3289 (2) CFFY OF CUPERTINO INSPECTION RECORD (Office Copy)
•
- 3289 10647 A Rosewood E/W Dividers
PCPlfIT P10. SANITARY DIST. NO. LOT F1U. ADDRESS
Re-Model Property Services
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Ru Ll dint. 5 25 AS3 Date Insp.
1;1ectrica1 5/25/II3 Power Pole_
Plumhing Linder ,round
lWchani.cal Rough Wiring
Temp. Gas/Elect. Ua7-Ls
Solnr Ceiling
Fire Sprinkler Fixtures Int/Ext _
Sign Hotors
Grounding
Fisc. Temp. Power
Other
FINAL. INSPECTIONS NuL Approved _
Date Insp.
Ars" -- PLUMBING Electric
Plumbing Date Insp.
Backflow
Fechanical Underground
Solar Underfloor
Pool Partial Hough
Gradin , Rough Complete
PInnning, Solar Rough
Fire Dept . [dater & Insulation
Health Dept. 'lain Drain
Building R/of/S Drain
Other Gas _ _
Other.
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.F.
S1ah-flembrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & Mood
Tiedowns One (lour Shaft
Diaphrams Condensate Drain _
Seismic Bracing Equipment. Anchoraf;r_
Ual.ls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Wallboards Int/Ext.
Firewalls
Other
• Not A2proved
APPLICANT TO FILL IN INFORMATION WITHIN RI D,LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION L9Q`iL PERMtr UMBER
Baum DDRESS 'tW APPLICATION & PERMIT ��
UU LDIss -
0101'JE•QS BUILDING-ELECTRICAL-PLUMBING-MECHANICA
owrvER's - - -
27
NAME PLAN CHECK VA LIDpGION
• QTY. ELECTRIC PERMIT FEE //(��I I�1 j40
PHONE "/H
CONTE TOE'S y
NAME OU -SWITCHES-RECEP 5.00/1.00 �3L p
LC.NO. LIGHTING FIXTURES 5.00/1.00 p
f,ONTRACTOR'S ;00 Q/ ^ T`!
ADDRESS APPLIANCES-RESIDENTIAL 4.00 U
PHONE PANELS - 5.00 DATE OF APPLICA TON•
AARRCHITECT SIGNS 6.00
Eo
NGINEER PLAN CHECK FEF. P. O.
LIC,NO. � SIGNS TRANS. 3.00
loo loss ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00
AT MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00. Ufa /
,/�3 ,
o a LICENSED CONTRACTORS DECLARATION U/ 3
w
o G I hereby affirm that I um licensed under provisions Of Chapter') ISSUANCE DATE
v,G i (commencing with Scatiun 7000)of Divi,mn 3 of IIIc Business and BLDG. ELECT. PLG. MECH.
D i Professions Code,and my license is in full force and effect. ❑ ❑ El ❑
Go License Class Lie.Number
y r Date Contractor
a m s BUILDING PERMIT
¢ ¢ w ¢
OWNER-BUILDER I1EC1-AkA PION
Is
; u y I hereby affiant that I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
F L wo J Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 6.00 Ou VALUATION $/FT.
;j 0Code:Any city or county which requires a permit to construct,alter,
¢
Q Q improve,demolish,or repair any shucture,prior to its issuance,also FLED.CONTR. LIC.NO. ELEC,
o , requires the applicant for such permit to file a signed statement that
TOTAL
a w m he is licensed pursuant to the provisions of the Contractor's License PERMIT%0
Fzi
Law(Chapter 9(cmamencingwith Sedum 7000).fDivision 3 oftbe Ayd t)y-C
-.
P 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H $ thebasis for thealleged exemption.Any violation ofSletion7031.5 STORIES TYPE CONSTR.
n ; by any applicant for a permit subjects the applicant toacivil penalty
of not more than five hundred dollars(55000.): ALTER-DRAIN& VENT-WATER (EA.) 4.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 ace.CROUP REB.UNITS
their sole compensation,will do the work,and the structure is not
intended or offcHTI for sale (Sec 7044, liusiness 11111 Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The 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 6D.FT,FLOOR AREA TOTAL ACREAGE
himself.or through his own employees,provided that such improve- ,
ments are not unaided or offered for sale.If,however,The building _ GAS-EA.SYSTEM-11NC.40UTLETS 4.00
'or improvement Is sold withal 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 im-
for RES IND CON PR Other'
prove 1,aso nee of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ L as owner of the property,he exclusively contracting with ❑
andProcontractorsmconstruethe pieced(Sec.7044,Business LAWN SPRINKLERS-1 INC5 V.B. 5.00 ASSESSORS PARCEL No.
and Professions Code:The CoMrlclor's License Law Joes na[apply _
to an owner of property who builds or improves Thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3/( �
- 3 -3 S
contracts for such projects with a contract0r(s)liclmwd pursuant To - /
The Contractor's License Law. SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT No. PARCEL NO.
❑ I ant exempt under Sec, ,B&P.C.for this WATER HEATER W/VENT ' 4.00
reason
Date Owncr_P .L WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
w'ORKFRS_COMP iN c Ln n71oN WATER TREATING EQUIP. 4.00
I hereby affirm That I have a certificmc of consent loself-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG,SITE NO.
copy thereof(Sec 3800,Lab.C.).
Policy Nn. Company -
Q ❑ Certified copy is hereby tarnished. FIRE SPRINK ENERGY 24
Z Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD.
F Q Applicant =_ Y ❑ NE] I Y [:) N�
� Lo CE RTI FICATE OF E X 1;M PT IO N F ROM WO R K E R S' PERMIT ISSUANCE 6.00 FLOODZONE A.L.U.C.
LU > I COMPENSAT'ION INSURANCE PLG.CONTE. LIC.NO. PLG.
Q, 0 (This section nead not be completed if the permit is for one - TOTAL Y❑ N Y N
::) Z hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
Ly I- mit is issued I shall not employ any person in any manner 10:u to
O W become subject to the Workers'Compensation Laws al'Califnrnia. OU
Date An (cant BUILDING
>_ H NOTICE' TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 4.00 a .
♦- Z emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECKO
provisions of The Labor Code. you must forthwith comply with FEE1144 •�
- V such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10S W O.F.M.). 3.00
CONSTRUCTION I.IiNDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE S'b
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the perhurunw 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.)7.50 600
Lender's Address ELECTRIC pZ'�
I certify that l have read this application and state that The above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with.II 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
hereby authorize roperty robwesins of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection th puity to.
(We) agree to save, indemnify and keap harnnless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue a 'uinst s; d City in consequence of the PERMIT ISSUANCE 3.00
granting of this pe miL - I MECH. LIC.NO. MECH. l
1 TOTAL JE/
sn � 3 .29�� TOTAL to U
g ppl¢anT o ru for Inc I�
OFFICE COPY