13811 (2) I
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION
13811
11 JOB IINIT
SSPPECTION RECORD
JOB ADDRESS 1� 7 �r'F•� � UNIT# LOT# 1� PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
OWNER «IC�+��Y 6120CA CONTRACTOR IS NOT STARTED WITHIN
INSPECTION ATE 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 PAW - ✓
UNDERGROUND /SLAB DE^ p I Wolf
PLUMBING _ N N
ELECTRICAL Is
MECHANICAL eLoc mEnnCH.
077 ❑' u\
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION s/FT.
MECHANICAL ,
PERMIT TO
ELECTRICAL
FRAMING
STORIES -TYPECONSTH.
INSULATION
v
OCG GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
-I OD ILOING USE
C , HES IND CON PB Om,,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL 7-7-88
'
ELECTRICAL FINALS DATE INSP. ACC.DATEACC.FILE NO.
FRAMING _RR SAN 01-7--ZSZ RF
ZONING ENG.SITE NO.
INSULATION ,g'_ PLUMBING -3- g �
-r u 'aw n GAS
MECHANICAL FIRESPRIrvK ENERGY T.
v [-] N❑ Y ❑ NC]
❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
PLooO ZONE A.L.0 c
LATH-INTERIOR ELECTRICAL .
LATH-EXTERIOR \ FIRE DEPT. / r❑ N❑ y N❑
SHEETROCK _ GRADE FEESUMMARY
SHEAR INTERIOR AcBUILDING
SHEAR EXTERIOR - -gj TEMPORARY APPROVALS o BUILDING
FIREWALLS ELECTRIC "' PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILOINGFINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC r
OONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING _
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
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
• BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLIK.ATION & PERMIT 13811
ADDRESS 11603 Forest Sprin COUrt BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
Lot 109 - P1 nJB�
OWNERS PLAN CHECK VALIDATION
"AME CITY, ELECTRIC PERMIT FEE
Gregor Grou , Inc.P"ONE 595-2100
cro"s
NAME 101 UTLETS-SWITCHES-RECEP 10.00/1.00 InI
NAME
Gregory Group, Inc. LIC.NO. 430097 LIGHTING FIXTURES 10.00/1.00 -
11TRACTORs 2?O C Twin Dolphin Dr. APPLIANCES 4.00
Redwood City, CA PRONE
595-2100 PANELS 10.00 DATE OF APPLICATION
ARCHITECT Aram Bassenian, A. I .A. & PANELS IOVER 200 AMP) 20.00 PLAN CHECK FEE .C.NO.
OR
ENGINEER
Associates uc no SIGNS TRANS. 3.00
SoC«E�ENG. 3990 Westerly Place, //17 SPECIAL CIRCUIT 5.00 PEFnjLr�pATION
New ort Beach CA ZIP EMP.METER OR POLE INS. 20.00 ley
ADDRESS rs 220 C Twin Dolphin Dr. Moroas SEE FEE SCH. J
"Redwood City, CA 94065 SERVICE CHANGE 20.00 �` S�
0 0 o LICENSED CONTRACTORS DECLARATION �yy �'COW
< o U I hereby affirm that I em licensed under provisions of Chapter 9 ISSUANCE DATE
w< w (commencing with Section 7000)Of DIVL,IOn 3 Of the tlusipnS and BLD ELECT. PLG. MECH.
r m Z Professions Code,W my license is in full force pqQ f •- t
License Class_D Lic.Number y.,}�1J�.7
F - o Date Contractor F
x BUILDING PERMIT
aOWNER-BUILDER DECLARATION INFORMATION
so 0
E:
3 y 1 hereby affimt that I am exempt fru. the Contractor's License MISC.- REFER TO ORD
VALUATION S/FT.
H u_0 < Law for thefouowing reason,(Sec.7031.5,Businessand Profusions PERMFT ISSUANCE 10.00
,A � Code:Anycity orcounty which regldresapermil mconstrucl,alter, / y ,IL,.{{}�
a¢ > 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / I �e++'CC P e 0
wD , requires the applicant for such permit to file a signed statement that TOTAL b PERMIT TO
m he is licensed pursuant to the provisions of the Contractor's License ��
FiQ Law.(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe rS a//-
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
r the basis for the alleged exemption.Any violation of5ectiou 7031.5 STORIES TYPE CONSTR.
A , by any applicant for a permit subjects the applicant to a civil penalty 00) 5
ALTER-DRAIN IEA. .
of not moa than five hundred dollars($500).): PL SV
❑ I,as owner of the property,or my employees with wages as BACK F LOW 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 I DRAINS-FLOOR,ROOF,AREA,COND. 5.00 /�- 3
Code:The Contractor's License law don not apply to an were of
property who builds or improves thereon,and who docs such work1121 FIXTURES-PER TRAP 5.00 52 FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that wch improve-
mentsarenmimcndedorofferedforsele.ll:however,the buildinK I GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RS IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with ❑ 0 0
licensed contractors to comtruct 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 23
ill
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 6_�J`-3� sad-
contracts for such projects with a contulaor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00TRACT NO. PARCEL NO.
❑ laDc.anis m exempt under Sec.-,tl.&BC.for this WATER HEATER W/VENT 6.00 � � / �
Owner Dale WATER SYSTEM 5.00 ACC.DATF ACC.FILE NO,
WORK P.RS'COMPBNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a ccrtificute Of imosenf to sel Ginsure,
or a certificate of Workers'C.»Ilensalion Insurance,or a certified ZONING ENG SITE NO.
copyNo.( se e.3goo,Lab., bnLted-ted -f_iCtRe
Policy eo Company_
O ❑ Certified copy is hereby furnished. FIRESPRINK ENERGY T-74
Z_ 2 ❑ Certif d copy - c city inspection division. MISC.- REFER TO ORD.
U Applicant _ Y❑ N[] Y ❑ No
~ rn PERMIT ISSUANCE 10.00
Cr
- .CERTII' 'F;%Bh1YfION FROM WORKERS' FLOOD ZONE A.L.u.C.
LU ( . PENSATION INSURANCIi PLG.CONTR. LIC.NO. PLG. �
CL 0 (This section need not be Completed if the permit is for one TOTAL Y N Y N
hu ad red dollars(S 100)or IessJ
U O 1 certify that in the performance of the work for which this per- CITV MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit u issued,I shall not employ any person in any manner so as to
U become subject m the Workers'Compensation Paws of Culifomiu.
U n Date-Applicant BUILDING
>- W NOTICE TO APPLICANT': If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00
�.. ? emption,you should become subject to the Workcm'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE Q
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.K) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.K) 6.00 SEISMIC FEE 1�
I hereby aflims 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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name e0 It QaC] 1
Lender's Addis 7- -,kA-- HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC �
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 Z
information u correct. 1 agree to comply with all city and county PLUMBING A
ordinances and slate laws relating to building construction, and BOILER-COtvP(3 H.P.Or 100,000 B.T.U.) 6.00 (/ ,,EL��,
hereby authorize representatives of on city es enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL L'V
above-mentioned property forinsp of this
purposes to
(We) as. to sive, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, cost end expenses which CONST.TAX O
may in any way cede galnst said Gly in consequence of the PERMIT ISSUANCE 10.00
Resoling of this MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of want/Contractor Dat ¢-aL 61
OFFICE COPY