13734 POST THIS CARD NEAR FRONT OF BUILDING
PCRMIT NUMBER
CITY OF CUPERTINO 13734
1 INSPECTION DIVISION
• 0, JOB INSPECTION RECORD
s,�✓ T PERMIT EXPIRATION
RE
JOB ADDSzza : 4 y' '�> �i UNIT# 'LOT#
- PERMIT EXPIRES IF WORK
OWNER QQ/,7 CONTRACTOR IS NOT STARTED WITHIN
INSPECTI DATE IN CTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
_ FOUNDATIONX017( ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER - '
PREGUNITE - - - �, I/�^ $ arp PERMIT VALIDATION
,9JO,C1iL ..
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING '
ELECTRICAL ISSUANCE DATE
MECHANICAL - ECT. PLG. MECR
0' ❑tAP 'Y-11-fno
.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDD C 3� PERMIT
WOOD'FLOOR Y ATION
VA UATI l' $/ET.
PLUMBING
MECHANICAL
ELECTRICAL - PER MIT TO-
FRAMING _ J `
INSULATION
STORIES TYPE CONSTR.
'
�3a J
UCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - SO.FT.FLOOR AREA TOTAL ACREAGE'
DIAPHRAGM 1
BUILOI
' HES IND CON ON -
PB Utl"r '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ CD Cl ❑ El
ASSESSORS PARCEL NO.
ROUGH
PLUMBINGZ7V A44 If, Q.
J TRACT NO PARCEL NO.
GAS TEST 6 4a2 -
MECHANICAL - I
ACC.DATE ACC.FILE NO.
ELECTRICAL :n- FINALS DATE INSP. -
FRAMING -a SAN MF'7
ZONING ENG.SITE NO.
INSULATION -a PLUMBING -
GAS
Q MECHANICAL FIRE SPRINK ENERGY T24
S6eCIACIACOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NEI ° 11 NEI
.
LATH-INTERIOR ELECTRICAL FLOODZONE A U.C.
LATH-EXTERIOR FIRE DEPT. I Y❑ N❑ Y❑ N❑
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING 0f(f Q42
SHEAR EXTERIOR _3O„ TEMPORARY APPROVALS BUILDING ar';.50
FIREWALLS ELECTRIC ) PLAN CHECK
GAS FEE /energy M-88
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR) MICROFILM
t )
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 149.00
oONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z 1 PLEASE GIVE JOB ADDRESS WHEN PHONING.
_ I
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. 19497.6341
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
s - 'BU I LDING PROJECT I DENT]FICAT1 N PERMIT NUMBER
_ ADDRESS Lot /{ SYPlan 2AR APPLICATION & PERMIT � ����
115x3 Fallcreek Sprint Court BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER' PLAN CHECK VALIDATION
_ NAME C;Qr-
GREGORY GROUP, ING]LNE 415- DTV. ELECTRIC PERMIT FEE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
SAME LIC.ND.B-430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS 220-C Twin Dolphin Dr.
19 00
CA 9406S 41E PRONE PANELS 10.08 GATE OF APPLICATION
pR °T PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER ARAM BASSENIA[AP&ASSOC< SIGNS TRANS. 3.00
ARCM.OR ENG. PERMIT VALIDATION
AO°HESS 3990 Westerly Place 11170 SPECIAL CIRCUIT 5.00 ,
CA
iI EMP.METER OR POLE INS. 20.00
ADDRES rs MOTORS SEE FEE SCH.
ADDRESS 220�WC-C Twin Dol bin Dr.
