17702 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT�N�UMBER
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CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
,/�_
JOB ADDRESS/j SG3 Si+`V 3+�P SpK��G L 1 UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER Cl ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLH4114WALIDATION
CUPERTINO STANDARDS. <R -,„A� �
GARAGE SLABS � P;La.�i �II //71,1 L y
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND IISLAB MAY ;j i9 iJ
PLUMBING '� {{..��
ELECTRICAL QtY Of COperdDO ISSUANCE DATE
MECHANICAL BLDGELECT PLC MECH
il Li
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR _ INFORMATION
PLUMBING 7
VALUATION SIFT.
MECHANICAL 18558M '
ELECTRICAL PERMIT TO
FRAMING
.INSULATION STORIES TYPECONSTR
- ,`, OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED oTeXSC(2VZ��-i°/-Fjc(Q-t R_3 3 i
ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE SO Ti TLOOHAHLA TOTALATTPEACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 2917 {
DI BUILDING USE
ROOF SHEATHING II Es IND CON re Ong,,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
ROUGH - - SAN.k _ _ ASSESSOHS PARCEL NO
^
PLUMBING ELECT.ENERGY �'� -Dag
TUBS B SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING EN GY AccOATE FILE NO
FRAMING ELECT.FINAL ST
INSULATION PLUMBING ZONING ENG SITE NO,
GAS TEST GAS
MECHANIC FIRE SPRINK FN Gy T.1a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ N❑ ' ❑' N❑
EXTERIOR SHEAR ELECTRIC R LEASE FLooU zorvE ALuc
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING 890.E
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE �'��
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 13.02
OCCUPANCYOF BUILDING ISNOTPERMITTE DUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 70.
36
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING. R?.35
z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! • CONST. TAX 902.02
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. 544.09
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
OUILIDING APPLICATION & PERMIT 17702
ADDS ESS 11863 Shasta Spring Court Lot 346 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
a
OWNER'S LAN CHECK VALIDATION
NAME bwg y & p, Inc.Inc•
OTV. ELECTRIC PERMIT FEE
oNE415/595-210,
NAMERAcroRs R"egwy Group, Inc. UTLETS-SWITCHES-RECEP 10.00/1..00
"'`^+F� LIC.NO.B4M7 ILIGHTING FIXTURES 10.00/1.00
ADDRESS
TORS 220-C Twin Dolphin Drive PPLIANCES-RESIDENTIAL 4.00
PHONE41 rq; PANELS 10.00 - DATE OF APPLICATION '-
ARCHITECT (1ss1nian/La�i N chitec s PLAN CNECK FEE P.C.NO.
U
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG203 Orchard Drive /100 PERMIT VALIDATION
ADDREss SPECIALCIRCUIT 5.00
Santa Pina CA
ZIP92707 TEMP.METER OR POLE INS. 20.00
APPLICANT'S 220-C Twin Dolphin Drive
ADDRESS MOTORS _ F E FEE SCH.
M, CA 94055 SERVICE CHANGE 20.00
0 a z t-'.
r o o LICENSED CONTRACTORS DECLARATION uj I v CJ ; T r
a u U I hereby affirm that I am licenwd under provisions of Chapter 9
i w - ISSUANCE DATE
y Q N (commencing with Section 7080)of DIVISIOn 3 of the Business and BLDG. ELECT. PLG. MECH.
F N z Professions Code,old my licenu is in full fur"wnLhe 7T
City of Cuorfine z Liccnsc Class D Lic.Number 4.7111f1
F L
- Date Contractor
wa OWNER-BUILD17R DECLARATION BUILDING PERMIT
Ao> O MISC.- REFER TO ORD INFORMATION
X ; LL I- 1 hereby affirm that 1 am exempt from the Contractor's License
u0¢ Law for the following reason.(Sec.703L5,Businessand Professions VALUATION $/FT.
