3261 v
CCI'Y 01' CUPERT'INO INSPYCTIOC RECORD (Office Copy)
326110649B 10649E Mnplew00d_.. -__
PEIIJIIT NO. SANLT'ARY DIST. NO. LOT t ADDRESS
Remodel Property Services 985-6928
PROJECT OWNER JOB SLTE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
IiuildinP Date Lnsp.
Iaectrical Power Pole_
I'Lumhiny _ Llnder�round
ticchnnical Rough Wiring
'1'enp. Gas/lilect. lla las _
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext _
Si ,n Notors
Grounding
Misc. Temp. Power _
Other
FINAL. IIISPECTIONS Not Approved _
Date Insp.
r"s PLUMBING
El.ectri.c
Date Insp.
Plumbing Backflow _ _ _
Mechanical Underground
Solar Underfloor
Pool Partial Rough
. Gradin , Rough Complete
Planning Solar Rough _
Fire Dept. Water & Insulation
Health Dept. Main Drain
Building - Z R1, R`- R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification IILCIIANLCAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Ilembrane Ducts & Insulation
Bond Beam Eire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & Ilood
Tiedowns One Hour Shaft
Di.aphrams Condensate Drain
Seismic Bracing Erjuipment Anchorage
llal..l.s-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Ilallbonrds Int/Ext.
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
J BU I LD ING PROJECT IDENTIFICATION LSC PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS
Mp1'VL BUILDING-ELECTRICAL-PLUMBING -MECHANICAL 3261
C OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
SJ11<r=S PHONE
�- CONT A rolls
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00 �=
uc.NO. LIGHTING FIXTURES 5.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS _ Pq�p
PHONE PANELS 5.DB pA FAPPLI CATION
ARCHITECT SIGNS 6.00 PLAN C E
OR
MY
ENGINEER
LIc.No. SIGNS TRANS. 3.00 zpy
ARCH.08 ENG. SPECIALCIRCUIT 5.00 PE OWhIno
ARCH Ess
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00 ` //oo LICENSED CON"TRACTORS DECLARATIONl/puI hereby affirm that I am licensed under provisions of Chapter 9 ?YA ATE
lronnnencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
iProfessions Code,and my license is in full force and effect - ❑ ❑
Zo 0 m o License Class Lic.Number.
F .. Date Contractor.
a Y g BUILDING PERMIT
M ¢ w OWNER-BUILDER DECLARATION INFORMATION
w ;LL uHi 1 hereby affirm that I um exempt from the Contractor's License MISC.- REFER TO ORD
Fu04 Law 1'91 the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
Code:Any city or county which nOuiresa permit toconsvucLalter. PERMIT ISSUANCE 6.00 oP-
¢ ¢ < 2 Improve,demolish.Or repair any structure,prior to its Issuance.also ELEC.CONTE. LIC.NO. ELEC. oZ O
- O ¢ 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 Con01cloi s License
F z i
Law(Chapter 9(commencing with Section 7000)of Division 3 office
- a llusiness and Professions Cadet o1 that he is em...pt therefrom and DTV. PLUMBING PERMIT FEE
IS F o the basis for the alleged exemption.Any vmialiol of Section 7031.5 STORIES TYPE CONSTR.
5-: by by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN -WATER IEA.) 4.00
of not more than five hundred dollars(4500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 2.00 OCG.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 _Ta.FT.FLOOR AREA TOTAL ACREAGE
himself or
nlenlsarc tIUTmgh[if,
own cm Ployeas,Provided that such improve
leo what ruche building GAS-EA.SVSTEM-11NC.40UTLETS 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 hit--
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 RES - IND cory PR ome,
❑ I,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 ASSESSORS PARCEL NO.
and Professions Code The Contractor License Law if mol apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3i
contracts for such projects with a coutractofw licensed pursuant m
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT No. PARCEL No.
❑ I an,exempt under Sec ,BAP.C.for this WATER HEATER W/VENT 4.00
reason `�
Date Oxmcl/`� WATER SYSTEM 4.00 ACC.DATE ACG FILE NO.
WORRERS'Cox ENS TION ECLARA'1"ION WATER TREATING EQUIP. 4.00
I hereby affirm that 1 have a,sUiticxte of consent to sell-41,1111, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance.or a certified
copy Ihcrmt(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy i,hereby furnished. FIRE SPRINK ENERGY T 24
Z_ Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. y❑ 'N❑ Y N❑
O Applicant
H. rn PERMIT ISSUANCE 6.00 FLOOD ZONE A.Luc.
LU > CERTIFICATE COM E SATIOTINS FROM WORKERS'
IL COMPENSATION INSURANCE PLG.CONTE. LIC.No. PLG.
d 0 1 rhis section need not be Completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
0 Z hundred dollars($100)or let .)
U 0 1 certify that in me performance of the Work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY
L,_ H mit is i.oued,I sha11 LOU employ ally Person in any mann,,so as m
O0 become subject to the W'orklrs''Compensation Laws of California. BUILDING Qa_V
Data Applicanl ALTER OR ADD TO MECH. 4.00
} 0 NOTICE'10 APPLICANT: If,after making this Certificate of I x�
F ? emption,you Should become subject to file Workers Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will] FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CON'SI RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0=C.F.M.) 5.00 SEISMIC FEE �a
I hereby idlum that there is a construction lending agency toEX HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT PTO 100,000 B.T.U.) 4.00
Lender's Name HEATI NG UNIT(OV ER 100,000 B.T.U.P.50 ELECTRIC pZ 4600
Lender's Address
I certify that l have read this application and stale than the above VENTILATION FAN (SINGLE) 3.00
inti.......ion is correct. 1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
uhove-mentioned 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 -penres which CONST.TAX
may in any way accrue agmns "inconseqe of the PERMIT ISSUANCE3.00mntin of this ennit. MECH.CONT. LIC.NO. MECH.
� p �� OTAL TOTALIs mrco Appheant/C tacto
OFFICE COPY