13801 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 13801
INSPECTION DIVISION
JOB INSPECTION RECORD
G{ i PERMIT EXPIRATION
JOB ADDRESS t•\�UZ C « (�CLI, �' 'ad1 "' UNIT# LOT# `
PERMIT EXPIRES IF WORK
OWNER � 'rT DU � CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER LASTCALLED INSPECTION. '
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING y ��
ELECTRICAL ISSUANCE DATE
MECHANICAL PLG. MECR.
a ,1✓ ID ❑' ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .{ PERMIT
WOOD FLOOR
M RMATION
I
VALUATION $/FT.
PLUMBING _ �Y •,, Y
MECHANICALS
ELECTRICAL PERMIT To
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP ,RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED sa IT.aoOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
e W LDI us[
RES IND CON
PB Otnxr
APPLY NO ROOFING UNTIL ABOVE HAS BEE SIGNED ❑ 0 ❑ El Cl
ROUGH ASSESSORS PARCEL NO.
PLUMBING
TRACT NO. PARCEL N0.
GAS TEST
MECHANICAL '
ELECTRICAL `? "i'II FIACC.GATE ACC.FILE NO.
FINALS DATE INSP.
FRAMING SAN * -2i
ZONING ENG,SITE NO,
INSULATION PLUMBING p—
OY GAS
ENERGY T]4
MECHANICAL FIRE SPRINK
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
B` Y NCl Y El NEI
LATH—INTERIOR . ELECTRICAL �f FLOOD ZONE AII.LL.�.U.C.
V Y❑ N❑ VLJ N❑
LATH—EXTERIOR -�' �/ FIRE DEPT.
SHEETROCK Z GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING - —
SHEAR EXTERIOR TEMPORARY APPROVAL - BUILD NG
FIREWALLS ELECTRIC FEE CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS B SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
1w ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE- MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT 1 DENTI FICATION PERMIT rvur4aER
BUILDING APPLICATION & PERMIT .A O A
ADDRESS 11512 Country Sprin- Ont q9 - Plan Q21g Court BUILDING-ELECTRICAL-,PLUMBING-MECHANICAL I38
OWNER'S _ PLAN CHECK VALIDATION
"AME DTV. ELECTRIC PERMIT FEE
HONE
NAME c R's UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
uc.ND LIGHTING FIXTURES 10.00/1.00
r:oNTRACDR•a220 Twin Dolphin Dr. , "C" PPLIANCES-RESIDENTIAL 4.00
aooREss
Ppri,dnod City , CIA
PHONE _ PANELS 10.00 Ir DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
OR Aram Bassenian, A.I.A.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. ^^O Westerly Pl , li1JO SPECIALCIRCUIT 5,00 PERMIT VALIDATION
y J
ADDRESS
zip
EMP.METER OR POLE INS. 20.00
APPLIUN 'S RC H MOTORS SEE FEE SCH.
ADDREaa 220 Twin Dolphin Dr. , p
Redwood rity, rA 94065SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION W
<v w I hereby affirm that I am licensed under provisions of Chapter 9 5 DATE
(commencing with Section 7000)of Division 3 of the Business and
ELECT. PLG. MECH,
0 lei Professions Co4G,and my license is in full torpGggQe-(fepL p"]�
zoH License Class JS Lic.Number_4JUL y./ EX
Q w f D Dale Contmclor
a y s BUILDING PERMIT
ac M < OWNER-BUILDER DECLARATION INFORMATION
oda MISC.- REFER TO ORD
m ; m I hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT.
F v_ 0J Law for the followingreason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter, /S Z/�-"
X ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
X$ he is licensed pursuant to the provisions of the Con(mctor's License
r z a Low(Chapter 9(commencing with Section 7000)of Division 3 ofthe d Kl HCl
4 c Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
ic H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE•C/ONSS/T_R.
by any applicant for a permit subjects the applicant a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 �N f✓�..
of not marc than five hundred dollars(5500).):
O 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Dec.GROUP RES.UNITS
their sole compensation,will do Ilse work,and the structure is not e 9
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's improv Law docs not who to an owner of
property who builds or improves thereon,and who does such work ' FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVS7EM-1 6.00
mems are not intended or offered for sale.If,however,the building I
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 'a BUILDING USE
builder will have the burden of proving that he did not build or ire- RES IND CON Pa Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively Contracting with
licensed contractors to construe( if,. project(Sec. 7044,Business LAWN SPRINKLERS- I INC 5 V.B. 6.00 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-OVER 5(EA.) 1.00 3 P 4 -.--9-3' 3t
,32
contracts for such projects with a contracums)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PPR EL NO.
