17705= POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY -OF CUPERTINO
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INSPECTION DIVISION
JOB INSPECTION RECORD
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PERMIT EXPIRATION
'
JOB ADDRESS UNIT# _ LOT#
-
PERMIT EXPIRES IF WORK
OWNER - CONTRACTOR
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
'
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION"
NOTE:-
LASTCALLED INSPECTION.
UFER
ALL GRADING AND DRAINAGE SHALL BE INSTALLED.
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
- -
PERMIT VALIDATION
PREGUNITE
CUPERTINO STANDARDS. ,
.
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N lllVl A
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
HAY 2'3 1989'
-
UNDERGROUND /SLAB
ISSUANCE DATE
PLUMBING
City• Ol {{
`COperpna
ELECTRICAL
MECHANICAL
BLDG
W
ELECT
PLG. MECH
WLGn
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
-
BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION
iVii W7
s/FT,
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
FRAMING
INSULATION
EMPTIES TYPE CONSTR
2 RIM
-
acc.cHnuP REs uNirs
Y4,1
R-3
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID -
sU. Fr. FLooR P." rarnL ncHSAct
DIAPHRAGM
ROOF SHEATHING
Bw LDIUSE
HES IN❑ COI G Py Upmi
KI 0 1:1 ED El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SAN.H
A5SL5SOGHS rPAHCEL NO
'� VJ-018`
'
PLUMBING 6AJT \'Z
ELECT. ENERGY
TUBS &SHOWER PAN 'Z
PLUMBING ENERGY
TRACT NO
Bm
PARCEL NO
MECHANICAL ,..
MECH.ENERGY
ELECTRICAL -
BUILDING ENERGY
ACC DATE
ACC FILE NO
FRAMING
ELECT, FINAL TEST
INSULATION l.♦;,
PLUMBING
ZONING
ENG. SITE NO.
GAS -TEST.
GAS
-
. -
MECHANICAL
FIRE SPRINK
y N[]y
ENERGY T 24
N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEARIq
ELECTRICAL RELEASE
FLOOD ZONE
Y E] NE
AL'UC
L NE
INTERIORSHEAR CV7FIRE
DEPT.
SHEETROCK 'L,'Z,a,
GRADE -
FEE SUMMARY
EXTERIOR LATH L
BUILDING -
BUILDING
90.50
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCHbOAT
ELECTRIC
PLAN CHECK
SEISMIC FEE
15.50
-62,00
13a
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED By BUILDING INSPECTOR.
MICROFILM
ELECTRIC
0z
ARRANGE FOR INSPECTION BY PHONING 252-4505,
LU
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
70.35
MECHANICAL
70.36
-'SEE PERMIT FOR EXPIRATION DATE -
CONST. TAX
3(9.,03.
IMPORTANT!
TOTAL
j544A9
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
OFFICE COPY
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NUMBER
?, 11 TO5
ADDRESS
ADDRESS 11841 Placer Spri Court Lot 336
'
OWNER'Sr
NAME
CITY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
PHONE -
NAMEmncroRs GrwY GYmP, Inc. '
OUTLETS -SWITCHES-RECEP 10.00/1.00
LICNO.
LIGHTING FIXTURES '10.00/1,00'
`SDRESS ORRADTSR'�20-C
ADTwin dolphin Drive
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00 -
vHONE
DATE OF APPLICATION
ARCHITEC - - ,
OR BaSsenian�Lagoni Architects
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ENGINEER LIC. NO.
ARCH, OR ENG.
AOORESC 2031 Orchard Drive //100
SPECIALCIRCUIT 5.00
PERMIT VALIDATION
y
EMP. METER OR POLE INS. - 20.00
' zIP
�1Slp•�,
rnvlM1�
APPucANrs Twin Dolphin Drive
ADOREss
MOTORS SEE FEE SCH.
RW. CA 9C65
SERVICECHANGE i 0.00
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LICENSED CONTRACTORS DECLARATION
1 IAY Z 0
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Codr nd my license is in full force t.
Class Number
ISSUANCE DATE
BLDG. ELECT.
