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13755 (2) POST THIS CAR 0C,NEAR FRONT OF BALDING PERMIT NUMBER tf,-M OF CUPERTINO . 13755 INSPECTION DIVISION AJOBINSPECTION RECORD / I, PERMIT EXPIRATION JOB ADOREp N� �UNIT# 'LOT# ' -T I PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION - DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- - FOUNDATION r'+��'��7j . 6 k - ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE )_2Q6'ec�a4.a�FN/J �A vE TVALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ,,,ope, city at V A ELECTRICAL! Y �111� ISSUANCE UMR MECHANICAL A BLDG. ELECT. PLG, MECH. 3,3o 131• ❑ ❑ lib DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION .r PLUMBING VALUATION $/FT. MECHANICAL 23,000.00 ELECTRICAL - PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR. OCC.GHOUP RES.UNITS ` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT,FLooH AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB , GO— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, 'ROUGH PLUMBING �,F,(�- .3�� GAS TEST TRACT NO. PARCEL NO. t ff MECHANICAL _a sy_ /y//_, ELECTRICAL - _ FINALS DATE INSP. ACC.DATE ACC FILE NO. FRAMING SAN INSULATION -'2 ,m PLUMBING ZONING ENG,SITE No. 7 3_ GAS MECHANICAL FIRE SPRINK , ENERGY L2E COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED IWEATING Y ❑ "❑ Y ❑ "❑ LATH-INTERIOR ELECTRICAL FLOODZONE LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ "❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR -�_I TEMPORARY APPROVALS BUILDING C FIREWALLS ELECTRIC I PEEN CHECK 3)8.8.3 C r — j GAS NO 160 TAPE OR PLASTER UNTIL ABOVE HASSIGNED OCCUPANCY SEI MIC F V OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM I LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ~o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. I PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. --SEE PERMIT FOR EXPIRATION DATE - MECHANICAL FC IMPORTANTI CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI (CATION PERMIT NUMBER BUILDING _ APPLICATION & PERMIT LOT 0'17 PLAN,3A BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'$ 11 PLAN CHECK VALIDATION NAME 415-595-2100 JED ELECTRIC PERMIT FEE GREGORY GROUP, IN¢(��ORAT NOMERAcroRs QQ UTLETS-SWITCHES-RECEP 10.00/1.00 99 B-43009700 qamp LIC.NO. LIGHTING FIXTURES 10.00/1.00 cONTRAGTOR's APPLIANCES-RESIDENTIAL 4.00 ADDRESS 220-1Twin Dol phi n D CA RWCBONE PANELS 1000 1 DATE OF APPLICATION ARCHITECT PLANCHECK FEE P.C.NO. OR ARAM BASSENIAN> AIAPANELS (OVER 200 AMP) zo.oaENGINEERASSOGIATELIC.No. SIGNS TRANS. 3.00ARCH.ORE P ATION ADDRESS SPECIALCIRCUIT 5.00 3990ert Westerly Place, # PEC 3 019®� IIPEMP.METER OR POLE INS. 20.00 APPLJ ' MOTORS SEE FEE SCH. ADDRESS 220-C Twin Dolphin Dr. RWG CA 94066SERVICE CHANGE 20.00 7 00 '02 LICENSED CONTRACTORS DECLARATION iL, I hereby aff..jiII that I am licensed under provisions of Chapter 9 ISSUANCE DATE N a m (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H D z Professions Code,bpd my license is in full force and effect. ❑ ❑ ❑ z o w - License Clasv-D Con Number 430 9 y 4 Date q Contruc f/or , .� ¢ ¢ w a OWNF.R-BUILDER LIEfc'sy�slly BUILDING PERMIT ° II MISC.- REFER TO ORD INFORMATION w ;LL H I hereby affirm that I am exempt fir the Contractor's License ca for the following reason.(Sec.7031.5,B.smcxsand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. Code:Any city or county which requires a permit to construct,alter, In R ¢s- FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. C.NO' ELEC. 1 Z3 OOO.00 D¢ requires the applicant for such permit t0 file a signed statement flint TOTAL A, w m u he is licensed pursuant to the provisions of the Contractor's License PERM IT TO FTa Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe T�W E ° Business and Professions Code)or ilia,he is exempt therefrom and QTV. PLUMBING PERMIT FEE T ¢ H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. ve T 3 - by any applicant fora permit subjects 5550).licanttoocivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more owner five hundred dollars(my em): a 4_✓� ❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 ES. their sole compensation,will do the work,and the structure is nal OCC. RES.UNITS intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ./J- 7 Code: The Contractor's License Low does not apply to an owner of /C J I property who builds or improves thereon,and who does such work FIXTURES-PER TRAPS.00 SO.IT.FLO°R AREA TOTAL ACREAGE x I himself or through his own employees,provided that such improve- menfsarenotintendedorofferedforsale.If,however,the building GA$-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00 r� or improvemem is sold within one year ol'<ompletion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that be did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 � IND COON O Dar ❑ I,as owner of the property,am exclusively contracting with .�,+ El 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 p to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 3 3 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PA EL NO, ❑n1 um exempt under Sec. B. , &P.C.for this re WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.006.00 ACC.DATE ACC.FILE NO. WORKERS'COMPRNSATION DECLARATION WATER TREATING EQUIP, 5.00 5.00 e I 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 thereof(See.3800,Lab.CJ. p Policy No. Company-Un-�-ted-�Pa C4 -1C o� o ❑ Cetlilicd copy is hereby furnished. FIRE$PRINK ENERGVT- Z z kty Certified copy filed,411i inspect division. 24 OApplicant MISC.- REFER TO ORD, YE] NEl vE] NEJ CERTIFICATE EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 F LOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG. CL O (Phis section need n°I be completed if the permit is for one TOTAL Y 0 N I] Y E] N❑ =) Z hundred dollars(S100)or less,) U O 1 certify That in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY 0 U mit is issued,e I shall not employ any person in any manner or as to Qw become subject To the Workers'Compensation Laws of California, CL Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } Z NOTICE TO APPLICANT: If,after making this Certificate of fix- 490.50 F _ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of ,he Labor Code, you must forthwith comply with 318.83 V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 '�energ CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for 1 EXHAUST HOOD(WITH DUCT) 5.00 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097•Cis C.). Sacramento S&L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's AAdress d-St--#�l1O1- HEATING UNIT(OVER 100,000 B.T.U.18.50 ELECTRIC 159.00 1 certify that I hR d a and state that the above VENTILATION FAN (SINGLE) 4.00 information n correct 1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING 9],OO ordinances and state laws relating to building construction, and above-hereby enti authorize representatives for ins of this city to anter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL 55.00 (We) agree to save, indemnify and keep Ilarmfess The City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX may injanyaccrue again aid City in consequence of the 10.00 282.68 gmn[ioMECH.CONT. LIC.NO. MECH. / TOTALTOTALtuican[/Contractor Dat 55.00 ,571 .16 OFFICE COPY