13746 t POST THIS CARD NEAR FRONT OF BUILDING
' CITY OF CUPERTINOMiT NGM11REH
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INSPECTION DIVISION � 13746
JOB INSPECTION RECORD \
c
�ju�� PERMIT EXPIRATION
DD S
JOB A
UNITlk ' 'ILOT# 1 PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
yV /�
INSPECTI DATE INSPECTORINSPECTION RECORD I 180 DAYS OF PERMIT ISSU-
ANCE OR
FOUNDATION _I�8�1' ( LASTV C 180 DAYS FROM
LASTCALLEDINSPECTION.
UFER �+
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB h
PLUMBING V ♦ �
1
ELECTRICAL ISSUANCE GATE
MECHFjfJ ICAL - LEcr. PLG. MECH.-
o a .
DP NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION S/FT.
PLUMBING - -
MECHANICAL
ELECTRICAL
FRAMING
STORIES TYPE CONSTR.
INSULATION
S OCC.GROUP RES.ON ITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - SO.FT.FLOOH AREA TOTAL ACREAGE
DIAPHRAGM I
BUILDING USE
NES IND CON PB 0,n,,
__j�PPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ F-1 ❑ I
ASSESSORS PARCEL NO.
ROUGH
PLUMBING '
GAS TEST TRACT NO, PARCEL NO.
• F .
MECHANICAL I
ELECTRICAL . FINALS DATE INSP. ACC.DATE ACC.PILE No.
FRAMING SAN'#
ZONING ENG.SITE NO.
INSULATION PLUMBING -
tak _ GAS - —�p�
FIRE SPRINK ENERGY T@<
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - ` "� ` NE:]
LATH—'INTERIOR 4-191 ELECTRICAL FLOOD ZONE A.L.U.C.
LATH—EXTERIOR 2(p FIRE DEPT. - `'❑ NC] r I] N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING '
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC I PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 8-19
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNE5 BY.BUILDING INSPECTOR) MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LEI ONE.WORKING DAY BEFORE REQUIRED INSPECTION. 1 PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICALrr An
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL � �571•�
CALLING FOR FINAL INSPECTION.
OFFICECOPY
APP,,ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL rOINT PEN ONLY
f
' BU I LDING PROJECT I DENTIFICATI ON .A 7MIT NUMBER
�J BUILDING APPLICATION & PERMIT
•- ADORE LOt Plan 3i3f2 3a 13746
7j BUILDING- ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S 415 PLAN CHECK VALIDATION
NAME GREGORY GROUP, IN,� CITY. ELECTRIC PERMIT FEE
D
NAMTRncmns LITLETS-SWITCHES-RECEP 10.00/1.00 qq no
SameLIc.N _E 99LIGHTING FIXTURES 10.00/1.00
CONTRACTogs PPLIANCES-RESIDENTIAL 4.00
ADDRESS 220_ 1 Ol RI I I]
RWC CA %1 NE _ PANELS 10.00 DATE K APPLICATION
ARCHITECT ANELS (OVER 200 AMP) 20.00 i 0.00 PLAN CHECK FEEP.C.NO.
'ENGINEER ARAM BASSENIAN> AIA -
r LIC.ND, SIGNS TRANS. 3.00
MTES
ADDREss SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
3990 Westerly Place, ##1,70
zIP EMP.METER OR POLE INS. 20.00 /�
" MOTORS SEE FEE SCH.ADDREW �yf
SERVICE CHANGE 20.00 �e
a LICENSED CONTRACTORS DECLARATION Efv g1 O O
IN u 1 hereby aflirt that I am licensed under provisions of Chapter 9 D V OISSUANC E
(commencing with Section 71X0)of Division 3 of the Business and B MECH.
iProfessions Cods,arkl my license is in full force a e f c
O License Cloo-b-Lic.Number_
w Dade` Contractor
J OWNER-BUILDER DECLA ION BUILDING PERMIT
S MISC.- REFER TO ORD INFORMATION
r I Law for the
affirm that I am exempt from the Contractor's teisious VALUATION
d Code:Any
city
ing ounty whichr.703 uires Perminess t tocnd Profusions PERMIT ISSUANCE 10.00
tE
Code:Any city or county which structurep prior
to its issuance,
alter,
tE MprOVe,dtn10I15f1,Or repair any$InICLUR,ppOf t0 Its DSIIanR.a30 ELEG CONTR. LIC.N0. ELEC.
requires the applicant for such permit to file a signed statement that TOTAL 1 10
he is licensed pursuant to the provisions of the Contractor's License
i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
c Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE
CONSTR,
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 O�
of not more than five hundred dollars(55001.1:
❑ 1,"owner
of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Co.GHOUP RES.UNITS
their sole compensation,will do the work,and the slruclurt u not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -3
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 Sa FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
or improvement is sold within one year 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 am-
BUILDING USE
provefor purposeofsale.). INDUSTRIAL WASTE INTER. 30.GO RES IND cory PB Omar
❑ 1,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 ASSESSORS PARCEL NO.
and Professions Code:The 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 9_3/ 3a- 33
contracts for such projects with a contmctol(s)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARYSTORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00 9�
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-ineurc' ZONING ENG.SITE NO.
or a certificate of Workers Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company United tedPacificL
O y❑G3}. Cenifiedcopyl ub fu nished. FIRESPRINK ENERGYT24
Z Z A'dbticanrtlfied o t e 'ty inspection division. MISC.- REFER TO ORD. y ❑ N❑ y ❑ N❑
O
Fw CERTI FICA .OP I PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C.
LL U AEMPTIFROM WORKERS'
I1 - COMPENSATION INSNS URANCE PLC.CONTR. LIC.N0. PLG.
CL Y❑ N❑ Y ❑ N❑
(This section need not be completed if the permit u for one TOTAL
Z hundred dollars($100)or 1..)
U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of Califomia.
n Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers Compensation APPLIANCE 5,00 PLAN CHECK y
provisions of the Labor Code, you must forthwith comply with FEE/_e.n
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1QOW C.F.N.) 4.00
' CONSTRUCTION LENDING AGENCY AIR HANDLING UNMOVER 10=C.EM) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cw CJ. I I HEATING UNIT(TO 100,000 B.T.U.) B.00 8.00
Lender's Name ;Arra rsntO-.S IL HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC
Lender's Add.--39{3_BY•$OIfO1••1}-St 'p� 159-00
-
I pp11..{{ggrrtlp �1Qmd this application and stale t att eabove VENTILATION FAN (SINGLE) 4.00
ih181MatiFfllnis 2o7r Y.W agme to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMP l3 H.P.or t00,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue a 'cast said City In consequence of the PERMIT ISSUANCE 10.00
granting ofthi 1. MECH.CONT. LIC.NO. MECH.
244 TOTAL TOTAL 1 ,571 .16
Signature pelican lConlractor ate 55.00
OFFICE COPY