14948 j L. ' POST THIS CARD NEAR F OF BUILDING PERMIT NUMBER
CITY OF CJ . iTINO 1
'INSPECTION DIWSION • ���
JOBJNSPECTION RECOF$D'
1 ' PERMIT EXPIRATION -
JOB ADDR ES s�� ff/ � �i.P!_'>�- 4,zer UNIT# / LOT# �� J PERMIT EXPIRES IF WORK
OWNER GdIitIaw CONTRACTOF� &tp� . �jCO�j/�• IS NOT STARTED.WITHIN -
INSPECTI DATE INSPECTOR INSPIECTION RECORD 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION L�j ,NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAuoP noN
CUPERTINO STANDARDS.. _
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB �
PLUMBING
- ELECTRICAL ISSUANCE DATE •,
MECHANICAL - Bloc. ELECT, I PLG. MECR✓-
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT;
-INFORMATION
WOOD FLOOR - LUATION S/FT.
PLUMBING - • ,7 189
MECHANICAL - ] '
ELECTRICAL. - vERnur rD„
0 U OrtinO�
FRAMING
SIORIES TYPE CNSTRN
INSULATION �' � � � - '
l 2
OCC GROUP RES.UNITS`
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "
$p,fi,Fl RPR[A T.I ALP 1E.Gt
ROOF- NOTE:NO FINAL INSR SHALL BE MADE BEFORE - - -
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID ,
�lb_ ROOF SHEATHING i 23AUILUING USE
S
IND CON PB Go-
-' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP 'K E D . El .'0
.ASSESSORS PARCEL NO,
ROUGH SAN.# 1y4 _3a�
PLUMBING ELECT.'ENERGY
TRACT No:- PARCEL No
TUBS 8 SHOWER PAN _ z ' 1 PLUMBING ENERGY
MECHANICAL _ : MECH. ENERGY •�Ac�c.D Are :ncc.PILE No. i
ELECTRICAL DT/l7F BUILDING ENERGY.
FRAMING ELECT.FINAL TEST '
ZONING ENG.SITE NO.
INSULATION O,. PLUMBING y, I
GAS TEST GAS
MECHANICAL
FIRE SPRINK ENERGY T 2.
' - _
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v UO N�. .Y El El
EXTERIOR SHEAR ELECTRICAL RELEASE �LooD TUNE AA.uc. I .
INTERIOR SHEAR FIRE DEPT:
SHEETBOCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING -
BUILDING
INTERIOR LATH i TEMPORARY APPROVALS
SCRATCH COAT % — - cl, ELECTC PLAN CHECK'
GASRIFEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - sEl ° •� 'j
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FIN AL.ISSIGNED BY BUILD ING INSPECTOR. MICROFILM 16X2 -
ARRANGE FOR,INSPECTION BY PHONING 252-4505, ELECTRIC
�
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAx •
24
I PLEASE READ REVERSE SIDE BEFORE -
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO�FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING ,;APPLICATION & PERMIT
ADDRESS 11581 Lake Spring Court BUILDING-ELECTRICAL-PLUMBING -MECHANICAL 14948
O .' U . , - 1'IS(Nj •;-- . PLAN CHECK VALIDATION
"AME
Developluts 415-W5Wg100 OTY. ELECTRIC PERMIT FEE
CONTRACTORS
NAME '. OUTLETS-SWITCHES-RECEP 10.00/1.00
Gregcj7y Q=. InGic.No. LIGHTING FIXTURES 10.00/1.00
,r ONTRACTOR S APPLIANCES-RESIDENTIAL 4.00 -
ADDRESS 220 C Twin'Dolrxks77 1t1/.�,, RWC
F^'ir N ' PANELS 10.00 DATE OF APPLICATION
ORcmrecr - - PANELS (OVEFF200 AMP) 20.00 PLAN CH EC K FEE P.C.NO.
DR ARAM MSSENIAN, AI
ENGINEER QC(•(1(
I N "' SIGNS TRANS. 3.00
'ADDRESS ARCH OR
ENG2031 Orchard Dr /l100 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
' ZIP EMP.METER OR POLE INS. 20.00, 92707
A S '
ADDRESS MOTORS SEE FEE SCH.
2207C.TWIn Dolphin Dr. . SERVICE CHANGE 20.00
00 LICENSED 'O, ACTORS DECLARATION
a ewi.� 1 hereby ffig..that I em licensed Under provisions of Chapter 9 1D ISyyySEEEUCCCANCE DATE
(commencing with Section 7000)of Division 3 o(the Business and BLD M � PL� MECH.
D z Professions Code,an{knry license is in full farce' d effect.
z o License Class f j Lic.Number 7 1
o m r
Date-Comractor J
¢ m f CuQ,B►iM/pINGPERMIT
¢ is w a
OWNER-BUILDER UECLA I ORMAT1RM
w3 LL r 1 hereby affinu that I nm exempt from theContmerm-'s License MISC.- - REFER TO ORD Cl
i. o¢ Law for the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE VALUATION S/FT.
