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13793 POST THIS CARD NEAR FRONT OF BUILDING PFHM1lli NUMBER CITY OF CUPERTINO 13793 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS I IS w ""�•-LL S'A�`�"1 CT ' UNIT# LOT# //�� /•,/],,, L - - PERMIT EXPIRES IF WORK OWNER � CZ�hpI2A C12al -kL.)C CONTRACTOR IS NOT STARTED WITHIN INSPECTION DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION opo +0 ,.b oN y C ANCE OR 180 DAYS FROM LIFER S y ¢Soh LASTCALLED INSPECTION. PREGUNITE - - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED aD��p UNDERGROUND /SLAB 1�t PLUMBING ELECTRICAL CE DATE 'MECHANICAL" ELECT. I PLO A MECR. . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED suao RM PERMIT INFORMATION WOOD FLOOR VALUATION $/GT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL II .- .,1 Vy L. FRAMING STORIES TYPE CONSTR. INSULATION 1 OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS 'BEENSIGNED ROOF SO,FT.FLOOR AREA TOTAL ACREAGE DF,4RkdSAGM- RLS IND ILOCON USE Otlm, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH GTEPLUMBING TRACT NO. PARCEL NO. AS ST MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN # Z ZONING ENG.SITE NO, INSULATION PLUMBING p- GAS _ 1- MECHANICAL 91 n FIRE SPRINK ENERGY TZA �i0 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ V N❑ FLOOD ONE AL.u.C. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT, I Y❑ N❑ Y0 N❑ SHEETROCK -I0 GRADE FEE SUMMARY SHEAR INTI BUILDING BUILDING . SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS ELECTRIC PLAN CHECK ` GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. � Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.ONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY CITY OF_CUPErTINO CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE -7 2 1.7 Date ...q.-1p.m................... 19............ Building Permit No. [.31 ... The Building Located at Owned by ......... �OQ�� C . ......................................................................................... Has Been om leted a�n (Altered) For Use As: ... .... ............................................................... ...................._..................................................._..................................................... ............................................................................................................................ .................................................................................................................................................. . .............. .s...... PD-7 BUILDING INSPECTOR APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER �E "OIL°I"` 11530 Well Springg ourt APPLICATION & PERMIT 13793 ADORE55 (Lot 91 - Plan 2CR BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE Gregory Group, Inc, PHONE 595-2100 CONTRACTORS NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 N Gregory Groups Inc. LIC.ND. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S X20 C Twin Dolphin Dr. 3 APPLIANCES-RESIDENTIAL 4.00 ADDRESS Redwood City, CA HONE 595-2100 PANELS 10.00 PATE OF APPLICATION PLAN CHECK FEE P.C.NO. ARCHITECT OR A am ossenlan, .I .A. & PANELS (OVER 200AMP) 20.00 ENGINEER am LIC.No. ISIGNS TRANS. 3.00 ARCH,08 3990 Westerly Place, /117 SPECIALCIRCUIT 5.00 ERMIT VALIDATION ADDRE'S Newport Beach, CA IIP 9266 EMP.METER OR POLE INS. 20.00 e a 1 APPLICANT'S MOTORS SEE FEE SCH. •7 o p ADDRESS 220 C Twolphi n Dn Dr. Redwood Cit SERVICE CHANGE 20.00 7 o o LICENSED CONTRACTORS DECLARATION a u u I hereby affirm that I am licensed under provisions of Chapter.9 ISSUANCE DATE 'a (commencing with Section 7000)of Division 3 of the Business and PLG. m 2 Professions Code.gnd my license is in full force ap4�f(q{'p� BLDG. ELECT. MECH. a i W License Class D Lic.Number_s{�-11114 Dale ContratorcL BUILDING PERMIT ¢ re w ¢ OWNER-BUILDER DECLARATION INFORMATION N'xh;LL a I hereby affirm MISC.- REFER TO ORD that I am exempt from the Contractor's License VALUATION S/FT. ..o ¢ Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 rw w� Code:Any city or county which requires a permit m construct,alter, 2 ¢ ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /�, I PER O¢ requires the applicant for such permit to file a signed statement that TOTAL � M T TO e w m u he is licensed pursuant to the provisions of the Contractor's License � O/�. Laza Law(Chapter 9(commenciagwith Suction 7000)of Division 3 of the 14 D Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ae H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant tort civil penalty of a.t more than five hundred dollars(85000.): ALTER-DRAIN&VENT-WATER (EA.) 5.00 S�/✓R ❑ I,as owner of the property,or my employees with wages us BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP PES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00 �-�3 Code:The Contractor's License Law does not apply to an owner of / property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 S 50.FT,FLOOR AREA TOTAL ACREAGE x:* himself or through his awn employees,provided that such in I �? mentsure not intended or offered for sale.If,however,the bwlding GAS•EA.SVSTEM-11NC.40UTLETS 6.00 (� t / or improvement is sold within one year of completion,life owner, GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE si }i builder will have the burden of proving that tie did not build or int- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner of the property,mm exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct life 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 o to an owner of property who builds or improves Glereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00 . �` 6�/ --3� 3 contracts for such projects with a contractons)licensed pursuant to BEWER•SANITAR V•STORM EA.200ft/10.00 / the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lam exempt Linder Sec.-,B.&P.C.for Ihis yyATER HEATER W/VENT 6.00 reason y Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK IiRS'COMPENSA'1ION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.L United Paclfl OR Policy No. Company ❑ Cerlifiedcapy hereby furm' FIRE SPRINK ENERGY T-24 ❑ Certified d e city m cion division. Zp Applicant _ MISC.- REFER TO ORD. Y❑ N❑ v ❑ N❑ CERTIFICATE OF EXEMPTION FROM WORKERS, PERMIT ISSUANCE 10.00 FLOOD ZONE �_ A.L.u.c. L COMPENSATION INSURANCE PLG CONTR. LIC.NO. PLG. (L Q (This section need not be completed if the pernil is for one TOTAL 3 Y❑ N❑ Y❑ N❑ =) Z .hundred dollars(S 100)or less.) U O I certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL H not is issued,I shall not employ any person in any nhanner so as to C) w become subject to rho Workers'Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING e) } tan NOTICE TO APPLICANT: If,after making this Certificate of I:x. ? emption,you should became subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK a g 3 provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit slmll he deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.RM.) 6.00 SEISMIC FEE �0 0/ I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 (lie performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.L Securit P c1f1C HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's NamAddress C�A HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address -s1s'J s- v,lr'' Icerlify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 1 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and ( BOILER•OOMP(3 H.P.or 100,000 B.T.U.) 6.00 �- hereby authorize representatives of this city to enter upon the BOILER-COMP Wine,100,000 BTU)SEE FEE SCH. MECHANICAL (%0 � ahmve-mentioned property for inspection purposes. i l (We) agree to save, indemnify end keep harmless the City of MISC.- REFER TO ORD. may i inn against liabilities,judgments, costs and expenses which CONST.TAX p N T may in any way accrue a al t said City in conseque a of,lhe PERMIT ISSUANCE 10.00 granting o p it. MECH.CONT. LIC.NO. MECH. / ^ TOTAL �' TOTAL J Td v Signator pplicant/Contractor a c OFFICE COPY