158825k_
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
15882
INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS,/a? q9 pz A•�` fe `w. A `- UNIT # p.
PERMIT EXPIRATION
_LO #
-
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
OR 180 DAYS FROM
LAST CAL L E D INSP ECTI ON.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATIONC7 ctANCE
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.H!)j
UFER
PREGUNITE
P[: RMIT VALIDATION
GARAGE SLABS
POUR NO CONCRETE
UNTIL ABOVE HAS BEEN SIGNED
MAY 23 1959
.
i I�, T
SISSUAN E DATE
UND-ERGROUND/SLAB
PLUMBING.VIN)a�,I
s
City Df cupft
ELECTRICAL
MECHANICAL
-
BLDG
ELECT I
PLG. MECH
r L
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
lk7INffO.RMATION
BUILDING PERMIT
WOOD FLOOR
V A*I ,, •
'an AIR
!/FT.
I
PLUMBING
MECHANICAL
ELECTRICAL
IQ%qm2PERMIT TO
sroR s TYPE CONSTR
FRAMING
INSULATION
-
O C GROUP
UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
Ra
' ROOF
NOTE: NO FINAL INSP. SMALL 57YADE BEFORE
THE CONSTRUCTION TAX IS PAID
SO FT, FLOOR AREA
I , ' . .
TOi L ACREAGE
•'
DIAPHRAGM
ROOF SHEATHING
IRES 'NO ILOCON usEED om,..,
E 0 ❑ Q
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS
DATE INSP.
ROUGH
SAN.N 1
ASSESSORS PARCEL NO
r�
OG 5-C..,�yO
PLUMBING Bl� 0
ELECT. ENERGY
TUBS 8 SHOWER PAN, O(d,
LUMBING ENERGY
TRACT NO,
PARCEL NO
MECHANICAL tOtf ?)T
MECH.ENERGY
ELECTRICAL
BUILDING ENERGY
DATE
ACC FILE NO
FRAMING b
ELECT. FINAL TEST
INSULATIONb
PLUMBING
ZONING
ENG, SITE NO.
GAS TEST -
GAS
MECHANICAL
FIRE SPRINN
Y
ENERGY 24
Y NE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR I
ELECTRICAL RELEASE
FLOOD ZONE
NE
❑ N�
AL Uc,.
Y L N�
INTERIOR SHEAR
FIRE DEPT. -
SHEETROCK
GRADE -
FEE SUMMARY
EXTERIOR LATH 'Z
BUILDING
BUILDING .
FLAN CHECK '�.�
5 RWIE
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
Lu
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
o� PLEASE GIVE JOB ADD RESSWHEN PHONING.
Z
—SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL
CONST. TAX
302-02
IMPORTANT!
TOTAL
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
OFFICE COPY
•
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CL 1:1
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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 -
15882 �'e�
�j G
B ADDRE°"OI"° SS 11842 Placer) WingCQurt Lot 320
OWNER'SV p, •
NAME J Y
CITY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
PHory
CONTRACTOR
AME ACTOR V1^^ry Group, Inc.
�11 Group,LIC.ND
OUTLETS -SWITCHES -RECEP 10.00/1.00
-
LIGHTING FIXTURES 10.00/1.00
COONTRACTOR'a 220-0 TwinDolphin Drive
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
PHONE415/595-Za
DATE OF APPLICATION'
ARCHITECT
OR Bassenian/Lagoni Architects
ENGINEER
Llc. No. )
PANELS IOVER 200 AMP) 20.00
PLAN CHECK FEE - P.C: NO.
SIGNS TRANS. 3.00
ry�p /�,�I� �,�J f�,�
ADDRESS END 2031 Orrhard Drive #100
' ,pq2707
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
rl`w•
I� „E
5-, ^J (YJ
EMP. METER OR POLE INS. 20.00
APPucgrvrs 22D -D Twin Dolphin Drive
ADDRESS
RX, CA 94065
MOTORS SEE FEE SCH.
Ter
SERVICE CHANEIDI, 2
LICENSED CON'T'RACTORS DECLARATION
S -V_
-
-
1 hereby affirm that I in licensed under provisions of Chapter 9
(Commencing with Section 7000) of Division 3.go�fythe pBusiness and
Professions Code, a I my license is in full fares- JSA�27ci-MAY
Licensc
License. Class_ Lin. Number-5�1�2(
Date Contractor
ISSUANCE DATE
BLDG. ELECT.
s�
�asJ
PLG. MECH.
r�Y
E
O` ^u Is,y,
[�/ 1 V µ,u0 .N�gliYlr
city
BUILDING PERMIT
INFORMATION
OWNER.BUILDER DECLARATION
I hereby al}lnn that I wn exempt from the Contractor's License
Law for tho following reason.(Sec. 7031.5, Ho,inessand Professions
Code: Any city or county which requires a pennit to construct, alter,
,Y
MISC.- REFER TO ORD
PERMIT ISSUANCE 10.00
VALUATION
$/FT.
