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13806 IP y POST THIS CARD NEAR FRONT OF BUILDINGPFf;NITNDM1IR€F;� CITY OF CUPERTINO - INSPECTION DIVISION 13806 JOB INSPECTION RECORD /�•� PERMIT EXPIRATION JOB ADDRESS C)TI ��*�`^` �^' UNIT# LOT 4f 1©� ' /' ��/q�c� / 1�p�,�`,� .E..T, PERMIT EXPIRES IF WORK OWNER Ca. - CJF-` Li��•l.0 yv Q• CONTRACTOR IS NOT STARTED WITHIN INSPECTION 6ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. LIFER PREGUNITE - a_.�MlT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT, PLG. MECR. - , DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION $IFT. - PLUMBING MECHANICAL - ' PERMIT TO ELECTRICAL FRAMING STORIES- TYPE CONSTR. INSULATION - , OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SQ FT,Fl00N AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE ' RES IND CON PB Ober El Ej APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 1:1 ASSESSORS ASSESSOR SPARC EL NO. ROUGH —/ , O / PLUMBING - •TRACT No. PARCEL NO. GAS TEST O 2 MECHANICAL 8- ELECTRICAL .'jf - FINALS. N,,DATEINSP. Acc.DATE Acc.FILE rvoFRAMING SAN # 'Z -(, 20WNG ENG.SITE NO. INSULATION TO/S PLUMBINGGASFIRE SPRINK ENERGY h10MECHANICAL Y ❑ 'N❑ Y ❑ N�COVER NO WORK UNTIL ABO EH S BE N SIGNED n HEATINGLATH-INTERIOR (Q`)j ) ELECTRICAL FL000 zorvE aL.u.c. LATH-EXTERIOR =�- V� FIRE DEPT. v� N� Y �] .N❑ SHEETROCK GRADE - FEE SUMMARY SHEAR INTERIOR {'} BUILDING SHEAR EXTERIOR .7 TEM IORARY.APPROVALS BUILDING FIREWALLS ELECTRIC - FEE CHECK GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY� SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC -' s F ONE WORKING DAY BEFORE REQUIRED INSPECTION. 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. OFFICE COPY . y APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY t' R,. BUILDING PRO.IECT IDENTIFICATION PER MIT NUDE- .. auILOING . APPLICATION & PERMIT 13806 ADDREss 11553 Country Spring Court BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S PLAN CHECK VALIDATION W595-NAME OTY. 2100 NELECTRIC PERMIT FEE y Group. Inc AME PHONE c DRs // UTLETS-SWITCHES-RECEP 10.00/1.00 NAME 'nCLIPS.N.430097 2<LIGHTING FIXTURES 10.00/1.00 McoNTRAcoRPs22D Twin dolphin Dr. , nCu 3 APPLIANCES-RESIDENTIAL 4.00 ADDRE55 Rpdwnnd City- CA PHONE _2 lCD I IPANELS 10.00JC) DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. on Aram Bassenian, A.I .A. ENGINEER LIC.NO. SIGNS TRANS. 3.00 ADDRESS ENG�7(x(10�eS to rly [l . , }rl�o SPECIALCIRCUIT S,OO PERMIT VALIDATION ADDRESS (`�J]IJ J' Zlv EMP.METER OR POLE INS. 20.00 ^ AvvucAN 's -RCN MOTORS SEE FEE SCH.PindWinind City, CA 114(16S C-I4/,µ-r-• ADDRE55 220 Twin Dolphin Dr. , SERVICE CHANGE 20.00 �O w o O LICENSED CONTRACTORS DECLARATION r a u U I hereby affirm that I am licensed under provisions of Chapter 9 I ATE N Q a_ (commencing with Section 7000)Of Division 3 of the Busuessand E C PLG. MECH. O z Professions Co(k,and my license is in full to WQr,(fap t. Z 05i License Class_ Lic.Number 1U11111``�J11 Q H w Date Contractor I G PERMIT Q y 2 J maw ¢ OWNER-BUILDER DECLARATION INFORMATION wo A U MISC.— REFER TO ORD g H 1 hereby affirm Ihe, 1 am exempt from the Contractor's License VALUATION $/FT. u0� Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 r w w J Code:Any city or county which requires permit to construct,alter, }`/ 7 2 Ix< improve,demolish,or repair any structure,prior to its issuance.also ELEC.CONTR. LIC.NO. ELEC. f '/ D , requires the applicant for such permit to file a signed statement that TOTAL /7 PERMIT TO u w m he is licensed pursuant to the provisions of the Contractor's License n� A ❑ Z T Law(Chapter 9(commencing with Section 7000)officiation 3 ofthe U 0 k, 4 ¢o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ r$ [he basis for the alleged exemption.Any violation of5ec[I a 7031.5 STORIES TYPE CONSTR, n ; _ by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5,00 � Slam mom than five hundred dollars(5500).): �' ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00 OCC.GROUP RES.TITS their sole compensation,will do the work,and the structure is not o / intended or offered for sale(Sec. 7044, Business and Professions ' DRAINS-FLOOR,ROOF,AREA,COND. 5,00 5 /�— 3 Code:The Contractor's License Law does not apply to an owner of S property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ FT,FLOOR AREA TOTAL ACREAGE imself or through his own employees,provided that such improve. meats are not intended or offered for sale.I f,however,the building GAS or 8.00 or improvement 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 he did not build or int- RES IND CON PD Other prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,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 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3 6 6- 9— 3/j3 2-4? contracts for such projects pursuant to 1 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 -793 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSAT'ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.0 Policy ND. Company".Lte"_a�1�P�1anC O ❑ Certified co I' er yfur FIRE SPRINK ENERGY T-24 Z Z XI Certified ed Ile cit inspection division. v❑ N❑ Y ❑ N❑ O Applicant -�Y=t _ MISC.