Code:Any city or county which requiresa permit to construct,alter, ELEG.CER LIC. 10.00 ppC�
Q improve,demolish,or repair any structure,prior to its issuance,also ELEG 1OV f
WO
a te
- DLL requires the applicant for such permit to file a signed statement that TOTAL SmP�q MIT TO
se he is icensed pursuant to the provisions of the Contractor's License
i
Law(Chanter 9(connnencing with Section 70001of Division 3 ofthe '
Business and Professions Code)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE
¢ r o the basis for the allegedexemption.p on.Anhe applicnt to a civi11703L$ STORIES TYPE CONSTR.
n ; °' _ by any apPlicam fora pemhit subjects the applicannoucivil penalty - ALTER-DRAIN&VENT-WATER (EA.) 5.00 2 51CR
grant more than five hundred dollars(S500)J:
C 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS-
_ _
their sole compensation,copsation,will do the work,and the structure is not
- - - intended or 0Mord for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.PT FLOOR AREA TOTALACREAGE
meanslof m ,or ugh intendsownemred In, 3,c, ,,providedthatimprove- GAS-EA.SYSTEM-1 6.00
cents arc not intended or employees,
for sales 1f,ed that s the building 3
or improvement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
34
builder wit]have the burden of proving that he did not build or an- BUILDING USE
prove for purpose.fsa]e.). INDUSTRIAL WASTE INTER. 30.00 RES IND . CON PB omen
CII,as owner of the property,u n exclusively contracting with 9ie ❑ ❑ ❑ ❑
licensed contractors to construct the project tSc,, 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 property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contmclsfor such projects with a commemr(s)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lamenemptunderSee ,B.&N C.IiNthis WATER HEATER W/VENT 6.00 8067
canon
Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORKFRS'COMPENSA'IION UECLARAT ION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate o(cousenl to Sell"u were, ZONING
or a certificate of Workers'Compensation Insurance,o a certified ENG.SITE NO.
copy thereof(See.3800,Lab.C.).
Policy No. Company _
❑ Certified copy is herchy furnished. FIRE SPRINK ENERGY T 24
Z 2 g Certified with the city inpeation division.
MISC.- RE FER TO ORD:
O Applicant_ V❑ N❑ v❑ N❑
w CERT'IF A'I'II OF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L,u U.C.
W > COMPENSATION INSURANCE! PLG.CONTR. LIC.NO. PLG. Y❑ N Y NE]Z .(This Section need not be completed if the permit is for(me - ..TOTAL
hundred dollars IS 100)or less.)
U O 4'eenny that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE' FEE SUMMARY
mit is issued,I shall not employ any per...m in any income,so as to
U become subject to lire Workers'Compensation Laws of California. ' '
U y -. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 50
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
L._ ? emption,you should become subject to the Worker Compensation APPLIANCE 5.00 PLAN CHECK. 15.50
povisons of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONS'I'RUCFION LENDING AGENCY AIR HANDLING UNIT(OVER IOSMC.F.M.) 6.00 SEISMIC FEE - 13 02
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) '5.00 ,
the performance of t c work for which this permit isissucd(Sec. MICROFILM
3097,Civ.C.). �ecurlty Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00 '-
Leader's Namc HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC 70 3J
LendersAdSF, ne_ readero-4th-flTc•
1 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 'I'd state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 70.35
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above mentioned property(Or inspection purposes.
70 '45
(We) agree m save, indemnify and keep harmless the City of MISC.- .REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which - CONST.TAX
ay in any way accrue against said City`in co sequence of the PERMIT ISSUANCE 10:0288-24
0
ranting of II a m' MECH.CONT. LIC.NO. MECH. -
cS�V7 TOTAL' TOTAL
1530.31 -
Signature ra
want/Contctor Date - -
OFFICE COPY
I
ELECTRIC SERVICE NOTICE OFFICE COPY
'BUILDING INSPECTOR'S NOTICE
'CITY OF ZUT PERTINO
p
i
f7,EC . 7 , 19 le�
To
You are hereby authorized to Connect electrical service for
Owner or Tenant "2
At
ires Size of Switch
No.of Wires Size of W
Motor Load Voltage Phase
Heating Load K.W. Voltage
s ,x=. »v✓
J Light 110_—New Service V Reconnect
No.of Meters / Heat 120—Three wire More Service
Move Meter
No.of Add.Meters P°M'ef Three Phase
Qr
ELECTRICAL INSPECTOR
BONDING INSPECTOR'S OFFICE Bldg.Dept.
I CITY OF CUPEPTINO y �, Office CnPV
Sanitary PeimitNo., /'�r�Z
❑ Backflow Device - -
[I .Sewer Connection Plumbing Permit No.,���'�Q
R�Plumbing Final Lot No.
f Owner or Tenant C: %",� 4E!!!
At
Tract
Date Connected 19—Date Final /-72
PLUMBING INSPECTOR
OFFICE
CITY OF CUPERTINO COPY
GAS SERVICE NOTICE, 19
i
I To
You are hereby authorized to connect the GAS service for
Owner or Tenantr"7J"r
At / :2/
New Service
I
No. of Meters ! Reconnect
IMove Service
I No. of Add. Meters
1 Move Meter
r
PLUMBING INSPECTOR
I
`J CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE LOT /
I
I
Date ---. ....._.+
19-0<;O- Building Permit No. A ..............
The Building Located at ..Z S�l'�... 4E'�-SPk'�.
.. ......G..............
_. ............................................
Owned by
Com e For Use As: .... -_"-w -
HasBeen � �.�.eC7....]!1/.__.................---.........._......
(Altered)
..........................---'.-- ..........---
..._......................_..........---........................................................................ .
........... ................. ....................
1 PD-7 ILDING INSPECTOR