13804 I JS y POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NU ,RER ,
INSPECTION DIVISION JVU4
JOB INSPECTION RECORD
$ n--- PERMIT EXPIRATION'
JOB ADDRESS 11` � �=AA� UNIT# LOTAF [0-,7
,,,/�,/ �^ - PERMIT EXPIRES IF WORK
OWNER (�` C �IJU (J G� CONTRACTOR IS NOT STARTED WITHIN
INSPECTION TE INSPE TOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIOATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB A PAW
PLUMBING
ELECTRICAL ' OE NCE GATE -
MECHANICAL - /y _ RLGc. L T. PLG, MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILUING PERMIT
WOOD FLOOR INFORMATION ,
' �V ALUATION $/FT.
_ PLUMBING � i _
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING .. z /=^,,.✓ :.. C,.
•
MEL - - STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
-
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
,rl ROOF SO.FT-.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
HES IND CON PB Otte,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH / ' TO Ov
PLUMBING
GAS TEST O - . TRAcr No PARCEL No.
MECHANICAL
ELECTRICAL -/ FINALS DATE INSP. Acc.GATE AccFn.ENo.-
FRAMING - $- SAN zoNlNc ENG.SITE No.
INSULATION - PLUMBING �_/y -
GAS
\ MECHANICAL FIRE'SPRINK ENERGY T 24
jL;;COVERNO,WORK UN,TIL,,ABOVEHASBEEN"SIGNED HEATING
LATH-INTERIOR
ELECTRICAL' /f; FLOOOZONE A.L.UC.
LATH-EXTERIOR . FIRE DEPT. Y❑ N❑ v❑ NE]
SHEETROCK J - , GRADE FEE SUMMARY
SHEAR INTERIOR - - BUILDING
SHEAR EXTERIOR - TEMPORARY APPROVAL_$ BUILDING
v
FIREWALLS - ELECTRIC PLAN CHECK u
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED, OCCUPANCY SEISMIC FEE, M
OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
y
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING. .
Z - 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
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
A.ILOING 11533 Country. Spring Court APPLICATION & PERMIT .�
ADDfl ESS 1 0 O-�
BUILDING - ELECTRICALIT 4 -PLUMBING-MECHANICAL (lJl
OWNEH'a +PLANC ECK VALIDATION
.+ NAME QTY. ELECTRIC PERMIT FEE e
Group- Inc
PHONE 1
NAMERAc GRs UTLETS-SWITCHES-RECEP 10.00/1.00
I LIC,N0, 430097 47LIGHTING FIXTURES 10.00/1.00
nory
oAei °fla 220 Twin Dolphin Dr. , IICII PPLIANCES-RESIDENTIAL 4.00 / ,
PHONES95-2100 PANELS 10.00 / DATE OF APPLICATION
ARCHITECT - - PLAN CHECK FEE P,C.NO.
OR Aram Bassenian, A. I'.A. PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG.(-
NG. PERMIT VALIDATION .
ADDESS 3990)Westerly Pl . , #1'70 SPECIAL CIRCUIT S.oD
zIv EMP.METER OR POLE INS. 20.00 -
AvvuEa 'S 220 Twin Dolphin Dr. , DCn MOTORS SEE FEE SCH. 41
Rpdwnnd City, CA 94nF;.q SERV ICECHANGE 20.00
'0 o LICENSED CONTRACTORS DECLARATION - A 11 1967a u u I hereby affirm that I am licensed under provisions of Chapter 9 lJ B ISSUANCE DATE
a, w (commencing with Section 7000)of Division 3 of the Business and
< e. BLpQ EL T PLG. MECH.
F o Z Professions Codi,and my license is in full fopp�fo•ss�agqpp,��[(fq.L q�hW.(.t(II,_JxgF
p z T O License Class Lie.Number YJV U7/
P =F J Date - Contractor
et XM4 OWNER-BUILDER DECLARATION - BUILDING PERMIT
I
a o INFORMATION
X
3 u H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
uo Law for the followingmason. 703 L5,Business and Professions / vnwnnoN $/FT.
E m g PERMIT ISSUANCE 10.00
E w >F CoderAny city or county which requires permit m construcq alter,
S�
M Ie Q o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. /� ---
o u requires the applicant for such permit to file a signed statement that TOTAL
a. PERMIT TO x m he is licensed pursuant to the provisions of the Contractor's License n
r z¢
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
s 4 o Business and Professions Cade)or that he is exempt therefrom and OTV. _ PLUMBING PERMIT FEE
f the basis for the alleged exemption.Any violation of Section 7031.5 . STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant to a civil penalty r� p
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5,00 (/--
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP REB.UNITS
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. 5.00 R-3
Code:The Contractor's License Law does not apply to an owner of
roperty 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-
Points are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,Ihe'owner-
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 RES IND CON PB Other
El 1,as owner of the property,am exclusively contracting with - R ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply q
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 3 4 �`- P- 31 .�3
contracts for such projects with a contraclor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. I TRACT NO. PARCEL
-
❑ I am exempt under Sec.-,BAP.C.for thisI WATER HEATER W/VENT 6.00
reason
Owner Date' 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 self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.0
Policy No. CompanyI nl tPd lac RPliBm -
U ❑ Certified copy is hereby furnished.
