3265 CITY 01' CUPEIM1I0 INSPECTIOV RECORD (Office Copy)
3265 _ 10653 A 11ap1_ewood
• PhPd1IT PTO. SANIT'AR`( DIST. NO. LOT NO.
ADORES - ------
Re-Model Property Services
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
MILldi.nr _ 5/25/33 Date L.nsp.
Electrical 5725783 Power Pole
Plumhing Ilndcrround _ --
Merchani_cal Roul01 Wiring
'Temp. Gns/Elect. llall.s _
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext _
Sign Motors
Grounding
Misc. _Temp. Power _
Other
FINAL. INSPECTIONS Not Approved _
Date Insp.
r'^s .—_ PLUMBING
Elerctri.c Z - Date Insp.
Plumbing Backflow
Mechanical Underground
Solar Underfloor _
Pool Partial Rough
• Grading Rough Complete
Planni.np Solar Rough _
rise Dept. Water & 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.N.
Slab-Ilembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & Hood
T:iedowns One hour Shaft
D.iaphrams CondensaCe Drain _
Seismic ]Statin£; EquipmenC Anchorage_
I1a1.Is-1,111els Flues & Comb. Air ---
Frame Other
Lath Not Approved
Uallboards Int/I..xt .
Firewalls
Other
• Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT P N ONLY
4 PERMIT NUMBER
BU I LDING PROJECT I DENTIFICATI ON ILOFT APPLICATION & PERMIT
BUILDING
ADDRESS
P BUILDING-ELECTRICAL-PLUMBING-MECHANIC 3265 GCC
OWNER'S PLAN CHECK VALIDATION
AME CITY. ELECTRIC PERMIT FEE
NAM AcroRs UTLETS-SWITCHES-RECEP 5.00/1.00 .�°
LIC.NO. LIGHTING FIXTURES 5.00/1.00 pAID
ADDRRAGroR's APPLIANCES-RESIDENTIAL 4.00 ✓� MAY 2
ADDRESS
PRONE PANELS 5.00 DATE OFA L
WX
ARCHITECTSIGNS 6.Q0 PL Ff1� KFEE .C.NO.
OR tt�r
LIC.No, SIGNS TRANS. 3.00 �perll
ENGINEER
ARCH.OR ENG. SPECIAL CIRCUIT Fj,QQ PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00 01
wo o LICENSED CONTRACTORS DECLARATION Y
a u v I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
m G n (commencing with Section 7000)of Division 3 Of the Business and
BLDG. ELECT. PLG. MECH.
H nz Professions Code,and my license is in full force and effect. ❑ El El El
D i., - LICen.ae Class L-c.Number.
Q z r w Date Contractor
a y s BUILDING PERMIT
a WA a OWNER-BUILDER DECLARATION INFORMATION
oU MISC.- REFER TO ORD
F
S LL h 1 hereby affirm that 1 am exempt Crum the Contractor License
a. D J Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE E VALUATION S/FT.
� - Code:Any city or county whichrequiresapermil tocomtn61.a1teq 6'00 n �Z/o as
R ¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC. LIG NO. ELEC. Uv
- D M requires the applicant for such permit to file a signed statement that TOTAL / PERMIT TO
u w$ he is licensed pursuant to the provisions of the Contractor's License
zi Law(Chapter 9(commencing with Section 7000)of Division 3 of the
40 Business and Professions Code)or that he is exen+pt Ihendun..and CITY PLUMBING PERMIT FEE
the basis for the alleged exmnption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
e_ by any applicant lira permit subjects the applicant tot civil penalty ALTER-DRAIN -WATER (EA.) 4.00
.1-mat more than five hundred dollars(S500).):
❑ I,as owner of the property,or my empluyces with wages., BACK FLOW PROTECT.DEVICE 2.00 DCC.GROUP RES.UNITS
their sole com pensmion,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:'Phe Contractor's I.icFI,e Law does not apply to an owner V
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 80.FT.FLOOR AREA TOTALACREAGE
. himself or not intends ownemployees,for sale.
if,
Oct such improve- GAS-EA.SYSTEM-1 4.00
mems are not intended his or offered for sale.IL however,the building
or improvement is sod 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 Int did not build or inn- RES IND CDN PB Dnne,
prove l'or Purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
Cl 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 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to ua owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5IEA.) 1.00 3A-�j_ j e�C
contracts rusts for such projects with a contruetortnl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the tracts for such
h prof a Law.
O I am exempt under Sec.-.B&P.C.I'or this WATER HEATER W/VENT 4.00
Date- Cys
Uam �• Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORRIiRS'C Mli. nT Of CLAkA'fION' WATER TREATING EQUIP, 4.00
1 hereby alTirm that I have.certificate of consent io sell'-insure ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance.or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
Q ❑ Certified copy is hereby i imbed. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
~ vD PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.Uc.
LU CfiRTll'IGO.N OP 1\IiNI('TION FROM WORKERS'
W _ CO.N IS$URANCI? PLG.CONTE. LIC.N0. PLG.
o (This notion need not be completed if the permit is lAL Y❑ N❑ yir one TOT ❑ N❑
Z hundred did...($100)or las.)
U O 1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,1 shall not employ any person in any..tanner w'us to
U become subject to the Workers'Compensation Law,of California.
i Date Appl+cant ALTER OR ADD TO MECH. 4.00 BUILDING w
} to NOTICE 'f0 APPLICANT: If,after making this Certificate of Ex-
F � emption,you shoulA hecomC,ubjen to the Workers'Compensat'ma 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 10SMC.F.M.) 3.00
CONSTRUCTION LENDING nC1iNCy AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE Sv
1 hereby affirm that there is it construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of W.work for which this permit is isxued(Sea HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATINGUNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC 0=
Lender's Address
-
I certify that l juice reed this application and state that the above V ENTI LATION FAN (SI NG LE) 3.00
oRAFsption n agate 1 agree w comply with ell city anA county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relining a budding construction, and
hereby authorise representatives of this city to cntcr upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against I bilitica,judgln nts, costa and a ,-o es which PERMIT ISSUANCE 3.00 CONST.TAX
nay in any way accrue against. id City in con,eZnce of the
granting of this p mil. MECH.CONT. LIG N0. MECH.
2Z - TOTAL TOTAL
Sig atere o ApplicantIC51fiactor Date
OFFICE COPY ,