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13758 POST THIS CARD NEAR FRONT OF BUILDING PFRNIIT NUMBER . �. . CITY OF CUPERTINO 1375$ INSPECTION DIVISION JOB INSPECTION RECORD .F da ��� . JOB ADORES UNIT# SLOT# PERMIT EXPIRATIONPERMIT EXPIRES IF WORK OWNER ZltG CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION -I - ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER 5 PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /.SLAB PAI PLUMBING -30 W , ELECTRICALA1 c MECHANICAL BLDG. L'rCT 1, PLG. MECH. V Or DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .. BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING VALUATION $/FT. MECHANICAL F ' $1Q9�000.00 ELECTRICAL r PERMIT To r FRAMING INSULATION sroRlEs TYPE CONSTR. v. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF OFT FLOOR FNEF TOTAL ACREAGE • BUILDING USE - RES IND CON PB O,Iv, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING - GAS TEST TRACT No, PARCEL No, MECHANICAL - 12 ELECTRICALr FINALS DATE INSP. ACC DATE ACC.FILE NO. FRAMING 'i ��� SAN # 3O INSULATION ,y'. PLUMBING ZONING ENL.SITE No. GAS MECHANICAL , FIRE SPRINK ENERGY T"24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ No LATH-INTERIOR - ELECTRICAL FLOODZONE A.L.U.C. LATH-EXTERIOR FIRE DEPT. Y❑ N❑ I Y❑ IN SHEETROCK _ GRADE - FEE SUMMARY SHEAR INTERIORlow BUILDING SHEAR EXTERIOR -$- TEMPORARY APPROVALS BUILDING 455.50 FIREWALLS ELECTRIC I PLAN CHECK 295.08 G C GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BE N SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR I MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION.. I PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. aq nn - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! ! CONST.TAX 282.68 PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. $ l 0497.8_ OFFICE COPY ;zizAPPUCANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 13758 aoOREss ,LOT,4S PLAN 2A BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWry Ra PLAN CHECK VALIDATION in "AME 415 WSIGNSTRAN . ECTRIC PERMIT FEE dMiLiLGREGORY GROUP> IN6k NE CONTRACTORS ITCHES-RECEP 10.00/1.00 sampLlc.rvo. _ XTURES 10.00/1.00 20 00 ADDRESS tORS -RESIDENTIAL 4.00 220-C Twin Dolphin Dr. 12.00 PHONE 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. °R ARAM BASSENIAW AIA R 200 AMP) zo.00 ENGINEER uc.No. . 3.00 ADD ESS E SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 3990 West rly P Q,#170 EMP.METER OR POLE INS. 20.00 APPLI Bc a MOTORS SEE FEE SCH. aooREss 220-C Twin Dolphin Dr. SERVICE CHANGE TSIC 7.00 o a i Foo LICENSED CONTRACTORS DECLARATION a u u I hereby affirm (hat I am licensed under provisions of Chapter 9 H Q y (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE H w i Professions Code,and my license is in full force and effect. . ELECT. PLG. MECH. License Class_B_Lic.Number- C� 097 0 4 y w Date-Contractor _ {7 -Ly� ILY. w OWNER-BUILDER DECL TI N By�1/La�D,�ING PERMIT W ;'c i- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO �pyRJRMATIQN H u 0 ¢ Lew for the following reason.(Sec.7031.5,Business and Professions ALUATION $/FT. Code:Any city or county which requirese permit to construct,alter, PERMIT ISSUANCE ¢0 improve,demolish,or repair any structure,prior ro its issuance,also ELEC.CONTE. LIC.N0. EL -4$1('109,000.00 u w0`LL requires[he applicant for such permit to file a signed statement that TOTAL S he is licensed pursuant to the provisions of the Contractor's License � E(M,IITT/O Law 9(commencing with Section 7000)of Division 3 ofthe HiQ C- g i 0 Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢r the basis for the allefd exemption.Any violation of Section 7031.5 u ; by any applicant for a permit subjects the applicant toa civil penally STORIES TYPE CONSTR. of not more than five hundred dollars(SS00).): ALTER-DRAIN III VENT-WATER (EA.) 5.00S',(� O I,as owner of the property,or my employees with wages as -91 BACK FLOW PROTECT. DEV ICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (See. 7044, Business and Professions Code ROOF,AREA,CON D. 5.00 �_. Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00EO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve 1 ments are not intended or offered for Sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). RES IND CON PS Other ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ® 11 El 1:1 El contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO. to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 q contracts for such projects with a contmctor(s)licensed pursuant to 3 G 6- 9- -3I i7 z 3J the Contractor's License Law. 1 SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this reason WATER HEATERW/VENT 6,00 Owner Date WATER SYSTEM r 79 7 Ste-" 5'00 ACC.DATE ACC.FILE NO. WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.005.0 I hereby affirm that 1 have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0. copy thereof(Sec 3600,Lab.0 I 1.,' Policy No. Company-Uys.f_tQd-Pa_C.i_f i-C_ ❑ Certified copy is hereby furnished. Z Z X Certified c py is 1 Iwith ity inspection division. FIRE SPRINK ENERGY T-24 O Applicant /r'' MISC.