13783 POST THIS CARD NEAR FRONT OF BUILDING
/. PERMIT NUMBER
CITY OF CUPERTINO 137$3
INSPECTION DIVISION
JOB INSPECTION RECORD
n PERMIT EXPIRATION
JOB ADDR ESS l/Sv7 J/�y�X" '��' GT UNIT# LOT#
c+ " PERMIT EXPIRES IF WORK
OWNER .E c pKa v L CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION _ z4oJ ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
LIFER
PREGUNITE PERMIT VALIDAYION
n
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB "
PLUMBING API-ff vIw ,
ELECTRICALAW
/� ISSUANCE DATE
ME HANICAL BLDG. ELECT, PLG. I MEC R.
E Ej�
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Sul D NG PERMIT
WOOD FLOOR MATION
VALUATION $/FT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING -
INSULATION STORIES TYPE CONSTR.
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO FT,FLOOR AREA TOTAL ACREAGE
' DIAPHRAGM - -
BUILDING USE
RES IND CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 11 El E3
ROUGH ASSESSORS PARCEL NO.
PLUMBING .-
GAS TEST v TRACT NO. PARCEL NO.
MECHANICAL -
ELECTRICAL 41fe FINALS ADC.DATE ACC.FILE NO,
FRAMING a SANft/�S-
DATE INSP.
INSULATION [p.-rjd!- I PLUMBING ZONING ENG.SITE NO.
�- o-r- GAS
MECHANICAL EIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y❑ N❑ Y ❑ N❑
LATH-INTERIOR - - �� ELECTRICAL FLOOD ZONE A.L.U.C.
LATH-EXTERIOR ,I I _ FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK , '.yd GRADE
FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK 2 yf
-! S GAS FEE ,l
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCvI ISEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN.PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL /
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TQ41LL-IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• PERMIT NUMBER
BUILDING PROJECT SprENTI ing
CouIONrt
APPLICATION & PERMIT
ADDDIN` 11507 Silver Spring Court 13783
ADDRESS
Lot 80 - Plan26
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
fire or Group, Inc. PHnNE595-2100
CONTRACTORS
NAME UTLETS-SWITCHES-RECEP 10.00/1.007)
Gregory Group, Inc. LIG.NO. 430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'22Twin Dolphin, Ste. C PPLIANCES-RESIDENTIAL 4.00 a
ADDRESS
Redwood City PHONE 595-2100 PANELS 10.06 DATE OF APPLICATION
OR
ARCHITECT PLAN Bassenian, A.I .A. , PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
& Associates LIC.No. SIGNS TRANS. 100
ADDRESS ENG. 3990 Westerly Pl . , #170 SPECIAL CIRCUIT 5.00 PERMITVALIpATION
ARCH.On
Newport Beach CA zip 9266C TEMP.METER OR POLE INS. 20.00 q .AQ1
APPLICANT'S 220 Twin Dol phi n Dr. , Ste. C MOTORS SEE FEE SC H. J`T+
ADDRESS
Redwood City, CA 94065 SERVICE CHANGE 20.00
w0 2 �k /
¢ D O LICENSED CON'T'RACTORS DECLARATION otY3 /�7
a i w 1 hereby affirm that 1 am licensed under provisions o'Chapter 9 `7 1 pANCE((DATE
,HA a e- (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F D z Professions Code,and my license is in full force and effect 1
o0m o Licemse CESS_B Lie.Numbc,A 3DD0-7 II-AW
w H Datc Contractor
ce Q y J
a-w < OWNER-BUILDER DECLARATION BUILDING PERMIT
w ;e.v I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
ca u.o iA Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
wCode:Any city or county which requiresa permit tuconstrua,alter,
Q Q Q 2 Improve,demolish,Or repair any structure,prior to Its issuance,also ELEG CONTE. LIC.NO. ELEC.
D , requires the applicant for such permit to file a signed statement that
X m TOTAL l `nP��
d he is licensed pursuant to the provisions of the Contractor's License V/ TLv`-
Fzi
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe V/
F x 4 Business and Professions Code)or that he is exempt therefrom and
H$ the basis for the alleged exemption.Any violation of Section 7031.5 ETV. PLUMBING PERMIT FEE
STORIES TYPE CONSTR.
by any applicant fora permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER IEA.) 5.00
myem
of not more than five hundred dollars($500h.):
❑ 1,as owner the properly,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,
ion,will du the work,and the structure is not
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
properly who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.66 50.FT.FLOOR AREA TOTAL ACREAGE
himself his own employees,provided that such inhprove-
monisare are not
otroteintendedoroffered for sale.IL however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or inh- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Other
❑ I,as owner of the property,am exclusively contracting withEl El El El 0
licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 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 q(,, / -?,1/ 332 j'
contracts for such projects with a contmcums)licensed pursuant to 3` r / 1�
the Contractor's License Law, SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Imn exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSA'rION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affrm that I have a certificate of consent toself-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy(hereof(Sec.3800,Lab.C.)4Jnited Pac/Relian
Policy No. Company
❑ Certified co hrreb a rushed.
z Z Certified f iu the city inspection division.
