13785 POST THIS CARD NEAR FRONT OF BUILDING F `
• rFaMtr NUMBER
CITY OF CUPERTINO 13785
INSPECTION DIVISION
JOB INSPECTION RECORD -
'1� r '• Q PERMIT EXPIRATION
` JOB ADDRESSU-
/� , �—y�UNIT# LOT# PERMIT EXPIRES IF WORK
e lAI
OWNER II.1%(.� -;I�l! �/�}C. CONTRACTOR IS NOT STARTED WITHIN
INSPECTION IbATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUANCE DATE
M CHAN ICAL BLDG. E 'fLc. MECH.
LSH LJ • ❑\
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION ff/FT.
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING ,�. '5
INSULATION STORIES TYPE CONSTR.
-miitf 1
OCC.GROUP RES.UNITS
s . , PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
r� .
ROOF SO,FT,FLOOD AREA TOTAL ACREAGE
} •4 DIAPRF17iGM - _
BUILDING USE
RESIND CON PB Otnr•
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑' ❑' ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING -Y'7-,Pf - "
GAS TEST _ TRACT NO. PARCEL NO
MECHANICAL _ 457
4 w
ELECTRICAL - — FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN #
INSULATION PLUMBING -_Z� ZONING ENG,SITE NO.
d GAS
MECHANICAL _ FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
LATH-INTERIOR ELECTRICAL ,Z, FL000 ZONE A.L.uc.
LATH-EXTERIOR _�_8 FIRE DEPT. Y❑ N❑ Y ❑ IN
SHEE ROCK GRADE
SHEAR INTERIOR FEE SUMMARY
BUILDING --Z
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC 7 PLAN CHECK
-aa GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuagNCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
W ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC :
Y. l ~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
/ Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
7- — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. Z.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
OU No 11537 Silver Spring Court APPLICATION & PERMIT
`^ - ADDREss Lot 83 - Plan 4B) BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13785
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
Gregory Group, Inc,.: PHDNE595-2100
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Gruop, Inc. LIC.NO. 430097 LIGHTING FIXTURES 10.00/1.00 cZ
CONTRACTDRs win 0 p in r. 3 PPLIANCES-RESIDENTIAL 4.00 a
AD 220
Redwood City, CA PHONE 595-2100 PANELS 10.00 DATE OF APPLICATION
ORRCHITELT ram assenlan, . . PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER Associates
LIC.No. SIGNS TRANS. 3.00
ARDR.DR ENG. 3990 Westerly PI , /170 SPECIALCIRCUIT 5.00 1111 PERMIT VALIDATION
ADDRESS
Newport Beach, CA ,,92660 TEMP.METER OR POLE INS. 20.00 �q -owl APPLILANT's 220 C TWin Dol phln Dr. MOTORS SEE FEE SCH. a
Redwood City, CA 94065 SERVICE CHANGE 20.00
,00 LICENSED CONTRACTORS DECLARATION
F i U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business amt
<N BLDG. ELECT. PLG. MECH.
o Professions Codyyxand m license is in full force�,4�,f
Er o N Date Class�y y Lin.Number 4.SS1. _�
QN�� Date-Contractora Le
¢ a,w a OWNER-BUILDER DECLARATION y U BUILDING PERMIT
X ;LL y I hereby affirm that I am exempt Iron the Contractor's License MISC.- REFER TO ORD �SIOINFORMATION
¢E, Law forthe following reason. 7031.5,Business and Professions VALUATION $/FT.
- PERMIT ISSUANCE 10.00 _
Code:Any city orcounty which requires a permit to construct,alter, / ,�y_0
¢Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. lf� ` I' r'
o¢ requires the applicant for such permit to file a signed statement that TOTAL
u w m u he is licensed pursuant to the provisions of the Contractors License ' PERMIT TO
Hzi
BusLaw(Chapter9(commencing with Section 7000)ofDivision 3 ofthe
4 c iness and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE / U
¢H$ the basis for the alleged exemption.Any violation of Section 703 L5 STORIES TYPE,CO/N/S�TR.
by any applicant for apermit subjectsthe$500).licam toacivil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 S/V!P'L�
of not mom than five hundred dollars(my em):
❑ L us owner at tireon,property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00
ILIA-
their sole compensation,will do the work,and the structure is not OCC GROUP RES.UNITS
intended or offered I'or sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of _
err' property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 M.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
�! mentsamnot intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,tire owner- GAS-EA.SYSTEM-OVER 4 IEA.1 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 RES IND CON Pa Omer
❑ 1,as owner of the property,am exclusively contracting witll lel f.�f. f'�
licensed contractors to construct the project(Sec. 7044,Business - 1:3ASISLE?SSOflS PARCEL N0.
and Professions Code:The Contractor's License Law does not apply LAWN SPRINKLER$-1 INC 5 t/.B. 6.00 6§
to an owner of property who builds or improves thereom and who LAWN SPRINKLERS-OVER 5(EA.)r 1.003 / 6�1,����d
contracts for such projects with a contractor(s)licensed pursuant to !'
