15142 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDINGPROJECT I DENTI FICATION PERMIT NUMBER
A'OORE41705 WALNUT SPRING COURT APPLICATIONU PERMIT 15142
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL .. I J `F
NAMERS regory Uroup, Inc. & PLANCHECK VALIDATION
Ahmanson Dev. 4k§�-,595-2100 OTY. ELECTRIC PERMIT FEE
crag's
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Gregory Group, Inc.,,.N(3V-430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS - Iwln 0 In r. PPLIANCES-RESIDENTIAL 4.00
ADDa�55� 94065 415-4 -2100 PANELS 10.00 GATE OF APPLICATION
ORCHHIITTE`T Aram Bassenian, AIA & Asso . PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE: P.C.NO.
ENGINEER C-8395 SIGNS TRANS. 3.00
ARC H.OR ENG. PERMIT VALIDATION
ADDRESS 2031 Orchard Dr. /100 SPECIAL CIRCUIT 5.00
Santa Ana Hts. CA. 9 7,p7 TEMP.METER OR POLE INS. 20:00
APPLICANTS MOTORS SEE FEE SCH. ?)0-
QAAI;r,
A°DREsa220-C Twin Dol bin Dr.RWC P SERVICECHANGE
o o
LICE
NSI:D CONTRACTORS DECLARATION'' -
a u sFi I hereby.fl'inn Ilial Iain licensed under provisions of Chapter 9 it ISSUANCE DATE
w G w (commencing with Section 7000)of Division 3 of the Business and 'SP T Ie---- BLDG. ELECT. PLG. MECH.
F y z Professions Code,unAmy license is in full fort ff
Z. z w W License Class DD Lia Number-
9 IN Ig is 19
H Date Contractor
a y s � BUILDING PERMIT
Ic ae.w OWNIiR-BUILUIiR DECLARATION INFORMATION
oa MISC.- REFER TO ORD
a. I hereby alEnn that I am exempt from the Contractor s License VALUATION S/FT.
ou u o a Law for the fallowing reasun.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
r NOJ Code:Any city orcounty which requires a permit to construct. 185,865
TE w ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIQ NO. ELEC.
o u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
Fir
Law(Chapter 9(commencing with Section 7000)of Division 3 oftbe SFDU
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ H O the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
nom $ by any applicant for a permit subjects the applicant leached penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 2 5NHR
of not more than five hundred dollars($500)-):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
invented or offered for sale(Sea 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA, 5.00 R-3 1
Code:The Contractor's License Law does not apply to an owner of
ll, property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT,FLOOR AREA TDTALACREAGE
® himself re through his own employees.provided that such improve- 291 7
ments mselfe notintenhis oroffered emploees,role.provided
that s the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
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 not build of on-
RES IND CON PB Over,
prove 1,as owner
of the.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as ownur of the properly,oto project
(Se . 7044,llag with ❑ ❑ ❑ ❑
licensed contractors Com to construct the project(Sec 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 gggEg90Rg PARCEL NO.
'to Professions Code:The Can tructor's License s th does not apply
In un owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3166-p 3 4' 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. PARCELING.
❑ 1 um exempt under Sec. ,B,&P.C.foi`Ihis WATER HEATER W/VENT 6.00 8098
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 Iterehy 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
copy thereof(Sec.3800,Lab.C.).0 n l ted Pacific
Policy No. Company
O [J Cerlilied copy is hereby furnished i FIRE SPRINK ENERGY T 24
Z Z w Certified copy is fill IT a city inspection division.
0 Applicant std/i MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
it CERT IFICATE 01'EXESIP-1 ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > CONIP17NKATION INSURANCE PLG.CONTR. LIC.NO. PLG.
0- Z tThR section need not be completed if the permit is I'or one TOTAL Y❑ N E] N
❑ Y ❑
Hundred dollars($100)or less.)
U 0 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued, I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
u Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 940.5
} W NOTICE '10 APPLICANT: If,after..king this Certificate of Ex-
♦- 2 emption.you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN QHECK,
Provisions Of the Labor Code, you must forthwith comply with FEE /ener
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 9Y .62.0
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE 13.02
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-3 HEATING UNIT(OVER 100,000 B.T.U.)9.50
i' CendehAddresssl� _C(� S-1-I- - )'.- ELECTRIC 70.35
I certify That I hove read this app`iicution and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING 70.35
ordinances and slate laws relating m building construction, and BOILER•WMPI3 H.P.Of 100,000 B.T.U.) 6.00 _
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100000 BTU)SEE FEE SCH. MECHANICAL
above-menlioned property for inspection purposes.
(We) agree to save. indemnify and keep harmless the City of MISC.- REFER TO ORD. •O
Cupertino against liabilities,judgments,costs and expenses which CONST.TAX
ay in any way accrue ogainsl Said City onsequence oV the PERMIT ISSUANCE H. .
anling of this pertnil / //J J� MECH.CONT. LIC.NO. MECH. ' •.I
TOTAL TOTAL
V
Signature o�nt/Llontractor -O�Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING ERmITNumReR
I
CITY OF CUPERTINO 15142
INSPECTION.DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB'ADDRESS'. 11712 _ lKLTINLIT 412flSr3 C I UNIT# LOT# PERMIT EXPIRES IF WORK '
OWNER (Q L .irJ CONTRACTOR s Q IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPEC 10 REC RD 180 DAYS OF PERMIT ISSU.
FOUNDATION — — - ANCE OR,180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER - �% ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF 1 PCRMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE•HAS BEEN SIGNED
UNDERGROUND./SLAB
PLUMBING
ELECTRICAL -
•D � ISSUANCE DATE
MECHANICAL aLOc ELECT PLc, menncR .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION $/FT.
� 30-
MECHANICAL
ELECTRICAL PEN TIT To
FRAMING SFUU
INSULATION
STORIES ` T.YPE.CONSTR,
-
2 SNHR
- OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3 i
50 ET 110011ARCA , TOTAL ACRLAGE
ROOF." NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID2917
ROOF SHEATHING RES .IND'Lo CON USEP8 . O, .,
-APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 El 'E IDA SSESSORSPAICELNO
ROUGH SAN.q ] �,• _ _
PLUMBING Cj ELECT.ENERGY
TUBS&$HOVJER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY - ACC DATE ACC FILE NO
FRAMING. 0 ELECT.FINAL TEST
INSULATION �c l-L� PLUMBING zorvlNc ENG SITE No.
GAS TEST - �-jp GAS
S'Lo �6 Sr/ MECHANICAL FIRE SPRINK ENERGYT.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "� "�
FLOOD ZONE ALUC
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR. 7. FIRE DEPT. Y ❑ N v ❑ N❑
SHEETROCK ' `�-- — GRADE FEE SUMMARY
EXTERIOR LATH `Y BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT — ELECTRIC - PLAN CHECK
GAS FEE 15.50
—lana�y 6200
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FE '
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. - MICROFILM
13.02
ARRANGE FOR INSPECTION BY PHONING 252-4505, ; ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
ZMECHANICAL
= SEE'PERMIT FOR EXPIRATION DATE —
IMPORTANT!. CONST.TAX • .
PLEASE READ REVERSE SIDE BEFORE _�
CALLING FOR FINAL INSPECTION. TOTAL 1„S'ar.02 -
OFFICE COPY`
J