13782 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY' OF, CUPERTINO'. ' h 13762
'INSPECTION DIVISION
N PE TION RECORD
JOB I S C ,
a, - - `S 2� r •' " ' ---I PERMIT EXPIRATION
JOB ADDRESS
�� L� /�y�T`� �- ^I' 1 �• UNIT# -LOT# ` PERMIT EXPIRES IF WORK
OWNER "B�+-+ \ �KIJLt ' —tk)C' CONTRACTOR - IS NOT STARTED WITHIN
INSPECTION D TE INSPECTOR INSPECTION RECORD ISO DAYS OF PERMIT ISSU'
FOUNDATION _ ANCE OR. 180 DAYS FROM
LAST CALLED INSPECTION.
LIFER - w
a
PREGUNITE„ PERMIT VALIDATION
• 1.. - I ;
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _
UNDERGROUND /SLAB
. PLUMBING P-
' ELECTRICAL a 148MANCE DATE
M CHANICAC .L CT-1, PLD. MECH.
El' f 0;.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED DING PERMIT ` <
INFORMATION '
-
:WOOD FLOOR .VALUATION I ,$/FT.
PLUMBING .1 - - vr, 1
MECHANICAL
'PEHMIT TO
ELECTRICAL 1 Y L
J ' '
FRAMING
STORIES TYPE CONSTR.
INSULATION
0 1, 6•P�
, - OCC.GROUP RES.UNITS '
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- I ROOF SO.F,,FLOOR AREA TOTAL ACREAGE
IiAA6M - '.• -
�. BUILDING USE
„ . RES•-IND - CON PB OM”
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED IS]- El -El El E:l
ASSESSORS PARCEL NO.
ROUGH ; �l .
PLUMBING'
"TRACT NO PARCEL NO:
GAS TEST
MECHANICAL '
,ACC.DATE ACC.FILE NO. 1
ELECTRICAL /,_'' FINALS gDATEINSP,FRAMING . SANZONING ENG.SITE NOINSULATION _Z PLUMBING
casMECHANICAL - FIRE SPRINK ENERGY TPG
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ! HEATING YE], NEI v ❑. N�
FLIOODZONE L.U.C.A.
LATH-INTERIOR �3' ELECTRICAL '
'I LATH-EXTERIOR -.' FIREDEPT. '�❑ N0 YL IN
SHEETROCK' ' GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING 8•
SHEAR'EXTERIOR. -Qjg} TEMPORARY APPROVALS BUILDING -„_ --
FIREWALLS' ELECTRIC - PLAN CHECK
—S'SB GAS . FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' I - SEISMIC FEE ,
OCCUPANCVOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY.BUILDING INSPECTOR:' MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELEcialc
10 ONE;WORKING DAY BEFOOE REQUIRED INSPECT'ION,, . ,.'�
_ PLUMBING
o� . , PLEASE GIVE JOB.ADDRESS WHEN PHONING.
Z, % • MECHANICAL
— SEE PERMIT FOR EXPIRATION'DATE. -
Z� 'IMPORTANT!; a x CONST.TAX;
r ,
X`'. • � ,
'PLEASE READ.REVERSESIDE BEFORE
' TOTAL / �(�t
CALLING FOR FINAL INSPECTION
OFFICE COPY '
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_APPLICANT TO FILL.IN INFORMATION WITHIN_RED LINES - !USE BALL POINT PEN ONLY-
BUILDING PROJECT,I DENTI FICAT[ON PERMIT NUMBER
BDILDING APPLICATION & PERMIT A n
AODRESs:II5Z(Lot5 Sunset SplJnpring Court BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I G
OWNER'S PLAN CHECK VALIDATION '
NAME OTY. ELECTRIC PERMIT FEE
•- e or Gp
r u PRONE _ `
N°MER"croRs UTLETS-SWITCHES-RECEP 10.00/1.00 /
)" uC.rvo. LIGHTING FIXTURES 10.00/1.00 -
coNTrsACmqdOC Twin Dolphin, Ste. C APPLIANCES-RESIDENTIAL' 4.00
AooREss
Re
• HONE _ PANELS 10.00 DATE OF APPLICATION wond
ARCHITECT PANELS (OVER 2OO AMP) 20.00 ' PLAN CHECK FEE P.C:NO.
uRENGINEER Aram Bassenian, A.I .A.
