3256 Cf'PY OF CUpl-',jtT1NO .INSPECTION RECORD (Office Copy)
3256 10659 D Maplewood
. PLPliI'T TIO. SANi1'ARY DET. NO. LOT HO ADDftI!Sti - -----
Re-Model Property Services
PROJECT 0WNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buildi.nr --- _-----------5 25 83_ Date Insp.
Electrical 5/25/83 Power Pole_
i'Lumhing Underground -— --
Nechanical Hough Wiring
Temp. Cas/Elect. flaLLs _
Solar Ceiling_
Fire Sprinkler Fixtures Int/Ext _
Sign Notors
Grounding
Misc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
Ars
— PLUNBING
Electric 3, Date Insp.
Pinmbin , Backflow
l4chanical Underground
Solar Underfloor _
Pool Partial. Rough
• Gradin , Rough Complete --
------
Planning Solar Rough
Fire 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-Membrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One (lour Shaft __
Dia,phrams Condensate Drain _
Seismic Bracing Equipment Anchorage
Ualls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
wallboards Int/Ext.
Firewalls
Other
Not A2proved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY
t • BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
LofT APPLICATION & PERMIT 3256
ADDITENG
DDRESS
BUILDING - ELECTRICAL-PLUMBING-MEC HANICA
wrvER's PLAN CHECK VALIDATION
AME CITY. ELECTRIC PERMIT FEE
ONE
u°t"sF " °R5 UTLETS-SWITCHES-RECEP 5.00/1.00 � rAf,�
LIC.NO, s LIGHTING FIXTURES 5.00/1.00 PAID
CON ?_APPLIANCES 4.00 p C �gg3
ADDRESS MA G O
PHONE PANELS 5,00 DATEM P LIGATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE PO
On -City of Cupenino
ENGINEER
LIC.No. SIGNS TRANS. 3.00
AARC OR DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00
nooA SSTs MOTORS SEE FEE �
SERVICE CHANGE 10.000.00
0 0 0 - LICENSED CONTRACTORS DECLARATION
L. I hereby afflnn
that 1 am licensed under provisions of Chapter 9 - ISSUANCE DATE
y 3 H (commencing with Section 7000)of Division 3 of the Business and BL ELECT. PLG. MECH.
F m z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
to m - License Class Lic.Nwnber
o Z F Da lc Contractor
F
a, w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
o d ° MISC.- REFER TO ORD INFORMATION
wS u hereby allirm that I an+cxempl from life C'onlmelor's Liccnsc VALUATION $/FT.
H.. o¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 6.00
A a Code-Any city or county which reyuiresa permit to consuuch alter. ��
4 O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO., ELEC.
LL requires the applicant far such permit to file a signed statement that TOTAL r PERMIT TO
ithe is licensed pursuant to the provisions of the Contractor's License
in Law(Chapter 9(commencing with Section 7000)of Division 3 of the ,q
�y//J
a Business and Professions Code)or that he is exempt IhereGam and CITY. PLUMBING PERMIT FEE C (/G4
o the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
a; � by any applicant for a permil subjects the applicant loo civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(5500).): -
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
sole compensation,will Jo the work,and lire structure is not
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Core:The Contractor's License Law does riot'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-
menis are not intended or offered for sale ll',however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 4.00
improvement is sold within one year of con+plation, it',owner- GAS-EASYSTEM-OVER 4 (EA.) 100 BUILDING USE
'Ider will have the burden of proving that h . .
e did riot build or int- RES IND CON PB Omer
;_Ove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ 1,as owner of the property,urn exclusively contracting with ❑ El E:1
licensed contiaclors 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 �(��I ��a
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 1.1
attracts for such projects with a contractins)licensed purxamm ID
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT No. PARCEL NO.
❑ I am exempt ander Sec. .B.&P.C.for Ibis WATER HEATER W/VENT 4.00
reason
Date ownerRvCC_ WATER SYSTEM � 4.00 ACC.DATE ACC,FILE No.
&C
W'ORKIiRs'COhPE.,A I N IiCLARATION WATER TREATING EQUIP, 4.00
I hereby affirm that I have a certificate of tt+manl to self-in Fure, ZONING ENG.SITE NO.
or u certificate of Workers'Compensation Insurance.or a certified
copy thereof(Sec.3800,Lab C.).
Policy No, Company
O ❑ Certified copy is hereby furnished. 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❑
y CERTHACAIF.OIt EXEMPTION 17ROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d o ('Phis section need not be completed if the permit is for onY e TOTAL ❑ NF] Y ❑ N❑
Z hundred dollars IS IOD)or less)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner m as to
U
Ubecome subject to the Workers'Con+pensation Laws of California.
to Dale Applicant BUILDING
OL ALTER OR ADD TO MECH. 4.00 f
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F, Z emption,you should become subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you nest forthwithcon+ply with FEE
U such provisions or this permit shall be devi red revoked. AIR HANDLING UNIT(TO 10=1C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)"C.F.M.) 5.00 SEISMIC FEE ( s
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. MICROFILM
3097,Civ CT. HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)7.50 ELECTRIC d
Lender's Add,ers r
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
ordinances n correct I agree to amply with all city and n. add BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and +late laws rola ling to building camstr anti co my
hereby aurhorue representatives of this airy lD carer open the BOILER-COMP (Over 100,000 STU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harnlm the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against s'id City in consea nice of the PER
ISSUANCE 3.00
granting of this pe In.L MECH.CONT. LIC.NO. MECH.
2 TOTAL TOTAL
Signa ore o- t for ata
OFFICE COPY