14968 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
♦• ' � 13UI LDI NG PROJECT I DENTI FICATION' - PERMIT NUMBER -
BUILDING APPLIEATICTN & PERMIT ��
ADDRESS 11592 Seven Springs Dr. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
36 RlIn
NAME r.�__._ R PLAN CHECK VALIDATION
HANE G J.JI)r Ip7tiJfl♦J Inc. & Ni1NnSOf1 DEV. OTY. ELECTRIC PERMIT FEE
416,eI595 21
NAM>ERncroRs UTLETS-SWITCHES-PIECED 10.00/1.00
Gregory Group, Inc. UC.NO. B-3120097 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS220 U Win Dolphin Dr. M APPLIANCES-RESIDENTIAL 4.00
/DDX 6 f
5 jJ,5-595-2100 PANELS 10.06 DATE OF APPLICATION
ARCHITECT ARAM-BASSENIM, AIA & ASSOCIA PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
/�� uc.rvo. p _ SIGNS TRANS. 3.00
ADDRESS ENG,2031 Drc qrd Dr. #100 JNIW nes SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
LLVV 7n Hts- CA- 927n7 ZIP Ana EMP. METER OR POLE INS. 20.00 n -
APPLICANT
NnrS
ADORE"
220-C Twin Dolphin Dr. RISC MOTORS SEE FEE SCH.
A
CA. 94065 SERVICE CHANGE 20.00 /vl� -
O o LICI '- NSFD CON'1'RACI'ORS DECLARATION �P( �"
a v u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
s, n (common ing with Section 7000)of Division 3 of the Business anJ BLDG. ELECT. PLG. MECH.
F w z Professions Code,and y license is in(all force
z o T - Liccnsu Clusx_❑_Lic.Number
2 m Date Contractor
y f BUILDING PERMIT
OWNER-BUILDER D17CLA ION
INFORMATION
is LL H I hereby HERR that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION
F .. o a Law for the Iollowing Reason.(Sec 703 1.5,Buslnessand Professions PERMIT ISSUANCE 10.00 S/FT.
Code:Any city or county which reyuircsa permit to conztmct.altxq 198 DOO
Q Q 0 Improve,demolish,Or repair any structure,prior to Its Issuance,aI50 ELEC.CONTR. LIC.NO. ELEC. 111 ISO,`J)
O R requires the applicant for such permit to file'a signed statement that TOTAL Jv PEHMIT TO
n w es he is licensed pursuant m the provisions of the Contractor's Lt.,.
Law(Chapter 9(commeicingwith Section 7000)o(Divi,hm 3 ofthe MEd
r,,Wp I
Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT MEd Pe Jr UU'
the basis for the alleged exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR.
d � by any applicant to,a permit sLbj,,Lxthe applicant toes civil parnilty ALTER-DRAIN -WATER (EA.) 5.00
of not more than live lmndred dollars($500).):: '2 �.�
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEV ICE 4.00
their sole compensation,will do the work,and the structure n not OCC.GROUP RES.UNITS
4 intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code_ The Contractor's License Law doers not apply to an owner of R-3 1
properly who builds or improves thereon,and who docs such work FIXTURES-PER TRAP •5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
A himself or otinthhis ownemployees,provided however,
such improve-
ments
mprove- 2263
mmselfo through his
onemploffered torso provided
that uhe building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4(EA.) 200
builder will have the burden of proving that he d - . - . .
id not build or im- BUILDING USE -
TimeforpurposeofsalcJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB _ Omar
❑ I,as owner of the property,am exclusively contracting with A El El F-1 [:1
licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:I he Contractor's Liccnsu Law docs not apply
to an owner of property who.builds Or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licen rd pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ tum cxanpt undar Sec ,B.&1'.C.Tor this WATER HEATER W/VENT 6.00
reason �7
Owner Date WATER SYSTEM 1 5.00 ACC.DATE ACC.FILE NO.
WORKFRS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby Afma that I have a ecrlifrcate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers' mn
Compensation Inoun ,or a certified
copy thereof(Sec.3800,Lab.C�nite(] Pacific
Policy No. Cmnpamy
O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T 24
Z Z OL Ceni red co s - •d with the city inspection division. MISC.- REFER TO ORD.
F O Applicant_ Y ❑ N❑ Y ❑ N❑
CCT CERTIPIC i 017 Ex,MPI'ION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.
LU OMPENSATION INSURANCE - PLG.CONTR. ❑C.NO. PLG.
CL O 1'1'his section need not he completed if the permit is for one TOTAL Y❑ N❑ Y ❑ IN
Z hundred dollars IS 100)or Tess.)
