15843 POST THIS CARD NEAR: FRONT OF BUILDING
PERMIT NumsEa
CITY OF CUPERTINO 15843
INSPECTION DIVISION
JOB INSPECTION.RECORD
_ PERMIT EXPIRATION
JOB ADDRESS- &- � Q . G C UNIT# LOT;_ :
PERMIT EXPIRES IF WORK +
OWNER CONTRACTOR ' IS NOT STARTED WITHIN
INSPECTION D E INSPECTOR INSPECT N RECO X180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: ' LAST CALLED INSPECTION. .
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '-'.
UNDERGROUND /SLAB
PLUMBING IZ.YP J
ELECTRICAL ISSUANCEUATE
MECHANICAL - e,:1G. ELECT. PLc. N[EJCC.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED8jJILDING PERMIT
WOOD FLOOR
�1 INFORMATION
\'�\ °
p" VALUAi ION SIFT.
PLUMBING � - � �,' - -ilk
'
MECHANICAL
ELECTRICAL 1 PERF+n iO
FRAMING
5 TYPE CONSTR.
INSULATION
I
OCC. ROUP tifUNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE Bo, °OR AREA 1OT ACREAGE
DIAPHRAGM- THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING 3Q w nuaOlOusE
RES IND CONN PB Om"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ E� ❑ 11
ASSESSORS PARCEL NO.
ROUGHIL / 36b-09-31.32.33
PLUMBING Z.616 ELECT.ENERGY
• TRACT NO. PARCEL NO..
TUBS B SHOWER PAN "2-L(WT I QL PLUMBING ENERGY X98 ,
MECHANICAL r22�.•by MECH.ENERGY
ELECTRICAL qcc.Oq TE ACC FILE No
'lam-6'("1 BUILDING ENERGY
FRAMING - 7-u?`T ELECT.FINAL TEST ZONING ENG.SITE NO.
INSULATION 7j .. PLUMBING
GAS TEST GAS.
7' FIRE BPRINK ENERGY T-2,1
MECHANICAL ' Y ❑ N[ r ❑ NEI
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOOZONE A.L.0 C.
EXTERIOR SH AR _ _ - ELECTRICAL RELEASE
-INTERIOR.SHEAR `— i G FIRE DEPT. Y❑ N� v I] -11
SHEETROCK $ GRADE FEE SUMMARY
.EXTERIOR.LATH ' BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING _
SCRATCH COAT ELECTRIC PLAN CHECK
— — GAS -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. MICROFILM I
ARRANGE FOR INSPECTION BY PHONING 252-4505,. ELECTRIC $49,6
�.
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION'DATE
IMPORTANT! CONST.TAx•
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE CDPV
APPLICANT TO FILL IN INFORMATION WITHIN' RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION .'PERMIT NUMBER
APPLICATION PERMIT
BUILDING DHES' 11 Trinity Spring Cain St 5843
ADRE-
LOt 3CO 1A BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S Gregosr Group, I . 0 PLAN CHECK VALIDATION
NAME V�x''�xM..// V�VIIF� 0I QTY, ELECTRIC PERMIT FEE
MwSon DeveloWMt ,,CNE415/595-2100
caoR's
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
ROME
Gregory Group, Ina..,0.415/595-2 LIGHTING FIXTURES 10.00/1.00
ACORES
CONTRACTOR'S win Dolphin PPLIANCES-RESIDENTIAL 4.00
M 94065 PHONE 415/59555-210 PANELS 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
OR ram $Sentare, PANELS (OVER 200 AMP( 20.00
ENGINEER Associate$ LIC.NO. C-43395 SIGNS TRANS. 3.00
AODHEON ENG. 2031 Orchardre• SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Santa Ana Hts, CA - zip 92707 TEMP. METER OR POLE INS. 20.00
APPLICANTS
ADDRESSMOTORS . SEE FEE SCH. - -
220-C Twin Dolphin Dr.,M 94065 SERVICE CHANGE 20.00
o o LICENSED COMERACfORS DECLARATION
<u v 1 hereby aftimi that 1 am licensed under provisions of Chapter 9 12 ISSUANCE DATE
m <y (commencing with Seciron 7000)of Division 3 of the Business and ELECT. 1 PLG. MECH.
