0535 CITY 01' CUPEIMNO INSUCTIOI! RECORD (Office Copy)
I
`.1535 _ 10631 Farallone Ave._ __ '
PEPdIIT NO. SANITARY DIST. NO. LOT N0. - ADDRESS
• Reroof residence Wiener 378-1074
PROJECT OWNER JOB SITE PIIO14E NO.
PERMIT ISSUED Date ELECTRICAL
Buil din 6-18-81 Date Insp.
Electrical flower Pole
Plumbing Underground
Mechanical Rou h Wiring _
Temp. Cas/I;lcct. alf s
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Si .n Hotors
Grounding
Ptisc. Temp. Power
Other _
FINAL INSPECTIONS Not Approved
Date Insp.
(,e.s _
PLUMBING
Electric '
• Date Ins p.
Plumbing Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
Planning Solar Rou h
Fire Dept. Water & Insulation
Health Dept. "lain Drain
Building R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date . Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-I9embrane 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
11al.ls-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 BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION FERMI MBER
BUILDING APPLICATION & PERMIT
AooRE/Ol31 F4R/J�CiV _�T� BUILDING _ 0535
(� — ELECTRICAL—PLUMBING—MECHANICAL
OWNERS - PLAN CHECK VALIDATION
NAME RONEs'F CITY. ELECTRIC PERMIT FEE
vIO ,0�1
CONTRACTOR OUTLETS-SWITCHES-RECEP 5.00/1.00
'Poet, 11C,No.J 'FC 03 LIGHTING FIXTURES 5.00/1.00
CONTRACTORS- PPLIANCES-RESIDE L 4.00
�f�j
11 r.i •"v vRONEfa�-�� • /Q PANELS .00 DATE OF APPLICATION
ARCHITECT
SIGNS vLAN CHECK FEE P.C.NO.
0.ENGINEER
LIC,NO. SIGNS TRANS., 00 '
AARCH,OR ODHESS ENG. SPECIALCIRCUIT _ D PERMIT VALIDATION
ZIP rTEMP.METER OR POLE I15.00 -
APPRCESES MOTORS SE ESCH.
AOORESS
SERVICE CHANGE 10.00
Foo LICENSED CONTRACTORS DECLARATION
a.u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
n w Icammencing with Section 7000)of Division 3 of the Business and
BLDG. ELECT. PLG. MECH.
r z Prol'cssions Cod c an m licrnsc is in full for pryd,L l(`SOS
`— ❑ ❑ ❑
i License Cl s Lic.Number —IY J
F_ Contr ctor
¢ ¢ i OWNS RB UILDER DECLARATION BUILDING PERMITINFORMATION
wH I hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD
R .. of Law for the following reason,(Sec,7031.5.Business and Profenions pERMIT ISSUANCE VALUATION $/FT.
iw0 Code:Anycity orcounty which requires a permit toconstimct,alter, - 6.00 d� V
¢ Q ¢ O improve, or repair any structure.prior to its issuance.also ELEC.CONTR. LIG NO. ELEG
— DLL requires the applicant for such permit to rile a signed statement that TOTAL
w $ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
i Law(Chapter 9(commencing with Section 7100)of Division 3 ofthe n_ u^`
r a. Business and Professium Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE OP /`V�
¢ 10 thebasis For the alleged ex em pt on,A n y viola tion of Sec lion 703 IS STORIES TYPECONTR.
by any oppllaum for a permit subjects the applicant lou civil penaltyALTER-DRAIN -WATER (EA.) 4.00
of not..or than Five hundred dollars(55001.P,
Cl I,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 does not apply to an owner of
property who builds Or Improves thereon,and who does such work FIXTURES-PER TRAP 4.00 s0,Fr,FLOOR AREA TOTAL ACREAGE
himself or through hisw
on furred fors,provided that such improve-
meets are not intended a offered for sale.IC however,the budding GAS-EA.SYSTEM-1 INCA OUTLETS 4.00
or improvement is sold within one year of 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 of Rs IND CON Pe Dmer
side.). INDUSTRIAL WASTE INTER. 20.00 E ❑ ❑
❑ I,as owner of the Pmperty,am Cx Closively contracting with
licensed contractors to construct the project(Sec. 7044,Business - LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:1'he Contractor's Liecnx Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPR INKLERS-OVER 5(EA.) 7.00
contracts for such projects with a contractotfs)licensed pursuant to
the Comractor's License Law. SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exempt it Set.—,BAP.C.for this WATER HEATER W/VENT 4,00
reason
Date Owner WATER SYSTEM 4.00 ACC.OATE ACC.FILE NO,
WORK ERs'COMPENSATION DEC1-ARAnOu WATER TREATING EQUIP. 4.00
1 herehy affirm Ihat I have a ceniFieate 9f omcul Io self-insum. ZONING ENG.SITE NO.
9r a certificate of Workers'Conlpunwtipon Insurance,or a cerlificd
copy lhereufIS - Lah,C.).
Policy No npany O
❑ Certified copy reby fumished.
Z 2 Cl Certl Ne filed with the city inspection division. FIRE SPRINK ENERGY T-24
O Applicant �/`•'� misc.- - REFER TO ORD. Y 0 IN Y ❑ NEI
� y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L,U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
Z (This section need not be completed if the permit is I'or one TOTAL Y❑ N� Y ❑ IN
hundred dollars IS 100)or Iesv.)
U O 1 certify that in the Performance of the work for whicll this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL F Init is issued,I shall not employ any person in any manu'r'e m)o
U w lxeoma Ml ict to the Workers'Compensation Lows at California.
Date Applicant BUILDING 6•�,s�
} 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 4.00
(_ ? emption,you should become subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1O=CF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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 must ISce. MICROFILM
3097,CY C.I. HEATING UNIT (TO 100,000 B.T.U.) 4.00
Lender's Name H EATI N G UN IT(OVER 100,000 B.T.U.P.50
Lender's Address ELECTRIC
I certify that 1 hm�e read this applicwion and nmc that the above VENTILATION FAN (SINGLE) 3.00
information is correct I agree m comply with all city and county PLUMBING
ordinances and state laws trading m building construction. and BOILER-COMP I3 H.P.or 100,000 B.T.U.1 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 1D0,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep hamtlrss the City Of MISC.- REFER TO ORD. -
Cupertino against liabilities,judgments, costs and sxpv ses whichpERMIT ISSUANCE CONST.TAX
may in any way accrue against said.City in consequence of the 3.00
granting of this perm) MECH.CONT. LIG NO. MECH.
TOTAL TOTAL �� O o
Signal—are of Ap—pin id/Contructor Date
OFFICE COPY