15887 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 15887
INSPECTION DIVISION
•
/nn �• JOBN•VP
B{ INSPECTION RECORD -
PERMIT EXPIRATION
JOBADDRESS/_1969 6IA4S74 W6' 4r UNIT# -_LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION -NOTE: ANCE OR.180 DAYS FROM
,
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.'
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERI.LT VALIDATION
CUPERTINO STANDARDS. ,+
GARAGE SLABS k�/•�►.J ` :'JI � � V 4
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �1
UNDERGROUND /SLAB HAY 2 3 987
PLUMBING
ELECTRICAL of of ClOQBI. N
ISSUANCE UAiE
MECHANICAL - BLDG ELECT I PLG. MECH
0 91
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $jFT.
MECHANICAL 11
ELECTRICAL - _ PERMIT To
FRAMING
INSULATION yy��.yy F.., [[]] eC�' T STORIES- TYPE CONSTR.
NN glofZ SCR UKP 4—►�1—q 1 1 �� OC( GROUP UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so rr FLooR ARLA Tom.ACRCACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID i b
_� BUILDING USE
ROOF SHEATHING �— REs 5 CON Pe ow.•
• APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ElASSESSORS PARCEL NO
RCUGH SAN _ IC>I C` /�� c
PLUMBING cu -�
ELECT.ENERGY IZ4 55-�aD
\
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
MECHANICAL IOLCLO MECR ENERGY jv 8m
ACC DATE ACC.FILENO
ELECTRICAL � BUILDING EN RC-LY
FRAMING tqcIjj ELECT.FINAL kST
INSULATION I-4 o s PLUMBING ZONING ENG.SITE NO.
GAS TEST �y0 GAS 1
MECHANICAL FIRESPRINK ENERGY T.]a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑_ N❑ Y ❑ N❑
EXTERIOR SHEAR -,�r ELECTRICAL LEASE FLOODz E AL cc
INTERIOR SHEAR 2P FIRE DEPT. Y❑ Nol Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORA Y APPROVALS BUILDING 916.00
SCRATCH COAT ELECTRIC PLAN CHECK �1
GAS FEEmm m
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY L ISEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC '
cn
I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -58
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
68 Fa
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. 1013.79
OFFICE COPY
G r
APPLICANT TO FELL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -
BUI LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BADDRESS ULLRING 11852 Shasta ring Court Lot 338 ' APPLICATION U PERMIT s �1 5887
L BUILDING-ELECTRICAL-PLUMBING-MECHANICAL rY
NAME a Dry nc, PLAN CHECK VALIDATION
PHONE
415/595-2100 OTY. ELECTRIC PERMIT FEE
NAMERAcrORs �/ a nC, UTLETS-SWITCHES-RECEP 10.0011.00
Llc.No, B-4397 LIGHTING FIXTURES 10.00/1.00
ADORE SSTOR2p-C Twin Dolphin Drive APPLIANCES-RESIDENTIAL 4.00
, CA 94065 PHON PANELS 10.00 DATE OF APPLICATION
ARCHiTEC
OR sseniankagoni Architects PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P;QNO.
ENGINEER ^'
FIC NO SIGNS TRANS. 3.00
ARCH.OR EN�31 Orchard Drive #100 PERMIT VALIDATION
ADOHEss SPECIAL CIRCUIT 5.00
Azl EMP.METER OR POLE INS. 20.00
PPLICANT'S
AODREss 220-0 Twin Dolphin Drive MOTORS SEE FEE SCH.
RK, CA 940ffi SERVICE CHANGE 20.00
Dai .i
Foo LICENSED CON TRACTORS ULCLA RATION
a u IHR I hereby affirm that I am licensed under provisions of Chapter 9
2 w . ISSUANCE DATE
y Q w (commencing with Section 700e)i i Division 3 of the Business and 1 BLDG. ELECT. PLG. MECH.
