3275 CIY Op CUPERTINO INSPECTIOL' RE?CORD (Office Copy)
3275 _ _ 19980 Olivewood_.E/W._Dividers
PCPS111• NO. SANITARY DISI. 140. LOT 110. ., ADURI(SS
Re-Model PRoperty Services
PROJECT OWNER JOB SITE PIIONE NO.
PERMIT ISSUED Date 17LECTRICAL
uildins. ____
5/25/83_ Date i.nsp.
M ectrical Power Pole
P lumh.ina Llndc rround --- --
Nrchnnical _ Rough Wiring _
Temp. Gns/lilcct. IIaLLs —_--
Solar Ceiling
Fire Sprinkler Fixtures Lnt/F,xt _
Sign Notors
Grounding
IUsc. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved _
Date Insp.
("7s —__ PLUMBING
Electric Date Lnsp.
111iimbin , Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rou;;h
. Gradin , hough Complete
Planning Solar Rough _
Fire Dept. Ilater & Insulation
Health Dept. *fain Drain
AUildinp ID (Z R/of/S Drain
Other Gas
Other.
BUILDING Not Approved
Date Insp.
Pad Certification 11EC11ANICAL
Foundation Date Insp.
Pre-GuniLe Underfloor S.M.
Slab-Membrane Ducts & Lnsulation
Bond Beam Fire Dampers
Underf.loar Girders fireplace
Floor Steel Grease Duct & hood
Tiedowns One (lour Shaft
Di.aphrams Condensate Drain _
Seismic Bracing RquipmenC Anchorage _
IlalLs-Pancls _ Flues & Comb. Air �-
Frame Other
Lath Not Approved
Wallboards Int/Ext.
Firewalls
Other
Not Approved
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
BUILDING PROJECT I DENT[FI CATION PERMIT NUMBER
nooasss OIakcssoU�ctnoo0' APPLICATION & PERMIT �,�I]
+ BUILDING—ELECTRICAL—PLUMBING—MECHANICA 1 J
OW ER'S
PLAN CHECK VALIDATION
ME L QTY. ELECTRICPERMIT . FEE
orvE
c N RA OR's
""ME UTLETS-SWITCHES 5.00/1.00' - Lt.,.No. . LIGHTING FIXTURES 5.00/1.00 I PAID
CONTRACTOR s, APPLIANCES-RESIDENTIAL' "4.00
ADDRESS ^Y � K 983
PHONE PANELS V 5.00 Fi tL�O APPLICATION
ARCHITECT _ - - SIGNS 6,00 PLAN CHECK FEE P,C.NO.
OR
ENGINEER - City of Cupel tine
Lic.NO. SIGNS TRANS. 3.00
ARCR.oR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
^ ADDRESS - -
;IP EMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCR'.
ADDRESCMRESS
SERVICE CHANGE 10.00
woo LICENSED CONTRACTORS DECLARATION-
a I hereby affirm that I am licensed under provisions of Chapter 9" - ISSUANCE DATE
w a H (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT.' PLG. MECH.
r z Professions Codetand my license is in full force and effect" LD ❑"
Z o w - Licenu Class
Lie.Number -
o a, Date _ C.io.ctor - BUILDING PERMIT
Q
Q c It J ' •.
a w owN1;R-BUILDER DECLARATION I INFORMATION
w LL vHi I hereby affirm that I em exem tt teem the Contractor.Licemc MISC..,
TO ORD
I VALUATION $/FT. •
HLLo.a Law for the following reason (Sec.7031.5.,BusinessanJ Professions PERMIT ISSUANCE' 6.00
Code:Any city or county which relannapermit to Construct.alter, _
or R¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. •a(ILS
or product the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
n w es LL he is licensed pursuant to the provisions of the Contractors License /
F z i Law(Chapter 9lcommcncing with Section 70001 of Division3Ola he R�i wo r, / L
a Business and Professions Code)or that he is exempt therelrom and QTY. PLUMBING PERMIT FEE
ii F o the baso for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d ; m bY.ny'applicant fora permit subjects the appliuunnoacivil penalty
ALTER-DRAIN& VENT-WATER IEA.) 4.00
of not more than five hundred doll...15500).1: - • -
'❑ I,us owner of the property,or Ory employees with wage;as BACK F LOW'PROTECT.DEVICE 2,00 C OCGROUP - RES.UNITS,
their sole comperscaNn,will do the work,and the structure is not -
ImetWed ot 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 of -
propertywhobuildsorimprovesthereon.and who does such work FIXTURES-PER TRAP 4.00 SO,CT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees, le.if,ho that such insProve-
mmmllorthtlntendcJoroffcrcd lot oyins.provide([
- x,the 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.) 100 BUILDING USE
builder will have the burden of proving that he JiJ n .
