13781 POST THIS CARD NEAR FRONT OF BUILDING " !
. , • PFNMIT NUNIHER
CITY OF` CUPERTINO 13781
INSPECTION DIVISION
^� JOB INSPECTION RECORD
PERMIT EXPIRATION-
• JOB ADDRESS ��5 �S'—SYN J'E7 U�/4,-,y - C,zUNIT# - LOT# ''V•
/'� _ PERMIT EXPIRES IF WORK
,OWNER .e -6;coa N CONTRACTOR IS. NOT.STARTED•.-WITHIN
INSPECTION ATE I INSPECTOR INSPECTION RECORD DAYS OFPERMIT ISSU--
FOUNDATION - E OR 180 DAYS FROM
LAS ED INSPECTION. '
LIFER -a
PERMIT VALIDATION
PREGUNITE' O �
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .
UNDERGROUND /SLAB ;
PLUMBING ,
ELECTRICAL ISSUFNCE:DATE -
M CHANICAL BLDG., ELECT, PLG. MECH.
�'. El El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION -$/FT
.
PLUMBING
MECHANICAL
PERMIT TO
- ELECTRICAL - t
�.L141
r FRAMING
STORIES TYPE CONSTR.
INSULATION -
i
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
+
ROOF O.Pi.FLOOR AREA iOTALACREAGE
D7AWJ.FVA6M' u' C -vx-1 jI +
BUILDING USE
+ RES IND CON Pp _ OJleI
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑-
ASSESSORS PARCEL NO.
ROUGH
PLUMBING61_ _
GAS TEST IrTACT No, PARCEL NO
S
MECHANICAL
• ELECTRICAL - _ '6. FINALS DATE INSP. ;Acc.onrE. ACC.PILE No.
a
'FRAMING — SAN # ; ZONING' ENG SITE NO.
INSULATION' '-20 PLUMBING g ..
•r
�7 GAS
MECHANICALFIREISPRINK ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BE EN SIGNED HEATING ❑ ' N O ` ❑ �❑
LATH-INTERIOR - i ELECTRICAL,• - •FLOOD ZONE A.L.0 c.
LATH-EXTERIOR' t
' . '] FIREDEPT. _$ J..
: -.V,❑ NE] V ❑ N
SHEETROCK I . - 7 (p 0 GRADE FEE SUMMARY
SHEAR INTERIOR' 2,"+j-� BUILDING
+ ' G '
'
SHEAR ExreRloR - —'7— - TEMPORARY APPROVALS BUILDING
FIREWALLS ' ELECTRIC PLAN CHECK
GAS FEE r• a�-��'
NO TA E OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY o SEISMIC FEE'
OCCUPANCY OF BUILDING IS NOTPERMITTED,UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE,FOR INSPECTION BY PHONING 252-4505, t, t ELECTRIC
o� ONE WORKING DAY BEFORE WREQUIRED INSPECTION. PLUMBING '
Z PLEASE GIVE JOB,ADDRESS' HEN PHONING. '
- SEE PE'RM IT .FOR.EXPIRATION DATE - MECHANICAL
9' CONST.•TAX
'IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALL
I . > TOTAL.
ING'FOR,FINAL•INSPECTIONJ ..
i. Qf FICE,,COPY '
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.BUI LDING PROJECT I DENTI FICAT16N - PERMIT NUMBER
OUILDI"G 11515 Sunset- Spring, Court APPLICATION & PERMIT 37
AR
ADOREss BUI LDING-ELECTRICAL-PLUMBING-MECHANICAL 1
i _
OWNER'S PLAN CHECK VALIDATION
NAME _ OTY. ELECTRIC PERMIT FEE
r Group- ONE
NAME ANTRAGTGRs 11UTLETS-SWITCHES-RECEP 10.00/1.00 '
N
Gregor
uc:ND. 7 LIGHTING FIXTURES 10.00/1.00
ADDRESS DR'a n
-220 Twin Dolphin, TY . '3 APPLIANCES-RESIDENTIAL 4.00
Redwood C CA PHONE 5 5• 1PANELS 10.00 DATE OF APPLICATION
ARC
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
O
DR Aram Bassenian, AIA ,
ENGINEER ,
Ri AssociatesLIc."o. SIGNS TRANS. 3.00
ARCH.DR ENG.3990 Westerly Pl , #170, PERMIT VALIDATION
AD DR ESR SPECIAL CIRCUIT 5.00
New rt Beach . ZIP EMP.METER OR POLE INS. 20.00 ` 81
Er -
APPLIGANT's " u MOTORS. SEE FEE SCH.
