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17708.• POST THIS CARD NEAR FRONT OF BUILDINGr r PERNlIj.\MBEFj. CITY OF CUPERTINO BUILDING USE . RLE IND CON PB 00- )Li LiL INSP. 1 770& INSPECTION DIVISION PLUMBING JOB INSPECTION RECORD TRACTNO PARCEL NO PERMIT EXPIRATION �"f� ✓a���� UNIT# MECHANICAL - JOB ADDRESS _LLI r�!_Y _LOT#- ' PERMIT EXPIRES IF WORK OWNER CONTRACTOR - IS NOT STARTED WITHIN 180 DAYS OFPERMIT ISSU- INSPECTION„rDATE INSPECTOR INSPECTION RECORD FOUNDATION' I ANCE OR 180 DAYS FROM NOTE: - > . _ UFER - •ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. 1, PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF .,PERMIT VALIDATION BUILDING CUPERTINO STANDARDS. - 'z '• ,{ E•�I 1/N(T G1 Y+,yI S-y.3.-�-•y J ISSUANCE DATE / GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ELECTRIC UNDERGROUND/SLAB PLUMBING _2 �.�� ELECTRICAL MECHANICAL - BLDG ELECT PLC, MLQ 11 PLUMBING MECHANICAL ELECTRICAL FRAMING INSULATION ROOF SHEATHING APPLY NO ROOFING UNTIL ISIGNED NOTE: NO FINAL INSP. SH; ry, THE CONSTRUCTION TAX W SIGNED FINALS SANA ®vr BEFORE 2M7. BUILDING USE . RLE IND CON PB 00- )Li LiL INSP. ELECT. FINAL TEST asLi PARCEL N 3Co' :.55 `-010 PLUMBING ZONING TRACTNO PARCEL NO ELECTRICAL- L7JLJJ BUILDING ENERGY ' FRAMING - ELECT. FINAL TEST INSULATION II PLUMBING ZONING ENG SITE NO. GAS TEST 2�, GAS. MECHANICAL - EIPE SPRINK Iy L NC ENERG�T.24 L NL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD zoNL °LJ N0 A u.c. `"L NL INTERIOR'SHEAR 5 FI RE DEPT. SHEETROCK 0.07 GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH - TEMPORARY APPROVALS ' SCRATCH COAT '- 4 ELECTRIC PLAN CHECK ElaXM SEISMIC FEE 62.00 GAS , NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED loccuPANcy OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. °z - PLEASE GIVE JOB ADDRESS WHEN PHONING.70 —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING .35 MECHANICAL 70-35 CONST. TAX 30W{i IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL j544•09 vrru:e wry J O ZZ F O CC T W_ D. D z UQ LL 00 F- LOE APRLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATI ON ADDRESSAPPLICATION ADDRESS 13ABUILDING &PERMIT - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER " 17708 OWNER'S^ T� (� NAME 'y Pt- 1 • Y OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE NAMERacroAs Q„ery amp, Inc. `�"^''!' OUTLETS-SWITCHES-RECEP 10.00/1.00 LIC.No. LIGHTING FIXTURES 10.00/1.00 RRAcroRs 220-C Twin Dolphin Drive ADDRESS APPLIANCES 4.00 PANELS 10.00 PHONE _ DATE OF APPLICATION ' AARRCHITECT /t�P� ^,,.� ;�,.},. ENGINEER Bassenian/Lagoni Amhi acts uC.NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.CrNO. .. SIGNS TRANS. 3.00 ADDRESS ENG. i Orictard Drive //100 ' .. zap 1110, SPECIALCIRCUIT 5.00 PERMIT VALIDATION fiS lSa'Es' TEMP. METER OR POLE INS. 20.00 aPPucaNrs 220-0 Twin Dolphin Drive ADORES$ MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 Me CA 94M5 5I�\ LIC17NSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my license is in full force and effect License Ckets B_Lic.Number_4 0 7- ISSUANCE DATE BLDG. ELECT: PLG. MECH. Date Contractor p� sx� pu w BUILDING PERMIT INFORMATION N OWER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law sand Profasione Code: Any lily or countywhihng reason. re 7037iresa permit ettuq Code: Any city Or county which requirese p riot mts issuance, improve, delnOhflL or repair any stfnetllre, prior to lt565ullnCL', a40 requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Git, Yl fL MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION 185,865 ' $/FT. ELEC. CONTR. LIC. NO. TE LEC. TOTAL PERMIT TO Law (Chapter 9 (commencing with Sect ion 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE � STORIES Z TYPE CONSTR. SNiR