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17716 POST THIS CARD NEAR FRONT OF BUILDING RMI NUMRER CITY OF CUPERTINO 17716 INSPECTION DIVISION JOB INSPECTION RECORD # PERMIT EXPIRATION JOB ADDRESS/�lI S� �� J�'F`—�AJ�o t�UNIT# _LOT •� PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION ANCE OR 180 DAYS FROM NOTE: LIFER ALL GRADING AND DRAINAGE SHALL BE.INSTALLED LASTCALLED INSPECTION. PR£GUN ITETO COMPLY WITH THE APPROVED PLANS AND CITY OF PeRwT VALIDATION P' GARAGE SLABS ' CUPERTINO STANDARDS. naD AiVry NUC.E POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 23 UNDERGROUND /SLAB .�'�q� � '� 19Jt` PLUMBING �E, � • 1 F ELECTRICAL . C11y Of CUper6RO ISSUANCE DATE MECHANICAL BLDG I ELECT I PLO. MECH ® ® It k] DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDy1' .1 BUILDING PERMIT n '� �.11 / INFORMATION PLUMBING WOOD FLOOR - vALUATTON STET. MECHANICAL �- • . rl �'� A 194150 ELECTRICAL PERMIT TD FRAMING - INSULATION STOHIES TVPECONSTR l �! � > 2 t OCC GROUP RES DO TS ce�vrcF,-� - R-3 1 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,Fr FLOOR AREA TOTAL ACRLAGE, AMk ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID W47 f, i I'~ .tJ)' N ROOF SHEATHING Res INBUILDIG USE D CON Pa OTT" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ROUGH SAN.q I — ASSESSORS PARCEL No PLUMBING ELECT.ENERGY I 3roro -��- oaI TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECH.ENERGY m ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG SITE NO. GAS TEST GAS MECHANICAL EIRE SPRINrc ENERGY T.}E COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ N❑ EXTERIOR SHEAR =vqELECTRICAL RELEASE FLDOU Z.0NL AL UC. INTERIOR SHEAR16(lff m5 FIRE DEPT. Y ❑ N❑ , LI N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH � BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING 972.00 SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 13.66 OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC .13 ~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. 73.0 - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL _73,113 IMPORTANT! CONST, TAX 32. PLEASE READ REVERSE SIDE BEFORE TOTAL � CALLING FOR FINAL INSPECTION. �JBQ.SG OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER ^ BUILDING ADDRESS 11853 Shasta Sprj Court Lot 347 b BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION ""ME Gregory Group, Inc. OTY. ELECTRIC PERMIT FEE ® ONE 41 nn AMFRAcrDRs N &Wy GW, Inc. UTLETS-SWITCHES-RECEP 10.00/1.00 `�"^�F� LtC.No. B4M7 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR EsACTOR Ann 's 220-C Twin Dolphin Drive APPLIANCES-RESIDENTIAL 4.00 M. CA 94065 vHONE415695.21PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR [ia$serljan/l dgOnl kClliteCtS PANELS (OVER 200 AMP) 20.00 ENGINEER /�,,,,�,�,,,,.1 fy� LIC.N/(O.(y� SIGNS TRANS. 3.00 ARCH OR ENG.2031 0rchard WI U UI ive j/100 PERMIT VALIDATION ARCH OR Ll/ SPECIAL CIRCUIT 5.00 Santa hia I-L-idits, CA zip g2707 TEMP.METER OR POLE INS. 20.00 ADDRESS M-C Twin Dolphin Drive MOTORS SEE FEE SCH. ADDRESS MH CA 94ffiq SERVICE CHANGE 20.00 iOtA--1' 0 LICENSED CONTRACfORS DECLARATION :1sem- V, a u 1 hereby affirm Ilhat I am licensed under provisions of Chapter t) ' Q u ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and r w i Professions Code.and beau.is in full force o5�tj�y V fl rl .01p i BLDG. ELECT. PLG. MECH, o f o License Class-D Lie Number 4J1 O 11, ' P - N r Date Contactor - Mw a OWNER-BUILDER DECLARATION BUILDING PERMIT K o O ILINFORMATION w ; N 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- TO ORD ie 0OJ Low for the following reason.(See.7031.5,Business and Professions VALUATION $/FT. - PERMIT ISSUANCE 10.00 �A Code:Any city or county which requires a perm It to constnhtt alter. 