7275 (2) CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
AIJI!?R0JhL:1
� I
PERMIT ISSUED DATE ELECTRICAL DATE INSP.'
ui in
ctric
PiumbinIZ Power Pole
mechanical er un
Teas ec u irin e Z
Solar Na.Us
ire tin er ei in
Sign
vctures Int/Ext
otors
Misc. roE�in
e ower
UtheT
FINAL INSPECTIONS / DATE INSP. Not ApproveT
Gas
Electric _30_F s Ll
Plumbinz PLUMING DATE TSP.
-mecnan3.cal
Solar Backflow
•Poolr un
ra in oor
,Fiann3.ng Partialou
Fire Dept u i o ete
heaith Dept. Solar Kougn
u in ater ' Insulation
er in . azn
o alm
as
—7-77-7
Other
BUILDING DATE INSP. of rove
Pad Certification
oun ation ELECTRICAL DATE INSP.
re- unite
a - rane Underfloor S.M.
bond eam cts , nsu ation
Undertioor Girders . Fire Danpers
Floor Steel ire ace
ie owns brease ouct
Diaphrams One Hour Shaft
eismecracin on nsate a3.n
WUls ane sui ment Anchorage
Frame �, Flues67 omTi fir
Lath tei�Fr—
Wallboards Int/Ex—t. of prove
� ewa—I�
er
Net rove
1
JT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
CI NG PROJECT I DENTI FICATION ":,PER NumeEE
APPCI,CATION & PERMIT n/
O o6Q '57'g- -C,C�e BUILDING—ELECTRICAL—PLUMBING—MECHANICAL : 7275
PLAN CHEC�VALIDATION
CITY.; ELECTRIC PERMIT =FEE pAiU
J PMO
CONTRACTORS
NA e— ZJ uJC UTLETS-SWITCHES-RECEP 5.00/1.00 �e A
1 N'. LIGHTING FIXTURES 5.00/1.00 "� 'Y
' TRACTOR, Z1 APPLIANCES 4.00 Of CUpe�ln�
17�
VOD Ess - - {\�]� '
U'Ia GGr 'T 4115s�.l�� '30 �a PANELS 5.00 DATE OF APPLICATION
ARCHITECT.- SIGNS B.00' PLAN CHECK FEE P.C.NO,
OR
ENGINEER
LIC.NO. - SIGNS TRANS. 3.00
'ADDRESS era r• - SPECIAL CIRCUIT 5.00
PERMIT VALIDATION -
LIP EMP.METER OR POLE INS. 15.00
ADDRESS PPLICANrs — ' MOTORS' - - SEE FEE SCH. / 1'J{Ip/{.'1(-
- �•, ADDRESS '
SERVICE CHANGE 10.00
'
,- 00 LICI?NSIiDCONTRACTORS�IIECLARATION -
a o G- 4t hhereby al firm they timer licansed miller provisioilsol'Chapter9 - - IS$U tTE '
,(commencing with'Sectiori 7000)of Division 3 of the Ihismess and
rn G ,wa„ , RLO ELE MECH.
H w z Professions la Code,and my license is in full force and effect. ' ❑ ❑
o z m o Date se Class _ Loc.Number .
r w � Uulc% Contractor• ,
-
a m BUILDING PERMIT
Emw •OwNIiR-BUILDER DECLARATION "!INFORMATION
Do - ! misc.— - REFER TO ORD
E
s, r I hereby affirm that I am exempt from the Contractor's License
LLo¢. Law firthe followingreason.(Sec. uires a,ermit tocodProfessions PERMIT ISSUANCE VALUATION $/FT.
r — 2 .Code:Anycolshcor m paircch structurepermitoits issuance,
6.00.
asa: 0_ improve;demolish,or rcpai,any slmchlr'ri,prior to its issu:mce,alto ELEC.CONIII. LIC.NO. ELECthal . p/ _
DLL requires the applicant for such permit to file a signed ntor's License
- - TOTAL I E
w $ he is licensed pecan[en the provisions of the Contracldon License xx
' TO
Law(ess and 9(cosions Codeng )or Senior is exempt there om red IIUI
— a he
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
r m the basis for the alleged exemption.Any violation of BCetion 7031,$ + - STORIES TYPE CONSTR:
as by any'uppli6mt lbr.a permit subjects the applicant toe civil penally ALTER-DRAIN -WATER (EA.) 4.00 '
of not more than five hundred dollars IS 500).):
O I,'as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 . 00C.GROUP RES.UNITS
their sole campenution,will do the work,and the structure is not ,
_ intended or offered for sale (Sec: 7044, BllslnesS-and Professions
C J The Contractor's License Law d DRAINS-FLOOR,ROOF,AR EA,CON D. 4.00 s not apply to n owner of '1
Irl sly who hold. 'nip rvusN I,and who does such work FIXTURES-PER TRAP ' ,' 4.00 FT.FLOORAREA 'TOTALACREAGE
hinslf Ori thiel his own lmpl0ytts,pr, ividled that rich'improve- GAS-EA.SVSTEM-11NC.40UTLET54.00
mems are hot intended o offered for sale,LI.however,the building
'or improvement Is sold within one year of completion the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
b alder will have the burden of proving that he did not build or tin RES IND C PB- Omer
pr. .for purpose of sale.).' -: y f- : ! INDUSTRIAL WASTE INTER. ' ,20.00
_ .yA I,as ower,of the property.am'P.iIaiivcly contuwliny with ❑ ❑ ❑ ❑
licensed comramors to construct the project(See 7044,Business LAWN'SPRINKLERS-1 INC 5 V.B.- „5.00 gsSEsso RCEL NO.
