13724 (2) ip-
Z POST THIS CARD NEAR FRONT OF EIJILDIN
PERMIT Nun+BER
CITY OF CUPERTINO 13724
INSPECTION DIVISION
• JOB INSPECTION RECORD
/ �� /�`� PERMIT EXPIRATION
/`
JOB ADDRESS 9'21 -" � �� ee/� UNIT# LOT#
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
FOUNDATION LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - -
UNDERGROUND /SLAB QFV p�- ; % '•
PLUMBING z ym
ELECTRICAL (�� U ISSUANCE DATE
MECHANICAL Rc ELECT. PLc. mFCR.
ayotcw�— CQ•
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION S/FT,
MECHANICAL 121 j2M
ELECTRICAL PERMIT To
1,^
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,1'i,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES IND CON PB OM,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Q, ❑ ❑ ❑ ❑
ROUGH 7/ ASSESSORS PARCEL NO. y
PLUMBING (,J�OI�—�
GAS TEST TRACT NO. ARCEL NO
MECHANICAL (�V?ff'
ELECTRICAL ACC.DATE ACC FILE NO.
FINALS DATE INSP.
FRAMING SAN #
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
LATH–INTERIORELECTRICAL FLOOD ZONE A.L.U.C.
LATH–EXTERIORFIRE DEPT. Y❑ N❑ Yo NE]
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING $71640
FIREWALLS ELECTRIC �, PLAN CHECK cdcj cn
GAS FEE EraW
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 9��
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX �7.03
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. E1249�
OFFICE COPY
-APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - lfE BALL POINT PEN ONLY
BUI -DING PROJECT 1 DENTI FICATION PERMIT NUMBER
BUILDING 11821 Sierra Spring Court APPLICATION & PERMIT
ADDRESS
Lot 13724
Lot 3(1�8828 y BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNEOWNERS LT'CgQry l]IQLip Inc. PLAN CHECK VALIDATION
• ' QTY. ELECTRIC PERMIT FEE
N�renson Develop>?rrt ,„ONE415/595-2100
NAEAcroHsMOUTLETS-SWITCHES-RECEP 10.00/1.00
D.`89WY DWI
Inc,/ uc.N.. B-430097 LIGHTING FIXTURES 10.00/1.00
DRESS Hs
ADDRESS Win In PPLIANCES-RESIDENTIAL 4.00
AO
M 94065 FHONE415/595-2100 PANELS 10.00 DATE OF APPLICATION
ORRCHITECT ram ssem an, PANELS (OVER 200 AMPI 20FEE00 PLAN CHECK P.C.NO.
ENGINEER Associates
sec.NoQ-&3T
SIGNS TRANS. 3.00
ADDRESS R ENG. , SPECIAL CIRCUIT S,QQ PERMIT VALIDATION
Santa Am Hts. Ca zlp92707 TEMP. METER OR POLE INS. 20.00
AAcHuRE
FPuCSS MOTORS SEE FEE SCH. Q ,r
220-C Twin Dolphin Or. M 94065 SERVICE CHANGE 20.00 J
wo LICENSED CONTRACTORS DECLARATION ```` „� J O\h�6�/�/✓J�/
a i w 1 hereby affirm that I am licensed under provisions of Chapter 9 ,nV U `\ ISSUANCE DATE
y< H (commencing with Section 7000)of Division 3 of the Business and G. ELECT. PLG. MECH.
H z Professions C de,a I my license is in full lure t -x
Z
o v, - License-Tis./p Ibl Lin.Number`
a m r w Date_-`./���-g�Contracmr_
Q y f J I
¢ ¢ IS a OWNER-BUILDER DECLARATION BUILDING PERMIT
" - INFORMATION
E,
;n I I hereby affirm that I um exempt from the Contractors License MISC. REFER TO ORD
u woj Law for the following reason.(Sec.7031.5,Basin...and Professions VALUATION $/FT.
s- - PERMIT ISSUANCE 10.00
Code:Any city or county which requires permit to construct,alter,a pp p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 121 788
- O ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
e. w m m he is licensed pursuant to the provisions of the Contractor's License
rzQ
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �.r-r�I��
s i o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE SFDWL
IS the basis forthealleged exemption.Anyviolalion of Sedi.n703LS STORIES TYPE CONSTR.
a ; - by any applicant for a permit subjects the applicant o a civil penalty ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars($500).)i q 5
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400 G
their sole compensation,will do the work,and the structure is not . . OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and ProfessionsDRAIN$-FLOORROOFAREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of , , R-3 1
himspropelf or through
builds or wn em es mereoq and whoat such improve-
work FIXTURE$-PER TRAP 5.00 SG.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such improve-
or nts improvemennot t
or within ted une or year o if,however,thebuildingowner-
GAS-EA.SV$TEM-1 1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 1954
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of the
INDUSTRIAL WASTE INTER. 30.00 RE I❑ ❑N ❑ Ome
❑ d as owner of the property,he project
contracting with
licensed contractors to the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's improv Law does not apply y 7
to tr owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3� �.0 9-3 dd/33
contrasts for such erne L with a conUaaor(s)licensed pursuant to C
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sea. ,B.&P.C.I'or this WATER HEATER W/VENT fiY)Cf'(J'
reason 6.00 0 r' A
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKERS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate ofc.n,Cot to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.) Pacific
Policy No. Company
O Certilie y is Imleby f�r�)shed. FIRE SPRINK EN
?p
2s
Z Z `� Cert if n Iled wAh the city inspection division.
