13786 POST THIS CARD NEAR FRONT OF BUILDING
. - PERMIT NUMBER
- CITY OF CUPERTINO 1786
INSPECTION DIVISION
k' •. JOB INSPECTION RECORD
G n , 'c 'PERMIT EXPIRATION
.AbFiA� JOB ADDRESS, t �S-5 p � -T�-�1�UNIT# LOT# �� • PERMIT EXPIRES IF WORK
OWNER Ci� E,.c7�.'C � -L �C. CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR.180 DAYS FROM
FOUNDATION - LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �p
UNDERGROUND /SLAB
PLUMBING _,93. a'd
ELECTRICAL I at Cam"CE DATE
ME ANCAL DG. ELECT. PLG. MECH,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
IN
WOOD FLOOR VALUATION $IFT. -
MECHANICAL'
PERMIT TO
ELECTRICAL
FRAMING -
GTOMES TYPE CONSTR.
INSULATION
1 �4
OCG GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT,FLOOR AREA TOTAL ACREAGE
• ROOF
DIAPHRAGM - BUILDING USE
RES IND CON PB O,hLf
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ 0
ROUGH ASSESSOi RS PARCEL NO
PLUMBING
GAS TESTTRACT NO. ,PARCEL NO. -
' ' � � ,
- MECHANICAL t OF '
ACG DATE ACC.FILE NO,
ELECTRICAL FINALS. DATE IN P.
FRAMING r.0 luSAN # ZONING ENG.SITE NO.
'INSULATION (p PLUMBING
GAS
FIRE SPRINK ENERGY T-24
MECHANICAL
COVER NO WORK UNTIL ABO E HAS BEEN SIGNED# 1 HEATING Y'� NE] ° E] N[-]
LX!TH-INTERIOR �p. ELECTRICAL PLooD zorvE aL.u.c.
LATH-EXTERIOR FIRE DEPT. Y❑ No Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING „
SHEAR EXTERIORTEMPORARY APPROVALS BUILDING I : -•
FIREWALLS - ELECTRIC - PLAN CHECK Y
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC r
F_ ONE WORKING DAY BEFORE REQUIRED INSPECTION• PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING. .. F
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
coNsr.rnx
IMPORTANT! ; , \
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
i
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
•
BUILPERMITNUMBERDING PROJECT IDENTIFICATION APPLICATION & PERMIT
BUILDING
ADDREBB (Lot 84 c Plan i3AR)our13786
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
N'VEQTY. ELECTRIC PERMIT FEE
Grere gory Group, Inc. °„DHE 595-2100
CONTRACTOR'SUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Gregory Group, Inc. LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S 220 C Twin Dolphin Dr. 3 PPLIANCES-RESIDENTIAL 4.00
ADDRESS
Redwood cit CA HONE 595-210 PANELS 10.00 / DATE OF APPLICATION
ARCHITECT Aram Bassenian, A.I .A. & PANELS (OVER 200 AMP) 20.00 PLA"`HEOK FEE v.c."°.
OR
ENGINEER
Associates uc No. SIGNS TRANS. 3.00
A"O`ORESS ENG3990 Westerly Place, 1170 SPECIALCIRCUIT 5,00 PERMIT VALIDATION
Newport Beach, CA �,P 92660 EMP.METER OR POLE INS. 20.00 �O
APPLICANT S220 C Twin Dolphin Dr. MOTORS SEE FEE SCH.
ADDRESSDDRESS
Redwood City, CA 94065 SERVICE CHANGE 20.00 p
woo LICENSED CONTRACTORS DECLARATION 4 'n0
1 hereby affirm that I am licensed under provisions of Chapter 9 Ut DATE
N < N (comnencing with Section 7000)of Division 3 of the Business and L ELECT. PLG. MECH.
H N z Professions Code,13d my license is in full force Self effect
Z o w- License Chases-D Lic.Number_4300W L=1�
Q m H w Dalc Contractor
m ¢ ¢ OWNER-BUILDF-R DECLARATION BUILDING PERMIT
e w u REFER TO ORD INFORMATION
w ;LL n 1 hereby affirm that I am exempt from the Contractor's License MISC.-
HwOJ Law for the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 10.00 / O VALUATION $/FT.
w Code:Any city orcounty which requires a permit to copstruct,alter, /0-¢.d
R u,Q 2 improve,demolish,or repair any strue ure,prior to its issuance,also ELEC.CONTR. LIG NO.
ELEC. +
iL O u requires the applicant for such permit to file a signed statement that TOTAL / PERMIT TO
e w m y he is licensed pursuant to the provisions of tile Contractor's License
Hir Law(Chapter 9(Commencing with Section 7000)of Division 3 ofthe
< Business and Professions Code)or that he is exempt Therefrom andOTV. PLUMBING PERMIT FEE
s-o the basis for the alleged exemption.Any violation of Section 703 L$ STORIES TYPE CONSTR.
i ;mby any applicant for a permit subjects the applicant ma civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500)):
❑ 1,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 n
intended or offered for sale(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 or improves thereon,and who does such well FIXTURES-PER TRAP 5.00 so.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
. meets a it not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
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 that he did not build or owner-
RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with to ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 Lj ASSESSORS PARCEL NO.
r 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 36 6--/�+
-3 11 3133
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. I TRACT NO. PARCEL NO.
