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13742 (2) POST THIS CAR D'NEARTRONT OF BUILDING FRMIT NUMBER'-CITY OF CUPERTINO 13742 INSPECTION DIVISION JOB INSPECTION RECORD _ PERMIT EXPIRATION JOB ADDRE / UNIT# 'LOT# I ' PERMIT EXPIRES IF WORK OWNER - CONTRACTOR IS NOT STARTED WITHIN INSPECTION' DATE I SECTOR INSPECTION RECO D 180 DAYS OF PERMIT ISSU- FOUNDATION - -Q -'�" I -( OhL-t N� ANCE OR 180 DAYS FROM- UFER IL-16-8K V LAST CALLED INSPECTION. PREGUNITE PERMIT VALIDATION PAID POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IDC 9 01987 . / UNDERGROUND /SLAB PLUMBING �1y�L1�l'QoF�f�yF. ELECTRICAL - CII IsosstuAW MECHANICAL BLDG, I ELECT. PLG. I MEC.. El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. _ I MECHANICAL ELECTRICAL PERMIT To FRAMING ) - INSULATION STORIES TYPE'CONSTR. OCC,GROUP RES.UNITS _ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGMI I I I -'')O BUILDING USE - C(J- HES IND CON PB O'n" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 9- ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING 4gfA4 , 6 - 7 '. GAS TEST _ �� TRACI NO. PARCEL NO. MECHANICAL 017or I '/ %; ELECTRICALFINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING ��- SAN # 1 INSULATIONPLUMBING _� ZONING ENC.SITE No. OI GAS FIRE SPRINK ENERGY L4< 'Z�i V.Q'Y MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING S ❑ N❑ Y ❑ N❑ LATH-INTERIOR ELECTRICAL (j„ FLooD ZONE A,L.Uc. LATH-EXTERIOR FIRE DEPT. i Y❑ rv❑ v ❑ No SHEETROCK . �2y- GRADE FEE SUMMARY SHEAR INTERIOR " BUILDING O 2 5_ SHEAR EXTERIOR 0- TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC I PLAN CHECK' GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTORI T MICROFILM- . I UJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC D -00 ® ~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS.WHEN PHONING. 97.00 — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! I CONST.TAX 282.68 PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. I R K 7l 19 OFFICE COPY APPLICANT TO FILL IN INFORMATION VVITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDEN71 F1CATION PERMIT NUMBERAPPLICATION & PERMIT ADDRESS BUILDING Lot #51 Pan 3B 13742 ss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNE PLAN CHECK VALIDATION NAME 415 QT99 Y. ELECTRIC PERMIT FEE GREGORY GROUP INC PHONE CONTNAMERRCT°n$ 99 UTLETS-SWITCHES-RECEP 10.00!1.00 Same LIC.NcB-430097 LIGHTING FIXTURES 10.00/1.00 Pi -00 CONTRACTORa PPLIANCES-RESIDENTIAL 4.00 12 00 ADDREss Z - TWin D j�'in Dr. PANELS 10.00 DATE OF APPLICATION AR H CT 1`CA 41 - PLAN CHECK FEE P.C.NO. OR 3990 Westerly Place //170 PANELS (OVER 200 AMP) 20.00 ENGINEER ww.. LIc.rA No SIGNS TRANS. 3.00 /'U� ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ARAM BASSENIAN, AIA ZIP TEMP.METER OR POLE INS. 20.00 EC 3 01987 Av Ic 7 MOTORS SEE FEE SCH. 7.00 A°DREsa /220-C.Twin Dolohin0r;".. J /�=1u _ SERVICE CHANGE 20.00 city edwoed-Grt CA-p940651." Foo LICENSED CO�TaRACTORS DECLARATION a i w I hereby affirm that I am licensed Under provisions of Chapter 9 ISSUANCE DATE w ¢y (Commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH. r N z Professions Code,Bod my license is in,full fort 0 Z ,4 - License Class Lie NmberEl 11 9 w F w Date Contractor r fBUILDING PERMIT Z ¢ w 4 OWNER-BUILDER DECLA ATION INFORMATION w Li ;LL w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD u0 ¢ Law for the followingreason.(See.7031.5,Business and Professions VALUATION S/FT. -04 Code:Any city orcounty which requires a permit to construct, PERMIT ISSUANCE 10.0010 00 ac R ¢ FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. TE 123 DDD.DD CLL requires the applicant for such permit to file a signed statement that TOTAL u a m he is licensed pursuant Jo the provisions of the Contractor's License PERMIT TO FZi Law(Chapter 9(commencingwith Section 7000)ofDivision 3ofthe E i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE M I-$ the basis for the alleged exemption.Any violation of Section 703 LS by any applicant for a permit subjects the applicant ton civil penalty STORI S P CON TR. of not more than five hundred dollars(S5000.) ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 4.00 �\ their sole compensation,will do the work,and the structure is not . OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and Professions Code: 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 does such work 12 F IXTUR ES-PER TRAP 5.00 U UU SG.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedorofferedforsale.If.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement 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 im- BUILDING USE prove for purpose of sale.). R IND CON PB Other D I.as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ElEl ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. 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 �� _9 3� -�3 contracts for such projects with a contortions)licensed pursuant to 3-2 the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 1 In nn TRACT NO. PARCEL NO. ❑ lam exempt under anon Sec._,B.&P.C.for this WATER HEATER W/VENT 6.00 no O�r'� Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to selhinsore. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(See.3800,Lab.C�Jn ted Pacific opt: Q Policy No. Company ❑ Certified copy is herebS furnished. ZZf�. Certified copy is filed 'Ih cit inspection division. FIRESPRINK ENERGY T-24 F O Applicant MISC.- REFER TO ORD. v N v 0 NEI it CERTIFICATE OF EXE PTION FROM WORKERS' PERMIT ISSUANCE 10.00 O.00 FLOOD ZONE A.L.U.o. LL > COMPENSATION INSURANCE PLG.CONTR.CL LIC.N0. PLG O (This section need not be completed if the permit is for one TOTAL 97.00 Y N� Y N� Z hundred dollars(S 100)or less.) V O I certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person in any manner so as to Ow become subject to the Workers'Compensation Laws of California. D. Date APPLICANT: I ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of Ex490-90 - �,z empti°n,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with NOD - CONSTRUCTION83 V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO IO,OW C.F.M.) 4.00 FEE ener 00 LENDING AGENCY AIR HANDLING UNIT(OVER I0,000CF.M.) 6.00 SEISMIC FEE 8.19 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(Sec. MICROFILM 3097,nde, CJ. Sacramento S&L HEATING UNIT(TO 100,000 B.T.U. 8.00 Lender'Ss Name Lender's Addre HEATING UNIT(OVER 100,000 B.T.U.)9.50 159.00 ry/�n TAY'EI-St-.-4-T01 ELECTRIC ® informRWGc,tation is ll this application and all llcthat the above VENTILATION FAN (SINGLE) 4.00 information n 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.or 100,000 B.T.U.) 6.00 97.00 hereby authorize representatives this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL 55.00 (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 may,in any way accrue against said City in Consequence of the PERMIT ISSUANCE 10.00 282.68 granting ofthis er il. MECH.CONT. LIC.NO. MECH. IOTA` TOTAL Signatur licant/Contractor 0107 55.00 OFFICE COPY