3287 CITY 01' CUI'ERl'L110 INSPYGTIOC RECORD (Office Copy)
3287_ 10676 Rosewood__,_E/W. Dividers
• I'ER11IT 110, SANITARY DISI, 110. LOT NO ADDRESS
Re-Model Property Services
PROJECT OWNER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Buildinc _ 5125/83 Date Insp.
E.1ectrical _ Power Pole_
I'LumhLp,( Llndcrround
Nechnnica.l Rough 11iring
Temp. Gas/1'.1ect. IIa117;
Solar Ceiling
FLre S rinkler Fixtures Int/Ext _
Sign Hotors
Grounding
Misc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
r.;s
PLUDfBItJG
Gl.ectri.c Date Insp.
Plumbin • Backflow
llechanical Underground
Solar Underfloor
Pool Partial. Rough
•
Grading Rough Complete
Ptanning Solar Rough
Fire Dept. Water & Insulation
Health Dept. *Iain Drain
Building R/of/S Drain _
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation
Date Insp.
Pre-Ganite
Underfloor S.M.
Slab-Hembrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One Hour Shaft _
Diaphrams CondensaLe Drain
Seismic Bracing Equipment Anchorage
Walls-Panels rues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/F.xt.
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONL
1
BUILDING PROJECT IDENTIFICATION ERMIT NUMBER _ y
'oUI DING _ APPLICATION & PERMIT n O I�
AOORE55 eAgT�.t.xsf [�O
Q1JId BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S P LAN CH ECK VALI DAT ION
NAME OTY. ELECTRIC PERMIT FEE
ONE
CONT CTOR'S
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
I.C.NO. LIGHTING FIXTURES 5.00/1.00 MAy 2' op
CONTR
ADDRESOTOR's - APPLIANCES-RESIDENTIAL 4.00 s�/ ]p®�
PHONE PANELS 5.00 D%0 ATION
O 6.00 ARCHITECT PLAN CHECK FE Ilj�j.NO.
DR SIGNS �
ENGINEER LIC.NO. SIGNS TRANS. 3.00 I
nooA'EOn ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00 / 1
ADDRESS MOTORS SEE FEE SCH.
ADDRESS AAAA./
- SERVICE CHANGE 10.00 �I
O M 2
r=C o LICENSED CONTRACTORS DECLARATION
w
a o w I hereby
encin affirm that 1 oro licensed under provisions of Chapter ll ISSUANCE DATE
H D Professions
with Section 700e itil'Division 3 of leeect.Business:uul it
a SLOG. ELECT. PLG. MECH.
H w 2 Professions Code,and my license is in full lone and effect. ❑ ❑ ❑ ❑
o7,m o License Class Lie,Number � ---
Dale Contractor
r s BUILDING PERMIT '!
X ¢O n C OWNER-BUILDER DECLARATION
is ; w y I hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD INFORMATION
w VALUATION $/FT.
Fu0J Law the following reason fSec,7031.5,Businessund Professions PERMIT ISSUANCE 6.00
Code:,Any city or county which requires a permit to construct,alteq - -
aH ELEC.CONTR. LIC.NO.
, a improve,demolish,or repair any structure,prior to its issuance,also ELEC
C u requires the applicant for such permit to file a signed statement that TOTAL PEA rt TO
A aa m Ile is licensed pursuant to the provisions of the Contractor's License _
H 2 i
Law(Chapter 9(commencingwith Section 7000)of Division 3 of the G�
f 4 o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
H 8 the basis for the alleged exemption.Any violation of Sccrion 7031.5 STORIES TYPE CONSTR.
by any applicant fora permit subjects the applicant tnacivil penalty -
ofnot more than five hundred dollars(5500).1: ALTER-DRAIN&VENT-WATER (EA.) 4.00
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 2.00
their sole 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:'fine Contractors License Low does not apply to lin owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such improve-
mentsarenorintended or offered For isownemployeesale.Tided that such
building GAS-EA.SYSTEM-11NC.4OUTLETS 4.00
or improvement is sold within one year of cognpletion' the owner- GAS-EA.SYSTEM-OVER 4 (EA.)builder will have the burden of proving that he did nor build or int- 1.00 BUILDING USE
prove for purpose ofsale.l. RES IND CON PB Corer
❑ I,as owner of[tic property,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 Q ❑ ❑ ❑ 1-1
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Cmometur's License Law does not apply / I
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS OVER 5IEA.) 1.00
Contracts for such projects with a contractous)licensed pursuant to
the Contractors License Law, SEWER-SANITARY-STORM EA.200Pt/8,00 TRACT NO. PARCEL NO. i
❑ I um exempt under Sec. ,R.kP.C.rbr Ibis WATER HEATER W/VENT 4.00
reason
�G- WATER SYSTEM 4.00
7 'TDate Owner. ACC.DATE ACC.FILE NO.
WORK IiRs'COMPINSA'I'ION DECLARAT ION WATER TREATING.EQUIP. 4.00
I hereby affirm that I have a certificate of consent m self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.380(L Lab.C.).
Policy.No. Connpany
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is fled with the city inspection.division. I
O Applicant MISC.- REFER TO ORD. Y [] No Y ❑ N[D e
0: CERTIFICATE 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZDNE A.L.U.C. -
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG.
C O (This section need not he completed if Ice permit Is for line TOTAL Y N YE] No
Z eundred dollars($100)or less.)
U O I certify that in the performance of the work for which this per- -OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, I shall not employ any person in any manner so as to
O U become subject to the Workers'Compensation Ltiws of California. �v
a. Dmc Applicant BUILDING /
} N NOTICE TO APPLICANT: If,alit.making This Certificate of rix- ALTER OR ADD TO MECH. 4.00
♦- Z emption,you should become subject to the Wo.keri Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C.1 such provisions or this permit shall be deemed revoked'.' AIR HANDLING UNIT(TO 10=CF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 5.00 SEISMIC FEE t"O
I hereby affirm thin there is a construction lending agency for EXHAUST HOOD WITH DUCT) 2.00 J
the performance of the work for which this permit is issued(Sc, - MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name H EATI NO U N IT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) '3.00 -
into....adon is correct. I agree to comply with all city and county - PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby auth...De representmives Of this city to Corer upon the
above-mentioned properly 1m inspection purposes. BOILER=COMP'IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in tiny way accrue against said' 'ity in c.mww enc of t e
grouting of this R'nliL / MECH.CONT. LIC.NO. MECH.
y 3 T°TA` TOTAL
Sign urecan nnrr t Do
OFFICE COPY