3276 Cl7'Y Op CUPHItT1NO INSPECTION RECORD (Off:ice Copy)-
3276 _ _ _ 10669 1.1aRlPcanod._14/S .Divi dare
PERMIT No. SANITARY DIST. NO. LOT NO. ADURhSS
Re Model - Property Services
PROJECT M,1MER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buildine 5/25/83_ Date lisp .
Electrical Power Pole_
PLumbill Under ,round -- --
tlechanical Routh Wiring --
Temp. Cas/fleet. 17a11.13 — --
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext _
Si ,n 11otors
Grounding
Misc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
PLUMBING
Electric
Date insp.
Plnmbin . Backflow
!lechanical Underground
Solar Underfloor
Ponl Partial. Rough
•
Grading Rough Complete
Planning Solar Rough
Fire Dept. water & Insulation
Health Dept. "lain Drain
Buildinp l0 R/of/S Drain _
Other Gas
Other
BUILDING Not Approved
Date Insp.
1'ad Certification HECHANiCAL
Foundation _ Date Insp.
Pre-Ganite Underfloor S.M.
Slab-Hembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One (lour Shaft
Di.aphrams Condensate Drain
Seismic Bracing EquipmenC Anchorage
halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext.
Firewalls
Other _
• Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTI FICATION PERMITN mBEE
BDILOINc APPLICATION & PERMIT 3276
ADDRESS - 1010iMNPLe00000 A=
a. BUILDING -ELECTRICAL-PLUMBING-MECHANICA
OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
. DN PAID
RONTRA TORS OUTLETS 5.00/1.00
"AME 2 51983
LIC.NO, LIGHTING FIXTURES 5.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 1,11
ADDRESS
PRONE PANELS 5.00 LIICATION
ARCHITECT SIGN$ 6.00 -PLAR CHECK FEE P.C.NO.
ofl
ENGINEER
uc.No, SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS I �1�
ZIP EMP.METER OR POLE INS. 15.00 o ADDRESS MOTORS SEE FEE SCH.ADDRESS
SERVICE CHANGE 10.00
woo LICENSED CONTRACTORS DECLARATION
<U I hereby affirm that I an,licensed under provisions of Ch-Pier 9 ISSUANCE DATE
H w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H w i Professions Code,and my license is in full force and creel. ❑ ❑ ❑ ❑
z .0 w License Class Lic.Number
O F w Uate Contractor
a y BUILDING PERMIT
ir ¢ IS u OWNER-BUILDER DECLARATION INFORMATION
F.
3 LL N 1 hereby affirm that I am exempt from the Conlraclor's Licenss• MISC.- REFER TO ORD
.. o j Law for the following reason.(Sec.7031.5.Business and Professions VALUATION SIFT.
H _ PERMIT ISSUANCE 6.00
Code.Any city or county which requires a permit to construct,alter, /�r�}}��
¢ ¢¢0 improve,demolish.or repair any structure,prior to its issuana)
ce,also ELEC.CONTE. LIC.NO. ELEC. l�
0 C requires the applicant for such permit to file a signed statement(hal TOTAL PERMIT TO
n w es he is licensed pursuant to the provisions of the Contractor's License
Lczi Law(Chapter 9(commencing with Section 7000)of Dlvision3 ofthe
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
S x 0 STORIES TYPE CONSTR.
¢ H $ Bu basis forand Pr fessi ns Code)exemption.Any ie is
of thenen out
L5 I
and
by any applicant for a pemlil subjects the applicant ton civil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
fuel more than five hundred dollars(5500).1:
❑ I,as owner of the properly,ar by employees with wages as BACK FLOW PROTECT.ECT.'DEVICE 2.00 OCC. EES.UNITS
their sole compensation,will do the work,and the structure is nal
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 ml owner of
property who builds or improves thereon,and who dues such work FIXTURES-PER TRAP 4.00 50.FT.FLOOR AREA TOTAL ACREAGE
. .himself re through his own rtered r s le.If.h (hat such immovr
meets are not intended or oRertJ l'or sale.If.however,tile building GAS-EA.SYSTEM-1INC.4OUTLETS 4.00
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 int- RES IND CON PB Omer
Prove for purpose Dl sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ [1 ❑ ❑
❑ I,as owner of the property,am exclusively contracting wish
licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS- 1 INC 5 V,B. 5.00 ASSESSo s PARCEL NO.
and Professions Code:The Contractor's License Law does not apply �� 7
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 i �7
contracts for such project,with a cunira,lons)licensed pureuent w
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/8.00 TRACT rvO. PARCEL NO.
❑ I ora exempt under Sec,..B.&PC.for this WATER HEATER W/VENT 4.00
son y-
Ualc�./a_ � Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
0.'ORKHRS'COYPENSA 'ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby alfirm that I have a certificate of corwnt to self insure, ZONING ENG.SITE N0.
or a certificate of Workers'Comn
pens:nion Insurance, t o certified
copy thereof(Sec.3800,Lub.C.).
Policy No. Company
-
0 ❑ Certified copy ie hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is tiled with the city inspection division. MISC.- REFER TO ORD. Y ❑ N❑ y ❑ N❑
applicant
F - PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.D.C.
� - CERTIFICATE OF EXEMPTION FROM WORKERS'
UJ > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
C o (This section need not be completed if the permit is for one TOTAL Y❑ NF] Y❑ NO
D 2 hundred dollar,(S 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
mil is issued, 1 shall not employ any person in any manner so as to
O W become subject to the Workers Compensation Laws of Calitormi'a' BUILDING
Uam Applicant - ALTER OR ADD TO MECH. 4.00
} m NOTICE TO APPLICANT: If,after making this Certificate of lix-
♦- Z emplisn,you should become subject to the Workers Compensation APPLIANCE 4.00 PLAN CHECK
pfovislans of the Labor Code, you must forthwith comply well AIR HANDLING UNIT(TO 10 C.F.M.) 3.00 FEE
V such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 5.00 SEISMIC FEE ,SO
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
tileance performof the wmk]or which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Civ.C.L
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00
. information estate.1 agree to comply with unt
all city and coy PLUMBING
ordinances and shote laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above incru ontd properly I'or inspection purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgment is and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against City in comeque a of Ilan
granting of this PL•nnit. MECH.CONT. LIC.NO. MECH.
/� TOTAL / O
TOTAL
Si,DctfFcof Applicant/Goner cls Daft
OFFICE COPY