13790 r
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO
13790
_ INSPECTION DIVISION
JOB INSPECTION RECORD I •
r 192 PERMIT EXPIRATION
`'�•. JOB ADDRESS w2j 1 '� UNIT# _LOT# Q✓
/ ��44....��. • - - PERMIT EXPIRES IF WORK
OWNER L LV-15 ( %2`C 6§eml -4or_ CONTRACTOR ISNOT STARTED WITHIN
INSPECTION CIATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION — ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
0
".IT VALIDATION
PREGUNITE 1p .14
POUR NO CONCRETEOUND UNTIL ABOVE
A
E S HAS BEEN SIGNED
UNDERG
PLUMBING
ELECTRICAL _ W�7 ISSUANCE GATE
BLDG. ELECT. PLG. MECH.
MECHANICAL ,
❑ ❑ ❑ ❑' .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION„•
WOOD FLOOR VALUATION BIET.
PLUMBING
MECHANICAL
ELECTRICAL - - - PERMIT TO
FRAMING
STORIES TYPE CONSTR.
INSULATION
I ..
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF _ _ SO.PT.FLOOR ANE/a TOT/+L ACREAGE
DTAPFIRACIM BUILDING USE
RES IND CON PB Omer.
=APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 11 1:1 E
ASSESSORS PARCEL NO.
ROUG
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
ELECTRICAL - /L/ FINALS DATE INSP. ^cc.DATE Acc,FILE NO.
FRAMING -'Za•^ SAN u zZ(q
.ZONING ENG.SITE N0.
INSULATION - - � PLUMBING �
GAS
FIRE SPRINK ENERGY T 24
n MECHANICAL Y ❑ NEI Y ❑ N[D
!
COVERNO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
flIOR ELECTRICAL _ FLOOD zorvE aL.u.c.
7 ERIOR .a.( FIRE DEPT. Y[j N❑ Y ❑ N❑
K GRADE FEE SUMMARY
ERIOR BUILDING - _
SHEAR EXTERIOR �� - TEMPORARY APPROVALS BUILDING
FIREWALLS . ELECTRIC PLAN CHECK _
-G FEE
G j` (�]' -F GAS
NO'TAPE OR PLASTER UNTIL ABOVE HAS 8919 SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY.OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
e
LU ARRANGE FOR INSPECTION BY P=PHONING.
ELECTRIC !
~O� ONE WORKING DAY BEFORE REQPLUMBING %
Z PLEASE GIVE JOB ADDRESS WHE- SEE PERMIT FOR EXPIRAMECHANICAL
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL ^<.
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDIN;PROJECT I DENTI FICATION PERMIT NUMBER
APPLICATION & PERMIT
BUILDING
ADDRESS 11509 Rock Spring Court 13790
Lot 88 - Plan 4C
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME Gregory Group, InoOTY.11
ELECTRIC PERMIT FEE
yONE 595-2
NAME CONTRACTOR's UTLETS-SWITCHES-RECEP 10.00/1.00 It
� NAME
Gregory Group, InG.W No. 430097 LIGHTING FIXTURES 10.00/1.00
ADDRESS oFs 220 C Twin Dolphin Dr. 3 PPLIANCES-RESIDENTIAL 4.00
ADDRESS
Cit CA PHONE595-21.00 PANELS 10.00
DATE OF APPLICATION
ARRCHITECT Aram assenlan, . . PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER Assoc i ates.Ic.No, SIGNS TRANS. 3.00
ARCH.OR ENG, 3990 Westerly Place /l17 SPECIALCIRCUIT 5.00 IT VAI IDATION
ADDRESS
Newport Beach, CA IP92660 TEMP.METER OR POLE INS. 20.00 1
APPLICANT'$ f 1
ADDRESS 221 C Twln 101phin Dr. MOTORS SEE FEE SCH. EzW
Redwood Cit CA 94065 SERVICE CHANGE 20.00 G
o o LICENSED CONTRACTORS DECLARATION pt4sf GD
a u u I hereby affirm that I am licensed Under provisions of Chapter 9 W7 ISSUANCE DATE
w<N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r o z Professions Code,:y7J m license is in full faregg ggnsy
Z,Oz w License Cluss_D y LiC.Number Y.7.0
Dore Contractor
¢ x s .�, BUILDING PERMIT
e e, w ¢ OWNER-BUILDER DECLARATION INFORMATION
a: 0La MISC.- REFER TO ORD
w 3. LL N I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
Hu0J Law for the following reason.(Sec.7031.5.Business Professions PERMIT ISSUANCE 10.00
Code'.Any city or county which requires a permit to construct,alter,
Q 17)
¢¢ 0 improve,demolish,or repair any structure,prior 10 its issuance,also EIEC.CONTR. LIC.NO. ELEC.
