13756 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBE
APPLICATION & PERMIT
A DRESS LOT u�;: PLAN 2BR 5A Evening Spring Cour 1375' 6
1 BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S r" - PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
Gregory Group, In�IONE 415
COONTRACTORS 90 UTLETS-SWITCHES-RECEP 10.0011.00 90,00
qamp LIC.NO. _ LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S 20.00
ADDRESS
2212.00
D-C TWIn Dol phln Dr. PPLIANCES-RESIDENTIAL 4.00 s
PRONE _ PANELS 10.Q� DATE OF APPLICATION
ARCHITECT . PLAN CHECK FEE P.C.NO,
OR ARAM BASSENIAN) AIA PANELS (OVER 200 AMP) 20.00
ENGINEER & ASSOCIATES
LIC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG PERMIT VALIDATION
ADDREss SPECIAL CIRCUIT 5.00
3990 W star1y Place !/
New or
Bc�i. CA j EMP.METER OR POLE INS. 20.00
ADDRESS 220-C Twin Dolphin n Dr. 7 MOTORS SEE FEE SCH. 7 D PDH/
ADDRESS /` `J
IWC CA 94 SERVICE CHANGE 20.00 EC 3 01981
00 LICENSED CONTRACTORS DECLARATION
a u U 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w 4 w (commencing with Section 7000)of Division 3 of the Business and PLG. MECH.
r y z Professions Code,and my license is in full force and effect. I ® I Q
z0 m - License Class_g Lia Number_ g.7
o Z F D Date Contractor
Q Y E J
¢ ¢ w u OWNER-BUILDER DECL I BUILDING PERMIT
X ;LL y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
FuoJ Law for the following mason.(See,7031.5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION g/FT.
f w�i Code:Any city or county which requiresa permit to construct,alter, $109,00¢ ¢ ¢ o
improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. $109 000.00
D¢ requires the applicant for such permit to file a signed statement that TOTAL s
e- w m°' he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe S?Jie/L
io Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
IS $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a; by any applicant for a permit Subjects the applicant to a civil penalty
of not more than five hundred dollars(S500).). ALTER-DRAIN&VENT-WATER (EA.) 5.00 S-
0 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 no[
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -3 1
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 55.00 sa PT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve
-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or hmprovement is sold within one year of completion,the owner- 6 nn
GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove 1,aso neeose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES 1❑ ❑N ❑ o❑
❑ L as owner of the property,he exclusively contracting with
licensed inions od 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 /
to owner of property who builds improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3p
contracts
acts for such projects with a contrtractodsl licensed pursuant to /
the Contractor's License Law. SEWER-SANITAR V-STORM EA.200ft/10.00TRACT NO. PARCEL NO.
mason❑ l am exempt under Sec..,B.&P.C.for this WATER HEATER W/V ENT 6.00 6 nn -717 9 r
Owner Date WATER SYSTEM 5.01) ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certifiedQ ZONING ENG.SITE N0.
copy thereof(Sec.3800,Lab.C.L United Pacific 23,9 'OF
Policy N
❑ Certified
Company
copy is hereby furnished.
Z ZCertifiedtified cd Iled with t ity inspec0um division.with I ity inspection division. FIRESPRINK ENERGY T-24
� O AVplictnt lt_ MISC.- REFER TO ORD. YF] NE] Y0 N[]
M y CP:RTI FIC EOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
F LOOD ZONE A.L.U.C.
W :f COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
0- 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y C] N❑
::) Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
W 1- mit is issued,1 shall not employ any person in any manner so as to
Ow become subject to the Workers'Compensation Laws of California.
D.
Uate Applicant ALTER OR ADD TO MECH. BUILDING
} to NOTICE TO APPLICANT: 11;after making this Certificate of Ex- 5.00 455.50
Z_ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with 296.08
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 FEE
/energy 16000
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0)000GRM.) 6.00 SEISMIC FEE 0
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 f5ec.
3097,Civ.C'. Sa cram e n toSe cram en to Sam/ HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Leader's A dresss�gq_gEieOr � AIR' HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
WGvtif Aat tlsa 11caoon an staehat the above VENTILATION FAN (SINGLE) 4,00 149,0
information is correct. I agree to comply with all city and county 2 tiePLUMBING 02.00
Ordinances and state laws relating Io building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(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 CONST.TAX
May in any way accrue against Said City in consequence of the 10.00
granting of this ermil. MECH.CONT. LIC.NO. 282-68
MECH.
TOTAL TOTAL
Signature neant/Cont [or Dat 55.00 1 ,497.89
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 13756
INSPECTION DIVISION
JOB INSPECTION RECORD /
ESS A✓�' /��' /(Y I PERMIT EXPIRATION
JOB ADDR
UNIT# LOT PERMIT EXPIRES IF WORK
1
OWNER & CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DA E INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER
LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I ;
UNDERGROUND /SLAB PAID
PLUMBING 3 f'9. DECp'j
ELECTRICAL C �ISa ATE
MECHANICAL BLDG- ELECT. PLG. MECH.
3 �b(t5 _ 0 r inlp E)DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION S/FT.
MECHANICAL - $)09,000,00
ELECTRICAL PERMIT TO
FRAMING
INSULATION STORIES - TYPE CONSTR.,
�� 40 OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF $O FT FLOOR AREA TOTAL ACREAGE
DMPHAA(•,k1. - -�-� � I
BUI WING USE
RES IND CON RE, Omr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ .❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING V,4 /J� 3 � -
GAS TESTTRACT NO.r PARCEL NO.
MECHANICAL
ELECTRICAL - MD
ATE INSP. ACC,OATE ACC.FILE NO.
FRAMING _ SA '
INSULATION - _a/_ PLZONING ENG.SITE NO.
ti 21 GA '
FIRE SPRINK ENERGY T 2
ME _CO ER NO WORK UNTIL ABOVE HAS BEE S NEO ' HE ❑ N❑ ❑ N❑LATH-INTERIOR 7��y_ ELFLODE ZONE AL.u.CLATH-EXTERIOR t_ FIR ' Y❑ N❑ Y ❑ NSHEETROCK -//- GRFEE SUMMARY_
SHEAR INTERIOR _1 _ BUILDING
SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING 455.50
FIREWALLS ELECTRIC PLAN CHECK
C h % GAS - FEE 296.08
lonergy 160 On
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE '
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR;
1 MICROFILM
\ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 149,00
(� o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 82.04
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 0
IMPORTANT! CONST.TAX 282.5E
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPV -
- I