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17719O Z z P: O LU - ao 0z 0 U. U Ed } Do A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ' 'SUI LDING PROJECT. IDENTIFICATION APPLICATION & PERMIT- BUILDING - ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 17719 BDILDIrvG1882 341 ADDREsa AWD Is OwrvER'a a NAME PHONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION , DATE OF APPLICATION " N9.ERAcrDGregory Rs Group, Inc. `�"^•'1� LIC.No. OUTLETS -SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00CONTR ADDREAcroRs 220-C Twin Dolphin Drive RIC CA 74065 PPH,OONI.E,4+1Q5.µ59,5-2100 APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT Bassenian/Lagoni A L.I1f lects OR ENGINEER ua No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 (�,,��,�.11�,� ARCH OR LVJ i ADDRESS ENG. 2031 lA U IQI U Drive #100 Santa A)a Fleifts. CA zip 92707 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION �+� I k.l II�f�JI ISSUANCE DATE EMP. METER OR POLE INS. 20.00 ADDRESS 220-C Twin Dolphin Drive M, CA 94065 MOTORS SEE FEE SCH. SERVICE CHANGE j7` --Ji 20.00 LICENSLD CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, d my license is in full force and effect. License Class- B- Li, Number_43ON7 Date Contractor p �F11 �y J �..�'J ..I BLDG. ELECT. PLG. MECH. ' ui� n _ - OWNER -BUILDER DECLARATioN I hereby affirm that I am exempt front the Commmor's License Law for the following reason. (Sec. 7031.5. Business and Professions Code: Any city orcounty which requires a permit to construct, alter. improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions on the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of Hit Business and Professions Code) or that he is exempt therefrom and the basis Cc' Ihr.HLged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects tire applicant loacivfl penalty Of not marc than five hundred property, o (my employees O Las owner at tee property. or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Soo 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who docs such work himself or through his own cmployecs, provided that such imp..., mends are not intended or offered for sale If. however, the building Or improvement is sold within one year of completion, the owner- builder will have the burden of proving that lie did not build of int- prove for purpose of the.). ❑ licensed1. os owner of the property. he exclusively vntmctBa wth andPro contractors : I construct the peaked (Sec 7044, Business and Professions Code: l'hc Contractor's License Law docs nal apply to an owner of property who builds or improves thereon, and who contracts contracts for such projects with a contradons) licensed pursuant to the Cmhdmetor's License Law. ❑ font exempt under Sec. ,B.&P.C. for this ocalsom BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCEVALUATION 10.00 �/I p�/� 194 540 $/FT. ELEC.CONTR. LIC. NO, - ELEC. TOTAL PERMIT TO D QTY. PLUMBING PERMIT FEE ALTER -DRAIN -WATER IEA.) 5.00 STORIES .2 TYPE CONSTR. 5W BACK FLOW PROTECT. DEV ICE 4.00 OCC. GROUP R_3 RES. UNITS 1 DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTUR ES - PER TRAP 5.00 GAS - EA. SYSTEM - 1 I NC.4 OUTLETS 6.00 GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 So. FT. FLOOR AREA 3047 TOTAL ACREAGE 1 5 l BUILDI USE RES IND CON PB Other ki ❑ ❑ INDUSTRIAL WASTE INTERS:-_ 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 8.00 ASSESSORS PARCEL NO, _ no LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ' SEWER -SANITARY -STORM EA. 2001t/10.00 TRACT NO, 80% _ PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 WOR K1iR5'COMP1iNSATION DECLARATION 1 hereby affirm that 1 have a certifies a of consent to self-insllf . or a certificate of Workers' Compensation Insurance, or a certified copy thercof(Sec.3800, Lab.C) L, +,�,� n Policy No Company_U lited-Pacifl( ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. ❑ Certified copy is hereby furnished. L Certified p a lilctl with file `y inspgction division. All, cant MISC. - REFER TO ORD. FIRESPRINK • Y ❑ N ❑ ENERGYT-24 Y E] No CCR FI A F.OF IiXEMPTION FROM WORKERS' COMPENSATION INSURANCE ffhis section need not he completed if tilt permit'is for one hundred dollars IS 100) or less. ) 1 certify that in the perlormance of the work lir which this par- mit is i,ssuud, I shall not employ any parson in, any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant Date i TO APPLICANT: If, after making this Certificate of Ea - empfion, you should become subject to the Workers'Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONs'f RUCTION LENDING AGENCY I herchy affirm that fhere is a construction lending agency for the performance of the work for which this permit is issued (Sec, 3097, Civ.C.). Lender's Name PERMIT ISSUANCE 10.00. FLOOD ZONE Y ❑ NE] A. L.U.C. Y ❑ N� PLG. CONTR. LIC. NO. PLG. i TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING 972 00 ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C,F.M.) 4.00 (HECK PLA �C „ FEE u rU 15.50 62.00 AIR HANDLING UNIT (OVER 10MIC.F.M.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Address 1 certify that I have read this application and state that the above id'ommtion is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep haRnI.A the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the tan NEII, f tt his per mit. --' -'-e HEATI NG UNIT(OV E R 100,000 B.T.U.) 9.50 ELECTRIC 73.13 VENTILATION FAN (SINGLE) 4.00 BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING 773.13 801 LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL misc.- REFER TO ORD. PERMIT ISSUANCE 10,00 CONST. TAX 3� .02 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL f 584.56 i Signature o Applicant ContractoreE, Fe te OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD Q V `� S J✓i�G " JOB ADDR ESS cA 44744 UNIT# _LOT# / . OWNER CONTRACTOR PERMIT NUMBER 17719 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE:' ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. i �® LIFER PREGUNITE PERMIT VALIDATION' ('I �.� `• l J'V1�V �' `VV ✓� ISSUANCE uAiE GARAGE SLABS I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED LI '�� UNDERGROUND/SLAB PLUMBING pp Bill t W w,y,,,� ELECTRICAL MECHANICAL - BLDG ki ELECT I PLG. MECR ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Q BUILDING PERMIT INFORMATION ' WOOD FLOOR PLUMBING VALUATION . SIFT. MECHANICAL ELECTRICAL PE"Mui TO gm FRAMING INSULATION STORIES 2 TYPPE�C�OONSTR ,rwi w fa' 2 ,OCC GROUP R- RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID $O FT FLOOR AREA t \ TOTALACREAGE�. :1 DIAPHRAGM ROOF SHEATHING 10 -LeC{ BUILDING USE RES IND CON PB Dm.- ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH 7/A�SS�ESSORSPARCELNO YY��Y� �-LLUl' 56-CQ5 PLUMBING ELECSAN.hT. ELECT. ENERGY TUBS 6 SHOWER PAN PLUMBING ENERGY TRACT NO 8a PARCEL NO MECHANICAL MECK ENERGY ELECTRICALry Z 1V r� BUILDING ENERGY ACC.DATE ACC FILE NO FRAMING (f'- ELECT. FINAL TEST INSULATION , PLUMBING ZONING ENG SITE NO, GAS TEST GAS MECHANICAL FIRE SPRINK Y ❑ N❑ ENERY T., G Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR O ELECTRICAL RELEASE - FLOODZONE Y❑ "_❑ A.L UC Y ❑ NO INTERIOR SHEAR (�`Z q FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING 1972.00 INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAIy„CH FEET TrWF GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I ISEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN PHONING.73.12 - SEE,PERMIT FOR EXPIRATION DATE - ELECTRIC 73.13 PLUMBING MECHANICAL IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. CONST. TAX TOTAL r 56G.5(j OFFICE COPY