13798 POST THIS CARD NEAR FRONT OF BUILDING �'IF
'
CITY OF CUP,ERTINO ` t PFIiM111T NUMBER
13?'ER
INSPECTION DIVISION
98
JOB INSPECTION RECORD
\ '. 1 # PERMIT EXPIRATION
JOB ADDRESS L 'L "I UNITLOT#
' Vy - PERMITIEXPIRES IF WORK
OWNER `-� G2cx . -t4mC, CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR p INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
- FOUNDATION -( p-y_,pf fRAMi�S' C�Q/�d��+ld 4;;/ar4pANCE OR 180 DAYS FROM
UFER - LASTCALLED INSPECTION.
PERMIT VALIDATION
PREGUNITE C�-7,�y-Qrt
'to STQM Pc1PE Sto
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p�!
UNDERGROUND /SLAB ✓
PLUMBING - [CZF3198i
ELECTRICAL - L ISSUANCE DATE
LD PLG, MECH.
CHANICAL
0 1 0'
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUnTION S/FT.
PLUMBING -
MECHANICAL
ELECTRICAL PERMIT To
FRAMING
STORIES TYPE CONSTR.
' INSULATION '
l
OCC.GROUP RES.UNITSy
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FL FLOOR AREA TOTAL ACR FADE
DIAPHRAGM
BUILDINGUSE
RES IND CON
PB OUwr •
APPLY NO ROOFING UNTIL ABOVE HAS BEE IGNED ❑ Q E:l ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST
TRACT NO. PARCEL NO
y
MECHANICAL x Y- r) ACC.DATE ACC.FILE NO.
ELECTRICAL �- FINALSJDATE INSP.
FRAMING .�� SAN # k o ZONING ENG.SITE NO,
INSULATION , PLUMBING
3ZTWK R. GAS
FIRESPRINK ENERGY T-24
MECHANICAL v No Y N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR. � . ELECTRICAL � � FL,.00DZONE A.L.U,C.
LATH-EXTERIOR ��j FIRE DEPT. v "� v �] "�
SHEETROCKGRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING 4: ;
FIREWALLS ELECTRIC PLAN CHECK _
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
`\ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
` SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION:
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date
... .—z--1'.. .................... 19............ Building Permit No.
The Building Located at .........Ws.�
Owned by ....... ......
Has Been Com leted or Use As:
............................................................
............ ............................................................I..............................................................
. ....... ... .. ... .... ........ ........................ ............. .................................................
.. .... .. . .. .... ... ................. ...............................................................
PD-7 ............
BUILDING INSPECTOR
i
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USWBALL POINT PEN ONLY
BUT LDI`NG PROJECT 1 DENTI FICATION 11 PERMIT NUMBER
APPLICATION & PERMI T� -�
RUILOING
ADDREaa J
11531 Well Spring Court 98
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL137
_ OWNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
PHONE 595-2 100
CONTRA TOR UTLETS-SWITCHES-RECEP 10.00/1.00 jig
NAME
I LIC.No430097 LIGHTING FIXTURES 10.00/1.00
CorvTRA Ton 220Twin Dolphin Dr. , IICII PPLIANCES-RESIDENTIAL 4.00
aooREss
PHONE - 10 I PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMP) ZOOO PLAN CHECK FEE P.C.NO.
OR Aram Bassenian, A.I .A. .
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
An .08
ADCH
DRESS LIC.
Westerly Pl , #170 SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZT EMP.METER OR POLE INS. 20.00 Palo
APPLI CA Ts 220 Twin Dolphin Dr. , II Cn MOTORS SEE FEE SCH.
ADDRESa
Rpdwnod Cit_y, CA ()4065 SERVICE CHANGE 20.00 .n
woo LICENSED CONTRACTORS DECLARATION gs,,�
rt v t I hereby affirm that I am licensed under provisions of Chapter 9 wf55UANCE GATE
< w (commencing with Section 7000)of Division 3 of the Business and LOG. ELECT. PLG. MECH.
Professions CodE.and my license is in full fory�j aft. 1�1
z o w - License Class_ Lie.Number�` /
9 w L w Date Contractor
a m s - BUILDING PERMIT
'¢ ¢ w a OWNER-BUILDER DECLARATION INFORMATION
o A G MISC.'- REFER TO ORD
E
1- I hereby affirm that I am exempt from the Contractor's License
u_O Law for the following reason.(Sec.7031.5,Businessxnd Professions PERMIT ISSUANCE 10.00 VALUATION
E Code:Any city or county which requires a permit to construct,alter, - A_w._/1
2 a Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0, ELEC. (o V r/ 0
I,
requires the applicant for such permit to file a signed statement that TOTAL / 6 PERMIT TO
E
w he is licensed pursuant to the provisions of the Contractor's License ^� /
Law(Chapter 9(commencingseith Section 7000)ofDivision 3 oflhe
a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE,COONSTR.
i ; •. by any applicant for a permit subjects the applicant has civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(1500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole Com pensntlon,will do the work,and the structure Is not OCC.GROUP RIES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 �-
Coda:The Contractor's License Law does not apply to an owner of
property who builds or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or iin-
Proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB oma.
❑ 1,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:The Contractor's License Law does not apply -
' to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 A3 4 6 131,33
contracts forsuch projects with a contractorts)licensed pursuant to SEWER-SANITARY-STORM EA.200f3/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I um exempt under Sec..,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a Certificate of consent 10 self-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof fSec.3800,Lab.0 c- Rel-.7.3n
Policy ere Company n -P1N-+x
O ❑ Certified cop n' FIRE SPRINK ENERGY T 24
CX Certified f' ms t division.
Zp Applicant /' I'LL MISC.- - REFER TO ORD. v❑ N❑ Y N❑
�• y PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
D: j CERTIFICATE OF EXEMPTION FROM WORKERS'
W _ COMPENSATION INSURANCE PLG.CONTE. sec.No. PLG.
d 0 (This section need not be completed if the permit is for one TOTAL -� Y❑ N❑ Y ❑ N❑
Z hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per- DTVMECHANICAL PERMIT FEE FEE SUMMARY
LL H our is issued,I shall not employ any person in any manner so as to .
U become subject to the Workers'Compensation Laws of California. 57,3 [♦-p
1C Date Applicant ALTER OR ADD TO MECH. 5.00 a BUILDING /
} rn NOTIC17 TO APPLICANT: If,after making this Certificate of F:n-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK a
provisions of the Labor Code, you must forthwith comply with FEE (3
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10f.I0DC.F.M.) 4.00 /
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE
I 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(Sec. MICROFILM
3097,Civ.C.). I HEATINGUNIT(TO 100,0008.T.U.) 8.00 G
Lender's Name SPC Ori tv Pa C]-flC - HEATI NO UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I ave rea t ¢app ica ion send state t VENTILATION FAN (SINGLE) 4.00
iafornmtion is correct. I agree to comply with all city and coumy PLUMBING
ordinances and state laws relating to building construction, and 6UILER•CQMPI3 H.P.Dr 100,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP I Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. /
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX W
may in any, w 'ecrue against said City in consequence of the PERMIT ISSUANCE 10.00
granting oft MECH.CONT. LIC.NO. MECH.
_ /A��,j��j� TOTALS TOTAL S�`3 �
~ at
SignatureO Meant/Contractore
OFFICE COPY