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13748 (2) POST THIS CARD NEAR FRONT OF BUILDING „ PFRMIT NUMBER CITY OF' CUPERTINO 13748 INSPECTION DIVISION JOB INSPECTION RECORD - c !� �ry�� PERMIT EXPIRATION JOB ADDRE Sx6 4 ��/7, � � � UNIT# SLOT# //�..� /\/ PERMIT EXPIRES IF WORK OWNER 1N `V C—CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION -! - - �a1,Li ANCE OR 180 DAYS FROM UFER L _ LASTCALLED INSPECTION. bf _ PREGUNITE - � 5 �j PERMIT VALIDATION NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB .'\ A PLUMBING ELECTRICALy ` icE DATE I, MECHANICAL/ - BLO s PLG. ME N C�k0 0 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION s/FT. PLUMBING MECHANICAL ELECTRICAL PERMI o .r L FRAMING INSULATION - STORIES TYPE CONSTR. OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF _ - SO.FT.FLOOR AREA TOTAL ACREAGE A M BUILDING USE NES IN CON PB 0"', APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING 7•�j _ / -" �• `TRACT NO. PARCEL NO, GAS TEST D (, - MECHANICAL ' ELECTRICAL FINALS DATE INSP. ACC.DATE ACC FILE NO. FRAMING Or-YPC. _ .Q SAN # ZONING ENG.SITE NO. ' INSULATION PLUMBING cmt GAS Q MECHANICAL FIRE SPRINK ENEHGV T9 r " ' Y ❑ N❑ Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . LATH-INTERIOR ELECTRICAL U.C. F i11r,�_dCA " `f FLOOD ZONE A.L LATH-EXTERIOR y FIRE DEPT. Y❑ N❑ Y❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING O' a' li SHEAR EXTERIOR �j TEMPORARY APPROVAL BUILDING FIREWALLS ELECTRIC PLANCHECK llw' ow GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR! MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, TOTAL ELECTRIC Iw-'� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 19' PLEAS 0 E GIVE JOB ADDRESS WHEN PHONING. 97 00 Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - rg nn IMPORTANT! CONST.TAX282.68 PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. 51 ,571.16 OFFICE COPY - - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY / BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 13 7 4 8 ADDRESS Lot 56' Plan 3AR BUILDING-ELECTRICAL-PLUMBING-MECHANICAL Gw E ur PLAN CHECK VALIDATION NAME ,•� 415 QTY. ELECTRIC PERMIT FEE NONE NAME AcaoRs UTLETS-SWITCHES-RECEP ' 10 LIC.N LIGHTING FIXTURES 10.000/10 g ro Rs ADDRESS 22 =C TwinoPPLIANCES-RESIDENTIAL 4.00 fpGNE 12 06qRWCPANELS 10.GO GATE OF APPLICATION ORRCNITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER ARAM BASSENIAN>c ,SIA uSIGNS TRANS. 3.00 AOORess SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 3990 Westerly Place ewport zI EMP.METER OR POLE INS. 20.00 ADDRESNrs MOTORS SEE FEE SCH. /1 ADDRESS Z20-C Twin Dolphin Dr. 7.0 Rwe `1 SERVICE CHANGE 20.00 -,02 LIC' SF. C RACfORS DECLARATION ND v w 1 hereby affirm that I am licensed under provisions of Chapter 9 ` ISS CE DATE G a (commencing with Section 7000)of Division 3 of the Business and< BLQG. PLG. ME H m zy Professions Codc Nn y license is in full force an f,6.9.7 z o `� - License Class Lic.Number - O w F Date Conl,.,T - a m a J OWNER-BUILDER DR RATION PERMIT g o>1S - FORMATION R ; a. r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD u_0 Law for the followingmason.(Sec.7031.5,Busmessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. Code:Any city or munty which requiresa permit toconsN➢ct,eller, ' 2 a¢p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0, ELEC. 1 O u requires the applicant for such permit to file a signed statement that TOTAL w PERMIT TO he is lice d Puri to the provisions of the Comounor's License F z i Law.(Chapter9(commencingwith Section 7]00)of Divis �O ion 3 of the J L < Bonnets and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE f i o I- g the basis for the alleged exemption.Any violation of Section 7031.5 malty STORIES TYPE CONSTR. A � by any applicant for apermitsubjects S500).liwnitoacivil penally ALTER-DRAIN (EA.) A,''//'' of not marc than five hundred dollars(my em): � �ZV M- ❑ Les owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,sole (S the work,Business the structure u not Li�l intended or offered for vie (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00 �-3 Code:The Contractor's License Law docs not apply to an owner aP 46 Property who builds or improves Ihemon,and who does such work FIXTURES-PER TRAP 5.00 MFT.FLOOR AREA TOTAL ACREAGE .,Or,himself are through his own employees.Provided that such ireProrc60.0 - mentsarethrouhhisnot intended or employees,ffered for prove. ided thathowevsuch ebudding GAS-EA.SVSTEM-11NC.40UTLETS 6,00 a 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.). INDUSTRIAL WASTE INTER. 30.00 ' RES IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ - ❑ ❑ Iicen,ed contractors to construct the project(Sea 7144,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply ��^ �/ i to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 Y, ,32 contracts for such projects with a contractoos)licensed pursuant to ,EWER-SANITARY-STORM EA.200ft/10.00 / the Contrectois License Law. 1 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason I7 S- Owner Date WATER SYSTEM 5.00 ACC.DATE PCC.FILE N0. WORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP, 5.00 I hereby affirm that 1 have a«rtificme of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO, copy thereof(Sec.3800,Lab.C.), Policy No. Company_11n-i-ted-Pac-i-f�-c- 0 ❑ Cerlifted copy is hereby farm ed q FIRE SPR INK ENERGY T]4 Fp Ap♦ llicanilificd with the city inspection Jiviston. MISC.- REFER TO ORD. v ❑ N❑ Y E] N❑ � T CER ATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC. W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL o (This section need not be completed if the permit is for one TOTAL 07 n, Y❑ N❑ Y ❑ N❑ Z:) Z hundred dollar,(S 100)or lav-) 0 O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to 0w become subject to the Workers'Compensation Laws of California. aa Date Applicant BUILDING >_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00490-90 F emption,you should become subject to the workers'Compensation 4 APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, YOU nwst forthwith comply with FEE 318.83 U such provisions or this Permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 1pnorgy 160-On CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 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. 5.0 MICROFILM 3097,Civ.CJ. s HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nacramente...QAV7e...+mk.IvG&&QAN- y 00. Lender's Ad dress qq--qq}r��{{�y._�{ 'C}_ n�- HEATING UNIT(OVER 100,000B.T.U.)9.50 �.- -9 ELECTRIC R�Qr19406.' eYCadY Ifl's`CyT TMA.,5 gte hea.TNlO tZe 3 VENTILATION FAN (SINGLE) 4.00 . 00 No nn.n.. rs a eel.1 agree to comply with.11 city and county PLUMBING ordinances and state laws retail,, to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00 97.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (01er,100,000 BTU)SEE FEE SCH. MECHANICAL Bove-mentioned property for inspection purposes. 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 PERMIT ISSUANCE 10,00 CONST.TAX O O may in any way accrue against said City in consequence of the 202.68 grayling of this pe MECH.CONT. LIC.NO. MECH. TOTAL Signatuno, licamucomiractor Ethic T 55.00 TOTAL $1 ,571 .16 OFFICE COPY