17718 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO � �718
INSPECTION DIVISION
JOB INSPECTION RECORD
5/f4S/'I' SVW�L G�/ PERMIT EXPIRATION
JOB ADDRESS
�� UNIT _LOT#���`J PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
-PREG UNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VA(.IDATTDN
I CUPERTINO STANDARDS. p .,1i✓ 1, <
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,!7"
0
UNDERGROUND /SLAB MAY 2• � IJ��J � ss.
-'..+�
PLUMBING Wn. -'
ELECTRICAL I riti Of cu!I
= � Issun"ce unre
MECHANICAL � , ��
BLDG ELECT PLG- MIC"
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
P f'
WOOD FLOOR * \V :N , INFORMATION
PLUMBING � I t VALUATION $IFT.
,_`�...
MECHANICAL e �Ty_
ELECTRICAL - e`� /�\ - _i/ PERMIT TO
FRAMING ` \VI, h '" 1 m
INSULATION STORIES TYPE CONSTR
!/ 2 Shit
w k-Nre-j,-s C—:NzM �-� Ict UCC OR", RES UNITS
V�C � 8St
PLACE NO SUBFLOOR UNTIL ABOVEHAS SIGNED R-3 1
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE So IT FLOOR AREA(( TOTAL ACREAGE
DIAPHRAGM 1 THE CONSTRUCTION TAX IS PAID 3047 . t 1 L,k
ROOF SHEATHING
W` /j BUILDING USE
RES INW 17 D CONPe on..•.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. W El ❑ ❑
ROUGH ELECT.
�
T.ENERGY �V
ASSESSORS PARCEL NO
PLUMBING ^-
� ELEC
TUBS&SHOWER PAN PLUMBING ENERGYrR�ACT NO PARCEL NO
MECHANICAL MECR ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PGRADE
ZONING ENG SITE NO.
GAS TEST
AL FIRE SPRINK ENERGY T.2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Y ❑ N'❑ Y ❑ "❑
EXTERIOR SHEAR L RELEASE FLOOD ZONE A.L UC
INTERIOR SHEAR Y❑ "❑ Y ❑ "❑
SHEETROCK
FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS ' BUILDING 972.M
SCRATCH COAT ELECTRIC PLAN HECK
GASFEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 13.66
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ED ARRANGE FOR INSPECTION BY PHONING252-4505, ELECTRIC 73.13
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING. MIX
z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!. CONST,TAX ��
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. � . j
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION �� �
aDILDING a ring `
ADDRESS
C BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'. nC PLAN CHECK VALIDATION
NAME t OTY. ELECTRIC PERMIT FEE
PHONE41501595=21 1
HAme ACTORS u'yM `^�F�w`tiFh Inc. OUTLETS-SWITCHES-RECEP 10.00/1.00
"' uc ND. LIGHTING FIXTURES 10,00/1.00
CONTRACTOR'S
ADDRESS 220-C Twin Dolphin Drive PPLIANCES-RESIDENTIAL 4.00
CONTR
RX. M 94065 PHONE 415 95-2100 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C:N0.
OR Bassenian/Lagoni ARChitmts PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.ND.(.�(C�-$395 SIGNS TRANS. 3.00
ARCH,OR ENG. 2031 Orchard
Drive Ve #100 SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
ADDRESS LLVW� Vl lel lel�1 TION
Santa aria Heifts, CA ZIP 92707 TEMP.METER OR POLE INS. 20.00 � \
APPur
cANs 220-C Twin Dolphin Driw@ MOTORS SEE FEE SCH.
ADDRESS
RWC- CA 94065 SERVICE CHANGE 20.00
,00 LICENSED CONTRACTORS DECLARATION
u o, I hereb al'finn that I:un licensed under rovisions of Chapter 911 ` !I• ISSUANCE DATE
3 w (conuran ing with Section 7000)of Division 3 of the Business and. MAY BLOC- ELECT- PLG. MECH.
r fn i Professions Coda,)yrd my license is in full for ,yy},tffid. ® M M M
oi w 0 Liven sc Cl axs_D Lic. .}uj/(
r m1 J Date Cont.actorrudor Citv y of.Capabre
¢ w a OWNER-BUILDNR DECLARn'DON r^- BUILDING PERMIT
°A DISC.- REFER TO ORD INFORMATION
X ; Ley I hereby ul'finn that I am exempt Grim the CoContractor's License
Fu0J Law for the follow ing reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCEVALUATION S/PT.
