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15894POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS L�! `��TUNIT# _LOT# • - OWNER CONTRACTOR, PERMIT NUMBER 15894 PERMIT EXPIRATION PERMIT EXPIRES IF WORK - IS NOT STARTED WITHIN . 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION... INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE IN TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PREGUNITE PERMIT VALIDATION IjL`1/1� `ssu Are ' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED_ ��'� UNDERGROUND/SLAB PLUMBING 2 _� I I -AY 2 • ELECTRICAL MECHANICALS Y11L BLDG BLDG ELECr PLG. MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION7-T ( f -+ _. PLUMBING MECHANICAL ELECTRICAL - _ PERMIT TO g� FRAMING INSULATION - - �j STORIES TYPE CONSTR e.un OCC GROUP k-3 RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ". ROOF - NOTE: NO FINACINSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID SO, IT FI.IIORAHEA / TOTALACREAGE NI DIAPHRAGM - - ROOF SHEATHING PkV-b BUILOI USE REs IND CON PB on,,, ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ' ROUGH SAN.N , _ ASSESSORS PARCEL NO PLUMBING , �Jt 'Z ELECT. ENERGY TUBS &SHOWER PAN "'L PLUMBING ENERGY TRACING PTIM PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL. •Y ' - BUILDING ENERGY A7CY UA*E ncc. FILE No FRAMING - (• •(• ELECT. FINAL TEST - INSULATION !PLUMBING ZONING ENG. SITE NO. GAS TEST GAS ' MECHANICAL • FIRE SPRINK _ Y ❑ N❑ ENERGY T 24 Y [:3 N COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED .HEATING - EXTERIOR -SHEAR ' � ELECTRICAL RELEASE FL000 20NE Y ❑ NO A LAI C Y ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE 1E�iW GAS n NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. ULl ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INS o� PLEASE GIVE JOB ADDRESSWHEN PHONINGPECTION. Z —SEE PERMIT FOR EXPIRATION DATE — MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX TOTAL i 518.79 IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY ' • • 0 Z Z N LU W _ ao D Z UQ W U Ow } N z U APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING -MECHANICAL -PERMIT NUMBER . ' 15894. BUILDING 11912 Placer Wi Court Lot 327 ADDRESS OWNER'!(3rW" frQLIp9 Inc.PLAN NAME Vt cyv' �r .., .,r,F. 1„GNE415/595-2100 P QTY. ELECTRIC PERMIT FEE CHECK VALIDATION CONT Inc NAMERACTOR' V p,� J UTLETS -SWITCHES-RECEP 10.00/1.00 ' ua NOB -430097 . DATE OF APPLICATION . LIGHTING FIXTURES 10,00/1.00 CONTRACTORS220-C. win Dolphin Urive ADDRESS, CA 94065 PHONE RryM.AYa, 415/595-21 APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT SSenlan gonl ArchitectSPANELS OR ENGINEER L.C. No. C-8395 (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. - SIGNS TRANS. 3.00 ARCHOss ENG. 2031 Drive 1/100 SantaHeights. C ,92707 SPECIAL -CIRCUIT 5.00 PERMIT VALIDATION A TEMP. METER OR POLE INS. 20.00 AppRESS 20 C Twin Dolphin Drive ADDRESS MOTORS SEE FEE SCH. ISERVICE CHANGE pi,, i - 20.00 IX, CA -94065 I a n LICENSED CON TRACTORS DECLARATION 1 , - ' 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, d my license is in full rare yl (. License Class_ Con Number _y� LiceDatLic.N, lOf ANC$ DATE" BLDG. ELECT. PLG. MECH. of o M OWNER -BUILDER DECLARATION 1 hereby affirn that I exempt from the Contractor's License Law for the fallowing reason. (Sec. 7031.5, Business Professions impe:Anyeity County which structurep prior it alter, issuance, structure, a it signed to IIS Iateme t that requires, demolish,apicor repair any permit t such permions file n sCn t actemeN that requires lhep pursuant he ii Capslicensed pu rsom n the provisions of the Contractor's License Section is 00) exempt theren3 of the Law(Chapterr(commenC Code) or therefrom mW Business end Professions Code) or that he is cion BUILDING PERMIT INFORMATION MISC. - REFER TO ORD -PERMIT ISSUANCE 10.00 VALUATION $/FT. 179 / I Y' 1 ELEC,CONTR. LIC. NO. $LEC. TOTAL MV PERMIT TO rs I W , QTY. PLUMBING PERMIT FEE of the basis for the alhgcd exemption. Any violation of $action 707 L5 by any applicant l'or a pennihsubjects the applicant toe civil penally of not ore than five hundred dollars ($500).): m STORIES 2 TYPE CONSTR. 