3292 CCI'ti' OF CUPERTINO INSPYGTIOV RECORD (Office Copy)
3292 _ 19960 C Olive_wood
• I'I:Pd1I'r NO. SANITARY DIST. NO. LOT NO ADDRESS -----
Re-Model Property Services
PROJECT OWNER J013 SITE PHONE NO.
PERPIIT ISSUED Date ELECTRICAL
Buildinr, _ 5/25/83 Date Cusp.
IJe_ctrical .5/25/83 Power Pole
I'lumbinr
Under round
Mcchani.caI Rough Miring
'Temp. Gas/Ficct. I!ala.s
Solnr Ceiling
Fire Sprinkler Fixtures Int/Ext _
Sirn Motors
Grounding
Hisc. Temp. Power _
FINAL INSPECTIONS NoC A roved _
Date Insp.
r"'s -- PLUMBING
Fl.ectri.cD
- .
ate Lnsp .
Plumbing Backflow
Mechanical Underground
Solar Underfloor
Pool .Partial. Rough
•
Grading Rough Complete —
I'.Ianning Solar Rough _
Fire Dept. Plater & Insulation _
Health Dept. `fain Drain
Building R/of/S Drain _
Other Gas _
Other _
BUILDING Not Approved
Date Insp.
Pad Certification IIECIIANICAL
Foundati.on Date Insp.
Pre-Ganite Underfloor S.N.
Slab-llemhrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girclers Fireplace
Floor Steel Grease Duct & Hood
Tiedowns One 110Ur Shaft__
n aphrams Condensate Drain _
Seismic Araciny, Equipment Anchorage
I!al.l.s-Pan els Flues & Comb. Air
Frame Other
Lnth Not Approved
Ilallbonrds Int/Ext.
Firewalls
Other
Not Approved
BUILDING
ELECTRICAL
PLUMBING
•
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LD I NG PROJECT I DE NTI FICATION 1„pPT' r" PERMITNUMBER
BUILUING. APPLICATION & PERMIT �_ 329:2.
AOOREss
I yL OC O/ (�ELJ BUILDING - ELECTRICAL-PLUMBING-MECHANIC
OWNER'S PLAN CHECK VALIDATION
AME - CITY. ELECTRIC PERMIT FEE
e -Et S PocsE pAIO
CONTR CTORs UTLETS-SWITCHES-RECEP 5.00/1.00 s'OTt
NAME
LIC.NO.
LIGHTING FIXTURES 5.00/1.00MAY 2S 19pJCON TRACTOR'5 ?_APPLIANCES-RESIDENTIAL 4.00
ADDRESS
/1
PHONE PANELS 5.00ity PP ICATION
ARCHITECTSIGNS 6.00 PLAN CHIRCIBIR41oNjin P.C.NO.
OR
ENGINEER
LIC.- c.NO. SIGNS TRANS. 3.00
ARCH.oR ENG. SPECIAL CIRCUIT S,BD PERMIT VALIDATION
ADDRESS
zIP EMP.METER OR POLE INS. _ 15.00
APPLICANT Srvs MOTORS SEE FEE SCH.
ADDRESS
_
SERVICE CHANGE 10.00
0 0 o LICENSED CONTRACTORS DECLARATION
¢ 1 hereby affirm tlmt 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
m Q hIconnnti ELECT.nencing with Section 7000)of Division 3 of the Business aBLDG. PLG. MECH,
H D z Professions Code,wid my license is in full force and effect. ❑
z o`v$' - License Class Lic.Number
-
2 H w Dale - - Contractor -
a y Z J
¢ ¢ w < OWNER-BUILDER DECLARATION BUILDING PERMIT
U REFER TO ORD INFORMATION
w; N I hereby affirm that'I am exempt Rom the CmLrnor<License -MISC.- VALUATION, $/FT.
.. oa Law l'or the following reason.(See,7031.5.Businessand Professions PERMIT ISSUANCE 6.00 >
L m Code:Anycityorcounty which requires a permit to construct,alter,
., Q E Improve,demolish,or repair any structure',pNIR to Its Issuance',also ELEC.CONTR. LIC.NO.
ELEC.
ILO requires the applicant for such permit to file a signed statement that TOTAL ( - PERMIT TO
d w m he is licensed pursuant to the provisions at tire Contractors License
HZQ Law(Chapter9(commencingwitlm Section 7000)of Division 3 of the a (�l�ts�.. '
P 4 D Business and Professions Code)or.that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; m by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 -
.of not more than five hundred dollars(55001.):
0 1.as owner of the property,or my enmployers with wages as BACK FLOW PROTECT. DEVICE 2.00
OCG GROUP RES.UNITS
their sole compenoition,will do tire oa
e wrk, nd 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 docs not apply to an owner of
properly who builds or improves there.,,and who docs such work FIXTURES-PER TRAP 4.00 50,FT,FLOOR AREA TOTAL ACREAGE
O hi IRS re through his own employees.provided that such improve-
in
mprove-
rents are not intended.or ofl'creA for seta.If,however.the building GAS-EA.SYSTEM-1INC.4OUTLETS 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 int- RES IND CON PR Other
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ I,as owner of Dm properly,am exclusively contracting with -
licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and professions Code:The Contractor's License Law does riot apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 ,3��,� �3
contracts fur such projects with a contracloriO licensed Pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lamesemptundcr Sec. .B.&P.C.for this WATER HEATER W/VENT 4.00
1.101,
Data -wucr
OWATER SYSTEM 4.00 ACC.OATE ACC.FILE NO.
2f/83_ �S-c-
WORK ERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I hove a certificate of consent to sell-insure. -- 20NI NNG ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab C.). -
Policy No. - Company - - -
O ❑ Certified copy iz he by fu fished. FIRESPRINK ENERGY T 24
Z Z 0 Certified copy is fled with the city ih•specliou division. MISC.- REFER TO ORD.
p. APPISmat Y ❑ N❑ Y'[:] N
to OF EXEMPTION 1*ROM WORKERS'" - PERMIT ISSUANCE 6.001-
CERTIFICATEFLOODZONE A.L.U.G.
Ud > COMPF-N$ATIONINSURANCF PLG.CONTR: LIC.NO. PLG.
d (This section need not be contpleteJ if the permit is for one TOTALV❑ -N❑ V ❑ N❑
Z) Z hundred dollars 1$100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PER FEE - FEE SUMMARY '
not is issued,1 shall not employ any person in any manner so as to
w become subject to the Workers' Laws of Calilorma. /O O`
O er
Dam Applicanl ALTER OR ADD TO MECH. 4.00 BUILDING
NOTICE TO APPLICANT': If,after making this Certificate of IIx
� Z emption,you should become subject to the W'orkers'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)000C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 100001C.F.M.) 5.00 SEISMIC FEE �.
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of Dm,wurk for which this permit is issued(Sec. MICROFILM
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATI NG UNIT(OV ER 100,000 B.T.UJ7.50 ELECTRIC
Leader's Address
I certify that l have read this application and late that the above VENTILATION FAN (SINGLE) 3.00
information is correct, 1 agree to comply with all city and county BOILER-COMP(3 H.P,or 100,0008.T.U.) 4.00 PLUMBING
ordinances and stale laws vto building construction. and
hereby authorize rtpresenlal representatives
of this city to enter upon the BOILER-COMP,(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-ro ntioned property for inspection purpows
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgmen costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way ac ere against svi City in conieq mence of the
granting of this Permit. MECH.CONT. LIC.NO. TOTAL TOTAL
MECH.
3
sigm more Df nnnlicamlc� tremor ate
OFFICE COPY