3294 CI"CY 01' CUPP.[:1'1110 INSPECTIOII Rf.CORD (Office Copy)
329410651) B tiagle..weod..-_.___
• PEMIT NO. SANITARY DIST. 170. LOT NO.
ADDRESS
-Re=Model Property Services
PROJECT OWNER JOB SITE PHONE NO.
PEM1IT ISSUED Date ELECTRICAL
Buildinr. ___ 2 Date Insp.
Mectrical _ 5/25/83 Power Pole__
Plumhin'g Underground - --
iicchani.ca.l. Rough Wiring _
Temp. Gas/l;lcct. Ila Lis _
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Hotors
Grounding
Hisc. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved _
Date Insp.
r'rs — PLUMBING
Eiectri.c 71 _ Date Insp.
Plumbing Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
• Gradin , Rough Complete
PLanni.nr Solar Rough
Fire Dept . Water & insulation
llealth Dept. `fain Drain
Building R/of/S Drain
Otlier Gas _
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundati.un Date Insp.
Pre-Gunite Underfioor S.M.
Slab-Ilembrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Firepiace
Floor Steel Grease Duct & flood
Tiedowns One Hour Shaft
Di.aphrams Condensate Drain _
Se.Lsm LC Bracin7S Equipment Anchorage _
11,11.1s-Panels Flues & Comb. Air _-
Frame Other
Lath _ Not Approved
I"aII. "Irds Int/Ext.
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
E BUILDING PROJECT IDENTIFICATION (-Ot`t PERMIT NUMBER
' BUILDING APPLICATION & PERMIT (�
ADDRESS BUILDING - ELECTRICAL-PLUMBING -MECHANICA v
� 0 S
OWNER'S PLAN CHECK VALIDATION
E OTV. ELECTRIC PERMIT FEE
ONE
CONTRAc Rs-` OUTLETS-SWITCHES-RECEP 5.00/1.00 ^i
NAME rI N Iy Ep�/
LIc.No. LIGHTING FIXTURES • 5.00/1.00MAY N 1, •
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS CIt of Cup cillo
PHONE PANELS 5.00 OPIE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARC H.OR ENG. 5.00 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT
zIP EMP. METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH. /���
ADDRESS
SERVICE CHANGE 10.00
o) LICENSI!p CONTRACTORS DECLARATION
a U u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
w G m (commencing with See tion 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F w z Professions Code,and my license is in full force and effect.. ❑ ❑ ❑ ❑
Z o. - License Clas Lie Number
o zx o Date Contractor.
a BUILDING PERMIT
EE w at OWNER-BUILDER DECLARATION INFORMATION
A w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
y p �VA LIJATION $/FT.
uoa Lawlor the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 6.00 a
� - Core:Any city or county which muluirma permit mconstruet,utter.EE
, ¢ n improve,demolish,or repair any structure,prior to its issuance,at,U ELEC.CONTR. - LIC.NO. ELEC, Qd
K he mle5 elledp pursuant
t t the perch t0 of
a signed statement that TOTAL
he is licensed pursuant en the provisions of the Contractor's License
F z i
Law(Chapterand
Professions
Codeng with Section is 00)exempt
t therefionrom
o ml'and
f�
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
H o the basis for the alleged exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR.
; by any applicant fora permit subjects the upplicam toacivil penally ALTER-DRAIN -WATER (EA.) 4.06
of not more than live hundred dollars($5001):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 50.FT,FLOOR AREA TOTALACHEAGE
. hino'c oT through his own employees'provided that act,inmrovo- GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
cents are not intended or Offered for sale.If,however,the bidding
or improvement is sold within one year of completion,the Owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CNG PB Omer
prove for purpose o1'saIcTL INDUSTRIAL WASTE INTER. 20.00
❑ I,as owner of the property,um exchesively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project (Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 A$sESSoas yyyAAARCEL No
and Professions Code:The Contractor's License Law does not apply 31 / /�2,_ ?
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 (p J J� r
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sc,,-,BAPC.to,OR, WATER HEATER W/VENT 4.00
rcavnn
Date Owncr.�'�� WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
'OkK iRS•COMPIiNSATION'DECLARATION WATER TREATING EQUIP. 4.00
I hemhy affirm Thur 1 Imve a certifeate of consent msell-insure. ZONING ENG.SITE NO.
or I certificate of Workers'Compenmtinn Irl,Lace,or a certified
copy thereoff Sec,3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is he by furnished. FIRE SPRINK ENERGY T 24
Z_ Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
F � Applicant
PERMIT ISSUANCE 6.00 FLOOOZONE A,L.U.C.
� - CIiRTI PICA'I'Ii OF GXIiM PITON PROM WORKERS'
LJ > COMPF-NSA1ION INSURANCE PLG.CONTR. ❑c.NO. PLG.-
CL O (This section need not be completed if the permit is for one TOTAL v❑ N❑ v❑ N❑
Z) 2 hundred dollar,IS 100)or less.)
U O 1 certify that in the performance of the work fur which this per-PAIRHANDLINGU
ECHANICAL PERMIT FEE FEE SLL p UMMARY
mit is issued,I shall not employ any person in any mamlcrso as to
Ow become subject to the Workers'Compensation Laws of California. BUILDING �v
Date Applicant ADD TO MECH. 4.00 D
} y NOTICE TO APPLICANT: If,after making this Certificate of Ex-
r Z emption,you should become subject t0 the Workers'CompensationE 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. ING UNIT(TO 10,000C.F.M.) 3.00
CONST RUCTION LENDING AGENCY ING UNIT(OVER 10)00DC.F.M.) 5.00 SEISMIC FEE1 hereby affirm that there is a construction lending agency for HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. UNIT,(TO 100,000 B.T.U.) 4.00MICROFILM
3097,Civ-C).
Lender's Name UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address r
I certify that I have read this application and state 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 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP Carr 100,000 BTU)SEE FEE SCH. MECHANICAL
uhuv-mentioned property Tor inspcc OOR PIITpOFCS.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,just mems, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue again mid City in consequence Of the
granting of th is nenut. MECH.CONT. LIC.NO. MECH.
�3 TOTAL TOTAL
SI lature.I AppIIeanl/ tmcli IAte
OFFICE COPY