3284 CfTY 01' CUP17I HO INSPECTIOI' RECORD (Office Copy)
32£34 _ 10646 Rosewood E/bl Dividers
I11;1UfIT NO. SANITARY DIST. NO. LOT 110. ADDRESS
Re-Model Property Services
PROJECT OUNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
BU Ll ding _ 8Date Lnsp.
I;.le_ctrLcal Power Pule
Plumhinp Underground — --
ifechani.cal Rough Miring
Temp. Gas/1'slect. 11alls _
Solnr Ceiling
Fire S rinkler Fixtures Int/Ext
Si ,n Hotors
Grounding
Hisc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved
Date Insp.
PLUMBINGE1.ectri-c
Date Insp .
Plumbi11 , Backflow _
Nechanical Underground
Solar Underfloor ---
Pool Partial. Bough
Gradin , Rough Complete
I'Lanning Solar Rough
Fire De t. Water & Insulation
Health Dept. Main Drain
Building R/of/S Drain _
Other Gas _
Other.
BUILDING Not Approved
Date Insp.
Pad Certification NECAANICAL
Foundation
Date Insp.
Pre-Gunite Underfloor S.H.
Slab-Ilemhrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & flood
Tiedowns One flour Shaft
D.i.aphrams Condensate Drain
Seismic Bracing I,quipment Anchorage
Plal..Is-Panels Flues & Comb. Air --
]Tame Other
Lnth Not Approved
Ilallboards Int/F.xt.
Firewalls
Other
Not Approved
APPLICANT TO,FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY,
BU LDI NG PROJECT 1 DENT[FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT
D
AD3284
REss �
EA-St, BUILDING —ELECTRICAL—PLUMBING—MECHANI
OWNE 'S PLAN CHECK VALIDATION
AME QTY. ELECTRIC PERMIT FEE d,1
. PHONE O
COINTHIPCTO.30
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
D
Rs LIC,NO, LIGHTING FIXTURES •5.00/1.00 J
1983
ADDRESS PPLIANCES-RESIDENTIAL 4.00 OfC/ PpL
ICATIONPHONE PANELS 5.06
ARCHITECT SIGNS 6.00 PLAN CHEC E P.O.NO.
OR
ENGINEER r
LIC.No, SIGNS TRANS. 3.00 -,
ADDRESS ENG. SPECIAL CIRCUIT 5.00 - PERMIT VALIDATION
ztv ITEMP.METER OR POLE INS. 75.00 /I
AMOTORS SEE FE_E SCH.
ADDDRESSDRESS
SERVICE CHANGE 10.00
02 LICENSED CONTRACTORS DECLARATION
a u w I hereby affirm that I am licensed under provisions of Chapter 9 #11ANC"E DATE
H f H (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H N z Professions Code,and my license is in full force and effect ❑ El ❑ ❑
o 0 m W License Class Lic.Number
Date Contractor
< r F �� BUILDING PERMIT
¢ IC ¢ OWNER-BUILDER DECLARATION
0 a" MISC.— REFER TO ORD INFORMATION
X g y I hereby affirm ing I am exempt from the Contractor's License
r u.o ¢ Law for the following reason(Sec.7031.5.Business and Professions PERMIT ISSUANCE 6 00 VALUATION $/FT.
Code:Any city or county which requires u permit to constrict,alter, _
y ¢a O improve,demolish,or repair any structure,prior to its issuance,also ELEC,CONTR. LIC.NO, ELEC.
La — DLL requires the applicant for such permit In lilca signed slulcnnnl that TOTAL PERMIT TO -
K he is licensed pursuant to the provisions of the Contractor's License
r z i Law(Chapter 9(ecmmencing,soth Section 7000)of Division 3 of Ne
E 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
term the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i by any applicant for a permit subjects the applicant lou civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars IS5001.):
❑ I,as owner of the Property,of my employees with wages us BACK FLOW PROTECT. DEVICE 2.00
their sola compensation,will do the work,and the structure Is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:'fire Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.60 50.FT,FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such imsirove-
mentsxrrthroughhis not onc...offered oyces, 00vi however,net,the budding GAS EA.SYSTEM-1INC.4OUTLETS 4-00
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 1.00 . BUILDING USE
builder will have the belle,,of proving flat he did not build or im-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. HES IND CON PB ower
CII,as owner of the property,am exclusively contracling with 20.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSO SPARCELNO.
and Professions Code:The Contractor's License Law does not apply �' i✓(s
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EAv) 1,00
contracts for such projects with a contractor(%)licensed Pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PA CELNO. '
❑ I am exempt under Sec. ,B.&P.C.Inr this WATER HEATER W/VENT 4,00
eason_
Dale Owner— � WATER SYSTEM 4.00 ACC.DATE ACC:FILE NO.
PIXI
W'O K ERS'COMPE.NSATION DECLARATION WATER TREATING EQUIP. 4.00
_ I hereby affirm that I have a certificate of ennsent to sell'-insure.
or a certificate of Workers'Compensation Inwrunce,or it certified ZONING ENG.SITE NO.
copy the...A(See 3800,Lab.C.L _
Policy No. Ccnnpuny
O ❑ Certified copy is hereby famished' FIRE SPRINK ENERGY T24
Z Z ❑ Certified copy is fled with the city inspection division. MISC. REFER TO ORD.
O Applicant Y❑ No , Y ❑ N❑
CC W CIFR'I'IFICATE OI'EXEMPTION PROM WORKERS' PERMIT ISSUANCE - 6,00 FLOOD ZONE A L.U.C.
LU COMiPENSATION INSURANCE - PLG.CONTR. LIC.NO. PLG,
CL,0 ('Phis section need nal be completim it tire permit i% for oreTOTAL V❑ N❑ Y ❑ N❑
Z hundred dollars IS 100)or Iris.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL r mit is issued,I shall not employ any person in any mmnner so as to
O W become subject to the Workers'Compensation Lawsof Calili rnia.
Dam Applicant BUILDING J
a ALTER OR ADD TO MECH. 4.00
} m NOTICE 'T APPLICANT': If,after making this Certificate of Ex-
Fz emption,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 provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 3.00
CONSTRUCTION LENDING AGI7NCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 .SEISMIC FEE iS1f
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.I 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLEI 3.00
information o correct. 1 s dating to comply will( all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and sem Inws roc to building const old C, and
hereby authorize representatives of this city to enter upon the
above-mentioned properly for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. ' MECHANICAL
(We) agree to saveindemnify and k• p harmless the City'of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, osis and expenses which PERMIT ISSUANCE 3,00 CONST.TAX
may in any way accrue against said .ity in consequence of e
granting of this Pen iL MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signanrra of
pplic.nt/C...ittallt.0 Da
OFFICE COPY