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13731 (2) I, POST THIS CARD NEAR FRONT OF BUILDING ' PERKIIT NUMBER . CITY OF CUPERTINO . , 13731 INSPECTION DIVISION _ JOB INSPECTION RECORD IIPERMIT EXPIRATION JOB ADD SS �.E /P�G"-? UNIT# LOT# �^ PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT.STARTED WITHIN INSPECTION DATE INVECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER �J.2- -�o-BS >xJ �LASTCA LEDINSPECTION.. . PREGUNITE Q��„fl8 T.HGLO CbWS 3R-OPL-to PER I TION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED DEC 3 Q 1981 UNDERGROUND /SLAB CIly pf��q,�-p��"F .� PLUMBING �� - "wo ELECTRICAL ISSUANCE DATE, MECHANICAL - BLDG. ELECT. PLG. MECH. ❑/_ ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT p INFORMATION WOOD FLOOR VALUATION S/FT. PLUMBING $971000.0 MECHANICAL ELECTRICAL PERMIT TO - FRAMING STORIES TYPE CONSTR. INSULATION _ OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - J ROOF O.FT.FLUOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE 19_Q RES IND CON PB Olney APPLY NO ROOFING UNTIL ABOVE HAGS BEEN SIGNED El 0 El El ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL' ELECTRICALACC,DATE ACC.FILENO. , FINALS DATE INSP. � .� FRAMING SAN # /,)-3.22 ZONING ENG.SITE NO. INSULATION PLUMBING 0-2�_ FIRE SPNINK ENERGY h]G' MECHANICAL p -.29-w COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING T n•� NE Y 1:1 NEI' EL000 ZONE A;L.0 c. LATH-INTERIOR 6-Ao- ELECTRICALr7- LATH-EXTERIOR �- FIRE DEPT. Y❑ N[] v �] N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR 5 BUILDING SHEAR EXTERIOR ..a TEMPORARY APPROVALS BUILDING 424.00 FIREWALLS ELECTRIC- -' PLAN CHECK 275.60 GAS FEE !energy 160.00 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY 'SEISMIC FEE 6.79 OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM- ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 142.00 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 92,00 Z .P PLEASE GIVE JOB ADDRESS WHENHONING. - SEE PERMIT FOR EXPIRATION DATE MECHANICAL IMPORTANT! CONST.TAX 282.68 PLEASE READ REVERSE SIDE BEFORETOTAL 1 .434.07 CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER B°Ilpl"G 0 an APPLICATION & PERMIT '_ 13731 BUILDING - ELECTRICA -PLUMBING-MECHANICAL OWNER'S i -FLAN VALIDATION ""ME 415 OTV. ELECTRIC PERMIT FEE GREGORY GROUP InONE coNrRAcroRs NAME Bis UTLETS-SWITCHES-RECEP 10,00/1.00 86,00 SAME uc.NO. _ LIGHTING FIXTURES 10.00/1.00 CONACIDTRACTOR R's f�TI�I PPLIANCES-RESIDENTIAL 4.00 n lll-ONE nRWC. _ PANELS 10.00 ton GATE OF APPLICATION RcmTER PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c.No. O OR ENIAN> AIA NGI EE LIAI / % SIGNS TRANS. 3.00 ARCHOR ENG.3^^D We StP.rly Place #17D S,DD PERMIT VALIDATION ARCH OR l�tJ SPECIAL CIRCUIT P�aMIT New ort Bch. CA. ZIP EMP.METER OR POLE INS. 20.00 APPLICANT SMOTORS SEE FEE SCH. ADDRESS 220-C Twin Dolphin Dr. EC�� RWC CA, 94065 -SERVICE CHANGE 20.00 00 o LICENSED CONTRACTORS DECLARATION C4 Of a v U I hereby mlinn that I am licensed under provisions of Chapter 9 - ..SATE Nam (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F 0 z Profession Codar�rtd my license is in full fore �jke{ z O sv(- Licenu Clas_O Lic.Number U`�l ❑ ❑ ❑ o H Dale Comouem a y BUILDING PERMIT A , OWNER-BUILDER DI: A ATION INFORMATION A. r I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION $/FT. a a. o`� Law for the following reason.(Sec.7031.5,Bund sand Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, $97,000.0 aG FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC. O S, requires the applicant for such Permit to Ille a signed statement that TOTAL PERMIT TO w $m he is licensed pursuant to the provisions of the Contractor's License ^ rir Law(Chapter9(commencing with Section 7000)ofDivision3 ofthe J 1h\J a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE R=$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 /� /�� of not moa than fisc hundred dollars($500).'