0248 CITY OF CUPERTINO INSPECTION RECORD (Office Copy)
0248 22085 Regnart Rd.
PEPIIIT NO. SANITARY DIST. NO. LOT NO. ADDRESS
Reroof Genevieve Ziegler 252-1102
PROJECT OWNER JOB SITE PHONE NO.
Date ELECTRICAL
Building 5-12-81 Date Insp.
Electrical Power Pole
Plumbing Underground
tlechanicalRough [firing
Temp. Gas/Elect. Ia is
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other
FINAL INSPECTIONS Not Approved
Date Insp.
Ge.s
Electric PLUMBING
Plumbing Backflow Date Insp.
Mechanical Underground
Solar Underfloor
Pool
• Grading Partial Rough
Rough Complete
Planning Solar Rough
Fire Dept. Water & Insulation
Health Dept. Main Drain
-Building R/of/S Drain
Other Gas
Other
STRUCTURAL Not Approved
Date Insp. - . .
Pad Certification MECHANICAL.
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-14embrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & Hood
T.iedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
Walls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Wallboards Int/Ext.
Firewalls
Other
Not Approved
.APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
' BUILDINGPROJECT PERMIT NUMBEIDENTIFICATION
'BUILDING APPLICATION & PERMIT. 02.18
-
PDD SE
O BUILDING-ELECTRICAL-PLUMBING
-MECHANICAL
LOWN R'S -
PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
CONTRACTOR'S
NAxtEOUTLETS-SWITCHES-RECEP 5.00!7.00
ACTOR
UC.NO. LIGHTING FIXTURES 5.00/1.00
ADDRESS -
APPLIANCES-RESIDENTIAL' 4.00 . '
DOR E
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT , PLAN CHECK FEE P.C.NO.
OR • SIGNS - 6,00
.ENGINEER "
im.NO. .a SIGNS TRANS. 3.00 .
Hoo Ess ENG.•. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ,
zm TEMP. METER OR POLE INS. 15.00 ^
APPLICANT S
ADDRESSMOTORS. SEE FEE SCH, FLOC(
ADDRESS
SERVICE CHANGE - 10.00
o ¢ i / +
r
00.
LICENSED CONTRACTORSDIiCLARATION -
¢ u w/ I hereh uffirm,th:d I am licensal under r visions of Cha I•r 9
NG
ISSUANCE GATE
(commencing with Section 7000)of Division 3 of the Rosiness and
•ry ¢ y BLDG. ELECT. PLG. MECH.
D z- Professions Code,and my license is in full force and effect ❑ ❑ ❑ E]u
Licne Class Lic.Number - .
AY 12
Data Contractor
a x - BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION' "
'o W UINFORMATION
w ; a- H I hereby affirm that I am exempt from the Conlracmr's License MISC.- - - FER TO ORD
F u w J Law for lire following reason.(Sea 7031.5.Businessand ProhceOons PERMIT ISSUANCE - 6.00 'VALUATION $/FT.
F Code:Anycity orcounty which requires a permit toumst HeLalter,
¢ ¢ Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. , - LIC.NO, ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTAL
6 w a,A he is licensed pursuant to the provisions of the Contractor's License I. PERMIT TO
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthc �^
Business and Professions Code)or that he is exempt Therefrom and QTY. PLUMBING PERMIT FEE �('E2_oo�
¢ r$ the basis for tile alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant fora permit subjects the applicant to a civilpenalty ALTER-DRAIN -WATER (EA.) 4.00
PVT more than five hundred dollars($500).): - -
p 1,as owner of the property,or my employees'with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS,
.their sole'com pensation,will do the work,and the st Rm t arc N nor
intended or'offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code:Tire Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,an,who does such workFIXTURES,PER TRAP 4.00 SO,FT.FLOOR AREA TOTAL ACREAGE
' . himself nls re through his own employees provided(hal such improve- - "
mmselfo not intended or employees,
sale.voided that suhemprovp GAS-EA.SVSTEM-11NC.40UTLETS 4,00
or-improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden ofproving that he did not build or im RES IND CON PB Omer,
prove for p 'mw Prior.). INDUSTRIAL WASTE INTER. 20.00
❑ h as owner of the property,am exclusively contracting with ❑ - 0 ❑ ❑ 11
licensed=contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
antl Professions Code:'f he Contractor's Lielinse Law docs not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) _1.00
contracts for such projecl4,with acontractor(s)licensed pursuant in ' SEWER-SANITARY-STORM EA.200k/8.00
the Contmclo�s License.Law. TRACT NO., PARCEL NO.
0 I am exempt under Sec ,B.AI'.C.for this WATER HEATER W/VENT 4,00
orlson _
Dmc- vier - WATER SYSTEM 4.00 ACC.DATE ACC.FILE No,
WOR K1iRS'COMPFNSA'I 16N,DiCLAtIAT ION WATER TREATING EQUIP. 4.00
hereby affirm that I have a certificate of consent to sci Finsure, - -
Or n certificate Of Workers'Compensation Inat Force,or a certifier) ZONING ENG.SITE NO.
copy thereof(Sec.3800,La,C.). - r
Policy No. Company
O ❑ Certified copy is hereh,funtished. RE SPRINK ENERGY T$4
Z Z 0 Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y E] N❑ Y ❑ NE
w - PERMIT ISSUANCE 6.00
jrLu - CERTIFICATE POF ENiATION ION FROM'WORRERS' FLOOD mNE A.L.u.C.
' W � COMPENSATION INSl1RANCE" PLG.CONTR. LIC.NO. LG.
d O ('Phis section need 'not he completed if the permit is for one TOTAL YN Q V N
Z hundred dollars IS 100)or less) '
U O I certify that in the performance of the work for which this per OTV MECHANICAL PERMIT FEE FEE SUMMARY
mit is issued.I shall not employ any person in any manner so as to
become subject to the Workers'Conrpensalion'Laws of California.
Date ApplicantBUILDING
NOTICF TO APPLICANT: If,after making this Cerlificateof Ex- ALTER OR ADD TO MECH, 4.00 r
'FZ
cliff lot,you should become subject to the Wod,,,O'CoPmensulion 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 revoked AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE r $�
I 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(See. - 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 certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00 -
information is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and, BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00
hereby aulhorire representatives of this city W enter upon lire
above mentioned property for inspection purposes. BAILER-COMP'IOver 100,000 BTU(SEE FEE SCH. MECHANICAL
(We) gree to save, indemnify and keep harmless the City of MISC._ REFER TO ORD.
Cope against liabilities,judgments, costs and expenses which CONST.TAX
may r any way accrue at, Trst said City in concecuence Of the PERMIT ISSUANCE 3.00
gtnn of this l!Frrnh. MECH CONT. . . LIC.NO. MECH.
TOTAL TOTAL oZ
�.
S gnalurc of Applicant( CHIT" r VDutr' '
:OFFICE
COPY