13729 (2) - F
POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
C-ITY OF CUPERTINO3729
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
308 ADD ✓"'� /„ L�t'u�t cJf�/LeT UNIT# LOT#
^1�--
1— � � � -- PERMIT EXPIRES IF WORK
OWNER !( 44L CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPE TION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION $ �,��^g8 �� P _ LASTANCE AL 180 DAPE:TI O .
UFER _ � LASTCALLED INSPECTION.
PREGUNITE MA
1�,11°� Ndi•DE`.- p P� DArION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED DEC 'S O 1981 /}
UNDERGROUND /SLAB ���
PLUMBING ' - "t ot�j^my�Ipl�er om ✓
ELECTRICAL - ISSUANCE DATE
MECHANICA BLOC. ELECT. I PLG. MECH.
0- El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $SFT.
PLUMBING
MECHANICAL - 3979000.00
ELECTRICAL PERMITTO
FRAMING
STORIES TYPE CONSTR.
INSULATION
led
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF — 05 IT,FLOOR AREA TOTAL ACREAGE
DbA�b{R{i�T - BUILDING USE
RES IND CON PB Oma
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ D ❑ ❑
ROUGH '
ASSESSORS PARCEL NO.
� ...,
PLUMBINGIk p
GAS TEST "
TRACTNO, PARCEL NO.
MECHANICAL •-71. 2711� 5
- ELECTRICAL ,,f' f� FINALS DATE INSP. 'ACC.DATE ACC.FILE NO.-
FRAMING SAN #
.ZONING ENG.SITE NO.
INSULATION PLUMBING O
GAS
MECHANICALFIRE SPRINK ENERGY T 24
D-1�-r5"rp" Y ❑ . N� r ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
�r� .
LATH-INTERIOR - ELECTRICAL 'j�•��.J� \'' FYE]
0 U.C,
.ZONE A.Ln� r-� N�
LATH-EXTERIOR - FIRE DEPT. -�—o `
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING O^
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK 424.00
GAS FEE 275.60
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEI IC FE _T60.
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY, PHONING 252-4505, ELECTRIC 149 On.
® F ONE WORKING DAY BEFORE REQUIRED INSPECTION. I PLUMBING
z� PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE- MECHANICAL
IMPORTANT! I` CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. 434,07
OFFICE COPY
ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .
I LDI NG PROJECT 1DENTI FICATION PERMIT NUMBER
"° Lot #55 PLAN 1 B APPLICATION & PERMIT
58� Fal 1 creek Spring Court BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 13729
ERs PLAN CHECK VALIDATION
E 415 QTY. ELECTRIC PERMIT FEE
I GR GORY rRO11P ONE
CONTRACTOR'S 595-2100
NAME 86 OUTLETS-SWITCHES-RECEP 10.00/1.00
11C.No LIGHTING FIXTURES 10.00/1.00 1.q no
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS 220-C Twin Dolphin Dr.
PROrvE PANELS 10.00 00 DATE OF APPLICATION
A EC�A 94065 415 , PIAN CHECK FEE .C.NO.
OR
NPANELS (OVER 200 AMP) 20.00
FIR
ARAM BASSENIAN> AIA
ucASSOC 1ATES .No. SIGNS TRANS. 3.00
AD
o ESS G SPECIALCIRCUIT 5.00 APERMIT VALIDATION
3990 Westerly Pl ace 7D'FI EMP.METER OR POLE INS. 20.00
APP NA rt • ' MOTORS SEE FEE 0.00
ADDRESS
Z2 -C � Dolphin Dr. SERVICE CHANGE 20.00 C
0 o O RWG
LICENSED CI;.Vf RACfORS DECLARATION /
a z w I hereby affirm that 1 m licensed under p,.A,iau of Chapter 9 T�E DATE
(commencing with Scotian 7000)of Division 3 of the Business and
Ci G m MECH.
H z Profess,o,¢Code,and y license is N full force anJ a b
z 0 License Class Lia Number_ - bD9.L
p z F o Date Contractor
P: r J BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DEC ATION
¢a U INFORMATION
X
1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u_o a Law for the following reason.(Sec 7031.5,Businessand Professions pERML7 ISSUANCE 10.00 VALUATION /FT.
Code:Any city or county which requires a permit to construct,eller, $Q•
te n Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. `P97 s D00•�0
- DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u lisrequires
is licensed pursuant to the provisions of the Contractor's License
r- zi Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthe t r / , )
¢ o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE S r _C/
¢I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d ; by any applicant Into permit subjects the applicanttortewilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 ¢
of not more then five hundred dollars(E500t) I 2
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE •4.00 (xC. ROUP REE.UNITS
their Sole compensation,will do the work,..it the:,toreture is not
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Lew does not apply to an owner of 0_
property who builds or improves thereon,and who does such work 1 l FIXTURES-PER TRAP 5.00 yes PT.RI OUR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments arc not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or int . - .
- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 R IND CDN -PB Other
,
❑ 1,us owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7144,Business LAWN SPRINKLERS- 1 INC 6 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License law does not apply
to am owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3 _g-j 13.2, 3 -
contracts for such projects with a eontmetorfs)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. - ARcEL NO.
❑ lam exempt tinder See-,It&P,C.for this
reason WATER HEATER W/VENT 6.00 S'
Q
Owner Datc WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERSCOMP17NSAI'ION DECLARATION' WATER TREATING EQUIP. 5.00
I hereby alhrn,that l have a entiGcate of consent to sell-inane, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certilied p .
copy thereof(Sec.3900,Lab.C.I United Pacific_ nN # 31
Policy No. COlnpany
O ❑ CertifieJ copP10�TEXEMPTIO!'FRDI
erebyu d.
Z 2 yf{. CeH if cJ ee tciinspection Division. FIRE SPRINK ENERGY T24
F O f Cy,t_ MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
2N CERTIP WORKERS' - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 C.
LL > COWRENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL v❑ N❑ Y ElN❑
hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit "issued,I shall min employ
eploy any peoon in any honer so as to
become subject to the Workeri Compenmtion Laws of California.
to Ddte Applicant C.
BUILDING
} GO NOTICE TO APPLICANT: If,after making this Certifcutu of fix- ALTER OR ADD TO MECH. 5.00424 On
F ? emption,you should become subject to the Workers'Compensation 4 APPLIANCE 5.00 20.0 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE 275.60
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 109WC.F.M.) 4.00
-zenergy 160.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0)000C.ENL) 6.00 SEI MIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the perlarmxnce of%p work for which this permit is issued(Sec. MICROFILM
3097,r'sNa). Ja Crament0 S&L HEATING UNIT(TO 100,000 B.T.U.) 8.00 - I
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.19.60
8.0
Lender's AJdre �-Q•1 ELECTRIC 142.00
f certify that I have read this a lir on and s utc ha the aWve VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all City and county BOILER-CONP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING 92.00
ordinances and tate laws relating to budding construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP LOver IOO,000STUISEEFEESCH. MECHANICAL
+f above-mentioned property for inspection purposes.
(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 282.68
may in any way acerue_agai t said City in consequence of the
granting of IIIit. MECH.CONT. LIC.NO. IMECH 51 .D1
TOTAL 1 ,434.07
Signet pplacamiLantractor
OFFICE COPY