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17724POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO ,. 17724 INSPECTION DIVISION -JOB INSPECTION RECORD /�/, Y4C 04 54I214/G / �� PERMIT EXPIRATION JOB ADDRESS UNIT# LOT#- - . PERMIY'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: UFER ALL AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS.( � . LASTCALLED INSPECTION. _ PREGUNITE PERMITVA(.IDATION IvNc�..cI hJif,r lJV ' �IssUANce unre' GARAGE SLABS ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p UNDERGROUND/SLAB PLUMBING � ELECTRICAL MECHANICAL - BLLO( . � ELECT LJ jP L�G, MECH ' 91 U DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - D - LJ 2 BUILDING PERMIT INFORMATION WOOD FLOOR VALUFTION $/FT. PLUMBING MECHANICAL ELECTRICAL PERMIT TO 9w FRAMING INSULATION STORIES .TYPE CONSTR. 2 5" OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF I NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so Fr, aooR AREA 3:�Q7 z TorAL Aeaenr.E '- I I I •I I� f - DIAPHRAGM ' ROOF SHEATHING Iq- BUILDING USE ))s IND LOON O Q, LSI APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH: SAN.# �+Ass�essoivs PARceL No :J J PLUMBING Z ELECT. ENERGY TUBS &SHOWER PAN %) PLUMBING ENERGY TRACT NO. PARCEL NO " MECHANICAL IErOtL MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC.DATE ACC BILE No FRAMING VU0 ELECT. FINAL TEST INSULATION � PLUMBING ZONING ENG. SITE NO. , GAS TEST GAS MECHANICAL FRE SPRINN Y - N[] ENERGY T 2 Y ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ri, ELECTRICAL RELEASE FLOOD ZONE Y � N� A.L.0 C. Y ❑ N❑ INTERIOR SHEAR- FIRE DEPT. - SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING 972.00 INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLACHECK FEE 62XD GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE '�•� OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC 3•13 w ONE WORKING DAY BEFORE REQUIRED INS PLUMBING z PLEASES GIVE JOB ADDRESS WHEN PHONINGPECTION. 79.13 - SEE PERMIT FOR EXPIRATION DATE - NICAL 73.13 . TAX rN •�IMPORTANT!PLEASE 1••� READ REVERSE SIDE BEFORECALLING FOR FINAL INSPECTION.TAL OFFICE COPY a M z Foo QUU N2w a y 00-� rxr R Q 60iU w � oit Fa N SE w 0 LL ta IL or r2< sE0 a~m • Al .AJPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 1 r�r�� I I r BUILDING ADDRESS 11911 Placer Spring Court LOC 329 OwNER'S 1/ �� NAME J/��_ % +/"r OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION C gqONE415/595-2100 ' , CONTRACTOR (JI)E( gory"YMr'mt Inc. UTLETS- SWITCHES -RECEP 10.00/1.00 •' LIONO. 8"430097 ' LIGHTING FIXTURES 10.00/1,00 CONTRACTORS 220-C Twin Dolphin Drive ADrDDyRtEESS APPLIANCES -RESIDENTIAL 4.00 (y/1/�[ RMAy CA 94065 PHONE415/595-2100 DATE OF APPLICATION PANELS 10.00 ARC HI TECTgassenian gom ArchitectS OR ENGINEER uc. NO. C-8395 PANELS (OVER MO AMP) 20.00 PLAN CHECK FEE P.C. NO, SIGNS TRANS. 3.00 ARCH. OR ENG. OM1 Molina! Drive itre 100 ADDRESS LVJ UI 1.11U111 UI ♦G Vll Santa Ana iiEl is 0{: zip 9270% SPECIALCIRCUIT 5.00 PERMIT VALIDATION �.�1JLJ t, l -` EMP. METER OR POLE INS. 20.00 AFDRESS s �0� Twin Dolphin Drive ADORESS MOTORS SEE FEE SCH. RX, CA 94065 SERVICE CHANGE 20.00 {�' a �� LICENSED CONTRACTORS DECLARATION r f• I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions s 2 my license is in full Toney 3b0§ r6 License License Class_ Contra mher_Y.SA1.'1/ Dafc Contractor '� ISSUANCE DA>� BLDG. ELECT. PLG. MECH, �'�� BUILDING PERMIT INFORMATION • OWNER-BUILDF-R DECLARATION I hereby affim rthat I am m exempt frothe Contractor's License Low for the following reason.