ELEC. CONTR. LIC. NO. ELEC.54.922
i TOTAL
OTV. PLUMBING PERMIT FEE
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit In file a signer) statement that
be is licensed pursuant to lira provisions a] He Contractor's License
Law (Chapter 9 (emnmencing with Section 7000) of Division 3 of the
Business and Professions Code) or Ilial be is exempt Ihetef.om and
PERMIT TO
SFRJ
the basis for the alleged exemption. Any violation of Section 7031.$
for permit dolimslhcapplicunttoucivil penalty
by any more then
ofcut1, as thus five hundred
(my
STORIES
2
TYPE CONSTR.
5 R
ALTER -DRAIN 5.00
❑ I, as owner ad the property, Or my employees with wages as
property, o crn1
(heir sole mmpcnsm ion, will Jo the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and 1'rol'essions
Code: The Contractor's License Law does not apply to an owner of
R-3
1
FIXTURES - PER TRAP 5.00FLOOR
GAS - EA. SYSTEM -1 INC. 4OUTLETS 6.00
AREA
�95�
TOTAL ACREAGE
LN
property who builds or improves Ihereon, and who does such work
himself or through his own employees, provided that such improve-
mentsarenotintendedorofferedforsale.If, however, the building
or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or ire-
prove for purpose of sale.).
Cl I, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
BUILDING USE
HE$ IND CON PB Other
INDUSTRIAL WASTE INTER. 30.00
licensed contractors In construct the project (See. 7044, BusinessLAWN
and Professions Code: "file Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
contracts for such projects will, a contractors) licensed pursuant IO
the Contractor's License Law.
❑ lam exempt under Sec. ,B.&P, C. fur Ibisrea
son
SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1,00
ASSESSORS PARCEL NO.
C
GC.
J:J
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Date -
WATER SYSTEM 5.00
ACC.OATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSAI']ON DECLARATION
1 hereby of oro that I have a certificate of Caaaent to "IG D"me,
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
l
PoL.licy No of I Sec. 3 SCompuny hited_Pacific
r41 Certified copy is hereby furnished.
A7 Cerfifiel cn i filed wish the �ity il�pection division.
Applicant
FIRE SPRINK
Y ❑ NJ[]
ENERGY T 24
Y ❑ NE]
MISC. - REFER TO ORD.
_ _
Vl
CER'T'o-'ICA'rls 0 1MPTR. FROMWORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
COMPENSATION INSURANCE
IThix section need not he rompleled if the permit is for one
Y ❑ NE]
Y E] NC]
PLG. CONTR. LIC, NO,
PLG,
TOTAL
hundred doll... 1$100) or less.)
I certify that in Orn performance of the work for which this per-
I ploy anY Person in any manner sn us In
mit is issued, I shall naem
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
832.00
become subject to the Workers' Cmnpensnlion Laws of California.
Dade Applicant
'1'O
ALTER OR ADD TO MECH. 5.00
NOTICE APPLICANT': 11, ALL, nuking this Certificate of IN -
emplicn, you should beromesubject to the Workers'Cmnpenention
provisions of the Labor Chile, you nu1sl forthwith comply with
such provisions or this permit shall be deemed revoked.
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=CF.M.) 4.00
PLAN CHECK
FE Friprov
62.00
AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE
10.85
CONSTRUCTION LiNDING AGENCY
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.
3097, Cie C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lenders Address
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
60.90
I certify that I [love read this application and state that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and
herebyactio riz properly forinsp od this
hereby authorize representatives folies ec this city to enter upon the
purposes.
PLUMBING
690
60
130ILER-COMP(3H.P.or100,000B.T,U.) 6.00
BOILER -COMP (Over 100,000 BTUI SEE FEE SCH.
MECHANICAL
60.90
(We) agree to Save, indemnify and keep harmless the City of
MISC. - REFER TO ORD.
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against said City in consequence Of the
moil O This permit'
`
PERMIT ISSUANCE 10.00
CONST. TAX
• 02
MECH. CONT, LIC. NO. MECH.
TOTAL
TOTAL ,405.07
Signature Of Applicant/Contractor Date
OFFICE COPY