3282 CITY OF CUPYRI1II0 INSPECTIOI! RECORD (Office Copy)
3282 10696 Rosewood NIS Dividers*
1'1111JUT MO. SANITARY DEST. 140. LOT 1,10. ADDUSS
Re-Model Property Services
PROJECT OWNER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Building 5/25/83 Dace TTISI).
Electrical Power Pole
I'Lum1ii vlg— UtidorCround
TIochan i cal Rough Wiring
Temp. GIS/Elect. balls
Solar Ceiling_
PLre
eiLL11Fl—
FLre S2rinkler Fixtures Int/Ext
Sign Notors
Grounding
Hisc. TeT2. Power
Other
FINAL IN-SPECTIONS
Not Approved
Date Insp.
rr
F 1. PLUMBING
I'Dimbing Backflow Date Insp.
Mechanical
Under round
Solar Underfloor
Pool Partial, Rough
Grading Rough Complete
1)Lanning Solar Rough
Fire Deft. Water & Insulation
Health De t. Main Drain
Building, R/of/S Drain
Other Gas
Other.
BUILDING Not Appruved
Date Insp.
Fad Certification IIECIIANICAL
Foundat i.on Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Ifembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & Hood
Tiedowns One Hour Shaft
D!aphrams CondensaLe Drain—
Seismic Bracing
Equipment Anchorage
Flues & Comb. Air
Frame Other
I,n t h Not Approved
Uallboards Int/Ext.
Firewalls
• Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATION - PERMIT NUMBER
RmLOING APPLICATION & PERMIT 3 2 8 2
ADDRESS A1n;A2Tlf d.SGb(lF U
6 HIVID S BUILDING -ELECTRICAL-PLUMBING-MECH ANI
CC
_-r
OWNER'S � PLAN PlVALIDATION
ME CITY. ELECTRIC PERMIT FEE
PRONE
CONTNAC OR'S r
NAME OUTLETS-SWITCHES-RECEP 5.00/1.00 p pp
• LIC.NO. LIGHTING FIXTURES 5.00/1.00 ',�'/�� J '983
ADanCONTRACTORS - APPLIANCES:RESIDENTIAL- 4.00 : YnfC
PHONE PANELS 5.00DATE OFA TION
ARCHITECT - SIGNS B.00 + PLAN CHECK FEE P.C.NO.
OR
ENGINEER
-ARCHENG. LIC ND. SIGNS TRANS. 3.00
- ADDRESS oREss SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
- ZIP - EMP. METER OR POLE INS. 15.00
ADDRESS APPLICANT'S MOTORS- SEE FEE SCH.
.� '
SERVICE CHANGE 10.00
,00 LICENSED CONTRACTORS DECLARATION
a U i hereby affirm that I am licensed under provisions of Chapter 9 ISSu/NCEDATEif
w (commencing with Section 7000)of Division 3 of the Business and
- G u - - BLDG. ELECT. ,PLG. MECH..
9 i License Professions Code,and my license is in full force and effect. .
2 0,� - License Lis.Number 11 ❑' ❑
v, D Dale Contmeter
a y
¢ ¢ ¢
'OWNER-BUILDER UFCLARAfION BUILDING PERMIT
0 d v + INFORMATION .
w ; r I hereby aft inn that I em exempt from the Contmctor's License MISC.- REFER TO ORD
u VALUATION
r u o� Lew for the following reason.(Sec 7031 5,Businesaand Professions pERMIT ISSUANCE 6.00 S/FT.
f ca i Code:Any city or county my wh icy regwres e p prior
is i snuct,eller,
¢ ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC,NO. ELEC. .�
o u requires the applicant for such permit to file u signed statement that TOTAL PER T TO
E:
m he Is licensed pursuant to the provisions of the Contractor's License _
E z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and OTY: PLUMBING PERMIT "FEE,". J&�
f i D
IS r m the basis for the alleged exemption.Any violation of Section 703L5 - - - - STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars($500).):
❑ I,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 (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code: 'fhe 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 SD.FT.FLOOR AREA TOTAL ACREAGE
himself re of intended
own employees,provided that such improve-
mentfforth intended orofTv,Vdemplo employees,
or rae. ided that such
building GAS-EA.SVSTEM-11NC.40UTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM.OVER 4 IEA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
'rovefor purpose ofsale.). INDUSTRIAL WASTE INTER. 2000 RES IND CON PB Omer
A I,as owner of the property,am exclusively contracting with - . Q ' ❑ '0 ❑ ❑
licensed'contractors to construct the project(Sec.7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply _
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5 (EA.) 1.00
contracts for such projects with a contmcmts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 -TRACT NO. PA CE O.
ont❑ lam exempt under Sec. ,B.&P.C.for this - WATER HEATER W/VENT 4.00
son
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE No.
WOR C ERS'COMP EN [7fcCARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have 4 certificate of consent)o self-insure. ZONING ENG.SITE NO.M
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.Gd. ,
Policy No.- ' Company '
0 ❑ Certified copy is herchy tunhid,ed. '
Z Z ❑ Certified copy,u filed with tine city Inspection division. FIRESPRINK ENERGY T 24
p Applicant MISC.- - REFER TO ORD. Y [] NE] I Y ❑ . NE]
CC D CERTIFICATE OP EXEMPTION FROM WORM RS' PERMIT ISSUANCE 8.00 FLOOD ZONE A.L.U.c.
LL > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
D' D This section need not be completed if the permit is for one ' TOTAL Y N Y ❑ N
7) 2 hundred dollars($100)or less.) "
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL-PERMIT, "FEE,, -FEE SUMMARY
LL F mit is issued, I shall not employ any person In any manners.as to - ,
0 W hccome subject to the Workers'Compensation Laws of California. -
Date Applicant BUILDING / S�
St. ALTER OR ADD TO MECH. - 4.00
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F 2 emotion,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply,with FEE
U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE rSD
-1 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.CJL - HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.P.50
Lender's NAdffircame ELECTRIC
I certifytlmtl have read this application and state,that the above VENTILATION FAN (SINGLE) 3.00
information 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 and orate lows relating to comply
with
ng const and co and
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. 'BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - -
Cupertino against liabilities,judgment , costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accme ainet so City in consequence f lh
granting of this ermit. MECH.CONT.• e LIC.NOy MECH.
3 TOTAL TOTAL
S stere App icant/Con Date '
r OFFICE COPY