- PERMIT ISSUANCE 10.00
F �>-i Code Any city or county which requiresa permit loconstr,Ialter, 100 OCC
Q 6 Q O Improve,demolish,or repair any Slmctu re,..... Ip Its ISSDa....,.ISO ELEC W
CONTR LIC.NO. )
0 a requires tine applicant for such permit to file a signed statement that ELEC.
u w m w he is licensed pursuant to the provisions of the Contractor's License TOTAL PERMIT TO
Hi>
Low,(Chapter 9(commencing with Section 7000)orDivision 3 ofthe �
4 o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
IS ro the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
u ; m by any applicant fore permit subjects theapplicant macivil penalty ALTER-DRAIN&VR,IEA.) 5.00
VENT-WATER, 2 SIR
of not more than five hundred Dollars(S500o.7: ,
❑ Lmy employees owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will(S IIIc work,and Ise structure is not OCC.GROUP RES.UNITS
Code:ed The
offered for sale(Sec. doe Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3 1
Cole:The hContractor',builds License Law neon not apply to an owner of
himself
who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such inulruve-
orunmentare not is sold or within
on year
(complever,tion the the owner-
GAS-EA.SYSTEM-i INC.4OUTLETS 6.00 '2917 n2Z
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 L•SE
builder will have the Of burden of proving that he did not buil)or int- BUILDING USE
prove for 1,as ownerose
of sale.). INDUSTRIAL WASTE INTER. 30.00 $ ❑ ❑No N ❑ o❑
❑ L as owner of the property,am exclusively contracting with
licensed colon,C,rd to construct for project(Sea does,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Codc:The Contractor's Lirense Law does not apply
to an Owner 01'property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 �/�/ �^�^
cuntnets for such projects with a contractortsl licensed pursuant to \.LL.(0 •JJ '
the Contractor's License Law, SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec ,B.&P.C.for Ibis
reason WATER HEATER W/VENT 6.00
Owner Dute WATER SYSTEM 5.00
ACC.GATE ACC.FILE N0.
wo RK6R5'COYIPHNS,UION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy lhereof(Sec.3800,Lab.C.). United Pao .
Polley No, Company Uc.V _If�G
O CM Certified copy is hereby furnished.
Z Z L Certified 's file) with the ''ly in�peCtion division. FIRE SPR INK ENERGY T-24
Applicant MISC.- REFER TO ORD. V� IN yC] INC]
~ O PERMIT ISSUANCE
LU > CERTIPICA TIiONSAEIOTINSHR N WORKERS' 10.00 FLOOD zorvE A.L.u.c.
CL COh11'IiNSAI'I(yN INSURANCIi PLG.CONTR. L(C.N0.CL 0 PLG.
Z I"this section need not be completed if the permit is for one TOTAL V D� N V IN
dollars IS 100)or less.)
V O 1 certify that in the performance of the work for which this per- OT,. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ'any person in any manner so as 10
O W become subject to the Workers'Compensation Laws of Callfomia.
Q. Dae` CANT:m ALTER OR ADD TO MECH. 5,00 BUILDINGW.50
} H NOi'ICIi TO APPLICANT: 11
,after making this Certificate of Ex-
F ? emption,you should become subject to the Worker,Compensation APPLIANCE 5.00 PLAN CHECK
sha
Provisions of the Labor Code, you must forthwith comply with
V such provisions or this permit ll be deemed revoked. AIR HANDLING UNIT(TO 10=1C.F.M.) 4.00 FEE /Energy 00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10P00C.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
13.02
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.TU) 800
Lender's Name . . .
Lender,Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I hnvu read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
- 70.35
information is correct. I agree lO comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00 ]Q•
hereby authorize representatives Al this city m enter upon the
35
above...enfioned property for inspection purposes. BOILER-COMP Over 100,000BTU)SEE FEE SCH. MECHANICAL
70-35
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uPerfino against liabilities,judgments, costs and expensed which
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00CONST.TAX
3�•�
rantin of[his permit. 302.02 CONT. LIG NO. MECH.
!� L
Signature of Applicant/Contractor _ TOTAL TOTADate 1,544.09J
.09
OFFICE COPY