3264 ♦ CITY 017 CUI'E[t1'IND IUSPECTI011 RECORD (Office Copy)
326410689 C Maplewood
P11PItIT NO. SANITARY DIST. NO. LOT NO.
ADDRESS
Re-11odel Property Services
PROJECT OUNER JOB SITE P11014E NO.
PEMIT ISSUED Date ELECTRICAL
Buildi_nP _ 5/25/83 Date Lisp.
IJectrical 5/25/83 Power Pole_
PLumhiny Undor ,round
Mechanical Rough Uiring
Temp. Cas/!acct. I1a1.7.s _
Solar CeilinL
Tire Sprinkler Fixtures Int/Ext _
Sign Rotors
Grounding
Hi.sc. Temp. Power _
Other
FINAL, INSPCGT'IONS Not Approved _
Date Insp.
r.,s
-- — PLUMBING
G1.ectri,c Date Insp.
Plnmbin , Backflow
!Techanical Underground
Solar Underfloor _
Pool Partial Rou;.h
• Gradin , or Complete --
i I'lannin 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 MECIIANLCAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane _ Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One (lour Shaft
Di.aphrams Condensate Drain _
Seismic Bracing Equipment Anchorage
Fla 1.—Is-Panels Flues & Comb. Air
Frame Other
lath Not Approved
Ilallboards Int/P,xt.
Firewalls
Other
. Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIF I CATIONP MIT NUMBER
Bm LDwc
�'V APPLICATION & PERMIT
• ADDRESS �4 WV.ST 26W 4
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
O AMERS oN �.42J?
.
E OTYELECTRIC PERMIT FEE PL NCHECK VALIDATION
CONTRACTORSUTLETS-SWITCHES-RECEP 5.00/1.00
NAME
LIC.NO. S LIGHTING FIXTURES 5.00/1.00 Agip,
CONTRACTORS Z APPLIANCES-RESIDENTIAL 4.00Jo
ADDRESS dA f1y,,
PHONE PANELS 5.00 "•DWT P TION
ARCHITECT - SIGNS 6.00 PLANCHECK E P.C.NO.
OR
ENGINEER '
LIC rvo, SIGNS TRANS. 3.00 /�Of
uC •
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMt OTION
ADDRESS
ZIP rrEMP. METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00
0¢ i
Foo LICENSED CONTRACTORS DECLARATION
G v u 1 hereby nffvm tl ul 1 ant licensed under provision of Chapter 9 ISSUANCE DATE
w< oAi (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
H wz Professions Code,and my license is in full force and effect ❑ ❑ ❑ El
0 u - License Class Lic,Number
2 y H o Date Contractor
rc x a a OWNER-BUILDER DECLARATION BUILDING PERMIT
¢ a INFORMATION
F. O s D MISC.- REFER TO ORD
3 I hereby affirm thus I am uxcmpt from the Contractor's Lien. VALUATION $/FT.
H .. o j Law for the IDllowing reason.(Sec.7031.5,liusiness and I'rolessioms PERMIT ISSUANCE 6.00 111
Code:Any city or county which requitesa permit toconslruc4 alter. /� /0
or ¢¢ Zi improve,demolish,or repair any structure,prior to its issuance.oho ELEC.CONT". LIC,NO, ELEC. OV
- O ¢ requires the applicant Tot such permit to file u signed statement that TOTAL ��-- PERMIT TO
wu he is licensed pursuant to the provisions of the Contractor's License
Hza
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe 7C�Etija�C (�
O Business and Professions Code)or than he is exempt therefrom and QTY. PLUMBING PERMIT FEE
4
¢ F $ 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 toacivil penalty ALTER-DRAIN VENT-WATER (EA.) 4.00
of not more than five hundred dollars(S5000:
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 2.00 DCC.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,AR EA,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 _50170T.FLOOR AREA TOTAL ACREAGE
himself or Out
rote his own employees,provided that such intpnme-
mnvieff rflimplendcd onafferedforsale.ILho Cher Suhe building GAS-EA.SYSTEM-1 INC-40UTLETS 4.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omv
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 El El 11 1:1 1:1❑ 1,as owner of the property,an exclusively 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:The Contractor's License Law does not apply p /
to an owner of property who builds or improves thereon and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 J 1, - /7L�-3 J�
contracts for such projects with a contractons)licensed pursuant to
the Contractor's Lice use Luw. SEWER-SANITARY-STORM EA.200ft/6.00 TRACT NO. vARc LNC.
O l am exempt under Sec. .B.&I'.C.for this WATER HEATER W/VENT 4.00
reason
Date Owner. _ WATER SYSTEM 4.00 Ace.DATE ACC FILE NO.
WORKERS'COMPliNSATION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate ofconscm to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lub.CJ.
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY R20
Z Z ❑ Certified copy is tiled with the city inspection division. MISC.- REFER TO ORD, v ❑ N❑ v ❑ No
Applicant
I- - PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
CERTIFICATE OP EXEMPTION FROM WORKERS'
LU _ COMPIiNSATION INSURANCE PLG.CONTE. LIC.NO. vLG.
CL O (This section need not be complete) it the permit is fin one TOTAL- E�j v❑ N❑ Y F] N F]
0 Z hundred dollars(S 100)or less.)
U O 1 artily thid in the performance of the work for which.him Per QTY. MECHANICAL PER FEE FEE SUMMARY
LL P mil is issued,1 shall not employ any person in any manner so as 10
Ow becomesubject to the Workers'Compensation Law's of California.
Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} N NOTICE '1'0 API'LICAN'f. If,after IuAing this Certificate of Ex-
F ? enquion,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10)MOOF.M.) 3.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MIC.FM.) 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. MICROFILM
3097.Civ.C.L HEATING UNIT (TO 100,000 B.T.U.) 4.00
Lender's Name HEATI NG UNIT(OV ER 100,000 B.T.U.)7.50 ELECTRIC a '14
Lender's Address
I certify that l have read this application and stare 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 slate laws relating to building construction, and
hefcby aulhoriec representatives of this city to zon, 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,liabilities,judgments, costs and expenses which CONST,TAX
'
may in any way accrue againstaid City in coq
nseuence of the PERMIT ISSUANCE 3.00
granting of this ennil. MECH.CONT. LIC.NO. MECH.
��� 3�1/�3 OTAL TOTAL 513 -ry
Slg core of Applicant/ nt acme Dme Ir
OFFICE COPY