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3270 (2) CITY 01' CUPE.RI'1NO INSPECTION RECORD (Office Copy) _3270 _ .10647 D Rosewood N_/S Dividers • PERMIT 110, SANITARY DISI. NO. LOT 1.10. ADORPSS Re-Model Property Services ' - PROJECT OfdNER JOB SITE PHONE NO. PERMIT ISSUED Date ELECTRICAL ISui] dinr ___ 5/25/83 Date Insp. Electrical 5/25/83 Power Pole I'lumhi lgr IInderround llcchani.cal Rough Uiring Temp. Cas/E1ect. Uaal.l .s _--- Solar Ceiling_ Fire Sprinkler Fixtures Int/Ext Sign Rotors Grounding Misc. Temp. Power _ Other FINAL INSPECTIONS Not Approved _ Date Insp. r'°s -- PLUMBING F,1. Date Insp. Plnmbin . Backflow 'techanical Underground Solar Underfloor _ Poni Partial. Rough • Gradin , Rough Complete Planning DSolar Rough F _ irere De t. Water & Insulation _ Health Dept. 'fain Drain Puildin R/of/S Drain _ Other Gas Other BUILDING Not Approved Date Insp. Pad Certification MECHANICAL Foundation Date Insp. Pre-Ganite Underfloor S.M. Slab-Membrane Ducts & Insulation Bond Beam Fire Dampers Underfloor Girders Fireplace _ Floor Steel Grease Duct & Ilood Tiedowns One (lour Shaft _ Diaphrams Condensate Drain Seismic Bracing Equipment Anchorage_ I1alls-1'anels Flues & Comb. Air Frame Other Lath Not Approved 11allboards Int/Ext. Firewalls Other Not Approved i APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LD ING PROJECT IDENTIFICATION IJ1.yk(. ERMIT NUMBER BUILDING .lea #N APPLICATION & PERMIT '270 1O BUILDING - ELECTRICAL-PLUMBING-MECHANI OWNER'5 PLAN CHECK VALIDATION AME QTY. ELECTRICPERMIT FEE ON CONTRACT OH'sNAME OUTLETS-SWITCHES-RECEP 5.00/1.00 LIC.NO, LIGHTING FIXTURES 5.00/1.00 e0 CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 40ADDRESS PHONE PANELS 5.00 DATED ATION ARCHITECT SIGNS 6.Q0 P .CHECK FEE C.NO. OR AYENGINEER n LID.NO. SIGNS TRANS. 3,00 ,( ADD Ess ENG' SPECIAL CIRCUIT 5.00 / PERMIT VA N Of APPLICANT zIP EMP.METER OR POLE INS. 15.00 � (/ N110 ADDRESSMOTORS SEE FEE SCH. OHEss SERVICE CHANGE 10.00 S/YSf�� o o LICENSED CONTRACTORS DIiCLARA'I'ION a Ea 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUAN E DATE v, <w (commencing with SrOom 7000)of Division 3 of the Business anA BLDG. ELECT. PLG. MECH. H D z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑ Q 0 n C License Class Lie.Number Date Contractor P: y 2 J rc 4 OWN Ii R-B UI LD 1:R DEC LA RATION BUILDING PERMIT E o a u INFORMATION K LL t- 1 hereby affirm that I am exempt from the Contractor's Lions MISC.- REFER TO ORD W VALUATION S/FT. F'u0J Law fortheity following reason, ywhich(Sec. requirsa permit ermit to construct, Professions PERMIT ISSUANCE 6.00 EE �i,f Code:Any dryer county which requiresu p riot t nu ,lter,al, ep 2 ¢ 4 O improve,demolish,or repair any shuc[um,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. o O� O or requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO e- w m U. he is licensed pursuant to the provisions of the Contractor's License HZQ Law(Chapter 9(commencing with Section 70001of Division 3 oftle 4 O Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE BOLL. lib $ the basis for the alleged exemplidn.Any violation of Seclion 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects to applicant to a civil penally ALTER-DRAIN -WATER (EA.) 4.00 of not more than five hundred dollars(55001.): ❑ I,as owner of the property,or my employees with wages us BACK FLOW 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,AR EA,COND. 4.00 - Code:The Contractor's License Law docs not apply to an owner at property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 50.FT,FLOOR AREA TOTAL ACREAGE b imselfre throughhisownemployers.Providedthatsuchimprove- entsarenotint"f",1oroffcredforsalr.vP"...evcq the building GAS-EA.SVSTEM-11NC.40UTLETS 4.00 r improvement is sold within one year of completion,the ownerGAS-EA.SYSTEM-OVER 4 (EA.1 1.00 BULLDINC usE uilder will have the burden of proving that he did not build or int- rove forpowner of the INDUSTRIAL WASTE INTER. 20.00 0RES IND0 0 PB 0 ❑ L as owner of the property, he exclusively contracting with ❑ licensed Contractors to construct the pri hen (Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PAR CEL No. to Professions Codon The Contractor's improv Law Juts not apply who �-+ to trownerofpropertywhobuildsor tons)vesthereon.and who LAWN SPRINKLERS-OV OVER 5IEA.1 1.00 3( 6 �y 3-3 s1 contracts for such censeprojects with a contmator(sl linnud pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT No. P Rc LNo. . ❑ I am exempt under See. ,I MIX.for this WATER HEATER W/VENT 4.00 reason Date rer�G' .OwWATER SYSTEM 4.00 Ace.DATE ACC.FILE NO. WORKERS'CO 1PEN I ECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm that I have u certificate of consent to self-insure. or a certificate of Workers'Compensation Insurance,Dip cerlfied ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No, Company Q ❑ Certified copy is hereby famished. RE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed' with the city inspection division. MISC.- REFER TO ORD. O Applicant Y [] N[] , Y [:] N[:) CC CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.UG, . LU COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG. Q. O (This section need not be completed if the permit is for one TOTAL Y n N❑ Y ❑ N D Z hundred dollar,IS 100)or less.) U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL E. mit is issued,1 shall not employ any person in any manner so as to O wbecome subject to the Workers'Compensation Laws ol'California. y Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING >- m NOTICE 10 APPLICANT: If,after making this Certificate of I.x- carat x- Z emption,you should become subject to the Workers'Compensation - APPLIANCE 4.00 PLAN CHECK provisions of the Labor Colic,you must forthwith comply with FEE . U such provisions or this permit shall be deemed revokCd. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 -AW CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE / Lhereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00 the performance of the work No which this permit is issued(Sec. - .MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U. 7.50 ELECTRIC CTR I C vtivV'•d"� I certlty that I hove read this application and slate that the above VENTILATION FAN (SINGLE) 3.00 ordinances n correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING ordinances end state laws relu ting ni building construction, and hereby authorize representatives of this city es enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL hereby coauthored property forinsp orth i purposes. (We) agree to save, indemnify and keep hornless the Cly of Misc.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX may in any way34accrue against op City in consequen a of the granting of this per iL MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Sign tore Of pplicaN/Con rift., Dam - - 415�/ro OFFICE COPY