13770 POST THIS CARD NEAR FRONT OF BUILDING
T7i
CITY OF CUPERTLNO INSPECTION DIVISION
JOB INSPECTION RECORD
l PERMIT EXPIRATION
p I
JOB ADDRESS �4f'�l.� ve./ sDK�w6'=1 UNIT# LOT# 70' oER•AlT EXPIRES IF WORK
OWNER /Q� J GR.OU /ti(c_ CONTRACTOR -
IS NOT STARTEV WITHIN
INSPECTION ATE 180 DAYSCIF Pg RMIT ISSU-
INSPECTOR INSPECTION RECORD _
FOUNDATION LAST 180 DAYS FROM
LASTCALALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .�
. UNDERGROUND /SLAB ,
PLUMBING QE It4 �t•"< /
ELECTRICAL nCE DATE
MECHAN
ALW
IC .i p JvL�c. MECR.
KR ii.-1 WL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED , j7; B`I LDINFORIATIONG ERMIT
WOOD FLOOR VALUATION SIFT.
PLUMBING - YrJ
MECHANICAL 147.01M
PERMIT TO
ELECTRICAL
FRAMING 1%ML
STORIES TYPE CONSTR.
INSULATION
'OCC.GO RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEDR-3 I
SO,IT.FLOOR AREA TOTALACREAGE
• ROOF
DIAPHRAGMFT�esl AcBUILDING USE
RES IND CON PB OR",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El El El ❑
ASSESSORSPARCEL NO.
ROUGH2-
PLUMBING -9 ,
•TRACT NO. PARCEL NO.
GAS TEST v -�
MECHANICAL6%Al Aif
ELECTRICAL FINALS MDATEINSP. A c. TE Acc.FILE NoFRAMING -Z SAN # .2ZONING ENG.SITE NO.
INSULATION' - PLUMBING5 169 40 GASFIRE SPOINK ENERGY T-Y<
MECHANICAL Y ❑ N❑ , Y ❑ N❑COVE NOWORK NTIL ABOVE HAS BEEN IGNED HEATING FLOOD 20NE A.L.U.C.
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR FIRE DEPT, v ❑ N❑ v ❑ NEI
SHEETROCK 53Wi3GRADE FEE SUMMARY
SHEAR INTERIOR _'51(11A jVC BUILDIN
SHEAR EXTERIOR Q TEMPORARY APPROVALS BUILDING `t�:/'Z� '
t FIREWALLS ELECTRIC FEEN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ISEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ELECTRIC
LU ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
! . 0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
I Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL /Y;3
CALLING FOR FINAL INSPECTION.
• OFFICE COPY -
9PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUIL Ess Ven rings Lane APPLICATION & PERMIT
(Lot 70 - Plan 4AR BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 13770
OWNER'S PLAN CHECK VALIDATION
® NAME QTY. ELECTRIC PERMIT FEE
auryDams Inc- PHONE 595-21
'
NAMECONTRACTORS19 UTLETS-SWITCHES-RECEP 10.00/1.00 119
NAME
Gregory Groups
Inc, sec.No. 43OQ97 29 LIGHTING FIXTURES. 10.00/1.00 29
CONTRACTORS ,Twin Dolphin Drive, Ste. C 12
AOOREss APPLIANCES 4.00
Redsood City, CA 94065 PHONE 595-2100 1 PANELS 10.00 10 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE PT.NO.
oR Aram Bassenian, A.I.A. & Assoc. PANELS (OVER 200 AMP) 20.00
ENGINEER
' sec,NO SIGNS TRANS. 3.00
AARCH.OR
DDRESS ENG 39% Westerly Place, #170 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Beach CA zIP92660 EMP.METER OR POLE INS. 20.00
�...Eesb rs 220 Twin Dolphin Drive, Ste. C 6 - MOTORS SEE FEE SCH.
RedAlood city, CA 94065 SERVICE CHANGE 20.00 -/�cp\ C
woo LICENSED CONTRACT ORS DECLARATION \7 3/p J
a o b 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
z w (commencing with Section 7000)of Division 3 of the Business and
< a BL PLG. - MECH.
r m i Professions Coup,and my license is in full to feet. El
Z i w o License Class Lin.Number_
Dale Contractor
BUILDING PERMIT
u OWNER-BUILDER DECLARATION INFORMATION
wH 1 hereby affirm that 1 can exempt from the Contractor's License MISC.- REFER TO ORD 50 ''
F LL o a Law for the fo8owing muson.(Sec.7031.5,BHSm.end Professions PERMIT ISSUANCE 10.00 10 �'(ilp-p-v S/FT.
Code:Any city or county which requires a permit to construct,alter. 147,M
)
2 rt s- 2 improve,demolish,or repair any sLCIUM,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. ,L (y�
D ac requires the applicant for such permit to file a signed statement that TOTAL 1B6 W PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
HiQ Law(Chapter 9(Commencing with Section 7000)of Division 3 ofthu SF-
4 4 Business and Professn u ioCode)or that he exempt therefrom and QY.TPLUMBING PERMIT FEE
R.,- the bans for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONS-ER.
v ; by any applicant for a Permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 S/v
of not more than five hundred dollars($500).): 2
❑ I,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
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 5 R-3 1
Code:The Contractor's 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 SEE FT,FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 " 6
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 2 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omar
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ T,as owner of the property,am exclusively contracting with
licensed contractors to constncl the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law don not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5IEA.) 1.00 3� ?3_j
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.ZOOft/10.00
the Contractors License Law. 10 TRACT NO. PARCEL NO.
❑ lam exempt under Seo. ,B.&P.C.for this WATER HEATER W/VENT 6.00CJ
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACG FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workeri Compensation Insurance,or a certified ZONING ENG.SITE NO.
ropy thereof(Sec.3800,Lab CAt/w,7 DwuRx
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
❑ Certified co ' B with the city inspection division.
7 MISC.- REFER TO ORD.Z Q APPBcant v[] Nv [:] NQ
CC CERTI' L XEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
LLI > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG, o-( Y E] N V NC]
Z (This section deed not be completed if the permit is for one TOTAL
hundred dollars(S 100)or Ina.)
U O 1 certify that in the performance of the work for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued, 1 shall not employ any Person in any manner so m to
become subject to the Workeri Compensation Laws of California..
O w BUILDING Bd
0. Date Applicant ALTER OR ADD TO MECH. 5.00 3
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 20 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE _37,2
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,OOC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,OOC.F.M.) 6.00 SEISMIC FEE /Q Y
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 t
the performance of the work for which this Permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
10 1 certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 Pit
mfmconion is Correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOIL6i-COMPIll H.P.Or 100,0008.T.U.1 6.00
hereby authorize representatives ofthis city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL sJ 0'0
above m'H000ed property for inspection parpoees.
lime e to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. __ r
Cupertino against liabilities,judgments, costs end expense which ,REMIT ISSUANCE 10.00 CONST.TAX l 6a
may in any way accrue against said City in consequence of the R
granliog of this , ./ MECH.CONT. LIG NO. MECH.
///'/8 _ TOTAL53.00 TOTAL P73 °
Signature of 1 'on[ractnr Dale
OFFICE COPY