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13789 (2) POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERMIT NUMBER Q INSPECTION DIVISION 13MB7 SV JOB INSPECTION RECORD PERMIT EXPIRATION Nw JOB ADDR//E��SS I�C�PdC��-� S.D'e•i'�G' UNIT# LOT# rPERMIT EXPIRES IF WORK OWNER (^f �Q QKQJ(J / C CONTRACTOR - 'IS NOT STARTED WITHIN INSPECTION DATE INSRECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LAST CALLED INSPECTION. LIFER Q PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PAID � PLUMBING ELECTRICAL men fts Te MECHANICAL. 0 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 4 RMIT INFORMATION. WOOD FLOOR vnwanoN s/FT. PLUMBING 'MECHANICAL PERMIT TO ELECTRICAL FRAMING sroRlEs TYPE coNsrR INSULATION , OCC.GROUP HES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF "- (� SO 1'T.FLOOR AREA TOTAL ACREAGE VTAPMFIAGM•� \ BUILDING USE 1 RES IND CON . PB OGmr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 ❑ Cl ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL (261 -/U ELECTRICAL ACC.DATE ACC.FILE ND. — FINALS D TE IN P. I FRAMING 7, - 444 SAN # a 6 � ZONING ENG.SITE No. INSULATION -lR� PLUMBING '1J GAS MECHANICAL FIRE SPRINK ENERGY 1 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y N� Y ❑ IN . LATH-INTERIOR _1'/f- ELECTRICAL FLOOD ZONE AL.0 C. Y•� N� y 0 N❑ LATH-EXTERIOR � FIRE DEPT.. LJ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR -�,I . _ TEMPORARY..APPROVALS BUILDING ••; FIREWALLS ELECTRIC PLAN CHECK ,� GAS FEE ' NO APE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY 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. NICL < - SEE PERMIT FOR'EXPIRATION DATE - MECHAAr IMPORTANT! CONST.TAX -PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY, APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING:PROJECT IDENTIFICATION PERMIT NUMBER (� BUIL 1NG APPLICATION & PERMIT 13 9 %R ESP .11508 Rock Spring Court BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S ? :Yi PLAN CHECK VALIDATION "AME ELECTRIC PERMIT FEE Gregory Group, Inc.pmoNE595-2100 CONTRACTOR'S OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME Gregory Group, Inc.,,,,,. 430097 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S Amon A 220 C Twin Dolphin -Dr. 3 APPLIANCES-RESIDENTIAL 4.00 a PHONE ( PANELS 10.00 DATE OF APPLICATION Aq PLAN CHECK FEE P.C.NO. ENGINEER Aram assenian, A.I.A. & PANELS (OVER200AMP) 20.00 Associates LIC NO SIGNS TRANS. 3.00 ARCH,OR ENG, PERMIT VALIDATION' 3 90 eSt&rly Place, #170 SPECIAL CIRCUIT 5.00 Newport �eac i, zm 92660 TEMP.METER OR POLE INS. 20.00 APPLICANTS win Dolphin Dr. MOTORS SEE FEE SCH. /J ADDRESS Redwood City, CA 94065 SERVICE CHANGE 20.00 pmb 02 LICENSED CONTRACTORS DECLARATION < u�u I hereby affirm that I am licensed under provisions of Chapter 9 & ATE H c w (commencing with Section 7000)of Division 3 of the Business and _ E PLO. MECH. F N i Professions Code,' d my license is in full force ff cI. Z i- D License Class Lic.Number�6-b-_9.� w H w Date Contractor rc x X st OWNER-BUILDER DECLARATION ERMIT INFORMATION X ;n H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD F ¢ O¢ Law for the following reason.(Sec.7031.5,Business and Professions pERMfT ISSUANCE 10.00 �O VALUATION $/FT. Code:Any city or eounty which requires a permit to construct,alter, ne ¢¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. u w m, requires the applicant for such permit to file a Signed statement that TOTAL / / �/ PERMITTO he is licensed pursuant to the provisions of the Contractors License _ H z a Law(Chapter 9(commenciagwith Section 7000)of Division 3 ofthe 4 D Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE ¢ F$ the basis for the alleged exemption.Any violation(it Section 7031.5 STORIES TYPE CONSTR. d3by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER IEA) 500 of not more than five hundred dollars(S500)J . . : ❑ 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 not intended or offered for sale(Sec. 7044, Business and Professions 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 $o.