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13759 (2) POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PFRMIT NUMBER INSPECTION DIVISION 13759 I JOB INSPECTION RECORD IT ON JOB ADDRESS `1S\ "��A "T""Nv' UNIT# LOT# PERM EXPIRES IF WO ��pp I/� y•� � q _ PERMIT EXPIRES IF WORK OWNER L_Ov IR�`� �+�w^* '1VL CONTRACTOR IS NOT STARTED WITHIN INSPECTION IDATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED AO 'UNDERGROUND /SLAB PAO-, PLUMBING _ C �919pl ELECTRICAL `� �SSUA ATE ME HANICAL (�B'L�o'cyi, LG. MECH. 1441A ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. MECHANICAL ELECTRICAL PERMIT TO II FRAMING ` Vl! INSULATION STORIES TYPE CONSTR. Lm A—w OW Fdl pW OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM — BUILDING USE RES NO CON PB Otlmr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING (� GAS TEST TRACT NO, PARCEL NO. MECHANICAL _ ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMINGCo- SAN # INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ LATH—INTERIOR III ELECTRICALFLOOD ZONE A.L.U.G. LATH—EXTERIOR -II. IXJ jFI Y❑ No Y ❑ No SHEETROCK _SHEAR INTERIOR FEE SUMMARY '�JI�SHEAR EXTERIOR •-Q APPROVALS BUILDINGFIREWALLS PLAN CHECK g FEENO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNESEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING i Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL Cr IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. _ OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY o BU I LDINS PROJECT I DENTIF[CATION PERMIT NUMBER AD 1 ver pring ourt APPLICATION & PERMIT AUDIT . (Lot 81 - Plan 3CR) 13759 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE Gregory Group, Inc.PHONE 595-2100 CONTNAMERACTOR$ UTLETS-SWITCHES-RECEP 10.00/1.00 Gregory Group, I LICNo. LIGHTING FIXTURES 10.00/1.00 ADDRESCONTR CTons 220 Twin Dolphin Dr. , IIGII PPLIANCES -RESIDENTIAL 4.00 ADDRESS Redwood Ci PHONE _ PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP[ 20.00 PLAN CHECK FEE P.C.NO. Aram Bassenian, A.I .A. ENGINEER & Associates uc.No. SIGNS TRANS. 3.00 ADDRESSE"G 3990 Westerly Pl . , #170 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION N EMP.METER OR POLE INS. 20.00 ADDRESS s 220 Twin Dolphin Dr. , "C" MOTORS ADDRESSSEE FEE SCH. Redwood SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION f5 a v u I hereby affirm that 1 am licensed under provisions of Chapter 9 V E DATE Nzw (commencing with Section 7000)of Division 3 of the Business and B PLG. MECH. ¢v H U i Professions Cod and my license is in full for�,R��pp�p,,��ff��er} zoo License Class�Uc.Number 9.1U11`! I� 4 z w Date Contractor D&I H uta ¢ e w - OWNER-BUILDER DECLARATION BUILDING PERMIT o A INFORMATION X 3 H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD LL o a Law for the following reason.(Sec.7031.5,Business and Professions O VALUATION $/FT. - PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construe 1,0ter, C.p.� Q , ¢2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. _7(0 � / 7/ DLL requires the applicant for such permit to file a signed statement that TOTAL u w m y he is licensed pursuant to the provisions of the Contractor's License PERMIT TO / H z a Law(Chapter 9(Commencing with Section 7000)of Division 3 ofthe q i D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ m the basis for the alleged exemption.Any violation of Section 7031.5 La by any applicant for a permit subjects the applicant toacivil penalty STORIES TYPE CONSTR. of not more than five hundred dollars(S500)J: ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ 1,as owner of the property,or my employeeswith wagesxs BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure n not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 IZS Code:The Contmctur's License Law docs not apply loan owner of _ himself ywho buildsorimproves emloyeere proved who does at such improve. work FIXTURES-PER TRAP S.QQ SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve ments are not intended Or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- builder will have the burden of proving That he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PS Omer . . ❑ I,as owner of the property,am exclusively contracting with ❑ F] ED EJ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 and Professions Code:The Contractor's License Law does,rot apply ASSESSORS PARCEL NO. to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3 GG_(�3� �y contracts for such projects with a eontractons)licensed pursuant to t' the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec..,B.