U O 1 certify that in the pe:rtormanee 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 manner so as to
become MI to the WorkersCompensation Laws of California.
U.)
Date Applicant ALTER OR ADD TO MECH500 BUILDING 916.00
>_ C. NOTICE TO APPLICANT: If,Her making this Certificate of Ex-
.
I- Z mnption,son shouldbttb111Csubjecttothe WorkeriCompensation APPLIANCE 5.00 PLAN CHECK 15.50
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M) 4.00 /energy I:I on
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10A00C.F.M.) 6.00 SEISMIC FEE
I hereby uffmm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 12 ql�
the performance of the work for which this permit is issucnl(Sec. MICROFILM
3097,CIv.C.I. HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's No nse Security Pacific_ HEATING UNIT(OVER 100000 BTU
, . . .19.
Lender's Address-4th fir. 8A:94.1-1-1 50 ELECTRIC 68.58
1 certily that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
ordinances is stated I agree to comply with all city and county PLUMBING
information
and state laws relating to building construction, and BOILER-QM'p(3 H.P.or 100,000 B.T.U.) 6.00 68.58
hereby authorize,representatives of this city to enter upon the BOILER-COMP IOwrion CEO BTU)SEE FEE SCH. MECHANICAL 68.58
ahove-mentioned properly for inspection purposes.
(we) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD.
uperlino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX 288.24
my in any wmt uu;nro against said City in consequence of the
ranting it. MECH.CONT. LIG NO. MECH.
�7/" TOTAL TOTAL 500.01
Signa of Applicant/Contractor to
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date ................ 1911— Building Permit No.
The Building Located at ....14.5-T...-----5EQ ............
Owned ......G-C�cop
A .... ........ I ..................... . .. ..................................
Has Been (ACom leted S:
qreForUseA ..........................................................
.................................................................................................................................................
..... ................................. ...........................................................................:-------- --------------------
...........................................................................................................................
.YIr ............................ ......5..........
PD-7 BUILDING INSPECTOR
POST THIS CARD NEAR FRONT OF BUILDING . i
PERMIT NUMBER
` CITY OF CUPERTINO
;. 149.68
INSPECTION DIVISION ve
JJOOBBII/NSSP'ECCTION RECORD
JOB,ADDRES�J/✓''�/v- ��7 VjhJ�'IV•S UNIT# _LOT#� '. PERMIT EXPIRATION .
�JNIi PERMIT EXPIRES IF WORK
OWNERCONTRACTOR v qG�w �!/� IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSP ION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION -) I.. ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER _ 11- C, ALL GRADING AND DRAINAGE-SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS:
GARAGESLABS
"{ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUN /SLAB �•T/z�d1•.
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG - ELECT. I PLG, MEC.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION T.
PLUMBING
MECHANICAL
ELECTRICAL - YFRnur to
FRAMING
sI TYPE CONSTR.
INSULATION ol `.Up �!RD "
OCC G UP UNITS
PLACE NO SUBFFr TOTAL REACE
LOOR UNTIL ABOVE HAS BEEN SIGNED 1 1
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD. FLooR AREO
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 2263
BUILDINGUSE
ROOF SHEATHING Res IND CON , PB OTnrr
APPLY NO ROOFING UNTIL ABOVE AS BEEN SIGNED FINALS DATE INSP. N -El ❑ E 1:1
ASSESSORS PARCEL NO.
ROUGH SAN.N / S�
PLUMBING _p,. _�J_ • ELECT.ENERGY
- TRAGI NO. PARCEL NO
TUBS 8 SHOWER PAN p dJ-Sy PLUMBING ENERGY
MECHANICAL MECH.ENERGY
- .OAiE ACC FILE NO
ELECTRICALBUILDING ENERGY
FRAMING ELECT.FINAL TEST zoNlNc -.ENG.SITE No.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPR INK ENERGY L]G
MECHANICAL ,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING" v Q' N� Y ,L • NEI
' TO OD ZONE A.Luc.
EXTERIOR SHEAR �(}4 - p ELECTRICAL RELEASE _ 0 N'[:] L1 N❑
INTERIOR SHEAR ��_LI. OIa FIRE DEPT.
SHEETROCK _ ' GRADE - FEE SUMMARY
EXTERIOR'LATH - - ` BUILDING -� ,
- INTERIOR LATH TEMPORARY APPROVALS BUILD4NG
SCRATCH COAT ELECTRIC FEE 15.60 1S•6O 1
GASen
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMOCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL'BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICR
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu o ONE WORKING DAY BEFORE REQUIRED. INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
ffNA
SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! 288 24
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. 50Q•�l
OFFICE COPY.