3271 C11'Y 01' CUPERTINO INSPECTION RECORD (Office . Copy)
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3271_ _ 10667 D Rosewood NIS DjvidyjS_
� PI:PJIIT NO. SANITARY DIST. NO. LOT NO. ADMIFSS
Re-7Sodel Property Services
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
nil ildinr• 5/25/83 Insp.
Electrical 5/25/83 Power Pule_
Plumhia Underground
ilechnnical Rough Niring _
Temp. Cas/Elect. Ila 1.l.s
Solar Ceiling_
Fire Sprinkler Fixtures Int/Ext _
Sign Hotors
Grounding
Misc. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved _
Date Insp.
r„s PLUMBING
Electric Date Insp.
Pliimbin , Backflow
Mechanical Underground
Solar Underfloor
Pool Partial. Rough
•
Crading Rough Complete
Planning; Solar Rough
Fire Dept. dater & Insulation
Health Dept. *fain Drain
Building R/of/S Drain _
Other Gas _
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.N.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Ploor Steel Grease Duct & Hood
Tiedowms One (lour Shaft
D.i_aphrams Condensate Drain
Seismic Bracing Equipment Anchoraf;e
Ilal.ls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Ilall.boards Int/Ext.
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —= USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION 4P44— - PERMIT NUMBER
,U.IN5 g�pµit, MIN)
& PERMIT
\ 5 BUILDING —ELECTRICAL—PLUMBING-MECHANI 3271
OWNER'S r {•lr,� PLAN CHECK VALIDATION
"QE OTY. ELECTRIC PERMIT, FEE .
CONTRA OR'$,
lG• PnoNE t
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
LIB.NO, LIGHTING FIXTURES 5.00/1.00 _�'A�D
ADDRESS DR's 'Z APPLIANCES-RESIDENTIAL 4.00 MAy
PHONE - PANELS 5.00 DATE OF941
ARCHITECT SIGNS 6.00 PLA ECK FEE .NO.
OR Clay Of Cu
ENGINEER
LIC,ND. SIGNS TRANS. - 3.00 - PBf
ARCL OR ENG. - ^ PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANT,
ADDRESS - MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00'
O o o_ LICENSED CONTRACTORS DECLARATION /Yso-EE -
rwa U 1 hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
Tri w BLDG.. ELECT. I PLG. MECH.
r w i Professions Code,and my license is in full force and effocL'
Z o m - License Claus Liu Number
o z -o Date _ Contractor
a is f a - BUILDING PERMIT,
¢ ¢ sE OWNER-BUILDER DECLARATION
IS
d so INFORMATION
wa, g¢ r I hereby affirm that I am exempt from the Contractor's License MISC.— - REFER TO ORD
Law forthe following reason. 7031.5,Business and Professions PERMIT ISSUANCE 600 VALUATION $/FT.
Code:Any city or county which requires a permit Dermot ruch alt", O�
aEQ improve,demolish,or repair any structure,prior to Its issuance,also EI-EC CONTR.: LIC.NO. ELEC. Z,
w
¢ requires the applicant for such permit to file a signed statement that TOTAL
X m a. he Is licensed pursuant to the provisions of the Cmimactor's License PERMIT TO
HZQr Law(Chapter 9(commeneiagwith Section 7000)of Divisian3 oflhc .a 6M�BLrL
4 O Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT _ --FEE
¢ H $ the basis for the alleged exemption,Any violation of Seetion 7031,5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00
'
of not more than five hundred dollars f$500).):
❑ 1,as owner of the properly,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,AR EA,CON D. 4.00 -
Code:The 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 4.00 50.FT,FLOOR AREA TOTAL ACREAGE
himself re through his own employees,Provided Owl such improve-
ments are throughot his or empld for salro if,however,that such
he building - GAS-EA.SYSTEM-1 1NC.4 OUTLETS 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 int
prove for purpose of sale.). INDUSTRIAL WASTE INTER2000 RES IND CON PB Other
. .
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to comlruct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply -
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3J-6 —zz.Co 3 �,r f
contracts for such projects with no contractor(,)licensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exempt under See. ,B.&P.C.for this WATER HEATER W/VENT 4.00
on
Date Owner Li WATER SYSTEM 4.00 ACC.DATE 'ACG FILE NO,
WORKERS, MPENSAI'ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate of consent to self-inwm. ZONING
or a certificate of Workers'Compensation Insurance,or a cerci fed ENG.SITE NO.
copy lhereof(Sec.3500,Lab.CA - -,
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant - Y ❑ N❑ Y ❑ N❑,
~ w - PERMIT ISSUANCE 6.00 -
� CERTIFICATE E EXEMPTION IONPROMWORKIiRS' ROOD ZONE A.L.U.C.LU
W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not be completed if the ponnut is for one - TOTAL Y❑ No Y ❑ N❑
hundred dollars IS 100)or less)
U O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,I shall not employ any person in any manner so ax to
U become subject totheWorkers'Compensation Lawsof California.
y Date ApplicantALTER OR ADD TO MECH. -4.00 BUILDING ,�a 0�
} W NOTICE TO APPLICANT'. If,after making this Certificate of Ex-
I— Z emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
3 such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.EM.) 5.00 SEISMIC FEE �y-V
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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT..(OV ER 100,000 B.T.U.)7.50 )d
Lender's Address ' ELECTRIC p"t ��
1 certify that I have read(]us application and stale that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply.with all city and county - PLUMBING
ordinmces and state laws elating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby mnamed rpurposes.epresentatives of this city to enter tip the BOILER-COMP.IDver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-ownd'ariz property lot inspection.
(we) agree 1. save, indemnify and keep horn less the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgme ts, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against st�d City in consalue ce of the
granting of this pe hIt - MECH.CONT. LIF NO. MECH.
TOTAL TOTAL 5<(p
Signrogn ur�nl/Contl a for Dale
OFFICECOPV