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13709�- POST THIS CARD NEAR FRONT OF BUDDING • PC HMIT NUMBER CITY OF CUPERTINOq INSPECTION DIVISION ' 1.379 JOB INSPECTION RECORD ' �( a� �+ PERMIT EXPIRATION JOB ADDRESS �1�� ` - • `^� "� UNIT# L,OpTw#�� PERMIT EXPIRES IF.WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATLS INSPECTOR INSPECTION RECORD d&A OF PERMIT ISSU FOUNDATION - �� p Flo16 _O 180DAYS FROM LED INSPECTION. UFER ,j!>° �( ET VALIDATION - PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBINGZ. P. ELECTRICAL ISSUANCE DATE MECHANICAL G. ELECT. PLC.I MECH, 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDh� BUILDING PERMIT INFORMATION tQ)z1 VALUATION PLUMBING Co ` w MECHANICAL PERMIT TO ELECTRICAL FRAMING )� STORIES TYPE CONSTR. INSULATION OCC.GROUP R TS PLACE NO SUB OOR UNTIL ABOVE HAS BEEN SIGNED ROOF SQ FT.FLOOR AREA TOTAL ACFEAfE DIAPHRAGM BUILDING USE HES IND CON PB Olney APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ '❑ ASSESSORS PARCEL NO. ROUGH 3�6-09 313.a,�23 PLUMBING 'TRACT NO. GAS TEST PARCEL NO. - . . � ��qd . MECHANICAL (00 ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMINGSAN s- - p� zoNlNc ENG.SITE NO. INSULATION I PLUMBI G 2Z GAS FIRE SPRINK ENERGY L34 MECHANICAL 0 N� ❑ N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.LU C. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR 'z.QWE FIRE DEPT. v� NE] vI] N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS ofi-cp FIREWALLS ELECTRIC PLAN'CHECK $15.51) GAS FEE512 00 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED JNSPECTION• PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! ' CONST:TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICECOPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT BUILDING 13 7 0 9 ADDRESS 11772 Trinity Spring Carat Lot BUILDING-ELECTRICAL-PLUMBING-MECHANICAL PLAN CHECK VALIDATION NAMOWNE„'S /�--�gory Inc. & "AME t]ty❑I.n Ds TV. ELECTRIC PERMIT FEE Atr�nsal Detre .anent„UNE 415/595-21 CONTRACTORSUTLETS-SWITCHES-RECEP 10.00/1.00 NAME Gytgxy DlcLp, Inc. LIC.NU. B-430097 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR, , � Twin DDI phln Q". PPLIANCES-RESIDENTIAL 4.00 ADDRESS RWC 94065 ONE Q15 595- PANELS 10.00 DATE OF APPLICATION 1 ARCHITECT Aram BaSSeman, P,IA & PANELS IOVER X00 AMPI 20.00 PLAN CHECK FEE PC,NO. OR Arm A ENGINEER SOCja LIC,NO. SIGNS TRANS. 3.00 ARCH.OR ENG.Sanl�1(�/� 5.00 PERMIT VALIDATION ADDRESS n1 QI)tard QI".s //IW SPECIAL CIRCUIT ZIP EMP.METER OR POLE INS. 20.00 /\ APPLICA MOTORS SEE FEE SCH. � �f 220.0 Twin Dolphin Dr. M 94065 SERVICE CHANGE 20.00 wo O LICENSED CONTRACTORS DECLARATION d < v u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE y (commencing with Section 7000)of Division 3 of the Business end ELECT. PLG. MECH. H D i Professions Code,Bnd my license is in full force4 'T L S 9 Iq i o",�- License C�t,�.-��.-/��y�..-Lia Number_ 1,V ` W O m B Date-'-H-s-a tst-Contractor v r \' p LDING PERMIT is S OWNF-R-BUILDER DECLARATION VQ REFER TO ORD C INFORMATION X a. H I hereby affirm that I am exempt from Ora Curtner.'s Licenx MISC.- \ VALUATION $/FT. H .. o`� Law for the following reason.(Sec.7031.5,tlusinnsand Profrlsslons PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to cons[ricL alto, app a2 Q improve,demolish,or repair any struclurt,prior to its issuance.also ELEC.CONTR. LIC.N0. ELEC. 121 /W - DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License ^'I ' Fi > Law(Chapter 9(commencing with Section 7000)of Division 3 of the SFl/lNL 4 Business and Profesions Code)or that he is exempt therefrom end QTY. PLUMBING PERMIT FEE M ¢ O STORIES TYPE CONSTR. ¢ H � the basis for the allege.)exemption.Any violation of Section 7031.5 n ; _ by any applicant fora permit subjects the applicant Ina civil penalty ALTER-DRAIN&VENT-WATERIEA.) 5.00 of not more thou five hundred donors(5500).): 2 5NHR El1,.,,owner of the property,or my employees with wagesus BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS their sole compensation,will do the work,and the stricture Is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00 R-3 1 Code:The Contractors License law don not apply to an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 s¢FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsare not intended orofferedfor sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 1954 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE oil er'will have the burden of proving that he did not build or im RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,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 ASSE58ORSPARCELNo. and Professions Code:The Contractor's License Law does not apply �g to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3 9-31 C3a1147 contracts for such projc4ts with a.conlmctods)licensed pursuant to SEWER-SANITARY-STORM EA:.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. . ❑ 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 NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm flat 1 have.certificate of consent t.selfmouire, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance or a¢rtified copy thereof(Sec.3800,Lab.C.). United Pacific Policy No. company - 0 ❑ Cerlifidd 'opy is hereby furnished. FIRESPRINK ENERGY T-24 Z Z X Cen ifle)>-s:WM' &P5 q+th the city inspection division. MISC.- REFER TO ORD. E] � E] O Applicant_ �J IC.-i ��. Y N Y N M res CERA PICATIi OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 ROOD ZONE A.LU.C. W > C'OMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. v� N� YE N� d O (This section need nut be completed if the permit is for one TOTAL Z hundred dollars(S 100)or less.) U O 1 certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any manner so as to L) become subject to the Worker,'compensation Laws of California. BUILDING n Dace Applicant - ALTER OR ADD TO MECH. 5.00 716.50 } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- � Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 15.50 provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO IO)WOC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE I hereby affirm that there u a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.I Sea.P,i ty PaC1f1C HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name UJ- y, �,�-1 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 9 Lender's Address - - - 1 certify that l have read this application and stale that the above VENTILATION AN (SINGLE) 4.00 inform.tma is mmeet. I agree to comply with all city and county PLUMBING (3 BB ordinances and state laws relating to building construction, anJ BOILER-OD P(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEE SCH. MECHANICAL 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.TAX may in any way accrue against said City in wnsequence of she PERMIT ISSUANCE 10.00 grn this per it. MECH.CONT.. LIC.NO. MECH. it TOTAL TOTAL Signnattture'/-olef/IA`pppliica'ntt'/ .Lluractor ate OFFICE COPY