3250 ...... ....
GfFY OF CUPFRTIMO IVSPYGTIOV RECORD (Office .Gopy)
325r) 19c)90 Olivewood,._Unit D NZS Dividers
PEPiu'r No. SANITARY—DIST. NO. LOT tF�-. ADDIIESS
Re-Model Property Services
PROJECT OWNER JOB SITE PHONE NO.
PER11IT ISSUED Date ELECTRICAL
Bu Ll d inp, 5 T2-5-F8—3 Date Insp.
Electrical 5/25/83 Power Pole_
T1-1711-�711 UndorEround
Moch'in i cal Rough Wiring
Temp. Gns/1"Icct. 11a1ls
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Hotors
Grounding
Hisc. jeTgp- Power
Other
FINAL INSPECTIONS Not ApProved
Date Insp.
PLUMBING
Electric Date Insp.
Plumbing Backflow
Nechanical Under round
Solar Underfloor
Pont Partial. Rough
• Grading Rough Complete
Planning Solar Poiigh
Fire Dept. Water & Insulation
Health Dept. 'fain Drain
Building
R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundat ton Date Insp.
Pre-Gunite Underfloor S.H.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fircplace,
Floor Steel Grease Duct & Hood
Tiedovins One Hour Shaft
D j a p I i raMS Condensate Drain
Sei.smE- EquipmentAnch-ur-a'�-,p
Flues & Comb. Air
Frame 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
FXJILDING PROJECT I DENTIFICATION - RMrc NUMBER
BUILDING GN1T I�c>z 4�g .1
Wry APPLICATION & PERMIT (�
ADDRESS J
taqq _ ,9 L BUILDING -ELECTRICAL-PLUMBING =MECHANICA
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
PHONE
cONTR OR
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00 ,po
LIC rvo,
5 LIGHTING FIXTURES 5.00/1.0 'AID- -
CONTRACTORS
ems
ADDRESS APPLIANCES-RESIDENTIAL - 4.00 OD dv
PRONE PANELS 5.00 MkxTa Es P ON
AnCRITECi SIGNS 6.00 PLAN CHECK FEE P.C.NO.
On
ENGINEER
' LIC NO SIGNS TRANS. 3.00 City of CuppEtini
ARCH.OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
PIP TEMP.METER OR POLE INS. 15.00
ADDRESS
MOTORS SEE FEE SCH. /1�
OORE55 ,ll/JJJ
SERVICE CHANGE ' 10.00 n,/✓�/\I/
w o O - LICENSED CONTRACTORS DECLARATION -
G iJ U I hereby affirm that 1 um licensed under provisions of Chapter 9 ISSUANCE DATE
H < w Icmnmencing will, Section 7000Yof Division 3 of the Business and
BL ELECT. PLG: MECR.
R H z Professions Code,and my license is in full force and effect
z o m - Li Genu Class Lia Nunn be ❑ ❑ ❑•
9 -D Doc Contractor
a Y E -a - I - BUILDING PERMIT
a ¢ OWNIi R-BUILDER DECLARATION INFORMATION
aoa ° - m MISC.- REFERTOORD
g 4 hereby a011O that SO ,xennpt frons the oicsow for v License
aoa Coale:Law Any city
or count which
hrequirs 5,tlnik otcontruct.ssions PERMIT ISSUANCE VALUATION S/FT.
Cods: ,, iI or taunt hichreruiresa ninnts issuance.
suance.mq 6.00 '� �/01/
w pcm
IS w BE ¢ improve,demolish,or repair any sVuclurc,prior to its ix ounce,also ELEC.CONTR. LIC.NQ TELEC
OTA
IY E O Q requires the applicant for such permit t0 file a signed\luletnetII that TOTA p� PERMIT TO
n w m a- he is licensed pursuant to the provisions of the Contractors License
FZQLaw(Chapter 9(colmnencine with Section 7000)of Division 3 of the s
i D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
aim by any npplic-ot for a permit subjects the applicant a cieilpenafly - - ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars(S5001):
❑ I.as than
of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 oee.GROUP RES.UNITS
(heir sole compensation,will do the work,and the sl octan is not
intended or Offered for sale (Sec,7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 x- ,
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,:md who dues such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employs,,,provided firm such int prove-
.. rocllts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or improvcmad Is sold within oli,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 im-
provefor purpo.seofsmc.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON . PS 0mm
O I,as owner of the property,am exclusively contracting with ❑ ❑ ❑' '❑ ❑
licensed contractors to construct the project(Sec. 7044,Bo,iness LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Profcssions Code:l'he Contractor's License Law docs not apply -
to un owner of property who builds or improves thereon.and who LAWN SPR IN KLERS-OVER 5.(EA.) 1.00F
contracts for such projects With cuntractor(s)licensed pursuant 10 SEWER-SANITARY-STORM EA. 200ft/8.00NO. �' PARCELING.
the CmHRctor's License Law.❑ .I mn exempt under Sec. ,IT&P.C.lie cis WATER HEATER W/VENT 4.00
reaf011Date Owner- WATER SYSTEM 4.00TE ACC.FILE NO.
s'C nl I . ION DIC1.ARATION WATER TREATING EQUIP. 400
1 hcrcby affirm that I have a certificate nfcimscnt to self-insure. G ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certifieA copy t ereof(Sec.3800,Lab.CJ.Policy Nn. Company
0 ❑ Certified copy is hereby fDrnLhcd. RI NK ENERGY RP42 ❑. Certified copy is filed with the My inspection division. MISC.- REFER TO ORD.O-. Applinmt N❑ v ❑ N❑fr i2 CIi If 1117[CAIli ol'l:XI;M PT ION I'ItOM WOIt K Ii RSd PERMIT ISSUANCE 6.00ONE L.U.C. -
_ COhIPENSATION INSURANCEPLG.GONTR. LIC.No. PLG.O '(1his'section need not he completed if.the permit is fur one TOTALN❑ ,Y ❑ N❑Z hundred dollar,IS 100).,less.)
0 O 1 certify Out in the performance of the work en which III,per- OTV. MECHANICAL PERMIT EE SUMMARY
F mit is issued,I shall not employ any person in any manner vl as toU beconm subject Io the Workers'Compensation Laws of Calih;niu. ��w Date ' Applicant ALTER OR ADD TO MECH. 4.00NG
} y NOTICE TO APPLICANT: If,after making this Certificate of Ex- _
I- Z eruption,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 shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 3.00
-CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE yso
I hereby afrinn first there is.a construction lending agsnay for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097.0,,C.). HEATING UNIT (TO 100,000 B.T.U.) 4.00
Lender's Name HELECTRIC
EATI NG UN IT 100,000 B.T.U.)7.50 Jv
Lander',Address ,r
I certify that l havura,dthieappl,toliot and,tate th:u the above VENTILATION FAN (SINGLE) 3.00 -
PLUMBING
t. I agree m cum I wiOl all cit InJ octant
LU
infinmutlon is tarot g pY Yt Y �gOILER-COMP(3 H.P.or 100,000 B.T.U.14.00
htoolh nGus and stmt Taws Relating m building ron ic, ion. and
lancby euthoriie representatives of Ihis oily to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCM. MECHANICAL
abuvnmem ioneJ property for inspection pugmxs
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and ex pouts which CONST.TAX ,
may in any way accrue againa d City in cunscqucnce of the PERMIT ISSUANCE 3.00
granting of(his 1 Fit de
sh MECH.CONT: LIC.NO. MECH.
� eorA TOTAL
SiF alurc u ApplcantiC tr etor + Dare
OFFICE COPY j