❑ IamexemptunderSee. ,B.&P.C.forlhis WATER HEATERW/VENT 6.00 (p 799.E
reason
Owner Date I WATER SYSTEM 5.00 ACC.DATE -ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sel Ginsore. ZONING ENG.SITE NO.
or'a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C111 �I
Policy No. CDInPa11y4Jn-i-tela-PaLJRe]la= -
O ❑ Citified copy i5 hereby furnished. FIRE SPRINK ENERGY T-24
Z Z X Certified copy a w% Ih y inspection division. MISC.- REFER TO ORD. Y[3 NC] Y 0 N[D
O Applicant .moi _
y PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
fY j CERTIFICAT' EXEMPTION FROM WORKERS'
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL V❑ N❑ Y❑ N�
Z) Z h united dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
IL F mit is issued,1 shall not employ any person in any manner so as to
1 1
O W become subject to the Workers'Compensation Laws of California. 410
Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING s 3
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex.
F ? emption;you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 7
Provisions of the Labor Code, you must forthwith comply with IFEE 3 /
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MOC.F.M.) 6.00 SEISMIC FEE Q
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which thisermil is issued(Sec. MICROFILM
3097.Civ.C.). Security Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address O, CA
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree lO comply with all city and county gO1LER-CDMP(3 H.P.Or 100,000B.T.U.) 6.00 PLUMBING
oduances and stale laws relaling,lo building construction, and L
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE F EE SCH. MECHANICAL LJ�
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 CONST.TAX 10
may in any way accrue•against said City in consequence of the PERMIT ISSUANCE 10.00
granting of th' r it. MECH.CONT. LIC.NO. MID 2 TOTAL
Signature plicantfConlractor a �✓
OFFICE COPY
w OFFICE
CITY OF CUPERTINO copy
GAS SERVICE NOTICE
I '
119-S S
To
i You are hereby authorized to connect the GAS service for
j Owner or Tenant G �F»>� h vI d D
j At Z
iNew Service
III No. of Meters Reconnect
No. of Add. Meters Move Service
ove Meter
PLUMBING INSPECTOR.
j
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO Bldg,Dept.
Office Copy
❑ Backflow Device Sanitary Permit No. Z Z 7 2
i ❑ Sewer Connection Plumbing Permit No. I
i
'1,4 Plumbing Final /r Lot No.
l Owner or Tenant ( 9--\ --P U 0 (t, (" rn-f
At C in
f t t C"rhrl l�1/ cfl
Tract9
7 9 t-
Date Connected 19 Date Final /A 7 19'-N:�p
i rn
�M PL J MBING INSPECTOR
ELECTRIC SERVICE NOTICE OFFICE Lv qJ
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
t '� 19 7,p
p To
You are hereby authorized to Connect electrical service for
�^ 10 'Owner or Tenanth
At � IS( Z C n V vt Y V y SPY'( yt - C�
if
f No.of Wires Size of Wires t Size of Swirch
I i !
I
Motor Load Voltage Phase
Heating Load K.W. Voltage
Light 110_New Service I ( Reconnect I
t, No.of Meters
I)
Heat 120Three Wire More Service
No.of Add, Meters Power.l/,*l Three Phose Move Meter
�• ELECTRICAL INSPECTORS/� !
CITYIQF CIILPE�tT;INO�p 1
CERTIFIIy#T,EE OfF„F C�O(M�PLETIiO,Nb
BUILD��,1�`INSPF�GTO[�;�tOF�ICEyB f �—f— ry'r�
Date ...... .. ...........7......... 19 .. BuilgLingrPermitTNov .3 0.........
0
c
The Building Located at .._ ./.51......._........._.�.AT. .::::::. .:. :.�aA.Q,....,,......_.I......
Z d /
Owned by ..L2-�'�' ...U.1! . ........(�-�Q.(!. ...........
Completed S 't
Has Been ForIUs�As:f......... :/. . .U...`.........................................._...
tered) o.................._..__. .. ..... .. . . .
................................................ .......... ... ..........,..._....,..,,.,. ,..
_........................... -- --- - -. .............. .
..................................................:::::::::::�:::ac:::r::::: .............................
.... . ... .....
G .............
.. . ............ ......
PD-7 BUILDING lLNSPEGTQROR