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13814 ' • Y POST THIS CARD NEAR FRONT OF BUILDING PFl,RMIL NUMBER CITY OF CUPERTINO 13814 • JNSPECTION DIVISION " JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS ��`3`3 S�R/N6 - C•T UNIT# LOT# �- PERMIT EXPIRES IF WORK OWNER ^ - fiO/C U CONTRACTOR IS NOT STARTED WITHIN INSPECTIOW ibATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM • FOUNDATION LASTCALLED INSPECTION. UFER PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED A F UNDERGROUND /SLAB Cyi PLUMBING 4 ELECTRICAL pMdMMEDATE M MECHANICAL - PLG. IUD, ❑ ❑ ❑ 0 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION1 WOOD FLOOR VALUATION s/ET. PLUMBING MECHANICAL PERMIT TO ELECTRICAL Iv/ FRAMING STORIES TYPE CONSTR, IN CATION _ _ 3. . >v6 OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50 IT.FLOOR AflEP TOTAL ACREAGE ROOF DIAPHRAGM BUILDINGUSE -2-13 .5 RES IND CON PB O'nw APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 1:1 1:1 1:1 E) ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST _ TRACT NO. PARCEL NO. 71- MECHANICAL ACC,DATE ACC FILE No. ELECTRICALFINALS DATE INSP. - - FRAMING ' SAN # a ZONING ENG.SITE No. INSULATION PLUMBING GAS _ Q MECHANICAL _ l! FIRE SPRINK ENERGY T$9 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ _ L 1 ❑ NEI ❑ NE] FLOOD ZONE .A L.D,C. LATH-INTERIOR / _ ELECTRICAL _ -QaL✓ ( YE:] N� Y � N❑ LATH-EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING _ p." SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK L/ GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM + UJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC !� F_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. f Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — CONST.TAX r " IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL -" CALLING FOR FINAL INSPECTION. ° OFFICE COPY �ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ' BUILDING PROJECT IDENTIFICATION PERMIT NUMBER EADDRW 11633 Forest Spring Cour APPLICATION & PERMIT" BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 13814 t 112 - Plan sem' PLAN CHECK VALIDATION f - OTY. ELECTRIC PERMIT FEE PHONE CONTRACTORS TGRs UTLETS-SWITCHES-RECEP 10.00/1.00 Gregory Group, Inc,,, ,,. 430097 LIGHTING FIXTURES 10.00/1.00 r-orvTRADTORs PPLIANCES-RESIDENTIAL 4.00 a °Welwood HYyC � ins ,Dolp595 21 PANELS 10.00 DATE OF APPLICATION ARRCHITECT Aram Ba$senian, A. I .A. & PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. O ENGINEER Associates uc.No. SIGNS TRANS. 3.00 ADDRESS ENS westerly ace, 70 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION Newport Beach, CA ZIP 9266 EMP. METER OR POLE INS. 20.00 Areca EFS MOTORS SEE FEE SCH. y� A°�e�woo i Jab y W1Q O Q In �r. SERVICE CHANGE 20.00 o LICENSED CONTRACTORS DECLARATION au u I hereby affirm that 1 am licensed under provisions of Chapter 9 s DATE ,HA a a- (commencing with Section 7000)of Division 3 ortLO Business and L PLG. MECH. H N i Professions Coda an ro license is in full Qa.e a ✓jffgn-� ¢ oto - License Class Li C.Number 0 w F Date Contranor a >< BUILDING PERMIT ¢ ¢ re 4 OWNER-BUILDER DECLARATION INFORMATION ij X u I- I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD u0 Law for the following reason.(Sea.7031.5,Businesswtd Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. � - Code:Any city or county whichrequireaapemsitto Construct,alter, �� .� in Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO ' w $ he is licensed!pursuant to the provisions of the Contractor's License It �� CU H z a Law(Chapter9(commencing with Section 7000)of Division 3 ofthc i 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ee ,- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n ; _ by any applicant for a permit subjects the applicant toe civil penally ALTER-DRAIN -WATER MA.) 5.00 of not mom than five hundred dollars($500).): . Z ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not / 2 - intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00 it 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 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such I mve- mentsamnot intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4'OUTLETS 6.00 / or improvement is sold within one year O(complm ion,the owner- GAS/ -EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Other prove for purpose of sale J. INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with El El ID licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCELNO. and Professions Code:The Contractor's License Law does not apply C to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 3F contracts for such projects with a contructuRs)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO. ❑ l an,exempt under Sec. ,B.&P.C.lin Olis WATER HEATER W/VENT 6.00 mama Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified Copy thereof(Sec.3800.Lab.C.). nl �P�l,-ifi� RE I Policy No. Company 0 ❑ Certified copy is h r shed. FIRESPRINK ENERGY T-24 Z = ❑ Certified copy ' city inspection division. MISC.- REFER TO ORD. O Applicant Y ❑ NE] YE] N� ~ vt PERMIT ISSUANCE 10.00 - CERTIFICATE F E%EMPPION PROM WORKERS' FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. / v N v N 0. Z (This Section need not be Completed if the permit is for one TOTAL hundred dollars IS 100)or less.) U O I Certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY UL U mit is issued,I shall not employ any person in any manner so as to U become subject to the Workcrs'Compensation Laws of California. l y UaBUILDING tc Applicant ALTER OR ADD TO MECH. 5.00 d } to NOTICE TO APPLICANT: If,after making this Certilicute of Ex- f- ? cmption,you should become subject to the Workers'Compensation APPLIANCE 5.00 'a PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE 3 U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1OXOC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00SEISMIC FEE, Q 9d I ftm hereby aft 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.) ta-C HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name !VC�Es� HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC W/Lender's Address 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 14 information is Correct I agree to comply with all city and county PLUMBING Ordinances and slate laws relating to building construction, and BOILER-COtutP 13 H.P.or 1 D0,000 B.T.U.) 6.00 hereby authorize repmsentalives of this city to enter upon the BOILER-COMP (Over IOO,ODOBTUI SEE FEE SCH. MECHANICAL above mentioned property for inspection purposes, t, (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. ,gq� / Cupertino against liabilities,judgments, Costs and expenses which CONST.TAX Vp� p may in any way a true against said City in consequcna of the PERMIT ISSUANCE 10.00 grant 0 M. MECH.CONT. LIC.NO. MECH. �1 TOTAL ��r TOTAL s 9�0 5 Signals Applicant/Contractor W J OFFICE COPY