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13795 I POST THIS CARD NEAR FRONT QF'BIJILDING PERMIT NUMBER CITY OF CUPERTIN01 13795 INSPECTION DIVISION JOB INSPECTION RECORD }� LL��1I � C,.,� �,l.� (1-� O� PERMIT EXPIRATION JOB ADDRESS ( «�y ��I--c^ I"� `�' UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR ISNOT STARTED WITHIN INSPECTION IDATE I INSP TOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING - ELECTRICAL O` I c cE DATE MECHANICAL ❑B O; PL4.MO DO NOT POUR FLOOR UNTIL AROVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION VALUATION SIFT. PLUMBING MECHANICAL �• 'J PERMIT TO ELECTRICAL _ FRAMING - 1)U✓>� - STORIES TYPE CONSTR. INSULATION ' OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED �' 4 ' ROOF SO,FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB O,hr, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ Ej ❑ 0 _ ASSESSORS PARCEL NO. ROUGH PLUMBING GASTEST -/�•. :RACI'NO. PARCEL NO T r - MECHANICAL ,s^ ACC DATE ACC,FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # Z ZONING ENG.SITE NO. INSULATION PLUMBING �• •�� IYA. 1A i il GAS MECHANICAL FIRE SPRINKENERGY T2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NE] NE] LATH-INTERIOR ELECTRICAL. _ FLOOD ZONE aL.0 c. LATH-EXTERIOR - �� - FIRE DEPT. Y F] "EI Y ❑ "C3 SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING _ SHEAR EXTERIOR W_ TEMPORARY APPROVALS BUILDING FIREWALLS. ELECTRIC PLAN CHECK GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ' OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC i o� ' ONE WORKING.DAY BEFORE REQUIRED INSPECTION. PLUMBING 1 Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL z CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION i PERMIT NUMBER y BUIL ING APPLICATION & PERMIT .Do Sir 11510 Well Spring Court BUILDING-ELECTRICAL-PLUMBING-MECHANICAL Lot 93 - Plan 48R 13795 OWNERS PLAN CHECK VALIDATION 4p NAME QTY. ELECTRIC PERMIT FEE Gregory Group, Inc PHONE 595-2100 CONTRACTOR'S NAME ICI OUTLETS-SWITCHES-RECEP 10.0011.00 119 Gregory Group, Inc.L,G,ND, 430097 aQ LIGHTING FIXTURES 10.00/1.00 aq CONTRACTOR'5 APPLIANCES-RESIDENTIAL 4.00 a ADDRESS 220 Twin Dolphin Dr. Redwood City PHONE _ PANELS 19.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR Aram Bassenian, A.I .A. & PANELS (OVER200AMP) 20.00 ENGINEER ASSDCldteS LIC.NO SIGNS TRANS. 3.00 AR1RESS ENG. 3990 Westerly Place, #170 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS Newport Beach CA zip 9266 EMP.METER OR POLE INS. 20.00 ADDRESS 220 C TwiMOTORS SEE FEE SCH. A ? Dol hln Dr. APPLICANT Redwood Cit A 94065 SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION n v 1 hereby affirm that I am licensed under provisions of Chapter 9 M IS DATE aa,, "' (commencing with Section 7000)of Division 3 of the Business and a BLDG. PLG. MECH. '^ Professions Code,' d my license is in full force 4 U7 H 4q �,IW 7 I� zo License Class D oNumber. H iu DaleCCorntractor Q y J BUILDING PERMIT Ix S,w u OWNER-BUILD17R DECLARATION INFORMATION X 3 LL ,- I hereby affirm that I am exempt from the Controctor's License MISC.- REFER TO ORD LL o c Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. -' Code:Any cityorcounty which requires a permit to construct,alter, Qp Q p Improve,demolish,or repair any StR Ctllre,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. / `Y e u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO A w mhe is licensed pursuant to the provisions of the Contractor's License H 2 a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE IS tine 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&VENT-WATER (EA.) 5,00 of not mom than Ove hundred dollars(8500).): ❑ 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;Inc)Professions I DRAINS-FLOOR,ROOF,AREA,COND. 5.00 K - 3 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.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsare not intended Uroffered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.4OUTLETS 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 lire burden of proving that he did not build or int RES IND CON PB Other prove for purpose of sale.), INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of The property,am exclusively contmcling with 9 ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply II - to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 6(EA.) 1.00 J 3a,,33 contracts for such projects with a contractor(s)licensed purstmnl to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,BAP.C.fur this I WATER HEATER W/VENT 6.00 ��r( reason Owner Doe WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that I have a certifcam of consent to self-insum, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0. copy thereof(Sec.3800,Lab.COn l ted Pacific/Rel- Policy No. Company O ❑ Certified CD sir• •by fu FIRE SPRINK ENERGY T-24 Z Z ❑ ferritic ded a city inspection division. MISC- REFER TO ORD. D Applicant_ - V [3 E3 Y [:] NE] it to CF.RTIFI AEXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 joFLOOD ZONE A.LU.C. UJ > COMPENSATION INSURANCE PLG.CONTR. LIC.No, PL CL O TOTG.AL N I / i ❑ ❑ ❑ ❑ (This section need not he completed if the permit is 1'or One Y N Y 7 Z hundred dGllmrs($100)OrlessJ U O 1 certify that in the performance of The work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U become subject to lire Workers'Compensation Laws of California. _ y Dam ApplicantALTER OR ADD TO MECH. 5.00 BUILDING 6-72 } to NOTICE TO APPLICANT: If,after making this Certificate of Ex ? emptian,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with FEE 7.a� V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 0 9�Z 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.). $eCUrlt PaC1f1C HEATING UNIT TO 100,000 B.T.U.) 6.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address --1-anc-1�$C A- I certify Rod I have read this application and stole that the above VENTILATION FAN (SINGLE) 4,00 oro information is correct.I agree to comply with all city and county PLUMBING ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00 �S ��I,�1,, hereby authorize representatives of this city to enter upon the BOILER-COMP (0.,100,000 BTU)SEE FEE SCH. MECHANICAL `�1L above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless The City of MISC.- REFER TO ORD. / Cupertino against liabilities,judgments, costs and expenses which /O CONST.TAX p� /O may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 O grantmgo iI, mit. MECH.CONT. LIC.NO. MECH. TOTAL 04 _ ��1 3 TOTAL Signal Applicant/ConUacfor Da e OFFICE COPY