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15807 APPLICANT. TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY • PERMIT NUMBER �] BUILDING PROJECT IDENTI IDENTIFICATION gppLICATION & PER'MIT . 15801 • Ao'bPEs6 Lot # 201 Plan 1 A 11609 Birch S r.i n COUrt BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OwNER'S reg rY rOUR p F PLAN CHECK VALIDATION -', NAAhmanson 8e V• 415-00- 100 QTY. ELECTRIC PERMIT FEE PHONE CONTRACTOR'S N OUTLETS-SWITCHES•RECEP 10,00/1,00 ' °Gegory Group, Inc.Lla B-430097 m NOLIGHTING FIXTURES 10,00/1.00 CONTRACTOR'S 220-C Twin Dolphin Dr. PPLIANCES-RESIDENTIAL 4.00 rTWC 94065 4Uq-E595-2100 PANELS 10.00 DATE OF APPLICATION ' ARCHITECTram aSSenlan AIA & Ass C.' PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C:NO. OR ENGINEER t-8395 LIC.N ISIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION AOJanta Ana3 t0rc rd Dr.. �`lJp(j(1 SPECIAL CIRCUIT 5.00 s. ��• 9 S7 EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. p ADOBf/{� C Twin Dolphin Dr. RWC9406 SERVICE CHANGE 20.00 Woo LLV LICENSED CON'T'RACTORS DECLARATION k.�a{/'� W/J/O - u w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE Z, (commencing with Section 7000)of Division 3 of the Business and a a � P r ®T. P� M . o Professions Code,uryj m license Is in lull for4- r ((�L,t c i=W License Class [j Y hie.Number�} (j�`1/ Dale Contractor P ,3 BUILDING PERMIT ¢ ¢ ¢ OWNER-BUILDER DECLARATION o d v INFORMATION w ;LL H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO OR e VALUATION $/FT. s- LL o 4 Law for the following mason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE ' 10.00 m� Code:Any city or county which reyuiresa permit to construct,alter, Q a ¢ Improve,demolish,Or repair any structure,prior t0 its Issuance,also ELEC.CONTE. LIC.N0. 154,922 - ELEC. • wC u requires the applicant for such permil to file a signed statement that TOTAL PERMIT TO m he is licensed pursuant to the provisions of the Contractor's License Uzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe SFDWL f 4 o Business and Professions Code)or that he is exempt therefrmn and OTV. PLUMBING PERMIT FEE ¢ H $ the basis for the alleged exemption.Any violation of S"tiu07031.5 STORIES TYPE CONSTR. w. by any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(55001.1: 2 5NHR ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND.. 5,00 Code CodThe Contractor's License Law does not apply to an owner of R-3 1 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE himsulf or through his own employees,provided that Such improve- - - mentsarcnot intended or offered for sale If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 2400 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving lhm he did not build OrionRES IND CON PB orM1e, prove for Lass neeose of sale.). INDUSTRIALWASTE INTER. 30.00 % ❑ ❑ ❑ ❑ ❑ d as owner of the property,he exclusively contracting with licensed contractors Code: I construct the project(Sec.7049,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0. and Professions property Contractor's(improv Law docs not apply - man owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 �. / con loads for such projects with o contmetorf sl licensed pursuant to - theContmmor'sLicenseLaw. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,L&P.C.for this reason WATER HEATERW/VENT 6.00 S098 Owner Date - WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. WORK ERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance or a certified copy thereof(Sec.3800,Lab.C.)United Pacific Policy No. Company O ❑ Certifedcopy is lmreby furnished. FIRE SPRINK ENERGY T 24 Z Z X] Certified copy is filed with the city inspection division. O Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ ~ Ul PERMIT ISSUANCE 10.00 LU - CERTIFICATE OF NI EXEMPTION ION FROM WORKERS' FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG. 1 0 0his section need not be completed if the permit is for'one TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dollars($100)or less) - O I certify that in U*e performance of the work for which this'per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to O w become subject to the Workers'Compenvtion Laws of California., a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 832.00 } 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex. I.. ? coalition,you should became subject to the Workers'Compensation APPLIANCE 5.00 PLAN PH ECK 15.50 promit visions of the Labor Code, you roust forthwith comply with FEE /energy 62.DD U such provisions or this pershall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 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 Pacif I'C HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name�F� �P_TD-�4-1`.��f1� HEATING UNIT(OV ER 100,000 B.T.U.19.50 ELECTRIC Loader's AAJress 60.90 I certify that I have read s application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county g01LER-COMP13 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING 60.90 ordinances and slate laws relating to building ems ruchan, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU(SEE FEE BCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- 'REFER TO ORD4 upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST..TAX may in any way accrue against said City in consequence of the ranting of this peen MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature of, t/Contractor Dale " OFFICE COPY ' /Z74O0,o • POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15807 INSPECTION DIVISION JOB INSPECTION'RECORD T/1� PERMIT EXPIRATION JOB ADDRESS Id1�1(� I Ry.l UNIT# _LOT# O PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION NOTE: - LASTCALLEDINSPECTION. . UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION • PREGUNITE CUPERTINO STANDARDS. GARAGE SLABS - - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING �I ELECTRICAL ISSUANCE DATE BLOC ELECT. PLG. MECH MECHANICAL ® 0 '�] .® SmtOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED [ I' Q,�� BUILDING PERMIT INFORMATION WOOD FLOOR Iv VAWAIION SIFT. PLUMBING 164 922 MECHANICAL 1 PERMIT TO ELECTRICAL ' FRAMING STORIT5 'r YPE CONSTR INSULATION OCG GROUP RES.UNITS �,. . PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - RA SO.E.PLooRAREA rorALACREAcc ROOF TOECONSTRUCTION TAXSHALL PA FINAL tNSP. EDMADE BEFORE 2400, . DIAPHRAGM _ BUILDING USE ROOF SHEATHING RES IND CON . PB Owe• APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS JDATEINSP. El ❑ ❑ E) ❑ ASSESSORS PARCEL NO ROUGH SAN.q -q( _ _ PLUMBING — 5 iC1 ELECT.ENERGY TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY 8098 MECHANICAL _ Q ' MECH.,ENERGY ACC GATE ACC FILE NO ELECTRICAL - _ Q BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY i-20 MECHANICAL v 0 N❑ v ❑ NF] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR 1.r c{ DIM ELECTRICAL RELEASFLOOD ZONE ALu.c. INTERIOR SHEAR FIRE DEPT. v N� Y ❑ N❑ SHEETROCK - ,�'j GRADE . . - FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH 0 TEMPORARY PP OVALS BUILDING 832.00. SCRATCH COAT ELECTRIC PLAN CHECK 8:80 GAS FEEenergy 6 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE to 85' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Go.gn LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB"ADDRESS WHEN PHONING. Z .MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONT.TAXp3 PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY '�e°p