the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fore permit subjects the 0).): nm too Civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN 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 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ROOF, AREA, D. 5.00 intended or offered fnr sale (Sec. 7044, Business and Prod"essinnsDRAINS-FLOOR, Code: The Contractor's License Law does not apply to an owoerof R�3 1 FIXTURES - PER TRAP 5.00 GAS-EA.SYSTEM-I 6.00 sD. Fr. FLOOfl AREA 2917 T�OTQAL �ACREAGE 2aa'i Vv u property who builds or improves thereon, and who does such work himsclfor otintenhOugh deownemredforsmle.if,however,tded that himprove- mems are not intended or offered (nr sale. If, the building mplevcq or improvemm�l is sold within one year of completion, the owner builder will have the burden of proving that he did not build or int prove for purpose of sale.). 0 I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDI USE RES IND CON. PB Omer ® ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors To construct The project ISeC. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, unit who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. _ -© Y� l.J contracts it ch such projects with a contmcmr(sl licensed pursuant m the ContracWis License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ Iain exempt under Sec. ,B.&P.C. for this "8reason WATER HEATER W/VENT 6.00 Owner Dune WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORK F RS'COMPF.NSA'I' ION DECLARATION 1 hereby affirm that 1 have a certificate ofsonsvo to self insure, or a certificate of Workers Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof' (Sec. 3800, Lab.CJ.��Ik,,.,� yy,��j�ff p F Policy No. Company_iil.1�.LQli_Pacif_1C FIRE SPRINK v N ❑ ❑ ENERGY T-24 v N ❑ ❑ CC��aCertified copy is hereby furnished. iOe is Bled with T n�city irypection division. Applicant Applicant MISC. - REFER TO ORD. CERTD'CATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLDOD ZONE A. L.u.C. COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N❑ Y ❑ IN PLG.CONTH. LIC. NO. PLG. TOTAL hundred dollars (S 100) or It..) ' 1 certify That in the performance of - the work fnr which This per- mit is issued, I shall not employ any person in any manner so as To QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING W.50 become subject to the Workers' Compensation Laws of California. DateApplicant NOTICE TO APPLICANT': If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE 15.50 62.00 enmtion, you should become subject to the Workers' Compensation provisions of The Labor Code, you MIST f1110lwith Comply will such provisions or this Parmit shall be deemed revoked. AIRHANDLING UNIT(OVER 10MC.RM.)6.00 SEISMIC FEE 11.02 CONSTRUCT ION 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 wine[, 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.)9.50 ELECTRIC 70.35 VENTILATION FAN (SINGLE) 4.00 I certify That 1 have read this application and edam Thad The shove Information is correct. I agree to comply wish all city unit county ordinances and state laws relating to building construction, anti76.35 PLUMBING BOILER-C�MPI3 H.P.Of 100,000 B,T,U.I 6.00 BOILER -COMP IOver 100,000BTU) SEE FEE SCH. MECHANICAL 7025 hereby authorize representatives of this city to enter Upon lila ahovo-mentioned property for inspection purposes. (We) agree m save, indemnify and keep harmless The City of MISC. - REFER TO ORD. upertino against liabilities, paig... Can, COSTS and expenses which may any way accrue against said City in consequence of the.02 ramiin g Of this Permit PERMIT ISSUANCE 10.00 CONST. TAX 3� MECH. CONT. LIC. NO. MECH. z �_ _� TOTAL TOTAL 1,544.09 Slgnaure of ApPreant/Contractor OFFICE COPY