15847 POST THIS CARD NEAR FRONT OE,BUIL„DING PERMIT NUMBER
CITY OF. CUPERTINO 15847
INSPECTION DIVISION
JOB INSPECTION RECORD -
PERMIT EXPIRATION
S
JOB ADDRESS rN C UNIT# • - -LOT# �a
PERMIT EXPIRES IF WORK
.
OWNER V CONTRACTOR - IS NOT STARTED WITHIN '
INSPECTION I I CONTE I INSPECTOR INSPECT N RECOR 180 DAYS OF PERMIT ISSU- .
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LASTCALLED INSPECTION. '
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CIN OF +rr vAuun noN
PR EGUNITE - CUPERTINO STANDARDS. - i
GARAGE SLABS - Q
POUR NO-CONCRETE UNTIL ABOVE HAS BEEN SIGNED lr 0 E
UNDERGROUND /SLAB (r Ak .3 R6QQ ,p11�'•%�
PLUMBING
ELECTRICAL - V`�QV n0 ISSUANCE UA IE '
MECHANICAL Na LUG ELECT PLG. n+ECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT”
.. INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING -
MECHANICAL "
ELECTRICAL', 1 PERMIT TO
FRAMING - -��-
STORI TYPE CONSTR.
INSULATION
miAOC GROUP ITs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so' ooB nnEA roTA ACBE.Ge
DIAPHRAGM • THE CONSTRUCTION TAX IS PAID '
BUll01 NG USE
ROOF SHEATHING. �L _ - RES IND CON PB ow..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS 'DATE INSP. 14 Cl ❑ • ❑ ❑
ASSESSORS PAHCL L NO.
ROU G SAN.q
PLUMBING o ELECT.ENERGY - TRACT NO,I PARCEL NOT
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH. ENERGY r
F,IIE No.
ELECTRICAL - BUILDING ENERGY Acq.DATE Acc.
FRAMING '7J ELECT..FINAL TEST '
ZONING ENG,SITE NO,
INSULATION, PLUMBING •
GAS TEST GAS
FIRE SPRINK ENERGY T.24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ Y n� Y N�
' .
' EXTERIOR SHEAR _ �- ELECTRICAL RELEASE FLOOD ZONEAL.0 C.
INTERIOR SHEAR a} - 9 W5 FIRE DEPT. . Y ❑ NE] Y ❑. N❑
SHEETROCK O. GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - BUILDING
INTERIOR LATH - TEMPORARY APPROVALS
-60
SCRATCH COAT ELECTRIC PLAN CHECK
GAS
FEE
S•50
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC'FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
en
I.---. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING. owm
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPOR:TANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION:
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE I aQuu
Date .....12).......... .�................ 119.f�
`. .. ..... Bwldii,gp�Permit No.
The Building Located at ...4� .C�.Z.. 1. ...ISV..-Z�.. .. ..............
Ownedby .........GL��J .........C . -- .. .......................... .. ................
Has Been Completed or Use As: C �.p W L
..... . .............................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..........o t"Os.............................................
PD-7 BUILDING INSPECTOR
r
LICANT TO.FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLYUILDINGPROJECTIDENTIFICATION PERMIT NUMBER
Nc %p•� - APPLICATION & PERMIT 1 �.Q
ADDBES 1782 Trinity Spring Court � i. I 8 Y
304 B BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S ^___�„ fy"y�r Inc. p PLAN CHECK VALIDATION
"AME (]f�'lDe e' Group, 0I Ty. '.ELECTRIC PERMIT FEE
`t Alrransal Developnent PHONE 415/595-21 •
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Inc. LIC.No. B-430097 LIGHTING FIXTURES 10.00/1.00
ADDREScroR's L.�C Twin Dolphin 0R. PPLIANCES-RESIDENTIAL 4.00
CONTRA
RYA, 9`1065 PHONE415/595-21 PANELS 10.00 DATE OF APPLICATION'
ARCHITECT Aro Bas'senianp AIA & PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE .C.NO.
OR 1 WW
ENGINEER
Associates LIC.NOC'-8395 SIGNS TRANS. 3.00
AR,SS ENc.
ADDRESS 2031 Orchard Or., /100 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Salta Ana Hts. CA n,92707 TEMP.METER OR POLE INS. 20.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH.
DRESS ESS ----- -
220-C
220-0 Twin Dolphin Dr. FK-94065 SERVICE CHANGE 20.00
F O o
LICENSED CONTRACTORS DECLARATION
<u v I hereby affirm that I am licensed under provisions of Chapter 9 Is r% ISSUANCE DATE
v, a m (consmemcing,wdh Section 7000)of Division 3 of the Business and -DG. ELECT. PLG. JMECH.