SERVICE CHANGE '20.00
o o LICENSED CONTRACTORS DECLARATION
a i W I hereby affirm that 1 am licensed under provision of Chapter 9 V,I 19WANCE DATE
a a (commencing with Secti(+n 7000)of Division 3 of the�B�u1siness and DG. ELECT. PLG. MECH.
r H i Professiom Cale,ennjji,my license is in full force I j W
Z O w - License Class_IS_Lic.Number V7
o Z s. Dole ControcW _ -
a m s a BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DEC RATION
¢ w u INFORMATION
we m I hereby affirm that I am exempt from the Contractor's License misc.- REFER TO ORD
u O j Law for the followin VALUATION $/FT.
r - grcawn.(Sec.703LS,tlusinmandProfessions PERMIT ISSUANCE 10.00 lO.00;
3 ,A as Code:Anycity orcounty which requiresa pemtit lomnstruct,elten, 1D9 ODO.D
ac ¢ a ° improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC,NO. ELEC. E
°u requires the applicant for such permit to file a signed statement that TOTAL w PERMIT TO he&licensed pursuant to the provisions of the Contractors License L
Law(Chapter 9(commeneingwith Section 7000)of Division 3 ofthe I F[7�(/
- a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
E x O
¢F the basis for the alleged exemption.Any violation o ction 7031.5 1 STORIES TYPE CONSTR.
sS - by any applicant fora permit subjects the applicant
to acivil Penalty
of not moa Than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
: CIZ,, J__A/l
elt-
0 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
then sale compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAIN$-FLOOR,ROOF,AR EA.COND. 5.00 �- 3 �.
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves themon,and who dose;such work F IXTUR E$-PER TRAP 5.00 SG.FT FLOOR AREA TOTAL ACREAGE
himselfornet intended
ownemployees.sale.If,however,
the
improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00 1
mems are not intended or offered for Selo.If,ed that s the building
or Improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES INC CDN PB otnx
Prove
for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,u owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 A55E550R5 PARCEL NO.
and Professions Code:The Contractor's License Law does not apply / /
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 3N b-9-3
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Low. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec.-.B.&P.C.for this WATER HEATER W/VENT 6.00
reason 7 9 y s
Owner Dam - WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby afOtm that 1 have a certifcate of convent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab C) ��/ SF
Policy No. company Un]_ted_Pac-i_f;.c_
O O Certified ropy isr yfuml FIRE SPRINK ENERGY T 24
z Z Certified co ed Aali/Ife airy inslxclion division.
p AAieant MISC.- REFER TO ORD.
rf\/ Y[:] NE] Y [:) NE]
~ w
- CERTI FI Tli OF EXEMPTION PPERMIT ISSUANCE 10.00
ROM WORKERS' FLOOD ZONE AL.U.C.
W > COMPEN$ATION INSURANCE I PLG.CONTE. ❑C.No. PLG. IV
d 0 (This Action need not be compermit
pleted if the is for one TOTAL 001 Y[:3 NE] Y [:] IN
Z In and rad dollars IS 100)or less.)
U O 1 Certify that in the performance of the work for which this per-, CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers Compensation Laws of California.
n
Date-Applicant TO MECH. 5.00 BUILDING 455.50
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD
♦- ? emotion,you should become subject In the Workers'Compen nation APPLIANCE 5.0000 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with
U such provisions or this permit sha l be deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.NL) 4.00 FEE /ener
JHA
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.K) 6.00 SEISMIC FEE F3
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
r no
the performance 52f the work for whict i permit is issued(Sec. MICROFILM
3097,Civ.C.). AaCraRlentO L HEATING UNIT(TO 102,000 B.T.U.1 8.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 149.00
Lenders Addmssnp���.(`(��radgfOY'd-5°t.._1/7Q1 ELECTRIC
I certify that 1p]� aWn, sl�hlls3n and state that the above VENTILATION FAN (SINGLE) 4.00
12
in
is c f c . I agree to comply with all city and county PLUMBING
ordinances and sato laws relating to building construction, and BOILER-COFiP(3 H.P.or 100,000 B.T.U.) 6.00
hum by authorlm representatives of ink city to enter upon the BOILER-COMP Over 10o,ODO BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
55 00
(We).agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, cmb and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the282.68
granting of permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signata pphcanl/Cnlmclor at - - 55.00 $1
1 ,497.8
OFFICE COPY