3277 C! l'Y OU CUPERTINO LASPECTIOV RECORD (Office Copy)
3277 )n^_3�+ap�ewood
PCPJIIT N0. SANITARY DIST. NO. LOT NO ADURh:55
Ali-Pie Property Service 935-6928
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Iluild DY _ _ Date Insp.
Electrical Power Pole
Plumhinr Underzround
Mechanical RouL�h Wiring
TcmU. Gas/Fiect. Ila 1.Is _
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext _
Sign Motors
Grounding
Misc. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved _
Date Insp.
nns PLUMBING
Electric 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 (D-( 2-JON R/of/S Drain
Other Gas _
Other _
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One Hour Shaft _
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage -
Walls-Panels Flues & Comb. Air
Frame Other
Cath Not Approved
Uallboards Int/Ext.
Firewalls
Other
• Not A2proved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
•BU LDI NG PROJECT IDENTIFICATION EMIT NUMBER
BUILDING APPLICATION & PERMIT � �-
ADDRESS rywtR ^jCU
i -kA.�o DIJ�O� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'SPLAN CHECK VALIDATION
AME DTV. ELECTRIC PERMIT FEE
-
PHONE - PAID
CONTRACTOR S
NAME UTLETS-SWITCHES-RECEP 5.00/1,00
LIC.No, LIGHTING FIXTURES 5.00/1.00 MAY 2 5 1983
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 5.00
ARCHITECTGN$ 600 PLAN CH CK FEE .NO.
OR
ENGINEER
LIC SI
c,rvo. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5,80 PERMIT VALIDATION
ADDRESS
ZIPEMP. METER OR POLE INS. 15.00
ADDDREORESNSS
Ars MOTORS SEE FEE SCH. I
SERVICE CHANGE 10.00 6
'02
0o UCENSEiD COIKrRACTORS DECLARATION
a u I hereby uffum Ihar I an,licensed under provisions of Chapter 9 ISSUANCE DATE
N a N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. I MECH.
F o z Professions Code,and my license is in full force and cltect. El ❑ El LEI z o w - License Class Lie.Number
o z D Date Cnntracmr
a y BUILDING PERMIT
¢ ¢ w OWNER-BUILDFR DECLARATION INFORMATION
K
3 u N 1 hereby affirm that 1 am exempt from the Cont HHNRr's License MISC.- REFER TO ORD
u 0 j Law for the following reason.(Svc 7031.5,Businessand Professions PERMIT ISSUANCE VALUATION 3/FT.
E - Code:Any city orcounty which requires a permit to construct.alter. 6.00 �/[)�'/yP�''�� !A
ac ¢ ¢ FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. /llao.
¢ requires the applicant for such permit to IIIe a signed stmenua t that TOTAL PERMIT TO
lie is licensed pursuant to the provisions of the Contractor's License
Hzi
Law(Chapter 9(comntencingwilh Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
3 ¢ D
¢ r the basis for the alleged exemption.Any violation of Section 7031.5 ' STORIES TYPE CONSTR.
p3$ by any applicant for a permit subjects the applicant toa civil Penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not mor,than five hundred dollars($500).):
❑ h 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 Profe.aions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:"rhe Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO.FT FLOOR AREA TOTAL ACREAGE
himself a through his own employees,fors Provided ev such intpmve-
memsmrenotintendedornempl forsola1t.however.the building GAS-EA.SYSTEM-11NC.4 OUTLETS 4.00
or impowemenl 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 in, RES "IND CDN PB Omer
provcforpurposcol'sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ I,as owner of the property.am exclusively contracting with
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORSPARCELNO.
and Professions Code:The Contractor's License Law dues not apply /-
to an owner of property who builds or improves thercon,and who LAWN SPRINKLERS-OVER 5IEA.1 1.00 3/(�J"
contracts for such projects with a conlraclons) ncrn d pursuanl to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. I PARCE NO.
❑ I and exempt under Sea .B.&P.C.for this WATER HEATER Al 4.00
on_
Owner'i WATER SYSTEM 4.00 ACC.DATE ACC.FILE N0.
WORKERS'C .1 eAh, [)N DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that 1 have acertificate ofConsent to self-insure, ZONING ENG.SITE NO.
or a cc,ff,mc of Worker,'Compensation Insurance,or a certified
copy therenflSec.3800.Lab.C.L
Policy No. Company
O ❑ Certified copy is hereby h.Hm,hcL FIRE SPRINK ENERGY T2
Z 2 0 Certified copy is fled with it,, city inspection division. MISC.- REFER TO ORD. y❑ N❑ Y ❑ NEI
O
Applicant
HPERMIT ISSUANCE 6.00 FLOOD ZONE A.L.0 c.
CC - CERTIFICATE OP EXEMPTION pkObl W'ORRERS'
DJ > COhIPENSAT'ION INSURANCE PLG.CONTR. LIC,NO, PLG.
0- O 1'1"Itis section need not be completed if the Permit is for one TOTAL Y❑ N❑ Y ❑ N❑
Z) 2 hundred d.1hos(Sloo)orless.l
U 0 1 eHify than in the pcoo,mance of III,work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
mit is issued. I shall not employ any Person In any nmaner sa as to
O W )become object to the Workers p Com ,HmUon Laws of California.
a
Date Applicao( ALTER OR ADD TO MECH. 4,00 BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
P4.60 emption,you should become subject to the Workeri Conlpensatron APPLIANCE PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 3.00
CONS'fkucnoN LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOC.F.M.) 5.00 SEISMIC FEE
1 hereby affirm that then is a construction Ieadinguguncy for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued ISce. MICROFILM
3097,CIC.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lenders Address
I certify that I have read Misapplication and stat,(hal the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city ami conalY BOILER-COMP13 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction. and
hereby autlmriec representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned property for inspection purposes.
(We) agree 10 cave, indemnify and keep hannlmx the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against sai City in consequ•n ce of the PERMIT ISSUANCE 3.00
granting of this permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Sign ort o pP icon/Contra, r Date
OFFICE COPY