15848 APPLICANT TO FILL IN INFORMATION WITH RED LINES -USE BALL POINT PEN ONLY
, _ ^
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDINGAPPLICATION & PERMIT
uE30AODRESS 15848
712A52 Trinity Spring Cant BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
I OWNER'S
,t
PLAN CHECK VALIDATION
NAME pcyyyJ wy, ) nc• o- 2GTY. ELECTRIC PERMIT FEE
n$On Devel prA soN/1
100
C04TRACTORs
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
Gregory .,Inc. LIC.No.64MI7 LIGHTING'FIXTURES 10.00/1.00 -
CONTRACTORS Twin Dol phi 0r PPLIANCES-RESIDENTIAL 4.00
RhRE�406220 C F^I 415/595-21
PRONE PANELS 10.00 DATE OF APPLICATION :.
ARCHITECT $Senian4 AIA & PANELS (OVER 200 AMP( 20,00 PLAN CHECK FEE :_Cr NO.
OP
ENCIrvEER ASSOCi atOS C-8395 SIGNS TRANS. 3.00
(��
AARCH OR DDRESS ENG, 2031 Orchard M.' J(400 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
;'� I IW. CA UI II IWZIP 92707 EMP. METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
AoDRESIi oREss
220-0 Twin Dolphin Dr. 1K 94065 SERVICE CHANGE 20.00
Woo LICENSED CONTRACTORS DECLARATION -
< it U I hereby of irm that I am licensed under proo4shons of Chapter 9 ISSUANCE DATE
N<H (commencing with Section 7000)of Division 3 of the Business and BLDG. .Bf ECT. PLG. MECH.
F z z Professions Code,alp my license is in full foo,43 , U`•
0 o„`3- License CIPsJ'ry}5�Lic.Number_ �Fss VF`XC ®.
g w H w Uate-_ ]-1--SS �� Contractor�i ti- •) Y-�
¢ y s BUILDING PERMIT
¢ Q a OWNER-BUILDER DECLARATION
w m INFORMATION
I hereby uffum that I am exempt front the Contractor's Li¢nu
MISC.- REFER TO ORD
LL p ¢ Ww for the following reason.(Sec.7031.5,Businessand Professions pERM1T ISSUANCE ' 10.00 VALUATION f/FT.
� - Code:Any city or county which requiresa permit to construct,alter,
�p y�
Q ,a ¢ improve,demolish,or repair any Structure,prior to its issuance,also ELECT CONTR. LIC.NO. ELECT. 138 306
a - DLL rNeires the applicant for such pemut to file a signed statement that TOTAL PERMIT TO
E
he is limped pursuant to the provisions of the CofDvisi i Li cc Pse'
r z i
Law(Chapter id pr Tessio s Cod )with Semon is 00)exempt
the un 3 of the : �L
¢ ¢ Business end lie alleged Cala)or that he is exempt e crefn70 and GTY. PLUMBING PERMIT FEE
F $ the any
applicant for the alleged ermit s bje Any violation of Sc cion malty STORIES TYPE CONBTR.
d ; � by anyorethafora permit subjects the 0).): ant mucivil Penalty ALTER-DRAIN -WATER IEA.) 5.00
i of not more than live hundred Jullars(S500).): ' 2 SNdt
❑ I,es owner of rhe property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their Sole compensolion,will do the work,and the structure is not
-' - intended or offered for In (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Calc The Contractor's License Law does nor apply to an owner of R-3 1
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 Sa FT.FLOOR AREA TOTALACREAGE
mems re not hrough
or often ]for sale.
If.
hJ ever,hat the
in
nlprove.lding GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
me ors are not intended oroffend]oil for sale.IL however,rhe building 2161
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did net build or int RES IND CON PB Omn
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 ❑ 0 ❑ 0
- ❑ 1,as m
owner of the property,am exclusively corecliny'with . .
licensed contractors to corutrucl the project IS".7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
and Professions Code:"The Co narui License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3G 6-O .y
Q x-3�3 -33
contracts for such projects with a contractorts)licensed pursuant to
the Con radon's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 -TRACT NO. PARCEL NO.
❑ tuno exempt under Sec. ,B.&P.C.fu this WATER HEATER W/VENT 6.00
Person
Owner [are WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'C)MPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby'atfnu rhut I have a evnifciu,of consent to self-in.mre, ZONING ENG.SITE NO.
copcertifcatc of Workers'Compensation Insurance,or u certified _
y thereof(lee.3800,Lan.C.). Lbited.Pacific
Policy Nn. Company _
O ❑ Certified copy is hereby furnished. FIRESPRINK - ENERGY T-24
Z 2 Cenify �y�Is fNJ Ith the city inspection division.
O pplicanl �61`I��Y-y� MISC.- REFER TO ORD. YEJ NEJ I Y [:] No
CC CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLD,CONTR. LIC.NO. PLG. 'Y� N� V� N�
Z CL
Il his section need not be completed if the permit Is fo/one _ TOTAL
hundred do11ars(5100)or less.)
