15151 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES, - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION- - PERMITNUMBER
BUILDINGRE1111 APPLICATION & PERMIT 1 [�1 51
LOTADDRESS
36684 WALNUT SPRING COURT 15 I
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
NA
MEfl'S Gregory Group Inc. PLAN CHECK VALI DAT ION
` Np Ahmanson Dev. 4l,5N,595-2100 OTY ELECTRIC PERMIT FEE
CONTRACTORS
NA'tregory Group, Inc. B-430097 OUTLETS-SWITCHES-RECEP 10.0011.00
LIC,No. LIGHTING FIXTURES 10.00/1.00
rorvqr�R�A(crofls win 0 p In r. PPLIANCES-RESIDENTIAL 4.00
A,RWC .94065 P�G�P-595-2100 PANELS - 10.00 DATE OF APPLICATION
ORRCHITECT ram aSsenlan, ALA & ASSOC PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER LIC.N0. C-8395 SIGNS TRANS. 3.00
ARCA EOR BS ENO. rc arc • ry7 SPECIAL CIRCUIT 5.00 PERMIT VALI DATION
Santa nil tS. 3L
ZIP TEMP.METER OR POLE INS. 20.00 '
APPLICANT'S - - MOTORS SEE FEE SCH.
ADDRESS 220-C Twin Dolphin Dr. RWC lnn�Q�
RVICE CHANGE 20.00
o o - LICENSED CONTRACTORS DECLARATION
Q U w I hereby all that I am licensed Under provisions of Chapter 9DEC ! 3 ISSUANCE DATE
N a (commencing with Section 70001 of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
H w i . Professions Code,�s1d my license is in full fore Rel. }s ® ❑ ❑
Q z r Liccnsc Cluss_DLic Number lvltJ Of�IjT'
Dale Cmnmel.r ' Cupertino
B: m E BUILDING PERMIT
ao n 0 OWNER-BUILDER DECLARATION INFORMATION
E:
; N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u 0 ar Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION SIFT.
� y Code:Any city orcounly which requiresa permit loconstruct.alteL 10.00 194,540
Q an cc ¢ 0 Improve,demolish,Or repair any structure,prior lD Its issuance,also ELEC.CONTR. LIC.NO. ELEC.
iL 0 le requires the applicant for such permit to file a signed statement that TOTAL
6 w m LL he is licensed pursuant to tile provisions Of the Contractor's License PERMIT TO
Hii Law(Chapter 9(commeecingwith Section 1000)of Division 3 ofthe SFDU
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
zoo the basis for alleged exemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR.
a- 2 by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5,00 2 SNHR
of not more than five hundred dollars($500l):
-❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 R-3 1
Code:The Contractor's License Law does not apply to an owner of
Properly who builds or improves Ihereon,and who does such work FIXTURES,PER TRAP 5.00 SG.FT.FLOOR AREA TOTAL ACRFAGE
himself or through his own employees,provided that such improve
mems are not intended or offered for sale.If;however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 3047
or improvement is sold within one year of completion,the owns,-
GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or ire. BUILDING USE
prove for purpose Grade.). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Dme,
❑ I,as owner of the property,am exclusively contracting with IJ 0 E D ❑
licensed contractors to construct'tile project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code',The Contractor's License Low does not apply p
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.1 1.00 3G 6-9'-31 U 133
contracts for such projects with it cuntractods)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITAR V 1000
-STORM EA.200ft1 . TRACT NO. PARCELNO.
❑ IUmexemplonder Sec. .B.&P.Cforthis
WATER HEATER W/VENT 6.00 8098
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'I ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance.or a certified I ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).United Pacific
Policy Nn. Company
O ❑ Certified copy is hereby furnished, FIRE SPRINK ENERGY T24
Z Z Certified copy ]s ed Ih the city inspection division. MISC.- REFER TO ORD.
O App icant v� N Y [J No
H 10.00
CL a- PERMIT ISSUANCE CIiRTIFICKI'li OIr IiXI1MP1'ION FROM WORKERS' ZONE A.L.UL.
LU > COMPENSATION INSURANCE PLG.CONTR. ❑c.NO. PLG.
CL O ('116,'section need not be compleled If the permit Is for ora TOTAL Y NE] V N[D
Z) Z hundred dollms(SIOOIorle".)
U O I certify that in the performance ol'the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,1 shall not employ any person in any manner m as to
U become subject to the Workers'Compensation Laws of California.
St. Uate - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 9'72.00
>_ W NOTICE TO APPLICANT': If,ufler making this Certificate of li x.
F ? eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 15.50
provisions of the Labor Code, you most forthwith comply with
U s]Rh provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE /en ray
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 13.65
1 hereby affirm that there is a construction lending agency 1'Or EXHAUST HOOD(WITH DUCT) 5.00
the,performance of(be work for which this Permit is issued(Sou. MICROFILM
309MCiv.C.). Security Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00
LenU pis Name HEATING UNIT(OVER 100,000 B.T.U.19.50
Lender's Add. -EllglaP`C-F3(1 p7j L- ELECTRIC 73.13
I certify that I have read this applica on arfE�4 e l I the above VENTILATION FAN (SINGLE) 4.00
infonnmion is correct. I agree to comply will] all city and county PLUMBING 73. 13
ordinances and stale laws relating to building construction, anti ' BOILER-COMP 13 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP Inver t00,0008TU15EE FEE SCH, MECHANICAL
above mentioned property for inspection purposes. 73.13
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
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
ranting of thisp I MECH.CONT, LIC.NO. MECH.
TGTAL TOTAL
Signature of Ap tic Cb tactor UaW - s
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDINGS PERMIT NUMBER
' CITY OF CUPERTINO 15151
INSPECTII)N DIVISION
JOB INSPECTION RECORD
/. 1i PERMIT EXPIRATION
JOB ADDRESS— J I (ll 1p)✓ kjlr I LS2lT S.7 LT UNIT# _LOT# 13—
PERMIT EXPIRES IF WORK
OWNER _ CONTRACTOR T C (L IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION ON R_ COR 180 DAYS OF PERMIT ISSUE
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PeHMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDDLC y '3 1988
UNDERGROUND /SLAB 1 d U
PLUMBING 2 — uty 01• Cu [Nl
ELECTRICAL pe�DD ISSUANCE DATE
MECHANICAL - - BLDG. ELECT. PLG. MECH
ef� ElDO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING '
MECHANICAL
ELECTRICAL EHMIT To
FRAMING Qc to
INSULATION STORIES TYPE CONSTH.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BASIGNEDSO FT 1'LOOH AHEA TOTALACHEAGE
ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM I THE CONSTRUCTION TAX IS PAID
W ROOF SHEATHING TIES IND'ILOCON11$EPB Ulna,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑
ROUGH SAN.a 7 ASCE SLSORS Pq RCEI.NO
PLUMBING ELECT.ENERGY
TH ACTNO PARCEL NOV
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL . MECH.ENERGY
ELECTRICAL BUILDING ENERGY e ncc.FILL No
FRAMING ELECT.FINAL TEST
ZONING END.SITE N0.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
NEI Y [D Np
FLOOD ZONE A,L a C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH — BUILDING -
INTERIOR LATH . TEMPORARY APPROVALS BUILDING
SCRATCHCOAT ELECTRIC - PLAN CHECK 2.00
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEI[AMW 62.00
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FIN ALISSIGNEDBYSUILDING INSPECTOR, MICROFILM
J •_
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESSWHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX _
PLEASE READ REVERSE SIDE BEFORE TOTAL • /
CALLING FOR FINAL INSPECTION.
OFFICE COPY 1 671.49