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17726_ POST THIS CAR D'NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD �J1{ r, '5W"411 JOB ADDRESS�J�S� �L""'••� e7UNIT# _LO # • OWNER -CONTRACTOR PER69T NUMBER 17726 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION - DATE INSPECTOR INSPECTION RECORD ALL GRADING AND DRAINAGE SHALL BE INSTALLED 70 COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. PLi- UFER PREGUNITE PERMI r VALIOATION y ,j F IT(1�(1-y'}siY'. A ! °-= . I 3 ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .• MAY 2 3 1989 UNDERGROUND/SLAB PLUMBING city AFF �.y�,,� ciy of CuQflft ELECTRICAL' MECHANICAL BLDG. ELECT Gt7 li 1 "G. NEC", 57 1 ji] Fes„ 3-z 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED . BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING . MECHANICAL ELECTRICAL. PERMIT TO FRAMING INSULATION - STORIES 2 TYPE CONSTH. - �� UCC. GROUP R•3 RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID sn IT FLooR AREA 3W TOTALACREAGE DIAPHRAGM - ROOF SHEATHING BUILDING USE RES IND CON PB 0", 11 L L L Q APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH - ASSESSORS PARCEL NO 2/_�o „G5�3 ago-(55-0O3 PLUMBING O ELECT. ELECT. ENERGY TUBS &SHOWER PAN (� PLUMBING ENERGY TRACT NO PARCELN MECHANICAL b MECH.ENERGY ELECTRICAL (9 `1 BUILDING ENERGY ACC DATE ACC FILE NO - FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG SITE NO, GAS TEST 'Z, GAS MECHANICAL FIRE SPRINK Y LNL ENERGY T24 Y L . NL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE L ryL AL UC. Y L NL INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH •Z BUILDING BUILDING 72.M INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT �, ELECTRIC PLAN CHECK FEE SEISMIC FEE lbobu 13.65 • GAS- - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING.252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. Oz� PLEASE GIVE JOB ADDRESS.WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - ELECTRIC 73.13 PLUMBING,73.13 MECHANICAL 79.13 CONST. TAX 3MA2 IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL �• OFFICE COPY Ul a¢z Foo QUU yT Z a Loz ¢ ¢ ¢ W V W36 W a_ 0 w ¢a0 ca A. wAOLL mLo H ¢ siD a 3 - 0 Z P: O rr T du CL o 7 z UO LL U, Cso. F - A :APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION & PERMIT BUILDING-ELECTRICAL-PLUMBIN-MECHANICAL G PERMIT NUMBER 17726 � n ^ Gb n I BUILDINGAPPLICATION ADDRESS11852 Placer Sprin Lott321 3 OWNER'S rye,,, �..,v .�LAN NAME "' ow "' av, Inc.I PHGNE 415/595-21 QTY. ELECTRIC PERMIT FEE CHECK VALIDATION CONTRACTOR S f�.,xs�� /�,� NAME GmKiOry GM4)F Inc. OUTLETS - SWITCHES -RECEP 10.00/1.00 uG No. 6-4397 LIGHTING FIXTURES 10,00/1.00 ADDR'IESSTO(�R�S 220-G/I(T�win Dolphin Drive PPLIANCES- RESIDENTIAL 4.00 M CA 94065 P..NE415/595-2100 DATE OF APPLICATION ' PANELS 10.00 ARCHITECT �I OR BaSsenlanA-agonl Architects 1 ENGINEER ' Lgrr(lc. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. SIGNS TRANS. 3.00 /o.(yC�8395 ARC H. OR LNG gOg1 UI IA IU I��.a- //IW ADDRESS G J SPECIALCIRCUIT 5,00 PERMIT VALIDATION Santa FleiqhU, CA Z1,927D7 9 �5 TEMP. METER OR POLE INS. 20.00 NPDDRESSPLICA TS 220-0 Twin Dolphin Drive MOTORS _ SEE FEE SCH. RWC CA 94065 (((' ppp �rrl `2 SERVICE CHANGE i I-ELAJ 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm thin I am licensed under provisions of Chapter 7 (commencing with Section 7000) of Division 3 of the Business and Professions Code,r� nd my license is N full for r,yy et. Litems Class_D _fy MAY �,A. s ISSUANCE DATE BLDG. ELECT. PLG. MECH. City of CUMN Cmurumber Dote Cnnlructor - _ OWNER -BUILDER DECLARATION I hereby affirm (hut I am exempt from the Contractor's tes,nose Low: Any ityfollowing reason. ch(Sec. reg03La permit town Professions Code:Anycity or coumyir any rtrivet epe I...1.ts construct, alter, improve, demolish, or repair h p emit toff prior to its issuance, also requires the applicant for such permit to file a signed Statement that he is licensed pursuant 1.n the provisions of the ComR¢mr's License (Chapter 9(comme with Section 00) BUILDING PERMIT INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION 