3257 CITY 017 GUPF,Itl'1N0 IUSPECTIM RECORD (Office Copy)
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3257 _ 10649-AnE.YL.._Dividers_.__
PUPJIIT NO. SANITARY DIST. 140. LOT 110. ADU[:ISS
Remodel Property Service
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Building Date Insp.
laectrical Power Pole_
Plumhinr; Under
Meehan ical Rough Wiring
Temp. Cas/Iacct. lla la.s_ —_----
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext _
Sign tlotors
Grounding
Hi.sc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
r„s
PLUMBING
Electric
Date Insp.
Plumbing Backflow
Mechanical Underground
Snlar Underfloor _
Pool Partial Rough
• Gradin , Rough Complete
PLanning, Solar Rough _
Fire Dept. Water & Insulation _
Ilea.lth Dept. `-lain DraLn
Building /b -I2--S3 R/of/S Drain
Other Gas
Other _
BUILDING Not Approved
Date Insp.
Pad Certi.fication MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane 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
Wallboards Int/Ext.
Firewalls
Other
. Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
MIT NUMBER
BUILDING PROJECT IDENTIFICATION �� APPLICATION & PERMIT
ADDRES= ��ST� w
3257
BUILDING- ELECTRICAL-PLUMBING -MECHANICA 3 2 5 7
wNER'Sq Pk PLAN CHECK VALIDATION
AME _ CITY. ELECTRIC PERMIT FEE
vwoNE J�
C TRACT s OUTLETS-SWITCHES-RECEP 5.00/1.00 PA1p
NAME
LIC.No. .� LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S 2 APPLIANCES-RESIDENTIAL 4.00 MAY Q 5 1983
ADDRESS
PHONE PANELS 5.00 DATE OF APPLICATION
OR
$IGNIS 6.D0 PLAN VI lEV P.C.NO.
OR Vf lr P rtlno
ENGINEER LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS
MOTORS SEE FEE SCH.
ADDRESSDREss
SERVICE CHANGE 10.00
'00 LICBNSCD CONTRACTORS DECLARATION J
a it u I hereby affirm I'm 1 am licensed under provisions of Chaplet') ISSUANCE DATE
y a N (commencing with Section 7000)of Division 3 of the Business and G. ELECT. PLG. MEDIA.
F y z Professions Code,and my lie...P is in full t'oree and effect ❑ ❑ ❑
z o m - License Class Lic.Number
o , r Date Contractor
a y f J BUILDING PERMIT
¢ ¢ w< OWNER-BUILDER DECLARATION INFORMATION
AOA. MISC.- REFER TO ORD
w LL N 1 hereby ulfum that I am exempt from the Contractor's License VALUATION $/FT.
u-
0< Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00
Code:Any city or county which reyuiresa permit reconstruct,alter,
¢ Q p improve,demolish,or repair any Structure,prior to its issuance,also ELED.CONTR. LIC.NO. ELEC. (o
- O LL Requires the applicant far sUeh per...it to file a signed statement that TOTA L� O PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License
rzQLaw(Chapter 9(commencing with Section 7000)of Division 3 ofthe }r
4 o Business and Professions Code)ar tltm Be is exempt themfrom and DTV. PLUMBING PERMIT FEE C/�
¢ o the basis for the alleged exemption.Any violation of Section 703 LS STORIES TYPE CONSTR.
Ba a3 _ by any applicant for a permit subjects the applicant o a civil penally ALTER-DRAIN&VENT-WATER (EA.) 4.00
PC not Inure than fisc hundred dollars IS500).):
❑ I,as owner of the property,or my employees with walks as BACK F LOW PROTECT.DEV ICE 2.00 acct GROUP RES.UNITS
their sole compensation,will do the work,and the....cure is not
intended or offered for sale (Sea 7044, Business and I'ofessions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law doe,not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 $O,FT.FLOOR AREA TOTAL ACREAGE
_- himself re through his own Proffered
ccs,Provided that such improve-
himselarenotintended isorofferedfeesprovied that STILL
building GAS-EA.SYSTEM-1INC.4OUTLETS 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 Ira did not build or ins- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 1:1 El 11 ❑ E]❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSOR PARCEL NO.
and Professions Code The Contractors License Law does nom apply
ar an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 J? 3
contracts for such projects with IT contracton s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO.I PARCEL NO.
❑ lura exempt under Sea ,B.&I'.C.for this WATER HEATER W/VENT 4.00
euson
Date � �J-�j Owner A..e WATER SYSTEM 4.00 ACC,DATE ACC.FILE NO.
wORKER3'COMP:NSn7 >iCLn A'I'ION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of cons.to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation In,a.unec,or v certified
copy thereof(Sec.3800,LibC.).
Policy No. Company
0 ❑ Certified copy i,hereby turnished. FIRE SPRINK ENERGY T24
Z Z ❑ Certified copy is fled with .he city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ v ❑ N❑
(r N CERI'114CA'I'I3 OP HYEAI I'fION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE
ELI > COk1PEN8ATION INSURANCE PLR CONTR. LIC NO. PLG.
0- O ('this section need nm be completed if the Penuit is ter one TOTAL Y❑ N❑ Y❑ N❑
::) Z hundred doll...IS 100)er less.)
U O I certify that in the performance of the work for which this per. OTV. MECHANICAL PERMIT FEE FEE SUMMARY
U_ P mit is issued, I shall not employ any person in any'manner m,es In
Ow become subject to the Workers'Compensation laws of California. OO
cmc Ap licant BUILDING
p ALTER OR ADD TO MECH. 4.00 g
} N N'OT'ICE TO APPLICANT': If,after....king this Certificate of Es..
� Z etr.plion,you should become subject to the workeri 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
CONSTRUCHON LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 5.00 SEISMIC FEE i56
1 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
HEATING UNIT(TO 100,000 B.T.U.) 4.00
3097,C,,CA Ind
Lender's N.... HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address r
I scHily fret I have read this application and state thm Clic above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city anA county' BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction, anJ
herby authoriec representatives of this city to enter upon 11, BOILER-COMP 10vnr 100,000BTU15EE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) aCri, to save, indemnify and keep ham.less the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgn.ents, osis and expenses which CONST.TAX
may in any way accue against ''d City In eonwrquenee of the PERMIT ISSUANCE 3.00
granting of this permit. / MECH.CONT. LIC.NO. MECH. 5
rn�O x/J: �r TOTAL TOTAL
Bignal�irco r pp moot/Contra Orr Dote-
OFFICE COPY