13810 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 1381 Q
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS � •� 'Q'=�`t7`S��i1/f; L7' UNIT# ,LOT#
�-^ � � • 10'e PERMIT EXPIRES IF WORK
OWNER U /.v V corvrRAcroR IS NOT STARTED WITHIN
INSPECTIO DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.'
UFER '
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED O_
UNDERGROUND /SLAB ��, lidil •�
PLUMBING
ELECTRICAL EDATE
MECHANICAL ECT. PLG. MEC..
_ a 1:1o a
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $,FT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
t L"
FRAMING
IsroRlEs TYPE corvsTR.
NS CATION
44
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "
O GT.FLOOR AREA TOTAL ACREAGE
ROOF
D ARHR oGen
B W LOI USE
IVES IND CON
PB plM1er
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACTNO.— PARCEL No.
MECHANICAL - '
ACF DATE ACC.FILE NO,
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION - PLUMBING
GAS '
FIRE SPR wa ENERGY o74
MECHANICAL Y [:] N Y ❑ NE:]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.U,C.
LATH-INTERIOR p.�2- ELECTRICAL _ v� N� Yo rv❑
LATH-EXTERIOR -Z1'wJ FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR _ BUILDING .Q
SHEAR EXTERIOR )-� TEMPORARY APPROVALS"' BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE /.
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC r
r H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL < .
IMPORTANT! CONST.TAX F
PLEASE READ REVERSE SIDE BEFORE TOTAL ,
CALLING FOR FINAL INSPECTION.
OFFICE COPV
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION
PERMIT NUMBER
(WILDING 11593 Forest Spring Court APPLICATION & PERMIT
.°°HE (Lot 108 - Plan 46R 13810
BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
O ER'5 4 \4 PLAN CHECK VALIDATION
\� NAME QTY. ELECTRIC PERMIT FEE
Gregory Group, Inc. PHDNE 595-2100
ua EHAcroHs I UTLETS-SWITCHES-RECEP 10.00/1.00 � l
lire or Group, Inc. LIC.NO. 430097 LIGHTING FIXTURES 10.00/1.00
r-ONTRACTORS 220 C Twin Dolphin Dr. PPLIANCES-RESIDENTIAL 4.00
ADDRESS (�
Redwood CitX, CA PHONE 595-2100 I PANELS 10.00 DATE OF APPLICATION
ARCHITECT T' m SSenian, . PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENDINEER Associates
sec.No. SIGNS TRANS. 3.00
ARCH.°HLNG. 3990 Westerly Place, #170SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
New ort Beach CA zip 92660 EMP.METER OR POLE INS. 20.00
Apoix nTs win 0 p In r. MOTORS SEE FEE SCH.
ADOREss
Redwood City, CA 94065 SERVICE CHANGE 20.00 �e9'
w o o LICENSED CONTRACTORS DECLARATION IDEct 7V
a u u I hereby uffrm that I am licensed under provisions of Chapter 9 -
w a to (commencing with Section 7000)of Division 3 of the Business and TE
LimnAt Cl Code,rr1y1nmy license is lx full forces '
G. MECH.
2a`� License Class_ Lin.Number�,J.UV7/ Z � I�
y r B Date— Contractor Pel Xx2
H BUILDING PERMIT
a w a OWNER-BUILDER DECLARATION INFORMATION
MISC.— REFER TO ORD
X 3 u 1 hereby affirm that I am exempt from the Contra( s Liunu VALUATION S/FT.
u. o Law for the following reason.(Sec.703 L5,Business and Professions /
H — g PERMIT ISSUANCE 10.00
P,� Code:Any cityorcounty which requitna permit to construct,alter,
rt2 Q Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. I V f0
E requires the applicant for such permit to file a signed stalemcnt that TOTAL / p �r�PERM�IT TO
w 2 he is licensed pursuant to the provisions of the Contractor's License U 7�
ar z a Law(Chapter9(commencingwith Section 7000)of Division 3 ofthe ({�'
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i 3 — by any applicant for a permit subjects the applicant toa civil penalty `/Y,
of not mom than five hundred dollars(SSUO)J_ ALTER-DRAIN& VENT-WATER (EA.) 5.00 S /7/L
"—
❑ 1,as owner of the properly,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 Occ.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not q
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 —J /
Code:The Contractors License Law don 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 TOTALACREAGE
himself or through his own employees,provided that such improve-
ments time not intended oroffered formic.If,however,the budding 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 ire. 1 RES INDPB Oreo USE
prove for purpose of sale.). INDUSTRIAL W ASTE INTER. 30.00
❑ 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. 600 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 MA.) 1.00 —
Q/ y 3/ �a
contracts for such projects with a contractor(s)licensed pursuant to v/ Pr /
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec..,BAP.C.for this WATER HEATER W/VENT 6.00 �!�'9
mason
Owner Date WATER SYSTEM 5.00 ALC.DATE ACC.FILE NO.
WORK F.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to selhinsurn,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lb.ctlnited P8C1f1C/Rel
Policy Nn CompanyU
O ❑ Certified co .her umished. FIRE SPRINK ENERGY T 24
Z Z ❑ Crrtif th the city inspection division. ❑ ❑ ❑ ❑
F p Applicam MISC.. REFER TO ORD. y N v N
cc res CG rIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 /0 FLOOD ZONE AL.u.C.
UJ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z( This section need not be completed if the permit is for one TOTAL Y cl N I] Y [:] N
hundred dollars(S 100)or Ins.)
U O I certify that in the Performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any peri n in any manner sn as to
U U become subject to the Workers'Compensation Laws of Califomia.
n Date Applicant ALTER OR ADD TO MECH. 500 BUILDING
j- w NOTICE TO APPLICANT: IL alter making this Certificate of His.un
r ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you must forthwith comply with y
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10P00C.F.M.) 4,00 FEE L3 /oZ p
CONSTRUCTION LENDING AGENCY AIR HANDLING UNrr(OVER 10)000C.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 permlt is issued fSec. MICROFILM
3197,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender',Name ecurit' I?acifi G/
Lender's Address F Crsco A HEATING UNIT(OVER 100,000 B.T.U.)8.50 ELECTRIC 44 (G
• I o rtily that I have read Ihia application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING -'dd
ordinances and state laws mlaling to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 .�
acovey authorize roperty tonins of on city m enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. �J
boveaneutlo authorize
property for inspection o this
purposes. MECHANICAL J
0"1 agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, crisis and expenses which CONST.TAX G
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 0
granting of i MECH.CONT. LIC.NO. TOTALOJ r
Siglal pliant/Conimctor / Date TOTAL
OFFICE COPY