328K (2) CITY 01" CUPEIMNO IUSPFGTIOV RECORD (Office Copy)
323k 10706 Rosewood N/S Divideis
I'I;pjll,r NO. SANITARY DIST. NO. LOT NO DO
ARI'SS - --
Re-Model Property Services
PROJECT OWNER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Bu Lldinr _ 5/25/83 Date T.nsp.
I;lectrLcal Power Pole
I'lumhinp Underground -- ----
Nechanical Rough luring --_
'temp. Gas/lilect. if!aLI.s
Solar Ceiling
Fire S rinkler Fixtures Int/Ext
Sign flotors
Grounding
Mist. Temp. Power _
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
Electric PLUMBING
Date Insp.
Plumbing Backflow
!lechanical Underground - --
Solar Underfloor
Pool Partial Rough
Gradin , Rough Complete
I'lanni.nr, 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.M.
Slab-Ilembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One flour Shaft
D.i.aphrams Condensate Drain
Se-Lsmic Bracing P.quipment Anchorage
!Ial..Is-Panels Flues & Comb. Air
Frame Other
Lnth Not Approved
llallboards Int/Ext .
Firewalls
Other
Not Approved
•V�
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' BU I LDING PROJECT I DENTIFICATION
ERMIT NUMBER
im LDING - APPLICATION & PERMIT
AOOHESs r ,���orr;rE 3 Z 81
• . IO1t' OEV�q P1=5 BUILDING -ELECTRICAL-PLUMBING-MECHANIC
owrvER's - - -
LANCHECK VALIDATION
ES
- OTY. ELECTRIC PERMIT FEE
CONTfl O PAIU
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00
LIC.NO. _ LIGHTING FIXTURES 5.00/1.00 MAY 25 1983
CONTRACTOR S APPLIANCES-RESIDENTIAL 4.00 /ns
PHONE PANELS 5.00 DATE X!kLAfAAIQiI
AARRCHITECT SIGNS 6,00 PLAN CHECK EEE reritalo
o
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
oDRESS ENG' SPECIAL CIRCUIT 5.00 kERM VALIDATION
ZIP' EMP. METER OR POLE INS. 15.00 -
ADDRESSrs MOTORS SEE FEE SCH.ADDflE55SERVICE CHANGE 10.00
o o LICENSIiD CONTRACTORS DECLARATION -
a u I hereby affirm Thal I am licensed under provisions of Chapter 9 ISS ANCE DATE
z w (Commencing with Section 7000)of Division 3 of the Business and ,
Hi Professions Code,and my,license is in fill[force:rod effect. BLDG. ELECT. PLG. MECH.
Or i m W License Class Lic.Number
m H Date Contractor
x
T ¢ w 4 OWNER-BUILDER DECLARA'HON INFORMATION
w ;a' H I hereby attain that I am exempt train the Contractor's License MISC.- REFER TO ORD
H u o Q Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION $/FT.
E Code:Any city or county which requiresapennit tocoustruct.rinr, 6.00 �J�d1 ea
to ¢ ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. Q✓A/'
0 u requires the applicant for such penin to file a signed statenent that TOTAL
aa m i he is licensed pursuant In the provisions of tire m
e CllnmPER MIT TOtor's License
H z
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
z o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
,. IC H p [tie basis for the alleged exemption.Any violation of Seclion 7031.$ DRIES TYPE CONSTR.
a ; E by any applicant fora undue dance..tire applicant toaeivil penalty ALTER-DRAIN -WATER (EA.) 4.00
' of not more[hon five hundred dalton(5500).)',
❑ ],as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not ,.
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner of,
property who bI11Ns or I,Ilproves 11hereon,and who does such work FIXTURES-PER TRAP 4.00 S0,FT,FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided tiro such improve. .
ments
improvemennot intended or within
onefor
year
o If.howevcq the building GAS-EA.SYSTEM-11NC.4OUTLETS q.00
or der will have
is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will hove the burden of proving that he did not build or ire- RES IND CON PB Other
prove['ors owner of tare.). INDUSTRIAL WASTE INTER. '20.00 ❑ ❑ ❑ ❑ 1a
❑ 1,as owner of the property,um exchis'ivbly contracting with.
licensed contractors lr construct the project(Sec.-7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSES 3SPARCELNP.
and Professions Code:The Contractor's License Law does not apply
to antr owner of property who builds or improves thereon,and who LAWN SPR IN KLERS-OVER 5(EA.) 1.00 ' l 3 ��
contracts For such cenjeas with o contractor(s)licensed purv,mht¢3 - '5161-
the
/ '
th0 1amcexe pt under
Sec. SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT o. PARCEL NO.
❑ I um exempt under Sec ,B.&P.C.for this WATER HEATER W/VENT 4.00
mason
Date owner. WATER SYSTEM . 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'IION DECLARATION WATER TREATING EQUIP.- 4.00
I hereby affirm that 1 have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy therenf(Sec.3800,Lab.C).
Policy No. Company '
0 ❑ Certified copy hs brachy funiished' FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspcetimu division.
MISC.- REFER TO ORD.
O Applicant V � N❑ � Y [-] N❑
CC rn PERMIT ISSUANCE 6.00
� - CIiR'1'lIe1CATE OPSAT'I N ION FROM WORKERS' FLOOD ZONE A.L,D U.C.
W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CIE. a Z (This section need not he completed if the permit is for one TOTAL Y�' N� Y � NE]
Zi hundred dollan(81001 or Iess.l
U O 1 certify that in a performance of the work for which taut Per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- not is issued.I shall not employ any Person in any manner ,,as to
. O L) become subject to the Workers'Compensation Laws of California.
y Dale - Applicant ALTER OR ADD TO MECH. 4.00 BUILDING SD
} W NOTICE TO APPLICANT: If,after making([is Certificate of fix- _
F Z eruption,You should M1CLOIIIC subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions (il' the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000OF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000QF.M.) 5.00 SEISMIC FEE S�
I hereby affirm that then is a conornetion lauding 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 ct,nify'thm 1 have read this application and Hate'thm Il,c above VENTILATION FAN (SINGLE) 3.00
information n correct I agree to comply with all city and county - PLUMBING
inform do and state laws relating to building l City and ion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby enti o ed representatives lorries of this city es eater hmnn the BOI LER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
hereby milinned properly tarvesp ofth i purposes.
(We) agree to 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
may in any way accrue against said City in conseque ce of the
granting of this permit MECH.CONT. LIC.NO. MECH.
r r Z TOTAL TOTAL / od
Sigh lure a pplican Contr. 4 r Ua e - (�
OFFICE COPY