15886 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15886
INSPECTION DIVISION .
I n JOB INSPECTION RECORD
JOB ADDRESS /�el'2 SH4ST� �Y�'��6 P�NIT# _LOT# PER MIT EXPIRATION
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAI.IOAnON
GARAGE SLABS
CUPERTINO STANDARDS. 111. ."
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ;, T, ;,�,;. , ,;�.;3• Q"(./
PLUMBING
ELECTRICAL ISSUANCI:UA I E
MECHANICAL - - aLOc ELECT PLG. MEC.
DO NOT POUR FLOOR UNTIL ABOVEHASBEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
t VALUATION
PLUMBING' SIFT.
MECHANICAL 1 }
ELECTRICAL - PERM1111 TO
FRAMING % sm
INSULATION STORIES TYPE CONSTA
2 5Md2
UCG GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3 I
ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE soIT aooR AREA Toms ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 1 , I 11 1
Rt BUILDING USE
ROOF SHEATHING
H S IND CON PB Oen.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.N _ _ F �^A
PLUMBING ELECT.ENERGY " —�-6)+
TUBS&SHOWER PAN PLUMBING ENERGY •TRACT NO PARCEL NO
MECHANICAL $OCI,D Q' MECH.ENERGY AMR
ELECTRICALACC DATE ACC FILE NO
O BUILDING ENERGY '
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITE NO,
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ 1 ❑ No
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE ALUC.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ - ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC
PLAU CHECK
GAS FEEILrOW
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE �2,
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
53
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 68.58
• O� ONE WORKING DAY BEFORE REQUIRED. INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT.FOR EXPIRATION DATE — rN
NICAL e f
IMPORTANT! TAX x,02
PLEASE READ REVERSE SIDE BEFORE AL 1,513.79
CALLING FOR FINAL INSPECTION.
OFFICE COPY I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT 1 5886
A.=S a a 1119
ADOREss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
- Zc(,L-b
OWrvER's
•
PLAN CHECK VALIDATION
NAME "' wrY Group, Inc. OTYELECTRIC PERMIT FEE
DEACTOR� PHONE415/5%-21
NAMegGry Group, Inc. OUTLETS-SWITCHES-RECEP 10.00/1.00 1
Lm.NOB-4 LIGHTING FIXTURES 10.00/1.00 -
ADDRESCTOR'spr]/t / Twin Dolphin Drive PPLIANCES-RESIDENTIAL 4.00
ADDRESS 220_�
Redwood City, CA 94065 PRo.E4 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR Bassenian/Lagoni Architects PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC,NO, SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS 2031 Orchard Drive #100 SPECIAL CIRCUIT 5.00 �17w (� ♦�I,
Santa Ana Heichts, CA zI EMP,METER OR POLE INS. 20.00 �•./�� pyy,A')�/� ��,
APPLICANT Twin Dolphin Drive MOTORS SEE FEE SCH.
ADDRESS
CLV'''t�
RISC CA 94065 SERVICE CHANGE -s r-., 20.00
°m z
Foo LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that 1 am licensed Imder provisions of Ch.pmr 9
Q w ]� "U"':
- ISSUANCE GATE
or, (commencing with Section 7000)of Division 3 of tile es
e Busins and jl I N c' r
0 mo
o Professions Colored my license is in full force PLG. MECH.
BLDG. ELECT.
z o m - License Class_Bar, Number� _
`C° "°` City of Cupertino
w a OWNER-BUILDER'DECLARATION BUILDING PERMIT
K o a o - INFORMATION
w g u_H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
HLL0 J Law for the following reason.(see.7031.5,Business and Pome,sluns PERMIT ISSUANCE 10.00 VALUATION S/FT.
mCode:Anycoyorcountywhichrequircrapermittoconstruct,alter,
0 179 O
0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
a te °rc requires the applicant for Such permit to Ills a signed statement that TOTAL
m" he is licensed pursuant w the provisions of the Contractor's Licenu PERMIT TO
HZaLaw(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe W.(�1 .,
z o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
w r m the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
n , . by any applicant five permit dollars(he0).): ant loacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 2 5 E.
of not more than five hundred dollars(my em:
❑ Las owner at one property,or my.and tile
S with wagesas
et BACK F LOW PROTECT. DEVICE 4.00
their sole Compensation,will(S the work and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale ISec. 7044, Business and Professions DRAIN$-FLOOR
Code The Contractor's License Law does not apply to an owner of ,ROOF,AR EA,COND. 5.00 R-3 1
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 S FT.FLOOR AREA TOTAL ACREAGE
O himself or through his own employees.Provided that Such improve.
counts are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-l1NC.4OUTLETS 6.00 � II
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 U
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.l. INDUSTRIAL WASTE INTER. 30.00 s IND CON PB Other
0 1,as owner°f the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-i INC 5 V.B. 6.00
and Professions Code:The Contractor's License Law docs not apply ASSESSORS PARCEL No.
To an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 t_"Q
contracts for such projects with a contractors)licensed pursuant to J'.1
the Comra,tcus License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
13lum .&P.C.
exempt EI this
reason WATER HEATERW/VENT 6.00 8098
Owner Ualc WATER SYSTEM 5.00
ACC.GATE ACG FILE N0.
WORK EItS'CohIPliNsnnoN DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation In suranse.or a cc,lifird ZONING ENG.SITE NO,
copy thereof(See.3800.LahC.).
Policy No. Company_16ai}ad_P cif
O p Cerlified copy is hereby fuYnisllce'd
Z Z Certified ° is fed with I nly!mVecuu. division. FIRESPRINK ENERGY T 24
F O Applicant MISC.- REFER TO ORD. ty N v ❑ N[]
CLy CI'RTIPICATE -E. EMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTE.. uG,NO. PLO.
CL O ('phis section neeJ not be completed il' the permit is for one TOTAL N� v ry�
Z hundred dollars IS 100)or less.)
U O I certify that in the performance of Ore work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person in any planner so as to
0 w become suhjecl to OIn Workers'Conlpensutinn Laws of California.
C. Uate nPPlic°ret ALTER OR ADD TO MECH. 6,00 BUILDING
} w NOTICE '1'O APPLICANT; If,after making this Certificate OFF
? emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAJy CHECK
provisions of the Labor Code, you must forthwith comply will, �t
U such provisions Or this hemi shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
PLRM
CONSTRUCTION LENDING AGENCY AIRHANDLINGUNIT(OVER IQOWC.F.M.) 6.00 SEISMIC FEE 12.53
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.
3097,Civ.CJ. HEATING UNIT(TO 100,000B.T.U.) 8.00 MICROFILM -
Lender's Name
Lender's Address HEATI NO UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 68.58
1 certify that I leve read Dlis 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 stale laws relating to building construction, and BOILER-COMP H.P.or 100,000 B.T.U.) 6.00
hereby authorwe representatives of this city to enter upon the
above-mentioned property lot inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which X 302.02
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TA
reel
• ing f t is permit MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL513.79
n
Sigature of Applkaul/Commetor Date a
OFFICE COPY