3658 CIT)' OF CUPERTINO INSPECTIOV RECORD (Office Copy)
3653 10649 D Maplewood Drive
PYPJ1IT N0. SANITARY DIST. 140. LOT NO. ADDRESS
• Re-liodel Property Services
PROJECT 0WNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buildine 6/2Z83 .� Date Insp.
Electrical 6/2/83 Power Pole
Plumbinr, Underground
ilechanical P.o �h Wirin
Temp. Cas/Elect. ha 11 lls
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Notors
Grounding
Misc. Temp. Power
Other
FINAL INSPECTIONS Not Approved
Date Insp.
Cos PLUMBING
Electric
Date Lnsp.
Plumbing
Backfloca
Mchanical - Underground -------
Solar
_____Solar Underfloor
Pool Partial Rough
Grading Rough Complete
Planning Solar Rough
Fire Dept. (dater & Insulation
• Health Dept. Main Drain
Building R/of/S Drain _
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.H.
Slab-Membrane Ducts & Insulation _
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One Hour Shaft _
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
1lalls-Panels Flues & Comb. Air
Frame other
Lath Not Approved
Uallboards Int/Ext.
Firewalls
Other
Not A2roved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES,- USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
EDILDirvG APPLICATION & PERMIT C C O
ADDRESS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL U 58
06 /eccSTdd
OWNERS PLAN CHECK VALIDATION
nP ��Cl DTV. ELECTRIC PERMIT FEE
xA".E croRs J 6N 7 UTLETS-SWITCHES-RECEP 5.00/1.00 L
NAME
uc.rvo. �j LIGHTING FIXTURES 5-00/1.00 SW
ATOR's
ADDRESS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO,
OR
ENGINEER
LIC.No. , SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
i,v TEMP.METER OR POLE INS. 15.00 ^ Irl
APPLICANTs MOTORS S H. ��UJ�///
ADDREss
SERVICE CHANGE 10.00 3
o00 p 1
F o o LICENSED CONTRACTORS DECLARA
cwikio ION N[ tl
¢ u U I hereby ation that 1 am 000)of under provisions of Chapter 9 ISSUA E �,f
N¢ w Uommencing with Section 70001 of Division 3 of the Nosiness and BLDG. ELECT. PLG. MECH.
H � z Professions Code,and my license is in full font and effect.
z o m - License Class Lic.Number 3-1 9N U T931
o r Date Contractor
- BUILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION
w3 w A u H I hereby affirm that am exempt frmn the Contractor'sLicmne MISC.- REFER TO ORD I�
LL o¢ Law for the following reason.(Sec.7031.5,Businessand Profcssionv PERMIT ISSUANCE 6.00 _ VALUATION S/FT.
L w z
Code: e,dem y Or county whiny structure p riot t o is issuance.
.also
¢ ¢ o improve,demolish,or repair any structure,prior m its issuance,also ELIC.CONTE. LIC.N0.
E LEC. C� d J
O¢ reel vires ns applicant for such permit to file a signed statement that TOTAL / � PERMIT TO
n w m�` he is licensed 9(copursuant Io the provisions of the )DfDivisiom 3 iodic /
F z a
Law(Chapter 9lcommencing with Section 70001+If Division3of the
E 4 c Business and Professions Code)Or that he is exempt therefrom and
DTV. PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.Any violation oPSection 7031.5 STORIES TYPE CONSTR.
03 � by any applicant for a permit subleetl the applicant to a civil penalty ALTER-DRAIN -WATER IEA.14.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wu50s as BACKFLOW PROTECT. DEV ICE 2.00 oce.GROUP RES.UNITS 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,GOND. 4.00
Code:The Contractors License Law does not apply 10 an owner of
property who builds or improves thereon,and who dues such work FIXTURES-PER TRAP 4.00 SD.IT.FLOOR AREA TOTAL ACREAGE
1l imself re through his own fiend for
provided that such improve-doing
ments midl. a not intended Or offend employee
sale.If,howevecihe building GAS EA.SYSTEM-11NC.4 OUTLETS 4.00
or lmprovcinenl 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 int- RES IND CON PB omen
prove for purpose of,ale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ I,as owner of the properly,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.rhe Contractor's License Law dues not apply �[
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts fur such projects with a COTAImetor s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL No.
❑ 1 ant exempt under Se,.-.B&P.C.for this WATER HEATER W/VENT 4.00
rea10nq
Date Owner r WATER SYSTEM 4.00 ACC.OATE ACC.FILE NO.
WORK 17 RS'COMPFNSAT1ON DECLARATION WATER TREATING EQUIP. 4.00
1 hereby of inn that I have a ccfliflcate of convent ID self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance.or a certified
copy Itutnul(See 3800,Lah.C.).
Policy No. Company
O ❑ Certified copy is hereby Punished. I FIRE SPRINK ENERGY T 24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
Applicant .Y❑ "❑ Y [-] N[]
O PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
W CERTUTCA li OP EXEMPTION FROM WORKERS'
W >_ COMPF,NSATION INSURANCE: PLG.CONTE. LIC.NO. PLG. Y❑ N❑ I Y C] N❑
CL O I'1'his section need not be completed if the permit is for one TOTAL
7) 2 hundred dollars IS 100)or le,)
U O I certify that in the performance ol'the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
O W beconm subject to tee Workers'Compensation Laws of Calitorr L, O C�
pate Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} 1a0 NOTICE'1'0 APPUCANL It,after making this Certificale of Ex-
f.. ? emption,you should become subject to the Worker: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=O.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 5.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency lot EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cie C). HEATING UNIT(TO 100,000 B.T.U.) 4.00 �i
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.17.50 ELECTRIC fA
Lenders Address
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply will,all city and county BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and stale laws relating to building construction, and
hereby authorise representatives of this City to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
u bove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City Of MISC.- - REFER TO ORD.
Cupertino against liabilities,jmd•meets, costs and uxpensex which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue again sax City in consequence 01 tile
gran unit. MECWCONT. LIC.NO. MECH.
` - G- ^ fD� TOTAL TOTAL 3 ,f
of d `_
Signature oI Appllca Doti' r Date
OFFICE COPY b-�
5, v o