13764 !' POST THIS CARD NEAR,FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 13764
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS��.7Z r4 AJ/ilf�r _14-ogmar «r UNIT# LOT# 36
PERMIT EXPIRES IF WORK
OWNER �404VAY (7/(OU/° /^IC/ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM,
LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PAID
UNDERGROUND /SLAB
PLUMBING DEC .� O 198/
Cpl
ELECTRICAL k -59" ISSUANCE GATE
MECHANICAL ' o MECH.
Q
BUILDING PERMIT
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
INFORMATION
WOOD FLOOR vn INFONSIFT.
PLUMBING
MECHANICAL - $109 000.0
ERMIT TO
ELECTRICAL
FRAMING ( !`
STORIES TYPE CONSTR.
IN CATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BftSIGNEID
ROOF OFT.-FLOOR ARE TOTAL ACREAGE
DIAPHRAGM 6btA 151
BUILDING USE
RES IND CON PB Ober
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING '
TRACT NO. PARCEL NO
GAS TEST "7cf,
MECHANICAL I I l
ELECTRICAL -9-s-SI6 4or FINALS DATE INSP. ACC.DATE ncc.FILE NO.
FRAMING - SAN # ZZ
ZONING ENG.SITE N0.
INSULATION 1,30-0 PLUMBING
GAS
MECHANICAL
FIRE SPRINK ENERGY T 24
- �
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v E] NEI v E:] N
LATH-INTERIOR i ELECTRICAL aooD zoNE - AL.U.C.
i LATH-EXTERIOR y FIRE DEPT. v "❑ v ❑ N[j
SHEETROCK - S GRADE FEESUMMARY
SHEAR INTERIORP}CepF bl ..8$ BUILDING
SHEAR EXTERIOR 9: �, TEMPORARY APPROVALS BUILDING 455.50
FIREWALLS ELECTRIC PLAN CHECK 296.08
7-I GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECT
ORMICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC 149.0
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 92.
04
z� PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL 55.0(
IMPORTANT! CONST.TAX 282m6f
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. $"Tim,
OFFICE COPV
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
14 BUILDING LOT /136 PLAN 2AR APPLICATION & PERMIT 13764
ADDRESS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME (415) OTY. ELECTRIC PERMIT FEE
E
NAME CTORi UTLETS-SWITCHES-RECEP 10.00/1.00 90 no
NAME
LIA6,,430097 LIGHTING FIXTURES 10.00/1.00 20 (10
roNTRA PPLIANCES-RESIDENTIAL 4.00
ADDRESS 220-C Twin Dolphin Dr.
CA 94065 (415) PHONEEQE PANELS 10.00 GATE Of APPLICATION
A T PANELS (OVER 200 AMP) 20.06 PLAN CHECK FEE P.C.NO.
OR ARAM BASSENIAN, AIA
2. A(z(znrTA:rES LIC.No, SIGNS TRANS. 3.00
ARCH.OREN SPECIAL CIRCUIT 5,60 PERMIT VALIDATION
al
ADDRESS 3990 Westerly Place170 EMP.METER OR POLE INS. 20.00 PAID
ADDR S p - ANT AdDRES MOTORS SEE FEE SCH. Dtb n
k
�WC CA 9406 SERVICE CHANGE 20.00 etfQ' _v
Doo LICENSED CONTRACTORS DECLARATION ^;`�
<u u I hereby affirm that 1 am licensed under provisions of Chapter 9 W[r Quawke
N<i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PL . MECH.
i Professions Code,an my license is in full forcg gp� ff r,(
o 0 W License Class Lic.Number_
are Contractor
a y BUILDING PERMIT
¢ ¢ ¢ < OW CR-BUILDER DECLA ION
wu MISC.- REFER TO ORD INFORMATION
F
;A I hereby affirm that I am exempt from the Contractor's License
u. o Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION g/FT.
