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SUIte �O� <-ITY, STATE,ZIPCupertino, CA 95014 CONTRACTORNAMEBIUe NOI�I�@rl� BUIICI@CS IC�C. PHONE916-218-2014 E-MAILmorgan@bluenorthernbuilders.com STREETADDRESS34H TaraVal St. CITY, STATE,ZIPS81l FraIICISCO, CA 94116 MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery): CONTACT NAME PHONE E-MAIL, Jacqueline Lo 408-252-3876 �klo_classical@yahoo.com sTaEETA��REss 10055 Miller Ave. Suite 101 c`TY, STATE,Z�PCupertino, CA 95014 LIST ALL BUILDING PERMITS ISSUED FOR PROJECT: PERMIT NUMBER DATE FINALED INSPECTOR SCOPE � B-2018-2106 02/10/2020 Jeff Greet Dental TI 2 3 4 NOTE: Please attach a copy of BOTH SIDES of the signed inspection job card to this application. - OFFICE USE ONLY- SPECIAL STIPULATIONS OR CONDITIONS: CHECKLIST: � Copy of Job Card Attached(both sides)? Permit signed off in system? � No other permits open or expired in system? � Verification of payment for certification? Cof'O Application.doc revised 08/OS/18 va.v i a:uvru� u v,�r rJl..1(V1V C,A►{,U —"--'� BI,9I.DLNGADDRESS I()p55h4ILLERAVE(,'U?ERTINp,CA95014-3�$ CONT'R��C7'ORBLUENORT}3ERt��BUII.DERSiNC p "" O�VNF72'S NAME:Lee Fujinrota L�&Assocs LLC; II2NIITNU 8-201&-210fi � PHONF_• PFIh4II7'iSSUFD:(kNUB/2019 ` �������"N�' AnDKESS:34A Tarav�l St San Fiancisco,CA 9411b T�'�'� rvSPecroR Dn'CE JOB DI'SCWPTIdN: — Fourvn.�rtun�s�re wowc DR LD DIlVTAL CARf:-T.I.-{2643 SF)CO�tiIBINE SUITE iQl WITH SUITE 102 F'IF,RS F'fJUNDATION � .� _ uFF�t GROUND �� i 1� GRADE BEAM ��LI�'f�s ��1j-fV'�{/� , � SLAB �'���,., �i..°"i�P,�Li��.��._i a�..�,` �_ ��,.����t ��, I RLNI�ORCE,vIENT < ..r�-.{ �/� �/-�'�) y ,n,a--►�ft �( t��tASONRYiSTEII, = U�� �i!^�F�-7lJ t���'TJ'�i...��'`i '��� � y TEII COLU.MN 5TEEL ��'���^�,g" to,� ����. �-.'��l.=� ���Yge--;; RbT.AItvTNG WALL " " � FRAMING UNDF�t FLOOR FRAMING �:` ROUGfI FRAME ' Zck ` l"' . � � $ ^, �-:' r ^ , CXTERIOR Si IEl\R �-�' �-- 1N1'EF:lOR SHEAR E" ' �r1 L I✓` tI�' �' '� � ^� �. �. t '�- i ^�, i � � '`i:��,,.' \ "� �- { � '"^./��^d.. �—} �. �r • � � �61t-/d ,-� � ' ��� '/ � ��'���- TO ARRANCE INSPDCIION:CALL 408-777-3228 BET4VE�'iV 7;3p q,N(,,q�r ;3p p NZ UNDERFLOOR MECIIA?VECAL MONDAY'I'HROUGHTHURSDAI'OR BEItiVFII�;7:30 A.M AND 2:30 P.iV1 O\FRIDAY. KOIJ((�-1 MECHAMCqL ,� CALI.AT I.F�iS1'24 HOU12S BF�RRE,[tF]QUIRE!)]NSPDCI'ION,J OB AllDRF�S AND ��;v� PII2Nf17'NtiMBF�2S AREYF�DID WHIN RF�QUFST[NGANI\'SPECT(ON. 'AIR CONI)]TIONEft YI72A4IT GXPIRES IF WORK LS NOT STAI2TFD WITHIN 1 gp pAYS OF PF}2MIT Li{)1I.FS'� ISS UANCE OR 180�AYS FRC?M Lr1ST CALLID INSPEC"I70N. I1C10DS NOINSPELTIONS FORBG7i;llINGH�lALS LNT[LALLR�QUTRII)BL�SINESS DUCI"'4VI2AP LICE�SES AREOETAINID. ELECTRiC4L T1TE INSPECI'OR DATE u�va�ca�ouiv�E�cr�ucAL -� ,�.,'- /o; SAIVITARI'li�.`SPF.CTIONS - L�NDERFLC�RII.F.,CI'R1CAL (�r� �iL.