94 �/T 194,540 b/FT. ELEC. CONTE. LIC. NO. ELEC. TOTAL PERMIT TO Coy I SFW Business antithe Business and Professions Code)i or that he is exemptSalo therefrom and is exempt OTY. PLUMBING PERMIT FEE exemption, the basis for the alleged exemption. Any applicant of Section malty for apermit dollars the 0).): am loucivil penally by any more of not more owner Coo he prop dollars (my em : ❑ o as owner at the properly, or my employees with re is not their sole compensation, will do the work, and the structure is not STORIES 2 TYPE CONSTR. ' 5*R ALTER -DRAIN 5.00 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 Professions Code: The Contractor's License Law does not apply to an owner of p R-3 1 FIXTURES - PER TRAP 5.00 GAS • EA. SYSTEM -1INC. 4OUTLETS 6.00 properly who builds or improves thereon, and Who does such work himself re through his awn employees, provided .I,ho that such improve ments not ended or If, the building 50. FT. FLOOR AREA 3047 TOTAL ACREAGE 2445 �� onefor or improvement is sold within one ywr of completion, the owner. within year builder will have the burden Of proving that he Aid not buil(( or int.BUILDII prove forof sale.). ❑ I, ass owner owner of the property, um exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 iG USE RES IND CON PB 0 INDUSTRIAL WASTE INTER. 30.00 licensed cantmetors to construct ole project (Sec. 7044, Business and Professions Code: 'rhe Contractor's License Law does not apply to an owner of properly 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. qF ,yf^hZ FT.✓ contracts for such projectSwithn crmlructneO licensed pursuant to the Contractors License Law. O tum exempt under Sec. ,B.&P.C. Inr Ibis ralloin 644- of L.0 .3 SEWER -SAN V -STORM EA. 200ft /10.00 TRACT NO. OryxO PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate orconsenl to sclhinsure. ZONING ENG. SITE N0, or a certificate of Workers' Compensation Insurance, or a certified copy thereof fSec. 3800, Lab .C.I.United aci.fic Policy No. Crnnpany_le--P ❑ Certified copy is hereby furnished. 1❑ Cerl ifl opy is filed With the Illy•' iospeUlinn division. A t (cunt MISC. - REFER TO ORD. FIRE SPRINK Y NC] ENERGY T@4 Y No CERTIFICATEOFEXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the permit is for one PERMIT ISSUANCE 10.00 FLOOD 20NE Y EJ N[ A.L.U.C. Y C: N� PLG. CONTE. LIC. NO. PLO, TOTAL hundred dollars (8100) or less.) I certify that in tiro performance of the walk for which this per- mit is issued, I shall not employ any person in any manner so as to GTY. MECHANICAL PERMIT FEE FEE SUMMARY become subject to the Workers' Compmualion Laws of California. ALTER OR ADD TO MECH. 5.00 Date - Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- BUILDING 9�2 APPLIANCE - 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE /Energy 1 .50 62-110 provisions of the Labor Code, you must forthwith comply with.00 emption, you should become subject Io the Workers' Compensation such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(OVER 10,000C.RM.) 6.00 SEISMIC FEE 13.65' CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 1 hereby affirm that there is a construction lending agency for Inc performance of the work for which this permit is issued (See. 3097, Cis C.). HEATING UNIT (TO 100,000 B.T.U.1' 8.00 MICROFILM I Lender's Address Lender's ds HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC 73.13 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) - 4.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and BOILER- H.P. Dr.100,000 B.T.U.1 6.00 PLUMBING 73.13 hereby authorirc representatives ec This city to enter upon the above-mentioned property for inspection purposes, to. BOILER -COMP (Over 100,000 BTU) SEE FEE SCH, MECHANICAL e 73,13 (We) agree to Save, Indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino againstliabilities, judgments, costs and expenses which may in any way accrue against said City it, consequence of the Rmlm X I Ibis permit. PERMIT ISSUANCE 10.00 CONST. TAX 302.02 MECH. CONT. - LIC. NO. MECH. , TOTAL TOTAL 1,584.x16 Signature of Applicant/Contractor Dare OFFICE COPY