5WR ALTER -DRAIN & VENT -WATER (EA.) 5,00 ❑ I, as owner of the propery, or my employees with wages., their Sole compensation, will do the work, anti the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP R-3 RES. UNITS 1 DRAINS -FLOOR, ROOF, AREA,COND. 5.00 Code: The Contractor's License Law does not apply 4: an owner of FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- ments are not intended.,,,ffBred for sale. If, however, the building Sb. FT. FLOOR AREA 22/_Q e. & 5 TOTAL ACREAGE IJ or improvement is sold within one year of completion, the owner builder will have the burden of proving that ht did not build or im. prove for purpose of sale.). 131, as owner of the property, am exclusively coal ranting wilIt GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other ® ❑ ❑ ❑' ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business o License s th docs not apply and Professions Corp: The who to owner of properly who builds who improvesense(] LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5IEA.1 1.00 ASSESSORS PARCEL NO. _ �^ tr puand contracts for is L cenprojects with u enntracrnt sl license(] pursuant to tr the Contractor's License Law. ❑ l am exempt under Sac.-, B.&P.C. for ibis reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORK 17 RS'COMPENSA'ITON DECLARATION 1 hereby affirm that I have a certificate ofcnnsenl to self -insure, or a certificate of Worker.' Compensation Insurance, or a cerlilied ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lah.C.). Policy Nn. ComPany_] Paci-fic Certified Copy i, hereby form, mJ. Cerifie coy is filed with tho 'ly in�tmion division, Applicant � FIRE SPRINK v N ❑ ❑ ENERGY T]4 y N ❑ ❑ MISC.- REFERTO ORD. I 14 FIC TEOF Ii=I'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. ,COMPENSATION INSURANCE (This suction need not be completed if the permit is far one PLG. CONTR. LIC. NO. TOTAL Y ❑ N ❑ N Y ❑ ❑ hundred dollars IS 100) or less.) 1 certify that in the performance of the work I'or which this Per- mit is issued, I droll not employ dry person in any manner so as In QTY MECHANICAL PERMIT FEE FEE SUMMARY . BUILDING 916• 00 1 become subject to the Workers' Compclhsalion Laws of California. Date Applicant - NOTICE TO APPLICANT: If, after making this Certificate of Ex. ALTER OR ADD TO MECH. 5.00 - APPLIANCE 5.00 PLAN CHECK FEE '15:50 (O�ZZ 00 Lai you should become subject to lite Workers' Compensation provisions of the Labor Code, you most forthwith Com Ply wills such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10=11F.M.) 4.00 - AIR HANDLING UNIT (OVER 10,000GEM.) 6,00 SEISMIC FEE 12.53 CONSTRUCTION LENDING AGENCY 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. 3097, Civ.CJ. MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address H EATI N G UN IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC (73 58 1 certify that I have read (his application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct 1 egret to comply with all city and county ordinances and little laws relating to building construction, and PLUMBING 6S rr gQILEH-CUMP13 H.P. Dr 100,000 B.T.U.I 6.00 BOILER -COMP Over 100,000 BTU) SEE FEE SCH. MECHANICAL 68.58 hereby authorize representatives ins of this city to roller upon the above-mentioned properly forinsp of this purposes. (Wc) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. pertino against liabilities, judgments, costs and expenses which ay in any way accrue against said City in consequence of the302.02ami of this permit. Islu pERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH.TOTAL TOTAL ,513.79 lgnatAp`piicant/Contractor Dale OFFICE COPY