3283 (2) CII'Y 01' CUPERT'1NO .INSPECTIOU RECORD (Office Copy)
—32H.q— 10666 Rosewood, _N/S Dividers
1111TI IT N0. SANITARY DIST. NO. LOT A10. ADDRESS
Re-Model Property At vices
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
BuLld[nc _ 5/25/83 Date Insp.
E]ectrLcal Power Pole
PLumhLny _ UndcC r011nd - --
ilcchanical Rough Wiring
'I'ernp. Gas/Elcct. flafl.s _
Solar Ceil:Lng
Fire Sprinkler Fixtures Int/Ext _
Sign flotors
Grounding
Hisc. Temp. Power _
Other
rINAL INSPECTIONS Not Approved _
Date Insp.
s — PLUMBING
El.ectri.c Date Insp.
Plumbing Backflow _
Mechanical Underground
Solar Underfloor
Pool Partial Rough
•
Grading Rough Complete
Planning Solar Rough _
Fire Dept. Water & Insulation
Health Dept. "fain Drain
Building R/of/S Drain _
Other Gas _
Other.
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundati.on _ Date Insp.
Pre-Cunite Underfloor S.M.
Slab-Nembrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One flour Shaft
Diaphrams Condensate Drain
Seismic ]tracing Equipment Anchorage _
llal.ls-l'anels Flues & Comb. Air
Frame Other
Lath Not Approved
llallboards Int/f?xt.
Firewalls
Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN-RED LINES USE BALI. POINT PEN ONLY
ERMIT NUMBER
FBUILDING PROJECT IDENTI FICATION APPLICATION & PERMIT ���
9uILDING M^^ ^
ADDRESS ,VWV r
BUILDING - ELECTRICAL-PLUMBING-MECHANIC
OWNERS PLAN CHECK VALIDATION
ME QTY. ELECTRIC PERMIT FEE
XONE
CONTE CTORs OUTLETS-SWITCHES-RECEP 5.00/1.00
NAME
CONTRA
uC.No. LIGHTING FIXTURES 5.00/1.00 PAID
ADORESGrDRs APPLIANCES-RESIDENTIAL 4.00 A 4�
ADDRESS - -
PHONE PANELS 5.00 DAP rl
ARCHITECT SIGNS 6.DB PLAN C EE C.NO.
on
ENGINEER
uc.rvo, SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 - PER A D N
ZIP TEMP.METEPPOR POLE INS. 15.00
ArE
ADDDRESSDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE .10.00oo 4k/74
Or
LICENSED CONTRACTORS DECLARATION '
a -v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
N (commencing with Section 7000)of Division 3 of the Business and
Q w BLDG. ELECT. PLG. MECH.
H O z Professions Cole,and my license is is full force and effect. ❑ ❑ ❑ ❑
ie - License Class o Number
0 -
0 - Date Contrudor
P ,2 BUILDING PERMIT
¢ 0 u a OWNER-BUILDER DECLARATION INFORMATION
X 4 a I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
H u O J Law far the following reason(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 6.00 VALUATION $/FT.
m� Code:Anycityorcounty whichrequiresupermittoconstnmt,alter, (p
Q improve,demolish,Dr repair any structure,prier 10 its issuance,also ELEC.CONTR. LIC.NO. ELEC. �-v
da -O¢ requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO
w$ he is licensed 9(copursuant n the provisions of the Contractor's 3 or use
HiQ
Law(Chapter 9fcommencingwith Section 7000)of Division3nl'the K
4 O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
5-: any applicant for a permit subjects the applicant in a civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(55001.):
❑ 1,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 nr offered for sale (Sec. 7044, Business azul Professions - DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code:T'he 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 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenetintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1INC.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 sem- RES IND CON P9 Omnr
prove for purpose of Sala). INDUSTRIAL WASTE INTER. - 2000
❑ I,as owner of the property,am exclusively contracting with . ❑ 0 ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
unit Professions Code:1'he Contractor's Licmuc Law does not apply 141,-
� �3 I
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts far5ueh projects with a Cantractons)licensed pursuant t0 / /
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ tum exempt under Sec.-,IL&P.C.for this WATER HEATER W/VENT 4.00
Icaon
Date ..�� Owner - WATER SYSTEM 4.00 ACC.DATE ACC.PILE NO.
WOR'ERS'COnf I UI'Chn RAT ION WATER TREATING EQUIP. 4.00
I hereby al'finn that I have u certificate cf canscnl to self-inxure• ZONING ENG.SITE N0.
or a certificate of Workers'Compensalion Insurance,or a certified
copy thereof(See.3800,Lab.C.).
Policy No, Cmnpany '
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y [] NF]
CC L4 CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.uc.
LU > COMPBNSATION INSURANCE PLG.CONTE. LIC.NO. TOPLG.
CL 0 (Thu section need not be completed if the permit is Ibr one- TAL Y[:] N Y[_] N
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person In any nuluucr 0 as to
O L) become subject to the Workers'Compensation laws of California.
y Dale Applicant ALTER OR ADD TO MECH. 4.00 BUILDING / J
} y NOTICI7 '1'O APPLICANT: If,after.making this Certificate of is.
Z emplion,you should become subject to the Workers'Compensation - APPLIANCE 4.00 PLAN CHECK
provisions of lire Labor Code, you must forthwith comply with FEE
U such provisions or this permit sfill he deemed revoked AIR HANDLING UNIT(TO 10=CF.M.) 3.00 T
CONSTRUCTION[.ENDING AGENCY AIR HANDLING UNIT(OVER 10)00nCEM.) 5.00 SEISMIC FEE. 75v
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.). 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 ,
I certify that l have read this application and stale 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 (o building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the 801LER-COMP (Over lo0,0oO BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and Sp harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, osis and expenses which CONST.TAX
may in any way accrue against said try in consequence of t e PERMIT ISSUANCE 3.00
granting Df this pcor 1, MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Sign, in pliant ont d Dn . �i
OFFICE COPY