- REFER TO ORD. Y [] NE] Y [:) N� H PERMIT ISSUANCE fry CERTIFICA OFSATION EXEMPTIONFROMWORKERS' 10.00 PLOOD ZONE A.L.U.C. Wa Q COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG Z (This section need not be completed if the permit is for one TOTAL Y N� Y ❑ No U O hundred dollars IS 100)or less.) 1 certify that in the performance of the work for which this per- CITY FEE SUMMARY LL U unit is issued, I shall not employ any person in any manner so as to MECHANICAL PERMIT FEE U W become subject to the Workers'Compensation Laws of California. M Date Applicant ALTER OR ADD TO BUILDING 455.50 >_ 2 NOTICE TO APPLICANT: If,after making this Certificate of Ex- MECH. 5.00 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 provisions of the Labor Code, you must forthwith comply with PLAN CHEC I296.08 U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIRHANDLINGUNIT(OVER10=C.F.M.) 6.00 SEISMIC FEE (3 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for wh�Iich tp�1,7ermit is issued(Sec. MICROFILM 3097,Civ.C.). SaCramen-LO J61L HEATING UNIT(TO 100,000 B.T.U.) 6.00 Lender's Name Lender's Address 3�s-Qr a�fOi"-ntl(1-SQt- HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC 1g9.00 I certify that 1 hR v d this is I P§a state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating m building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (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 ecrue against sai City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX granting of thi 'L MECH.CONT. LIC.NO. MECH. 282.69 / TOTAL TOTAL Signature ofA f nt/Contractor Da 55.00 $ 1 ,497 89 OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERMIT NUMBER 535 " INSPECTION DIVISION " JOB INSPECTION,RECORD 1WPERMIT EXPIRATION - JOB ADDRESS 11584 Evening' Spring Court UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER Gregory Group CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PCHr,ur VALIDATION GARAGE SLABS CUPERTINO STANDARDS. 'J POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB y� "••- PLUMBING ELECTRICAL - i 'ISSUANCE DATE MECHANICAL 7 BLDG ELECT.I PLG. I MECH ❑ ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED L� BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION $SFT, PLUMBING _ I MECHANICAL - ELECTRICAL ... PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR, OCC.GROUP RES UNITS —�� PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT 1LOON AREA TOTAL ACREAGE \ ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE i DIAPHRAGM THE CONSTRUCTION TAX IS PAID y; ROOF SHEATHING RES ND aDCON USE om', APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ nSSE SSORS PARCEL NO ROUGH SAN.a PLUMBING ELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY IHACT NO PARCEL NO MECHANICAL MECH.ENERGY ' ELECTRICAL BUILDING ENERGY Acc.DATE Acc.PILE No FRAMING ELECT.FINAL TEST INSULATION PLUMBING - ZONING ENG.SITE NO. GAS TEST GAS MECHANICAL FIRESPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ❑ "❑ ` ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE AL UC. �. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH I TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE-.OR PLASTER UNTIL ABOVE-HAS SIGNED occuPANcv SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC _rte cl; H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MEHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE �� CALLING FOR FINAL INSPECTION. TOTAL • ' ', '� OFFICE COPY - J_. r ,. rye' "�z, . . 1, � � r APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY �UI LDI NG PROJECT I DENT]FICATION PERMIT NUMBER mar-mus. APPLICATION & PERMIT ADDRESS SnBUILDING-ELECTRICAL-PLUMBING-MECHANICAL 15-351[ [1 wrvER's j - PLAN CHECK VALIDATION Ln >E 7 rvnmE L /d OTY. ELECTRIC PERMIT FEE PHONE NAIVE OUTLETS-SWITCHES-RECEP 10.00/1.00 �-zi/41a uc.N LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ` ADDRESS .Shhp ✓'� q _APPLIANCES-RESIDENTIAL 4.00 vuONE . Jp2P PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.N0. OR PANELS (OVER 200 AMP) - 20.00 ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH,OR ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIF EMP.METER O POLE INS 20.00' ^ APPLICANT'$ ADDRESS MOTORS SEE FEE SCH. ( SERVICE CHANGE 20.00 Y r n Foo - LICENSED CONTRACTORS DECLARATION a u I hereby affirm that I am licensed under provisions of Chapter 9 w - ISSUANCE DATE Nay (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H N Z Professions Cod• rid license is in full force ❑ ❑ ❑ o i H p 1-ic4nse C'ss Lic.Nunther Uute �4 Conlmnnr�'-- a r BUILDING PERMIT Q w OWNER-BUILDER DECLARATION INFORMATION E ;LL w 1 hereby affirm that I am exempt from tire Contractor's License MISC.