AS_ nc
iatpq
uC.No. yIJO SIGNS TRANS. _ 3.00
ARCH.OR ENG. Westerly Pl , #IPERT VALIDATION
3990
ADDRESS J SPECIAL CIRCUIT, 5.00 MI - -
zw EMP.METER OR POLE INS. 20.00
APPLICANT$ a MOTORS SEE FEE SCH. nn
A.C.E. 220 Twin Dolphin Drive, C �� �'07.e/LLrt.>
Retilannod City, CA C1406� . SERVICE CHANGE 20.00 V / -f
Foo LICENSED CONTRACTORS DT:CLARA;TION
¢ U I hereby affirm Thal I"am licensed udder provisions of Chapter 9 0 NCE DATE
yrt n (commencing with Section 7000)of Division 3 of,the Business and6113G. ELECT.' PLG, MECH.
r D i Professions Cec��4Ie,and my license is in full for g pI [yL�L
oi L D License Class.l5 Lic.Number Y. ll67-/ -
H Date Contract.,
a y s - " - - BUILDING PERMIT
¢ ¢ w ¢ OWNER-BUILDER DECLARATION - INFORMATION
oAIJ MISC.- REFER TO ORD.
X ;w m I hereby ufrom that I am exempt from the Contractor's License VALUATION $/FT.
F .. O4 Law forthe following reason.(Sec.7031.5(Business and Professions PERMIT ISSUANCE 10.00
vi Code:Any city occounty which requiresa permit toconstrucLalter, %Z 7 '
Kw G improve,demolish,or repair any structure,prior to its Isssancc;also ELEC.CONTR. LIC.NO. ELEC,
0 LL requires the applicant for such permit to file a signed'statement that ' TOTAL l PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
F z a Law(Chapter 9(comncncingwith Section 7000)of Division 3 of the
20 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ s- m, the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
s ; _ by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollufs(5500).):
❑ Las owner of the property,.,my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the,sl iucture is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Cade:The Contractor's License Law dues not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improvo-
mems are.not intended or offered forsalc.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 600
Cr improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
-
builder will have the burden of proving that he did not build or it.- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIALWASTE INTER. - 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 SSE$SORS PARCEL NO..
and Professions Code:The Contractor's License Law'does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS;OVER 5(EA'.) 1,00 + ��6.-7 -31f 31j�3
contracts forsuch projectswith a contractors)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 TRACT NO.
the Contractor's License Law. 'PARCEL NO.
❑ lam exempt under Sec.-,B.&P.C.for this ' WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM "5.00
ACC.DATE ACC FILE N0.
WORKERS'COMPENSA'r10N DECLARATION WATER TREATING EQUIP. .5.00
Thereby affirm that 1 have a certificate of consent to self-instue, ZONING ENG.SITE NO. -
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3600,Lab.C.O n 1 t e d` Pa C/R
Policy No. Company '
O q Cetli1 ted COPY I hereby furnished. FIRE BPRINK ENERGY T 24
Z Z 1.'A Certified c _I ilh the cit pection division. MISC.- REFER TO ORD. N
' ❑ ❑ ❑ - ❑
O Applicant_ _ Y N Y N
CC PERMIT ISSUANCE 1400FLOOD ZONE A.L.U.C.
� CER'TI EIC - :OP EXEMPTION FROM WORKERS'
LL " COMPENSATION INSURANCE ' . PLG.CONTR. LIC.NO. PLG.6-
❑ (This section need not be completed if the permit is for one TOTALY❑ N❑ v ❑' N❑
D Z hundred dull...(S 100)or less.) '
L) O 1 certify that in the performance of the work for which this per CITYMECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 02
} to NOTICE TO APPLICANT: IL after making this Certificate of Ex. -
F Z emption,you should become subject m the Workeri Compensulion APPLIANCE 5.00 PLAN CHECK
provisions or the Labor Code, you must forthwith comply with FEE
CJ such provisions or this permit shall be deemed revoked.' AIR HANDLING UNIT(TO IOMCF.M.) 4.00
CONSTRUC'T'ION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the ,CN.n).once of the work dor which this Permit Is issued,(Suc.
3097, HEATING UNIT ITO 100,000 B.T.U.) '8.00 MICROFILM
Lenderi'ss Name�E-C.11�1_t. dCl_'f7C HEATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's'AAdress_ - P,aP -„n Mata c� 3 ELECTRIC
1 Certify that l have read thlsa mallon an stale hal the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING �Gj
ordinances and slate laws relating to building construction, and 'I BOILER-COMPI3H.P.or100,000B.T.U.) 6.00 'Ur7 ''^^
y hereby authorize representatives of this city toenterupon the BOILER-COMP (Ovor 100,000 BTU)SEE FEE SCH. MECHANICAL. Z:if-
grant
to
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 CONST.TAXmay in any ay accrue against said City in coasn line- of the PERMIT ISSUANCE 10.00 in en l MECH.CONT. LIC.NO. MECH. p
TOTAL p
1dil I� � TOTAL
Signa[ I Applicant/Contractor
OFFICE COPY - .