3251 CI1')' OP CUPERTINO INSPECTION RECORD (Of Iice .Copy)
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3251 Unit A _19986 OliveWQod...E/i].Aividarc
111;P111T NO. SANITARY DIST. 110. LOT NO. ADDUSS'
lie
Re-Model Property Services
PROJECT OWNER JOB SITE PHONE NO.
PERPIIT ISSUED Date ELECTRICAL
Bu[Idi_nr _ 5/25/33 Date Insp.
I;]ectrical 5/25/83 )ower Pole
Ptumhin,� Underground
Ncchnni_ca.l _ Rough Wiring
'I'enp. Gas/Elect. f,!aIIs
Solar Ceilingz
FLre Sprinkler Fixtures int/Ext
Sign Hotors
Grounding,
Misc. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved _
Date Insp.
r, s —_ — PLUMBING
El.ectri.c Date Insp.
Pinmbin , Backflow
!Iechanical Underground
Solar Underfloor
Pool Partial Rough
• Gradin , Rough Complete
PlanninF,, Solar Rough _
Fire Dept. Mater & Insulation
Health Dept. 'fain Drain
Building o—lz �3 R/of/S Drain
Other Gas _
Other
BUILDING Not Approved
Date Insp.
Pad Certi.ficat.ion MECHANICAL
Foundation Date Insp.
Pre-Gucu.te Underfloor S.M.
Slab-1lembrane Ducts & Insulation
Bond Beam Fire Dampers _ __
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic , racilw EquipmenC Anchorage _
11alls-Panels 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 WITS IN RED LINES - USE BALL POINT PEN ONLY
1' s� auaoBUILDING•PROJECT IDENTIFICATION 4pFT APPLICATION & PERMIT PER IT NUMBER
ADDRESS . 'u.r;A R ec+s�a�.$es; _ _ _ `3251
O BUILDING-ELECTRICAL-PLUMBING _MECHANICAL
wNER'S PLAN CHECK VALIDATION
•x "AME DTV. ELECTRIC PERMIT FEE
PHONE
NAME croRs � OUTLETS-SWITCHES-RECEP 5.00/1.00 !!.
LIC.ND. LIGHTING FIXTURES 5.00/1.00 4°
ro"rRAcroR'sppLIANCES-RESIDENTIAL 4.00 Liv. ��ID
ADDRESS .
PHONE• ANEI-S 5•56 DATE OFAPPLICATI
ARCHITECT - SIGNS 6.00 PLAN CHECK FEE P.C.NO.
DR MENGINEER LIC,' ' c.no, SIGNS:TRANS., 3.00 Y 2 519E
ARCH OR ENG. SPECIAL CIRCUIT 5,00 .PERMIT VALIDATION
ADDRESS
-ZIP EMP. METER OR POLE INS. 15.00 - City.Of CUpe
APPLICANT'S MOTORS' SEE FEE SCH.
AGO.ESS
-
• SERVICE CHANGE 10.00
oi
,00 o o LICENSI>U.CON'I'RACTOR$DECLARATION +
v I hereby affirm that I ries licensed nude,provisions of Chxpter.9 ISSUANC DATE -
w¢ n (cum mmusi , llr Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H o Professions Code,and my license is in full force and effect.
z o.i- License Class Lie.Number - ❑ ❑ ❑ ❑
o w Date Convuclor
Q'y BUILDING PERMIT
E S, w u
OWNER-BUILDER R-BUILDER DFCLA RATION _ INFORMATION
I hereby affirm that I um exempt team file( Lwrnr- MISC.- REFER TO ORD +
.. oa Law focthe following reason. 7031.5.Busam"and Professions PERMIT ISSUANCE vnwATtON $/FT.
