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13817 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY ' a I UI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER 11663 Forest Spring Court APPLICATION & PERMIT p '7 ' ADOREtr (Lot 115 - Plan 3A 30 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNERS PLAN CHECK VALIDATIONNAME V OTV. ELECTRIC PERMIT FEE Gregory Group, Inc. ONE 595-2100 CONTRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00 �/ NAME roNTR ToG�n NO, LIGHTING FIXTURES 10.00/1.00 ;::R_nC6_1 WinDolph>n Dr. 3PPLIANCES-RESIDENTIAL 4.00 } AOORE a PHONE 1 PANELS 10.00 /O DATE OF APPLICATION ADRROHITECT Aram assenian, A.I .A. & PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.N . ENGINEER Associates LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENG L9900Wester Iy Place, #170 SPECIAL CIRCUIT 5,00 PERMIT VALIDATION A Newport Beach, CA ZIP 92660 TEMP.METER OR POLE INS. 20.00 A"Ll CANT DDR5220 C Twin Dolphin Dr. t�rl MOTORS SEE FEE SCH. AA Redwood Cit CA 94065 SERVICE CHANGE 20.00 �el O o LICENSED CONTRACTORS DECLARATION I d v 1 hereby affirm that 1 am licensed under provisions of Chapter 9 I CE DATE (commencing with Section 7000)of Division 3 of the Business and PLG. MECH. F i Professions Cale,mm litmus is in full fors{,a{�y,�yl�U, 1--I , 02 ; Licenu Class (Sy Lic.Number 4-JS1U`1L_ Q a LR Date Contractor a V x � BUILDING PERMIT Ic ¢ w ¢ OWNER-BUILDER DECLARATION INFORMATION AOA " MISC.- REFER TO ORD m ;u N 1 hereby affirm that I am exempt from the Comra,mr's Linrsu u o 4 Lew for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUaTIOry S/FT. E - ss Code:Any city orcounty whichrequiresapemti t to-nstrvet,a0er, re Io < I improve,demolish,or repair any structure,prior m its footrace,also ELEC.CONTR. LIC.NO. ELEG 0 LL requires the applicant for such permit to file a signed statement that TOTAL /i PERMIT TO a w m he is licensed pursuant to the provisions of the Contractor's License f-v�� / F a, i Law(Chapter 9(commencing with Section 7000)of Division 3 of the V �J Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. d ; - by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 �'- /�[,� of not more than Ovc hundred dollars(S5000.): s� U N Ka , 0 I,as owner of the property,or my employees with wagesas 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 1 DRAINS-FLOOR,ROOF,AREA,COND. 5.00 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,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsamnotintendedorofferedforsale.IL however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 ^-'a or improvement is sold within one year of completion,the owner- , GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or iso- BUILDING USE s prove for pugsoso ofsale.). INDUSTRIAL WASTE INTER. 30.00 - RES IND COONN PB Om., ❑ d as owner rs the property,he exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project j La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 855E RS FARDEL Na. and Professions Code:The Contractor's o License Law does not apply to atm contracts for of h projects who builds or improveserse n,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3 the ContsctorIshceneLwitharontmetosisl licensed pursuanu° SEWER-SANITARY-STORM EA.200ft/10.00 Q TRACT NO PARCEL NO. the Contractor i License Law. S/ 0 Iamexernmandcr Sec. ,B.hP.C.hmrthis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5 G ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARA'I'[ON WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a cvtific.fc.fcmouut to self-insure. ZONING ENG.SITE NO. or a certificate of Workers Compensation insurance,or a certified copy thereof(Sec.3800,Lab.C.I ❑ Policy No. company-llnited-Lac-i-f ic)le O ❑ Cerdiied ropy is hereby furnished. FIRESPRINK ENERGY T 74 Z Z ❑ Certified cop - the city inspeclion division. MISC.- REFER TO ORD. O Applicant _ _ e Y❑ N❑ Y ❑ N❑ Cc: y CERTIFICA :OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOODzONE A.L.UC. L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y[:] ry❑ Y CIL ❑ N❑ O t'fhf section need not be completed if the permit is for one TOTAL Z hundred dollars(S 100)or less.) U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY U. U mit is issued,I shall not employ any person in any asanner so as to become subject to the Workers'Compensation laws of California. 