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13757 (2) POST THIS CARD NEAR FRONT'OF BUILDING "CITY OF CUPERTINO PERMIT NUMBER � INSPECTION DIVISION 13757 �.. JOB INSPECTION RECORD I PERMIT EXPIRATION JOB ADDR S �� UNIT# 1 LOT# PERMIT EXPIRES IF WORK OWNER .1/G CONTRACTOR IS NOT STARTED WITHIN INSPECTI N DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _ �.'��''( +. .fiANCE OR 180 DAYS FROM t UFER Ai,,,, LAST CALLED INSPECTION. � L((//pD,,I��Q1 ,ne C PREGUNITE - - 9. 8`^-�'^'�J PERMIT VALIDATION PAW POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED � ') UNDERGROUND /SLAB PLUMBING A , ELECTRICAL city $ MECHANICAL BLDG. ELECT. PLG. MECH ❑ ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING 1 VALUATION $/FT. MECHANICAL - - $97 0000 .0( ELECTRICAL - P MIT To FRAMING ` 7`,[J�..(� • INSULATIONSTORIES TYPE CONSTR. Shla' ✓ OCC.GROUPRES.UNITS PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED I' ROOF - 50.FT FLOOR AREA TOTAL ACREAGE DTAPMRAGM - O_ BUILDING USE HE i INU CON PB Diner APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ROUGH —ASSESSORS PARCEL NO. PLUMBING GAS TEST _ TRACT NO. PARCEL NO. MECHANICAL _ _ 746I //✓� ELECTRICAL FINALS DATE INSP. I ACC.OATE ACC.FILEND. FRAMING _ SAN # INSULATION a .. O PLUMBING zomwc ENG.SITE NO. Gti GAS - MECHANICAL FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U,C. LATH-EXTERIOR _ FIRE DEPT. Y❑ NEIY ❑ N[:]SHEETROCK GRADE FEE SUMMARY - - SHEAR INTERIOR .7:7 BUILDING SHEAR EXTERIOR - 8-- o TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC I PLAN CHECK 275.60 i 1- GAS FEE NO TAPE OR PLASTER UNTIL A OVE lenergy 160-on HAS BE SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR I MICROFILM 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 -IMPORTANTI I CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. ,434.0 OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I L131 NG PROJECT I D VTI F[CATION PERMIT NUMBER BUILDING LOT /t46 • PLAN lAR APPLICATION & PERMIT ADDRESS CnII 4 Eypning td-ng rt BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWJ NER'a 5 PLAN CHECK VALIDATION "AME 415 QTY. ELECTRIC PERMIT FEE GREGORY GROUP> INC< RRONr NAME CONTRACTORS 595 2100 86 OUTLETS-SWITCHES-RECEP 10.00/1.00 86,00 NAME Same LICry LIGHTING FIXTURES 10.00/1.00 12 Q CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ' ADDRESS 220-C Twin Doliphin Dr. , P ry PANELS 10.00 DATE OF APPLICATION AWGECTC PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER ARAM BASSENIAN> AIA uc.NO. SIGNS TRANS. 3.00 ADDRESS G. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION 3990 Westerly Place //170 zIP EMP.METER OR POLE INS. 20.00 ADDRESS MOTORS SEE FEE SCH. 220-C Twin ORIHnrD01 Phi n Dr. SERVICE CHANGE 20.00 •p�' 0 RW6 CA 9406.5 0 LICENSED CONTRACTORS DECLARATION D 3 0 !987 v u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE w a a (commencing with Section 7000)of Division 3 of the Business and G. MECH. r y i Professions Code, d my license is in full for �y�{,eff I e ❑ 1oz o License Class Lia Number 1111`1 o�t�,'F w Date Contract 1 a a OWNER-BUILDER D TI N BUILDING PERMIT o a v INFORMATION x g n y 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD u o a Law for We following reason.(Sec.7031.5,Business and Professions VALUATION' $/FT. H _ PERMFT ISSUANCE 10.00 Code'.Any city or county which requires a permit to construct,alter, in 00 SE ¢¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. TE LEC, $97 DDD.DD o ¢ requires ilicensed the applicant for such permit to file a signed statement that TOTAL , ERV/ ' T n w m he is licensed pursuant to the provisions of the Contractor's License H z r Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe sioa Business and Professions Code)or that he is exempt therefrom and ¢ H m the basis for the alleged exemption.Any violation of Section 703 L5 QTY. PLUMBING PERMIT FEE STORIES TYPE STR, a. by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(8500).): 1l. ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 7 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 Contractor's License Law does not apply to an owner of property who builds Or Improves thereon,and who does Sault work FIXTURES-PER TRAP 5.00 rS n 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale,If,however,the building GAS-EA.SYSTEM-1 INC.40UTLET3 6.00 r 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 ire- BUILDING USE prove for purpose ofsalr.). INDUSTRIAL WASTE INTER. 30.00 RE I❑ ❑N Pa Omer El El 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 SSCRS PARCEL NO. and Professions Code:The Contractor's License Law does not apply Q to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.003�r contracts for such projects with a contractods)licensed pursuant to / it the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00ID TRACT NO. PARCEL NO. ❑ I um exempt under Sec ,B.&P.C.for this 1 WATER HEATER W/VENT 6.00 reason Owner Date 1 WATER SYSTEM 5.00 ACGDATE ACC.FILE NO. WORKIiRS'COMPENSA'I'ION DECLARATION WgTER TREATING EQUIP, 5.00 1 hereby affirm that I have a certificate of consent to sell insure, -or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.0 1 Policy No. Co epany.U.n i tad-Qa_d1i C O D Certified copy is hereby furnished RE SPRINK -ENERGY T-24 Z Z yLV Certified , i led wlyyff��yyff city inspection division. F O Ap5lmanl ./�L= MISC.- REFER TO ORD. YE) N Yo NEI CC W CERTIF EOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE ii=_ LIC.NO. PLG 4. O 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 O I certify that in the pehl'o.....c of the work for which this per- ECHANICAL PERMIT FEE FEE SUMMARY LL mit is issued, I shall not employ any person in any manner so a,to become subject to the Workers'Compensation Laws of California. > y Date Applicant ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- 424.00 Z_ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FE_E le.ne. 275.60 suh provisions or this permit shall be deemed revoked. ING UNIT(TO 10=CF.M.) 4.00160.00CONSTRUCTION LENDING AGENCY ING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for HOOD(WITH DUCT) 5.00 6-79 the performance pf the work for whi�FF��ppt s permit is issued(Sec. 3097,Civ.C,. Jacramento J5� HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 'i'1 Lender's Name Lender's Address - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 142.00 1 certify that I read th a pV t d stat756Nah a that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING oNinances and state laws relating to building construction, and BOILER-ODMP(3 H.P.or 100,000B.T.U.) 6.00 92.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (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 OR6. CONST.TAX may in any we, accrue against said City in consequence of the10-00 granting oft MECH.CONT. LIG NO. MECH. 282.68 TOTAL TOTAL @@ Signature of prean ontractor Dap 51 .00 •p 1 ,434.07 OFFICE COPY • z ✓ ELECTRIC SERVICE NOTICE tour BUILDING INSPECTOR'S NOTICE • CITY OF CUPERTINO SFfir 9 pip, To You are hereby authorized to Connect electrical service flat 'Owner ar Tenant (r-2f=_A/f12V (> c o P At I� � 7u" V-0 ��..)�IUC-1 `ori IG1 &x,-, (f1 . J � No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase t ;I Heating Load K.W, Voltage No.of Meters Light 5F 10 New Service Reconnect Mem 170Three Wlre More Service No.of Add.Meters Power Three chose Move Meter O'r ELECTRICAL NSPECTOR CE • CITY OF CUPERTINO • COFPY GAS SERVICE NOTICE qe' To You are hereby authorized to connect the GAS service for Owner or Tenant (s' GO'nRq �` 200? At ((57t-4 Fa)Eti'n r ,— J New Service x No. of Meters ' Reconnect No. of Add. Meters Move Service ff /M�o�veMeter n PLUMBING INSPECTOR A� v-1 l.l' �Jo � L Aj X p„ • ' CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE c �7�- CITY (OAF. CUPERTINO DATEJFr 1i 2� 11, jq?)q BLDG. PERMIT NO. THE BLDG. LOCATED AT I 1 ��-\ • t='VE�.I l!-� S 1 Ims GlT OWNED BY �s-�F6�D�Y HAS BEEN OMTER ED FOR USE AS S\D l �L ®t+.ir�L�pct TEREDI J BUILDING INSPECTOR