13808 A
ST THIS CARD NEAR FRONT OFeBUILID ING
PERMIT NUMBER
CITY OF CUPERTINOX808
INSPECTION DIVISION
JOB INSPECTION RECORD
•'y (}F, T PERMIT EXPIRATION
JOB ADDRESS 1��, J wN�'./�� SP�LII�-1 "\ UNIT# LOT# `O� ,PERMIT EXPIRES IF WORK
OWNER ^yC]O'� (W-CA �• CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD ' 180DAYSOFPERMITISSU-
FOUNDATION - X21. ANCE OR 180 DAYS FROM
UFER �,Z LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING p,
ELECTRICAL UANCE DATE
MECHANIC!L EcT. PLG. MECH.
p; p ❑ ❑ ❑' p'
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION °
WOOD FLOOR VALUATION
PLUMBING � � � � $/FT.
-
MECHANICAL
ELECTRICAL PERMITTO
FRAMING
INSULATION - STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
l° PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FI.FLOORAREA TOTAL ACREAGE
ROOF
- DFAPtFRAQhl '.
BUILDING USE
RES IND CON PB Ober
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED. ' ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
\�• PLUMBING
GAS TEST TRACT NO, PARCEL NO.
MECHANICAL I AD
ELECTRICAL ACC.DATE ACC.FILEND.
FINALS - DATE INSP.
FRAMING- -2-' SAN *aZ-1
INSULATION %2. PLUMBING zowNc ENG SITE No.
O-ZS-
GAS O-Z$�- ,
FIRE SPRINK ENEjGY T-]E
MECHANICAL -LS-
COVER NO WORK UNTIL ABOVE HA 'BEE N'SIGN ED -:: HEATING ❑ "❑ " ❑ "❑
FLOOD ZONE A.L.U.C.
LATH—INTERIOR ", ELECTRICAL
LATH-EXTERIOR S FIRE DEPT. v❑ N❑ Y ❑ N❑
SHEETROCK 8 - GRADE -FEE SUMMARY
SHEAR INTERIOR - p� BUILDING ,f,S'. ' _
SHEAR EXTERIOR i - .EIC TEMPORAR APPROVAL BUILDING
FrNOTAPE
ELECTRIC PLAN CHECK
k •T17 GAS FEE
PLASTER UNTIL ABOVE HAS BEEN SIGNED occupgNcv SEISMIC FEEF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINGLEASE GIVE JOB ADDRESS WHEN PHONING.- MECHANICAL
- I — SEE PERMIT FOR EXPIRATION DATE — r L_I -`'
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL `
CALLING FOR FINAL INSPECTION.
I` OFFICE COPY
L IN INFORMATION WITHIN RED If - USE BALL POINT PEN ONLY
IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER
y Spring Court BUILDING-ELECTRICAL-PLUMBING-MECHANICALPlan 2RR) 13808
PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
_ PHONE 595-2100
Rs UTLETS-SWITCHES-RECEP 10,00/1,00
y Group. LIC.NO.430097 LIGHTING FIXTURES 10,00/1.00 30
nooRess °fly 220 Twin Dolphin Dr. , IIDII 3 APPLIANCES-RESIDENTIAL 4.00 a-
-PHONE PANELS 10.06 J0 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
ENGINEER
Aram Bassenian, A.I .A. PANELS (OVER 200 AMP) 20.00
LIC. 0. SIGNS TRANS. - 3.00
ADDR.SS ENG.399O� Westerly Pl . , 111/0 PERMIT VALIDATION
ADDRESS r SPECIAL CIRCUIT 5.00
e rt
CA zip EMP.METER OR POLE INS. 20.00
APDArI T'S
ADDRESS 220 Twin Dol phi n Dr. , C MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
r
00 LICENSED CONTRACTORS DECLARATION n�,
a V 0 1 hereby affirm that I am licensed under provisions of Chapter 9 - V
z w (commencing with Section 7000)of Division 3 of the Business and BL I T. LG. MECH.
V't2 u Professions Co�Ig,and my license is ill full forey,,��µp�pp��'..(((��c�
o z�W License Class_I$__Con Number 4..S1JUJ`
Dafe Contractor
Ey f J
¢ ¢w a OWNER-BUILDER DECLARATION BUILDING PERMIT
wo D INFORMATION
;' I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u O a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT.
I- - PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
2 rt a G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. LJ
iL 0 LL requires the applicant for such permit to file a signed statement that TOTAL / -/
e w m he is licensed pursuant to the provisions of the Contractor's License PERMIT
Tw
r i¢ Law(Chapterand
Professions
odeng )or Section is 00)exempt
the on 3 of the
f ¢ D Business and Professions Come)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H the basis for the alleged exemption.Any violation of Section malty - STORIES TYPE CONSTR.
a; by any applicant fora permit dollars(he0).): antloecivil penalty ALTER-DRAIN -WATER (EA.) 5.00 t� S, lvh (/
of not more than five hundred dollars my a .):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400
their sole compensation,will the work,and the structure is not . .
OCC.GROUP RES.UNITS
(S
intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does nal apply loan owner
property who builds or improves thereon,and who does such work
F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself through his own employees,provided that such improves J-
menls arere not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00 Y/
or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA,) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES I❑ ❑N ❑ Om.,
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. do44,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Profession,
rowner of Code:The who
wilds o License Law does not apply Y
to tr owner of property who bailds tr improves rased uand who LAWN SPRINKLERS-OVER 5IEA.1 1.00
the Contractor's
for such projects with a contraclorts)licensed pursuant to /
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ .I am exempt under Sec,_,B.&P.C.for this WATER HEATER W/VENT 6.00 `7 r-
reason
Owner Date WATER SYSTEM 5.00 ACL.DATE ACL.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent In self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copy thereof(Sec.3800, 11L
Lab )
Policy No. CompanyL1s.
_ eu.-Pacae-llam
Q ❑ Certified copy is here b furnished.
Z Z N Certified ca w to city inspection division. FIRE SPRINK ENERGY T-24
H O Applican k � MISC.- REFER TO ORD. • Yr] NE] Y Q N[
y CERTIFIC OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.L.
Wim_ COMPENSATION INSURANCE PLC.CONTR. LIC.NO,
d ' �D LG
(This section need not be completed if the permit is for one TOTAL Y� NV [] N❑
Z hundred dollars 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 any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
Is. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING sQ�
>- to NOTICE TO APPLICANT: If,after making this Certificate of Ex
z emption,you should become subject to the Workers Compensation L.1 APPLIANCE 5.00 PLAN CHECK 33
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE 3S
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.EM.) 6.00 SEISMIC FEE O/
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,CN.CJ. Seeuri tv Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00 lg
Lender's Name
Lender's Add.. San-F.ra.ne4s-eon C•A HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC � -
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 1 a...
information is correct. I agree to comply with all city and county BOILER-COMP(3H.P.Dr 100,000 B.T.U.) 6.00 PLUMBING //� 0`6
'ordinances and state laws relating to building construction, and
s hereby authorize representatives forms of this city to enter upon the BOILER-COMP IOYer 100,000 BTU)SEE FEE SCH. MECHANICAL /
�- hereby authorize
property for inspection purposes. -I
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which
may in any way accrue against Said City in consequent of the PERMIT ISSUANCE 10.00 O CONST.TAXCx� efoN `-
granting oft ' it. / MECH.CONT. LIC.NO. MECH. _
TOTAL / TOTAL
Signator pplicant/Contracmr Ua b
OFFICE COPY