, ADDRESS 220 Twin Dolphin Drive, � C
Redwood Cit CA 94065 SERVICE CHANGE 20.00
0 0 o LICENSED CONTRACTORS'DECLARATION
¢ I Imreby affirm that I um licensed under provisions of Chapter 9 - .ISSUANCE DATE
e z"' (commencing with Section 7000)of Division 3 of the Business and BLDG. .ELECT. PLG. MECH.
,w i Professions Cos(e,and my license is in full forey��nn�/�I p�f[�ppCc{{ - I--it
o 0 m a License Class-IS Lia Nmnber 416141
Dale - Contractor
¢ Y BUILDING PERMIT
¢ ¢w u OWNER-BUILDER DECLARATION „ _ INFORMATION
wO A,H I hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD
3 y y P _ VALUATION SIFT.
F _ 0 4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE, 10.00
Code:Any city or county which requiresa permit toconslruct,alter, //,��✓s ��
re ¢ ¢40 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIF NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL / . PERMIT TO
o. w 2 he is licensed pursuant to the provisions of the Contractor's License
Hzi
Law(Chapter 9(commencingwith Section 7000)of-Division 3 ofthe
< Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT .FEE
IS the basis for lite alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONST
u ;,- by any applicant love hundred
theapplicant).) toucivilpenalty ALTER-DRAIN -WATER (EA.) 5.00 •�/�
of floe more than Ilve hundred dollars the .1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Oce GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered.for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 /
Cade:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work 12, FIXTURES-PER TRAP5.
nt0 SO.FT.FLOOR AREA'.'TOTAL ACREAGE
himself or through his own employees,provided that such improve-
Tesarenolintendedorofferedforsale.If,however the budding GAS-EA.SYSTEM INC.INC.4 OUTLETS 6.00
or improvement is sold withigone year of completion,lire owner- GAS•EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or inn-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES. IND CON PB ower
zI,as owner of the property,um exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct Ore project(Sec. 7044,Business , ' LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Pon'essions Code The Contractor's License Law docs not apply 3(6
�_p// / ,p'
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 PP(p JJ d' sN
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITAR V-STORM EA.200f1/10.00
the ConItractor s License Law. -�TjRACT NO. PARCEL NO.
C, am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 / `p r
atom /
Owner" - Dale WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSAT1ON DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sel Giosure, .
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,LAC.United, Pae/Relidrl.
;1 Policy No. Company
Q ❑ Cerrifiede islere rushed. - FIRESPRINK - ENERGY T-24
Z Z OC Cerlifie tlh the oily inspection division.
O Applicant / t MISC. REFER TO ORD. Y❑ N❑ v ❑ N❑
D: y CCRI' CAI'E 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE 'A.L.0 c.
LU COMPENSATION INSURANC17 PLG.CONTE.- LIC.No. PLG.
EL O. fl'his section need not be completed if the per.iP is for one TOTAL f Y❑ N❑ Y.❑ N❑
` 0 Z hundred dollars($100)or IeS,.)
U O 1 certify then in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
O Wbecome subject to the Workers'Compensation Laws of California. BUILDING
y Dam Applicant ALTER OR ADD TO MECH.. 5.00 S-17,3
'
} 0 NOTICE TO APPLICANT: If, her making this Certificate of fix-
F ? emptiom,you should become subject to the Workers'Compensation L4 APPLIANCE 5.00 FEE PLAN CHECK ? 7
provisions of lire Labor Code, you Most forthwith cant Ply with J 7
C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 -
CONSTRUCTIONLENDINGAGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE �O •;
1 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(Sue. MICROFILM
3097,Civ C.). f HEATING UNIT(TO 100,000 B.T.U.) 8.00 OO//W
Lender's Name Security Paci_fice HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC �O
Lender's Address 4an4ra'ne-i-s-eo;-GA
I certify that I Have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING /,/
ordinances and state laws relating to building construction, and BOILER-COMP(3'H.P.or100,000B.T.U.) 6.00 )
hereby enthori it representatives ec this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCM. MECHANICAL rw
above-mention it property for inspection purposes.
(We) agree to save, indemnify and keep harmless the Chy,ol MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX b
may in any way accrue against said.City in consequence of the PERMIT ISSUANCE 10.00
gmntin li: reran' MECH.CONT. - LIC.NO. MECH.
> , ' a TOTAL -- TOTAL �y
Sip4tApplicant/Contractor Dat 5
OFFICE COPY' •., 1