2300 (2) Cl VY 01' CUPFPTINO INSPECTIOV RECORD (Office Copy)
2300 829 Rose Blossom Dr.
1'I:RitI'r NO. SANITARY DIST. NO. LOT NO. ADDIit;SS
I L R. Schroeder
.- �� F�%
PRO CT ¢-k. OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Bui]di.nr _ _8_ Date Insp.
Electrical Power Pole _
I'Limlling Under , __
round
ilechanical Rouhh !•tiring
Temp. Gas/lilect. halls _---
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext _
Si ,n Motors
Grounding
Hisc. Temp. Power
Other
FINAL. INSPECTIONS Not Approved-
Date
MovedDate Insp.
"s - PLUMBING
Electric Date Insp.
Plumbing Backflow _
'lechanical Underground
Solar Underfloor
Pool Partial Rouph
Grading Rough Complete
Planning
Solar Rough
Fire De t. Plater & 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-Gunite Underfloor S.M. _
Slab-Hemhrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
floor Steel Grease Duct & llood
Tiedowns One Hour Shaft _
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
flal.ls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext.
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
U R R
/ BU I LDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT ,,
00
AooR
Ess
LmNG BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
XOWNER'S h.ME PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
roPHONE
NAMERAcaoRS OUTLETS-SWITCHES-RECEP 5.00/1.00
'-�
LIC.No. LIGHTING FIXTURES 5.00/1.00
CONTRACTOR
ADDRESS TRAC APPLIANCES-RESIDENTIAL .4.00
PHONE _ PANELS 5.00 DATE OF APPLICATION
OR
ARCHITECTSIGNS 6.00 PLAN CHEC77 P.C.NO.
ENGINEER
uc.No. SIGNS TRANS. 3.00
ADDRRESS END. PERMIT 5.00 PERMIT VALIDATION
zip jTEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
AOORE55
SERVICE CHANGE 10.00 L� o
o o LICENSED CONTRACTORS DECLARATION
rt u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N (commencing.with Section 7000)of Division 3 of the Business and
Q c BLDG. ELECT. PLG. MECH.
H N Licen,.Professions Code,and my license is in full force and effect ❑ ❑ ❑
oz w License Class Lin.Number Date.Contractor
m s - BUILDING PERMIT
¢ ¢w a OWNER-BUILDER DECLARATION
o INFORMATION
u.
r'xa g u N I hereby affirm 1haLl am exempt from the Contractor',License MISC.- REFER TO ORD
u 0 4 Law for the following reason.(Sec.7031.5,Businessd lh
anofess'ions VALUATION
H - PERMIT ISSUANCE. 6.00
Code: e,dem y demolish,
county whiny Structur e p riot In cons issuance,
alter, �� Pv
¢ ¢ Q Q improve,demOlsh,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a w0 ¢ requires the applicant for such Perini[to tile a signed Statumont that TOTAL PERMIT-TO
$ y he is licensed pursuant to the provisions of the Contractor's License
H z Law(Chapter 9(commencing with Section 7000)of Division 3 of the
i 4Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE
2 I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
u ; by any applicant for a permit subjects the applicant toa civil penalty
of not more than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 4.00
❑ I,as owner of the property,or my employees wilh we
as BACK FLOW PROTECT.DEVICE 2;00 OCC.CROUP RES.UNITS
their pole comp illiti n,will do the work,and lite sire"me is not
intended or offered I'or sale (Sce 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License law does not apply to do owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SG,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-1INC.4 OUTLETS 4.00
t or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
prove for purpose of sale.). . INDUSTRIAL T RES IND CON PB Omer
❑ I,as owner of the property,am axclusivel 20.00 0 -0 0 ❑ ❑
P I' Y� Y contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN.SPRIN KLE RS- 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 property who builds or improves thereon,and who LAWN SPRINKLOV,E 1,00
contracts for such projects with a contractmts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA. 200ft/6.00 TRACT NO. PARCEL NO.
❑ lam exempt under See .N.&P.C.for this WATER HEATER W/ 4.00
reason *Xlei
Date owner WATER SYSTEM 4.00 ACC.DATE qct.FILE No.
W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that 1 have a certificate of consent¢s rel Gin sum,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy N..-Company
O ❑ Citified copy is hereby forinslich FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC- . .REFER TO ORD.
F O Applicant V EJ N V N
� N CERTIPICATIi OF EXEMPT ION PROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
uJ > COMPFNSATION INSURANCE PLG.CONTR. LIC.NO.CL PLc.
Z This section need not be completed if the permit is for one TOTAL Y 0 NE) V ❑ N�
hundred dollars(S 100)or less.) -
U O I certify that in (he performance of the work for which this per- QTY. MECHANICAL PERMIT - FEE FEE SUMMARY
L F- mit is issued,I shall not employ ny person'n any manner so as to
htcomesyplem to the Workers' mmpensaf Last's of Califyria..
ODate$_`)-�7.Applicant S.ty.(�[.f�- BUILDING b
>_ y OTICE TO APPLICANT: Ih attar muki this Cert it ic.nc of Lx- ALTER OR ADD TO MECH. 4.00 � /�
H option,you should become subject to the Workeri Compensation APPLIANCE 4.00 PLAN CHECK 6'O
provisions of the Labor Code, YOU must forthwith comply with FEE
U such provisions or this permit strait be deemed revoked. AIR HANDLING UNIT(TO 10X100 C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10)D09C.F.M.) 5.00 SEISMIC FEE
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.L HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
(.certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information 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
ereby autherac representatives of this city 10 enter upon Inc BOILER-COMP (Over 100,000 BTU) FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. -
(We) agree hr save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT-ISSUANCE 3.00 CONST.TAX
9' in any way aL rue against said City in consequence of the
g tog 0(this p MECH.CONT. - LIC.NO. MECH"
$� .$'7. TOTAL TOTAL
signature of Ap unnt/Contractor Uatc
'OFFICE COPY