15880 (2) N POST THIS CARD NEAR FRONT OF BUILDING
PER MIT NUMBER
CITY OF -CUPERTINO T' 580 '
INSPECTION DIVISION
JOB INSPECTION REC D
Cor •3 � Q J/��/ PERMIT EXPIRATION
JOB ADDRESS UNIT# _LOT#
COUP coNTR -
PERMIT EXPIRES IF,WORK 1
OWNER � 2F6 ACTOR,
IS NOT STARTED WITHIN 1
INSPECTION DATE INSPECTOR 'INSPECTION RECORD 180 DAYS OF PERMIT.ISSU-..'
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:; LASTCALLEDINSPECTION. 1
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED r . i
PREGUNITE. TOCOMPLY'WITH THE APPROVED PLANS'AND CITY OF PPHMIT VALUATION
CUPERTINO STANDARDS.. '
-1' GARAGE SLABS -. ' . PAI
;
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Rl -}� •.�
_ UNDERGROUND•-/1�S�LAB Ap,f'( 2�8 , / 1
PLUMBING .. •�+G�� �.,JI •
ELECTRICAL - MY of CU ISSUANCE UATE�
.. MECHANICAL �' - V,l,= s1 QLt� ��11.1•� SDG. . ELECT PBG, MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION .
. .WOOD FLOOR - IALUATION- - SIFT. '
PLUMBING
MECHANICAL '; -
ELECTRICAL, - - vEHnvT To
FRAMING •sm'
INSULATION, ^ STORIES TYPE CO�NSST�TyyR.
.- UCC GROUP —RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED S,, YaaoHAHEA roinL� „eACE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
4 _ ' BUILDING USE
ROOF SHEATHING RES IND CON PB' O"'P, .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' FINALS DATE INSP. 0 E, Ll E 1-1
'
ROUGH SAN ASSESSORS PARCEL NO.
PLUMBING ELECT.ENERGY TRACT NO. �. PARCEL NO. .
TUBS OWER P — PLUMBING ENERGY
ANICAL MECH.ENERGY 1
iELECTRICAL - - BUILDING ENERGY - ACC DATE .ACC FILE NO.
!FRAMING - I ' t ELECT.FINAL TEST
ZONING
-' �INSU CATION ENG.SITE NO
- �, PLUMBING ' � _
GAS TEST _ GAS
MECHANICAL -
Fl E. ENERGY T,24
� '.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,' Y ❑ No' V 11 NO
J
FLOOD ZONE - auu c.
EXTERIOR SHEAR' _ Jg �; ELECTRICAL RELEASE v ❑ N❑ Y ❑ R
INTERIOR,SHEAR _ FI ?E
PT ,
EETR OCK C FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING LATH TEMPORARY APPROVALS BUILDING ��
SCRATCH COAT ELECTRIC 1, - PLAN CHECK me�qq./y�
., GAS FEE 62M
r NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED; OCCUPANCY SEISMIC FEE 9.7?
OCCUPANCYOF'BUIL DING ISNOT PERMITTED UNTIL BU ILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ��
ELI ONE WORKING,DAY BEFORE REQUIRED INSPECTION. PLUMBING ,$Q. f
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION.DATE ,
IMPORTANT! CONST.TAXZ.Q2
PLEASE READ.REVERSE SIDE BEFORE TO , 1,.331.%5`,
CALLING FOR FINAL INSPECTION.
OFFICE COPY.
'`APPL''ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENT[FICATION PERMIT NUMBER '
BUILDINGLOT 1fgs Dr, APPLICATION & PERM�iT fx1/y�{
! BUILDING - ELECTRICAL-PLUMBING -MECHANICAL V lJ O
Oy1NER3 r�_-�. &(Xlp, I�. -PLAN CHECK VALIDATION
RAME n L'1n Dee wH - OTV. ELECTRIC PERMIT FEE
AtrransaTl bevel oppent PHONE 415/5952100
NAE"x°r°R'
NEUTLETS-SWITCHES-RECEP 10.00/1.00
& 7Y GrOLPI
INC. LIC.No. B-430097 LIGHTING FIXTURES 10.00/1.00
ADDRESS - 220-C Twin Dolphin Dr. APPLIANCES-RESIDENTIAL 4.00
R,rLi CA 94065 I.CNE415/595-2100 PANELS 10.00 DATE OF APPLICATION, +
ARCHITECT PLAN CHECK FEE P.C.No
DR BaSSenlan/Lagmi A-ichiteCt$ AIA PANELS (OVER 200 AMP) 20.00 - ;
ENGINEER !Y O Asocial C-83�5
ICJ sec.No(y� SIGNS TRANS. 3.00
ARCH.OR SS ENG,,,fa 20�31� Dr., 1W SPECIAL CIRCUIT 5,06 PERMIT VALIDATION
Santa hia HDOTtS, CA zIP 92707 TEMP.METER OR POLE INS. 20.00
Ara
ADDDRESSDRESS MOTORS SEE FEE SCH.