1-- O A�pGcanl -p�r/-- MISC.- REFER TO ORD. Yo N[] Y [3 NF
� y CERTIFICATE OF EX 'MPTIONE FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
IL > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG,
CL O (This section need not be Completed if the permit is for ane 77 TOTAL v N Y El NEI
::) Z hundred dollars IS 100)or less.)
0 O 1 certify mat in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued, I shall not employ any person in any manner so as to
0 L) become subject to the Workers'Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING $716.50
} on NOTICE TO APPLICANT: If,after making this Certificate of Ex-
H Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with 15.50
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE E 62.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6,00 SEISMIC FEE
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,CIv.C.L It I,Pa�ci�f�i�,y� HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's NamAddesaue'u 'e tJl�r�-�F-9 HEATI NG UN IT ER 100,000 B.T.U.)9.50
Lender's Address s ELECTRIC $49.88
I certify that I have read this 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 state laws relating to building construction, and BOILER-COMP Q H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH.
above-mentioned properly for inspection purposes. MECHANICAL •�
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any ay accrue against said City in consequence of the PERMIT ISSUANCE 10.00 $297.03
granlin Of Ihis p il. MECH.CONT. LIC.N0. MECH.
LVA T71K- OTAL TOTAL
Signature of AOplica t Contractor Vale 1249.21
OFFICE COPY
` ' • POST THIS CARD NEAR FRONT OF MILDING
CITY OF CUPERTINO ` . 113n'�24
INSPECTION DIVISION
JOB INSPECTION RECORD
1r Q� PERMIT EXPIRATION
1 1 LJL I �1�Y1'� ��J _Ih l_./1u 12' UNITSk _LOT#t- V--___•
JOB ADDRESS
1'CfIMIF EXPIRES IF WORK
(wNEn G(Z[G; ) Ej GR 0 C.' n CONrnnCTonl.�/Zltr'- /Z� IS NOT STARTED WITHIN
INSPECTION ' D E INSPECTOR INSPECTI . RECOR` / HIO DAYS OfPERMIT ISSU-
FOUNDATION 12;1• - � �- i-L�*•v+., h /' ^INCL OR 1111 DAYS FROM
UFER ' I.ASTBALLED INSPECTION.
PREGUNITE � PEn NIl�VALIOAtION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB 1
PLUMBING , ..I
ELECTRICAL ISSUANCE un IE
MECHANICAL
L. ELECI. PLG. nu1011.
—��>Q(�;,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
��;; �' }}I -"' INFORMATION
PLUMBING
WOOD FLOOR —�VALUATION — SIFT.
MECHANICAL lit FTi'l'•
ELECTRICAL - vErimn To
FRAMING
—.'STONIES TIFF CONSTTI.
INSULATION
oCG GNOUV TIES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED,• T.FL 1 sR.rwon nnEA lornl.ncne ACF
ROOF
DIAPHRAGM
9118 USE
NES.-L 7l ES, INU CON CUN VO UIM1w
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGN ❑-" ❑ ❑ ❑ ❑
ROUGH //nssESSORS PARCEL No,
366J
PLUMBING 7 J �P j;:.f -
�^
GAS TEST
ITIAUI NO. PAI+CEL NO,
1
MECHANICAL bl?ff•
ELECTRICAL ACC.OATE ACC.FILE NO.
FINALS ' ��'�' " .DATE � �`INSP.!'�
FRAMING SAN # WOVALLS
INSULATION �-S- ¢ PLUMBINGZONING ENG.SIFE NoGAS FIRE SPRINK ENERGY L]4COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED: HEATINGMECHAF�ICAL Y ❑ N❑ ` ❑ N❑
LATH-INTERIOR ELECTRICALFL000 zoNE n.L.ucLATH-EXTERIORFIRE DEPT. `"❑ NOv❑ N❑
SHEETROCK Ci=IITGRADE .,,�v;!p;:SHEAR INTERIOR :FEE SUMMARY
BUILDING _SHEAR EXTERIOR TEMPORAR BUILDING '�-i1U,El
FIREWALLS ELECTRIC PLAN CHECK )) '
-� ' GAS FEE LIY.:1 C1' dl.r.•I ri
0 TAPE OR PLASTER UNTIL ABO E HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
? MICROFILM
ARRANGE FOR INSPECTION BY PHONING M-4505, ELECTRIC
• o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 114!,ti
PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
APPLICANTS POaTIPf COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
7
Date ...--7...77J.,--------------- 19.81- Building Permit No. -------------------
The Building Located at ----
Ovnedby ... ..................... .......................................
Has Been (Altered) or Use As: ...-------------------- '.......-t.---......... b\)L(.............
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PD-7 BUILDING INSJIEOR