ot build or ins" RES IND CON PB Oihur
prove for purpose of sale). INDUSTRIAL WASTE INTER. 20.00
C3 1,as owner of the property,am exclusively'contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSES ORS PARCEL IN
and Professions Code:The Contractor's Licenw Law does not apply
to an owner of property who builds or iml thereon,and who LAWN SPRINKLERS-OVER 5(EA.) - 1.00 - Jl •L5
contracts for such projects with it contrucmms)licensed pursuant to
the Contractor's License Law. - . SEWER-SANITARY-STORM EA.200ft/8.00 TRACT O. ' PARCEL NO.
❑ l am exempt under See ,B.&P.C.to,this WATER HEATER W/VENT 4.00 '
ransom_ '
Dulc�� Owner- - WATER SYSTEM 4.00 ACC.DATE ACG FILE NO.
/C WORK FRS'CO.MPI:. A'FION DECLARA'T'ION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certifeac of consent tosel4instue ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified ,
copy thereof(Son.3800,I.ah.C.). -
[',,heY No. Com.any _
O O Cerlitredeopy'is hereby furnished. FIRE SPRINK ENERGY T24
Z_ 2 ❑ Certified Copy is tiled With lire city inspire'tion division. MISC.- REFER TO ORD. Y ❑ •N C] Y [-],, NE]O Applicant -
rn PERMIT ISSUANCE 6.00 . FLOOD ZONE A.L.uc.
> CIiRTIPI COT OPSAhION INSFROA1WURKIiRS'
tll COMPENSATION INSURANCE PLG.CONTR. uC.NO. PLG.
CL 0 - 1'fhis section need not he completed if'the permit is for one TOTAL Y❑, NY [:] N
❑ ❑
D Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F .nit is issued, 1 shall not employ any person in any manner so as to _
Uw become subject to the W.HCN;''Compcn,rIma Laws of Calil'ooli.. BUILDING f - ��
C. Date Applicant ALTER OR ADD TO MECH. 4.00
} to NOTICE_ TO APPLICANT''. If,after making this Certificate of E!x- -
? emption,you should become subject to the Worked Compensation - APPLIANCE - 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith Comply with FEE'
U such provisions or this pei nit shall be deemed revoked.. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY' - AIR HANDLING UNIT(OVER 10000C.F.M.) 5.00 SEISMIC FEE:' ��
I hereby affirm that there is a construction lending agency tie EXHAUST HOOD (WITH DUCT) 2.00
tire perlilrmance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). - HEATING UNIT(T0.100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T._U,)7.50
I-under's Address ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00 -
intornationis correct. I 'ece tit COIRRY wills all City and County - PLUMBING
nlma t : and tat In .chit; g t I lding nal Yat. and BOILER-COMP(3 H,P.or 100,000B.T.U.) 4.00
h r by authorize representatives of the cipto enter upon the BOILER-COMP (Over 100,o00BTU)SEE FEE SCR: MECHANICAL '
adTOVT m ntioned property for inspection purposes.
(we)
urpos -
(We) avec to save. inderimily ' Id keep hannl ss-tit Cil;of MISC.- REFER TO ORD. ..-
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 -CONST.TAX
nt ny in any way accrue against r d City in Coo'ecum 'L.of he
granlingofthisp unit MECH.CONT. LIG NO: MECH.
3 >� I
TOTAL TOTAL < 00
Sig tore. Ap ¢ant Cot .tor Ute OFFICE COPY COPY