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13813 I (� POST THIS CARD NEAR FRONT OF BUILDING Hnu NUMBER �. CITY OF CUPERTINO 13813 INSPECTION DIVISION �QB INSPECTION RECORD 1 ((�� I/�LC�` Qom' /� LK7Z3 UNIT# LOT# >T 1 "N� of ' PERMIT EXPIRATION JOB ADDRESS l /" PERMIT EXPIRES IF WORK OWNER K Gwaou C' CONTRACTOR IS NOT STARTED WITHIN INSPECTION 6ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- NCE OR 180 DAYS FROM FOUNDATION 2 O ksTC&EDINSPECTION. UFER PREGUNITE w,IT vnu On TION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB quy PLUMBING - V� ELECTRICAL ISSUANCE DATE MECHANICALBLDG, ELECT. PLG. MECH. ❑ ❑ El 0 DO NOT POUR FLOOR UNTIL AB6VE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATIONv §/FT. PLUMBING A MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INS CATION , pt -�� UCC.GROUP RES.UNI i§ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • 'ROOF - - SO.FL FLOOR AREA TOTAL ACREAGE BUILDING USE HES IND CON PB Olnw APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ El ❑ E) ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING :2--2-RA GAS TEST p-/tom- iRACI NO. PARCEL N0. MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL - FINALS DATE INSP. FRAMING SAN *112234 zoNlNc ENG.SITE No. INSULATION PLUMBING GAS -lo �C. MECHANICAL _ _ `C FIRE SPRINK ENERGY T]a COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �j. Y "❑ Y NEI LATH-INTERIOR / -' >, ELECTRICALFLOOD ZONE A.L.U.C. LATH-EXTERIOR ll`y� FIRE DEPT. Y❑ NE V❑ NO SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING _ •'G- BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK - GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE / UCC UPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC S �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - . C �. IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY A,! BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ANDRESS R 11623 Forest Spring Court 138 3 r' (Lot 111 - Plan B BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OwNER'5 PLAN CHECK VALIDATION HAMSOTV. ELECTRIC PERMIT FEE Gregory Group, Inc.P„SNE - '95-2100 NONr"Acrons ! JL UTLETS-SWITCHES-RECEP 10.00/1.00 NAME , Gregory Group, Inc. LID.ND. 430097 LIGHTING FIXTURES 10.00/1.00 a OONTRAITI" 220 C Twin Dolphin Dr. PPLIANCES-RESIDENTIAL 4.00 ADDRE City, C OVE 595-2100 PANELS 10.00 DATE OF APPLICATION ARCHITECT ram assenian, ANELS (OVER 200 AMP) 20.E PLAN CHECK FEE P.C.NO. ENGINEER Associates ,C.NO. SIGNS TRANS. 3.00 ARCH.ORENG. PERMIT VALIDATION ADDRESS 3390 Westerly Place z #17 SPECIAL CIRCUIT 5.00 .nQ({►�1� t ��' Newport Beach, CA 21P�266O TEMP. METER OR POLE INS. 20.00 ADDRE94Ta 220 C Twin Dol him Dr. I MOTORS SEE FEE SCH. t7 Redwood Cit CA 9406 SERVICE CHANGE 20.00 alb w 0 o LICENSED CONTRACTORS DECLARATION �W " u 1 hereby aI irm that I am licensed under provisions cf Chapter 9 ISSUANCE DATE G Q w (commencing with Section 7000)of Division 3 of the Bi sinms and BLDG. ELECT. PLG. MECH. Prof.ions Code,and nh,license is in full force,4,laryryyy��cJJJ'FF�� i 0 - License Oa"-D Lic.Number 43U1il� Q w Date Contractor - ¢ m f r BUILDING PERMIT ¢ ¢ i OWNER-BUILDER DECLARATION INFORMATION w y I hereby al fvm that I am exempt from the ContraVALUATION ctor's License MISC.- REFER TO ORD ,. oj Law for the following reason.(Sec.7031,5,Businessmd Professions PERMIT ISSUANCE 10.00 S/FT. Code:Anycity ormunly which requires a permit to construct,alter. I[Z / SC 2 Q improve,demolish,or repair any structure,poor to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO X he is licensed Immount to the provisions of the Contractor's License iQ Law(Chapter 9(commenc'mgwith Sclion 70001nf Division3 oflhe p J i 4 D Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE V /c'� " � ¢ H the basis for the alleged exemption.Any violation of Section 7031.5 mSTORIES TYPE CONSTR. by any applicant for a permit subjects the applicant toacivil Penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 �jv of not ore than five hundred dollars(S500).): 131,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RF,S.UNITS their sole compensation,will do the work,and the stmctme is not r intended or offered for sale(Sec. 7674, Business and ProfessionsDRAINS-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 T13FIXTURES-PER TRAP 5,00 A sa FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- means mprove- /- mentsarenotintendedoroffered for sale.If,however the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 V or improvement is said 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 int- BUILDING USE prove for purpose of rale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Odie, ❑ 1,as owner of the Properly,am exclusively contracting with IN ❑ ❑ O D licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 1and Professions Code:'rhe Contractor,License Law docs not apply ASSESSORS PARCEL NO. t to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 3/ _9_ 3��3�� 3j mnlrucls for such projects with a cm t,,cImO)licensed pursuant In C' the Cunt amor's License Law, SEWER-SANITARY-STORM EA,200ft/10.00 / TRACT NO, PARCEL NO. ❑ lam exempt under Sea ,B.&P.C.furlhis I WATERHEATER W/VENT 6.00 7 �9f reason Owner Date WATER SYSTEM 5.00 ACC.DATE 'ACC.FILE NO. 1 WORK ERS'COMPENSA I ION DECLARA I ION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a ecUilicale of consent to self-innne, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or v¢nificd copy thermf(Sec.380),Lab.C.).United Pacific/RE Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Cenifcal E d I the city inspection division. p Applicant- MISC- REFER TO ORD. Y � N❑ Y � N� /~ PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c. / cc: rn CERTI FIC !OF EXEMPTION FROM WORKERS' LU - COMPENSATION INSURANCE PLG.CONTR. sic.NO. PLG. I/ v❑ N Y ❑ N CL Z (This section need not be completed if the permit is for one TOTAL hundred dollars IS 100)or In,.) V O I certify that in the Performance of the work for which this Ier- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL mit is issued,I shall nut employ any person in any manner so as to M:conlu subject to the Workeo''Compensation Laws of California. BUILDING s�SZs d nate Applicant ALTER OR ADD TO MECH. 5.00 >_ 0NOTICE TO APPLICANT: If,after making this Certificate of Ex- F.. 2 emption,you should become subject to the Workers'Compensation 4 APPLIANCE 5.00PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,0MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.EM.) 6.00 SEISMIC FEE Qr'� 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. MICROFILM 3097,Civ.C). HEATING UNIT ITO 100,000 B.T.U.) 8.00 Lenders Name security eacifi � � Lender's Addre-� -nr-1ZC-f� HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC � I Certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 / information u correct. I agree to comply with all city and county PLUMBING Old/ ordinances and state laws relating to building construction, anJ BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 1\ hereby uuthoriZC representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL , above-mentioned property for inspection purfwscs. (We) agree to save, indemnify and keep hannlem the City of MISC.- REFER TO ORD. / Cupertino against liabilities,judgments, costs and expenses which CONST.TAX 6- 4^/ may in any way accrue against said City in Co. ac Ce of the PERMIT ISSUANCE 10.00 0 granting of the MECH.CONT. LIC.NO. MECH. ff, TOTAL 5 TOTAL �S10 Signature of g ntaDid c,`c I OFFICE COPY