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3258 CITY OF CUPERTINO INSPECTIOL' RECORD (Office Copy) 3258 _ 19960 B Olivewood 17/S Dividers PCPdII'I' No. SANITARY DIST. NO. LOT NO ADDRESS ----- ,,^..e-Model Property Services' PROJECT OWNER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL BuLldine 5/25/83 Date Insp. Electrical 5/25/83 Power Pole Plumbing Undnr_fround llechanical Rough Wiring 'I'cnp. Gas/Elect. UaLLs Solar Ceiling Fire Sprinkler Fixtures Int/Ext Sign Ifotors Grounding Hisc, Temp. Power _ Other FINALII1S1'EC'I'IOCJS NoC Al oved _ Date Insp. C, PLUMBING Electric Date Insp. Plumbing Backflow ilechanical Underground Snlar Underfloor Pool Partial Rou¢h Plannin Solar Complete —` 1'.Lanni.n Solar Rough Fire Dept . plater & Insulation Health Dept. Main Drain Guildinr R/of/S Drain other Gas Other. BUILDING Not Approved Date Insp. Pad Certification MECHANICAL Foundation Date Insp. Pre-Gunite Underfloor S.N. Slab-Membrane Ducts & Insulation Bond Beam Fire Dampers _ Underfloor Girders Fireplace Floor Steel Grease Duct & hood Tiedowns One (lour Shaft Diaphrams Condensate Drain Seismic Bracinf; Equipment Anchorage __ _ Halls-Panels (rues & Comb. Air Frame Other f,ath Not Approved Uall.boards Int/Ext. Firewalls Other Not Approved buILL)INU ELECTRICAL PLUMBING MECHANICAL MISCELLANEOUS �1 APPLICANT TO FILL IN INFORMATION WITHIN RED LIN-ES - USE BALL POINTY N ONLY • BUILDING PROJECT YDENTI FICATION 9 d NUMBERMIT r-1- iZAPPLICATION & PERMIT IrvG 3258 AOOHANICAL- BUILDING ELECTRICAL- p - OWERPLAN CHf ^ ATION NAM '5 E QTY. ELECTRIC PERMIT- FEE r . - PHDNE 51983 1` CONTRABITORs ' - OUTLETS-SWITCHES-RECEP 5.00/1.00 Od Mtsll AY 2, ( NAE 1'11 LIC NO. LIGHTING FIXTURES 5.00/1.00 e0 CO TRACTOR •i qpp LIANCES-RESIDENTIAL 4.00 Od ' c'jfy,of Capertloo ADDRESS 5 PHONE PANELS " 5,00 DATE OF APPLICATION ARCHITECT - t SIGNS 6•.DD PLAN CHECK FEE - P.C.NO. OR ENGINEER sec"No. SIGNS TRANS. - 3.00 ARCH,OR ENG. - SPECIALCIRCUIT 5.00 PERMIT VALIDATION ADDRESS i,p EMP.METER OR POLE INS. 15.00 APPLICANTS MOTORS SEE FEE SCH. I .ADDRESS o,2� • SERVICE CHANGE • 10.00 0Ti 0 0 • I.IC1iNS1iD CON'1'RAC'rORS DECLARA'r10N' a u v 1 hereby affirm that 1 am licensed under provisions of Chapter 9 PPISSUANCE DATE -Nw Icomntenuing with Section 70001 of Division 3 of the Business anA LDG. ELECT. PLG. MECH. H m i Professions Code,and my license is in full ford,and effect. z o u, - License Class Lic.Number - EJ ❑ ❑ o m Date Contractor X a OWNHR-BUILDER DECLARATION BUILDING PERMIT A o A U MISC.- REFER TO OR INFORMATION w ,� N' I hereby affirm that I am exempt from the Contractolis Livens° vA Lunn ON $/FT. .'Rh 0 a Low for the following reason.(Sec.703 I.S.Business and I'rofessinns - "PERMIT ISSUANCE ' 6.00 e Code:Any city or county which requires a permit to Construct,alter, Q/O QQ QImprove,demolish,Or repair any structure,prior to Its issuance.also ELEG CONTR. LIC.ND. E , ep - o u requires the applicant for such permit m file v signed stmcnmm that - OTA icll PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License rzi Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe ^I' a Business and Professions Code) or that hfr e is exempt thereom told QTY. PLUMBING PERMIT FEE �'/' D Z oo 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 toa civil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00 of not more than five hundred property, s($5000.)ysnip ❑ L as owner im the property,or my employees with wages Is BACK FLOW PROTECT.DEV ICE - 2.00 Oce.GROUP