220-0 Twin Dolphin Dr., M, 94065 SERVICE CHANGE pAln 20.00
o o LICENSED CONT WIV w V1 RACTORS DECLARATION V r 1 CS`
or u I hereby aflirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
z fcomntxncing with Section 70001 of Division 3 of the Bmin<ss and
AT ¢ ,AG By ELECT PLG/ MECH.
F o 0, Pro. ..re Calc, Se my license00 is if full ford L IIS✓,�I(
2 0 Liccnw CI c Lic.NuIr�E
m H Da1c � Conlructt City of ,(`uY``�� pp
a r E M� BUILDING PERMIT
¢ ¢ wOWM1'ER-BUILDIiR DECLARATIONA INFORMATION
wa y I hereby affirm that 1 am exempt from the Contractors License MISC.- REFER TO ORD
LL_oa law for the following reason. 7031.5.Businexxand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
n y
Code Any city of county which requires a permit to construct,alter,
ar S, <0 improve,demolish,or repair any structure,prior to its issuance,x150 ELEC.CONTE. LIC.NO. ELEC. 13B.306 -
O C requires the applicant fof such permit to file a signed statement that TOTAL
u w §m he is licensed pursuant to the provisions of the Contmctoi s License PERMIT TO
F i x Laos(Chapter 9(Commencing with Section 7000)of Division 3 ofthe SF�
a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
R H the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty
of not more than live hundred dollars 155001.1: ALTER-DRAIN& VENT-WATER (EA.) 5.00 2 5"
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
- intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor',License Law docs not apply to a,owner or
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO. T. LDOR AREA TOTAL A REAL�yE
me mil re through his own emNdyeas,provided that such improve- �a��• 1py"�
or
are not intended or within d lot ore,
however,the the o mer- GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 'g}{7} 174b 421 7""
or improvement is sold within one year of he didt ion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving That he did not build or ice- BUILDINGUSE
prove for pura the ppose of RES IND CONN - O:1
' ❑ I, owner of the ropcny,em exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
anJ Professions Code:The Contractor's License law dues not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS,-OVER 5(EA.) 1.00 10
contracts for such projects with a contractotts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200@/10.00 TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,B.&P.I'.for this WATER HEATER W/VENT 6.00
res n
Owner Date WATER SYSTEM 5.00 ' ACC.DATE ACC.FILE NO.
WORKERS'COMPRNSAFION DECLARA'T'ION WATER TREATING EQUIP. 5.00
1 hereby alfirm that I have a cerlificum of consent nI wif-insure. - ZONING ENG.SITE NO.
in, ¢rtificalc of Workers'Comnwnsuru
tmtian Ince,or a cc,lified.
copy mcreof(Sec.3800•Lan.C.). Lhi ted Pacific
Policy No. Company -
O ❑ Certilic yl5 he by furnislna FIRE SPRINK ENERGY T-24
(- O p .Certif Id with the city inspect ion division. MISC.- REFER TO ORD. Y N y N
m i� ❑ E]
01: w CERT(FICATE OF EXE. I'TION FROM WORKERS• PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. y� NE] YE] NC]
O (Thu section need not be completed if the permit is for one TOTAL
0 2 hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,1 shall not employ any person in any manner so as to
O L) beconm subject to the Workers'Compcnart ion Laws of California.
Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
�-? emption:you should become subject to the Worked Compensation APPLIANCE 5.00 PLAN CHECK 15.
provisions of tire Labor Code, you most forthwith comply with -
U such provisions or this pcmnt shall be deemed revoked.o AIR HANDLING UNIT(TO 10=C-F.M.) 4.00 FEE EneroW 62.00
CONSTRUCTION LliNDINC AGENCY AIR HANDLING UNff(OVER 10=QFR) 6.00 SEISMIC FEE 9,73
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
30y47,Civ.C.) HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender,Namc Tt Pae-
Lender's Add 4Lf1-FI-�F-94111 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 55.50
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
ordinances n correct 1 agree to comply with all city and county PLUMBING 55.50
ordinance and state laws relating to building construction, and BOILER.COMP(3 H.P.Or 100,000 g.T.U.) 6.00
hereby authorize representatives of this city 10 enter upon the BOILER-COMP (Over 100,000 BTU(SEE FEE SCH.
above-mertionedproperty for inspection purposes. MECHANICAL 55.50
- (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. yy�
Cupertino against liabilities,judgments, Costs and expenms which CONST.TAX 12.02
may way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
On
Ing Ol lh per it
MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 1,331.75
Sign Or ApplicrintlCothoftant., tc
OFFICE COPY
CITY OF CUP ERTINO
f ,. •_ CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date ......�t.....4 .�.. Cl.
'. ... .., 19.. ..�,. Building Permit No. ...
The Building Located at ---1,_N.'.�
Owned by ... ..
I - ..
.I Has Been For Use As: ...........
(Altere ) ..............................
F ,
f'.
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BUILDING INSP GTOR
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