fw>S Code:Any city or county which requires a permit to construct,a Iter, $109 OOO.00
¢ ¢¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. ,
0, requires'the applicant for such permit to file a signed statement that TOTAL 149 Uti PERMIT TO
W :1
se " he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
4 �l
Business and Professions Code)or that Ise is exempt therefrom and CITY. PLUMBING PERMIT FEE w
It f D the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(55000.):
0 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.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 55.0
• property who builds or improves thereon,and who does such work FIXTURES.PER TRAP 5.06 SO.FT.FLOORAREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building I GAS-EA.SYSTEM-I1NC.40UTLETS 6.00
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 im- RES IND CON PB other
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000
0 1,as owner of the property,am exclusively contracting wi . .
th ❑ ❑ ❑ ❑
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 an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 346-9-21 3 J 33
contracts for such projects with a contractm(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL No.
0 lam exempt under Sec. ,B.&P.C.forlhlg WATER HEATER WIVENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insum, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.Ca)In)ted Pacific �,IZZ
Policy No. Company U
O 0 Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z 11(
Certified,4y is filed s't the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
PO Ji Y N Y N
' rnrOp PERMIT ISSUANCE 10.00 .O FLOOD ZONE A.L.U.C.
LU CERTI FIC COMPENSATION
INS FROM WORKERS'
UJ _ COMPENSATION INSURANCE PLG,CONTR. LIC.No. PLG.
CL (This section need not be completed if the permit is for one TOTAL 92. Y❑ N❑ Y❑ N❑
hundred dollars(E 100)or less.)
U O 1 certify that in the performance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY
U. - mit is issued,I shall not employ any person in any manner so as'to
U become subject to the Workers'Compensation Laws of Calilornix.
wDate Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 455.50
>_ ran NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F 2 emp!i.n,you should become subject to the Workers'Compensation 4 APPLIANCE 5.00 20.0 PLAN CHECK 296.08
provisions of the Labor Code, you must forthwith comply with
() such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE /energy 160.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE 7 G,P
I hereby affirm that there is a construction lending agency for 1 EXHAUST HOOD(WITH DUCT) 5.00
the performanp pf a wo k fyr wh,'eq{his permit is issued(Sec. MICROFILM
3097,Civ.C.). JOC�a m6n'LO JNL HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name300 Brad ford C+ ELECTRIC 149.0
Lender's Address' al- HEATING UNIT(OVER 100,000 B.T.U.19.50
1 certify that I have rest this application 3017 state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING 92.0
ordinances and state laws relating to building construction, and BOILER•COIV1P13H.P.Cr100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. 55.0
(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
t may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
granting of 9p it. MECH.CONT. LIC.NO, MECH.
TOTAL
Signature o plicenl/Contractor U� 55.00 TOTAL =1.,.49T.89•�
OFFICE CQPV
JOB ADDRESS //r�2 rG'��'!nl s�ie/.�r C�2T UNIT# r' ILOTr7j:' 3
PNER /'`` G/(OIJ/ //IG CPNTAAC70R '✓:•li hl . ',r r s'.. _ .IS NOT
LAINSPECT ON DATE INSPECTOR INSPECTION RECORD •^� Mr6i�V
FOUNDATION ANCE ORY
LAST CALLED INSPECT
•
LIFER }
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING Y
ELECTRICAL ISSUANCE DATE
BLDG. ELECT. FLG.
MECHANIC p ❑ O
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMT
INFORMATION
WOOD FLOOR VALUATION
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING
STORIES TVPE[I
! IN CATION A '
Occ.GROUP RES L
iAd
q PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO IT FLOOR APEAI TUTA:A
BIAPHRAfGM �--
j Buil DING usE
RES IND CON Pn
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑
ASSESSORS PARCEL Ni
ROUGH
PLUMBING -0
• GAS TEST TRACTrvo PARI
MECHANICAL
ELECTRICALFINALS DATE INSP.^ 2- J ACC.DATE ACCFI
C
FRAMING �-C�• $ SAN 0
ZONING ENG SI
INSULATION 0 PLUMBIf1G
GAS ✓
RI
FIRE SPNK ENERG
' MECHANICAL ,Y' �/ _ V ❑ N V C
COVER NO WORK UNTIL AB VE HAS BEEN SIGNED HEATING
ELECTRICAL FLOODZONE A.L.
