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15828 (2) POST THIS CARD•NEAR FRONT OF BUILDING CITY OF CUPERTINO PERMITNUMBER . INSPECTION DIVISION JOB INSPECTION RECORD p� PERMIT EXPIRATION JOB ADDRESS - ILQ-IO e)PCM f_7 So. C-�1T- UNIT# _LOT# . PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - -NOTE: ANCE OR 180 DAYS FROM ' UFER � ALL GRADING AND DRAINAGE SHALL BE IN LAST CALLED INSPECTION, PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CIN OF - PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ UNDERGROUND /SLAB PLUMBING - �. f,-.'' ' . .�'✓. ' . ELECTRICAL ISSUANCE DATE MECHANICAL FLOG, ELECT PLG. MECH . o. DO NOT POUR FLOOR U IL ABOVE HAS BEEN SIGNED q BUILDING PERMIT ,, 1 INFORMATION WOOD FLOOR - aw O PLUMBING C vALuaVALUATIONaiPT. 01t�0 MECHANICAL 1\y 0� CUQ 1!35!865 ~.L ELECTRICAL - PERMIT TO FRAMING - SFQU - i INSULATION STORIES TYPE CONSTR - DCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3 . I SO FT FLOOR AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE .' DIAPHRAGM THE CONSTRUCTION TAX IS PAID 2917 BUILDING USE ROOF SHEATHING RES IND, CON PB Om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ 5 A971'RS PARCEL NO ROUGH SAN.# I PLUMBING _ _ �e ELECT.ENERGY TRACT NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL r X74MECH.ENERGY _ 8098 ELECTRICAL -� BUILDING ENERGY ACC.DATE ACC FILE NO FRAMING P F. ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION _ PLUMBING GAS TEST GAS C MECHANICAL, EIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN.SIGNED HEATING Y [:] N❑ ❑ N❑ FLOOD ZONE ALU C. A EXTERIOR SHEAR L.t ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT: Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE ,/ ' FEE SUMMARY EXTERIOR LATH BUILDING g BUILDING .INTERIOR LATH - ;5 TEMPORARY APPRCVALS - . SCRATCH COAT —AAA en C`99 ELECTRIC FEE 15.50 CH7ECK I,U GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNEDOCCUPANCY. SEISMIC FEE gT OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM I ARRANGE FOR INSPECTION BY PHONING 252-4505., ELECTRIC 4 o� . ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. = SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! . CONST.TAX• 3 /> IV/ PLEASE READ REV@RSE SIDE.BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LD1 NG PROJECT I DENTI FICATION -PERMIT NUMBER_ - t ` ADDRENG Lot # 203 .Plan 3B APPLICATION & PERMIT 15 8 2 8 A11618 Birch Spring Court BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 0Wry Eil PLAN CHECK VALIDATION NOME Gregory Group, Inc. & QTY. ELECTRIC PERMIT FEE Ahmanson Deva 415-595-2100 CONTRACTOR'S NAME Gregory Group, Ince B-430097 UTLETS-SWITCHES-RECEP 10.00/1.00 - Le.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S _C Twin DOlphln Dr. APPLIANCES-RESIDENTIAL 4.00 ADDRESS RWC 94065 416-695-2100 PANELS 10.00 DATE OF APPLICATION OR ARCHITECT Aram Bassenian, AIA & Assoc PANELS (OVER 200 AMP), 20.00 PLAN CHECK FEE P.C.-NO,. O ENGINEER -8395 LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS Santa AnarcHts. CA. 92707 SPECIAL CIRCUIT, 5.00 ZIP EMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS SEE FEE SCH. AOORESS 220-C Twin DOLPHIN Dr. RWC SERVICE CHANGE 20.0094065. '02 0o LICENSED CONTRACTORS DECLARATION /(/L,�O o ' a U v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE - a i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H N i Professions Code,angmy license is in fall three n effect. p 0 w o License Class Lic.Number_43009.7- Dale Contractor m, W4 OWNER-BUILDER DECLARATION A1� BUILDING PERMIT A o W U INFORMATION X ; LL w I hereby affirm that I am exempt from the Contractor's License MISC.