Z Z X Certified co fi the city inspection division. FIRESPRINK -ENERGY T-24
O Applicant- MISC.- REFER TO ORD. l .-=) v F] N❑ v ❑ N[]P: rnPERMIT ISSUANCE 10.00
OC - CERTIFIC OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.O.
COMPE
ION
CL a (This section need not beTcoomple ed INSURANCE
thepermitis for one PLG.CONTE. LIC.N0. PLG
TOTAL
d0 Y❑ N❑ Y ❑ IN[J
=) Z hundred dollars($100)or less.)
U O I certify that in the performance of the work for,wInch this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
O Wbecome subject to the Workers'Compensation Laws of California. BUILDING
o, Date Applicant ALTER OR ADD TO MECH. 5.00 S c3
�- to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE5.00 PLAN CHECK .fG
provisions of the Labor Code, you must forthwith comply with FEE 3 7�
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE, 0 pal
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.).
Lender's NamSecurity Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00 0/
eHEAT]NG U N IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address�R�i-$.EOE CA
1 certify that 1 have read this application and stale that the above I VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING �Sd"✓
] ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U.) 6.00 r1,s
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over L00,000BTU)SEE FEESCH. MECHANICAL V J'
above-mentioned properly for inspection purposes, J
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. / p
Cupertino against liabilities,judgments;costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX bj
may in any way accrue ag 'ssl said City in consequence of the
granting Of fJt6i/L11yL MECH.CONT. LIC.NO. MECH. �--c
TOTAL r
Signature plicant/Contractor ate 2
OFFICE COPY
EES 1 or ��
CTIA
UN
I�1G NOEgOROUNBOVEIHAS§8ES10
'00 ` s 4,lita�,«LSret_ w.i:�:,.�{ >, ;•` ,".�F'. . . .P uD �!,�tn.'.
rNO.TfP.OUR;FLOOR UN L .� CC
BOV
• P�UMBINO WOOD FLOOR
E HAS BEEN SIGNEO -��
OR
MECHANICAL E
O Eoc IS
J'"` • ;iu ELECTRICA
L l
FRAMING
I ULATION
PLACE NO -St,BFLOO ER
. _ R UNTIL VE
AIAPHR,;GM� ROO`t_ HAS BEEN SIGNED s'oRrzs
1 l
APPLY NO ROOF, OCC.GROUP
NG UNTIL ASO
VE HAS BEEN SIG s°" FwoR AR
PLUMBING ROUGH EA
GAS TEST NED
EECHANICAL G Res iN uiEo�NG
ECTRICAL / Q ° CON
FRAMING �B _ ASSESSORS 0o
SOLATION Q_$� FINALSO OV/ - TRACi
g—. —�
y). SANS ICG DATEI
COV PLUMBING INSP, A—E
R
LATH–INrFR CORK UNTIL ABOVE GAS - AQ
sH K TH–ExrERIOR ; HAS BEEN SIGNED MECHANICAL Lj t _y zoNiryc
EE TROC HEATING ENG.
/
SHEAR INTERIOR ^� ELECTRICAL FIRE SPRIryK
F FEAR EXTERIOR 'c�C/. m FIRE DEPT. O- _ r NQ EVER
WALLS n /-• GRADE FE000
BUILDING10N[' 4.E
1 ( Y No
NO TAPE y /
OCCUP OR CASTER U – – ELECTRIC PPR – . .
UNTIL OVALS SUMMARY
ANCYpF BUIL DINGISNO BD RE HAS B€ IGNEO GAS BUILDING -�
MITTEC UNTI OCCUPANCY .
+ ARRANGE F IL
ALIS FEENCHECK
G FIN
�{ SI
z
ON WORKING DAYB EFI ON cNED BY BUILDINGSEISMICFEE i
ASEGIVE� AYBEFOR BYPHONIN .INSPECTOR.
—SE OB AppRE R REQUIREp� 252-4505 MICROFILM
E PERMIT FOR Exp RATPHONINGPECTION. 2 ELECTRIC
P MPO ON DATE _ v PLUMBING
LEASE RE RTANT'1 ;
CALCI AD REVERSMECHANICAL
NG FOR FINALE NSPDECTEp RE 11 3, t. ._a .'Y; CONST.rq
APPLIC N. x .
- ANiS POST
RJO COPY
TOTAL
CITY OF CUPERTINO PG &E.
COPY
GAS SERVICE NOTICE
•4 n rid rn h�o � i 9��
To
You are hereby authorized to connect the GAS service for
Owner or Tenant t
I _
At
New Service
No. of Meters
Reconnect
No. of Add. Meters Move Service
Move Meter
PLUMBING INSPECTOR
r ELECTRIC SERVICE NOTICE P.G.8 E.COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
l' You are hereby authorized to Connect electrical service for
'Owner or Tenant
i
Ai
No.of Wires- Size of Wires
Size of Switch
Motor Load Voltage
Phase
Heating Load K.W.
Voltage �"
No.of Meters Light t t0__N ew Service S(- DLL)Lp
emnnect
Heat 120__Three Wire
No.of Add.Meters More Service
Powe` Three Phase
Move Meter
�� ELECTRICAL INSPECTOR