3269 (2) „
C1 I'Y OI' CUPERTUM INSPECTIOl! RECORD (OH ice Copy)
3269 _ _ 10667 A Rosewood N/_S_ Dividers_,_
PI:Pd1IT N0. SANITARY DIST. NO. LOT NO. ADDRESS
• Re-Model Property Services
PROJECT OIdNER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
SuLldinc 5/25/83 Date insp.
Clectrical 5 2SLa3_, Power Pole_
71711-H-,
_ mhLI Under ground -- ----
Nechani.cal Rough Wiring, --
Temp. Gas/Eicct. _ Ua1.Zs
Solar Ceiling,
FLre Sprinkler Fixtures Int/Ext
Sign ifotors
Grounding
Misc. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved _
Date Insp.
--
PLUMBING
Electric Date Insp.
PLnmbin , Backflow _
Mechanical Underground _
Solar Underfloor _
Pool Partial. RoLmh
• Gradin , Rough Complete
P.L.inning Solar Rough _
Fire Dept. I-later & Insulation
Health Dept. ".lain Drain
Building R/of/S Drain _
Other Gas
Other
BUILDING Not Approved
Date Insp.
Cad Certification MECNANiCAL
Foundation
Dace Insp.
Pre-Gunite
Underfloor S.M.
Slab-Llembrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & flood
Tiedowns One flour Shaft _
Di.aphrams Condensate Drain _
Seismic Bracing EquipmenC Anchorage_
Ilal.ls-Panels F].ue.s & Comb. Air
Frame Other
lath Not Approved
Ualiboards Int/I,xt.
Firewalls
Other
•, Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENT]FICATI ON WTP_+`.v.- PERMIT NUMBER
+
BUILDING pt �Q y p A�,`� �.ry APPLICATIONS& PERMIT - _ - r�C(�
ADDRESS RT�`S00 Z U J
BUILDING —ELECTRICAL—PLUMBING—MECHANICAL
l0 kVtO
OWrvER's .T• PLAN CHECK VALI D
NAME QTY. ELECTRIC PERMIT 'FEE:
KIRLD DrvE MAY 2
NAME CORSSMOXeES' OUTLETS-SWITCHES-RECEP 5.00/1.00 ' S 19g
NAME
uC.NO. - LIGHTING FIXTURES 5.00/1.00 _'•�
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 �'•"v - Pity�f CUPeIf�(Io
ADDRESS
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT I SIGNS
- 6.00 PLANCHECK FEE P.C.NO.
OR
ENGINEER LIC.NO - SIGNSTRANS. ° 3.00
ARCH,OR ENG, SPECIAL CIRCUIT ,5,0D PERMIT VALIDATION '
ADDREss a
ZIP EMP.METER OR POLE INS. 15.00
APPu CA MOTORS- MOTORS - SEE FEE SCH. -
ADDRss - SERVICE CHANGE 10.00
o o LICENSED CONTRACTORS DECLARATION
a v v 1 hereby affirm that I am licensed under provisions of Chapter 9 _ , ISSUANCE DATE
Fz w (commencing with Section 7000)of Division,3 Of the Business and
D i Professions Code,and my license is in full force and effect. - BLDG. ELECT. PLG. NIECE.
o L License Class Lic.Number ( �-�
9 L t Pate Contractor 2 ,ti
a Y �, ,BUILDING PERMIT.
¢ w¢ - OWNER-BUILDER DECLARATION
d o d o MISC.--. REFER TO ORD I - INFORMATION
X I hereby affirm that I am exempt from the Contractor's License
�+ v, VALUATION $/FT.
✓lava a Law for the fallowing reason.(Sec.7031'3,Rioncessi n i Professions PERMIT ISSUANCE6'00'
'
Code:Any city or county which requires a permit to construct,alter,
T
Q Q Q 2O improve,demolish,Or repair any Structure,prior to Its Issuance',alio ELEC. LIC.NO. ELEC.' /)" '✓, LO
O ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w m a he is licensed pursuant to the provisions of the Contractor's License
Law(Chaptcr9(commencingwith Secti(in7000)ofDivision3oftlie - //�^JJ(__
- ¢ Business and Professions Code)or that he Is exempt therefrom and QTY. PLUMBING PERMIT FEE /�" d <---
¢ r O the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
5_: any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.)of not more than five hundred dollars(5500).)'. . •'
❑ 1,as owner of the property,or on,enmloyees with wages as 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,AREA,COND. 4.00 -
Code:The Contractor's License Law docs 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
dimGmT
or through his own employees,provided that such improve- F
entsre not intended or offered for Sala If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 4.00
r impovement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) ' 1.00 BUILDING USE
uildewill have the burden of proving that Ile did not build or inn orpurposeofsale.). INDUSTRIAL WASTE INTER. 20,00 .BEs: IND CON PB _ oma,
❑ I,as owner of the Properly,ant exclusively contracting with ❑- ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN_SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code It,,Contractors License Law does not apply _
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 _
contracts for such projects with a contractons)licensed pursuant to 3• S
the Contractors License Law. - SEWER-SANITARY-STORM EA.'200ft/8.00 TRACT NO. PAPICEt NO.
-
❑, 1amexempt under Site ,B.&Ilot do, WATER HEATER W/VENT 4.00
reasoli
Date ����Owner WATER SYSTEM. 4.00 ' Ace.DATE Acs FILE NO
woRKliRs'coM E 1 ).cCANsn' RATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I Imve a certificate of consent to self-insure, '
or a certificate of Workers'Compensation Imuran..,or a.'citified ZONING ENG.SITE NO.
copylhcreoflSec.3800,1eb.CJ.
Policy No. Company - -
0 ❑ Certified s hereb furnished. '- L
copy Y FIRE SPRINK ENERGY T-24
N
Z ❑ Certified copy is filed with the city .inspection Division' MISC.- REFER TO ORD.
Z nnndeam Y ❑' N v ❑ N❑
~ rn- PERMIT ISSUANCE 6.00
LU CERTIFICATEPFNEEMPT ION FROM WORKERS' FLOOD ZONE A.L.u.C.
UJ _ COMMPENSAATION INSURANCE PLG.CONTR. LIC.NO. PLG. -
CL O (This section need not be completed if the permit is for one TGTAL Y❑ N❑ Y ❑ IN❑
D Z hundred dollars IS 100)or lc.,)
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, I shall not employ any person in any manner so as to
U become subject to the Workers Compensation Laws of California.
i Date - Applicant ALTER OR ADD TO MECH. q,pp BUILDING a0 VD
} W NOTICI7 TO APPLICANT: If,after making this Certificate of Ex-
F, Z maroon,you should beconiesubject 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 deemed Disused. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10)"QF.M.) 5.00 SEISMIC FEE, Sp
I herehy infirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work I nr which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TD700,000 B.T.U.) 4.00
Lender's Name HEATING UN IT(OVER 100,000 B. . .)7.50
Lenders Address TUELECTRIC uD
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
• information n correct11 agree to to building with all city and county BOILER-COMP(3 H.P.or 100,000B.T.U.) 4.00 PLUMBING '
ordinances and state laws reloto c to lywit co city
,,,m5, and
hereby authorize representatives of this city to enter anon the BOILER-COMP 60sr 100,000 BTU)SEE FEE SCH. MECHANICAL'
above-mentioned property for inspection purposes.
(We) agree to save, indenmify and keen Inrmlcas the City of MISC.- REFER TO.ORD. '
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue,ngalnsl said ty in consequence of the PERMIT ISSUANCE 3.00 -
grxnting of Ilia permit. /� MECH.CONT. LIC.N0. MEGH. pq.
S'YL.C�wi4f' a7�
TOTAL TOTAL
Signet roof Apptean Conte t r Daate I
OFFICE COPY - a