and Professions Code:- Contractor's License Law dues not apply
}.. . In an owner of prop I who Iilds or improves thereon,and who " LAWN SPRINKLERS-OVER 5 (EA.) 1,00
contracts for such j cis a contractors)licensed pursuant to -
,'''„ the Commctu, I nsrrl ., ?. SEWER-SANITARY-STORM EA..200ft/8.00 . TRACT NO. PARCEL NO.
❑ lam cxcn and ,6.&P.C.for th is. WATER HEATER W/VENT' • 4.00
>( rearm — —
Owner Un WATER SYSTEM '4.00 ACC.DATE ACC.FILE NO.
- ' 0RK r�1At/. ION DECLARATION WATER TREATING EQUIP:, 4.00 '
r l Jicteby affrm that I have if certificate of consent to wI(insure, ZONING ENG.SITE NO.
or L certificate of Workers'Compensation Insurance,or a certified
C
thereof(Sec.3800,LvA C..). '
I alley No.—Company
—
El Cl Certified olY k hereby1cmished + - FIRES RINK 'ENERGY T-24
Z fled py is filed with•Ihulinty inspection division. MISC:- - ` REFER TO flD.
APpluant • Y ❑ N❑ Y ❑ NPERMITASSUANCE 00 TIPICATli061:XIiMPTIONPROMWORKERS' FL000 ZONE J.C.
LU > ,`,, COMPENSATr10N'INSURANCE - PLG.CONTE. sec.No. s PLG.
d O (this WCR611 nee l n L he omplCted it III& pCnnit is,for ane ' TOTAL Y❑ N❑ Y❑, N❑
Z Minded dollars(8100)or
U O 1 certify that in the,performa eciof the work-for which this per CITY- MECHANICAL PERMIT FEE FEE SUMMARY
Il P mil is issued.I shall not employ any prison in any manner so as Io
U become subject l0 the.Workers'Compensation Laws of California.' J
_ O w Dolt Applicant BUILDING
a . . ALTER OR ADD TO MECH. 4.00
} m NOTICE TO!APPLICAN'I': II',ager nicking this'Cerlil'ic:to of fix-
Z 'tmption,you should become subject to the Worker'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you'must forthwith comply,wilh FEE `r-
- U such provlsionsor.thfs permit shall be dmevok
deemed red ' > AIR HANDLING UNIT TO 10=C.F.M.) 3.00
.,t, AIR HANDLING UNIT(OVER 10X0C.EM.) 5.00 'SEISMIC FEE, ✓
CONS]RUCTION Lf NDINC AGENCY
N her by'tllino that there ra"a Cons[ru lion lending agency for ,EXHAUST HOOD (WITH DUCT) 2.00
filep fo nmice o6tlie work for w1fich this permit is Issued(Sec. ' ' 'MICROFILM
3097,Cry C.)..;•-' HEATING UNIT(TO 100,000 B.T.U.) 4.00
I-endcr's NamAddress
H EATI NG UN IT(OVER 100,000 B.T.U.P.50
Lcndcrs Address - ''ELECTRIC
l certify that Phave read this application and state that lite above VENTILATION FAN (SINGLE) 300
Information is Correct I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.cr100,000B.T.U.) 4.00
hereby-authonze representatives of this city to enter upon the J BOILER-COMP (Over 100,000 BTU)SEE FEE SCH: MECHANICAL
above-mentioned property for inspection purposes. -
` (We) a , �eve'inde y I'd"kecp'harmlcss the City of ;1, MISC.-` - REFER TO ORD. '
+; Qiperlino,a est/loaboloti jdJ ancosts and exPenue which .PERMIT ISSUANCE 3.00 CONST.TAX '
may m an wace - ugai t said City in consequence of the
6mnbngo t penin CH CONT LIC.NO. 7, MOECA
. -
'r TOTAL l_Q %Sig r of Iwnl/Con ctor ;v - Date /(rJ
OFFICECOPY