- REFER TO ORD. P v v PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > CFRTIF ATEOFEXEMPTIONINS FROM WORKERS' CL _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. / Y❑ N❑ Y C] N❑ 1 O e section nee.) not be completed if the permit is for one TOTAL Z) Z hundred dollars IS 100) Icss.) O I certify that pe the performance of the work for which this per, OTV MECHANICAL PERMIT FEE FEE SUMMARY LL F Star is issued,I shall not employ any Person in any manner so as to 0OW become subject to the Workers'Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 >_ tan NOTICE TO APPLICANT: If,after making this Certificate of Ex- p Z _ emplion,you should become subject to the Workers'Compensation L4 APPLIANCE 5.00 PLAN CHECK 'ss�y 03 provisions of the Labor Code, you must forthwith comply with FEE / FJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO IODWC.F.NL) 4.00 CONSTRUCTION LI:NDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 0 02 I 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.). Security Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00 / Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9,50 ELECTRIC �7b Lender's Address San Fra.��.�oA I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 rQ information is correct.I agree-to comply with all city and county BOILER H.P.or 100,000 B.T.U.) 6.00 PLUMBINq ordinances and state laws relating to buildin6 construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP IOvm 100,000BTU)SEE FEESCH.. MECHANabove-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 In .CONST.Tmay in any way accrue agains aid City in consequence of thePERMIT ISSUANCE 10.00granting of 11 MECH.CONT. LIQ NO. MOTAAL M TOT Signature team/Co tractor - Da OFFICE COPY +t is FOUNDATION't F r. Temi INSPECTOgt i INSPECT'lu"- I'm bUUN I POUR No CONCRETE UNTIL ABOVE HAS UNDERGROUND /SLAB BEEN SIGNED PLUMBING ELECTRICAL N', PAID MECHANICAL 't LIE 0 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED PLUMBING WOOD FLOOR IL MECHANICAL VALUATei W ELECTRICAL FRAMING INSULATION 510RIES 1441 PLACE NO SUBF 00 UNTIL ABOVE If -zrj-1,&5 0 C QAOI,,. S BEEN SIGNED ROOF DIAPHRAGM- 11 FEDOR ARIA X10 APPLY No ROOFING UNTIL ABOVE HAS BEEN SIGNED RFs cok� PLUMBING ROUGH El I) GAS TEST MECHANICAL 114ACT N, ELECTRICAL FRAMING FINALS DATE INSPACC,DATE Ac INSULATION SAN 1-2 2—V7 . PLUMBINGZONING GAS EN MECH COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ICAL F'HE SPHINK Yo N[] LATH-EXTERIOR ELECTRICAL FLOOD ZONE SHEETROCKFIRE DEPT. y 0 N❑ SHEAR INTERIOR I� I GRADE SH EAR I A t N I UH bUILDINGFEESUMM V FIREWALLSTEMPORARY APPROVALS BUILDING ELECTRIC /I, PLAN CHECK GAS NO TAPE OR PLASTER UNTIL Ft��n HAS BEEN FEE OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT I I ED UNTIL IL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, LU ARRANGE FOR INSPECTION By PHONING 252,4505 MICROFILM 0 . ,�11 ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECT16N. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING — SEE PERMIT FOR EXPIRATION DATE MECHANICAL impo CONST.TAX PLEASE READ REVERSE SIDE 13EFORE CALLING FOR FINAL INSPECTION. TOTAL APPLICANTS POSTING COPY i ELECTRIC SERVICE NOTICE P.G B E.COPY I BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO fs y�� /7 r�C"p� P- To nk4forle F �, l9 uU f 9 You are hereby authorized to Connect electrical service for 'Owner ar Tenant At —�� No.of Wires Size of Wires Size of Switch Motor Load Voltage Phase I Heating Load K.W. Voltage No.of Meters ( b9hi I IO_New5erviceytgb���� nn ,�Recoect l(/1 Heot 1P0Three Wire More Service No.of Add.Meters Power three Phase Move Meler �• ELECTRICAL INSPECTOR CITY OF CUPERTINO P.G.B E COPY GAS SERVICE NOTICE,- c DJoJPrn I( (�� L 119 l)O To You are hereby authorized to connect the GAS service for Owner or TenantOR At 1 c *1 ` New Service *,E . No. of Meters Reconnect No. of Add. Meters Move Service Move Meter PLUMBING INSPECTOR