15841 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NumaER
CITY OF CUPERTINO 15841-
INSPECTION DIVISION
JOB INSPECTION RECORD
e "'� `••'6{+�'� • E ZjO PERMIT.EXPIRATION
JOB'ADDRESS
UNIT# '_LOT#
OQ�'�71QOc �12�t.o� PERMIT EXPIRES IF WORK
' DINNER �' CONTRACTOR � IS NOT STARTED WITHIN I
INSPECTION DATE INSPECTOR - INSPECTION RECORD 180 DAYS OF PIE RMIT ISSU-
FOUNDATION - ANCE OR 180 DAYSFROM
• NOTE: LASTCALLED INSPECTION. !
UFER ALL GRADING AND DRAINAGE SHALL.BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PER VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS q
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB J/
PLUMBING. - ( • , / /
ELECTRICAL - ISSUANCE DATE
MECHANICAL & FLECr PLG.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR P�'1 INFORMATION
PLUMBING VALUATION S/FT.
" o
MECHANICAL Ids 194►540 +
ELECTRICAL - U( CUp [11GD PEIRMIT TO
FRAMING �'1 SFDU
INSULATION _ STORIES TYPE•CONSTR,
2 5NHR
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
r ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO ..F •FL OR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 3047
ROOF SHEATHING '3�„\—�� RES euuo ONusE
INU I O P9 00—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ ❑ ❑ 11
ASSESSORSPARCEL NO
ROUGH SAN.# Bf _
PLUMBING bl� - ' tJL,{ ELECT.ENERGY `l '
TUBS.B SHOWER PAN I PLUMBING ENERGY` TRACT NO PARCEL No
MECHANICAL 2 _ lcil MECH.ENERGY - 80.D
ELECTRICAL —� 'Q _ BUILDING ENERGY ACCATE ACE.FILE No
FRAMING -2 - ELECT.FINAL TEST
ZONING, ENG.SITE NO. ,
' INSULATION � _•Z, Ce PLUMBING ,
' GAS TEST - GAS ' '
FIRE SPRINK ENERGY T-IA
MECHANICAL • v ❑ N❑ v ❑ . N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR 'Z,( ELECTRICAL RELEASE FLOOD ZONE A u.C.' ,
INTERIOR SHEAR FIRE DEPT. ' Y❑ N[] Y L N❑
SHEETROCK - — GRADE - FEESUMMARY
EXTERIOR LATH — — BUILDING
INTERIOR LATH . 2 TEMPORARY APPROVALS ' 'BUILDING72-00-
SCRATCH COAT ELECTRIC' PLAN CHECK 15.50
GAS FEE/anArgly 62 00
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE"'
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
a
ARRANGE-FOR INSPECTION BY PHONING 252-4505, ELECTRIC
1 73.13
LU ONE WORKING DAY BEFOREREQUIRED INSPECTION: PLUMBING .
PLEASE GIVE JOB ADDRESS WHENTHONI NG.
73.13
z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE - 373 Al
CONS, .TA
IMPORTANT! 0
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
4?
,S
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .
BUI DING PROJECT IDENTIFICATION PER MITNUMBER
" h nDDRES
LILDI Lot # 210 Plan 4B APPLICATION & PERMIT CQ A
1 1617. Cedar S rim 1,
Court BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 584
OWNER'S U regoryy roup( Inc & PLAN CHECK VALIDATION
NAMEAhmanson D@V. 415-5§5-2100 QTY' ELECT RIC PERMIT FEE
PHONE
CorvrRAcroRs or UTLETS-SWITCHES-RECEP 10.00/1.00
rvnMEGre Group, In B-430097 LIGHTING FIXTURES 10.00/1.00
9 Y P, rLm.ND.
CONTRACroWs 0 C Twin Dolphin Dr. PPLIANCES-RESIDENTIAL 4.00
ADDRESS RWC 94065 4-l5r595-2100 PANELS 10.00 DATE OF APPLICATION
ARCHITECT Aram Bassenian, AIA & Ass PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE ,P.c,No.
