3263 CITY Op CUPERTINO INSPECTIOV RECORD (Office Copy)
3263 _ 10698 Blanlewood_ _
1'CPJII'P f(0. SANITARY DIST. NO. LOT NO AUDPESS
Re-Model Property Services
PROJECT OWNER JOB SITE PHONE NO.
PEF11IT ISSUED Date ELECTRICAL
Building — 5/25/83 Date Insp .
M e_ctrical 5/25/83 Power Pole
PLumhing Undcrfround _
lechani.cal Rough Wiring
Temp. Gas/iacct. IlaLis
Solar Ceiling
Fire Sprinkler Fixtures int/Ext
Sinn Hotors
Grounding
Hi.sc. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved _
Date Insp.
r'cs PLUMBING
FIoctri.c Z Date Insp.
Plumbing Backflow
!lechanical Underground
Solar Underfloor _
Pool Partial hough
• anig Rough Complete
Planning
=_
Pl.anni.n(; Solar Rough
Fire Dept. Water & Insulation
Health Dept. "lain Drain
Building Z 8 BGk R/of/S Drain _
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Ganite Underfloor S.M.
Slah-Membrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & flood
Tiedowns One (lour Shaft
Di.aphrams Condensate Drain
Seismic Bracing, Equipment Anchorage
11al..Is-Panels Flues & Comb. Air
Frame Other
lath Not Approved
Uallboards Int/f:xt .
Firewalls
Other
. Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES,- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUM R
BUILDING APPLICATION & PERMIT 3263
ADDRESS
' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OwrvERS CLANHECK VALIDATION
NAME _ V ONE DTV. J.DFT ELECTRIC PERMIT FEE
WCS
NAMERA r Rs & OUTLETS-SWITCHES-RECEP 5.00/1,00 `r%�0
UC.No. S LIGHTING FIXTURES 5.00/1.00 --eu PAID
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 Jo
ADDRESS MAY 151190� 190
PHONE PANELS - 5.00 MAY, v c T�bM)
ARCHITECT $IGH$ 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER City of Cup rtino
LIC.No. SI GE TRANS. 3.00
ARC H.OR ENG. 6,U0 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT
ZIP EMP,METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
5
d
' 2 Foo LICENSED CONTRACTORS DECLARATION SERVICE CHANGE 10.00
0
a E,u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
as "' IconDn curing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H H i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑
Z O �2 - License Class Lie.Number
ga E ° Date Contractor BUILDING PERMIT
BE B, w u OWNLR-BUILDFR DECLARATION INFORMATION
w0
LL ae I hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD
u0er so
Law for the foli.eving rean.(Sec.7031.5,Basincssand Professions 6.00
PERMIT ISSUANCE VALUATION SIFT.
r N
as I Code:Any city or countypair any Structure permit loconsuancalter, O
T 4 0 improve,denuslish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. q 00 �"�
-O LL requires the applicant for such permit to file a signed stalement that TDTAL OC .--- PERMIT TO
d w m he is licensed pursuant to the provisions of the Contractor's License
H Z ee Law(Chapter 9(coin mmucingwlth Section 70000ol'Division 3ut the o/JV
Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
otcr O tire basis for the alleged tnempttrn+.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ; � by any applicant for a permit subjects the applicant tea civil penaltyALTER-DRAIN& VENT-WATER (EA.)
of not more titan five hundred dollars 0500L).
❑ L as owner,of the property,or my employ...with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP REs.UNIIs
the it sok 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 o1'
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SD.FT.FLOOR AREA TOTALACHEAGE
himscllor through his own employees,provided that such impro c.
. ments are Rot intended of offered for sale.If,however.the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of copletion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that hme did not build or int- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑
❑ 1,as owner of the property,am cxclmively contracting with
licensed contractors to,construct the project ISee. 7144,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:'The Contractor's License Law does nm apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.1 1.00 3/ G 3 3-y4_j_
contracts for such projects with a contractahs)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ tom exempt under Sec. .B.&P.C.list this WATER HEATER W/VENT 4.00
rcas0n
[)ate OwnLr�SC WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WC KIiRSC h1PB, 1 N[)�li/C`LARATION WATER TREATING EQUIP. 4.00
I hereby infirm that 1 have a certificate ofconsent to reit-insure, TONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3900,LabEA
Policy No. Company
O ❑ C,Nilied cop)'Is hereby famished, FIRE SPRINK ENERGY T-24
Z Z ❑ Ceril'ied copy is fled with the city inapuetimi division. MISC.- REFER TO ORD. Y ❑ N❑ v ❑ N�
I"- oApplicant
PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.uc.
LU -
CERTIFICATE OF EXEMI''TINS FROM WORKERS'
UJ >_ COAf I'F:NSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
C TOTAL Y N❑ Y❑ N❑
Z) 2 ,(This xctldn need not he romplttcd if the permit is tisr one
hu1 ver dollars IS 100)or Iess.l
U O I is issu that in the porfonnanan of the work fur which this per,F� N
ECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.I shall not employ any person in any, manner so m❑+
O w become subject to the Wlicant 'Compenwtinn Laws of Culi(omia BUILDING �0 =1
Dau Applicant ADD TO MECH. 4.00
} U3 NOTICE TO APPLICANT: If,atter making This Certificate ul'Ex-
F. 2 cmptiun,you should become subject In the Wnrkcri Compensation 4.00 PLAN CHECKprGvisien, of the Labor Code, you must forthwith comply with FEE
sch provisions or this permit shall be deemed revoked. NG UNIT(TO 1Q000CF.M.) 3.00
CONSTRUCT ION LENDING AGENCY NG UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE j0
I hereby affirm that there is a construction lending agey ts' HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is Issued(Sec. MICROFILM
3097,Civ CA HEATING UNIT (TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000B.T.1-117.50 ELECTRIC pZ
Lenders Address
I eerily that l haverexd thisapplimatiom and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct, I agree to comply with all city and county BOILER-COMP13 H.P,or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby auDtnricc representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
abase-mentioned pn9xit,for inspection purposes,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and ex Penses which PERMIT ISSUANCE 3.00 CONST.TAX
maY m any way accrue against d City in consequen a of the
grunting ol'this per tit, ) MECH.CONT. LIQ NO. MECH.
OTAL
2z/O/y�� TOTAL ,3� fU
Signal roof Apphcanl Con u or D' c _J
OFFICE COPY