43
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00
uwCTRACT NO. PARCEL NO.
reason
❑ lamuxcmpterSeo. ,B.&P. for this WATER HEATERW/VENT 6.00 /
Owner 75C�'.f
Date I WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
WORKIi RS'COMPISNSA7lON DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent W self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
Copy formal(Sec.3800,Lab.C.I
Policy No. Company-Ilnited PacificRe
❑ Certified copy is herub furmshc FIRE SPRINK EENEGUY TZ 2 ❑ Certified c It city inspection division. 24O Applicant- - w i MISC.. REFER TO ORD, v❑ N❑ ❑ N❑CfiRTIFIC'A OF'E%EMPTION PROM WORKERS' PERMIT ISSUANCE 1000 / FLOOD ZONE .L. C.
Lu > COMPENSATION INSURANCE . .d O PLG / ❑ ❑ ❑ N❑Z1'fhis section need mol bo completed if the permit is for one TOTAL V N
hundred dollars(5100)err less.)
U 0 1 certify that in the performance of the work for which this per- QTY FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to MECHANICAL PERMIT FEE
U 0 becume subject to the Workers'Compensation Laws of California.
D-
Date-Applicant ALTER OR ADD TO MECH. 5,00 BUILDING
f Bx" 7
} 0 NOTICE TO APPLICANT: If,after making this Certificate olJ
F. ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 a PLAN CHECK
provisions of the Labor Code, you must forthwith comply with ��
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10ACC.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIRHANDLINGUNIT(OVER10=C.F.M.) 6.00 SEISMIC FEE 0
1 hereby affirm that Oren is a construction lending agency for I EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which Otis permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name-SeCUrit Paeiff* ���
Lenders Address-S�b CA HEATING UNIT(OVER 100,0000.T.U.)9.50 ELECTRIC &I
% I certify that I have read 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 0
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 k5 -�
�., V-� hereby authorise representatives of this city to enter upon the BOI LER-COMP(Over 100.000 BTU)SEE FEE SCH. •/��
above-mentioned prepesentat representatives
this
purposes. MECHANICAL V
(We) agree to save, indemnify and keep It less the City of MISC.- REFER TO ORD. /
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX �J� (J
may in any way cc against said City in consequence of the PERMIT ISSUANCE 10.00
granting i I MECH.CONT. LIC.NO. MECH.
Signal c Applicant/Contractor lwTOTAL TOTAL 3
� 1'�
OFFICE COPY .J
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTORS NOTICE
CITY OF CUPERTINO
To
r You ore hereby authorized to Connect electrical service for ,
r � � t
'OTenanto ner or Tena4
At / 'fr Z 7 r P rY� Sri IF
(
No,of Wires Size of Wires Size of Switch
Motor Land Voltage Phase
Heating Load K.W, Voltage
No.of Meters i ( L'qh' I l0__New Service Reconnect
Heat 120Three Wire More Service
No.of Add, Meters power
{\\\ � � /1� three Phase Move Meter
Q� ELECTRICAL INSPECTOR SAY 1/1 n -A i
CITY OF CUPERTINO OFFICE
COPY
GAS SERVICE NOTICE19
To
You are hereby authorized to Connect the GAS service for
Owner or Tenant r�— �r—n C/
At —7Sr PY rl fn �1
I
New Service t" �
No. of Meters Reconnect
No. of Add. Meters _Move Service
•��-'—�� me Meter
.. PLUMBING INSPECTOR
OM I
I i
BUILDING INSPECTOR'S OFFICE
I CITY OF CUPERTINO Bldg.Dept.
Office Copy
I )
f
,Q.
Backlow Device Sanitary Permit No.
12 2,«
❑ Sewer Connection Plumbing Permit No. -/ 5��r
'R1 Plumbind Final Lot No.
3
Owner or Tenant r0 f
At Z7 (nI P\F- I-IiAnz) CT
I Tract_ 79
Date Connected 19 X Dote Final � F' "- 2— 1 q�
/1 PLUMBING INSPECTOR
CERTIFICATE OF COMPLETION
j BUILDING INSPECTOR'S OFFICE UT�3
E
CITY OF CUPERTINO
DAT19 / BLDG. PERMIT NO. T
THE BLDG. LOCATED AT f S3� S/ �lle�-S/b j-j Uri C�1
OWNED BY-
HAS
Y
HAS BEEN I OMPLE FOR USE AS : I7h UVL
2
ALTERED)
O•
BUILDING INSPECTOR