1 J`t,540 2¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. Jt JiV ea o¢ requires the applicant for such permit to file a signed statement that TOTAL t � ' w he is licensed pursuant to the provisions of the Contractor's License PERMIT JWTO H z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the s x D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE re r m the basis for the alleged exemption.Any violation of Section 7031.5 u ;- by any applicant for a permit subjects the applicant toa civil penalty STORIES TYPE CONSTR. of net more than five hundred dollans($500)J: ALTER-DRAIN&VENT-WATER (EA.) 5.00 2 5" ❑ 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 tended 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 R-3 1 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT FLOOR AREA TOTAL ACREAGE himself through his own employees,provided that such improve ments are improv not mens is sold or within offered on forsale.o If,however the building GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00 3047 /1 f 1E/ Or improvement is sob within one year of lie did the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 G 1-1V builder will have the burden of proving that he did no[build or.int- BuRLD1 USE prove for purpose ofsale.). S IND CON PB OtM1er, ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 RES El ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044, RosinessFANMN5 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'I lie Contractors License Law does nut apply to an owner of property who builds or improves hereon.and who 5(EA.) 1.00 'G'L� A�1� contracts for such projects with a comnetor(s)licensed pursuant to .1✓ L--C.Ythe Contractor's License Law. EA.200tt/10.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,R.&P.C.for thisreason 6.00Owner Date 8098 5.00ACC.DATE ACC.FILE NO. WORK F.RS'COMPENSATION UECLARAT ION , 5.00 1 hercby affum that I have a certificate of consent to sell-insure. or a certificate of Workers'Compensation Insurance,Or a certified ZONING ENG SITE NO. copy thereof(Sec.3800,Lab.C.). Policy Nom . Copany-Lhi.ted-P-aoifac 0 jyfJl Certified copy is hereby furnished. z Z A Certific oIy is filed with tlVvily ins pedion Division. FIRE SPRINK ENERGY T 24 F O Applicant - MISC.- REFER TO ORD. Y N❑ Y [:] N[] D- 5 CER'I'IIICA'1'1!OI'IiXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU - COMPENSATION INSURANCE i PLG.CONTH. LIC.NO, PLG. CL D ('Phis section need not be Completed if the hmmit is for one TOTAL Y E] N� Y ry� Z hundred dollars(SI001 or less.) U O 1 Certify that in the peRouRaact of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to 0 W become subject to the Workers'Compensation Laws of California. a Dg1C Apphc°m ALTER OR ADD TO MECHBUILDING >_ 9 N NOTICE 'I'O APPLICANT: 11,after making this Cen ficata of fix- . 5.00 Z emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK 15.50 Provisions of the Labor Code, you must forthwith comply with U such provisions or this permit slhall be deemed revoked AIR HANDLING UNIT(TO 10ACC.F.M.) 4.00 FEE CONST'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.FM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 13.65 the performance of the work for which this permit is issued(Sec. 3097,Cis C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lenders Name Lender's Address P HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read This application and slate that the above VENTILATION FAN (SINGLE) 4.00 73.1.1 nuation n cored. I agree to comply with all city and countyy info ordinances and state laws relating to building construction. and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING hereby authorize representatives of this city to enter upon the BOILER- above-mentioned Properly for inspection purposes. COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. 2-1-11 Cupertino against liabilities,judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX 3� mntia of this permit - to CONT. LIC.NO. MECH. S=2 .02 TOTAL TOTAL Signator pp vamIContractor Date 1 ,584.,1506 OFFICE COPY