FIRESPRINK ENERGY T.24
O Applicant MISC.- REFER TO ORD, Y❑ N Y 0 IN
IL T CERTII TE 017 EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 /O
FLOOD ZONE A.LLLC.
W > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
1 0 fTlhis Section need not be completed if the permit is for one TOTAL / /3 Y❑ N Y C] N
� Z hundred dollars IS 100)or less.)
U O I certify that in the performance ol'the work for which this per. CITY MECHANICAL PERMIT FEE FEE SUMMARY
IL U mit is issued,I shall not employ any perwn in any manner so as to
becoom subject to the Workers'Compensation Laws of California. `
l) i Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING s2/LQ�I
} N NOTICE '1'O APPLICANT: If,after making this Certificate of Ex-
F. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith conhply with -133
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10DWIC.F.M.) 4.00 FEE 3S
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10060 GEM.) 6.00 SEISMIC FEE /L) O�
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,Civ.C.). Security P HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name. Y dC1f1C
Lender's Address_&a.R__F_rd'nC-7SEO;CA HEATING ON IT(OVER 100,000 B.T.U.19.50 ELECTRIC 0`
o'O
s , I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
t information is correct. 1 agree to comply with all city and county - PLUMBING �O
I\701 ordinances and state laws relating to building construction, and v BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 1- i
hereby authorize representatives of this city to enter upon the BOILER-COMP (Dyer 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL Gl'EJj
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgmeins, costs mW expenses which CONST.TAX '1 6
may in any •ly a nre,against said City in consequence of the PERMIT ISSUANCE 10.00 oC
granting If I MECH.CONT. LIC.NO. MECH.
_ TOTAL ..� TOTAL
Signa Applicant/Contractor Da •s T�
OFFICE COPY
X
IN E
)ISODAYS F-P,-E
NorO
ITI
�'� NM
ISO DAYS FR
POUR NOLEDI
6UNCRETE UNTIL ABOVE ECTI
I, PER VAL.1
L UND HAS BEEN SIGNED
PLUMBINGERGROUND /SLAB
ELECTRICAL I
MECHANICAL
.Do goT Po"I'DR FLOOR UNTH ABOVE HAS B J SLIAN11 I
WECT E
11 "l-C.
PLUMBING —lu FLOOR
MECHANICAL V ING-PEA
Mif
ELECTRICAL INFORMATiON
FRAMING vniunPiiiry see-i-,
INSU
LgTION
PLACE NOSUBFLOOR UNTIL ABOVE
ROOF HAS BEEN SIGNED --l-EcL 11165E ONSIF1
DIAPHRAGM Res N,I S
APPLY NO ROOFING
c
ABOVE HAS BEEN SIGNED
PLUMBING ROUGH RE, F)IJILIIINI(ISE
LO
GAS TEST 0 ❑ D
0N
MECHANICAL ✓ As ORSPAQCELNO
❑
ELECTRICAL
FRAMINGei ACT No IJ
IN
PACILNo
Ul ATJON FINALS
SAN DA TE 'AIC
INSP. ACC T
PLUMBING 0
COVER No WORK UNTIL ABO UAS ENG.S,,,mo
MECHANICAL LATH-INT- R SIGNED HLATH- EATING
EXTERI
SHEETROCK OR 4/Z ELECTRICAL NE] ❑0
SHEAR ,,tHJOR C FIRE DEPT. L
GRADV C.
SHEAR EXTERIOR E y
RIOR No
FIREWALLS 0 BUILD - 0 No
FEE SUMMARY
TEmPORARY
NO ELECTR APPROVALS ,/ BUILDING
OCC T PE Oil PUSTERUN '7— �j - LOING
UPANCY OF BUILDING TQ ABOVE HAS BEEN' '- GAS PLAN CHECK
ISN rPERMiTTE SIGNED OCCUPANCY FEE
'N T'L BUILDING FINAL
ARRANGE F SEISMIC FEE
I FOR INSPECT 'SSIGNED BY BUILDING INSPECTOR.
:D
ONE WO CNBHONINGMICROFILM
YB F REREOUIRE61NSPECT16N ELECTRIC
PLEASE \1 (' 252-4505
S I VE JOB D ESS WHEN PHONING.EE PER IT FOR E PIRATION DA PLUMBING
TE
PLEASE RE IMPORTANT! MECHANICAL
CALLING AD REVERSE SIDE 13EFOIJE CONST TAX
OR FINAL "YSPECTION.
TOTAL