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13774 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO RM1,IT NUMBER INSPECTION DIVISION - 13774 JOB INSPECTION RECORD 1�� 11 `-II PERMIT EXPIRATION JOBADDR ESS ,ISb� � 'lJy � UNIT# LOT#. "� OWNER 67t /`^R\, PERMIT EXPIRES IF WORK �T�•-^� r -3f��`• CONTRACTOR IS NOT STARTED WITHIN INSPECTION ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ' Z-u ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PERMIT VALIDATION PREGUNITE - - - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - %\ '..• '' UNDERGROUND /SLAB PLUMBING ELECTRICAL I NCE DATE MECHANICAL T. PLG. MECH. - D i s DO NOT POUR FLOOR UNTIL A 0 E HAS BEEN SIGNED LDING PERMIT INFORMATION WOOD FLOOR VALUATION L $/FT. PLUMBING - - - MECHANICAL - PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INSULATION - - �r i\ OCC.GROUP RE/UNITS PLACE-NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF SO;FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM L BUILDING USE RES IND CON PB Olna APPLY NO-ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH. s r . 1 .J :j PLUMBING -24- U f ' TRAn No: PARCEL No. GAS TEST MECHANICAL -/01' ACC.DATE ACC.FILE NO. ELECTRICAL FINALS E IN P. .FRAMINGI h SAN F Z ZONING ENG,SITE NO. INSULATION _ PLUMBING 9--3 —rr GAS MECHANICALFIRE SPRINK ENERGY T1< COVER N WORK UNTIL ABOV AS BEE IGNED HEATING " ❑ N❑ ° ❑ "❑LATH-INTERIOR ELECTRICALa000zoNE A.L.u.c. � Y❑ N❑ Y ❑ N❑ LATH-EXTERIOR meg_ FIRE DEPT. SHEETROCKGRADE FEE SUMMARY SHEAR INTERIOR `C BUILDING SHEAR EXTERIOR - 'TEMPORARY APPROVAL BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS '3 HOZ` FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE Y OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING s C)� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL /•' CALLING FOR FINAL INSPECTION. ` OFFICECOPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDI'° 11503 SpriLAPPLICATION & PERMIT Seven ngane ADDRESS 13774 Lot 73 - 3A BUILDING - ELECTRICAL-PLUMBING-MECHANICALI ti OWNER'S PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE Gregory Group, Inc.1H0NE595-2100 CONTRACTORS NAMEUTLETS-SWITCHES-RECEP . 10.00/1.00 . Gregory Group, Inc.LIC.NO. 430097 LIGHTING FIXTURES 10.00/1.00 coNTRACTOR's 220 Twin Dolphin Dr:, #G PPLIANCES-RESIDENTIAL 4.00 ADOR ESS R d d ONE _ PANELS D.OD DATE OF APPLICATION ENGINEER ram Bass enian, •A.I .A. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No. OR ENGINEER LIC, I .A. SIGNS TRANS. 3.00 ADDRESS 3990 Westerly Pl . , #17O ' SPECIALCIRCUIT 5.00 PERMIT VALIDATION TIP EMP.METER OR POLE INS. 20.00 ADORE Mrs 220 Twin Dol phi n Dr. , t C MOTORS SEE FEE SCH. ADOREss Redwood City, CA q4n65 SERVICE CHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION a o b I hereby affirm that 1 em licensed under provisions of Chapter 9 p DANCE DATE m G N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F 0 i Professions Coda,and my license is in full force and effect. _ Licensc Class_ Lic.Numbcr30O(}7 it �yy Q w Date Contractor Cft a , 2 BUILDING PERMIT ¢ a, w ¢ OWNER-BUILDER DECLARATION INFORMATION seof MISC.- REFER TO ORD ; LL N 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION f/FT. Hu0J Law for the following reason,(Sec.7031.5.BusinessandPro(essions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alteq �� ,ti}� ar Q G 0 improve,demolish,or repair any structum,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. 'n/ (� O u requires the applicant for such permit to file a signed statement that TOTAL / PERMIT TO AID wr3 he is licensed pursuant to the provisions of the Controcmr's Licenw w rii Law(Chapler9(commencing with Section 7000)of Division 3 of the x o Business and Professions Code)or that he ev exempt therefrom and GTY. PLUMBING PERMIT FEE ¢ F 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 mom than five hundred dollen(5500).): '�--'- ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.ROUT Re;.UNITS their sole compensation,will do the work,and the stretme is not J intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 / Code:The Contractor's License Law does not apply to an owner of properly who builds or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 !-. So.FT.FLODR AREA- TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsam not intended or offered for sole.If,however,the building' GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or Improvement is 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 im- provefor purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 �RE�E1s IND CON PB orae, $y ❑ 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 ASSESSORSPARCELNO. and Professions Code:The Contractor's License Law docs not apply } ij to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1:00 contracts for such projects with a contmetons)licensed pursuant to the Contractors Licenu Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO.' PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 - ACC.DATE ACC.FILE N0. WORKE.RS'COMEENSA'FION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.CJ. - Policy No. Company ac-/Rea i-a-n ❑o❑,�. Certified cops herby furnls FIRESPRINK ENERGY T 24 Z Z "ACCet ified �' Jed y'y1 -ction division. MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ O_ CC h CERTIFIC EOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U C .L.UL LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. )) (� CL a (This section need not be completed if the permit is for one TOTAL /�t Y❑ N❑ Y ❑ N❑ ::) Z hundred dollars(S 100)or less.) - U Q 1 certify that in the performance of the work for which this per- GTY MECHANICAL PERMIT FEE FEE SUMMARY LL I- 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. Is. Date Applicant ALTER OR ADD TO MECH. 5.00 . BUILDING 15_4 } e4 NOTICE TO APPLICANT: If,after making this Certificate of Ex- F Z_ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 9 _ provisions of the Labor Code, you most forthwith comply with FEE p�} CJ such provisions or this permit shall Redeemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE � a 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(Sec. MICROFILM 3097,Civ,C.), 1 HEATING UNIT (TO 100,000 B.T.U.) 6.00 Lender's Namc Security Paeifir. / Lender's Address�aFl-FPanC4SeO�A H EATI N G U N IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC /76 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00IN //� information correct I agree comply with all City and county BOILER-COMP l3 H.P.or 100,000 B.T.U.) 6.00 PLUMBG ordinances and state laws relatiti ng to building construction. and _ hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for Inspection purposes: (We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. /Q Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may N any way acct against said City in consequence of the PERMIT ISSUANCE 10.00 grin Unit ace MECH.CONT. LIC.NO. MECH. TOTAL cc TOTAL f 30 Signalu App cant/Co 'rust a -� OFFICE COPY.