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15870 POST THIS CARD NEAR.FRONTOF BUILDING RMITN M9ERJ CITY OF CUPERTINO 1570 M INSPECTION f)IVISION 1 I JOB INSOECTION RECORD _ PERMIT EXPIRATION JOB ADDRESS / / klI"LJ� C UNIT# LOT# J -- -PERMIT EXPIRES IF WORK , OWNER C..) CONTRACTOR �QL IS NOT STARTED WITHIN INSPECTION DA INSPECTOR INSPECTION RECORP 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE - .TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION _ _ CUPERTINO STANDARDS. GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB r PLUMBING ELECTRICAL- T . OPIP ISSUANCE OA TE ' MECHANICAL - - - ELECT. PLG„ MecH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - \�,`� �n UILDING PERMIT WOOD FLOOR SEC B� INFORMATION VALUATION _ $/FT, " PLUMBING MECHANICAL PERMIT 10 1 ELECTRICAL �. FRAMING - ' INSULATION STORIES TYPECONSTR. OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - . ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sO.Fr.aooR AREA Tout ACREncq DIAPHRAGM - THE CONSTRUCTION TAX IS PAID 12349 BUILDING USE ROOF SHEATHING RES IND CON PR OIL- APPLY NO ROOFING UNTIL ABOVE HAS BEEN.SIGNED FINALS DATE INSP. -© ❑ ❑ 0 11 ASSESSOR5 PARCEL NO ROUGH SAN.q, / PLUMBING 'ELECT.ENERGY 'z e . NO TUBS&SHOWER PAN PLUMBING ENERGY 8098 MECHANICAL MECH.ENERGY acc.DaTE Acc,Fn.E rvo. ELECTRICAL BUILDING ENERGY _ FRAMING ELECT.FINAL TEST ZONING ENG.SIT ENO , INSULATION PLUMBING GAS TEST - - GAS • FIRE SPRINK ENERGY T,PE MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y N Y ❑ N� E4TERIOR SHEAR ELECTRICAL RELEASEFLOOD ZONE A U.C, INTERIOR SHEAR _. FIRE DEPT. Y ❑ N[j Y N❑ SHEETROCK GRADE - _ FEE SUMMARY EXTERIOR LATH" - BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT _ ELECTRIC PLAN CHECK GAS FEE NO TAPE OR'PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICWAS o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING I PLEASE GIVE JOB ADDRESS WHEN PHONING. ? - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL " IMPORTANT! CONST.TAX.. PLEASE READ REVERSE,SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. , OFFICE COPY ,/ ,PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY B;M LD1 NG,PROJECT IDENTIFICATION .PERMIT NUMBER BUILDING 11803 -trinity Wing Court APPLICATION & PERMIT O ADDHE Lot BUILDING-PLECTRICAL-PLUMBING-MECHANICAL OrLWqNER'S - - PLAN CHECK VALIDATION HfTIl SOn DeVI ElVrort ' 415 595-2100 CITY. ELECTRIC PERMIT FEE �`MI`"ly PHONE a CONTRACTORS NAME UTLETS-SWITCHES-RECEP 10.00/1.00 Inc. LIC,NO. 8430097 LIGHTING FIXTURES 10.00/1.00 CONTHACTOWS 220-0 Twin Dolphin APPLIANCES-RESIDENTIAL 4.00 ADDRESS RK 94065 1HONE415/595-2100 ' PANELS - 10.00 DATE OF APPLICATION ARCHITECT furan OnSSEnian1 AIA PANELS 200 AMP) 20.00 PIJsNCHECK FEE .NO. V A W z ENGINEER. AssociatesLIC.N0. 0-8395 SIGNS TRANS. 3.00 - ARCH.OR ENG. M191 0rch......! Dr., #100 SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS LW VI 1.111 U UI Santa Ana HtS. CA zip 92707 TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS 220-0 Twin Dolphin Dr. M 94065 SERVICE CHANGE 20.00 (� / o o LICENSED CONTRACTORS DECLARATION aW 1 hereby affirm (hat Iain licensed under provisions of Chapter 9 lel V OISSUANCE DATE N 11 a m (commencing with Section 7000)of Division 3 of the Business and .gyp ELECT. PLG. MECH. H 0 z Protmionu Code,Sit my license is in full force L `j`X--`w,l( o`�- Licence Cl Lie,Number _ p .� Q z r w Darn .1S-1-Y_�Contractor __ VV. . ¢ x s BUILDING PERMIT it ¢ w a OWNER-BUILDER DECLARATION INFORMATION Oau. MISC.- REFER TO ORD w 3 LL r• I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT. Hu OLaw for the followingreasoo.