14952 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERT'INO 14952-4
INSPECTION DIVISION
JOB INSPECTION RECORD
/�-, 0 1 /.,,-may '�y��`' _ 7� PERMIT EXPIRATION
JOB ADDRESS 110A bE1lM VII INLT� X I- 11E UNIT# •jLOT# I✓5 l
PERMIT EXPIRES IF WORK
OWNER — U' CONTRACTOR IS' NOT STARTED WITHIN
INSPEC ION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE' ACE OR 180 DAYS FROM
LEER � �17j-C4i� ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPEC TION:',
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERtdIT VAIJ0AT1oN
CUPERTINO STANDARDS. r'
GARAGE SLABS �•
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ` �• � �
UNDERGROUND /SLAB /<}i
PLUMBING
ELECTRICAL - - ISSUANCE DATE
MECHANICAL - Luc. ELECT. PLG. MEc.. ,
PAA
. o
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED (1(�1NFORMATION ILDING PERMIT
=.•
' - WOOD FLOOR � . 'JUN 7 199 vALuanoN- sTF�. ._
PLUMBING - RD
ot
MECHANICAL - City Up n
ELECTRICAL - PERMIT TO
FRAMING _
INSULATION - - - STORIES TYPE CONSTR.,
- OCG.G OUP ES.-UNILS .
LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
- ROOF NOTENO FINAL INSP.SHALL BE MADE BEFORE s"'`r. LopR AREA To nL ncRPAce
DIAPHRAGM THE CONSTRUCTION TAX IS PAID.
'BUILDING USE '
ROOF SHEATHING p� - PES wO CON Pe 011111
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS' ' - DATE INSP. ® 0, - ❑ - ❑ ❑ °
ROUGH SAN.k
. ASSESSORS PARCEL No.
� �,�
PLUMBING ]' ya 1 ELECT:ENERGY ' -
TUBS&'SHOWER PAN, / - PLUMBING ENERGY _ TRACT rvo PARCEL No, r
MECHANICAL �— — MECH.ENERGY . — q, ACC FAT E' • ACG.FILE NO 1
ELECTRICAL - BUILDING ENERGY — 'e„
- FRAMING ELECT.FINALTEST '
'ZONING'1ENG.SITE NO
INSULATION - PLUMBING
GAS TEST - GAS '
MECHANICAL vIRE.SPRINK EN ERGY T 2
COVER NO,WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y '° E] "�!
. FLOOD ZONE A u:c.
EXTERIOR SHEAR_ 0-S_gty' ELECTRICAL RELEASE -
INTERIOR SHEAR _ - FIRE DEPT. , y NLI , Y ❑ No,
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH rz. BUILDING' '
. INTERIOR LATH TEMPORARY BUILDING
gmm
.
SCRATCH COAT ELECTRIC PLAN CHECK 15.50 .j
GAS92 AM
NO TAPE OR,PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPAI SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY.PHONING 252-4505, .. ELECTRIC
o0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB.ADDRESS WHEN PHONING. ,
- SEE PERMIT FOR EXPIRATION DATE= MECHANICAL
CONST.TAX
IMPORTANT!
PL'EASE.READ.REVERSE SIDE BEFORE ' TOTAL`
CALLING FOR FINAL INSPECTION.' 1530.31
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date ---J-14 ..p.. V-3.............. 19!b.1... Building Permit No.
The Bu Located at .....5evF-.A&1 ....1-33
�- '-
Owna4 by .PnG-C3-0.;.zy......
1�(Altered�) -------*. ...
Has t, 11 For Use As: ....Sf-77.40...................
.............................. .......................................... ------------- ------ .... ........ ...... ........ ......... ....
.......... — j--- -- -------- ---------
.......................... ........................... ......................................................................................
.......................***............*------- ------
PD-7 BUILDING INSPECTOR
_ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER-
mD'L°In° even rns Drve APPLICAIIPN,& PERMIT
ADDRESS 11622 SSpigi :
BUILDING-ELECTRICAL PLUMBING -MECHANICAL 14952
NAME S f�,�,,,.�� lam.,,,,.xLAN CHECK VALIDATION
NAGE
Gregory J "'oup, Inc.I & Nmns OTY. ELECTRIC PERMIT' FEE
• Ere
RACTo s
NAMEUTLETS-SWITCHES-RECEP 10.00/1.00
Inc, uc.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR 22p C nt1 PPLIANCES-RESIDENTIAL 4.00
ADDRESS 415-595- SODOlphln Dr.
15- 80 PHONE PANELS 10100 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.0 NO.
e�RiG,NEER ARAM RNSSEAIIAN, AIA & ASSOCIATES PANELS (OVER 200 AMP) 20.00
((��,,�,,y,��.�,rmy� Dr.,
NNO(.y(� SIGNS TRANS. 3.00
ADDR.SS ENG. 2031 VI V IDI D UI )(1W SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
'ATEMP.METER OR POLE INS. 20.00 -
APPUDANrs MOTORS SEE FEE SCH.
AOOness 220-0 Twin Dolphin Dr. RX
SERVICE CHANGE 20.00
,00 LICENSED CONTRACTORS DECLARATION
a u U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
z m w (commencing with Section 7000)of Division 3 orthe Business and< w BLDG 6 CT. PLG. MECH.
H ti z Professions Code,d, my license is in full force a�,�£f�feeL
z o m - License Cless_C Lic.Nu,nM. I(T-Jr\1
9 N r Date Contmclor -
¢ ¢ w< OWNER-BUILDER DI'CLARtVN ,7 NG PERMIT
.W 3 LL y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD FORMATION
FLL0 J Law for the following.....F.(Sec.7031.5,B.Imessand Professions PERMIT ISSUANCE 1000 VALUATION S/FT.
Code.Any city or county vHuchrquimslirysmlt tncunslrrmt,alten lOG rysZy
ec ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. WW>U.V
a wO u requires the applicant for such Permit to rile a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
Law(Chxptr
e9(commencingwith Section 7000)of0.vision 3 o(the SFDU
a
Buy.rays and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
i o
¢ H $ the basis for the alleged exemption.Any vapplica of See der malty STORIES TYPE CONSTR.
by any applicant lira permit subjects th5000f)cam mucivil penalty ALTER-DRAIN 5.00
of not more than five hundred dollars(55001.). 2 �.�
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole comperasi will do the work,and the structure is not
intended or offered for sale (Sec. 7644, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 So FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employes,Provided thin such improve- .
menu are not intended or offered for sale If,however,the building GAS-EA.SYSTEM,-1.INC.4 OUTLETS 6.00 2334
orimpro - -
vement is sold within one year of completion, the owner- GAS EA.SYSTEM OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or am- BUILDING USE
Prove far purpose of sale.). INDUSTRIAL WASTE INTER: 30.00 RES IND CON PB Other
❑ ],as owner of the property,am exclusively contracting with ® ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V:B. 6.00 ASSESSORSPARCELNO.
and Professions Code:'I'lie Contractors License Law does not apply - _
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 '
contracts for such projects with a contraatorls)licensed pursuant to
the Contrector's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1im'exemptundcTSec. ,B.&P.C.for this WATER HEATERW/VENT .6.00 8067
reason
Owner Dare WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that I have a certificate of consent tD self-in ore.
or a"nif ate of Workers'Compensation Inwrance,or a certified ZONING ENG.SITE NO.
copy mersof(See.3800,Lab.C.). United Pacific
Policy No. Company
O ❑ Curtilied copy is hereby famished. RE$PRINK ENERGY T Z4
Z Z Q Cenif Illed witb Ibu city inspection division.
p Abplicuo7 MISC.- ' REFER TO ORD. v ❑ 'N❑ v ❑; N❑
CrN CE fNff'lCA oP EXEMPTION FROM WORK 1:RS' PERMIT ISSUANCE 10.00 4 FLOOD ZONE A.L.uc.
LU > COMPENSATIONANSURANCE PLG.CONTR_ LIC.NO. PLG,
CL 0 (This action need not be completed if the Permit is for one TOTAL' v❑ N El Y [:] N❑
hundred dollars(S I W)or less.)
U 0 I certify that in the performance(it tire work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit R issued I shall not enpm
. loy any Aurum in any hnenner u to
O w become subject to the Workers'Compensation Laws of California.
C. NDateOT Applicant ALTER ORADDTO MECH. 5.00 BUILDING 940.50
} to NOTICE 'TO APPLICANT: If,after making the Certific-atc of Ex-
2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLA CHECK
provisions of the labor Code, ycm,prol forthwith imply with
U such provisions or this l enn t shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE enerW 62.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10M)OF.M.) 6.00 SEISMIC FEE 13.0
I hereby affirm that there a a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of work. w,yich M�renail is issued(Sec. MICROFILM
3097,Ci,.C.). J2CUrI y YaCli ll, HEATING UNIT(TO 100,000 B.T.U.) 8.07
Lender's Name HEATI NG UNIT 100,000 B.T.U.)9.50
Lender's y that _ _p ELECTRIC 70.35 -
I calif that I uvc neer,}agree
a comply
and state that the above VENTILATION FAN (SINGLE) 4.00
information a correct I agree to comply with all city and county PLUMBING 70.355
ordinances and state caws relating In building construction, and BOILER-OCXvP 13 H.P.or 100,000 B.T.U.1 6.00
hereby antimund ropertyfor insvei of this city to enter upon the BOILER-COMP (Over 100,0008TU1 SEE FEE SCH.
abovenmcmioncd property for inspection purpuus. MECHANICAL
(We) agree to ave, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
70 -45
u,rtino against liabilities,judgments, costs and expenses which CONST.TAX
hay in any way accrue against sand City in consequence of the PERMIT ISSUANCE 10.00 288.24
noting ofd � MECH.CONT. LIC.NO. MECH.
rA ) TOTAL TOTAL 1530.31
Signeturc of (cant/Contmctnr Date
OFFICE COPY