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such inipm - meets are not intended or offered for sale.It,however,the huilding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or int- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Omer . D 1,as owner of the property,am exclusively contracting with El - ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractors License Low does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.003� 3 x-33 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 / the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B,&P.C.for this reason 7( l f WATER HEATER W/VENT 6.00 C�G Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, s or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. - copy thereof(Sec.3800,Lab.C.).� ,, r�,, /-Re Policy No. Compuny_I1nItEd-PPP -is 0 ❑ Certified copy' ereby funtiShe ' FIRE SPRINK ENERGY L24 Z Z ' ❑ Certified F, will city it: cfion division. MISC.- . REFER TO ORD.O Applicant _ Y ❑ N� Y N� . CC CC w+- PERMIT ISSUANCE 10.00 CERTII'IC P EXEMPTION FROM WORKERS' FLOOD ZONE A.L.uses W > MPENSAT']ON INSURANCE PLG.CONTE. LIC.NO. PLG. (This section need not be completed if the pennit•is for one TOTAL Y❑ N Y ❑ No D Z hundred dollars($100)or less I L) O 1 certify that in the performance of the work for which this per- QTY.' MECHANICAL PERMIT FEE FEE SUMMARY LL mil Is Issued,I shall not employ any person in any manner so as to O w become subject to the Workers'Compensation Laws of California. BUILDING d Date Applicant �-/ S� } So NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 JJ FZ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK tJS7�3 prosGims of the Labor Code, you must forthwith comply with FEE C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE /O 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(Sec. HEATING UNIT(TMICROFILM 3097,Civ.CJ. O 100,000 B.T.U.) 8.00 Lender's Name Security Pacific Lender's Address rancisco, HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 16 "oI certify that l have read this application and state that the above VENTILATION-FAN (SINGLE) 4.00 lbinformation is correct. I agree tD comply with all city and county PLUMBING ordinances and state laws relating to building constructionand BOILER-COMM H.P.or 100,000 B.T.U.) 6.00hereby authorize representatives of this city to enter upon theBOILER-COMP IOver 100,000 RTUI SEE FEE SCH. MECHANICAL 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 10.00 ` CONST.TAXmay in any ee,agaiy in cona� t grantingoft ECH.CONT. ,LIG NO. MECH.TOTALTOTAL Signature ot,#5rplicant/Contractor 10m AfCJ OFFICE COPY — — JOBANSPEL: I IUN HEUUHU —_.__ �`=. 'a..•.:rz-�' JOB ADDRESS &/.-,7V P ;ROC,K �A�, �6 L7 PERMIT EXPIRATION UNIT# _LOT# • OWNER ` PERMIT EXPIRES IF WOR INSPECTION O' ij CioNTRACTOR IS NOT STARTED WITH]: DAT INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSI . FOUNDATION � UFER 3 ANCE OR 1BO DAYS FRO: O PREGUNITE LAST CALLED INSPECTI OF �,�PEHMII VALI CATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PLUMBING UNDERGROUND /SLAB DEC 2 31987 1 ELECTRICAL City Cup rU M CHANICAL -- IsSUsvamcE DATE BLDG. ELECT. PI.G. MECI za 00 NOT POUR FLOOR UNTIL ABO E HAS BEEN SIEO �__-=L J WOOD FLOOR BUILDINGPERMIT PLUMBING _ INFORMATION .//1 VA_ AT IOSIFT.N --- MECHANICA TS�� ELECTRICAL FRAMING PLr+^In To INSULATION i STORIES TYPE CONSTR PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OGG GROUP REs UNITS ROOF DIAPHRAGM, it p So.PI FLOORAREA TOTAL ACREAGE APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED BU'L L(INUSE HES IN(l G(1N PB Olrrnr HOUGH 1:1 ❑ ❑ ❑ ❑ PLUMBING nssessoHs PARCEL NO. 7 7 GAS TEST MECHANICAL THncT No. PARCTLNG. ELECTRICAL FRAMING FINALS DATE INSp Acc OnrE ACC FILE NO. INSULATION SAN it PLUMBING ZONWG ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T.]a COVER NO WORK UNTIL ABOVE HAS BEEN SIGN HEATING ❑ N❑ LATH—INTERIOR Y ❑ N❑ LATH—EXTERIOR 4V ELECTRICAL FLOOOzaNE —A.L.U.C. SHEETROCKE-fr_Fr 'L�Geer, �5 �5��iS FIRE DEPT. Y❑ N N❑ Y ❑ ❑ r _ SHEAR INTERIOR y GRADE --__ SHEAR EXTERIOR 1 y BUILDING FEE SUMMARY FIR WALLS cl�b� TEMPORARY APPROVAL BUILDING ELECTRIC PLAN CHECK GAS NO TAPE OR PLASTER UNTIL ABOVE HAS EN S�OCCUPANCY FEE OCCUPANCY OF BUILDING ISNOTPERMIT7'E DUNTIL BUILDING FINALISSIGNED BY BUILDING INSPE CTOR. MICROSEISMIFILM MICROFILLMM _U ARRANGE ECTION o~� ONE WORKING DAYPBEFO EB REQUIRED INSPECTION. ELECTRIC INS ECTION. ,,.r Z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL A, 4PPLICANTS POSTING COPY