'Zf U y Dme Applimnt ALTER OR ADD TO MECH. 5.00 BUILDING sS� f _ } Us NOTICE TO APPLICANT: If,after making this Certificate of Ex- 2 emption,you should become subject to the Workers Compensation LFAPPLIANCE 5.00 9,0 PLAN CHECK F3 provisions of the Labor Code, you must forthwith comply with FEE 35 U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1000DC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.DO SEISMIC FEE 13 �t 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 ISec MICROFILM 3097, .am �eC�lt PdC l f l ,� HEATING UNIT(TO 100,000 B.T.U.) 6.00 / Lender's Adce�� HEATING UN IT(OV ER 100,DOO B.T.U.)9.50 ELECTRIC /7� � Under's AJdre ,— I certify that I have read this application and state that the above s ) VENTILATION FAN (SINGLE) 4.00 information is Correct.1 agree to comply with all city and county BOILER-OOIaP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING 113 VUi ordinances and state laws relating to budding construction, and hereby authorise representatives of this city to enter upon the BOILER-COMP (Over bov100,000 BTU)SEE FEE SCH. MECHANICAL �6,1l� above-mentioned property 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 PERMIT ISSUANCE 1000 CONST.TAX f0 - may in any way accrue against and City in consequence of the gtlNiagO(t MECH.CONT. LIC.NO. MECH. 9 TOTAL' �/ � (� S� Q Signature o Iicam/Contractor TOTAL J —� OFFICE COPY 4 POST THIS CARD NEAR FRONT OF BUILDING ? CITY OF CUPERTINO PERMIT NUMBER INSPECTION DIVISION 13817 . JOB INSPECTION RECORD JOB ADDRESS PERMIT EXPIRATION< «�� 7CVJfCI UNIT# LOT# I I� PERMIT EXPIRES IF WORK OWNER CR�c72Y � I SNC-• CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- , FOUNDATION 'AN CE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE zv PERMIT VALIOATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUPID IISLAB PLUMBING - ELECTRICAL NCE un LE MECHANICAL U T. PLG. MECH, 0 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED NG PERMIT WOOD FLOOR INFORMATION; VALUATION SIFT. PLUMBING , S MECHANICAL `� ELECTRICAL PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR, OCC GROUP RES,UNITS` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF 50.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE 1-1 alai�I RES INU CON PB Odin, 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSOR—PARCEL NO. ROUGH PLUMBING p - 3,Z,9' GAS TEST :T P4RCEL NO. - - MECHANICAL ' ACC,OATS ACC.FILE NO. ELECTRICAL ���� FINALS DATE 'NSP. FRAMING SAN #LZZ S INSULATION PLUMBINGZONING ENG.SITE NO. - s- l�I i GAS V �� FIRE SPRINK ENERGY T.Za MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, ❑ "❑ ❑. NE] FLOOD ZONE A,L.U.C. LATH-INTERIOR 0,27- ELECTRICAL .-- r L e� LATH-EXTERIOR /0-"b-&Ba Zc FIRE DEPT. Y❑ N❑ Yo No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING 1-IS .+ SHEAR EXTERIOR .�._" . TEMPORARY APPROVALS BUILDING _ } FIREWALLS ELECTRIC PLAN CHECK / GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL S _ CALLING FOR FINAL INSPECTION. OFFICE COPY CITY OF CUPERTINO CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE Date Building Permit No. The Building Located at ............ Owned by --- 47( ......../�' /�?....................................................... Has Been <(3:'m I For Use As: ........ (Altered) ....7..... W.............................. ......................................................................................................................................... ............ ................................................................1. . .......... ........................................................................................................................................ f'.............................. PD-7 BUILDING INSPECTOR BUILDING-INSPECTOR'S OFFICE •+-� .r";' CITY OF CUPERTINO Cffic o.w. Bid,, Copy i ❑ Backflow Device ', Sanitary Permit No. Ewer Connection 'y Plumbing Permit No. © Plumbing Final , ' Cl /' Lot No. 1 1 Owner or Tenant l �S2e c, n-LI.V,' G7,,Qo un, z _I 1 Tract Date Connected ' 1.9 Date Final C� 19 �" �' PLUMBING INSPECTOR OFF CE CITY OF CUPERTINO COPY COPY GAS SERVICE NOTICE MOO , 1 5 1198� To You are hereby authorized to connect the GAS service for , OO'` �o wner or Tenant �T fc'.C�C �2�/ G .,r) At Sa Ta New Service i No. of Meters nUL Reconnect No. of Add. Meters 'M•ove Service Move Meter PLUMBING INSPECTOR p r e ELECTRIC SERVICE NOTICE OFFICE COPY 4 S BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO To MOO , 1 S , ,q a(e) • you are hereby authorized to Connect electrical service for ^ Owner or Tenant 2�C O R`1 �— At . r No.of Wires Size of Wires Size of Switch C)o I) �-A ) Motor Load Voltage Phase Heating Load K.W. Voltage Na.of Meters O Light '• t t 110 New Service Recoone I1 Hear I POThree Wire More Service No.of Add.Meters ` Power Three—P1}ha`asse Move Meter O• ELECTRICAL INSPECTOR