- - REFER TO ORD .. o a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. PERMIT ISSUANCE 1 t1 185 865 3 > F Code:Any city or county which renaires a permit to construct,alter, , O improve,demolish,or repair any struchue,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. a. O u¢. requires the applicant ler such permit to file a signed statement that TOTAL - ''1P1'E'RMIT TO K $ he is licensed purslm d to the provisions ol'the Contractor's License SFD W RM r z i Law,(Chapter 9(commencingwith Section 7000).0Division 3 of the 4 o Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE ce I- $ the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. T;_ by anyapplicaN for a permit subjects the applicant foacivilpenalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500f): 2 5NHR ❑ Las 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,AREA,COND. 5.00 R-3 I Code:The Contractor's License Law does not apply to on owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 S0.FT.FLOOR AREA TOTAL ACREAGE • himself through his ownemployees,fors providedthatsuch improve- 2917 hients mself a through his or offered ees,provided that s the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200 BUILDING USE builder will have the burden of proving that he did not build or im - . - . . RES IND CON PB Orher prove 1,as ownerose the.l. - INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ Cl d as owner of the property,he exclusively.7044,tBu with licensed contractors : construct the project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Chile:The Contractor's License Law does not apply -a��,�/� /� to contracts owner of property who builds t r improvesthereon,p.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 L..ILLxr) ✓ / the Contractor's oar'sor h cense L with a contructorl s7 licensed pursuunt to SEWER-SANITARY-STORM EA.200tt/1400 `+^�sO ✓✓✓✓ ��/ the Coaactor's LlcenSe Law. � TRACT NO, PARCEL N0. ❑ lam exempt tinder Sec. ,B.&BC.I'or this reason WATER HEATER W/VENT 6.00 8098 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby at if that I have a certificate ofconsent to self-insure' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copythermffsee.3g00,Lab.C.LUnited PACIFIC Policy Nn. Company O ❑ 'Certilied copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z �( Certified copy is filed with the city inspection division. P: O Applicant I MISC.- REFER TO ORD. Y [:] N❑ Y E) N❑ to PERMIT ISSUANCE 10.00 CC - CERTIFICATE OIs EXEMPTION FROM WORKERS' FLOOD ZONE A.Lu.C. LU > COMPENSATION INSLJRANC17 PLG.CONTR. LIC.NO. PLG. CL O (This section need not be completed if the permit is for one TOTAL Y E) N❑ Y❑ N❑ 0 Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- QTV. MECHANICAL PERMIT FEE FEE SUMMARY LL f mit is issued, 1 shall not employ any person in any manner so ax to O W become subject to the Workers'Compensulion Laws of California. a Date Applicant ' ALTER OR ADD TO MECH. 5.00 BUILDING 940.5 } m NOTICE 'TO APPLICANT'. if,after nuking Ibis Certificate of E.- F ? emption,you should become subject to the Workers'Compensulion gppLIANCE 5.00 PLAN CHECK 15.50 provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10/DDC.FJVU 4.00 FEE /energy CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE 13.02 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this ermit is issued(Sec. MICROFILM 3097,Gv.C.)' Security Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nana-I-FRIh�drCa��r_. HEATING UNIT(OVER 100,000 B.T.U.) ELECTRIC 70.35 Lender's Name 1 certify that I love read this application and state t Iat the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county PLUMBING 70.35 ordinances and state laws relating to building construction, and BOILER-CLNv1P(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEESCH, MECHANICAL above-mentioned properly for inspection purposes. 70.35 (We) agree to save, indemnify and kap harmless the City of MISC.- REFER TO ORD. Cupertinog judgments, p - CON T.TAX ana against Inabilities, ud mems, costs and expenses which PERMIT ISSUANCE 10.00 may in any way accrue against s'id City in consequence of the A ranting of this purmil,� MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature of A a onhactor Ua[e OFFICE COPY