13800 POST THIS CARD NEAR FRONT OF BUILDING HMITNUMRER .
CITY OF CUPERTINO
:r, INSPECTION DIVISION 1.380a
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS // Un/ S — (1JIT# LOT#
pp� '' A �� PERMIT EXPIRES IF WORK
G
OWNER O �W E 640C1 1/CJI CONTRACTOR IS NOT STARTED WITHIN
INSPECTION ATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION f ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB n1
r �q
• PLUMBING
ELECTRICAL ISSUA E
MECHANICAL eL G. MECH.
/r „'210, L 'low ❑ D.
00 NOT POUR FL OR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR vALuanoN STET.
PLUMBING / A •�
MECHANICAL v '
PERMIT TO
ELECTRICAL K /
FRAMING C
STORIES TYPEECONSTR.
'INSULATION '
- � / '
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 FT,FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
BUILDING USE
RES IND CON PB OIM1ei
APPLY NO ROOFING UNTIL ABOVE HAS BE SIGNED ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH e'r
PLUMBING i 1'Doe
TRACT NO. PARCEL NO
GAS TEST
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICALFINALS.. DATE I INSP.
FRAMING �•.^ SAN # dol- zaNlNc ENG,slrE No.
INSULATION - PLUMBING -
GAS
FIRE SPRINK ENERGY T.ZA
MECHANICAL D—T v ❑ N❑ r ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED(';: HEATING
FLOOD ZONE A.LU.C.
LATH—INTERIOR ELECTRICAL O-
LATH—EXTERIOR FIRE DEPT. Y❑ N❑ v❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING -p—
SHEAR EXTERIOR. - TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC I - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
.ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING r
�Io PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION'DATE - MECHANICAL
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 POANT. PEN ONLY
BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
s BDILOING APPLICATION & PERMIT
ADDRESS 11522 Country Spring Court 13800
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S {'•.5; PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
Gregory Inc- PHONE 595-2100
CONTRACTOR OUTLETS-SWITCHES-RECEP 10.00/1.00 / 01
NAME
Gregory Inc. LID.-o.430097 ILIGHTING FIXTURES . 10.00/1.00 a
rorvTRAcroR's 220 Twin Dolphin Dr. , IICII 3 APPLIANCES-RESIDENTIAL 4.00
ADDRESS
Rpdwnnd City, CAPHONE - 1 I IPANELS 10.00HI) DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR Aram Bassenian, A.I :A.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. 1 . ,Westerly Pl . , 170 SPE C IAL CI RCUIT 5,00 PERMIT VALIDATION
ADDRESS
ziPi drin
EMP.METER OR POLE INS. 20.00
AReCA IIC II MOTORS SEE FEE SCH.
rsADDREss 220 Twin Dolphin Dr. ,
City,dwood SERVICE CHANGE 20.00
Doo LICENSED CONTRACTORS DECLARATION 2�
¢ U U I hereby affirm that I am licensed under provisions of Chapter 9 ^ ISSu DATE
y<i (commencing with Section 7000)of Division 3 of the Business and BLDG. PLG. MECH.
r D i Professions C ,and my license is in full forrg �fYcl.
z o 13- License ClasseLic.Number- y/
D w L w Date Contractor
a, 2 w¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
MISC.- REFER TO ORD INFORMATION
w3°'w I hereby affirm that I am exempt fror the Contractor s License VALUATION S/FT.
r LL o as Law for the following reason.(Sec.7031:5,Businessand Professions PERMIT ISSUANCE 10.00 / y fv
W Code:Any city or county which requiresa permit to construct,alter, '+ti
2 To 4 C improve,demolish,or repair anVtructure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC.
u DLL requires the applicant for such permit to file a signed statement that TOTAL / PERMIT TO
8 he is licensed pursuant to the provisions of the Contractors License � //
as Li.(Chapter 9(commencingwith Section 7000)of Division 3 oflhe - X74 X/4
E o Business and Professions Code)or that he isexempt therefrom and OTY. PLUMBING PERMIT ' FEE
¢ H. the basis for the alleged exemption.Any violation of Section 7031.5 STpORIES TYPE CONSTR.
i; - by any applicant for a permit subjects the applicant loacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 pr 3 N%17'U
of not more than five hundred dollars 0500)):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00OCC.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 K_3
Code:The Contractor's License Law does not apply to an owner of
' property who builds or improves(hereon,and who does such work FIXTURES-PER TRAP 5.00 �.j so.Fr.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
ments are not intended or offered for sale.If,however,the building
or improvement is Said within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) -2.00 BUILDING USE
builder will have the burden of proving that he did not build or im. RES IND CON Pe Other
prove for purpose of sale.). JINDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business ' LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL1NO.
and Professions Code:The Contractor's License Law does not apply / (�Y 7
to an owner of property who builds or improves(hereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3� p^
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.