� - Code:Any cityor county which requiresapermit tuconstruct.a[ter, - 6.00
¢ Q 1 2 improve,dvd lish,or repair any slnucEme,prior to its issuance.also FLED,CONTR. LIC.NO. ELEC. d0 z .�
D m regaims the applicant for Such permit to file a Signed,tlament that + TOTAL •,� PERMIT TO '
a
w m he is licensed pursuant to the provisions nC Om Contractor's Licenx' .
vii
Law(Chapter 9(commencing with Section 7000)ofDoision3ofthe. EHODeL a
4 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
o the ha,is for the alleged exemption.Any violutinn of Seclion 7031.5 STORIES TYPE CON$TR.
w. by any applicant for a pernit subjeet6lic applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not inure than five hundred dollars($500).): '
.-❑ I,as owner of the property,or my employees will,wages as BACK FLOW PROTECT.DEVICE 2,00 5CC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not -
intended br'offercd for sale (Sec. 7044. Business and P ol'c"kills DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:rhe Contractor's License Law does not'upply to an owner 01
property who builds or improves thereon,and who doe's such work FIXTURES-PER TRAP 4.00 .SO.FT.FLOOR AREA TOTAL ACREAGE
himself or.[1mu,b his own employees,presided that such improve-
..+emus are not intended or offered for sale.If,however,the•'budding GAS-EA.SYSTEM-I INC.4OUTLETS 4.00
or lder wiemmnll Is solJ within one year of completion, the owner-
builder will GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
have the burden of proving that he diJ noI build or int- RES IND CON ve arner
prove to,as mes s,of sale.). e INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ L as owner of the property',ani exclusively contracting with -
liccnsed contract ors to construct the projca (Scc.7044,Rusincss LAWN SPRINKLERS- 1 INC 5 V.BI 6.00_ -ASSESSORS PARCEL N0.
and Professions Code. I'lie Contractors License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3/4 - 5`3_3 5, r
contracts for such projects with a contractor(s)licensed pursuant to
the Contractors Liccnsc Law. SEWER-SANITAR V-STORM-EA.200ft/8.00 TRACT NO. PARCEL NO.
.. ❑, I.:un,xcmH under Sc,,-,B&P.C.I'orI WATER HEATER W/VENT 4.00
\Tx/ reason
Date Own,., WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO,
W'oRRliRs'COMPi: Sn'I' RtSlirstc' WATER TREATING EQUIP: 4.00
I I ): t,c
I hereby affirm that I have a Canilicale ofcomzent to selflua re, ---ZONING ENG.SITE NO.
or a certificate of workers Compensation Insurance.or a certified
copy detect(Slic.3900,LabCA
Policy No. Company
O ❑ Certified copY'iz hereby lurniahcd. FIRE SPHINK ENERGY T 24
Z 2 ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. v❑., N❑ v ❑ ' N❑
Applicant
I-' .PERMIT ISSUANCE . 6.00 FLooDZONE ,A.L.U.C.
fY - CERTIFICATEOF EXI;MP PION FROM WORK ISRS'
CON PL'NSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
w N N
o- D mid, salon need not be completed if the permit for one TOTAL ❑ ❑ ❑ ❑
:D Z hundred dollar,(5100)or less.). ..
U O 1 artily 0e, in the pc,formm,ce of the wurk fo,.1dell this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,1 shall not employ any'Perwn in mry manner so as to
U become subject to the Workers Compensation Law,of California: OV
BUILDING G•
O,w Dam Applicant ALTER OR'ADD TO MECH. 4.00
} fA NOI ICE TO APPLICANT: IC atcr making this Certificate()(lex-
F ? vMPlion.you should become Subject tn the Workers'Compcnsatiou APPLIANCE 4.00PLAN CHECK ,9J
provisions of the Labor Code, you most forthwith comply with LE
FEE
U site[]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 10MC.F.M.) 5.00 SEISMIC FEE Sd
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of Om work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVEFL100,000 B.T.U.)7.50 ELECTRIC
Lender's Address -
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 _
infnunation is correct. I agree to comply with all city and county - BOILER-COMP(3 H.P.'or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws ,eluting to building construction, and -
hereby authorize representatives of this City to enter upon'lm BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. ' MECHANICAL -
above-mentioned property for inspection purposes. -
(We) agree to sive, indemolfy and keep harmless the'City ut MISC.- a REFER TO ORD.
Cupertino against liabilities,judgments.'costs and expenses which 0 _ CONST.TAX
may
we. accrue a ai I said City-in conic ucncC of the
PERMIT ISSUANCE 3.0
y in any Y 6 4
gnnling o(thix�lcm,u MECH.CONT. LIC.NO. MECH. _
\ ' YI?ielieol/ ,Zl�n ,fi.�. ..J�2��
TOT TOTAL ss
1 Sig]�ature of Applican�] tmctoS�i' r te r
OFFICE COPY