. Q - S1V q Aa ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure u not OCG GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Profession DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Vr Code:The Contractor's License Law docs not apply to an owner of property who builds or Impfnvl5 thereon,and who does.such work FIXTURES-PER TRAP 5,00 I Sa FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- me mprove- GAS-EA.SYSTEM-1 INCA OUTLETS 6.00 menus are not intended or offered for sale.If.however,the building Or improvement is sold within one year of completion,the owner- bei wner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE Oma builder will have the burden of proving that he did not hiss'!d or ire prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 E IND CON PB CJ 1.as owner of the property,am exclusively Conus Hng with ❑ ❑ ❑ E] licensed contractors to construct lire project(Sec. 7044, Businv 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.) 1.00R(n) n _ 7I ZContractsfor such projects with a conlmcmds)licensed pursuant to 1 3the Contract sLicense Law. SEWER-SANITARY-STORM EA.200ft/10.00RACTNO. ARCE lamcxcmptundcrSec. ,B.&P.C.forthisATER HEATER W/VENT 6.00 reasonOwner Date WATER SYSTEM 5.00CCDATEACG FILE NO. WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00I hereby affiirm that I have u certif kale ofConant to self-inure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certifiedcopy thcrcoflSec.3800,Lab.COnited Pac fie- #Policy No. companyU -L O O Certified copy is hereby(.Hushed. RE SPRINK ENERGY TY4 Z Z )Q Cenlfi•d c I• Th the city inspection division. MISC.- REFER TO ORD,O APPlicant_ _ �s .❑ N❑ Y ❑ N❑CC CERTIF F,OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00OOD ZONE A.L.l1.C. LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. L.G.P1 Q. O TOTAL I Y❑ N❑ Y❑ N❑ � Z (This section need not he completed if the unit is for o Hundred dollars(5100)or less.) one U O 1 certify that In the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. y Dam ApplicantALTER OR ADD TO MECH. 5.00 BUILDING 424.00 j- N NO'T'ICE TO APPLICANT: If,after making this Ccrtitleate of fix F Z col ption,you should bee comsubject to the Workers'Comm pealion APPLIANCE 5.00 PLAN CHECK 275.60 provisions of the Labor Code, you most forthwith comply with FEE such provisions or this permit shall be decreed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00 160 no CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10DMC.F.M.) 6.00 SEISMIC FEE 6.79 1 hereby uffirin that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performanceId �y Es� h permit is issued(Sec. MICROFILM 3097,Civ.CJ, II �ktlflHEATING UNIT(TO 100,000 B.T.U.) 8.00 8.00 Lender's Name Address 9.9-Bradford-St- �.ffl HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 142.0 Lender's Addr^ ❑/1f1 p I certify that I above 2 VENTILATION FAN (SINGLE) 4.00 8.00 information is correct.1 agree to comply with all city and county PLUMBING 92.00 ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.1 6.00 hereby authorize mpmuntatives of this city to enter upon the BOILER-COMP (Oxer IO0.D00 BTU)SEE FEE SCH. MECHANICAL ,i above-mentioned property for inspection purposes. si no (Wc) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgmenu, cusp and expenses which PERMIT ISSUANCE 10,D0 CONST.TAX 282.68 may m any way econ .against said City in consequence of the10.00 grantingof lh a MECH.CONT. LIC.NO. MECH. /�f� TOTAL 51 .00 TOTAL $1 ,434.07 p Signatur lcanl ru on te for - ale / -r OFFICECOPV