F y z Professions Code,ypd my license is in full Toast N{�1,yff�- L
o i m o License Class_D Lic.Number�r}�JUsU(
Q m j Dme Contmaor (y`, of puRB*
IE a w a OWNER-BUILDER DECLARATION lll� A BUILDING PERMIT
U MISC.- REFER TO ORD INFORMATION
K
; u H 1 hereby aHinn that I am exempt from the Contractor's Licemc VALUATION
F LL o j Law f..the following reason.(Sec.7031.5,Businessond Professions PERMIT ISSUANCE S/ET'
to Code:Any city or county which requires a permit to construct,alter, 1 Q00 /���
Qa, ¢ IrnpfOVG dU111011511,Or repair any Strnetnle,prior 10 IIS ISSIIanL'l',also ELEG CONTR. LIC.NO. ELEC. 179 `�x..4/
Dto
a requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
La m m L. hC is licensed puceuaN to the provisions of the Contractor's License
H z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE SFDU
a I- the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
n , by any applicant fora uncle dollars(lie applicant loucivil Pcnahy ALTER-DRAIN 5.00
of not more than five hundred dollars fmy em' 2 SIM
❑ Las owner at the property,or my,and tires with wages as BACK F LOW PROTECT. DEVICE 4.00 :RES.
OF sole r compensation,will(S [tie work,and the and
Professions is not OCC.GROUP RES.UNITS
Code:IJ or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 1
Code:The Contractwho
build,or i iipro a Law does not apply to s s owner of R-3
propertywho buddyts improvesthereon,and who doessuch work FIXTURES-PER TRAP 5.00 s FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees, le.If.cd that such improve-
orFornts improvemenotnt
intended sold w thin one year
IL howevee thebuildingowner-
GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00 f1�1/o 3 Ulu )l
or improvement isre b within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 LYq IY La J
builder will have the burden o(pmving That he did not build or ins- BUILDING USE
prove for purpose ofshep INDUSTRIAL WASTE INTER. 30.00 R�pE-aS Imo CON PB ower
❑ d as owner of the pro Party,he exclusively ec ( contracting with - CJ � ❑ ❑ ❑
licensed colons Cors to construe the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or insproves(hereon,and.who LAWN SPRINKLERS-OVER 5(EA.) 1.00 {�
contracts for such Projects Mill a conlraclorto licensed pursuant to 1.1
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00
❑ TRACT NO. PARCEL NO.
lam exempt under Sec. ,&&P.C.❑n Olis
reason WATER HEATER W/VENT 6.00 QQ98
Owner True WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
WORKERS'C'OMPENSA'17ON DECLARATION WATER TREATING EQUIP. 5.00
1 hereby ammr that I have a certifiCme of'coosent hr self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
coPy thereof(Sec.3800,Lab.C.),I L y,,,.I
Policy No. Compmry_UnLte2(dL_ Clf-
O 7 Certified copy is hereby furnished.
Z Z /J Certitic is Bled with th. 'ty in)pec tion division. FIRE SPRINK ENERGY T 2
Applicant _ MISC.- REFER TO ORD. y N v N�
~ NO PERMIT ISSUANCE
Q- - CERTIFICATE OF EXIiNIPT10N FROM WORKERS' 10.00 FLOOD ZONE A.L.U.C.
Li 1 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG
CL Z (' Phis sectirin Fred not be completed if the permit is for one TOTAL Y E] NE] v N�
hundrod dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- QT,. MECHANICAL PERMIT FEE
H mil is issued,I shall not employ FEE SUMMARY
LL U p oy omy Person in any manner so to
beannu wb)ret to the blockers'Compensation Laws of California.io
i
Umc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 916.00
} m NOTICE TO APPLICANT: II',aflclmaking Olis Certificate of Ex-
FZ emplion,you should become subject to the Workers'Compensmion APPLIANCE 5.00 PLA HECK 1
Provisions of the Labor Cade, you mut forthwith comply with rye, A1
U such pruvisionsor thispermit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE/energy �
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 12.53
I 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.
3097,nder's .am HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM
Lender's Nan.
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify tlis have read(his application and state that the above VENTILATION FAN (SINGLE) 4.00
68.58
information n correct 1 agree to comply with all oily and county PLUMBING
ordlnenccs and slate laws relating to is building construction, the BOILER-COMP(3H.P.or100,000B.LU.) 6.00 68,58
above-lIt,rby authorize roperty lollies of this city to enter upon the
above-mcmioncd Properly for inspection purposes, BOILER-COMP(Over 100,000 BTU(SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless thMI
e City of SC.- REFER TO ORD.
u68-58
pertino against liabilities,judgments, rusts and ezpenaes which
may in any wayaccrueagainst said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
ranting of this pmmit MECH.CONT. LIG NO. MECH. 02
d=� TOTAL TOTAL
Signature of pplicunt/Contractor Uule 1,513.79
OFFICE COPY