�' i UNDF,RCROUVD 120L`(�-IELECTRICAL ���;'� f�,.,,,+; , ' I�YUROFLUSf3 - PV SYST�v1 VISUAL - EV CE{A RGTNG STATIQN t�2EASE INT6'RCEPTOR - ;I�N1YOItARY POWER YOLE P['BL1C wof2KS SF.RVICE UPGRADE RiGfiT OF WAY ELEf'IRIC MFTER RII_FASE GRADING rLUloID11vG f2bTAINiNG WALL LiNDERGROUND WATERSEF2VICE FIRE uEP4RTMErT UNDERGRC}UNDSEWII2 '- ,=� r+;:� S[TECOMPLIANCE �','a�� � PROPER"I'1'LL�ECLEANO[;T � �'%�� � FIREMAINSYSTEMS �1 UNDEttCROUND C�4S PIPI1'VG FIRE SPRINKLE2S-RUUGH Q1}, � -..�,.::. ._,. -i :i`: UTDERFL(X)RPLliMB[\'G � 'y,�;?�-j._� FIRESPRINKLER-FINAL q�i j, ��� �� RUUc�iiPLUMBIIvG „, FIREALAR'VIFINAL '► SHOIVERPAN ��(� � STANDPII'ESl'�TEMS VJf\TER HEATER iNGINEEftLD PROTEC"I'ION SYSTi.M CiAS TEST T-BAR-F1RE C,AS MEl'ERRELEASE tinsc.LNseEcrions INSULAiIOY DIIviOLITION STRUC'1'URE UNDERFLOOR 1NSULATION .4CCESSIBTI.ITY INSUI.AT[ON c :,R 1'.I.PREP ��woa�e�crelaox�rr[sttFs TEMPORA RY OCCUPA NCY SHEEI'ROCK � -��^ DocTJrofEvraTto;v INTE:RIOR LATH PAD/SET$ACK C�RTIFICATION E�7'E�RIOR[ATH EPDXYOBSERVATION LETTER SCIZATCH COAT DF,PAItTM11E\T Fi1�AlS S WIMD�pNG POOL PLANNING-CALL(408)777-3308 POOL PRE-DECK PUBLIC W t3I2KS-CALL(408}79'7-3354 YOOL PRE-GCJl�i1TE FIRE-CALL(403)378-4010 POOL PR�PLA STIIZ SAN[TARY-CALL(403)'S3-'071 PCX�L DFMOLITION BU/LDING FNL41,S RooFt!�G MEC7If1NICAL •7 l^r ROOF PRE-INSPECTION EL.ECTRICAL TEAR OFF PLUVIBING � PLYWOpD NAIL BIIII_DIN � � - B TENS ,�� l� ( ����� ���� � �c�e� 1�.,�?.� j� c� CT,� G�- � -� --,4 1 �, � � �ti �-. �r��� "� � i�� .� � � r.:�� ����� �- � ��� ��� t , ? �� �� `�, �`" � �` ��.� ��'�;--� ��� �-� �� ������ �' �,�� t � � i�� �:},�; _# ����j,���� -_ �,,� � ��' �,r..�.� 1 a'�����.;� � •� � � � i l � ��� ��- �-f � `�' `_ '—''�` ��,c-�"��' � `-~�,� ,�! � r � �� �,� a ~�;� �� -�j "� ' � �`;#� �� ���`�¢"-� �'�,�, r�.� � �' '[������_ �� l � � �, u ��'- �.. }k f / ' V� � „ ,� i�,A s'` �` a '�-�. 5 Y' . Y v�3 G�-, " 1P�s S � �. � .Cc�1��°�S 1 `� 1 �, Q � � � ��� �y � ���:� �� �` �� "+ � � � � � � CUPERTINO Receipt No.: 265039 10300 TORRE AVE „� Receipt Date: 02/24/2020 '*y ���,��,�i�� CUPERTINO, CA95014 Telephone: Cupertino, CA 95014 RECEIPT RECORD&PAYER INFORMAT/ON RecordlD: B-2018-2106 Record Type: Magnet Converted Property Address: 10055 MILLER AVE,Suite#101,CUPERTINO,CA 95014-3468 Description of Work: DR LO DENTAL CARE-T.I.-(2643 SF)COMBINE SUITE 101 WITH SUITE 102 Payer: KAPPLER INC(HOLGEN KAPPLER) Applicant: N/A Kappler Inc. 615 S College St Charlotte,NC 28202 PAYMENT DETAIL Date Payment Method Reference Cashier Comments Amount 02/24/2020 Credit Card HALEYM $357.00 FEE DETAIL Fee Description Invoice# Quantity Fee Amount Current Paid Occupancy-Certificate of Occupancy/Compl 50085 1.00 $357.00 $357.00 $357.00 $357.00 AA_Receipt_Template.rpt Print Date:02/24/2020 Page 1