- REFER TO ORD aL o j Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION � - Code:Any city or county which requires a PERMIT ISSUANCE 10.00 Q 5/FT. l Permit at Q ¢O improve,demolish,or repair anyoittstructure.prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC O u requires the applicant for such perntil to lite a signed statement that TOTAL C� PERMIT TO A w m he is licensed pursuant to the provisions of the Contractor's License _ FZQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the i D Business coil Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE IY F m the basis for thealleged exanplion.Any violation of Section 7031.5 STORIES TYPE CONSTR. a3 _ by any applicant for a permitsubjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ h as owner of the property,or my employees withwages as BACK FLOW PROTECT. DEV ICE 4.00 their sole compensation,will do the work,and Om in n¢turc is not . 00C.GROUP RES.UNITS intended or offered for tele (Ser. 7044, Business and ore DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of - -'�' + property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 5 himself or through his own employees,provided that such improve- so.FT.FLOOR AREA TOTAL ACREAGE mvnts are not intended-roffered for clic.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 r or improvement is sold within one year of completion,tie owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or an- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Dore. ❑ 1,as owner of the property,am exclusively contracting with ,Rnd l`ed contractors to construct the project(Sec. 7044.Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCE L NO. and sed contractors Code:Thu Contractor's License Law 7044 not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts forsuch projects with a contractor(,)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO. ❑ lain exempt under See. ,B.&P.C.for this 6.00 reason WATER HEATER W/VENT Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. wo RK ERS'COMPF.NSnTION DECLARn'nON WATER TREATING-EQUIP 1 hereby affirm that 1 have a ceni0cam of consent to self-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. IRPy thereof(Sec.3800,LaKC.). Policy No. Company U `❑,r Certified copy is her(ry f rnish4J.y Z Z }t Certd p i fs with 0 • ci i ec n division. FIRE SPRINK ENERGY T 24 Pp ppilnnt _ I MISC.- REFER TO ORD. YNEI=,L.� F] N[] M W CIRRI ICATS 01'li x E.MPTION PROM WORKERS' PERMIT ISSUANCE 10.00 LU 1 COMPENSATION INSURANCE PLG.CONTR. L.U.C. LIC.NO. PLG.tThic 40ctiun 0107 not he completed if Wp permit is (or one TOTAL E3 N[] UO him fireddollars[51001 Pe less.) I certify Ihat li the t clupmunce of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY 0 H mit is issued, I shall not rkers' any person in any manvcr so as to � w become subject to tlIe Workers'Compensation Laws of Cnliforniu. a Dmf APPLICANT I ALTER OR ADD TO MECH. BUILDING } to NOl'ICF,TO AI'PLICAN'T: If after making Otis Q•rl ilicate of fix- 5.00 F Z mnption,you should become subject to the Worker-i Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000OF.M) 4.00 FEE CONSTRUCTION L17NDING AGENCY AIRHANDLINGUNIT(OVER 10pODOEM.16.00 SEISMIC FEE 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. 3097,Civ.C.). �- RL G UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Leader's Name Lender's Address , G UNIT 100,000 B.T.U.)9.50 ELECTRIC D 00 I certify that I have read this application and state that the aboveTION FAN (SINGLE) 4,00 information is correct I agree to comply with all city and county PLUMBING ordinances and state laws relining to building construction, and COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby oulhuriee representatives of (his city to enter upon th1 - above-mentioned property for inspection purposes. COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save ' it f y and keep harmlesslhe City ofREFER TO ORD. upertino again d li' 7itics,ju hit lts, costs and 4xpepses which CONST.TAX may in any way erne against saii'aty in conseyu0 a of theISSUANCE 10.00 rdldl thr LIC.NO. MECH. OTAL ^® sign=of Applicant/Contractort0 y TOTAL CJ{ OFFICE COPY 2 I