❑ lamexemptunder Sec. ,B.&P.C.fortllis WATER HEATER W/VENT 6.00 779f
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I 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.0)
Policy No. CompanY-4n7-ted-P�RE�1$D
0 ❑ Cerlifiedc he by furo FIRE SPRINK ENERGY T-24
ZZ �(Certifie e I Ie ci eQe Om division. MISC.- REFER TO ORD. y❑ N❑ Y NE]
Q Applicant-p
2 N CERTIR ATF OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UL.
LU a COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL O (This section need not be completed if the permit is I'or one TOTAL Y❑ No , Y❑ No
::) Z hundred dollars IS 100)Or less.)
U 0 I certify that in the performance of the work for which this per, OTY.. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
OO become subject to the Workers Compensation Laws ofCalifurnia. BUILDING
Date Applicant I ALTER OR ADD TO MECH. 5.00
} ran NOTICE TO APPLICANT: If,after making this Certificate of Ex-
H ? eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 4a�Q PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE 3d o
C..1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.EM.) 6.00 SEISMIC FEE �-
1 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 tV P8C1ie1C HEATING UNIT(TO 100,000 B.T.U.) 8.00 / G
Lender's Name rip HEATING UNIT(OVER 100,000B.T.U.)6.52 ELECTRIC
Lender's Address San-Fra.nR•r'I"S"e0, GA
1 certify that I have read this application and slate that she above VENTILATION FAN (SINGLE) 4.00 �.- p
information is correct.I agree to comply with all city and county BOILER H.P.or 100,000 B.T.U.) 6.00 PLUMBING QL'Ji
ordinances and stale laws relating to building consUucli,on and
hereby authorize representatives of this city to enter upon the BOILER-COMP love,100,000BTU)SEE FEESCH. MECHANICAL /
above-mentioned property for inspection purposes.
(We) agree to Save; indemnify and keep harmless the City of MISC.- REFER TO ORD. Q
Cupertino against liabilities,judgments, costs and expenses which /0 CONST.TAX I
may in any accrue ag n51 said City in conseq once of the PERMIT ISSUANCE 10.00
granting Ii ��// MECH.CONT. LIC.NO.
TOTAL
Sigm pplicant/CcTmmclor r Date
OFFICE COPY
i
ELECTRIC SERVICE NOTICE OFFICE COPY
I BUILDING INSPECTOR'S NOTICE / d
CITY OF CUPERTINO f�-
1
To 19 '`SO
I You ore hereby authorized to Connect electrical service for
I y Owner or Tenant tti- 'c—p 0d y y
d —/.'Ir U V /J
t + No.of Wires /
Sizeof Wires — -Sizeof Switch
_ Motor Load '
�— Volroge
� Phase
Heating Load K.W.
Voltage
iNo.of Meters Light_l IO_New Service
Reconnect
I Heor 120—Three Wire
No.of Add.Meters More Service
I Power Three Phase
I Move Merer.
0• ELECTRICAL INSPECTOR 1 1
i 1
e CITYfOF(j@UPERTINO,O
CERTIFIC(ATEE� OFF CIq,M,PLET10'W'
BUILDING`INSPECTTOR'SIOFFICE E
p Ort' 7P-
Date .....(U.... .. ................... 19.0... Building rPermitTNov�.3. C71�
The Building Located atIn
..�...� R
..2z.....�..o ..utT� :.: sr:� .... .. .
Owned by . ..t'Q.. ...O....V. l:y..
Has
.. ........:....r..
( ^......................................
Has Been " Com leted
( tered) ForlUsa As
...
................:..........
......................................I...............................
.................................................................. .......... ...... .......
..
BUILDING ,�IN$PE6TORL;:;
' I
OFFICE
- „ CITY OF CUPERTINO COPY
GAS SERVICE NOTICE
lo — 7 119 -W
i
To
' You are heieby authorized to connect the GAS service for
' Owner or Tenant ,y C NJ-,) �p
I At ' 2- 2— Oy S
I �/S- C' 1�1'�r-t u
I /
New Service-
No.
erviceNo. of Meters - Reconnect
I Move Service
I No. of Add. Meters
Move Meter
i
PLUMBINSPECTOR pp .
BUILDING INSPECTOR'S OFFICE
Bldg.Dept.
� CITY OF CUPERTINO Office Copy
❑ Backflow Device Sanitary Permit No. (2-2-71
1 ❑ Sewer Cohnedion Plumbing Permit No.
CDU
❑ Plumbing:F1nol Lot No.
t ,9{
I Owner or Tenant -P 4 A / �•- a�L
r At C I
1
Tract_ 7g
l
T-
II Date Connected 3 — 19 ate Final l� —7 10
PLUMBING INSPECTOR j
I