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13797r. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY OFFICE COPY PERMIT NUMBER BUI[DING PROJECT I IDENTIFICATION APPLICATIONPERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL 13797 IL eIss 11521 Well Spring Court ADOREs,+ OWNERS NAME OTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE 5_ ACTORs NAME if UTLETS- SWITCHES -RECEP 10.00/1.00 &STLIGHTING FIXTURES 10.00/1.00 Ll..N- 430097 fig crows 220 Twin Dolphin Dr.,. "C" AooR Ess 3 PPLIANCES-RESIDENTIAL 4.00 aI. PANELS 10.00 Ppdwnnd City- CA PHONE _ DATE OF APPLICATION ARCHITECT Aram Bassenian, A.I.A. OR ENGINEER uc. NO PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS E"G 3990 Westerly Pl., #170 ZIP SPECIALCIRCUIT 5.00 VAXD PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 APPLIc a 220 Twin Dol phi n Dr. , "Cu ADDfl E55 MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 Rpdwnnd • - �y LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisionsof Clmpter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cock, and my license is in full tor�t�{� fPyL License Class _K Lie. Number y�yH J ISSUANCE DATE SLOG. ELECT. PLG. MECH. MV Date Contractor 600, OWNER -BUILDER DECLARATION I hereby affirm That I or exempt from the Contractor's and Pr License Law for the following reason. (Sue. uiresa. permittown Professions alter, Code: Any city or county which structure permit o its issuance, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed slat is Li ensu he is licensed pursuant to the provisions of the ) ofD¢ision License Law (Chapter 9(eommenCodwith Section is exempt Division3 and Business and Professions Code) or than h is exempt Therefrom and BUILDING PERMIT INFORMATION MISC.- REFER TO ORD VALUATION � J OL" // $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC, TOTAL / PERMIT TO DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis tot the alleged exemption. Any violation of Section 7031.5 An i by any applicant for a permit subjects the applicant too civil penalty Of not more than five hundred dollars (4500).). ALTER -DRAIN & VENT -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 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- mentsamnotintendedoroffered for sale. If, however, the building BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP �- 3 RES. UNITS / DRAINS -FLOOR, ROOF, AREA,COND. 5.00 F IXTUR ES - PER TRAP 5.00 50, FT, FLOOR AREA TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner. e burden of proving te did not build or im- builder will have ththat h prove for purpose of sale.).WASTE ❑ 1, as owner of the property, am exclusively contracting will, - . .. GAS EASYSTEM -OVER 4 IEA) 200 BUILDING USE RES IND CON PR Omer a ❑ ❑ ❑ ❑ INTER3000 INDUSTRIAL . . licensed contractors to construct the project (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 contracts for such projects with a coNructor(s) licensed pursuant to the Contractor's License Law. I LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. 3� - 4-3 / 3.1123 / SEWER -SANITARY -STORM EA. 200tt/10.00 TRACT NO, PARCEL NO. ❑ 1amexemptunder Sec. ,B.&P.C.for this reason WATERHEATERW/VENT 6.00 7/�r/j�- Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof(Sec. 3800, Lab ) Policy No. company Uni-ted-Pac-4Reli_anc FIRE SPRINK Y ❑ No ENERGY T24 I Y ❑ N❑ ❑ Cerlilie lathy fun jfilt)U. N Cerl if o filed w he sty inspection dJ Sion. Applicant_ MISC.- REFER TO ORD. CERT CAPE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG, CONTR. LIC. NO. PLG, TOTAL / COMPENSA'T'ION INSURANCE (This section fired not he completed if the permit is for one Y ❑ N ❑ Y ❑ N❑ hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued. 1 shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT': If, after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 IAPPLIANCE 5.00 PLAN CHECK FEE �' 3S emption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /L) CONSTRUCTION LENDING AGENCY I hereby affirm that There is a construction lending agency forEXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec. 3097, CN.C,), Lender's Name �.e C_uL• Pacific Lenders Addmss�.n-F_ra.nC1-S-C -CA MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC qVENTILATION FAN (SINGLE) 4.00 PLUMBING d� I certify that I have read this application ana stale that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL T/xJ 6 S hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes, MISC. - REFER TO ORD. CONST. TAX G (We) agree to save, indemnify and keep hurni Inc City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of ll, ran /44 PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL�s� TOTAL SS30 Signature -7 A fit/Contractor Idle OFFICE COPY CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO 2� 3 -7�� SATE I BLDG. PERMIT NO. I L��S THE BLDG. LOCATED AT 115 % C1• ! OWNED BY HAS BEEN (COMPLETE -, `j>,^. n ✓� FOR USE AS I (ALTERED( I i I i 1 BUILDING INSPECTOR POST THIS CARD NEAR FRONT OF'BU,LDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS /y'��-�- ��+ARz�� C7 UNIT# LOT# _ OWNER �� v/i?. '6PCQ U /N C. CONTRACTOR INSPECTION TE INSP CTORINSPDECTION RECORD FOUNDATION �. 9. /G/`id/y/.✓(r LeRKt _e,; t (�jy o UFER PREGUNITE - UND PLUMBING ELECTRICAL UNTIL ABOVE HAS BEEN SIGNED MECHANICAL ELECTRICAL FRAMING INSULATION ROOFING UNTII RO MMM PERMIT NUMBER 13797 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. 0 PERMIT TO J/ . STORIES TYPE CONSTR. RES ❑ IND ❑ CON ❑ PB ❑ Omer ❑ LATH -EXTERIOR ` ASSESSORS FARCE: NO, SHEAR EXTERIOR OFFICE COPY MECHANICAL HEATING _ ELECTRICAL FIRE DEPT. GRADE BUILDING TEMPORARY APPROVALS ELECTRIC GAS - FIRESPRINK ENERGY T 24 ❑ "❑ ❑ ' "❑ EL000 zorvE aL.u.c. Y❑ N Y❑ No FEE SUMMARY BUILDING PLAN CHECK ' FEE COVER NO WORK UNTIL ABOVE HAS BEEN SI D LATH -INTERIOR / LATH -EXTERIOR ` SHEETROCK SHEAR INTERIOR b --(b SHEAR EXTERIOR FIREWALLS I OCCUPANCY SEISMIC FEE )NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC / �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. - Z' - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL ` IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY