0526 (2) Cl'CY OF CLPE1,11'11f0 INSPECTIOk RECOPCOPY)
0526 21950 Rucker Dr.
PCPSIIT NO. SANITARY DIST. NO. LOT id0. ADDRISSti
Plumbing Alberson 257-8989
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
BuiIdi.ne Date Insp.
Electrical Power Pole _
Plumhinr_ 7-21-81 Underground
Mochanica.l Rou ,h Wiring
Temp. Cas/Elect. flails
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Hisc. Temp. Power
Other
FINAL. INSPECTIONS Not Approved
Date Insp.
r,`s PLUMBING
Electric Date Insp.
Plumbing Backflow _
Mechanical UnderEround
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
PL,inninp Solar Roo ,h
Fire Dept. [later & Insulation
flealth Dept. "fain Drain
Puildin R/of/S Drain
Other Gas
Other
BUILDING 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 & flood
Tiedowns One flour Shaft
D.iaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
Halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/F.xt.
Firewalls _
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN'ONC .Q )
BU I LDING PROJECT I DENTIFICATI ON / 1 IT NUMBER
aUIDLDING APPLICATION & PERMIT `. 0526
BUILDING — ELECTRICAL—PLUMBING —MECHANICAL
wry R'a - PLAN CHECK VALIDATION
ME Y ELECTRIC PERMIT FEE
PH
_NOMERacTOR's n _ OUTLETS-SWITCHES-RECEP 5.00/1.00
A-A-A ACE P uc.No. LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S APPLIANCES RESIDENTIAL 4.00
AouR Ess '
Tgiv
PANELS - 5.00 DATE OF APPLICATION
PHONE
ARCHITECT K F
SIGNS 6.00 PLAN CHECEE P,C.NO.
DR
ENGINEER
' -uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG, - - PERMIT VALIDATION
ADDRESS - SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE .00
9
OUPEWINI
•uOF+
oo LICENSED CONTRACTORS DECLARATION //-�•
¢ u U I hereby affirm That I am licensed under provisions of Chapter 9 jut ISSUANCE DATE
v, w (conononcing with Section 7000)of Division 3 of the Busimess and
< vAi BLDG. ELECT. PLG. MECH.
F w z 'Professions Code,and my license is in full for;•:nd c fe•. - ❑ _ ❑ ❑
z O m — License Class/Y= Lie.Number
x 4 o Date Contractor
¢ ¢a OWNER-BUILDER DECLARA'TON PAID, BUILDING PERMIT
— o a v 'INFORMATION
w F I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
u m p VALUATION $/FT.
Foo J Law for the following reason.(Sec.7031.5.Ousinessand Professions PERMIT ISSUANCE 6.00
Code:Any city or county which requires a permit to construct,al leq
ge Q ¢ 0 improve,demolish•or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
u 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
F z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 Business and Professions Code)or that Ile is exempt therefrom and QTY. PLUMBING PERMIT FEE
fi0
¢ F $ the basis for the alleged exemption.Any violation t load ion malty STORIES TYPE CONSTR.
by any applicant fora permit subjects the applicant macivilpenally ALTER-DRAIN -WATER (EA.).4.00
of not more than five hundred prop dollars 1my mal:
❑ Las owner at the property,or my employees with wages as - BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
(heir sole compensation,will Jo the work,and the structure is not
intended or offered for sale (Sec. 7044, Ba,iness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4i00
Code,The Contractor's License Law docs not apply to an Owner of
property who builds or improves thereon,and who Rocs such work FIXTURES-PER TRAP 4.00 so.PT.FLOOR AREA ToraL ACREAGE
himself or through his own employees,provided that such improv
mems are not intended or Offered for sale.If,however;the building GAS-EA.SVSTEM•11NC.40UTLETS 4.00
► or improvement is sold within one year at completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose ofsale.). INDUSTRIAL WASTE INTER2000 RES IND CON PB Omer
Cl 1,as owner of the property,am exclusively contracting with . .
❑ ❑ El 0 11
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts forsuch projects with a contractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.—,]I&P.C.for fins WATER HEATER W/VENT 4.00 -
reason le
Dam - Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby infirm that I have a certificate of conserl to self-Insure, -
- or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG:SITE NO.
copy tile (Sec 3800,Lab C).
Policy NtCi�ElEdElfiaeysJ/VrsL]A
Q y❑❑ Certified copy is hereby furnished.
Z 2 rq Certif dd apy is filed I tat 1 i� 1' Bion. FIRE SPRINK ENERGY T]4
O Applicant fad
c MISC.- REFER TO ORD. YEl NEl Y � N�
rn —� PERMIT ISSUANCE 6.00
'LU CIiRTI FIC O%i ENSATI I''I ION RAN WOHKEHS' r FLOOD ZONE A.L.U.C.
CL 0 COAIPEt be completed
if then - P .CONT uo'L /oZ37 PLG.
1 (This SKlars need not be Completed If the permit is for one Q(� TOTAL/
f L) Z hundred dollars in the
fort .
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued.I shall not employ any person in any manner us as to
Ow become subject to the Workers'Compensalion Laws of California.
Dat; Applicant BUILDING
El. ALTER OR ADD TO MECH. 4.00
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you mast forthwith comply with FEE -
U. such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 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. 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.)7.50
Lender's Address - ELECTRIC
I certify that I 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 county PLUMBING
! D agrees and state laws relating to'building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
!\ Aemby aathoriov representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mcnfioned 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 PERMIT ISSUANCE 3.00 CONST.TAX
may In any way accrue against said City in consequence of the
•
lingo thispermit. MECH.CONT. LIC.NO.- MECH.
TOTAL TOTAL
tgf uture of Applicant/Contractor TDe f.0o
OFFIC@ COPY