3260 CITY OF CUPPd:T1N0 INSPECTIOL' RECORD (Office Copy)
326010658 C Maplewood E/W Dividers
• PKI111IT TIO. SANITARY DISI. NO. LOT NO.
ADDRESS ���------
ReVlodel Property Services
,. PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Bui] dine _ 5/25/83 Date Insp .
Electrical 5/25/83 Power Pole
PLumhing _ Underground --
Mchani.cal Rough Wiring
Temp. Gas/Elect. flails
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext _
Sign ilotors
Grounding
Flisc. Temp. Power
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
Ars -- PLUMBING
Electric 3 -Z - .
Date Insp.
Plumbing
Backflow
Mchanical Underground
Solar Underfloor _
Pool Partial. Rough
Gradin , Rough Complete
�i
planning Solar Rough
Fire Dept. Water & Insulation
Health Dept. Main Drain
Building Z -.Z fh - $ R/of/S Drain
Other Gas _
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-lhmhrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One (lour Shaft
D.i.aphr:vms Condensate Drain _
Seismic Bracing Equipment Anchorage _
Ual.ls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards int/Ext .
Firewalls
Other _
s Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LOING PROJECT I DENTIFICATI ONERMIT MEER
BUILDING _ "PT' APPLICATION & PERMIT - 3260
ADDRESS U
�� �� BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
GINNED S PLAN CHECK VALIDATION
ME (] OTY. ELECTRIC PERMIT FEE
L L)Q,7 PHONE-f S=6T_6 PAID
CONTRACTOR S
NAME UTLETS-SWITCHES-RECEP 5.00/1.00 TQ
Lac.No, �-LIGHTING FIXTURES 5.00/1.00 �_ MAY 2 5 1983
CONTRACTORS -RESIDENTIAL 4.00
A DDREss
PHONE PANELS 5.00 TIO
ARCHITECT .S•IGN$ 6.DD PLAN .NO.
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5,60 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00 j
JJ�d3
w o o LICENSED CONTRACTORS DECLARA TION
a U u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F m z Professions Code.and my license is in full force and effect. ❑ ❑ ❑ ❑
z o m- License Class Lie.Number
g r o Date Contractor
Q Y F J
Ix
BUILDING PERMIT
re ¢ OWNER-BUILDER DECLARATION
O REFER TO ORD INFORMATION
E
3 LL H I hereby affirm that I am exempt from ElieContractor's
License MISC.- vALUAn ON §/FT.
ac o V Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00
0 Code:Any city or county which reyuiresa permit to constn¢t.alter. /Q �0
2 improve,demolish,or repair any stnrclure.prior to its issuance.at, ELEC.CONTE. LIC.NO. ELEC. 00
u. u requires the applicant for such permit to file a signed statement that TOTAL s... PERMIT TO
A w m he is licensed pursuant to the provisions of the Contractor's License
Hzi
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �/�/�I�C L.
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
H Oo the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a, by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(S5000:
❑ 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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
_ Dents are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLET$ 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.( 1.00 BUILDING USER
builder will have the burden of proving that he ATA not bull']or im-
proveforpurposeofwlc.A INDUSTRIAL WASTE INTER. 20.00
RES IND CON B ower
❑ 1,as owner of the property,am"elusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044, Business LAWN SPRINKLERS-I INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:'rhe Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
cmllmcts for such projects with a contraetor(O licensed pursuant m
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft18.00 TRACT NO. PARCEL NO.
❑ lam exempt under Scc. ,It.&P.C.tin this WATER HEATERW/VENT 4.00
reason
Dote yy�T� _Owncr�_ WATER SYSTEM 4.00 ACC.oATE Ace FILE NO.
WQRKiI S .NSAT'ION DECLARATION WATER TREATING EQUIP, 4.00
1 hereby affirm that 1 hove a certificate of am.oml to aeI&iusum-, ZONING ENG.SITE NO.
or a certificate of WorkersContperosalion InsurunN,or u certified
copy thereof(Sec 3900,Lah.C.L
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant v [:] N❑ v [:] NF]
CC CERTIFICIE OP EXEMPITON FROM WORKERS. PERMIT ISSUANCE 6.00 RLooD ZONE A.L.U.C.
Lu >_ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL O (This section need not be completed If u n
the permit ' for o TOTAL Y ElNE] v ❑ NNE-10 2 hundred dollars IS 100)or less 1
U O I certify that in the performance of the work I'or which this per OTY.
3097,Civ.C.l. MECHANICAL PERMIT FEE FEE SUMMARY
LL 6 mit is issued,1 shall not employ any person in any nmnner su as to
O W become subject to the Workers'Compensation LawS of Culifmm... BUILDING
Date Applicant ALTER OR ADD TO MECH. 4.00 /y
} 141
N NOTICE,TO APPLICANT': If,after making this Certificate of Es..
F Z emption,you should become Sumter to the Workers Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U snob provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.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 issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC �� U`
Lenders Address
I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00
information is correct.I 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
above-mentioned property for inspection purposes.
(We) agree ro save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against aid Ciry m consequence of the PERMIT ISSUANCE 3.00
gran f Pis permit A,/y /s 3 MECH.CONT. LIC.NO. MECH.
'�/T"o, 5/ TOTAL TOTAL 3 sa
SI atura ApprcantlConfrtter U _�
OFFICE COPY