15869 POST THIS CARD'NEAR FRONT OF BUILDING
,.. PERMIT NUMBER
CITY OF CUPERTINO 15869
INSPECTION DIVISION }
JOB INSPECTION RECORD .
PERMIT,EXPIRATION
JOB ADDRESS I vG NIT# _LOT#
/ PERMIT EXPIRES IF'WORK
OWNER 1A CONTRACTOR 6- ,� IS NOT STARTED WITHIN,
INSPECTION DATE INSPECTOR INSPEC ION RECOv 180 DAYS OF PERMIT ISSU
FOUNDATION ANCE OR 180 DAYS FROM
. NOTE:' LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITETO COMPLY WITH THE APPROVED PLANS AND CITY OF PERmiI VALIDATION
_ CUPERTINO STANDARDS.
GARAGESLABS _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB Q
PLUMBING -
ELECTRICAL _ ��� n° ISSUANCE DATE
MECHANICAL - c --r. PEO MECH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT'
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL JC20 70
ELECTRICAL ,PERMIT To
FRAMING.
INSULATION STORIES TYPE CONSTR.
.. UCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE su.FT EwoII AIreA TOTAL Acn encE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID -
p BUILDING USE
ROOF SHEATHING , - \ I ES N c
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSPIN LPB L
. X
ROUGH
> ASSESSORS PARCEL NO.
. � � SAN.N / _ � <
PLUMBING - �, L, ELECT.ENERGY 1 366-09-31132.33
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No, PARCE
MECHANICAL - MECH.ENERGY. 8098 _
ELECTRICAL _I _ BUILDING ENERGY Acc.Dore Acc.FILE mo.
FRAMING - 4,1ELECT.FINAL TEST
ZONING -ENG.SITE NO.
INSULATION I _ `CV PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T 2E
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 'r•L. NL v NL
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE A.L,U C.
INTERIOR SHEAR -L. cL FIRE DEPT. YL NL T,L NL
SHEETROCK - !� yjG( GRADE FEE SUMMARY
EXTERIOR LATH, 1)Z-6{ BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALSsemoo
SCRATCH COAT "� LY ELECTRIC PLAN CHECK
GAS AS EMW
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEO BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�• f- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING:
SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX 03
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. I TOTAL
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date ------- j-
- --- ............... 19-81- Building Permit No.
The Building Located at
......................... ...............
Has Been 5z@�� For Use As: ...............!�; L
(Altered) ........
.................................................................................................................................................
.............. ...................................................................................................................L..............
................................................................................f\.................. ......................................
v
PD-7
BUILDING 114SPECTOR
APPLICANT TO FILL IN INFORMATION-WITHIN RED LINES - USE BALL POINT PEN ONLY ^
BU LDI NG PROJECT 1 DENTI FICATI ON "PERMIT NUMBER r
ADDRESS 11783.Trinity Spring Curt APPLICATION & PERMIT ' 15869
Lot ���p y�y (may T BUILDING-ELECTRICAL-PLUMBING-MECHANICAL e°
NAMO.NE S W v- J W.wF/t 1�•`^ PLAN CHECK VALIDATION
AFTWSCn Developmrt 415/595-2100 GTI. ELECTRIC PERMIT FEE
F"�'-'�� vHarvF
NAMER"r°�rT�°�R sf�w v� TLETS-SWITCHES-RECEP 10.00/1.00
Gregory amW, INC.INCLIC.No. &4�97 - LIGHTING FIXTURES 10.00/1.00
CONTRACTOR Win Uolpinin Dr. APPLIANCES-RESIDENTIAL 4.00
ADryDOrRES($��f(����j
rs11L 6406 PHONE 415/595-21 PANELS 10.00 DATE OF APPLICATION'
ARCHITECTIr2/Il SSenlana PANELS (OVER 200 AMPI - 20.00 PLAN CHECK FEE
oR
ENGINEER Associates
uc.No. C-83%
SIGNS TRANS. 3.00
AA CHDDRESS ENG 2031 Orchard •f SPECIAL CIRCUIT 5.00 PERMITVALIDATION
Santa Ana Ilts. LA 5?707 TEMP.METER OR POLE INS. 20.00
APPLI
ADDRESS MOTORS SEE FEE SCH.
220-0 Twin Dolphin Dr. FK 94065 SERVICE CHANGE 20.00 d
o 0 LICENSED CONTRACTORS DECLARATION
a u o I hereby affirm that I am 0censcd under provisions of Chapter iiA<0 ISSUANCE DATE
w 2 w (commencing with Section 7000)of Division 3 of the Business and -s ELECT. PLG.. MECH.
