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1772110 POST THIS CARD NEAR FRONT OFIBUILDING CITY OF CUPERTINO".' INSPECTION DIVISION'. JOB INSPECTION RECORD J�gSP«t�c�/�� A� �f C— JOB ADDRESS UNIT# _LOT# ' - OWNER CONTRACTOR... PERMIT NUMBER 17721 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- OR. 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATIONANCE NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIT/ OF CUPERTINO STANDARDS. LIFER PREGUNITE - PERMIT VALIDATION `�'� "': ISSUANCE BATE GARAGE SLABS �, POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED lAY 3 3 1589 UNDERGROUND/SLAB PLUMBING q UIy, OLx ELECTRICAL MECHANICAL FLUB ELECT '`LG. MECH, lAu lU DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION ��Fm SIFT, PLUMBING ' MECHANICAL ELECTRICAL ' PERMIT To FRAMING - INSULATION -� -sroRlEs rope CONSTR. OCC GROUP R`S RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -ROOF. .NOTE: NO FINAL INSP. SHALL BE MADEBEFORE THE CONSTRUCTION TAX IS PAID sa FT FLOOR AREA TOTALACREAGE 3M7 BUILDING USE IND CON- PB O'l— ❑ ❑ ❑ ❑ DIAPHRAGM ROOF SHEATHING -161RES APPLY NO ROOFING UNTIL ABOVE HAS-BEEN SI ED FINALS DATE INSP. ROUGH SAN.k nssessoRl_sPARceL Nom PLUMBING oa,' . 'j, ELECT. ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO, .CCC' BATE PARCEL NO ACC. FILE NO. MECHANICAL MECH.ENERGY ELECTRICAL. f BUILDING ENERGY FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG SITE NO: GAS TEST GAS MECHAARELEASE F!RESPRINK ❑ "❑ ENERGY T.14 ❑ "❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATI EXTERIOR SHEAR ELECTINTERIOR FLOOD ZONE A.LUC $HEAR FIRE DYSHEETROCK 'L�, GRADE FEE SUMMARY EXTERIOR LATH. "2'1SIi BUILDI' BUILDING PLAN CHECK FE SEISMIC FEE 15,60 104.99 INTERIOR CATH' TEMPORARY APPROVALS SCRATCH COAT ELECTRIC GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, H ONE WORKING DAY BEFORE REQUIRED INSPECTION. o PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - -SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC PLUMBING 73.13 MECHANIC CONST. TAX IMPORTANTI PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. 1 TOTAL ' M4,56 OFFICE -COPY 0 O Z Z P O = T W CL C1 0 z UO LL r- Ow } N F'Z `+. pAPP61CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER '�" 17721 AUILDIN11851 ar mg L� 335 .Vase 'S�,� �.,,,,'W^ f�, NAME x„ g„ w.J G �s Inc. - OTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE NAMERAcraRs y Group, inc. UTLETS-SWITCHES -RECEP 10.00/1.00 UC.NO. LIGHTING FIXTURES 10.00/1.00 ' ADDRESS Scrons ADDRESS 2Z0_C Twin Dolphin Drive APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION ARCHITECT OR BaSsenlan/Lagmi krhitec1 ENGINEER LIC.NO PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. ' ISIGNS TRANS. 3.00ARCH 08 ADDRESS ENG 2031 Orchard Drive /100, ' zIP SPECIAL CIRCUIT. 5.00 PERMIT VALIDATION .e/+!,/r �� r EMP. METER OR POLE INS. 20.00 AwucANrs 220-C Twin Dolphin Drive AOORESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 RWC, CA 9111106.9 I ., LICENSED CONTRACTORS DECLARATION 1 - I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. License Class -B. Lic. Number -4-M7 Contractor' ' ISSUANCE DATE a BLDG. ® ELECT. ® PLG. MECH. EE UDate Gill ot AIIQ PERMIT INFORMATION OWNER-BUILIIF.R DECLARATIONBUILDING I hereby affirm Thal Lam exempt from the Contractors License or countng reason.whiSec.703 ie, S,Businessend Professions Code:Law Any it totsi suance, alser,o Code: Any city or county which structure, requires, demolish. or repair any rant to I e a si n Its issuance, 6150 tr a tune, prior requires the applicant for such permit to file a signed statement that he is licensed pursuant the provisions of the Contractor's License - MISC.REFER TO ORD" PERMIT ISSUANCE 10.00 VALUATION rr�a,�r C,^sfn� 1TF1a`10 $)FT. ELEC. CONTR. LIC. N0. ELEC. TOTAL PERMIT TO DTV. PLUMBING PERMIT FEE en t Division 3 of Law (Chapter 9 Professions Business and Professions Code) or That he is exempt therefrom and Cod with Section is exempt W STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Suction 7031.$ by any applicant for a permit Subjects theapplicant loo civil penalty of not more than five hum red dollars ($500),): 2 Ir 5NHR 00 ALTER -DRAIN -WATER (EA.) 5. ❑ 1, as owner of the properly, or any employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE. 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, 5.00 intended or offered for sale (Sec. 7044,.Business and Professions Code; The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who does such work himself (it through his own employees, provided that such improve- mentsarenotintendedoroffercdfn,sale. If, however, the building or improvement is sold within one year of completion, lire Owner - builder will have the burden of proving that he did not build or im- prove for purpose of sale,), ❑ I, as owner of the property, am exclusively contracting with R-3 1 FIXTURES - PER TRAP 5.00 sa. FT. FLOOR AREA 3047 (2445L;71 TOTAL ACREAGE W� GAS - EA. SYSTEM -1INC. 4 OUTLETS 6.00 BUILDNG USE RES IND CON PB Other ® ❑ ❑ ❑ ❑ - INDUSTRIALWASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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 - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. �� DI contracts for such projects with a emrtactor/s) licensed pursuant to the Contractor's License Law. - SEWER -SANITARY -STORM EA. 200fU10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,B.&P.C. for this leall 80% WATER HEATER W/VENT - 6.00 Owner Data WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP, 5.00 WORKERS'COMPENSATION DECLARATION 1 hereby -affirm that I have a eenificete of consent to setbinsure, or a certificate of Workers' Compensation Insum,ce, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab .C.). y,,,� Policy No. L'oInPany-'Uniteded-Paci.fir FIRE SPRINK v ❑ N ❑ ENERGY T 24 v ❑ N❑ ❑❑y Certified copy is hereby fumished. A pllcan�t ilialo is filed with the 'ty inspection division. P MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION 'ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A. L.U.C. COMPENSATION INSURANCE Olds section need not he completed if the permit is for'one PLG.CONTR. LIC. NO. PLG. TOTAL Y ❑ N ❑ Y ❑ N❑ hundred dollars ($ 100) or Icss) 1 certify that in the performance of the work for which this per- alit is issued, I shall not employ any person in any manner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING (179 rn become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT': If, after making this Cerlificate of Ex - APPLIANCE 5.00 Is LAHECsK FEE/ r -+ti' yy 15,50 62.00 emption, you should become subject to the Workets Compensation provisions of the Labor Code, you limit foNhwilh comply with such provisions or this permit shall be deemed revoked AIR HANDLING UNIT (TO 10=r_F.M.) 4,00 AIR HANDLING UNIT (OVER IQ=CF.M.I 6.00 SEISMIC FEE 13.65 . CONSTRUCTION LENDING 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 I11is permit is issued (Sec. 3097, Civ CA MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 6.00 Lender's Address Lender's Address HEATING UNIT (OVER 160,000 B.T.U.)9.50 ELECTRIC 73.13 VENTILATION FAN (SINGLE) 4.00 1 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 slate laws relating to building construction, and PLUMBING 73.13 BOILER- OOMP(3 H.P. or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned Property for inspection PaTPOWS BOILER -COMP IOv., 100,000 BTU) SEE FEESCH. MECHANICAL 71-13 (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, casts and expenses which May in any way accrue against Said City in consequence of the antis of his PenoiL ` �'� MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX 3� MECH. CONT. LIC. NO. MECH. TOTAL TOTAL1f`58 •56 Signature of Appmant/Contactor Dale OFFICE COPY