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13743 POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO PER,nIITNUMBER INSPECTION DIVISION 13743 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADD S��S�'�7/41��11�7C�DJ�[.f3 � UNIT# LOT# - PERMIT EXPIRES IF WORK OWNER /( 'L/�G' CONTRACTOR IS NOT STARTED WITHIN INSPECTION) DATE IlUPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION k �` �',al�ss cby IZ-- � ANCE OR 180 DAYS FROM LIFER LAST CAL LED I NSPECTI ON.- - - Olc �C I PREGUNITE 'I- UpS IPS s eLroW VnLlOanoN PAW POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED EC 3,O 1981 0 UNDERGROUND /SLAB t�, j. PLUMBING &awgw ELECTRICAL ISSUANCE DATE MECHANICAL eLOG, ELECT. PLG. MECH. ❑, ❑ ❑ ' ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING VALUATION S/FT. MECHANICAL $1090000.0 ELECTRICAL PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED Y f'_ ' ROOF SO,FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM ODI LONG USE HES, IND CON PR Gmel APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING - - . I GAS TEST TRACT NO. PARCEL NO. Q — MECHANICAL _ b ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING p SAN # INSULATION - PLUMBING ZONING ENG.SITE NO. GAS �1 FIRE SPRINK ENERGY T24 k CO 'F - MECHANICAL _ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ Y ❑ "❑ LATH-INTERIOR Z Wg ELECTRICAL �_ /- FLOOO zorvE �A,I.Z,LATH-EXTERIOR ' FIRE DEPT. Y❑ rv❑ SHEETROCK ,2 /d% GRADE FEE SUMMARY SHEAR INTERIOR _ BUILDIN 'Y'Y 2'-E14; SHEAR EXTERIOR ARY APPROVALBUILDING 455.50 FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE,HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTORAMECHANICAL ARRANGE FOR INSPECTION BY PHONING 252=4505, o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING.- SEE PERMIT FOR EXPIRATION DATE -IMPORTANT!PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. � OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY k1 NLDINGPR04ECT IDENTIFICATION PERMIT NUMBER �I Ao'oAEss of 50 Plan 2B APPLICATION & PERMIT I 11545 Evening Spring COUrit`. BUILDING- ELECTRICAL-PLUMBING-MECHANICAL 13743 OWNER'S PLAN CHECK VALIDATION NAME 415 OTY. ELECTRIC PERMIT FEE CONTGREGORY GROUP> INC< ,„mNE NAME 90 90 UTLETS-SWITCHES-RECEP 10.00/1.00 90,00 Same uC.ry LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00 ADDRESS 220-C Twin Dolphin Dr. CA PHONE _ PANELS IO.00 DATE OF APPLICATION A CT PLAN CHECK FEE P.C.NO. FR ARAM BASSENIAN, AIA PANELS (OVER 200 AMP) 20.00 ENGINEER FS LIC.No. SIGNS TRANS. 3.00 PAI ADDDRESSE SPECIALCIRCUIT 5.00 PER MIT VALIDATION r Y 11709) EMP.METER OR POLE INS. 20.00 DEC 3 01.987 ADDRESS PLICA MOTORS SEE FEE SCH. , s 220- TW7 n Dolphin Dr. SERVICE CHANGE 20.00 VV OWMIJ Wo o LICENSED CONTRACTORS DECLARATION _ Q i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and F D i Professions Code,and my license is in full Ibre y(yg BLDG. ELECT. PLG. MECH. Z o w - License Class 6 Lia Number V 7 Q z H w Date Contractor a m BUILDING PERMIT ¢ ¢ w 4 OWNER-BUILDERDE ION o a 0 INFORMATION K ; LL m I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD He, of Law for the following reason.(See.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. Code:Any city or county which requires a permit to construct.alter, $ QQ Q p Improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. .P109,000.00 ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO u w m" he is licensed pursuant to the provisions of the Contractors License rZLaw(Chapter 9(commencing with Section 7000)of Division 3 of the Q 1 4 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE LQ ge ¢r$ the basis for the alleged exemption.Any violation of Section 703 LS STORIES TYPE CONSTR. Ate _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ��/��' ❑ I,as owner at the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will(S the work,and the structure is not intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00 _ Code: The Contractor's License Law docs not apply to an owner of property who holdsorr improves employees, does such improve- FIXTURES-PER TRAP 5.00 • SO FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such improve- mentsarenotintcndcJoroffercJforsale.IL howeveq the budding GAS-EA.SVSTEM-11NC.40UTLETS 6.00 00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM OVER 4 (EA.) 2,00 BUILDING USE prove for purpose of.]I.). INDUSTRIAL WASTE INTER. 30.00 RE IND 11 ❑N EPR l ED❑ 1,as owner of the property,am exclusively contracting with 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 to as owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 *92( 9-3 3 contracts for such projects with a contractods)licensed pursuant to the Contractor's License L.W. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO, PARCEL NO. ❑ Ior) reason am exempt under Sec,.,BAP.C.for this WATER HEATER W/VENT 6.00 00 Owner Date WATER SYSTEM 5.00 ACG DATE ACC.FILE N0, WORK ERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 / I hereby affirm that I have a certificate of consent to self-D'um. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.0 Policy No. Companyl?ni ted-P_ac-f_ic_ �_- O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T Z Z X Ccrtificd copy c c inspec ' n division. 24 H 0 Applicant 7EF'3TOSRSACDD REFER TO ORD. v ❑ NE] Y ❑ NE] CC h CERTIFICATE 'EXEMPTION FROM WORKERS' UANCE 10.00 FLOOD ZONE A.LU.C. LL > COMPENSAT'[ON INSURANCE PLG.CLIC.NO. 'PLG. d ❑ IT his section need not be complete) if the permit is for one TOTAL VE] NF] Y C] N � Z hundred dollars(S 100)or less.) U 0 I certify that in the performance of the work for which this per- QTYEHANICAL PERMIT FEE FEE SUMMARY 1L 1- mit is issued,1 shall not employ any person in any manner so as to O w become subject to the Workers'Compensation Laws of California. y Date Applicant TO MECH. 5,00 BUILDING } W NOTICE TO APPLICANT: If,alcor making this Certificate al'Ex- 455.50 F Z_ emptimn,you should become subject to the Worken'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with 296.D U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C 8 .F.M.) 4.00 FE Ey` . C .0 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,Oo0CEM.) 6.00 SEISMIC FEE 6j 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance o� rk for IT h y g permit is issued(Sec. 5.00 MICROFILM 3097,Cie.C.). J �1 amen LO JHL HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name 8.00 Lender's Address p��� /�p /l/�C HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC IV I certify that 111.) Gad 1hiA A,E94QU state that the above VENTILATION FAN (SINGLE) 4,00 149.00 information is correct. 1 agree to comply with all city and county 12 1111 ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,0 o0 B.T.U.) 6.00 PLUMBING 92.00 hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE BCH. above-mentioned property for inspection purposes. MECHANICAL 55.DD (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which =PERMIT CONST.TAX may in any way accrue,against said City in consequence of the 10.00 granting of this per it. MECH.CONT. LIC.NO. MECH. TOTAL 55.0 I TOTAL 1 ,497.8 Signature ofA ni/C nUac[or D c OFFICE COPY CITY OF CUPERTINO • CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE Date 1.)&...1A..........1....... 19-6-8.. Building Permit No. The Building Located at --- ...... (f Owned by ....... ...... ........ . ....... Has Been A t- let For Use As: ......... [ e ere .........................................................................I........................................................................ .................................................................................................................................................. ........... ............................................................................................................................ .......................... ... .................................... PD-7 BU1qING\INSPECTOR Ok (4- BUILDING INSPECTOR'S OFFICE ,tom;•Y.b ` CITY OF CUPERTINO Ofificck sC pi. e Cop. - p E ❑ Backflow Device Sanitary Permit No. ��/ /a/- % E ❑ Sewer Connection""--- Plumbing Permit No. o` LL ❑Plumbing Final - Lot No. o` Owner or Tenant �2c� 02�r G�>-Q j.,? 0 f © At :� 1-11 i Q nu .Tract - Date Connected /J 71 �VUU 19_Date Final 19 D PLUMBINGINSPECTOR • ELECTRIC SERVICE NOTICE oFF*PY ' BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO To le You are hereby auth o rized to Connect electrical servicef''or Owner or Tenant l '� P�=r nm / V lTL'eo's In At I 1 C '7l 1 I No.of Wires 41 Size of Wires Size of Switch Ue) A A'ti0 Motor Load Voltage -U- Phase Heating Load' K.W. 'f+- Voltage F% r-, Na.of Meters ��` ( Light �� I10_New Service Reconnect l(/1 Heor 120_Three Wire More Service_ No.of Add.Meters Power Three Phose Move Meter �M ELECTRICAL INSPECTORC�/`�++ 1 OFFICE 60 �� CITY OF CUPERTINO COPY GAS SERVICE NOTICE E i 19 8V LL � ' To You are hereby authorized to connect the GAS service for I 2v c, i Owner or Tenant o C � New Service T O r. �= No. of Meters Reconnect -(Z- � No. of Add. Meters Move Service 4-)- Move Meter PLUMBING INSPECTOR ©,