F D z Professions Code,Bad my license is in full for��TRet. I,y�y-III/
z 0 h1' - License C I.ic.Num j p
O H Date_ � Gmtmclor��. .GV yA�
Y � J - BUILDING PERMIT
I[ tc ce o OWNER-BUILDER DECLARATION INFORMATION
X
r I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
H VALUATION S/FT.
HLL0< Law for the followingredson.(Sce,7031.5,Business and Professions PERMIT ISSUANCE 10.00
ia -' Code'.AnycityorcounlywhiehrcquiresapermittoconstmeL al ler, [�
er S 0 pr 1 y prior to its issuance,also ELEC.CONTR. LIC.NO. 152,727
< P improve,demolish.Or repair an structure,p ELEC.
D u requires the applicant for such permit to rile a signed statement that TOTAL PERMIT TO
a w esu, he is licensed pursuant to the provisions of the Contncmr's License
Hi > Luw(Chaptcr9(commencing with Section 7000)of Division 3 of the
a Business and Profevions Code)or that he is cxmnpt therefrom and GTY. PLUMBING PERMIT FEE SFUU
or r $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
s by any applicant for a permit subjects the applicant loacivil penalty ALTER-DRAIN -WATER IEA) 500
of not more than O . .
rive hundred dollars(S500),I: 2 s 5
❑ 1,as owner of the property,or my employees with wags as BACK F LOW PROTECT. DEV ICE 4.00 DCC.GROUP RES.UNITS
0mlr sole compermliun,.will do the work,and the structure is nnl
intended or offered for sale (Sc,. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3
Code:The Contractor's License Law dos not apply to an owner of 1
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
mems are nm intended or offered fur-sale.It,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 .�. �
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
E IND CON PB Or",
prove 1,aso nee of sale.). - INDUSTRIAL WASTE INTER. 30.00
❑ d as owner rs the properly,he exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors Cad to construct the pmcen (Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 8.00 ASSESSORS PARCEL NO.
and Professions Cade: he Contractor's License Law does not apply
to tr owner of property who builds or improves rased uand who LAWN SPRINKLERS-OVER 5(EA.) 1.00 366-09-31,32,33
theCois cto,'sor h cense L with a contmgo11 s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contr'actor's License Law. TRACT NO. PARCEL NO.
❑ I ant exempt under Sec. ,BA P.C.for this WATER HEATER W/VENT 6.00
reason 8098
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECIARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a ceRifmule of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.). United Pacific,
Polly No: Company
O ❑ Cotlired copy is hereby lumished FIRE SPRINK ENERGY T24
Z Z 'Cert ifi is ed with the city inspection division.
0 App u _ - MISC.- REFER TO ORD. Y C] IN EJ Y E] IN C]
CC w PERMIT ISSUANCE 10,00
CC - CERt'IFICATE E SAIDO NSFROM WORKERS' FLOOD zorvE A.L.u,C.
W COAIPP:NSA1lON INSURANCIi PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y El NEI
0 (This section need not be completed if the permit is for one. TOTAL
hundred dollars IS 100)or I..)
U 0 1 certify that in the performance of the work for which this per, QTYMECHANICAL PERMIT FEE FEE SUMMARY
LL (- undo issued,I shall not employ any Peron in any manner so as to
U become subject m the Workers'Compensation Laws of California,
U a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING $825.00
} W NOTICE 'TO APPLICANT: IL after making this Cenilicale of Es-
r Z cmption,you should become subject to the Workers'Compensation APPLIANCE _ 5.00 PLAN CHECK ypry�(
provisions of the Whirr Code, you most fnTthwith comply willi FEE` �uJ
U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10=C.F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00 SEISMIC FEE : 10.71
'I hereby affirm that there is aconstruction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the perfor nice of the work iia w
nhich this permit is issued(Sec. MICROFILM '
3097'Gv.C.), Security Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00
Leader's Name-,�-�� HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC
Lender's AddrrsarETIAISdLCI_ a_4th-FTr-:5 9_941:1 $60.35
I certify Ihm I have read this applicalion and slate that the above &VENTILATION-FAN (SINGLE) 4.00
• informztlon is correct.I agree to comply with ell city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-CO POH.P.or100,000B.T.U.) 6.00 .35
hereby authorize representatives of this city to ewer upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to savu, indemnify and keep Ilamdss the City'of MISC.- REFER TO ORD. ,l'
upeft no agamst liabilities,)u( fientS, Costs and expenses which CONST.TAX 7•W
ay in any way accrue against mid City in consequence of(he PERMIT ISSUANCE 10.00 $29
of this permit,. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL Q
ignature of App cant/Contrnclor Dale ) $1391.29
OFFICE COPY