13819 POST THIS CARD NEAR FRONT OF BUILDING
rf RMIi NUMBER
CITY - OF CUPERTINO
INSPECTION DIVISION 13819
JOB INSPECTION RECORD
��^ 5.� 1 , PERMIT EXPIRATION
JOB ADDRESS /J ) �� ' UNIT# LOT# \ I"
// �p�, � PERMIT EXPIRES IF WORK
OWNER yle� �' cn(tu h-1c ` CONTRACTOR IS NOT STARTEb WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION - - LASTCALLED INSPECTION.
UFER
PR EGUNITE PERMIT VALIDATION,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING 1. Q� -�p1
ELECTRICAL' '�- - u cE DATE
MECHANICA ELECT. MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED INFOLNG PERMIT
DIRMATION
WOOD FLOOR- - VALUATION s/FT.
PLUMBING
w
MECHANICAL '
ELECTRICAL - PERMIT To
FRAMING
sroRlEs TYPE corvsTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
' SO.FT FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM BUILDING USE
—2h IGX—
HIS IND CON PB 00-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑ ❑ ❑. ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING of t� '
GAS TEST -"-- 'TRACT NOj PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING .'Z,4^ SAN #! Q -
INSULATION PLUMBING 1 1 ZONING ENG.SITE NO.
GAS 6- L� 1
FIRE SPRINK ENERGY T-24MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING zz_-Z4 N r OO NE Y El N0
LATH-INTERIOR - ELECTRICAL FLOOD zorvE aL.0 U.C.
LATH-EXTERIOR FIRE DEPT. i Y❑ N Y ] N❑
SHEETROCK GRADE i - FEE SUMMARY
SHEAR INTERIOR .-a, BUILDING -/ ^v
SHEAR EXTERIOR _a _ _ TEMPORARY APPROVALS BUILDING ,.
FIREWALLS ELECTRIC PLAN CHECK
GAS
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN.PHONING.
Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX F
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
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
CrUILDING APPLICATION & PERMIT
ADDRESS 11683 Seven .Springs COUrt BUILDING - ELECTRICAL-PLUMBING-MECHANICAL13819
OWNER'9 - PLAN CHECK VALIDATION
� "AME DTV. ELECTRIC PERMIT FEE
fire or Grou In PHON
CONTRACTORS
NAME IfUTLETS-SWITCHES-RECEP 10.0011.00
regory Group, Inc. LIG."G 430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 z;L.
ADDRESS 220 CCTwin Dolphin Dr.
Redwood. Cit A PHONE595-210 I PANELS 10,00 D DATE OF APPLICATION
ARCHITECT Aram Bassenian, A. I .A. & PANELS (OVER 200 AMP) 20,00 PLAN CHECK
OR FEE .C.NO.
ENGINEER
Associates uc.No. SIGNS TRANS. 3.00
ARCH,OR ENG. 7 0 W terly Place, #17 SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ewport Beac9h,
ZIPEMP. METER OR POLE INS. 20.00
APPLICSA46r
APPLIC220 G Win Dolphin Dr. MOTORS SEE FEE SCH. `7 �
IF
Redwood City, CA 94065 SERVICE CHANGE 20.00
o O o LICENSED CONTRACTORS DECLARATION e�
a v I hereby affirm that I sots'chard.under provisions of Chapter 9 r"r ISSUANCE DATE
m Q w (commencing with Seel ion 70000 of UNision 3.f the Business enJw BLDG. PLG. MECH.
H D z Professions Cods,andlicense u in full furca�.gIJ,{(1p{'1�
Z o`2' - License Class �-Lie.Number-n
2 z Date Contractor
a r s BUILDING PERMIT
Q c w a OWNER-BUILDER DECLARATION INFORMATION
" MISC.- REFER TO ORD
R
3 d N I hereby affirm that I am exempt from the Contractor's License
uoa Law for the fovowing reason.(Sec.7031.5,Busimssand Professions PERMFT ISSUANCE 10.00 VALUATION 5/FT.
Code:Any city or county which requiresz permit to construct,alter. /a[� -0
2 ¢ Q 0 improve,demolish,or repair any structure,poor to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / Iry
-0, requires the applicant for such pert..t to File a signed statement that TOTAL PERMIT TO
w8 u- he is licensed pursuant to the provisions of the Contractor's License p `
F z
in
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
a Business and Professions Code)or mut he is exempt IhcreRum and QTY, PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n by anyace fare pune ..subjects the applicant toe civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not momenthan Five hundred doll. (5500)J
❑ 1,as owner of the property,or my employees with wagnas BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will du the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00 �_3
Code:The Contrxtor's License Law does not apply to an owner of
property who builds or improve,thereon,and who does such work I F IXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTALACREAGE
himself or through his own employees.provided that such improve- GAS SYSTEM-1 INCA OUTLETS 6.00
I
ems are not intended or offered for sale.If,however,the building
m
or improveinent 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 im-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. - 30.00 Rs IND CON PB Omer
❑ I,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 docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3 4 6-F- 33)-j 2_3
Contracts for such projects with a conlractorts)licensed pursuant to
the Contractor's License Law. I SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W/V ENT 6.00 7 f
reason
Owner Dale I WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK r;RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE No.
a certificate of Workers'Compns
eation Insurance,or a certified
copy thereof(Sec 3800,Lab.0 I
Policy No. cnmpanyUn.i-ted-P-ac-if-i.c-/ReT
O D Cenificd copyi. ere` fumished FIRE SPRINK ENERGY T 24
Z
❑ Certified c 1 the city inspection division. MISC.- REFER TO ORD.
ZO Applicant/- - Y ❑ N❑ Y ❑ N❑
CC res CERTIFICtrEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTIT LIC.NO. PLG.CL 1 / YE] No Y ❑ N❑
Z (This section need nal be comple¢d if the Permit u for one TOTAL
hundred doll...IS 100)or less.)
U O I certify that in the performance of the work fir which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workeri Compensalion Laws of California.
UJ Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F 2 emption,you should become subject to the Workcm'Compensation APPLIANCE 5.00 PLAN CHECK �77
U to
suchlprovisions or this permsions of the Labor it shall be deeou smed revoked t forthwith comply with AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE '3"l
IF 4
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency far EXHAUST HOOD(WITH DUCT) 5.00
the pert'ormance of the work for which this permit u issued(Sec. MICROFILM
3097,CIv.C.). Security Pacific HEATING UNIT 170100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT 100,000 B.T.U.)9.50 /
Lender's Address 5 run r�i_ _O_GA ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING -
oWinancn and state laws relating to building construction, and BOILER-ODMP(3H.P.or 100,0008.T.U) 6.00 (]
hereby authorize representatives of this city to enter upon the BOILER-COMP(Ova,1DD.000 BTU)SEE FEE SCH. MECHANICAL
above-mcmioned properly for inspection purposes.
(we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. o `
Cupertino against liabilities,judgments, costs and expenses which rPERMIT ISSUANCE 10.00 CONST.TAX 0 �O
may in any way accrue againat said City in consequence of the
granti 1 - MECH.CONT. LIC.NO. MECW Cal
TOTAL
/164041 7 '- TOTAL a'74�/
Signatoplicant/Contoactor DAC
OFFICE COPY