4576 CITY 01' CUPERTINO INSPECTI01i RECORD (Office Copy)
4576 _ 19960 D Olivewood
PEPJSIT 110. SANITARY DIST. NO. LOT 110. AllUlU:SS --
• Remodel Property Services
PROJECT OWNER JOB SITE PHONE NO.
PMMIT ISSUED Date IiLECTRICAL
Buildinr, Date Insp.
Electrical Power Pole
PIumhfnc Underground
llcchanical P.ou h Wiring
'i'enp. Gas/I11cct. ilaI s
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sien Notors
Grounding
Hisc. Temp. Power
Other _
FINAL INSPECTIONS Not Approved
Date Insp.
(,vs _
PLUMBING
Electric Date Insp.
Plumbin , Backfloc:
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
• Plnnnin , Solar Rough
Fire Dept. Water & Insulation
Health 'Dept. Main Drain
Buildin R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Ilembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & Hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Aracin/ Equipment Anchorage
Ilalls-Panels Flues & Comb. Air
Frame - 3 Other
lath Not Approved
Uallboards Int/Ext.
Firewalls
Other
. Not Approved
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN,INFORMATION WITHIN. RED LINES - USE BALL POINT PEN ONLY
-� ' •' BUI LDI NG PROJECT I DEN TI FICATION - PERMITNUM BER `
ABUILDING APPLICATION & PERMIT A-C 7 C
� UURE55 1 - ' - LI' J 1 U
Y `O /' i - BUILDING - ELECTRICAL-PLUMBING-MECHANICAL a
OWNER's G• PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE -
• O I�G PHONE - •
NAME ORs UTLETS-SWITCHES-RECEP 5.00/1.00 •/'
AME
uc,NO, LIGHTING FIXTURES
coNTRACTORS - APPLIANCES-RESIDENTIAL -4.00 -
�� ADDRESS :
PHONE PANELS - 5.00 DATE OF APPLICATION
ARell ITECTSIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR '
ENGINEER -
' uc.NO SIGNS TRANS. 3.00
ARCH,OR ENG. SPECIALCIRCUIT 5.00 ' P ERMIT.VALIDATION
ADDRESS }; '
ZIP EMP.METER OR POLE 15.00
APPuc4rvrs Aill MOTORS SEE FEE SCH.
ADDREss
SERVICE CHANGE .00
3.{
w o 0 4LICENSED COMfRACI'ORS DECLARATION
a u u I hereby ffor, that I am licensed under nasi...o of Chapter 9 - - City of ClIpertino - ISSUANCE DATE
w <vWAi (commencing wi0t Section 70001 of Division 3 of the Business and BLDG. ELECT. PLG. - MECH.
H o z Professions Code,and my license is in full force and effect _
z o w - License.Class LIc.Number - ElEl ❑
Q F w Date Contractor -
a Y f BUILDING PERMIT
rc o: w ¢ OWNER-BUILDER DFCLARA'fION INFORMATION
U REFER TO ORD'
X
g; LL.N I hereby affirm that I am exempt from the Contractor's License MISC.-
uoa Law for the following reason.(Sec.7031.5,Bisinessand Professions PERMIT ISSUANCE `/ALunnDN 3/Fi.
- Code:Any city or county which re4uiresa permit foconsiructulter. - .6.00 gpp
Q6 ¢ 40 improve,demolish,or repair any structure,prior to its issuance,also ELEC,CONTR. 'LIC.NO., ELEC. LIF-
Or
O IS requires the applicant for such permit to file a signed statement that TOTAL O p PER
A w m u he is licensed pursuant to the provionnsof the Contractors License (1
r z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the U 1
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r D the basis for the alleged exemptiol,Any violation of Section 703L5-
STORIES IfYPE CONSTR.
w. by any applicant for a permit subjects lire applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00 City of Coperti 0
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW 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 (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
property who builds Or improves thereon,and who docs such work F IXTURES-PER TRAP 4.00sD.FT.FLOOR AREA TOTAL ACREAGE
• himself re through his own employees,provided that such improve-
.cuts
mprove-
mmselfo not intended or employeeffered for sale.provided
1151 such
building GAS--EA.SVSTEM-11NC.40UTLETS 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 Oil- RES IND CON PB Omer
prove for purpose ofsah.). INDUSTRIAL WASTE INTER., -20.00 El El ❑ ❑ El
licensed
1,as owner of the property.am exclusively contracting with
licensed contractors to construct the project(Sec. 7044.Bri,iness LAWN SPRINKLERS-1 INC 5 V.B. • 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law docs not apply'
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
mulcts for such projects with a contruetohs)licensed pursutmt to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ l am exempt under Sec---B&P,C.[or this WATER HEATER W/VENT 4.00 '
reJ
Date( • :` Ow nor WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. -
WORK ERS'COMPENSATIONDpCLARA'IION WATER TREATING EQUIP. .4.00 '
I hereby aflirm that I have a certificate ofcommut to sell insure, - - ZONING ENG.SITE NO.
or a certdicate of Workers'Compensation Insurance,or a certified
mpy thcrcof(Sec.3800,Lab AIA.
Policy No. Company •'
0 ❑ CertifiedcoiXisherebyfurnished. I' FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is Filed with the city inspection dividan MISC.- REFER TO ORD.
O Applicant i Y ❑ N Y ❑ N❑
cc: N CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 PLOOD ZONE A.L.u.C.
LU >_ COMITNSA'I'ION INSURANCE PLG.CONTR. LIC.NO. . - PLG.
d D (This section need not be completed if the permit is for one TOTAL , Y❑ N❑ Y ❑ N❑
0 Z hundred dollars(S 100)or less,)
U O I certify that in the Performance of the work I'or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
Ly H mit is issued,1 shall not employ any person in any manner so as to
O U, become subject to the Workers'Compensation Laws of California. /o
Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} y NOTICE TO APPLICANT'; If,after making this Certificate
FZ eruption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
prus of the Labor Code, YOU must forthwith comply with FEE
U
such Provisions or this permit shall be deemed revoked., AIR HANDLING,UNIT(TO 1Q000QF.M.) ' 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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 the work;for which this permit is issued(Sec. MICROFILM
3097,Civ,C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's ddyess 17
Address cnrc
Lender's AdHEATING UNIT(OVER 100,000 B.T.U. .50 ELECTRIC Ef
r
I certify that I have read this upPluotion and late flat file above. VENTILATION FAN'(SINGLE)' 3.00
I� information is correct.I agree to comply with all city and county 'PLUMBING
ordinances and state laws relating to building construction. and BOILER;COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby rothorieu representatives of this city to'enter upon circ BOILER-COMP (Over 100,000 BTU)SEE FEE SCR. MECHANICAL
above-mmntioncd properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs aril expenses which - CONST.TAX
may i any way a against said City in conscyuence oi'the PERMIT ISSUANCE 3:00
g ngof this permit. j MECH.CONT. LIC.NET MECH.
N s/ �� TOTAL TOTAL 3
'ignatureof APplcant/C ntractor ( Date
OFFICE COPY