F D z Professiorm Code,andply license ism full fort L
, 02 -a`3 - License s Lic.Numbe ,I
0 r w Datc_ .f-L�LUU Contractor _ C--lgry
Y d,8 BUILDING PERMIT
Ic w o OWNER-BUILDER DECLARATION INFORMATION
w 0 a r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORDOW�
u VALUATION SIFT,
F a.a Law for the following reason.(Sec.7031.5,Businessand Professions pERM1T ISSUANCE 10.00
Code:Any city ur evanty which requires a permit to construct.alter, 7
< p improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR. LIC.NO. ELEC. 121, pp
/W
O ae rest uires the applicant for such permit to file a signed statement that TOTAL w PERMIT TO he is Iiccrued pursuant to the provisions of the Contractor's License,
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE g
St the basis tort the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 2
ofnmore ore than five hundred dollprs(5500).1: EDR
❑ I,as owner of the property,or my employees with wage,us BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UWTS
(heir Nile compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLODR,ROOF,AREA,COND. 5,00
Code:'1'be Contractor's License Law does not apply to an owner of R-3 1 -
propcnywhobuldsorimprovesalereon.and who does uch work FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTAL ACREAGE
• Rents re not hrough
ownemployees.for sale.If,ed however,
Arab impmvc GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
mu crus are not intended or offend for sale.If, mpletion,the building 1954
or Improvement is sold within one your 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 ins. BUILDING USE
prove for purpow of sale.). INDUSTRIAL WASTE INTER. 30.00 yREEls IND CON PB Dmar
❑ I,as owner of the property,am exclusively contracting with Ijy. ❑ ❑ ❑ ❑'
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Processions Code:'I'he Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 366-09-31,32,33
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec.-,EL&P,C.for this WATER HEATER W/VENT 6.00 8098
"awn
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKS RS'COMPENSATION DECLARATION WATER TREATING EQUIP.. 5.00
I hereby atfirm that 1 have a certificate of consent to self-insure.
or a certinheate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.381X),Lab.C.l. It( Pte,,,F,a -policy No. Company_ Ltal Pk6J_+
.O Cl Ce IT �dyopy Is h rt fumi lied FIRE SPRINK ENERGY T 24
Z Z Y_Can!'l spy d wlh the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O A pbcmu- YNl Y N V N
CC y CERT 1171CA If.OF EXEMPTION PROM WORKIiRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c.
LU > C0WiPFNSA6ON.INSURANCE PLG.CONTR. LIC.NO. PLG, Y❑ N❑ v ❑ N❑
CL O ('Phis sectidn end not'he mntplctcd if the permit is for one TOTAL
Z:) Z hundred dollars(5100)or Its.) -
U O 1 ccrtity that in the parlonnnnce of tine work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, I shall not employ any person in any mapper so as to ,
O become subject to the Workc,,Compensation Laws of Califomiu.
Ed Oat° Applinnt ALTER OR ADD TO MECH. 5.00 BUILDING $716.50
to NOTICE '10 APPLICANT: If,atter making this Certificate of rix-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLANXH_ECK
provisions of the Labor Code, you most forthwith comply with FEE Liturgy WA
U such provisions or this permit shall be deemed re.'oked. AIR HANDLING UNIT(TO 10=C.F.K) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.F.M.) 6.00 SEISMIC FEE $8.54
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the
3097 eCi.C.)ee of the work for which this permit is issued(Sec. HEATING UNITATO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name $ELFUrit Pacific
Lender's AAdross , r-._ .1 1 HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC '
1c,Rily thus l have read t his application and state that the above VENT,LAT I ON FAN IS I NGLE) 4,00
Information is correct. I agree to comply with all city and county PLUMBING
( ordinances and state laws relating to building construction, and BOILER-OCYaP(3 H.P.or 100,000 B.T.U.) 6.00 $49.88
hereby authorize representatives of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL fTD
xlwve-mentioned property for inspection perpues. 9,00
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgmmnts, costs and expenses which PERMIT ISSUANCE . 70.00 CONST.TAX
nay in any way a against said City in consequence of this
r of this blit.c MECH.CONT, LIC.NO. MECH. .
297.03
�C TOTAL TOTAL
ignature o Applic ret/Contractor Date 11249.21
OFFICE COPY