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13753 1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION ! PERMIT NUMBER A auuolNG 1PLAN 313 APPLICATION & PERMIT A �� n1 115544 I 3 Morning Spring Court BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I OWNER'S - PLAN CHECK VALIDATION NAME 415 1 noL CITY. ELECTRIC PERMIT FEE GREGORY GROUP, INC�DNE CIS CONTRACTORS NAME 9g OUTLETS-SWITCHES-RECEP 10.00/1.00 99.00 Lie.N _ 21 LIGHTING FIXTURES 10.00/1.0021 ,00 CorvrRAcroR's 3 APPLIANCES-RESIDENTIAL 4-00 12.00 ADDRESS 220-C Twin Dolphin Dr. PHONE _ 1 PANELS 10.80 10 00 DATE OF APPLICATION ENGINEERARAM BASSEN IAN, AIA PANELS (OVER 200 AMP) 20.08 PLAN CHECK FEE OR & ASSOCIATES I SIGNS TRANS. 3.00 ARCH.OR G.` } SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS i (( 7 77 Newport BChWe� erly P acezP htQO EMP.METER OR POLE INS. 20.00 APPLICANTS ct�u MOTORS SEE FEE SCH. / ADDRESS 220-C Twin Dolphin Dr. J _ SERVICE CHANGE 20.00 7.00 0 ,C2 LICENSED CONTRACTORS DECLARATION 4 0*8' ¢u I hereby affirm that I am licensed under provisions of Chapter 9 DECC ISSUANCE GATE a, a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. eL MECH. r y i Professions Code,and my license is in full force and effect. z D m - License Cla Lie.Number 9 N r w Date Contractor a y s BUILDING PERMIT ¢ ¢ ¢ a WNF.R-BUILDER DECLA ON INFORMATION Soo ° MISC.- REFER TO ORD x g: F- I hereby affirm that I am exempt from the Contractor's License a a.t� Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 10.00 VALUATION $/FT. f NNJ Code:Any cityorcounty which requires a permit to construct,alter, ELEC.CONTR. LIC.N0. $123,000.0 C a ¢ improve,demolish,Or repair any structure,prior to ifs issuance,also ELEC, 11 a g O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w$w he is licensed pursuant to the provisions of the Contractor's License � � Hz> La..(Chapter 9(commencingwilh Section 7000)of0ivision 3 of the &C/ 4 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ s¢-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 ` ,( of not more than five hundred dollars($500).): `t N/ /'V ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 �-3 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work 12 FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-i INC.4OUTLETS 6.00 or impro - . .1 2.00vement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA builder will have the burden of proving that lie did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner of the properly,am exclusively contracting with a Cl ❑ ❑ ❑ licensed contractors to Construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3. G 31 3a 33 contracts for such projects with a cuntractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL NO. the Contractor's License Law. ❑ tum exempt under Sec. ,B.&P.C.forthis WATER HEATER W/VENT 6.00 7C19S� reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby sf firm (list I have a certificale of consent to self-insure, or a Certificate of Workers'Compensation Insurance,or a certifiedZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.0.). 9 Policy No. Company-Un.lted-PaC-1-t-I:S- 0 ❑ Certified Copy is hereby furniisbcd. FIRE SPRINK ENERGY T 24 Z Z JIQ Certified y Jed wi city Ins e-ion division. MISC.- REFER TO ORD. D Applicant Y❑ N❑ V E] NC]w RI CC -- 10.00 � > CHRI'IF TE OF EXEMPTION WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.u.C. LU _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. IL O (This section need not be completed if the permit is for one TOTAL97 00 Y❑ N[] Y❑ N❑ =) Z hundred dollars(SIDO)or less.) 0 O I Certify that in the performance of the work for which this per. CITY. - MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. ow Dare Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 490.50 N NOTICE TOIAPPLICANT; If,eflat making this Certificate of Ex- emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK IEnergy 18 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 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MIC.RM.) 6.00 SEISMIC FEE 8.19 I hereby affirm that there is a construction lending agency for 1 EXHAUST HOOD(WITH DUCT) 5.00 5.00 the performance Of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 6.00 MICROFILM 3097,Civ.CJ' Sacramento S&L 1 8.00 Lender's Name I, -� HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC 159.00 Lender's Addres 1 certifyinformation that re ka sa,comply o nd all c that d countyhe above VENTILATION FAN (SINGLE) 4.00 information n correct. 1 agree to comply with all city and county PLUMBING •97.00 ordinances and sate laws relating to 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 BOILER-COMP (0.,100,000BTU)SEE FEESCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.• REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX 28,2 68 may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00QG q granting O411 lh M MECH.CONT. LIQ NO. TOTAL 55.00 TOTAL �R 1_+571.16 Signature of caN Contractor ate r s OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PFRMITN NUMBER INSPECTION DIVISION 13753 JOB INSPECTION RECORD �f PERMIT EXPIRATION JOB ADDRESS�i1/�J's_.'/�'J�'Q��t�QW*A�S" e UNIT# LOT# /�/v PERMIT EXPIRES IF WORK OWNER GAF CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSP TION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM -�-13-BS ` V � LAST CALLE D I NSPECTI ON. UFER 7'ue' $ 5y<q �lNw Y1-1Yt�tl PREGUNITE -�y-�$" / d 2 �� LAT PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PAID UNDERGROUND /SLAB C 3 01987 PLUMBING Q, ELECTRICAL Iss NCE unrE e ( PLG. MECH. MECHANICAL 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL $323�000.0 ELECTRICAL PERMIT TO FRAMING STORIES TYPE CONSTR. INSULATION r � SOCC.GROUP RES.UNITS ,,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF $O.RT FLOOR AREA TOTAL ACREAGE OrAPRR'AGM BUILDING USE RCS IND CON PB Oil- ROOFING NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ El1❑ El ❑ ASSESSORS PARCEL NO ROUGH PLUMBING TRACT NO, PARCEL NO, GAS TEST, ,. MECHANICAL ` . ELECTRICAL ' /N - - FINALS DATE INSP. ACCDATE ACC.FILE NO FRAMING 7-I'3'$$ SAN * ? 9 INSULATION �a'- PLUMBING Nn ZONING ENG.SITE NO. 3E GAS MECHANICAL FIR ESPRINK ENERGY T 24 i/l{� Y ❑ "❑ Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ELECTRICAL FLOOD ZONE A.L.U.C. LATH—INTERIOR _ .•% LATH—EXTERIOR FIRE DEPT. IV Y❑ N Y ❑ No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR -8 BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING 490.50 FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 159.00 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� Z MECHANICAL PLEASE GIVE JOB ADDRESS WHEN PHONING. 97.00 - SEE PERMIT FOR EXPIRATION DATE - 55-00 IMPORTANTI CONST.TAX 282.68 PLEASE READ REVERSE SIDE BEFORE ,.$71.16_ 1 CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY