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13815 (2) ' POS CARD NEAR FRONT OF BUILDING �•`Y •• PFRnIIr NUMBER TY OF CUPERTINO INSPECTION DIVISION 13515 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 116 1434EST fi24/l/c- C7. UNIT# LOT# _ PERMIT EXPIRES IF WORK CONTRACTOR IS NOT STARTED WITHIN INSPECTIO ATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU- FOUNDATION 1 ANCE OR 180 DAYS FROM LIFER LAST CALLED INSPECTION. PREGUNITE PERMIT VALIDATION PAID POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED , UNDERGROUND /SLAB p C2a � PLUMBING _ y, �� i�,,ww ELECTRICAL ww7gSwUA CE DATE MECHANICAL BLDG I ELECT. PLG. MECR. ",�o ❑ ❑ ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION SIFT, PLUMBING- MECHANICAL ELECTRICAL PERMIT To FRAMING STORIES TYPE CONSTR. IN CATION occ.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM o BUILDING USE / -)1! 1- RES IND CON PB Olnm APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 11 El Q El El ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST TRAcr No, PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO, FRAMING SAN SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS _ FIRE SPRINK ENERGY L24 MECHANICAL 11_ _ ij COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING � `" ❑ NE] Y ❑ N� FLOOD ZONE aL.u,c. LATH-INTERIOR ELECTRICAL _ _ G� , LATH-EXTERIOR FIRE DEPT. Y❑ NQ v 0 N[_ SHEETROCK • hAyGRADE FEESUMMARY SHEAR INTERIOR - BUILDING G BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK T . GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UN TIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. _ PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. " - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY . APPLICANT TO FIL rFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY J BU I LDING PROJECT PERMIT NUMBER BUILDING 11643 Fore APPLICATION & PERMIT AOOREuBUILDING-ELECTRICAL-PLUMBING-MECHANICAL 0 13815OWNER'S PLAN CHECK VALIDATION "AME QTY. ELECTRIC PERMIT FEE Gregory Group, I CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME Gregory Gross In .LIa.NU. 430097 LIGHTING FIXTURES 0.00/1.00 cZ ADDRESS 2 O C �' n Dolphin Dr 3 PPLIANCES-RESIDENTIAL 4.00 AODRESS 2p 1 wy1ii Redwood Clty, GA PHO 5_2160 PANELS 10.00 0 DATE OF APPLICATION ARCHITECT Aram Bassenian, A. I.A. & PANELS (OVER 200 AMP) 20.00 :Z1. ;ECK FEE OR .G NO. c(�►V ENGINEER Associates uc.No. SIGNS TRANS. 3.00 ARCH.OR E"`39907 Westerly Place, x/1.70 SPECIALCIRCUIT 5.00 �� LIGATION ADDRESS ADDRESS ( Ad Newport Beach l A ZIP 92660 EMP.METER OR POLE INS. 20.00 APPLICANT'S Wln 01pflill Ur. "-7 MOTORS SEE FEE SCH. . RE dJyl �e�wood City, CA 94065 SERVICE CHANGE 27.00it wo o LICENSED CONTRACTORS DECLARATION <u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000)of Division 3 of the FLuiness and BLDG. ELECT. PLG. MECH. F N i Professions Code,aryl my license h in full fore�p�,�((y�t� z O,n- License Class IS_Lic.Number 4311.N7 ❑ ❑ ❑ ❑ O z r Dole Contomim a y 2 , BUILDING PERMIT ¢ ¢ OWNER-BUILDER DECLARATION INFORMATION w v, 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD o g Low for the following nxson.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 0 VALUATION 5/FT. u H - Code:Any city or county which requires a permit to construct,alter, J �f Q Q 0 improve,demolish,Of repair any]IN[tllre,prior LO its ISSIIanCe,aI50 ELEC.CONTE. LIC.N0. / ELEC. LL requires the applicant for such penhil to FITC a signed statement that TOTAL g PERMIT TD X $ he is licensed pursuam to the provisions of the Contractor's License - z/ �� / H i a Law(Chapter 9(Commemcingwlth Section 7000)mf Dlvlslon3 ofthe ,L) Business and Professions Code)or that he is exQTY. PLUMBING therefrom and QTPLUMBING PERMIT FEE ¢ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE�C�ONSTR. T ; _ by any applicant fife permit dollars(heappli<am toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not morethanor hundred dollars the applicant ❑ I,as owner of the properly,or my cmployccs with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure u not intended or offered for sale (Sea 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-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 SO.FT.FLOORAREA TOTALACREAGE himself or through his own employees,provided that such improve- mentsare not intended oroffered for sale.IL however,the building GAS-EA.SYSTEM-11NC.40UTLETS 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 the burden of proving that he did not build or im- prove for purpose of vale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB ower ❑ I,as owner of[tic properly,um exclusively com acting with 91 ❑ ❑ ❑ ❑ licoowd contractors to construct the project(Sec. 7144,Business I LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code: rhe Contractor's License Law does not apply o p to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 J4 6-/'-3 j 3 x/23 contracts for such projects with a conlractoos)licensed pursuant to / the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 Q TRACT NO, PARCEL NO. ❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 7 / � '� reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK ERS'COMPENSA'TION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a ccrlificale.1 Consent m self-insure. ZONING ENG.SITE NO. or a etrufcam of Workeri Compensation Insurance,or a certified copy thereof i Sea 3800,milab.C.0nited Pacific/Rel- 0 Policy Nany U ❑ Certified copy.Isle by furnished FIRE$PRINK ENERGY T-24 Z Z ❑ CeniOcd cop a Ith Ily inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ O Applicant_ _ V N Y N F-- y PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c. Lu CER'fIFICA r SAEM PITIONlNS FROM WORKIiRS' W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. /Oq v N Y N CIL 0 (This section deed not be completed if the permit is for one TOTAL C ❑ ❑ ❑ ❑ Z hundred dollars 1$100)or less.) U O 1 certify that in the perfomiance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person in any runner so as to become subject to the Workcl 'Compensation laws of California. gs� U BE Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING - to NOTICE 'TO APPLICANT: If,after making this Cerlifcale of Ex- F Z emption,you should become subject to the Workers'Comper,a Non APPLIANCE 5.00 �s0 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE 3 Q T" U such provisions.,this permit shall to deemed revoked. AIR HANDLING UNIT(TO JOAMCF.M.) 4.00 . CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1Q000CF.M.) 6.00 SEISMIC FEE I hereby affirm thus 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,Cw.C.). HEATING UNIT(TO 100,01X7 B.T.U.) 8.00 Lender's Neme Security Pacific HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC Lender's Arctic an-Fa-ansi-SGo-,-CA (� I certify that I have reed this application and state that the above VENTILATION FAN (SINGLE) 4.00 / (� information is correct.have I agree to comply with ell city and county PLUMBING Q ordinances and slate laws rebating to building constmetion. and I BOILER-= H.P.or100,DOOB.T.U.) 6.00 // hereby aWhoriu representatives of this city to enter upon the BOILE (3 R-COMP IOvnr 100,000 BTU)SEE FEE SCH. MECHANICAL W/ above-mentioned properly for inspection purposes. (We) gre, to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. / Cupertino against liabilities,judgments, Cools and expenses which PERMIT ISSUANCE 10.00 I CONST.TAX (C`� may in any way accrue against said City in consequence of the CX granting of this til. MECH.CONT. LIC.NO. MECH. /` �� TOTAL TOTAL j Signamreo cant/Contractor Dale OFFICE COPY