Ew>4 Code:Any city or county which reyuiresa permit mconstrucCalte', 10.00
m Q ¢O improve,defaults]),or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.L 194,540
IT
- 0 u requires the upplreann lar such permit to file a Signed statement that PERMIT
TO
a w m hpursuant e is licensed to tire TOTAL provisions of the Contractor's License
r z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe .NU
4 0 Business and Professions Code)or that he is exempt therefrom and
¢ H o the basis for the alleged exemption.Any violation of Section 7031 QTY. PLUMBING PERMIT FEE
5 STORIES TYPE CONSTR.
u 3 m by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500H.): ALTER-DRAIN&VENT-WATER (EA.) 5.00 2 WR
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 4.00
their sole compensation,will do the work,and th .e structure is not OCC.GROUP RES.UNITS
- Mnded or offered for sale(Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 R-3 1
:The Contractor's Lice ase Law does not apply to an owner of
property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 $D.FT.FLOOR AREA /�rarAL ACREAGE
himself ye through his own employees,for Sir
that such improve- 2445�V
me imp rov eme intended or within.one year o Ic however.completion.
the own ng GAS-EA.SV STEM-1 1NC.40UTLETS 6.00 3047
or improvement will
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 of im- BUILOIN I G USE
prove 1,as ownerose
of.the.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ d as owner r, the property,am exclusively contracting with Le ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO,
and Professions Code:The who
builds
ampr vee th docs not apply
no tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 D(V
contracts ct such projects with a contme[orf s)licensed pursuant to PARCEL
/
the 1 Hit exempt
License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO,
O I um exempt under Sec..,B.&P.C.for this
reasonWATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACG DATE ACC.FILE N0.
WORKIik S'COM PIiNSn'110N DECLARATION WATER TREATING EQUIP. 5.00
I hemby allirm that I have a certificate of con,Let to self-insure.
or a cernilicate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thcmol(Sec.3800,Lab.CJ. C
Policy N rt is Locany
-1 A'l�1F -Pati I iE -
Z ❑ Cratifle"91;2 le hereby lu ill the FIRE SPRINK ENERGYTQ4
Z Z XI CertifiM � i ix filed wish the cit innec�on division.
F_ O Applicant __ MISC.- REFER TO ORD. vE] N� Y � NE]
CCN CIiillpICA'r Ii OP EXEMPTION P OM WORKF-RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LLLC.
LU � COA1Pi" "TION INSURANCE, PLG.CONTE. LIC.NO. PLG.
11 (This section need nor be completed if the permit is for one TOTAL Y❑ NY C3 N
Z hundred dull...IS 100)or less.
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mil is issued,I shall not employ any person in any manner so as no
become subject to the Workers'Compensxl ion Laws of California `
- O_ DatL Applicant ALTER OR ADD TO MECH. 5 pp BUILDING 972.00
} N NOTICE TO APPLICANT': If,after making this Certificate of Ex-
F.. ? eruption,YOU should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN/CHECK 15
provisions of the Labor Code, you mist forthwith comply with /
(���
FEE
U such provisions or this permit shall be demned revoked AIR HANDLING UNIT(TO 10=C,F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 13.65
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of tire work for which this permit is issued(Sec. MICROFILM
3097,CieC,f HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lenders Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 73.13
1 certily that I have read this application and state that the above VENTILATION FAN ISINGLE) 4.00
i ordinances
n correct.l 1 agree to comply with all city and county, PLUMBING
hereby nes and cute laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 73.13
hereby enthuriie rpetforties of this city to enter upon the
above-mm�nioncAproperty for ins faction purposes, BOILER-COMP IDVer t00,0008TU1 SEE FEE SCH.
I p ct MECHANICAL
(We) ugrga m save, indemnify mW keep harmless the City ch MISC.- REFER TO ORD.
73.11
Cupertino against liabilities, Inst aidls, costs coil expenses which CONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ram guf this permit MECH.CONT, LIC.NO. MECH.
S Z-? TOTAL TOTAL ❑�7� CC
Signature of pplicant/Contractor Dale sSiiF.:N
OFFICE COPY