&P.C.Ibr this reason I WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKS RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby ul'lilm that 1 have a certificate of consent to sel Finsen. or a certificate of Workers'Conil olsation Insurance,or a certified ZONING ENG.SITE NO. copy meneu f(Sec.3800,LaDC)Onited Pd Cl RellallC Policy No. COnnpany 0 [] Certified copy e$IT chy f fished. Z 2 GY Cetlifrd��y file the city inspection division. FIRE SPRINK ENERGY T-24 APP caul_/"'/ - 12TITAL ) - REFER TO ORD. Y� NEI Y ❑ N� I- O �/ IT ISSUANCE O Q- N CER'TIIP TIiONSATIOTINS FROM 10.00 FLOOD ZONE 0.LU.C. W COMPENSATION INSURANCE LIC.NO. PLG. EL 0 ('this section need not be completed if the permit is for one TOTAL Y❑ N� Y� No hundred dollars(5100)or less.) U O I certify that in the performance of person work for which this per- MECHANICAL PERMIT FEE FEE SUMMARY U.0 F mil is issued,I shallnut employ oanyri person in any manner so is to0 w become subject to the Workenc'Compensation Laws ol'Culilrmiu. Date Applicant R OR ADD TO MECH. S,pQBUILDING �}'rn NOTICE TO APPLICANT: IL after making this Certificate of Ex- emption,you should become subject to the Workers'CompensationANCE 5.00 PLAN CHECKprovisions of the Labor Code, you must forthwith comply with FEEsuch provisions or this permit shall be deemed revoked. NDLING UNIT(TO 10=CF.M.) 4.00CONSTRUCTION LENDING AGENCY NDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE �I hereby affirm that there is a construction lending agency forUST HOOD(WITH DUCT) 5.00the performance of the work for which this Perrot is issued(Sec. MICROFILM 3097,Civ.C.). Security Pacific , ING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address-Sa.n_Fr-aR&i.5E0,GA HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that I have read this application and state that theaboveVENTILATION FAN (SINGLE) 4.00 information n correct 1 agree to comply with all city and county PLUMBING 99 (� ordinances and stale Taws relating To building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 �J hereby authorise representatives of this oily to enter upon the �� above-mentioned property for inspection purposes. BOILER-COMP (Ovar 100,000 BTU)SEE FEE SCH. EMECHANICAL -- (We) agree to save, indemnify and keep hrmless the City of MISC.- REFER TO ORD.Cupertino against liabilities,judgments, costs and expenses which AX p / may in 'vny wa accrue against said City in conseque a of the PERMIT ISSUANCE 10.00 d granting of ^`�. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL �� S,gna[u,l�01 Applicant/Contractor Date s S OFFICE COPY � J08ADDRESS uNErt.tL-11Z�F Uie`i GIzL.�, IUNaE PERMIT EXPIR, n,..... INSPECTION CONT" CTOR FOUNDATION ATE s'PERMIT EXPIRES INSPECTIO ' f IS NOT STARTEE UfER -3 RECORD 'S' 780 DAYS OF PERI PREGUNITE ANCE OR 180 DA' LASTCALLED INSI POUR NO CONCRETE UNDERGROUNDUNTIL ABOV cL—ALI�AT E HAS BEEN SIGNED /SLAB PLUMBING p ELECTRICAL - PAID M CHANICAL C 2 31981 DO NOT POUR F asuA 'CE DATE LOOR UNTIL D1°T' G� 1 OPG. ROVE 11AS �1 PLUMBING WOOD FLOOR BEEN SIGNED ❑ MECHANICAL BUILDING PE—RK INFORMATIOI ELECTRICAL VAwNF0-NN— FRAMING N — FRAMING INSULATION Eqm T TD S1 pgIL5 TYPE C PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OCC GROUP DIAPHRAGM ROOF Hrs u APrT ILODH AREA PLY NO R 'OT"`°0 ROOFING UNTIL ABOVE HAS BEEN SIGNED — � PLUMBING ROU H RLSLOING usi ❑ NO CON PO GAS TEST - ❑ ❑ ❑ ASSESSORS PA ECEE ND. MECHANICAL ELECTRICAL —TRACT NO FRAMING ��-� - P^r+ceE INSULATION �-Z - FINALS DATE SAN # LLLINSP. ACC.DATE ACC EIEEr w PLUMBING AS - ZONING COVER NO.WORKUNTIL ABOVEHgSgEENSIGNED HEATING eNo.siTEn LATH- MECHANICAL INTERIOR 21_ EIRE SARIN, �— LATH-EXTERIOR �7— �� ELECT � � Y ENEgcr r.7 SHEETROCK 1 =E ELECTRICAL ❑ "❑ ❑ '�r N SHEAR INT _ Q _ .t FIRE DEPT. FLOOD,ONL �_. INTERIOR SHEAR EXGRADE Y❑ ❑ -.31-gj`.�j " Y❑ EXTERIOR pp BUILDING NI FIREWALLS V FEE TEMPORARY APP OVALS (i NO TAPE OR P _ ELECTRIC BUILDING CASTER UNTIL Ago E H S BEEN SIGNED UCCUPgN t GAS ^ - PLAN CHECK CY OF BUILDING IS NOT P OCCUPANCY FEE ERMITTED UNTIL BUILDIN G FINAL IS SIGN ED BY SEISMIC FEE LU ARRANGE F BUILDING INSPECTOR. ~ ONE W OR INSPECTION By p MICROFILM �- o� PLEASE DAY BEFORE HONING 252ECT1 z ASE GIVE JOB ADDRESS WHEN PHONRED INSPECTION. ELECTRIC HONING. � - SEE PERMIT FOR E PLUMBING EXPIRATIONDATEDATE _ h$„ t IMPORTANT! MECHANICAL --� PLEASE READ REVERSE CALLING FOR FINAL INSPE BEFORE ' coNsr.TAX .vPPLICANTS POSTING COPY TOTAL