PLG. MECH,
Datense
C.
Date Comrudor
_
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
ing reason. (Sec. 7031.5, Buncssand I'rll'essions
Law far the followsi
Code: Any city or county which requites a permit to construct, alter,
Improve, demolish, or repair any structure, prior to Its Issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant Id tire provisions of the Contractor's License
BUILDING PERMIT
INFORMATION
MISC.- REFER TO ORD
VALUATION
85f86
185 865
$/FT.
PERMIT ISSUANCE 10.00
ELEC.CONTR. LIC, NO.
ELEC.
TOTAL
PERMIT TO
OTY. PLUMBING PERMIT FEE
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation ofSection 7031.5
by any applicant for a permit subjects the applicant unit civil penally m
of not ore than five hundred dollars ($5001.1:
2
5NHR
ALTER-DRAIN-WATER(EA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
intendedoroffered for sale (Sec. 7044, Business and Professions
BACK.F LOW PROTECT. DEVICE 4,00
OCC. GROUP
R-3
RES. UNITS
1
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
Cade: The Contractor's License Law does not apply to on owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
mentsarenotintendedor offered for sale. If, however, thehuilding
FIXTURES - PER TRAP 5.00
SD. FT. FLOOR AREA
2917
TOTAL ACREAGE
:
2 zj�j
' GAS - EA.SYSTEM - I INC. 4OUTLETS 6.00
or improvement is sold within one year of completion, tire
e owner-
builder will have the burden of proving that he did not build or im-
prove forPropose DfsaleJ.
❑ I, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4IEA.) 2.00
,
BUILDING USE
RryESt IND CON PB Other
Ld ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 3000
.
liewd contractors to construct the project (Sec. 7044, Business
an Code: The Cotnractor's License Law does not apply
to an owner of property who builds or improvesthereon, and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
�•7 V
ec m
contracts forst h projects
the Contractor's wi0lacontrac
Licer(s)licensed pursuant to
c I-aw. -
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO .
PARCEL N0.
❑ I urnexempl under Sec.-, BAP.C. for this
reason
�p
BVA
' .
WATER HEATER W/VENT 6,00
Owner Date
WATER SYSTEM 5.00
ACC.OATE-
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSATION DECLARATION
1 hereby affirm that I have a certificate ofconsent to self -insure,
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
copy thereof(Sce. 3800, Lab.C.). United Pacific
Policy No. Company
FIRE SPRINK
Y❑N❑
ENERGY T-24
Y❑ No
Certified o y is filed. with t -ity inspection division.
[j Certified copy is hereby furnished.
App icanl _
MISC. - REFER TO ORD.
CE RTIFICA'1'F- OI' IiXF MPTION FROM WORKERS'
PERMIT ISSUANCE 10.00
FLOOD
COMPI:NSA7'ION I NS URANCE
(This section need not be completed if the permit Is for one
Y ❑ N❑
Y ❑ N❑
PILO. CONTR. 0C. NO.
PLG,
TOTAL
hundred dollars (S 100) o r. less.)
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
940 5D
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: IL after making this Cerlif icatc of Ex-
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=C.F.NL) 4,00
PLAN CHECK
FEE
15.50
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00
' CONSTRUCTION LENDING AGENCY
SEISMIC FEE
13.02
I hereby affirm that there is It construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address
HEATING UNIT (OVER 100,000 B.T.U.19.50
ELECTRIC
70.35
VENTILATION FAN (SINGLE) 4.00
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
PLUMBING
70.35
BOILER -COMP 13 H.P. or 100,000 B.T.U.) 6.00
BO LER-COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
70.35
hereby authorize representatives of this city, to enter upon the
above-mentioned properly for inspection purposes.
MISC. - REFER TO ORD.
(We) agree to save,Inchon ify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against said.City in consequence of the
mut' got this penult
PERMIT ISSUANCE 10.00
CONST. TAX
302.02:
MECH. CONT. LIC. NO. MECH.
_
TOTAL
TOTAL
,544.09
Signature of pplieant/Contractor - Date
OFFICE COPY