OR
ENGINEER
uc.NO. _ SIGNS TRANS. 3.00
ARCC",08DRESS ENG 2031 Orchard Dr./1100 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Santa Ana Hts. CA. 92707 TEMP.METER OR POLE INS. 20.00
noonessTs MOTORS' SEE FEE SCH.
220-C Twin DOlphlnDr.RWC94065 SERVICE CHANGE 20.00
O o LICENSED CONTRACTORS DECLARATION,
< U u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w<
so with Section 7000)of Division 3 of the Business and - SLOG. ELECT. PLG. 'MECH.
F D z Professions Code,qqd my license is in full force and effect. ® - W
Q 0 N License Cass-0 Lic.Number_fDDw
Date Contractor
¢y E BUILDING PERMIT
¢ O IS 4 a U OWNER-BUILDER DECLARATION [IfIFORMATION
K g¢ m 1 hereby affirm that I um exempt from the Contractor's License MISC.- REFER TO ORD VALUATION S/FT.
u o Q Law for the followingreason.(Sec.7031.5.Business and Professions ^ O
N w PERMIT ISSUANCE 10.00 97sr �O .
Code:Any city or county which requires a permit to construct,,also `hVVV 90'
¢ Q Q D rmprOVs,he applicant
Or repair any permit
to file
a ani t0 its issuance,aI50 ELEC CONTR. LIC.N0. ELEC
DLL requires the applicant fur such permit to file a signed statement that TOTAL ' PERMIT TO
n w he is licensed pursuant to the provisions of the Contractor's License
FZQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe FF ` ft
E 4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Ot Uu it `r^0
the basis for the alleged exemption.Any violation nf5ection 7031.5 STORIES TYPE CONSTR.
n , M1y any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00
ofnot mom than fivehundred dollar,($500).): 2 5NHR
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400 Oce.GROUP RES.urvtTS
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. 5.06
Code:The Contractor's License Law does not apply to an owner of - I
Property who builds or improves[hereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 6.00 3DQ7
mems are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build Or to- REB IND • CON PB Omer
prove for purpose Ofsalc.). r INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑' ❑ ❑ . ❑
licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon.and who LAWN SPR INKLERS-OVER 5(EA.), 1.00
contracts for such projects with a contractor(s)licensed pursuant toESEWER-SANITARI V-STORM EA.200tt/10.00to
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this W/VENT 6.00 , 8098
reasonOwner Date 5.00 .. ACL.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION NG EQUIP. 5.00
I hereby affirm Brat 1 have a certificate ofronsent to self-insure, ZONING ENG.SITE NO.
oracertificate of Workers'Compensation Insurance,or a certified copythemaf(See.3800,Lab.C.). United PeClfIC
Policy No._Company0 ❑ Cetlifiedcopyislmrebyfurnished. aFIRESPRINK ENERGY T-24
Z Z 1Q Certil sed copy is filed with the city inspection division.
O A(PH:Cant . . ' REFER TO ORD. Y N❑ Y❑ N❑
Fy PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.D c.
LU CERTIFICCOI OF EXEMPTION INS PROM WORKERS' -
LU _ COMPENSATION INSURANCE PLG,corvTR. LIC.no.' PLG.
Q. O (This section need not be completed if the permit is for One TOTAL Y❑ N❑ Y ❑ N
=) Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1H... mit is issued,1 shall not employ any person in any manner sous m
OW become subject to the Workers'Compensation Laws of California.
y Date Applicant. r ALTER OR ADD TO MECH. 5.00 BUILDING 972.DD
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE/energy 62.00
U such provisions Or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00 .
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 13.65
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work fqr which this Bermjl is issued(Sec. - MICROFILM
3097,Civ..C.,. Security Pacific 1 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name yq - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 73.13
Lender's Address b Q�-.
1 certify that I have lead this ap ¢au n u1n sale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING 73.13
Ordinances-and state laws relating to building construction, and BOILER-COMP 13'H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon.the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 73. 13
above-mentioned property for inspection 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 10.00 CONS D
may in any way accrue against said City in consequence of the
ranlingofthis perm' MECH.CONT. - LIC.NO. MECH.
TOTAL
TOTAL
Signature of Ap1 n Contractor Dale
OFFICE COPY' X579