RES,UNITS their sole compensation,will(S the work,and the structure is not intended or offered ntract for sale(Set, (toe Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 ` Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who dues such work FIXTURES-PER TRAP 4.00 SO,Er.FLOOR AREA TOTALACREAGE himself re through his own employees.Provided that such improve- mentsarcnotlntendedoruffcrcoyeesule.Tided that such building GAS-EA.SVSTEM-11NQ40UTLETS 4.00 or improvement is sold within one year of completion, the owner- GAS-EASYSTEM-OVER 4 IEA.) 1.00 " BUILDING USE builder will have the burden of proving tial h .e did not build or im- RES IND CON P9- Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 11 El Cl Cl El ❑ 1,a,owner of the properly,ani exalmivcly contracting with licensed contractors to construct aro project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESS RS PARCEL NO. , and Professions Code:The Contractor's License Law,does not apply -to an owner of property who builds or inhproves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 �•i 3 counsels for such projects with a conlructonx)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT No. PARCEL No. ❑ lam exempt under Sec. .B.&P.C.lilr this - WATER HEATER W/VENT 4.00 Date- Owm'r WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. ORMRS'CC ; D wS KATION WATER TREATING EQUIP. 4.00 1 hereby affirm that I have a Certificate of Cml\ent to self-insure, ZONING ENG,SITE NO. or a certificate of Workers'Compensation Insurance.or a certified copy thereof(Sec.3800,LAC.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY x24 Z Z ❑ Certified copy ix tiled with the city inspection division. " MISC.- REFER TO ORD. v ❑ N❑ Y ❑ No F O Applicant - - � w CERTIIICATEOF.EXEMPTION FROM WORKERS" PERMIT ISSUANCE 6.00 FLOODZONE n.L.u.C. LU >_ COMPENSAT'IONINSURANCE . . . PLG.CONTR. LIC.NO. PLG.' V[J N❑, . v ❑ NE]O (This section need not be completed if the permit is for one TOTAL 0 Z hundred dollars 1 S 100)or less.) U O 1 certify that in the performance of th,work fon which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY mit is issued,I shall not employ any person in any mamler so as to 11 U become subject to the Workers Compensation Laws of California. BUILDING 60 U w' pate Applicant ALTER OR ADD TO MECH. 4.00 } 0. NOTICIi"rO AI'I'LICAN'I': II,after making Ills Cert it Testa of 1: � ? emption,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 slhall be deelmed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 3.00 1 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 5.00 SEISMIC FEE ,S(J 1 hereby affirm that therei,a 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00' Lender's Name - - HEATING UN IT(OVER 100,000 B.T.U.)7.50 - ELECTRIC Lender,Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 information n correct. I agree to comply with all city and Coumy BOILER:COMP(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING ordinances and etme laws re Wt c m building const andic, and my hereby authorise representatives of tills City Io enter upon the BOILER-COMP IOVe1100,000 BTU)SEE FEE SCH. MECHANICAL above-nmntioncd property for inspection purposes. (We) agree to save, indemnify and keep harmlev the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX - may in any way accrue against sa' City in consequence of file PERMIT ISSUANCE 3.00 gnntingof this p•old. MECH.CONT. LIC.NO. MECH. {!/(y� TOTAL TOTAL Sd SlgAaturc ohA pplmuntlu Ualc OFFICE COPY