ra u requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TO
w $ he is licensed pursuant to the provisions of the Contractor's License ��T
H z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe - b(jz
¢ Business and Professions Code)or that he isexempt therefrom and OTV. PLUMBING PERMIT FEE
Ic $ the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
u ; - by any applicant fore permit dollars the($500).):
toacivil penalty ALTER-DRAIN -WATER IEA.) 5.00 /'�/{,�L//r
of not more than five hundred dollars($500)J: �' �.V/V"v
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
their sole compensation,will Jo the work,and the structure is not
intended or offered for sole (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds ar improves thereon,and who docs such work I FIXTURES-PER TRAP S.00 SO.FT.FLOOP AREA TOTAL ACREAGE
himself or through his own employees,provided that such nimmve-
mentsarenotinrendedorofferedforsale.If,however,the budding GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- I GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he dud not build or far-
proveforpurposeofsale.). . - INDUSTRIAL WASTE INTER. 30.00 REB w0 CON PB Dinar
❑ 1,as owner of the properly,am exclusively contracting with 23-1 ❑ ❑ ❑ ❑
licensed contrechas to construct the project ISee. 7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 t1J 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 3 / [-9-,3� 1..�3
contacts such projects with a contracmr(s)licensed pursuant m SEWER-SANITARY-STORM EA200ft/1000V r
01e Contractor's . .
License law. TRACT NO. PARCEL NO.
❑ Iain exempt under Sec.-,IL&P.C.for this WATER HEATER WIVENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent 4m self-insure' ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab C.).United Pacific/R(
Policy No. Company
O Cl Certified copy is Pity furtiehed. FIRE EPRINK ENERGY T 24
❑ Certified f th the city inspection division. MISC.-, REFER TO ORD.
Z 0 Applicant _ Y ❑ N❑ Y ❑ N❑
Fy PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
Lu CERTI ATEOFEXEMPTION FROM WORKERS'
W � COMPENSATION INSURANCE PLG.CONTR. LIC.N0. PLG. ,
Z ('This Section need not be Completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
hundred dollars(S 100)or Ie..)
U O I certify that in the performance of the work for which this per- QTY, MECHANICAL PERMIT - FEE FEE SUMMARY
U_ F 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.
Ca Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICAN I': If,after making this Certificate of I:x
F ? emption,you should become subject to the Workers'Compensation gppLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE 3 +�
U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LEND INC AGENCY AIR HANDLING UNIT(OVER I0,000C.FM.) 6.00 SEISMIC FEE /Q 9^t.
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.Cie.C.). Security Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name /l•.�
Lender's Address -1_anCls CO.,_ HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC d
I terrify that I have read this application and stare that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, Slid BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL �b
above-mentioned property for inspection purposes.
(We) agree to save, indemnity and keep hernnless the City of MISC.- REFER TO ORD. /Jr
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX (O R
may in any way accrue against said City in Consequence of theJIT
granting of *FM ECH.CONT. LIC.NO. MECH.
TOTAL TOTAL Os
Signal o pliant/ ontractor Made- -
•OFFICE COPY
• JOB INSPECTION RECORD
I SpC! lK ' I`, � ( PERMIT EXPIRATION
JOB ADDRESS V UNIT# LOT# �-
C �EEULC C1�Cx1 , 3fJC. PERMIT EXPIRES IF WORK
owNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION D TE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - SVCE OR 180 DAYS FROM
UFER STCALLED INSPECTION.
PREGUNITE 31^�7 FAIT VALIDATION
DEQ `J'l
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1�
UNDERGROUND /SLAB (il� t 'NO
PLUMBING 3
ELECTRICAL
ISSUANCE DATE
MECHANICAL BLDG. ELECT,
PLG, I MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES,UNITS
P CE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SD FT,FLOOR AREA TOTAL ACREAGE
I
` BUILDING USE
RES IND CON PB DE,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El El ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING _
GAS TEST �� TRACT NO, PARCEL NO
MECHANICAL _
ELECTRICAL . Sf FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING Nc ,DI P .,'� .�` SAN # Z
INSULATION PLUMBING Zc"'"G ENG.SITE NO,
E As IGAS
MECHANICAL FIRE SPRINK ENERGY T)A
COVER NO WORK UNTIL ABO E HAS BEEN SIG EO HEATING Y ❑ N Y ❑ N❑
LATH-INTERIOR - ELECTRICAL FLOOD ZONE A.L.U.0
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK tea- E/ GRADE
-•, FEE SUMMARY '
SHEAR INTERIOR (p- - a BUILDING
SHEAR EXTERIOR ^�• - TEMPORARY APPROV BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE 0 PLASTER U TIL BO E HAS B GNEO IOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z v PLEASE GIVE JOB ADDRESS WHEN PHONING. rr PLUMBING
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
I
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL