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13745 (2) POST THIS CARD NEAR FRONT OF BUILDING j PFHMIT NUMBER CITY OF CUPERTINO 13745 INSPECTION DIVISION JOB INSPECTION RECORD ��1• ,("[/��, /• 'y��- - PERMIT EXPIRATION JOB ADDRE /"� j�'�'1 �'�R��`"� UNIT# LOT# r 1 - PERMIT EXPIRES IF WORK OWNER _Azf //(/� CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- , FOUNDATION ANCE OR 180 DAYS FROM'- UFER _ LAST(FORMNSPECTION. PREGUNITE PERMIT VAUDATION DEC 9 01991 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - i/"* •. UNDERGROUND /SLAB PLUMBING _ ELECTRICAL - ISSUANCE DATE MECHANICAL BLDG. ELEcr. PLc. m R DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED / P✓/� BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. - ' � � - .MECHANICAL _ ( $97,000.001 ELECTRICAL I PERMIT To FRAMING I� 1"�r�._' INS CATION - STORIES TYPE CONSTR. 2- StiINIv OCC,GROUP REI.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FF.FLOOR AREA TOTALALREAGE DLACHRAGM BUILDING USE RES IND CON RE Omer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED QY ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. ' - _ PLUMBING -j/ GAS TEST ` TRACT NO. PARCEL NO. - V - ' MECHANICAL ACC.DATE ACC.FILE NO, ELECTRICAL FINALS DATE INSP. ' FRAMINGE� MECHANICAL SAN 7k 23l INSULATION PLUMBING Lk zoN'NG ENG.SITE Not GAS FIRE] NK ENERGY T-24 Clo NOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NE N Y ❑ � LATH—INTERIOR -wo ELECTRICAL FL000 zaNE A.L.0 c. LATH—EXTERIOR FIRE,DEPT. Yo NE] Y0 N� SHEETROCK GRADE FEE SUMMARY SHEAR INTERIORBUILDING SHEAR EXTERIOR \3, _� TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC - PLAN CHECK L~• GASFEE 275.60 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SETS 4T '€lY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR' MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL • IMPORTANT! CONST.TAX 282.66 PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. $ 0494.07 OFFICECOPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - VSE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER NB ILDING APPLICATION & PERMIT 13745 ADDRESSLOT 59 Plan I AR BUILDING -ELECTRICAL-PLUMBING-MECHANICAL NW6FallGree1( Spring Court PLAN CHECK VALIDATION NAME 415 QTY- ELECTRIC PERMIT FEE GUIPORY IM1595 2100 CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 NAME � 16 00 uc.no. LIGHTING FIXTURES 10.00/1'.00 faNT 20-C Twin Dolphi PPLIANCES-RESIDENTIAL 4.00 ADDRE99 RWC CA 94065 415 ,-595-2100 1 PANELS 10.00 DATE OF APPLICATION ARCHITECT ODI ASSO < PANELS (OVER 200 AMP) 20.00 • PLAN CHECK FEE C.N OR O ENGINEER ARAM BASSENIANV ,AIA SIGNS TRANS. 3.00 ARCH.OR ENG. S.00 ALIDATION ADDRESS SPECIAL CIRCUIT 3990 Westerly Place ff170 Newport zIP PPAA EMP.METER OR POLE INS. 20.00 ['/1 °RE ' . , C MOTORS SEE FEE BCH. l/'�fyl�.p' 220-C Twin Dolphin Dr. SERVICE CHANGE 2000.RK CA 94065 ��„ ,• o o LICENSED CON'TRACTORS DECLARATION 1 a v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE O1 (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH. o z Professions Code,anQ,my license is in full fore f . 0 - License Class_[$_Lia Number- - ❑ ❑ ❑ Q z w Date Contractor - a y s - BUILDING PERMIT M IS i D OWNER-BUILDER UEC ION INFORMATION mw I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD u_ 0Oj law for the following reason.(Sec.7031.5,Businesaund Professions PERMIT ISSUANCE 10.00 VALUATION SIFT. I - Code:Any city or county whiehmquiresa permit loconsweLetleq d 2 ¢ ac 0O improve,demolish,or repair any structure,prior to its issuance,also ELEC. LIC.NO. ELEC. • $97,000.D0 la S reyuirei the applicant Ibr such permit to file a signed statement that TOTAL PERMIT TO La he is liccmed pursuant to the provisions of the Contractor's License r x i Law.(Chapter 9(commencing with Section 7000)of Division 3 of the L a Business and Professions Cale)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 15 r. M II- the basis for the alleged exemption.Any violation of Section 7031.5 nSTORIES TYPE1t15NSTR. A , by any applicant fore permit subjects the applicant toa civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dolla6 0).1:(550 I s ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECTDEV ICE 400 Oce.GROUP RT.SNITS their sole conspeddatiun,will do the w . . work,Slid the structure is not I intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 2-3 Code: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 r,r, nn S0,FL FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building I GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner 6.00 - builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE prove for purpose of salt.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Our., ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PAHCEL NO. and Professions Cade: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 3 1 • 9 3/ 3� the Card for suchprojectswith amntractorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Cons moor's h projects is w. TRACT NO. ARGEL NO. ❑ lam exempt under Sec. ,B.&P.C.lisr Ibis WATER HEATER W/VENT 6.00 reason Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DI'CLARATION WATER TREATING EQUIP, 5.00 I hereby affirm that I have.certificate of consent to self-insure' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insumnee,or a ce,tifieJ p copy thercol'(See 3900,Luh.0 O BF Policy No. CompunyOni-ted-P_aci-i.c- - ❑ Certified copyI;Jbyy�1ggGi ISC. REFFIRESPRINK. ENERGY T 04 Z p Certified co a dl inspection division. M - ER TO ORD. A licCer V[:] N❑ Y [:] N❑ ~ va PERMIT ISSUANCE 10.00 cc - CI>RTIFIC �OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C. IL 7 COMPENSATION INSURANCE PLG.CONTR. LIC,NO. PLG. = 0 ('Phis section need not be completed if the permit is lin one TOTAL v❑ N❑ Y E] N❑ hundred dollars IS 100)or less.) 0 O 1 certify that in the performance of the work for which this per- CITYMECHANICAL PERMIT FEE FEE SUMMARY IL F mil i,issued,1 Shall not employ any person in any manner SO as to U become subject to the Workeri Compensation Laws of California. LU Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- F.. ? emption,you should Isecome subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE 275.60 U such provisions or this penmll shall be deemed revoked. AIR HANDLING UNIT(TO 10MOQF.M.) 4.00 -J-p�Tp� CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWC-EM.) 6.00 I SEI$M�C F� I hereby affirm that them is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance s�.1fl p� ! ch Ipermit is issued(Sec. MICROFILM 3097,Civ.C. S�Q 2 b }s /{�!� HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name-.ScJy--l1Y' -d-Jt.-I/-tvl- HEATI NG UNIT 100,000 B.T.U.I B.50 8.00 ELECTRIC Lender's Address-RWC eA-94063 I certify that I have mad this application and state that the above VENTILATION FAN (SINGLE) 4.00 . information is correct.I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-OONP(3H.P.or 100,000 B.T.U.1 6A0 hereby authorize representatives of this city to enter upon the BOILER-COMP (Ove,100,000 BTU)SEE FEE SCH. MECHANICAL 00 above-mentioned property for inspection pertu ne, (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - Cupertino against liabilities,judgments, costs and expenses which PERMITISSUANCE 10.00 CONST.TAX 282.68 may in any way accrue against said City in consequence of the granting of this permit MECH.CONT. LIG NO. MECH. TOTAL TOTAL 51 .00 434.07 Signator phcant/ ontroctor 1 a¢ OFFICE COPY f