15868 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
•CITY OF- CUPERTINO 15868
INSPECTION DIVISION
JOB INSPECTION RECORD
9 PERMIT EXPIRATION
JOB ADDRESS V ! 1— LOT
��n -- � PERMIT EXPIRES-IF WORK
OWNER �r pIJ corvTR ACTOR �'s1G1 �-Qa 'G��QD cJ I5.NOT STARTED WITHIN
INSPECTION D E INSPECTOR INSPECTI N RECOR 180 DAYS OF PERMIT ISSU.
FOUNDATION• ANCE OR 180 DAYS FROM
NOTE: _ LASTCALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
- PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF � PERMIT VALIDATION
G1D(I�M�IS
b Le£xi,° l,S FI
' GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .I -
UNDERGROUND /SLAB
PLUMBING �, tY ' -,Ire
ELECTRICAL ISSUANCE:DATE
MECH.
MECHANICAL 1pELECT PLO.
�
DO NOT POUR FLOORUNTILABOVE HAS BEEN SIGNED - t B c PERMIT
INFOR
WOOD FLOOR .`a� INFORMATION
PLUMBING - - C;� Ot CLQ N SIFT.
MECHANICAL
RMI1 TO
ELECTRICAL
FRAMING
Jt '
-
STORIES _. vPE CONSTR. .
INSULATION -
COG OHouP RM—UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
SO I,rlOODAIlEA i0i/•L ACR_EPGE
ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
_ RUILoINr.use
ROOF SHEATHING - REj .'IrvD Cory PR un..,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ o 13 '
nSSEBSORS VAHCELNq
ROUGHSAN.N
PLUMBING ELECT.ENERGY TRACT N o
TUBS 8 SHOWER PAN - PLUMBING ENERGY -
MECHANICAL �_'• ��'" - MECH.ENERGY
ELECTRICAL - ACC.DATE ACC,PILE No.
BUILDING ENERGY
FRAMING . _ ELECT.FINAL TEST _ ZONING ENG:SITE NO
'INSULATION _� — � PLUMBING
I
GAS TEST GAS
MECHANICAL --TIRE SPRINK. Ervencv T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '•� �� .A.LT N❑
EXTERIOR SHEAR ELECTRICAL RELEASE PLaaO ZONEuc.
INTERIOR SHEAR _IZ_ FIRE DEPT. v ❑, N� v ❑ N❑
SHEETROCK _ GRADE FEE SUMMARY
EXTERIOR LATH L, BUILDING '
INTERIOR LATH' 0 'TEMPORARYA APPROVALS BUILDING
SCRATCH COAT "�ZY"`�. 9 4= ' ELECTRIC PLAN CHECK 15a
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1110,71
OCCUPANCY OF BU ILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION'BY PHONING 252-4505, ELECTRIC 0.35
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE.JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!. CONST.TAX '
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I PROJECT IDENTIFICATION .PERMIT NUMBER
BUILDING 11763 Trinity Spring Cant APPLICATION & PERMIT' 15868
. AOOREss
Lot 294 3B BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
�MERS fye,yq..+r GroUp, T PLAN CHECK VALIDATION
nson`�DeveeloRrent9 1 415/5952100 D� ELECTRIC PERMIT FEE
PHONE
NOANMERAcro R's UTLETS-SWITCHES-RECEP 10.00/1.00
GrtWr'Grow, Int' LIC.No.B-43 7 LIGHTING FIXTURES 10.00/1.00
CGNTRACTORs win Dolphin Dr. APPLIANCES-RESIDENTIAL 4.00
RWC E�4065 „N„E 415/595-21 PANELS 10.00 DATE OF APPLICATION
ARCHITECT Arm Basseni Nps ANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.O.NO.
OR
ENGINEER Associates C
lua No. SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
- AODRESS 2�Da.3,.1 Orchardor., 1 SPECIALCIRCUIT 5.00 '
Santa Ma i ts.'si CA zIP 92707 EMP.METER OR POLE INS. 20.00 - .
APPLICANTS MOTORS- SEE FEE SCH. 1�
AopRE s
2 Twin Dolphin Dr. Ib,C 94065 SERVICE CHANGE 20.00
o M_
F O O LICI'.NSIiD CONTRACTORS DECLARATION
v u I hereby affirm that I am licensed under Provisions of Chapter 9 ISSUANCE DATE
wG w (conunencing with Section 7000)solUivision 3'.f the Business and BLDG. ELECT. PLG. MECH
F w z Professions Code,®d my license is in tW effect.
z 0 o Cicenxu C�W.Is
,In_It I J '.pp-Cunt Tactor_
s -a - / BUILDING PERMIT _
te Q w 4 OWNIi R-BUILDF-R DECLARATION INFORMATION
o A U MISC.- REFER TO ORD
X ;u N 1 hereby ufOrm Ihm I ran exempt from the Contractor's License
a. 04 Law fur tiro fullowing rcasou.(Sol.7031.5.B minaeand Professions PERMIT ISSUANCE 1000 , VALUATION S/FT.
Cale:Any city orcounty which rerjuires B permit ro construct,alien
G0 improve,demolish,or repair any structure,prior io its isuanm:also ELEC.CONTR. LIC.NO. ELEC. 152,727
K O or requires the applicant for such pgrmil to file a signed statement that ., TOTAL PERMITTO
A w he is licensed pursuant to the provisions of the Contractors License
F z r Law.(Chapter 9(commencing with Section 7000)of Uivision 3 ofthe
4 Business and Professions Cale)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE SF L
the basis for the alleged exemption.Any violation u(Section 7031.5 STORIES TYPE CONSTR.
dam _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not mom than five hundred dollars(S500).): 2 5
❑ 1,as owner,of the proscoy,or my com o,ces with wages as BACK FLOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS
their sok compensation,will do the work,and the sectio e u not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:.The Contractor's License Law does not apply to an owner of R-3 1
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 Sa FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
ments arenot intended or offered for sale.It,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 2349
or improvement is sold within one year of completion, the owner- 2349
-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or ntI- BUILDING USE
Prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 Re; IND CON PS Other
❑ I,as owner of the property,am.exclusively contracting with a ❑ ❑ ❑ ❑
licensed contractors to construct the project(See 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 366-09-31,32,33
contracts for such pmyuctswith a...tractorts)licensed Pursuant to SEWER-SANITARY-STORM EA.200it/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
❑ I am oxempt under See. .B.&P.C.for this WATER HEATER W/VENT 6.00 8098
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE NO,
WORK ERS'COMPENSA'I'ION UHCLARA"TION WATER TREATING EQUIP. 500 _
hereby affirm (hut 1 have u ci,rtifcmc of consent to self-insure- ZONING
or u certificate of Werkcrd Compcn.cition Insurance,or a certified ENG-SITE NO.
copy thereof(See.3800,Lab.C.).Wited .Pacific -
Policy No. Cnmpuny
O ❑ Certified copy is briefly tarnished, FIRE SPRINK ENERGY T-24
Z Z Hfc Ie til with the city inspection division. MISC.- REFER TO ORD.
O Ap aant V ❑ N❑ Y ❑ N❑
Mto CIi RTI FICAIT'OPLrli PTION.FROM WORK ERs' PERMIT ISSUANCE 10.00 PLOODZONE A.L.U.C.
ILS COMITNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. YE] NE] YE] N❑
*.Q- Z This section need nut be cma,bbed if the Permit u for one TOTAL
hundred dollars IS 100)or less.)
U O 1 ecnity that in the perfunnencc of the work for which this Per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not enlPWy any person in any manner so as to
U become subject to the Workers'Compensation Wes of California.
U Or Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} 0 ' NOTICIi TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you should become subject to the Workeri Compensation APPLIANCE' 5.00 PLAN CHECK $15.50
Provisions of the Labor Code, you most forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOOF.M) 4.00 FEE $52.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE $10.71
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.). p,,,,,.,, HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's N. '❑t it Pacific
Lender's AJdnss�s HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC $60,35
I ce,ity that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
_ information is correct. I agree to comply with all city and county - - PLUMBING '�C
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 1 DO,D00 B.T.U.) 6.00
hereby authorize repmortictivs of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned property for inspection purWses. .35
(We) agree to save, indemnity and keep harmless the City of MISC.- REFER TO ORD.
against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
nay in any way accrue against said City in consequcnee of the - 7.03
this p mntil. I' MECH.CONT: LIC.NO. MECH.
TOTALTOTAL �Fy[upa,timl
i ore o pplican /Contractor Dec 1391.29
OFFICE COPY