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13772 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY '•)';'• )1-BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 13772 AooRE" 11502 Seven Springs Lane BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S (Lot 68 IBR) PLAN CHECK VALIDATION NAME - GTY. ELECTRIC PERMIT FEE PRnNE CONTRA oR NAME I UTLETS-SWITCHES-RECEP 10.00/1.00 TnCNO, 430097 LIGHTING FIXTURES 10.00/1.00 coNTRA oR' 220 Twin Dolphin Dr. "CII PPLIANCES-RESIDENTIAL 4.00 AooREu PHONE _2 1 PANELS 10,00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO. OR Aram Bassenian, A. I .A. . ENGINEER LIC.No. SIGNS TRANS. 3.00 :ooAEOR ENG PERMIT Westerly PI . , #170 SPECIALCIRCUIT 5.00 PERMIT VALIDATION zap EMP.METER OR POLE INS. 20.00 A'!' t TS MOTORS SEE FEE SCH. ADORE=S 220 Twin Dolphin Drive, C SERVICE CHANGE 20. u 0 0 0 LICENSED CONTRACTORS DECLARATION / �J/� 1 u- I hereby aflum that I am licensed under provisions of Chapter 9 1v SSUANC/E GATE a w (commencing with Section 7000)of Division 3 of the Business and B�LDG7. ELECT. PLG. MECH. D i Professiol„Code,and my license is in full force and effect. B'T Z D„2 - License Class Lic.Number_430097 Q z R w Dete Contractor a xs OWNER-BUILDER DECLARATION - BUILDING PERMIT x INFORMATION aoa " MISC.- REFER TO ORD `, ' , X ;LL N I hereby affirm that 1 am exempt from the Contractor's license I VALUATION S/FT. H .. o a Law for the followin,mason.(Sec.7031.5,Busines,and Professimu PERMIT ISSUANCE 10.00 Code:Any city or county which requiresa permit to construct,alter, Q2 Q Q improve,demolish,or repair any,truclure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. to - o u requires the applicant for such permit to rile a signed statement that TOTAL PERMIT TO w $ he is licensed pursuant to the provisions of the Contractor's License a ^�3 �� HiQ Law(Chapter 9(Commencing with Section 7000)of Division 3 of the Z i o Business and Professions Code)or that he is exempt therefrom and GTV. PLUMBING PERMIT FEE SS R the basis for the alleged exemption.Any violation of Section 7031.5 1STORIES TYPE CONSTR. a ; _ by any applicant for a permit subjects the applicant too civil penalty of not more than five hundred dollars($300)J' gLTER-DRAIN&VENT-WATER (EA.) 5.00 IS-AM/11C � ❑ I,as owner of the pmperty,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the stractom is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -A, Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SC.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.'SYSTEM-11NC.4 OUTLETS 6.00 or improvement 1,sold within one year of completion, 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 ice- RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 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 1,9 ASSESSORS PARCEL NO. and Profession,Code:The Contractor's License Law does not apply In an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.006..� y !? contracts for such projects with a contrealorts)licensed purwam m the Cont setae-'=License Lew. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. C, lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason 11,7 Owner Date WATER SYSTEM 5.00 5 ACC.DATE ACC.FILE NO. WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to scl6insum. ZONING ENG.SITE NO. or a certificate of Workeri Compemation Insurance,or a Certified copy thereof(Sec.3800.L b.CJ. Policy No.-Company- R�#-ed-Pae. Re+1-f7 Q ❑ Certified copy reby furnts e� FIRE SPRINK ENERGY T 24 Certified co 1 the city L'om division. MISC.- REFER TO ORD. Z ZO APPlitant _ Y ❑ N❑ Y ❑ N❑ Fin PERMIT ISSUANCE 10,00 FLOODZONE A.LU.C. � CERTIFICA .OF EXEMPTION FROM WORKERS' LU > COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG. Y❑ N❑ Y❑ N❑ CL Z (This section need not be completed if the permit u for one _ TOTAL hundred dollars IS 100)or I..) U O 1 certify that in the performance of the work for which this per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit u issued,I shall not employ any person in any manner so as to U Ubecome ecoe subject to the Workers'Compensation Laws of California. b ED Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING S3 } N NOTICE. TO APPLICANT: If,after making this Ccrhficam of Ex- F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U wn provision,or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)"C.F.NL) 4.00 FEE3 of p CONSTRUCTION LENDING AGENCY AIR HANDLING UNTT(OVER 1000C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 .6 1 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,CIv.C.). t HEATING UNIT(TO 100,000 B.T.U.) 8.DO Lender's Name_:_51301A'_-ty-Pac-1-f-1C HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Addma,l4an-Franel'seo-CA 1 certify that 1 have read this application arbude thm the above; VENTILATION FAN (SINGLE) 4.00 _ information u correct I agree to comply with all chs and county PLUMBING ` D ordinances and state laws relating m building construction, and BOILER-COAT(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city W enter upon the BOILER-COMP (Over t00,0008TU15EE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. ' (We):agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. / /y Cupertino against liabilities,judg,nents, Costs and expense which CONST.TAX [y fie Q may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 O •� granting of t it �J MECH.CONT. LIC.NO. MECH. /��a�/- 7 TOTALTOTALAen �� a Signature pplic nt/Contractor Cage / FFICE COPY POST THIS CARD NEAR FRONT OF BUILDING �- ' \�!� 1 Jam, •- NUMBER CITY *OF CUPERTINO 1FRA9i 137ER INSPECTION DIVISION 72 JOB INSPECTION RECORD C fnp'/ PERMIT EXPIRATION JOBADDRESS ��5 Oz SE!/H-+Y/SlY2/�/6-f �'✓UNITtk LOT# V //�� • PERMIT EXPIRES IF WORK OWNER crap U /. C_ CONTRACTOR IS NOT STARTED WITHIN INSPECTION D TE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLEDY INSPECTION. - ' PREGUNITE - - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ' PLUMBING ' < t I ELECTRICAL E ISSUANCE DATE MECHANICAL _ L ELECT. PLG. MECH. ❑ Q DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION .VALUATION' 5/FT. ' PLUMBING MECHANICAL PERMIT TO ELECTRICAL I v - FRAMING J STORIES TYPE CONSTR, INSULATION OCCGHOUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' SO.FT FLOOR PREA TOTALACREAGE ROOF DIAPHRAGM • L BUILDING USE RESIND CON PB Omni APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - E:] ❑ E] E ROUGHASSESSOHSPARCELNO. PLUMBING - _ TRACT NO. PARCEL NO GAS TEST . MECHANICAL ELECTRICAL -If-srFINALS DATE INSP. ACC.DATE ACC.FILE Na. FRAMING - SAN # ZONING ENG.SITE NO. INSULATION -3 - C PLUMBING io GAS '. 00 } lelj#tW MECHANICAL _ O FIRE SPRINK ENERGY T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I HEATING O�fZ Y [D NL] Y E:] N� FLOOD ZONE AL.U.C. LATH-INTERIOR - ELECTRICAL N� v�] N❑ LATH-EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR c BUILDIN -j„ .� SHEAR EXTERIOR rj t TEMPORARY APPROV LS BUILDING FIREWALLS ELECTRIC PLAN CHECK _ GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BE SIGNED OCCUPANCY SEISMIC FEE '•� OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM / 1 ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ELI ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. Sys - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL /, •�� CALLING FOR FINAL INSPECTION. OFFICECOPY -