl fly inspection division.
Z Applicant �•1 ji,�'•y,�, I MISC.- REFERTO ORD. v � N❑ r � N�
O
� N CERTIFICATE OF EXEMPT ION FROM WORKS RS' PERMIT ISSUANCE 6.00 FLOODZONE- A,L.UC.
LU > COMPENSATION INSURANCE 'PLG.CONTR. _ LIC.NO. PLG.
Z (-Chis section need not be completed if the permit is for one _ TOTAL V❑ N� V N�
hundred dollars(SIOOIOr less.) '
L) O 1 certify that In the performance Of the work for which this per- OTV. MECHANICAL PERMIT FEE" - FEE SUMMARY
UL F- mit is issued, I shall not employ any person in any manner so as to
U bosom ub'ect t the Workers' m tion Laws of li(ontin. -
ED Dat ya�Applicant p �Cgy[IL ALTER OR-ADD TO MECH. 4.00 BUILDING
} ti NO CE TO APPLICANT: Ifcafter mukmg Ih1s Cerld is of Ex-
F Z emption,you should become subject 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 10)DDOC.EM.) 5.00 SEISMIC FEE r /x'U
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. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.17.50
Lender's Addmss ELECTRIC
I certify that I have mad this application and state that the above VENTILATION FAN (SINGLE). -
information n coraco.I agree to colo b with all city and county PLUMBING
ordinances and stale laws relating to building construction,co :cod BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter Inion the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTUI,SEE FEE SCH. MECHANICAL
(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 3.00 CONST.TAX
may in any way accrue,against Said City in consequence of the
granting Of lh�ryennit. - MECH:CONT. LIG NO. MECH.
0L/`�r�, _ lr/ TOTAL TOTAL
0
Signature
'�of Applicant/Contras r Date
f4II& rr. RPI J'10144*_ OFFICE COPY