3286 ClPY OF CUPERTMO IHSPYCTIOV RECORD (Office .Copy)
• 32$6_ 10686 Rosewood NIS Dividers
PEPJIIT N0. SANITARY DIST. NO. LOT N0. ADURFSS
Re-Model Property Services
PROJECT OUNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
BuLldinn. 5/25/83_ Date Insp.
Electrical Power Pule
I'lumhin" Undercround — --
1lcchanLcal Rough Miring _
Temp. Gas/IRlect. Halls _
Solar Cc 111
Tire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved _
Date Insp.
r,"s PLUMBING
Electric Date Insp.
Plumbing Backflow
iiechanical Underground
Solar Underfloor
Pool Partial Rough
• Gradin , Rough Complete
I'Lanning Solar Rough
Fire Dept. (dater & Insulation
Health Dept. "lain Drain
Building R/of/S Drain _
Other Gas _
Other
BUILDING Not Approved
Date Insp.
1'ad Certification MECHANICAL
Foundation Date Insp.
Pre-Gun.i.te Underfloor S.M.
Slab-Nembrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & Hood
Tiedowns One hour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equi.pmenC Anchorage _
a1.1s-1'ancls F] ues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext .
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI- POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION ERMIT NUMBER
noose:s IJlX0.1't4¢g0r9�-N. APPLICATION & PERMIT �Q�^
BUILDING -ELECTRICAL-PLUMBING-MECHANI U V
..DEH s PLAN'CHECK VALIDATION
•
I(E�/E _ 1k((5 r� PAAD ELECTRIC PERMIT FEE A,-1 PHONE D
CONT cross OUTLETS-SWITCHES-RECEP, 5.00/1.00
NAME
LIC.NO. LIGHTING FIXTURES 5.00/1.00 /`I 51983
ADDRESS
APPLIANCES 4.00
AooREss •- ^
PHONE - PANELS 5.00 /ty Of b ucnnoN
ARCHITECT SIGNS 6.00 PLAN CHECKTI P.C.NO.
OR
ENGINEER -
' uc,NO, SIGNS TRANS. 3.00
ARCHE F ENG, - SPECIAL CIRCUIT 5,00 PERMIT VALIDATIONSS
-
ZIR EMP.METER OR POLE INS. 15.00
APPLICANT MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00 /,UANCE
���
0 o LICENSED CONTRACTORS DECLARATION
a u v I hereby affirm Thal I am licensed Under provisions of Chmltar 9 - ATE
Z w (commencin with Section 7000)of Division 3 of the Nosiness and
H 4 > g BL G.
r O i Professions Code,and my license is in full force and effect. ELECT. PLG. I MECH.
Z O 2 - License Class Lie,Number El ❑ ❑
mr Dale Contractor
m s BUILDING PERMIT
or 4 OWNER-BUILDER DECLARATION -
a u, u INFORMATION
se ;LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
r w O 4 Law for the following reason.(Sec.7031.5,Businessand Professions - PERMIT ISSUANCE 6.00' VALUATION $/FT.
-' Code:Any city or county which requiresu parilil loconetracl,alley,
ar ¢¢ 40 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC. ,(JVr+.lRa
LL requires the applicant for such permit to IIIc a signed statement that TOTAL PERMIT TO
E:
$m he is licensed pursuant to the provisions of the Contractor's License
I- z >
Law(Chapter 9(commencing with Section 700(def Uivision 3 ofthe
4 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT - FEE
I t o
M F $ the basis for the alleged exemption.Any violation o(Section7031.5 STORIES TYPE CONSTR,
a- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars($5001.):
❑ 1,as owner of the property,or my employees with wages as BACKFLOW 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:The Contractah License Law does not apply to an owner of
property who builds or improves thereon,and who does spell work FIXTURES-PER TRAP 4.00 $0.FT.FLOOR AREA TOTAL ACREAGE
to
himself or through his own employees,provided that such improve-
meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 aullowG USE
builder will have the burden of proving that he did not build or im-
provefor pUTOscOfsale.). IIND- CON PR Other
❑ 1,as owner of the property,am exclusively contracting with - ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the p...PnH(Sr,, 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSOHS PARCEL NO.
and Plnl' ....s Code: The Compel r'>Licanx:Law does not apply 2
to an owner of property who builds or inl loves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3/G �✓
,. contracts for such projects with a contractorto licensed pursuant to
the Contractor's License Law. - SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&RC.for this WATER HEATER W/VENT 4.00
reason
Dated owner WATER SYSTEM 4.00 ACC.OATE ACC.FILE NO.
r0lWORCI"ISATIONDIiCI.ARATION WATER TREATING EQUIP. 4.00
I hereby affirm that 1 have a certificate of consent to self-insure, - -
or a certificate of Workers'Compensation Inwrmnce,or a ccrlil'ied ZONING ENG.SITE NO.
copy thereof(Sec.3900,Li b.C.).
Policy No. Company
O ❑ Certified copy ix hereby furnished. FIRE SPRINK ENERGY T 24
z ❑ Certified COPY AS filed with the Lily inspection division.
0 Applicant MISC.- - REFER TO ORD. Y❑ N❑ Y ❑ N❑
~ viPERMIT ISSUANCE 6.00
CCCLRTIPICA'1'Ii OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
W COM PF:NSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL O ('Phis section need not be completed if the Penult[ is for one TOTAL Y❑ N❑ Y ❑ N❑
D Z bundmd dollars IS 1001 Or less.)
U O 1 certify that in (lie performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY "
LL H mit is issued,I shall not employ any person In any manner sn as ua `
U become subject to the Workers'Conlpensat ion Laws of California.
0ate Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
y Drsd
} N NOTICE TO APPLICANT: If,after making This Certificate of rx.
? 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 provisions or this permit shall be dce...I revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.F.M.) 5.00 SEISMIC FEE ' so
I hereby affirm that there is a construction lending agency fm' EXHAUST HOOD(WITH DUCT) 2.00
file performance of tlm work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T,U.1 4.00
Lender's Name H EATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that 1 mermaid this application and state that the above VENTILATION FAN (SINGLE) 3.00
Information n correct I agree to comply with all city and county PLUMBING
ordinances and state laws relating m building l city action,nd co and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 -
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes; BOILER-COMP (Over 700,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to Sovc, indemnif and keep harmless The City of - misc.- REFER TO ORD.
Cupertino against Iiabilities,judgr encs, costs and expenses which CONST.TAX
ain
may in any way'accom agsaid City in con"ace o the PERMIT ISSUANCE 3.00
granting Of this •rmiL MECH,CONT. LIC.NO. MECH.
TOTAL TOTAL �SvO
I
- Sigl cur of Appli ant/C roc or Date
OFFICE COPY