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requirrtsa permit meonsNucl,alter, [� y}'� a ¢G 2O improve,demolish,or repair any simeture,prior to its issuance,atm ELEC.CONTR. LIC.NO. ELEC. 152 7 o ¢ requires the applicant for such permit to flu a signed statement that TOTAL PERMIT TO E $ he is licensed pursuant to the provisions of the Contractor's License r z i Lev,(Chapter 9(commenecrg with Section 7000)of Division 3 ofthe L a Business and Prolcuiuns Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. La ; m by any applicant for a Permit subjects the applicant to a civil{malty of nmmom than five hundred dollars($SOO).): ALTER-DRAIN& VENT-WATER (EA.) 5.00 2 5NR ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE - 4.00 OCC.GROUP RES.UNITS their wee compensution,will do the work,and the structure is not _ intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA.CONO. 5.00 R-3 •1 Code:The Contractor's License Law does not apply to an owner of . property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,00 sa FT.FLOOR AREA TOTAL nrn EAGE himself or through his own employees,provided that such improve- menu are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00 2349 or improvement is xild within one year of completion,the owner . . .GAS-EASYSTEM-OVER 4 (EA) 200 BUILDING USE builder will have the burden of proving that he did not build or ire- ES IND CDN PB Omar. Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors m construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Commetor's License Lw does not apply to an owner of property who builds or improves Ihcrcon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 366-09-31,32,33 contracts for such Projects with a contractoNO licensed Pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ [am exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00 8098 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE NO. WORKRRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hmchy etfirm that I have.certificate of conxnt to self-insure, ZONING ENG.SITE NO. or a certificate of Workers Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Ilnited.Paciflc . Policy No'-Company- 0 o. CompanyO ❑ Certified coy is hereby furnished. FIRE SPRINK ENERGY T 24 Decertifi F Ih the city'...spec..... division. ZO Appli<b - . _C MISC.- REFER TO ORD. 'YL Y ❑ N❑ Cl - PERMIT ISSUANCE 10.00 FLAL.0 c. LL RTIP'ICA'1'Ii OF EXE. PTION FROM WORKERS' LU . ' COMPENSATION INSURANCE PLG.CONTR. LIG NO. PLG. Y Y N 6. O (This section Iced not be completed if the permit is for one TOTAL EJ ❑ ❑ Z hundred doll...IS 100)or less.) U O 1 certify that in the Performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I Shall not employ airy parson in any,nam e,so as to U become subject to the Wmkars Cumpemalion Laws of California. 0 LU Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING $825.00 rn NOTICIi TO APPLICANT: IL after making this Certificate ul Es- �, Z, emption,you should become suhject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK a 15,5D provisions of the Labor Code, you must forthwith comply with, FEE FM I � U Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000CF.NL) .4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 109MC.F.M.) 6.00 SEISMIC FEE ' $18.71 1 hereby affirm that there Is 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.). $eC111'1t Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name- HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lenders AJdrcss -Fl r. 941 ELECTRIC 35 f ( certify that)have read agrees application and Astatecity,and theaboveVENTILATION FAN (SINGLE) 4.00 information 6 estate.. I agree to comply with all city.xnd county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000B.T.1-1.1 6.00 .35 hereby authentic representatives of this city to enter upon the BOILER-COMP (OPer 100,000 BTU)SEE FEE SCH. MECHANICAL .hove-mentioned property for inspection pmr,ses. (We) agree to save, indemnify and keep b.Hniess the City of MISC.- - ' REFER TO ORD. uperlino against liabilities.judgments, costs and expenses which CONST.TAX ay in any way accrue against Said City in consequence of the PERMIT ISSUANCE 10.00 obthes omit. MECH.CONT. LIC.NO. MECH. IlTOTAL TOTAL y Signature of Appllc t/Contractor m �O- 11.1J OFFICE COPY - 2� -v`f t2oot Stt AIS 6fT - gig -HCl CLQ�� ex. LcA o mac.