C.) O 1 Certify that in the performance of the work for which thii per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY
EL U mit is issued.I shall not employ any person in any manner so as to
-
become subject to the Workers Compenurion Laws of Californu.
wa Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING $776.00
} N NOTICE. 'TO APPLICANT: If,after making this Certificate of fix
H.. ?
sorption,you should become subject to the Workeri Compenwtion APPLIANCE 5.00 PLAN CHECK 15.00
provisions of the Labor Code, you must forthwith comply with
5 such provisions air this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1O=C.F.M.) 4.00 FEE E
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby athero that there is a coiutmction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the p,,l'oon unce of rhe work for which this Nonir is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 700,000 B.T.U.) 8.00
Lender's Name_SeCUr1t PaOifle -�r�zr
Lenders AdJres�U.1_GIl_._S]9.1 HEATING UNIT(OVER 100,000 B.T.U.)8.60 ELECTRIC $55.50
I cert By that I have read th is application and state that the alwve VENTILATION FAN (SINGLE) 4.00
information u curate. I agree to comply with all oily and county PLUMBING
ordinances and slate laws relating to building construction, and
BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 •
50
hereby authorize representatives of this city to enter upon the BOILER-COMP (Owe 1pQ.000 BTU)SEE FEE SCH. MECHANICAL f�
above-mentioned property for inspection purposes.
(We) agree to mvc. indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlimo against liabilities,judgments, costs and expenses which CONST.TAX $29
7.03
03
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ntin of this Permit. MECH.CONT. LIG NO. MECH.
_ do= 1 tj TOTAL TOTAL $Q13.?26C.76
ifAdf.mo Applica /Contractor ate GV
OFFICE COPY
POST THIS CARD NEAR FRC NT OF BUILDING rRM17 NO%IBEH
CITY OF CUPFRTINO 15848
INSPECTION DIVISION
JOB INSPECTION RECORD
• �J � .��y (�� ;`y '•. PERMIT EXPIRATION
JOB ADDRESS t�7S2 `�� `UNIT# LOT '
Ep�.� y PERMIT EXPIRES IF WORK
OWNER ��.{J�{ CONTRACTOR ♦ IS NOT STARTED WITHIN
` 4INSFEC•T,ION$4-NMft G;�DATE9 IINSPECTDRF 1I�INSPECTIOWRECOR �,;.7&r A. DAYS OF PERMIT
FOUNDATION NOTE: LASTCA 180 DAYS FROM
LASTALLED INSPECTION.
UFER 12 ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
6FDURIHOFCDNCRETE;UNTILABOVE!HAS;BEEN,MGNEDr 1
UNDERGROUND /SLAB —
k', PLUMBING
ELECTRICAL:'; ISSUANCE DATE
MECHANICAL - BLDG ELECT.
PLG, MECH.
.
ADO'NDTt'POURLFLOOR;UNT[Lk`ASOVE!HAS BEEN!SIGN_ED, a9UILDING.PERMITT ?�
= r ' WOOD FLOOR NF•ORMATIONr >:
VALUATION $/FT.
PLUMBING 0itkilo - -
MECHANICAL C1tY of
�•�� ' PERMIT
ELECTRICAL
'm- FRAMING, .. '
A - STORI TYPE CONSTR.
INSULATION . y
OC ROUP ITS
IPUACE!NB!SUBFLr00RIUNTILOFABOVEIHAS'BEEN`SIGNED� 50,FT RARER TOTA ACREAGE
n
ROOF �� � : ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
yt DIAPHRAGM: .- - THE CONSTRUCTION TAX IS PAID
~ - BUILDING USE
ROOF SHEATHING Y' L RES IND CON vB Omr, '
} SAP.P.L•,Y.?NO�ROOFIRBI,UNTICtABOVEiHAS�BEENSIGNED' FINALS,` b., ixDATE ciNSPT P 0
AS$E$BORSPARCEL NO.
ROUGH SAN.No .
PLUMBING O •Z,0) ELECT.ENERGY
TRACI NO. PARCEL NO.
TUBSBSHOWERPAN, PLUMBING ENERGY �qd
MECHANICAL MECH.ENERGY
ACC.DATE ACC.FILE NO.
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST '��OL GAS
FIRE SPRINK ENERGY T,]A
MECHANICAL Y L NL Y ❑ NL
§? COVER NOIWORK'UNTIL ABOVE HAS BEEN SIGNEDiTM HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.L.U.C.
INTERIOR SHEAR -Q�4 FIRE DEPT. v N[ v L N❑
SH EETROCK OW5 GRADE FEE SUMMAF(Yj��
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH I� TEMPORARY APPROVALSSmm
SCRATCH COAT ELECTRIC PLAN CHECK
FEE 1
GAS
AO-TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED' OCCUPANCY SEISMIC F
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL 50
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY