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13741 (2) ' POST THIS CARDNEARFRONT OFBUILDING t, I �^ PFRMIT NUMBER ,CITY OF'CUPERTINO 131'41 INSPECTION DIVISION JOB INSPECTION RECORD �• PERMIT EXPIRATION JOB ADORE f7 �+� r .vd- UNIT# LOT# 16-Ai1 I I PERMIT EXPIRES IF WORK OWNER //(/ coNrRAcroR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD I 180 DAYS OF PERMIT ISSU- FOUNDATION - - ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB P%11D PLUMBING _ ELECTRICAL 5 .DATE MECHANICAL �' L- PLG. MECR. 00 NOT POURTLOOR UNTIL ABOVE HAS BEEN SIGNED BUrCDINfG PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION S/FT. • MECHANICAL $109�000�0 ELECTRICAL PERMIT TO FRAMING i - _ v` I- INSULATION STORIES TYPE CONSTR. Ald OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL BOVE HAS BEEN SIGNED a N, / ROOF O.IT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM 11 • BUILDING USE RES IND CON PB Olney APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH. ASSESSORS PARCEL NO. _ PLUMBING ,a9 GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICALfz 15' FINALS DATE INSP. ACC.DATE ACC FILE NO. FRAMING ,op./of SAN I* ,,Z3jj 6F INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL ffL'��7 L.� FIRE SPRINK ENERGY T-2E COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING u ❑ N❑ Y ❑ N❑ LATH-INTERIOR ELECTRICAL FLOOOZONE A.L.u.c. t>ar� LATH-EXTERIOR FIRE DEPT. ) Y❑ N Y ❑ N❑ SHEETROCK .'Z GRADE FEE SUMMARY SHEAR INTERIOR - L ., BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC FEE 296.06 CHECK 29f"W R G .� �S' GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEIN 9IGNED IIJCCUPANCY SEI IMIC FE - OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANTI CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. $ 9497�ag OFFICE COPY BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO , Office eCDept. ce Copy ❑ Backflow Device Sanitary Permit No. ❑ Sewer Connection Plumbing Permit No, Q Plumbing Final Lot No. Owner or Tenant C- cuo 7 At � � ��� f=lit=t�i d'c., SPR i IL 7H S C?" � � Tract Date Connected 19Q'a Date Final6CI /19 PLUMBING INSPECTOR • CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE ' ,• CITY OF CUPERTINO DATJE OC-1 D 19aeipBLDG. PERMIT NO. I37 THE BLDG. LOCATED AT I �� �UFNN-7.5 SPrI J,k, CI OWNED BY �r2FD.OZYCuP HAS BEEN )COMPLETED) FOR USE AS PES! DC- (ALTERED) • BUILDING INSPECTOR ELECTRIC SERVICE NOTICE OFFICE COPY ` BUILDING INSPECTOR'S NOTICE., CITY OF CUPERTINO 70 IS, You are hereby authorized to Connect electrical service for Owner or Tegcnt ��F7-C4 rP—y (�p0J7 At 17 Fl1t=c J � No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase -lecting Load K.W. Voltage` Vo.of Meters ((11 Light ' FDI 10New Service x Reconnen Heat 120_Three Wire More Service Vo.of Add.Meters Power /t '� r C /J;j wThree Phase fpr Mave Meter �• 40ELECTRICALINSPECTOR to �L/ (I D O o Z Z { 0 0 0 O C , v ° O 3 a m � o A �• i t V, O y � N � m � • � " fl �\r � yr fJ n0 0- APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BmtDIrvG p aq APPLICATION & PERM6T �f AooR ess 1374 1 J BUILDING- ELECTRICAL-PLUMBING-MECHANICAL D E NAME 415 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION LDNTRALTORS GREGORY GROUP IN'fwlE NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 uc.rva20 LIGHTING FIXTURES 10.00/1.00 20.00 rolls PPLIANCES-RESIDENTIAL 4.00 ^°DRE12 00 aa 220-C Twin Dolphin Dr. PWC OR CA 94065 HONE PANELS 10.00 ARCHITECT GATE OF APPLICATION ENGINEER ARAM BASSENIAN, AIA PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. LIC.NO. SIGNS TRANS. 3.00 ARCH.DR ENG. ADDRESS 3 9 We erly Place// ga SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ' NewportzIv EMP.METER OR POLE INS. 20.00 AvvucA rs ADDRESS 221-C Twin Dol phi n Dr. MOTORS SEE FEE SCH. , C Q4SERVICE CHANGE 20.00 o ¢ i t o o LICENSED.CONTRACTORS DECLARATION 6 I7U 1 a u I hereby affirm that I am licensed under provisions of Chapter9 DEC 315511a NCE DATE o,<Z. (commencing with Section 7000)of Division 3 of the Business and PLG. MECH. F m z Professions Code,and my license is in full force and effect. BLDG. ELECT. l z0 w - License CIau�B_Lic.Number 8 D w H Dale OContootor 1197 ¢ F ¢ ¢w a OWNIiR-BUILDER DIiCL, ION BUILDING PERMIT a'xl ;0 N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION u O j Law for the following reason.(Sec.703 t.5,Businessand ProfessionsVALUATION - $/FT. - PERMIT ISSUANCE-10.00 fou Code: e,demysh counpair any struiture,res a pioittoconstrucLaheq $109,000.0¢ ¢ a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. $119 f 111.1 G u requires the applicant for such permit to file a signed statement that TOTAL w m he is licensed pursuant W the provisions of the Contractor's License PERMIT T H z i Law(Chapter 9(commeneing with Section 7000)of Division3 of the 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ H a the basis for the alleged exemption.Any violation of Section7031,5 STORIES TYPE CONSTR. Or 3 - by any applicant fora permit subjects the applicant toa civil penalty � S.✓14�c of not more than five hundred dollars(myem): ALTER-DRAIN&VENT-WATER (EA.) 5.00 O 1,as owner at the property,or my employees with wageset BACK FLOW PROTECT. DEVICE 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 DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The who builds License Law does not apply loan owner work property who builds or improves thereon,and who does such work 1 1 FIXTURES-PER TRAP 5.00 •1 D.FT.FLOOR AREA TOTAL ACREAGE himself or through his own empioyces,provided that such improve- immixare let intended or offered for sale.If,however,the building GAS-EA-SYSTEM-11NCAOUTLETS 6.00 or improvement is sold within one year of completion, the owner- 6.0 builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose oftele.). INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON PB Other ❑ 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 ASSESSORS PARCEL NO. and Professions Codc: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 39-3 contracts for such projects with a contractions) icenscA pursuant to / the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 11.11 TRAC_TN 0. PARCEL NO. ❑ lain exempt under Sec..,B.&P.C.for this WgTERHEATERW/VENT 6.00 (�(� 799,I� reason _} Owner Date WATER SYSTEM 5.00 ACC.GATE ACC,FILE N0, WORKERS'COMPENSA'[ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofcousent to self-insure, I or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.0 ,L,r , Policy No. Co hereby yUn i_te"--ac-i_f-ice- �T _ D Certified copy is hereby famished. - FIRE SPRINK ENERGY TY4 Z Z X Certified c - it the , y inspection division. rCI Applicant_ MISC.- REFER TO ORD. yE] NE] YE] N[] CC y CERTIFI Tit 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 10.UU FLOOD ZONE A.L.U.C. L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Q_ O (This section need not be completed if the permit is for one TOTAL Y O NE] Y E) NEI :) Z hundreddallars(5100)orlessJ U O I certify that in the performance of the work for which thisper- QTY. MECHANICAL PERMIT FEE FEE SUMMARY L I- mit is issued,1 shall not employ any person in any manner so as to become subject to the Workeri Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >- W NOTICE.TO APPLICANT: If,after making this Certificate of Ex- F ? emption,you should become subject to the Workers'Compensation A JAPPLIANCE 5.00PLAN CHECK 20 provisions of the Labor Code, you must forthwith comply with 296.18 U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10p000-F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 5.1 0 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). Sacramento Sgt. HEATING UNIT(TO 100,000 B.T.U.) 8.00 8.00 Lender's Name Lent �Addfeisa�} 'iBr-a(,1'fOr-d-St-���'11- HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC 149.00 I a h c Is application and stale that iheabove VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives ins of this city es enter upon the BOILER-COMP f0ver 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property forinsp of this purposes. 5r, no (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the - 2112 All granting of this .L MECH.CONT. LIC.NO. MECH. 4447 TOTAL 55.00 TOTAL Signature o team/Conhador Dat $', ,497-89 • OFFICE COPY