(Sec. 7031.5, Businessond ProfessionspERMIT Code Any city or County' which requires a permit to construct, alter, improve. demolish, or repair any sUucwre, prior to its issuance, also requires the applicant for such permit 10 file a signed statement that he is licensed pursuant to the provisions of the Contractor's License MISC. - REFER TO ORD ISSUANCE 10.00 VALUATION ��/Z�a 194`HV , $/FT. ELEC. CONTR. LIC. NO, ELEC. TOTAL PERMIT TO GTY. PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 700(bot'Division 3 of fin, Business and Professions Code) or that he is exempt therefrom and STORIES TYPE CONSTR.' the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for it permit subjects the applicant to a civil penalty of not marc than five hundred dollars (S50OL): 2 SIYf1R ALTER -DRAIN -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsare not intended oroffered l'.,Sale. If, however, the building R-3 1 FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA 3047 orAL ACREAGE 2446 W v GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is Sold within one year of completion, the owner- builder will have The burden of proving that To did not build or int. prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILOI USE RryE$n IND CON PB other N ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed emittacmrs to construct the project (Sec. 7044, Business and Professions Code: T'he Contractors License Law does not apply toan owner of property who builds or improves thereon, and who LAWN SPRINKLERS -I INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1,00 ASSESSORS PARCEL NO. - MrD contacts for such projects with a contmctorts) licensed pursuant m the Contractor's License Law. SEWER -SANITARY -STORM EA. 200f1/10.00 TRACT NO, PARCEL NO. ❑ I am exempt under Sec.-, B.&PC, tin this reason WATER HEATER W/VENT 6.00 Owner Dote WATER SYSTEM 5.00 -ACF DATE - ACC. FILE NO. WATER TREATINGEQUIP. 5.00 WORKS RS'COMPENSA'f10N DECLARATION 1 hereby affirm that I have it certificaite of consent to selbinsure' Or a certificate of Workers' Compensation InsuraVe, or a certified copy themof(Sec. 3800, Lab.C.)L ZONING ENG. SITE N0. { Policy No. Company -�II��fsj'f}I'f��{ Pa(J11 iL• ❑ Ceillfied copy is hereby fT tsllLH�x' �I Corti fi- coy i> Bled with the city inspection division. Applicant FIRE SPR INK v ❑ 'N❑ ENERGYT44 v ❑ N❑ Misc.- REFER TO ORD. CHR'1'I FICATE OI° fi%IiMPTION I7ROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This section need not be completed if the Perini( is fur One PLG. CGNTR. LIC. NO.PLG. TOTAL Y ❑ N❑ Y ❑ No hundred dollars (S I OOj or less.) I certify that in the performance of the work for which this per- mil is issued, 1 shell not employ any person in any manner so as m OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING 972.00 become subject to the Workers' Compensation Laws of California. Date • Applicant '1'0 ALTER OR ADD TO MECH. 5.00 NOTICE APPLICANT: If, after making this Certificate of Ex- emption, you should become subjem to the Workers' Compensation Provisions of the Labor Code, you most forthwith comply with such provisions Or this permit shall be deemed revoked. APPLIANCE 5.00 AIR HANDLING UNIT (TO 10,000QF.M.) 4,00 PLAN CHECK FEE /Enmly • 1 .50 62.00 AIR HANDLING UNIT (OVER 10=11F.M.) 6.00 SEISMIC FEE 13-65 CONSTRUCTION LENDING AGENCY I 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, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address H EATI NG N IT ER U 100,000 B.T.U.) 9.50 ELECTRIC 73.13 1 certify that I have read this application:ed state 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 PLUMBING BOILER-CUMPI3 H,P,Or100,000B.T.U.1 6.00 Boo ER (Over 100,000 BTU) SEE FEE SCH. MECHANICAL 7q 13 hereby authorize. representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. - Cupertino against liabilities, judgments, costs and expenses which may m any way accrue against said City in consequence of the matin f 11 is permit. PERMIT ISSUANCE 10.00 CONST. TAX 3� MECH. CUNT. LIC. NO. MECH. TOTAL TOTAL 1,584.56 Signature .1 Applicant Contractor Date OFFICE COPY