LATH-INTERIOR
- �J
LATH-EXTERIOR FIRE DEPT. J Y❑ NO V L_
SHEETROCK GRADE - FEESUMMARY
SHEAR INTERIORCICF�T D, 5-31- O. BUILDING
F SHEAR EXTERIOR''-�f ,Cj-jl-�� TEMPO RARYAPPROVALS✓ � BUILDING
FIREWALLS ELECTRIC .- O- `PLAN CHECK e
_li \ -1-5-e,,5, 9 11 IGAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. OMICROFILM
� I
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
w ' ''
I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
CCONST.TAX
IMPORTANT!
• PLEASE READ REVERSE SIDE BEFORE 'TOTAL ISE
CALLING FOR FINAL INSPECTION. t
APPLICANTS POSTING COPY
�'ffOUN DATIONPAID..• _ ",� . ' ?`
LIFER � �;'r�-��-PC+`b I� '
PREGUNITE VE HAS BEEN SIGNED DEC 3 01987
POUR NO CONUNDERGROUND /SLAB city of c
- •
eLOc
PLUMBING O ELECT. ❑ ❑
1 ELECTRICAL ❑
MECHANICAL _�. BUILDING PERMIT
INFORMATION
�P�� SIFT.
vPLUATION
I 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNS t5 r r .LV
WOOD FLOOR Ef '
PERMIT TO
PLUMBING
MECHANICAL STORIES TYPE CONST
h � ELECTRICAL '
FRAMING J��Q R
RESUNll
DCC GROUP
INSU ATION �
f $O fI FLOOR PRfP IOtPI PCRt
i PLACE NO SUBFLOOAUNT"ROOF
HAS BEEN SIGNED BUILDING USE
PR
_ RES IND CON AGM I]
i �• DIA O ❑
ASSESSORS PARCEL NO
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED pPRCLI
'PACT No.
ROUG
a.
PLUMBINGncc.P'L
'
GAS TEST INSACC-DATE.P.
MECHANICAL N FINALS DATE
M
, A fir ZONING ENG Sll
ELECTRICAL V_ � .Y f.c-. SAN i+ y 'I
FRAMING i30�E7� p /I�[ PLUMBING V��
FIRE SPRINK ENERG
INSULATION GAS• Cl
�y 'r• Y 0 No Y' MECHANICAL
nooO zoNE ALI
HEATING Ffr�� r O L
I COVER NO WORK UNTIL ABOVE HAS BEEN IGf�D ELECTRICAL
n
i LATH-INTERIOR � FIRE DEPT. O " r
F
LATH-EXTERIOR h GRADE 1
BUILDING
SHEETROCK ` C' BUILDING
` SHEAR INTERIO TEMPORARY APPRR OVALS •PLAN Cp,EC.Kr0
.y
I
SHEAR EXTERIOR ELECTRIC FEE
\� FIREWALLSvz" GAS SEISMIC FEE
Q m n EN SIGN EO OCC
—I .
MICROFILM
NO TAPE OR PIASTER UNTIL ABOVE '- BE
u OCCUPANCY OF BUILDING ISNOT PERMIT-E D U NTIL BUILDING FINALIS SIGN ED BY BUILDING INSPECTOR ,ELECTRIC
�'
ARRANGE FOR INSPECTION BY PHONING 252-4505, PLUA101NG`g.
` w ONE WORKING DAY BEFORE REQUIRED INSPECTION. MECHANICAL
p� PLEASE GIVE JOB ADDRESSINHEN PHONING.
I` Z — SEE PERMIT FOR EXPIRATION DATE — CONST.TAX
I � c
IMPORTANT!
TOTAL
C PLEASE READ REVERSE SIDE DEFORE
CALLING FOR FINAL ItnSPECTION.
' :.PPLICANTSPOSTINGCOPY -__.