H o z Professions code.Bit my licenu is in full fi4 ]fect. AI.
uz O Liccn_ !-t fo bm
9 Dates �\
Contructor-
a y f fit BUILDING PERMIT
ar or in a OWNER-BUILDER DECLARATION INFORMATION
is I hereby 5ffimi tlwt I am cxcm f from the Contractor's Liccnu MISC.- - REFER TO ORD
I VALUATION S/FT.
F l� oa Law for the followingroason.(S,c.7031.5.Businessland Professions PERMIT ISSUANCE 10.00
Code:Any city or county which mentors,a Peres it to construct,alter,ac 7O DIY
, ¢ p improve,demolish,or repair any structure.prior to its issuance,also ELEC.CONTR, LIC.NO, ELEC. 138 306
-0¢ requires the applicant for such permit to file a signed statement that _ TOTAL PERMIT TO
w $ he is licemed pulsation to the provisions of the Contractors License
r z i
La.(Chapter 9(commencing with Section 7000)of Division 3 ofthe
- a Business and Professions Coda)nr that Inc is exanpt.thercfronl and CITY. PLUMBING PERMIT FEE rF�L
De H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n ; by any applicant for a permit subjects the applicant to.civil penally ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than O01.):five hundred dollars(550 - '2 5"
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE _4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(See. 7044. Business and Prom,sions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Comracwr's Liccnx'Law does not apply to an owner of. R-3 1
property who builds or improves themon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
ommusmenotinlendedoroRered formk.ILhowevcr,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 2161
or unprovement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING uSE
builder will have the burden of proving that Ile did notbuild or am- - RE IND CON PB Other
prove tot pulpouof sale.). - - INDUSTRIAL WASTE INTER. 30.00
❑ 1,ea owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed comnmon to construct the project(Sec.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
m an Owner of pruperty,,who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 . ' 3/6-Q(p
� 3� 33
contracts fm SaCh projects wish a contructodo licensed pursuant to `e
the Contractor's License Law SEWER-SANITAR V-STORM EA.200k11 0.00 TRACT NryO. PARCEL NO.
❑ lu.m,vmpt,mdtr Sec. ,B.&P.C.mr.this ' WATER HEATER W/VENT 6.00 849
reason
Owner Dam WATER SYSTEM 5.00ACC.DATE ACC.FILE NO.
WORKHRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of cununt to sell-insure. " - ZONING ENG.SITE NO.
or a certificate of Workers'Conspenmlion Insurance,or a certified
copy thereef(Sm.3800.Lab.C.).Wited Pacific
Policy No. Company
0 TTj❑j(( Ccrtifiedcopyisherchyfurnislmd. FIRESPRINK ENERGY T 24
P.p A�pficant Cedd' '° is' dad lh the city inspection Aivisinn. MISC.- REFER TO ORD. - Y❑ N❑ I Y ❑ IN E]
Cc y. CERTIFICATE OF EXEMPTION FROM WORKERS' - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c.
UJ � COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG.
CL fl'his action need not he completed if the permit is fur one TOTAL v❑ N❑ Y❑ N❑
hundred dollars(S I W)or less.)
U O I certify that in the perfornsance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
U- H mit is issued,I shall not employ any person in any manner as as to
U become subject to the Workers'Compensation Laws of California.
U i
Date-Applicant- ALTER OR ADD TO MECH. 5.00 BUILDING k9.73
�- m NO]WE TO AI'I'LICANT'.
It,after,making Ibis Certificate of Fs
F 2 emption,you should become subject to the Workers'Congwnsaiioo APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deensed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10SWC.F.M.) 6.00 SEISMIC FEEI hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) ' 5.00
the ed.n ince of the work I'or which this permit is issued(Sec. HEATINGUNIT(TO 100,000 B.T.U.) 6.00 MICROFILM
tv
acific
Lender's Name m� _P (F Fl -C�-�11 H EATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC , ,
Lender's Address-l-CfIL1a!-G
I entity that I have read this a comply and state that the above VENTILATION FAN (SINGLE) 4.00
ordinances n curate. I agree to comply with all city and county PLUMBING
oNinonres and state laws relating In building construction, and BOILER-COMPI3 H.P.Or 100,000 B.T.U.1 6.001 $55.50
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI 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.
upertino against liabilities,judgments,'costs and expenus which PERMIT ISSUANCE 10,00 CONST.TAX
nay in ally way acnese against Said City-ill consequence of the
Oflhi pcnniI. p� MECH.CONT. ( LIC.NO. TOTAL
I ob TOTAL
ahme of Applin (/Contractor Date $1326.76
OFFICE COPY