15838 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Y `w YBUI LDI NG PROJECT I DENTI FICATION ^PERMIT NUMBER
apD,�LR°�,NsG o APPLICATION & PERMIT' 1 5838
I lOs4 a pringaUr
POt BUILDING - ELECTRICAL-PLUMBING.-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAm Gregor Group,Group, Inc. & QTY. - ELECTRIC PERMIT FEE
�ihmans n '. ev.
. • A,I,5-595-2100
CONTRACTORS - UTLETS-SWITCHES-RECEP 10.00/1.00 -
NAME
Gregory Group, InCII NJ3-430097 LIGHTING FIXTURES: 10.00/1.00
ADoR's22O-C Twin Dolphin Dr. APPLIANCES-RESIDENTIAL .4.00
ADDRESS ORESSRWC 94065 415m,595-2100 PANELS 10.00 •DATE OF APPLICATION f•'
ARCHOR ITECTAram Basseni,dn, AIA & Assoc. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEET P.L.WO.
ENGINEER C-8395
uc.No SIGNS TRANS. 3.00
ARcH.oR ENc.;2D31 Orchard Dr.1�1DD SPECIAL CIRCUIT' - 5.00: • PERMIT VALIDATION
ADDRESS
Santa Ana- Hts.CA. 92707z,P EMP. METER OR POLE INS. 20.00
APPLICANTS - MOTORS SEE FEE SCH.
A°DREan220-C Twin Dolphin Dr.RWC. '
p SERVICE CHANGE . . 20.00 /
w o O
LICENSED CONTRACTORS DECLARATION PAID
/(O( cr
I hereby ani�n that I am licensed under provisions of Chapter 9 r-`L�LISSUANCE DATE t
HG N lammnencing with S,,tion 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
F N z Pnol'essions Codc,..'yyiNdI mY liccnu is in full tirtcc'w�,{pI,d{,yj'(� I N(1
, C) - License Class_
D Lic-Number 4S11V .7 T I'1'J 'LJL�k/
2z t w . Date' Contractor
rc,Q w a
OWNER-BUILDER DECLnRn'fION - - BU144DING PERMIT
o - 'REFER TO ORD Ol Cup[rak001MATION
X 3 u 1 hereby affirm that 1 em exempt from the Contract Dr's License MISC.- - : VALUATION $/FT.,
to u_a j Law for the following reason.(See.7031.5,Business and Professions PERMIT ISSUANCE - 10.00 194+540
Cade:Any cityor county' ru
which requiresa permit toconstc4 alter,
2 ¢ Q 2 improve,demolish,or repair any structure,prior to its issuance.also ELEC.CONTFU - LIG N0. ELEC.
-o In requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
wm he is licensed pursuant to the provisions of the Contractor's License
Uzi Law(Chapter9(con.mencingwithSection7000)ofDivision3offit, 1 SFDWL
< Business and Professions Code)or that he i...count therefrom and QTY. PLUMBING PERMIT FEE {
I Oo the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.;
i ;� by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER IEA.) 5.00 2 •5NHR
of not more than five hundred dollars(5500).):
❑ 1,as than
of the property,or my employees with wages its BACK F LOW PROTECT. DEVICE-` 4.00 -
OCC.GROUP RES.UNITS
their soleCompensation,rorwill(S the work,and Business
a Tactors is not - -
n, 'vended or ol'(orcd for sole (Sec. 7044, Busincu and Professions DRAINS-FLOOR„ROOF,AREA,COND. 5.00 R-3 . 1 '
Codc:'file Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided that such improve- GAS 6.00 p
stents are not intended oroftered for sale.If however,the building 3D47
or improvement-is sold within one'ycar of completion, the er owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING
buildwill have the burden of proving thin he did not build or un- - - RES IND CUSE PB Other
' prove for purpose of sale.). INDUSTRIAL WASTE INTER. '30.00 Rin ES
El El •❑
❑ 1,as owner of the property,am exclusively contracting with -
licensed contractors to construct the project ISee. 7044,Business LAWN SPRINKLERS- 1,INC 5 V.B. '•6.00 ASSESSORS PARCEL NO,
:rod Professions Code:The Contractor's License Low does not apply /
S-OVER 5(EA.) 1.00
to an owner of property who builds or improves thereon,and who LAWN SPRINKLER
contracts for such projects with a contme orlsl licensed'punuanI to
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.2001t/10.00 TRACT NO. PARCEL NO,
❑ IamexemptunderSec. ,B.&1'.17.tin this WATERHEATER,W/VENT 6.00 '8D98
reason
Own, Dole _ - WATER SYSTEM .5.00 ACC.DATE. 'Acct.FILE NO.
"woRRrRs'COMPIiNSATiON DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure. - ZONING ENG.SITE,NO.
e certimfied He of Workers'Compensation Insurance,or a certified
copyerenf(Stie.3800,Lab.C.). United PACIFIC
policy No. CoHipsHy _ '
O •❑ Certified copy'is hereby furnished., FIRE SPRINK ENERGY T$4
Z Z CX Certified copy is filed with the city inspection division.. MISC.= REFER TO ORD.
O Applicant - •. - _ Y❑ N❑ Y ❑ N❑
j = CHRrIPICATE 01'EXEMPTION FROM WORKIi KS" PERMIT ISSUANCE . y, 10.00 FLOOD ZONE A.L.u.C.
LJ7• COMPENSATION INSURANCE �. PLG.CONTR. LIC.NO. - PLGI TOTAL. V❑ N❑ Y ❑ N❑
0- o - IThis section need not be completed if the permit is for one
0 Z hundred dollars IS 100)or tell.) '
U O 1 certify that in the pertiormaHee of the work for which this per, QTY. MECHANICAL PERFd1T FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any manner so as to . '
U bccomcsuhjccllotheWorker,'C°mp"eatioinLawsofCulll'ornio. BUILDING 972.00
w Date - Applicant
n ALTER OR ADO TO MECH. 5.00
}.w N prion,TO APPLICANT: IL after making this Certificate Ex-
F" Z sorption,you should m become subject the Workers'Compensasa tion APPLIANCE ', 5.00 PLAN CHECK
provisions of the'Labor Code, you must forthwith comply will, FEE /energy62.00
U such provisions or this permll shall be deemed revoked, - AIR HANDLING UNIT-.(TO 1Q000C.F.M.) X4.00
CONSTRUCTION LENDING AGENCY ' AIR HANDLING UNIT(OVER I0,000GEM.)'6.00 SEISMIC FEE 13.65
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(See.
- MICROFILM
3097,Civ.C.l. Sec r't Pacific -HEATINGiUN1T TO 100,000 B.T.U.) 8.00
Lender's Name HEATIN G'UN IT I% 100,000 B.T.U.)9.50 ELECTRIC 73.13
Lcndur's AJdsss_p.F -1 q� arca er-o-4t 1i-p-1
I certify Ihat IhaJve read I ne'P ("anion and store that the abovi• 'VENTILATION I% 100,000
4.00
inlarna'ton is correct. I agree to comply with all city and county - PLUMBING 73. 13
S ordinances and state laws relating to building construction, anti' BOILER-Comm H.P.or 100,000 B.T.U.) 6.00 -
'VVI hereby moliori ,prcprescnlutncs of this city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SEH. MECHANICAL 73.13
above-mentioned property Ror inspection purposes.
(We).agrec lO ere, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which - - CONST.TAX
PERMIT ISSUANCE ' 10.00
may in any way accrue against said City in conscyuence of the 03
' •melting of,his Pet � � - � MECH.CONT. - LICiNO. MECH. 1
TOTAL TOTAL
Signature of Applieunt/Contractor .. Date t
OFFICE COPY LS79`
J
dPOST THIS CA `��dUICDING, PERMIT NUMBER .,
-� CITY VINO 15838. .
INSPEC. ION
4
JOB INSPECTION RECORD '
PERMIT.EXPIRATION
l 1S e��+ sP�L `
JOB AD KESS —UNIT# _LOT#
Y ��al -� PERMIT EXPIRES IF,WORK
OWNER IAC CONTE ACTOR.6I��`C' .caian� �'� '� IS •NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECO D 180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM'
FOUNDATION .Z •S'� NOTE-'
LASTCALLEDINSPECTION.
UFER iz ALL GRADING AND DRAINAGE SHALL BE:INSTALLED .
` PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF Pn+Mn VALIDATION
CUPERTINO STANDARDS. .
GARAGE SLABS •A -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED' - �� C ! ^" -`•'""""
-UNDERGROUND /SLAB ice•_.' - ��/
PLUMBING - 1 A 7
ELECTRICALI. -
155UnNCE Unit
. MECHANICAL - + . I3FILDG ,ELF:cT. 111, 1 MCCI+ ,
DO NOT.POU'R FLOOR UNTIL ABOVE HAS BEEN SIGNED - - uaowM PERMIT
. _ \ \�INFORMATION
WOOD FLOOR _ VnuIATION -SIFT.
PLUMBING ' " •i. \
MECHANICAL' ` - � - §41546' '
' I'FiR MII TO .
' ELECTRICAL '?
FRAMING' r SFD 'I—
STORIES TYPE CONST E, I
- INSULATION - -
2 5NHR
OGL GROUP HE5,UNIT1
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.F. Fulov 4,ren TOTAL NCR.
I
DIAPHRAGM THE CONSTRUCTIONTAX IS PAID'• q
- - - �
__EEETLDINGCON USE El
ROOF SHEATHING '^ f -
RES IND -cory PB Om.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS - FE
INSP. - .❑ a
n5sessORs Pnl+cel.NO,
'ROUGH - SAN.a PLUMBING ELECT.ENERGY TRAGI NO. PARCEL NO
TUBS&SHOWER PAN -j3' 5` PLUMBING ENERGY
MECHANICAL ?. 1 MECH.ENERGY' iE ncc.FILe NO.,
ELECTRICAL BUILDING ENERGYFRAMING 1a ELECT.FINAL TESTZOwNG ,[NG.5ITE NOINSULATIONGAS TEST ��+ t-1�(y GAS
_ FIRE SPRINK ENERGY T@4
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . NO' ❑ N�
FL000 ZONE . ATIU C, I
EXTERIOR SHEAR 3• /' ELECTRICAL RELEASE '
INTERIOR SHEAR FIRE DEPT. Y(] rv� ❑ rv❑
SHEETROCK GRADE 'FEE SUMMARY .
EXTERIOR LATHBUILDING ,BUILDING 079 on
INTERIOR CATH, = - TEMPORARY APPROVALS
PLA
SCRATCH COAT,
ELECTRIC. FEEN CHECK .. . 15.50
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FE
OCCUPANCYOF BUILDING IS,NOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
(C
y ARRANGE FOR-INSPECTION BY, PHONING 252-4505 ELECTRIC
Lu
ONE WORKING DAY.,BEFORE REQUIRED INSPECTION. PLUMBING .
. O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z ' MECHANICAL 71 I'a
`' 1 SEE PERMIT FOR.EXPIRATION DATE'
—
„ IMPORTANT! CONSTTAX a
PLEASE READ REVERSE'SIDE BEFORE TOTAL '$ 9
CALLING FOR FINALANSPECTION.
OFFICE COPY