14939 APPLICANT TO ;FILL IN INFORMATION WITHIN RED LINES -,USE BALL POINT PEN ONLY
BUILDING PROJECT I IDENTIFICATION PERMIT NUMBER
aDILDIND. al res, Pring APPLICATION & PERMIT 14939
ADDRESS Lot 8 Ra Plan Spring
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL t
OWNER'S p �1.,,,� I�,�
NAME Gregory Group, Inc. &.NvanSOn DeV. PLAN CHECK VALIDATION
PHO E
r;-595-91(n.
_ OTV. ELECTRIC PERMIT FEE ,
CONTRACTOR'S
NAME Gregory � 1 OUTLETS-SWITCHES-RECEP 70.00/1.00
t 13-43OOg7 LIGHTING FIXTURES 10.00/1.00
uc.rvo
r:oNrRLF{�Ac},r1oR's 220 C Twin Dolphin Dr. all APPLIANCES-RESIDENTIAL 4.00
ADD "-1$'5 PHON615-595-2100 PANELS 10.00 DATE OF APPLICATION
ARCHITECT r� AIAASSOC1ateS PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER C_8295 -
-' Llc.rvo. SIGNS TRANS. 3.00
ARCH OR ADDRESS ENG. • SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Santa Ana HtSs. CA ,/Z/U/ TEMP.METER OR POLE INS. 20.00
APPLICANTS win In Dolph . MOTORS SEE FEE SCH.
ADDRESS g41N5
SERVICE CHANGE 20.00
w o o LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that I um licensed under provisions of Chapter 9
w rt N (Commencing with Section 7000)of Division 3 rthe Business and EAT
BL ECT. , E MDATE
H m Z Professions Code,andpy license is in fall force a d effect,
Z 0 o License Class_Ij_Lic.Number -430097
9 to E jo Date Contractors AW
¢ w a OWNER-BUILDER DF.0 RCA ATION BUILDING PERMIT
¢ - INFORMATION
K
;LL H I hereby ufrrm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD '
VALUATION $/FT.
H iL0 J Law for the following reason.(Sec,7031.5,Business and Professions PERMIT ISSUANCE 10.00
vs vs vs Code:Any city or county which requiresa permit to construct,alter, /yy�
Q.p ¢ 2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.GONTR, LIG NO. EL cc., 122low
-D ¢ requires the applicant for such permit to file a signed statement that TOTAL
A. w m u I PERMIT TO
he is licensed 9(copursuant to the provisions of the Contractor's License
F z a
Law(Chang ProcommenCode)with Section is exempt
the SFDUL
i c Business and Professions Code)or that he is lien,` cb ti ram 1.5 QTY. PLUMBING PERMIT FEE
¢H m the basis for the alleged exemption.Any viola)ion of Beclion 7031.$ STORIES TYPE CONSTR.
it ; _ by any applicant for a permit subjects the applicant ma civil Penalty
of not more than five hALTER-DRAIN IEA.) 5.00undred delta.(4500)): 2 SNHR
❑ 1,as owner of the property,or my employees With wages as BACKFLOW PROTECTDEVICE . 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
Codli:The Contractor's License Law does not apply to in owner of R-3
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,Provided eve such improve-building
men`s are not intended or altered for sale.If,however,the builAing GAS-EA.SVSTEM=I INC.4OUTLETS 6.00 1515,.-
�y or improvement is sold within one yea of completion,the owner- GAS-EASYSTEM OVER 4 (EA.) 2.00
® builder will have the burden of proving that h . - .
e did not build or im- BUILDING USE.
prove for purpose of sale.). RES No CON PS Other
-❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 Ix El 0 1:1 11
licensed contractors to construct the project(Sea 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 property who hailds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ Inc exempt under Sac,-.It&P.C.for this
mason WATER HEATER W/VENT 6.00 8067
Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
- WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 )iereby aRmn that I have u certificate ofeansenr to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copy thereof(Sec".3800,Lab.0 I �y,,,1 p -
PolicyNo. Company UO itel-Pacific: - t
O ❑ CertiOedcopyisberebyfurnished. FIRESPRINK ENERGYT-24
- Z.Z X Certifies 'I is "ed with the city inspection division.
FO Applicant MISC.- REFER TO ORD. y� N� 'YC) N[J
CC W CER' 'IC'A'I'E OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A:L.u.C.
W 1 COM1IPISNSATION INSURANCE PLG,CONTE, LIC.NO. PLG.
0- Z (This section need not be completed if the permit is for one TOTAL V N Y[] NE]
hundred dollars IS 100)or It..)
