13816 (2) POST THIS CARD NEAR FRONT OF BUILDING
MIT NDb,REH
CITY OF CUPERTINO
INSPECTION DIVISION �i 1361 6
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS `" „ ` "E"" ` `.UNIT# LOT# , 1�
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 15AYS OF PERMIT ISSU-
FOUNDATION
ANCE OR 180 DAYS FROM
UFER law
LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED too
UNDERGROUND /SLAB q
PLUMBING
ELECTRICAL O M Issu DATE
MECHANICAL PLG. mECH,
�- ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION S/FT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL - - -
FRAMING
STORIES TYPE CONSTR.
INSULATION
/ OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "•
ROOF SO.FT.FTCOR AREA TOTAL ACREAGE
DIAPHRAGM Iewl.Dwc USE
_I RES IND CON PB ONm
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 E] ElASSESSORS PARCEL NO.
ROUGH �•
- �
PLUMBING -
GAS TEST
TRACT No. PARCELING
MECHANICAL
ELECTRICAL - �/ FINALS DATE INSP. ACC-DATE ACC.FILE NO.
FRAMING SAN #1-2Z43
ZONING ENc.SITE NO.
INSULATION PLUMBING
C GAS
MECHANICAL _ FIRE SPq INK ENERGY T]a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E3 N ❑ NF]
FLOOD ZONE A.L.uc.
LATH-INTERIOR _ ELECTRICAL _11 IL L t
LATH-EXTERIOR FIRE DEPT. Y E] No Yo N❑
SHEETROCK C1- - GRADE _ FEE SUMMARY
SHEAR INTERIOR BUILDING -1
SHEAR EXTERIOR - I - TEMPORARY APPROVALS 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 BUILDING FINAL ISSIGNED 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 y
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLNT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
3 816
/
nOILGI°REsNG 11653 Forest Spring Court APPLICATION UPERMIT -
A
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
- Fil anOWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
Gregory Group, InC.P„DNE 595-2100
`
CONTRACTOR J1 OUTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group, Inc. ue.No 430097 LIGHTING FIXTURES 10.00/1.00
CONTRNTRADRESCTOR's
AD220 C Twin Dolphin Dr. PPLIANCES-RESIDENTIAL 4.00
A
Redwood Cit CA ,PHONE 595=2100 PANELS 1D,D0 DATE OF APPLICATION \
ARRCHITECi ram assentors, . . ANELS IOV ER zoo AMP) 20.00 PLAN CHECK FEE P.C.NO, ,
ENGINEER Associates
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG. - 990 We erly Place, Q1 / - •�{ERMIT VALIDATION
AooREss JJ }1^, z6 SPECIAL CIRCUIT S�� /S-1'Y
New ort each f ZIP 9 6 EMP. METER OR POLE INS. 20.00 p
ADDRESS Ts 220 CiTwin Dolphin Dr. MOTORS SEE FEE SCH. "7
Redwood City, GA 94065 SERVICE CHANGE 20.00 fI r ve.ssrs�
0 0 o LICENSED CONTRACTORS DECLARATION ,w
wI hereby affirm that 1 am licensed under provisions of-Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH.
F y z Professions Cade, nd my license is in full force and effect. II''L�LL
Z: Om - License Class_ Lia Numher_�0097 1!J-
0
z -w Date Contmnor-
a Y BUILDING PERMIT
¢ ¢ n< OWNER-BUILDER DECLARATION INFORMATION
X
y I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
F .. LLoj Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
Code:Any city or county which requires a permit to construct.alter, 14.42
re W , < 0 improve,demolish,or repair any structure,prior to its¢nuance,also ELEC.CONTE, LIC.NO. ELEC.
O u requires the applicant for such permit to rile a signed statement that TOTAL 1 PERMIT TO
E
he is licensed pursuant to the provisions of the Contractor's License
Law(Chater9(commencin with Section 7000)of Division 3 of the
- a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ _ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n ; - by any applicant fora punnet dollars theaoplicatoacivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars the 7ln.1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole codpenvtion,will do the work,and the structure¢not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Profcsvoes DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
media ant,not intended orofferedfor sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.D0
or improvement 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-
'roveforpurposeofsileJ. INDUSTRIAL WASTE INTER. 30.00 EES IND Cory PB Omer
0 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 A ESSORB PARCEL NO.
and Professions Code:The Contractor's License law does not apply y r�
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 346
- 9's�i 3aj 13
theContractor's
o is for such projects with a contradnr(s)licensed pursuant m i SEWER-SANITARY-STORM EA.200ft/10.00 /
this Contractus s h License taw. TRACT N0. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this ( WATER HEATER W/VENT 6.00
mason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK ERS'COMPENSA'TION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a cefHGcate of consent to self-insure, ZONING
or a Certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.)
Policy No. company_United_Pacif Lc LRe
O ❑ Certified copy ish yyfu ear"'
FIRE SPRINK ENERGY T_Ya
Z 2 ❑ Ccr ificd copy U 1 Ifl city inspcdion Division.
p Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ No
CC T CERTIFICATE EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 C.
LU > COMPENSATION INSURANCE PLG.CONTR, ❑c.NO. PLG.
CL 0 ('Phis section need not be completed if the permit is for one TOTAL �/ Y CDN❑ Y [:] N❑
hundred dollars IS I DO)or less.)
U O 1 certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workeri Compensation taws of California.
Date-Applicant BUILDING
O_ ALTER OR ADD TO MECH. 5.00
} 0 NOTICE '1'0 APPLICANT: IL after making this Certificate of Ex-
�.. ? emption,you should become subject to the Workers'Compensation f4 APPLIANCE 5.00 PLAN CHECK �/ 33
prov ions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10A000.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 S
the performance of the work for which this permit is issued(Sec. MICROFILM
3097.Gv.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name ecu ityy� Paeifi(�`L.,a
Lender's Addreul! sYf3 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that l hevcrcad ml,application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county fMLE�CHAN
MNG V "
ordirunces and state laws relating to building construction, and BOILER-COMPI3 H.P.or lOD,000 B.T.U.1 6.00
hereby authorize mprenenmlives of this city to enter upon the BOILER-COMP (Over 100,0X0 BTU)SEE FEE SCH. ICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. / p
Cupertino against liabilities,judgments, costs and s,,n..which PERMIT ISSUANCE 10.00 CONST.
may in any way accrue against said City in consequence of the
poindrlg Of t'' MECH.CONT. LIG NO. MECH.
� roTAL bl TOTAL / a
Signature pplicant/Contractor Ua c
OFFICE COPY