3262 C1'I'Y OF CUPERT1.110 INSPECT101' RECORD (Office Copy)
3262 _ 10693 C Maplewood
11CPdI1T NO. SANITARY DLST. NO. LOT NO ADDRESS
Re-Model Property Services
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
BuLldi_nr _ 5/25/33 Date Insp.
Electrical 5/25/83 Power Pole.__
Phlmhi 1pg Linder ,round
licchani.cal Rough Uiring
'temp. Gas/l,lcct. f1a 11s
Solar ;e—ii i-E&
Fire Sprinkler Fixtures Int/Ext _
Sign Notors
Grounding
Hi.sc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
PLUMBING
El.ectri.c Z N2 A Date Insp.
Plumbing Backflow
Mechanical Underl;round
Solar Underfloor _
Pool Partial. lough
• Grading Rough Complete —
11lanninp Solar Rough _
Fire Dept. Water & Insulation
Health Dept. `-fain Drain
Guildinr "Z- Z d R/of/S Drain
Other Gas
(ether
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date insp.
Pre-Gunite Underfloor S.M.
Slab-Menhrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Crease Duct & Ifood
Tiedowns One (lour Shaft
Dlaphrams Condensate Drain _
Seismic Bracing Equipment Anchoraf;e_ __
IIa11S-Pancls Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext .
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY
1 14
BUILDING PROJECT IDENTIFICATION L�P'CERMIT NUMBER
EDILDasG APPLICATION & PERMIT 262
ADDRESS
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
I OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE A
PRONE
c NTR TLm. Q -SWITCHES-RECEP 5.00/1.00
NAME UTLETS
LIC.NO. L.J LIGHTING FIXTURES 5.00/1.00
r,ONrRAcrogs APPLIANCES 0/
4.00 J'� Cih,ofe J 1jg�
ADDRESS
PHONE PANELS ,S.00 D APPLICATION
OR
$IGNS 6,00 PLAN CH 'O P,C.NO.
ENGINEER
uc.NO ISIGNS TRANS. 3.00
ARC H.08 ENG. SPECIAL CIRCUIT S. PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00
o ¢i i
F o o LICENSED CONTRACTORS DECLARATION qlr�l d
<t'u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DA E
h G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. I MECH.
F y z Professions Code,and my license is in full force and effect.
Z o m - License Class Lic.Number E �- ❑ ❑
Q N to Uate Contfactor
BUILDING PERMIT
¢ w
OWNER-BUILDER DECI,ARATION INFORMATION
oA MISC.- REFER TO ORD
X 3 LL y 1 hereby affirm that I am exempt from the Contractors License VALUATION SIFT.
� uoa Low for the fullowingreusms.(See.7031.5,Busincss and Professions PERMIT ISSUANCE 6.00
� vl P, Code:Anycityorcounty which requiresa permit to construct alter. ^/d
¢ ¢ Q O improve,demolish,or repair any'structure,prior to its issuance,'also ELEC.CONTR. LIC.NO. ELEC. ^ (JO d
- O ¢ requires the applicant for such penuil to file a signed statement that TOTAL( �/ PERMIT TO
A w m he is licensed pursuant m the provisions of the Contractors License
Fit Law(CharrWr 9(commencingwith Section 700nRof Division 3 of the C
4 Business and Professions Code)or that he is exempt Ihcrefrom and OTY. PLUMBING PERMIT FEE
6 F $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
A � by any applicant tura permit subjects applicant too civil penalty ALTER-DRAIN&VENT-WATER IEA.) 4.00
,,fact more than five hundred dollars(S500)j:0 1.as owner of the property,or my em PI eyees with wages as BACK FLOW PROTECT.DEVICE 2.00 Ace.GROUP RFS.UNITS
their sole compensation,will do the work,and the structure Is not
intended or offered for sale (See 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 dues such work FIXTURES-PER TRAP 4.00 $0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare Get intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 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 ins- RES IND CON PB Our.,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project)See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Pmil'essions Code:The ConifacDc'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 3
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT No. PARCEL No.
❑ lam exempt muter Sec. .B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Late 3 Owner WATER SYSTEM 4.00 ACC.DATE ACG FILE NO.
WORKERS' 'W/PI!NSA'I'ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby;dfrm that I have a cerlificme ofconsent to WIf-i...re. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
Copy Ihereof(Sec.3800,LabC.).
Policy No. Company
0 ❑ Certified copy is hereby famished FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is fled with 0a• city inspection division. - REFER TO ORD.MISC.
O Applicant Y E] NY❑ F] NE]
QC y CER'I'IPICA'rE OP rXBMP'I'ION FROM WORKERS, PERMIT ISSUANCE 6.00 FLOOD 2orvE A.L.U.c.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
C 0 This ceclum need nut be completed it [liepenuil is for one TOTAL V E] NE] Y ❑ N❑
Z) Z hundred dollars(s 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued I shall not employ any person in any manner A;as tp
QU become subject to the Workers Compensation Laws of California. BUILDING
Date Applicant ALTER OR ADD TO MECH. 4.00 /0 oa
} tad NOTICE. TO APPLICANT: If,after making this Certificate of Ex-
F 2 einpli all 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 be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONST RUCTIONLENDING AGENCY AIR HANDLING UNIT(OVER 10,00DGEM.) 5.00 SEISMIC FEE J -0
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,Cie C.): HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC pt C2
Lender's Address
I certify than l have read this application and stale that the aboveVENTILATION FAN (SINGLE) 3.00
inform at.... is cancel. I agree to comply Willi all city and caumy BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and slate laws relating to building construction, and
iho
4creby aulri a 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 to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,juJgme. costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against sa' City in conseqTOTAL TOTAL
rocur IT luc 'e of the
granting of this par MECH.CONT. LIC.NO. MECH.
Signa re of APPlicmv(Cnn
OFFICE COPY