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12172 < 5 POST THIS CARD NEAR-FRONT OF BUILDING PFHMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION • JOB INSPECTION RECORD PERMIT EXPIRATION 10400 RIDGEVIEW DRIVE „L JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNER GROSVENOR CONTRACTOR CAL AIR CONDITIONING IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 1>0 DAYS OF PERMIT ISSU- pq ANCE OR 180 DAYS FROM FOUNDATION Q -/•S'0 / �'(uM� �• AI S LASTCALLED INSPECTION— UFER - S LP/r af0klI PERMIT VALIDATION PREGUNITE 1,dc arvse, 7xizocyy,�� •) 6TIC / - Z- -'"-lyaL'•T��, 4 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL• P,i}V r•!ISSUANCE•DATE ' MECHANICAL - eLDG. ELECb11P.LG, MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INSULATION ' OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I\ • ROOF SO.FT,FLOOR AREA TOTAL ACREAGE \) DIAPHRAGM BUILDING USE RESIND CON P9 Olnel APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO, PARC L NO. GAS TEST MECHANICAL ELECTRICAL FINALS >.j .DATE' , INSP. ACC.DATE acc.FILE No, FRAMING SAN # - ,ZONING ENG.SITE NO. INSULATION � PLUMBING �� GAS / — 7 1YL1 FIRE SPRINK ENERGY T 2 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ ❑ N❑ FL000 zoNE A,L.u.c. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. Y❑ "❑ Y ❑ N❑, SHEETROCK GRADE - ' FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR , - TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK FEE GAS —J-YI 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 ARRANGE FOR INSPECTION BY PHONING 252.4505; ELECTRIC UJ- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION.DATE MECHANICAL IMPORTANT! CONST,TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY 150'2 Ag PLIC TCPPTL4g4A;A Q)RMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT HUILDWc 12172 ADDRESS 10400 Ridaeview Drive BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 104 OWNER'S PLAN CHECK VALIDATION NAME DTV. ELECTRIC PERMIT. FEE Grosvenor .Internatigyj CONTRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00 NAME Cal-Air Cona1ti0nin9,G.ND, 1377.95 LIGHTING FIXTURES 10.00/1.00 ADDRESS R's APPLIANCES-RESIDENTIAL 4.00 1775 S. 1st St. , #661HONE947-0155 PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc,NO SIGNS TRANS. 3.00 ARCH.OR ENG. - PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5.00 IIP EMP.METER OR POLE INS. 20.00RM�U;AN&DATE ADDRESS MOTORS SEE FEE SCH. ADDRESS 17.75 S: 1st ST. , San Jose SERVICE CHANGE 20.000 w O O LICENSED CONTRACTORS DECLARATION < u v I hereby affirm that 1 am licensed under provisions of Chapter 9 hw (commencing with Section 7000)of Division 3 of the Business and ¢ o. BLDG. ELECT. PL ;+o MECH. H D i Professions C.ldP�,ap{I,yny license is in full lb¢e,,y�4p effect ' 0. - License Cl as _l.,-LU__Lie.Number y:,j.( El 1:1 El w H w Dare �. 09727 Contractor_ - r ¢ y s BUILDING PERMIT ¢ ¢ OWNER-BUILDER DECLARATION a K w o - INFORMATION won MISC. REFER TO ORD ,� y I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. FU0 Law forthe followingreason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, ¢ ¢4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. w - ¢ requires the applicant for such permit to file a signed statement that TOTAL A, $ he Is licensed pursuant to the provisions of the Contractor's License PERMIT TO F Z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the sin Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE R H$ the basis for the alleged exemption.Any violation of Section malty STORIES TYPE CONSTR. u ;� by any applicant for apemre subjectsthe$500).liwnt DOS civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred Dollars(b5001J: * ❑ 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,AR EA,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 FIXTURES"PER TRAP 5,00 SO,IT,FLOOR AREA TDTALACREAGE himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-iINC.40UTLETS 6.00 ments are not intended or offered for sale.It,however,the building or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Other . 0 1,as owner of the property,am exclusively contracting With ❑ ❑ ❑ ❑ ❑ 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 property who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SAN V-STORM EA.200F1/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lam exemp rly,Sec. ,B.&k.for this reason / WATER HEATER W/VENT 6.00 A 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, or a Certificate Of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(*%.3800,� Lab.C.). T i Policy No. Company - O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z IX Certified copy is R cit ins ection division. MISC.- REFER TO ORD. F O APPI�c�uAt ], 9� 7(1�(1�q Y ❑ N❑ ,Y ❑ N❑ CC y WWCII.•IiRTIH P,CATLQQF"h F.h,9,-,Q1CYrROM WO KI:RS' PERMIT ISSUANCE 10.00 FLODD ZONE A.L.U.C. UJB COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 1 Cl v❑ N❑ Y ❑ ❑ (This section need not be completed if the permit is for one TOTAL N Z) Z hundred dollars I5100)or less.) U O 1 certify that in the performance of the work for which this per- CITY. - MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,1 shall not employ any person to any manna'so.,to U become subject to the Workers'Compensation Laws of California. 0 n Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate Of Ex- F. ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE Z� 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.CJ. a HEATING UNIT(TO 100,000 B.T,U.) 6.00 Lender's Name XT -P. HEATING UNIT I0 VER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC • I certify Ihal I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 �p2 information is correct.I agree to comply with all city and county PLUMBING ordinances and state laws relating to building conslruclion, and BOILER-COMP(3H.P.or 100,Oo0B,T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. ECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- Cupertino ISC.-Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE - 10.00 CONST.TAX may in any way accrue against said City in consequence of the gr. ting of thisrenniL MECH.CONT. LIC.NO. MECH. /O _ ^ - /N�TOTAL /1 a� Signature of Applicant/Co Date /Uj..-�ly.f'�f/Jn-'Mfg L.'I/ /%J TOTAL Y OFFICE COPY