❑ f am exempt under Sac.-,BAP.C.for this WATER HEATER W/VENT 6.00 '7 C/Glr
reason
Owner Dale WATER SYSTEM 5.00
ACC.OATS ACG FILE NO.
WORKS RS'COMPENSAT ION D17CLARATION 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 o certified
copy thereof(See.3800,Lab.C.A nited Pacific/Re
Policy No. Company UU -
O ❑ Certificd cop hereby coshed. FIRE SPRINK ENERGY T-24
Z Z ❑ Certificd fl h 11, city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Q Applicant L� Y N V N
� T CERTIF ATEOIr EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZDNE A,L.U.C.
COMPENSATION INSURANCE • PLG,CONTR. LIC.NO. PLG.
d 0 . (This section need not be Completed if the permit is for one TOTAL /3 Y❑ N❑ Y ❑ N❑
Z hundred dollms($100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I shall not employ any person in any manner so as to
U I become sub ect to the Workers'Comp enation Laws of California.
0 n Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex- r
� ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.002C) PLAN CHECK d3
provisions of the Labor Code, you must forthwith comply with FEE �S
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 e1
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER iQOWGEM.) 6.00 SEISMIC FEE /Q wt./
1 herebyaffirm that there is a construction lending agency I'or I EXHAUST HOOD(WITH DUCT) 5.00
the performance of To work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ' QCUC iIt Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC rj -/
Lender's Address anUFr 1'C 1 kL, %iA / (p
I wrtily that I have mud this application and state that the above VENTILATION FAN (SINGLE) 4,00
information is correct. I agree to comply with all city and county PLUMBING „-_i
ordinances and state laws relating to building construction, and
BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 3
hereby authorize representatives of this city to enter upon the BOILER-COMP (Own 100,000 BTU)SEE FEE SCH. MECHANICAL 6s
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 against said City in�Zcoqlo;;rc of the PERMIT ISSUANCE 10.00granting er � MECH.CONT. LIC.NO. MECH.TOTAL bS TOTAL S33'3
Signa f App(cant/Crnllractor Date '
OFFICE COPY
�. n-11
/
ti
OT
•p
' .. • L
2
2= �
n p / ;INSPECTION'RECORD [ �ii
pa n
n �� ✓
HAS BEEN SIGNED
SLAB
C17 TC
rj
''DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
�W*^ PLUMBING
i' MECHANICAL
ELECTRICAL
FRAMING
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
DIAPHRAGM G
i
a i
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING
GAS TEST
MECHANICAL .l"0 '30 -(P
ELECTRICAL i /f)aCh 1 FINALS DATE INSP
FRAMING cll - rreO-1 •-�,Gj iii•+ c_ SAN n -7 {�(-
INSULATION IPLUMBING -
QK GAS
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR - - ELECTRICAL
LATH-EXTERIOR FIRE DEPT.
SHEETROCK GRADE
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC
- � GAS
NO TAPE ORP ASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECT(
w ARRANGE FOR INSPECTION BY PHONING 252.4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
I z� PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!
ATE -
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
L CALLING FOR FINAL INSPECTION.
APPLICANTS POSTING COPY II
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION 13786
JOB INSPECTION RECORD
JOB ADDRESS ,, PERMIT EXPIRATION
I IS-3g """^� ""'I L". I
UNIT# _LOT#'
C� X.I �,, PERMIT EXPIRES IF WORK
OWNER ` CONTRACTOR IS NOT STARTED WITHIN
'�, _,' INSPECTION``. '' DATE '- INSPECTOR •'+'•'' INSPECTION.RECORDAI'?I . f°'.1 ; 188 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
LIFER LASTCALLED INSPECTION.
PREGUNITE PERMFTVALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDA0
UNDERGROUND /SLAB A � �87
PLUMBING D nIS
ELECTRICAL Ac untE
ME ANICAL DG. ELECT. PLO. w"'s � ❑ ❑ ❑i .. ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR _ ';INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL
ELECTRICAL
PERMIT To
FRAMING
INSULATION qFLOOIIAREA
PE CONSTR,
ES.UNITS
• 'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF ALACREAGE
-_ DIAPHRAGM _ -
BUILDING USE
RES IND CON PB Gln',
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDi ❑ ❑ ❑ ❑ ❑
ROUGH n55ESSORS PARCEL NO.
PLUMBING
' GAS TEST /, TRACT NO. PARCEL N0.
MECHANICAL
ELECTRICAL r finj iFINA LS«°'•6,'s." DA Elk", 70N P.
ACC DATE ncc,FlLe Nn.
FRAMING 9- SAN #
INSULATION (D PLUMBING ZONING
ENG.SITE NO.
3. GAS
MECHANICAL --TIRE SPRINK ENE "Y
COVER NO WORK UNTIL.ABO E HAS BEEN SIGNED a HEATING Y ElN❑ Y ❑ N❑
LATH—INTERIOR FLOOD IGNE A.L.u.c.
ID' ELECTRICAL
LATH—EXTERIOR _ _ FIRE DEPT. Y❑ N❑ Y❑ N❑
SHEETROCK •$ GRADE '"
°i -•�� ? FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
A 7-az- GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED: OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED By BUILDING INSPECTOR.
I MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.