U O 1 certify that in the performance of the work for which this Per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1mil is issued,I aht all noemploy any person in any manner so as to
U become subject to the Worken'Compensation laws of California.
ad La.
nam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 716.50
} m NOTICE '1'0 APPLICANT;If,after making this Certificate of Ex-
F Z emprion,you,should become subject to the Workers'Compensation - APPLIANCE 5.00 PLAN CHECK 5.50
provisions of the Labor Code, you most Eulhwith comply with _
such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE /ene6'2.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1000C.F.M.) 6.00 SEISMIC FEE 854
I hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00
the perfonamt ce'O 1L,the walk for which this permit is issued(See. MICROFILM
3097,Civ.C.). Jeaurlt Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name��_ -4flP,_SF-L%M HEATI NG UN IT E R 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address f 49.gg
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
intbnnation is correct I agree to comply wilh all city and county PLUMBING 4g.88
ordinances and state laws relating to building construction, and BOILER•COMP(3 H.P.OF 100,000 B.T.U.) 6.00
hereby authorise representatives of this city m ewer upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL 49.88
hereby
above-mentioned property Itativsp of ion 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 288.24
Gay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
rantingofthis f lit. MECH.CONT. LIC.NO, MECH.
Nj TOTAL TOTAL 1240.42
Signature o p man[/Contractor I atc '
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING. PFRMIT NUMBER
CITY OF CUPERTINO 14939 •I .
— INSPECTION DIVISION
JOB INSPECTION RECORD 6' r
ry PERMIT EXPIRATION
�- JOB ADDRESS 91.S.S�Ji �^/7R SDKon/G G; UNNIIT�# _LOT# PERMIT EXPIRES IF WORK�I
0WNER Qa 0 CONTRACTOR p✓ IS NOT STARTED WITHIN
INSPECTI O DATE I INSPECTOR INSP TION REC RD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 18D;DAYS FROM
`I NOTE: LASTCALLED INSPECTION.
LIFER Io- L ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERAUT VALIDATION
PREGUNITECUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ; `� ✓
UNDERGROUND /SLAB 0 .J/Pd(.�
PLUMBING, •�'� '
ELECTRICAL UANCE DATE
MECHANICAL a BLDG 'CT.I PLG. % MEC.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED auILO PERMIT
INFORRMM ATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL �L
FRAMING-
STORIES TYPE CONSTR.
INSULATION'
OCC.GROUP RF.SIff.UNITS
(6
- LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so FT.FLOOR ABtn IDTA ncBence
r • I DIAPHRAGM THE CONSTRUCTION TAX IS PAID {
ROOF SHEATHING - nuu.DuvN use
_p• C2� HES IND CON PB Umv.
APPLY NO ROOFING UN11L ABOVE HAS BEEN SIGNED FINALS DATE INSP. ® ❑ ❑
ASSESSORS VANCLL NO
ROUGH SAN.#
PLUMBING k- ka, ELECT.ENERGY Z
TRACT No PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY 2 •
MECHANICAL �'Z MECH.ENERGY 87
ACC GATE ACC FILE NO
ELECTRICAL ee) BUILDING ENERGY ,
FRAMING .ELECT.FINALTEST ZONING ENG.SITE NO.
INSULATION 16-6 PLUMBING
GAS TESTGASfl�
•/• FIRE SPRINK ENERGY T-24
• MECHANICAL Y O Nv E] NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD 20NE A L U.C.
EXTERIOR SHEAR ELECTRICAL RELEASE ,/.Jw
INTERIOR SHEAR to p FIRE DEPT. v L7N❑'
SHEETROCK p 7jlw GRADE FEE SUMMARY
EXTERIOR LATH — BUILDING •�' BUILDING
nmo
INTERIOR BATH. TEMPORARY APPROVALS
SCRATCH,COAT ELECTRICPLAN CHECK 15.54
FEE !
GAS ' /.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING,252.4505, ELECTRIC
aT FONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
a 0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
' z MECHANICAL
—.SEE PERMIT FOR EXPIRATION DATE — -49,813
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE , TOTAL
CALLING FOR FINAL INSPECTION. 1240.42
OFFICE COPY
CITY OF CUPERTINO —!
a
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE '
4.07—
Date
d7 Date .......L7- /................ lWW Building Permit No./.r
The Building Located at ../,.0.', ' /YT.8Y5 ...St7�/.�✓..fj... � ;.
4 Owned by ....�7O1{TG/I ........ ................................
t „ Has Been (Altered) For Use As: ....5.. ...Y..f .......................................
r. I
..................................................................................................................................................
..._..........................------................................._........................................................................ - -
PUJ BUILDING INSPECTOR
y