3267 CITY Or CL'PE.11TITIO IVSPECTiOV RECORD (Off ice .Copy)
3267 _ _ 19930 A Oli_vewood NIS Dividers
PEP AT N0, SAMIT'ARY DIST. NO. LOT 1d0 ARMS -----
• Re&&del Property Services
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date . ELECTRICAL
Building 5/25/83 Date Insp.
U e_ctrical 5/25 83 Power Pole
Plumhing Underground
Mechanical Roul;h Wiring
Temp, Gas/Elect. Iialls _ --
Solar Ceiling
Fire Sprinkler Fixtures int/Ext _
Sian 15tors
Grounding
Fli.sc. Temp. Power _
Other
FINAL IIISPECTIONS Not Approved _
Date Insp.
Qs PLUMBING
Electric Date Insp.
Plumbing Backflow
i1chanical Under round
Solar Underfloor _
Pool Partial Rough
. Gradin , Rough Complete
--
I'lnnni.nSolarSonr Ron hough
Fire Dept. water & Insulation _
Health Dept. "lain Drain
Building R/of/S Drain
Other Gas
Other _
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
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
Diaphrams Condensate Drain
Seismic Bracing, Equipment Anchorage
llal..ls-Panels Flues & Comb. Air
Frame other
Lath Not Approved
Uallboards Int/Ext .
Firewalls
Other
Not A? roved
BUILDING +
ELECTRICAL
PLUMBING
•
11ECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POI EN-ONLY
BUILDING PROJECT IDEN7I FICATION .�N4 ��MI�TRER
amLOwc =p APPLICATION & PERMIT3267 .
ADDRESS N6•Q{{�$, SOa7T1�'
ac .5 BUILDING - ELECTRICAL-PLUMBING-MECHANICA
OWNER'S PLAN CHECK VALIDATION
NAME e GTY. ELECTRIC PERMIT FEE.
PHorvE
c TRA oRs UTLETS-SWITCHES-RECEP 5.00/1.00
NAME
Sec.No. s. LIGHTING FIXTURES 5.00/1.00 w _
CONTRACTOR'S Z pPLIANCES-RESIDENTIAL . 4.00
ADDRESS'
�. PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGNS 6.08 PLAN CHECK FEE . ,P.C,NO.
OR
ENGINEER
Sec.No. SIGNS TRANS. 3.00 PAI D�
AT H.OR ENc. SPECIAL CIRCUIT 5.00 �. PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 15.00 Et�1 251 83
APPLICANTS - MOTORS SEE FEE SCH. 'fl
ADORESS - 1
SERVICE CHANGE -' 10.00 C - ert1110
v 0 z r
F D o LICENSED CONTRACTORS UIiCLARAPION Z
a u G 1 hereby affirm that I am licenud under provisions of Chaplrr 9 - ISSUA CED E Q
y a co (Commencing with Section 7000)of Division 3.of the Business anti - BLDG. ELECT, PLG. MECH.
F w z Professions Code,and my license Is in full force and effect. ❑ ❑ ❑ ❑
Poo
z o w- License Class Lic.Number
O z r e, Date Contractor -
a ir - - • • j BUILDING PERMIT
¢ ¢ w a ,OWNIi R-B UILUIik UFCLARATIUN INFORMATION
e- oaU MISC.- REFER TO ORD
3¢ w 1 hereby affirm that I am exempt from the Contractor i License VALUATION $/FT.
al u_o J Law for life following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE - 6.00
Code:Any city or county which rquiresa permit loconstruct,ultcq
2 ¢ a improve,demolish,or repair any structure,prior to its i,sumtac,also ELEC.CONTR. LIC.NO.
0E LEC.
ou
O LL regnlrts the upphcanl for SUCK permit tU elle a signed Statement Ilial - TOTAL PERMIT TO
¢ w m he is licensed pursuant to the provisions of the Conlrmlor License
i Law(CImpIcT 9 fcommenciny with Section 7000)of Division 3ofthe
r z < Business and ProNssions Code)or that he is exempt lhercl'roin and QTY. PLUMBING PERMIT FEE Ei'+'lo n liff�_
fx o
¢ H the basis for the alleged exemption.Any violation Elf Sect ion]031.5 STORIES TYPE CONSTR.
i_: any applicant for a permit subjects the applicant Ica civil penally ALTER-DRAIN&VENT-WATER (EA.) 4.00 '
of not more than five hundred dollars(5500).):
' Cl h as owner of the property,or my employees with wages as BACK F LOW 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 (Seo. 7044, Business and Professions ' DRAINS-FLOOR,ROOF,'AREA,COND.'4.00
Code:'[lie Contractor's License Law docs not apply tom owner of
properly who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 So.FT.FLOOR AREATOTAL ACREAGE
Ilinuel(or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA:.SYSTEM-1INC.4 OUTLETS 4.00
or inptrovument is sold within one year of ronysid tot, the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 RUILOwG USE
builder will have the burden of proving that he did noLhuilJ or in,. RES IND CON PR O Ho
prove for purpose ol'salc.l. INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ 1,as owner of the properly,all exclusively con trading witT
' licensed contractors to construct file project 1- 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 - r ASSESSORS PARCEL NO.
and Professions Code:The Contractor-s License Law does not apply _
to an owner of property who builds or improves thereon,anJ who LAWN SPRINKLERS-OVER 5(EA.) •1.00 /-y '3 - 3 .S
-contracts for such projects with a contmclor s)licensed pursuant to n
SEWER-SANITARY-STTRACT No
the Contractor's License Law. - ORM EA.200ft/5.00 : PARCEL No.
'0 Iantexcmploubi-Sec. .B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Date OwnerfLSl� WATER SYSTEM 4.00ACC.DATE ACC.FILE NO.
wo RR1i BY o, P.NSAT NI�ARATV)N WATER TREATING EQUIP. c 4.00 _
1 hereby affirm that 1 have a certificate of cement to sell-insure. ZONING ENG.SITE N0.
I,,a Political,of Workers'Comnensation Ensu race.or a certilled
copyLthercof l Sec.3800,LIb.C.L -
Pohcy'No. Company
O ❑ Cerlificd'copy is hereby'lemishcd. FIRE SPRINK ENERGY L]A
Z'Z -0 Certified copy i fled will, Hili city inspection division, MISC.- REFER TO ORD: Y ❑ N v ❑ N❑
F- yApplicant
PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u.c.
- CERT11'ICA'I'E OF EXEMPTION FROM WORRIiRS'
LU COMPENSA'1ION INSURANCE. PLG.CONTE. -..LIC.NO. PLG.
1 0 I'1]its Section need not.be completed if the permit is for line TOTAL 'Y❑ N❑ v ❑ N❑
Z:) Z hundred dollars(S 100)or less.)
U 0 E certify that in the,perform:utm of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H not is issued,I shall nut elnp toy any person in any nt anner w as la
U w become subject to the Workers'Compensation Laws of California. BUILDING
40
} a
Dmc - Applicant ALTER OR ADD TO MECH. 4.00 a
In NOTICE TO should
If,offer making this rs'C'Icate of Ex-
? emvision you should bor Co subject Al the Warkeot eco p comply
ion APPLIANCE 4.00 PLAN CHECK
provisions Al the Labor Cole, yule must d rcv.kh comply with FEE
U such provisions or this permit shall be ecemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.)-' 3.00 '
CONS'('RUC'('ION LENDING AGENCY AIR HANDLING UNIT(OVER 10)MOC.F.M.) 5.00 SEISMIC FEE ,SO
1 hereby affirm that there is a construction leading agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work HIT which this permit is issued(Sec. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's NameHEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC q 40
Loader's Address
I certify that I have read this application and state Ih:u the above. VENTILATION FAN (SINGLE) 3.00
information is correct, 1 agree to colnply will,all city and county BOILER:COMP H.P.or 100,000 B.T.U.) 4.00 PLUMBING
hereby eau and stale laws relating In building construction. and
hereby enlhoriee representatives of this city lir ,mer upon the ,BOILER-COMP'(Over 100000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned PnReeHy for Inspect tun purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments. costs Jed expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way acenm against su'd Glty in consequntnc of the
Frnntinhl6 permit. ��.� MECH.CONT. LIG.NO. MECN. TOTAL
OTAL
Signiu mot pp(cunt) o rv' flit, D: c '- /
OFFICE COPY y`J, /