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13787 (2) POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO RMIT ND ,BEH INSPECTION DIVISION 1378 JOB INSPECTION RECORD p' PERMIT EXPIRATION JOBADDRESS ;�ac'/< UNIT# LOT# fS PERMIT EXPIRES IF WORK - OWNER 6,eaclD CONTRACTOR IS NOT STARTED WITHIN INSPECTION VATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180'DAYS FROM UFER LAST CALLED IN¢PECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB _ PLUMBING -,Fe low - NCE DATE MECHANICAL - T. PLG. MECH. u �WIo o' of 0 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED , G PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. MECHANICAL PERMIT TO ELECTRICAL - - FRAMING INSULATION s1DRIEs rvae CONSTR. OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF SO.FT.FLOOR GREI TOTAL ACREAGE DIAPHRAGM ip BUILDING USE HES IND CON PB 00", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 El ❑ I] 0 ROUGH ASSESSOHS PAHL"NO. PLUMBING , GAS TEST / TRACT NO. PARCEL NO. MECHANICAL - e}^ 65ba t57 ELECTRICAL '-- rVlAjTEINS . ACC.DATE ACC.FILE NO. FRAMING - - zoNlNc ENG.SITE NO. INSULATION '�-8-8'fs+E .}3• FIRE SPRINK ENERGY T-24 FLATH-INTERIOR VER NO WORK UNTIL ABOVE HAS BEEN SIGNED Y (] N� Y � NE] aooD zorvE aL.0 c. -EXTERIOR 'J. FIRE DEPT. Y❑ ,Ncl vo N❑ ROCK - GRADE FEE SUMMARY R INTERIOR' BUILDING SHEAR EXTERIOR - _dd! TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK 9-1-a GAS FEE - NO TeAPE _UNTIL ABOVE HAS BEEN SIGNED fOCCUPANCY SEISMIC FEE i OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I.- ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL ,.. - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL �r CALLING FOR FINAL INSPECTION. , OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY FIJI LDI NG PROJECT IDENTIFICATION* PERMIT NUMBER „a°"°'"° 11528 Rock Spring Court APPLICATION & PERMIT , A°DREss 13787 Lot 85 - Plan B BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OwNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE 'Gregory Group, Inc VHONE 595-2100 Ocions NOME ME UTLETS-SWITCHES-RECEP 10.00/1.00 o NAME La Gregory Grou InC dID.ND 4300 LIGHTING FIXTURES 10.00/1,00 f,DNTR ACTORS220 Wln 0 p In Dr. 3 APPLIANCES-RESIDENTIAL 4.00 ADDRESS Redwood City PHONE 595-2100 PANELS 10.00 DATE OF APPLICATION ARCHITECTAram Basseni an, A.I .A. & PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER Associates LIC.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADIYew port Beach, CA, y Place, 60 SPECIAL CIRCUIT 5.00 92660 TEMP.METER OR POLE INS. 20.00 APPLICANT'S ��]� (� Tw�A D91 pI�in Dr. MOTORS SEE FEE SCH. Ao2sC�W00 G 11Y� , A (.L 4T Ubb Y SERVICE CHANGE 20.00 Doo LICENSED CONTRACTORS DECLARATION E4q I 1 87 <u u I hereby affirm that 1 am licensed under provisions of Chapter 9 !� O 1.'7 ISSUANCE DATE I-, a w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H y z Professions Code,an my license is in full force Z i m W License Class Lic.Number_ 4515L7Lis - Date Contractor ¢ y f BUILDING PERMIT rt ¢ re u OWNER-BUILDER DECLARATION INFORMATION X ;°' y 1 hereby affirm that I am exempt from the Contractor's License MISC..- REFER TO ORD .H u. 004 Law for the followiagreason10.00 .(Sec.7031.5,Businessand Professions PERMIT ISSUANCE / VALUATION $/FT. Code:Any city or county which requires a permit to construct,alter, re or Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEG O ¢ requires the applicant for such permit to file a signed statement that TOTAL / PERMIT TO w $ he is licensed pursuant to the provisions of the Contractor's License C' /� Fzi Law(Chapter 9(commencing with Section 7000)of Division 3 of the fr < Business and Professions Code)or that he is exempt thereom and OTY. PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ./ of not more thALTER-DRAIN&VENT-WATER (EA.) 5.00 � an five hundred dollars(8500).): �N( ❑ I,as owner of the property,or my employees with wines as BACK FLOW PROTECT. DEVICE 4.00 / (Itch sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner of _ property who builds or improves thereon,and who does such work IXTUR ES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTAL ACREAGE himself or()trough his own employees,provided that such holuov Rents are not intended or otTered for sale.If,however,fire buildinwg GAS-EA.SVSTEM-11NC.40UTLET$ 6.00 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 am. BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 REB IND CON PB Other O I,as owner of the property,am exclusively contracting with . . �, ❑ ❑ ❑ ❑ licensed contractors to construct the projeCY(Sce.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO, and Professions Code:1'he Contractor 1 License Law dues not amply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS,OVER 5 IEA,I 1.00 �� _ ��,3 J ,� 33 contracts for such projects with a contractods)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sea ,B.&P.C.for this - WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5,00 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, ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified Copy1hercof(Sec3500,Lab.c.United Pacific/Re Policy No. Company O ❑ Certified cop lori by furnisFIRE SPRINK ENERGY T-24 Z Z 13 Certified I d a city mxpd tion division. O Applicant_ J MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ rnPERMIT ISSUANCE 10.00 f FLOOD ZONE A.L.u.c. CIiRTIPICA fE OF EXEMPTION FROM WORKIiRS' L COMPFNSAT10N INSURANCE PLG.CONTE. LIC.NO. PLG. ' CL Cl (This section need not be Completed if the permit is for one TOTAL Y E) N❑ Y❑ N❑ hundred dollars(S 100)Or less,) L) O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner so as In O UILI becomesubject to the Workers'Compensation Laws of California. M Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �� } W NOTICE TO APPLICANT: II',after making this Certificate of Ex- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 0 PLAN CHECK provisions of the Labor Codd, you most forthwith comply with F0 EE L.J such provisions or this pcono shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 D CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 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. MICROFILM 3097,Civ.C.). Security Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00 / Lender's Name Lender's Addle �_ anci_scoy-GA_ HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC p ss y. I certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 If�. information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Dr 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. MECHANICAL �j/� 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.TAX W may in any way accrue,against said City.in con quene of the granting of p MECH.CONT. LIC.NO. MECH. ply �� 7 TOTAL i TOTAL Signature pp¢an[/Con rector D. OFFICECOPY