13760 (2) POST T'HIS'CARD,NEAR FRONT OF BUILDING
PFRhnT NUMBER
CITY OF CUPERTINO 13760
• INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 1C� l J ��I� �D�� 1-S IT# LOT'Et I 1` 1
/` 4 -� PERMIT EXPIRES IF WORK
OWNER G-IIz�' � CONTRACTOR IS NOT STARTED WITHIN
INSPECTION k,'DA, ,E,,, lNSPECTOR INSPECTION.RECORD 01P�:vl 180 DAYS OF PERMIT ISSU-
FOUNDATION '- _ - ANCE OR 180 DAYS FROM
UFER _ _ � _
LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTILABOVE--.HAS BEEN SIGNED, _
UNDERGROUND-/SLAB
PLUMBING _ j7
ELECTRICAL _ ISSUANCE DATE
MECHANICAL - BLDG. ELECT, PLG. VECb.
u —__ a/ ��.� ❑ ❑ ❑ LE
DO NOT POUR FLOOR UNTIU•ABOVE HAS BEEN SIGNED' ("BUILDING PERMIT o, s
WOOD FLOOR. -..'ALUA FORMATION-,"}5-�°-y
VALUATION S/FT.
PLUMBING _
MECHANICAL
ELECTRICAL PERMIT To
FRAMING
INSU ATION - - STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIVABOVE'.HAS'BEEN.SIGNED'
ROOF SO FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM _ '
9uILDING USE
RES IND CON PB Oran
tAPPLY NO ROOFING UNTIL`ABOVE'AAS:BEEN SIGNED-1 ❑ ❑ ❑ ❑ ❑
ROUGH .
ASSESSORS PARCEL NO.
_
PLUMBING Oct _ e3FOU.A , Q _
GAS TEST
TRACT NO. PARCEL NO.
=y-
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL ... iF,INA'L'SV_Sft DATE i?;INSP.
FRAMING O-zj- SAN * l2[�-TZ g
INSULATION �O' tj_W PLUMBING ZONING ENG.SITE No.
GAS
MECHANICAL FIRE SPRINR ENERGY T-74
COVER N0IWORK;UNTIL*ABOVE;HAS;BEEN.'SIGNEDM HEATING. Y ❑ IN ` ❑ N
.
LATH-INTERIOR `�- FLOOD ZONE A.LU.C.
ELECTRICAL
- -
LATH-EXTERIOR '_12_g'g FIRE DEPT. Y ❑ N❑ Y ❑ N❑
SHEETROCK ,Ip-�Z— Qj - ; GRADE..._ - �xFEE SUMMAMt�W v�
. .. .: _...,.w"10
SHEAR INTERIOR - - BUILDING
SHEAR EXTERIOR 7-a,i-. =TEMPORARY APPROVALS;: BUDDING „
FIREWALLS .. ELECTRIC'._ - - .: PLAN CHECK
GAS FEE
.. `: ..
NO';TAPE OR PLASTER UNTIL',ABOVEHAS BEEN,SIGNEO 0cCUPANCY . SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR tI NSP ECTI OWBY' 252-4505,
ELECTRIC
0� ONE=WIDRKING;DAY�B.EFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE (,dYE;JO&,ADDRESS,WHENjP.HONING.
IMECHANICAL
E_PERMIT FOR EXPIRATION':DATE — —
I _ .
CONST.TAX
IMPORTANT!
PFI ASE READ REVERSE SIDE BEFORE TOTAL
n C AILING FOR FINAL INSPECTION.
IIr NJ T TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Pe a ...ING PROJECT I DENTI FICATION I PEHMI1 NUMBER
11703 Seven Springs Court APPLICATION & PERMIT 13760
Lot 119 - P1 BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
rNER'a
'NAME r '�1 f4 lT I {}, PLAN CHECK VALIDATION
H OTY. '�"1 NS ELECTRIC PERMIT,7`'Po C FEE{,
Gregory Group PHDNE 595-210
/ CONTRACTOR
NAMEOUTLETS SWITCHES-RECEP 10.00/1.00
/
Gregory Grose In&-NO 430097 � LIGHTING FIXTURES 10.00/1.00
COADDRESS
DRESCrons 220 C Twin Dolphin Dr. PPLIANCES-RESIDENTIAL 4.00
Redwood Cit CA PONE PANELS 10.00 DATEOF APPLICATION
ARCHITECT Aram Bassenian, A. I.A. & PANELS 200 AMP) 20,00
on PLAN cn1:cK FEE P.c.No.
ENGINEEfl
AssociatesLIC.NO. SIGNS TRANS. 3.00
AMC".OR EN°. 3990 Westerl Place RMIT VALIDATION
ADDREStr y , #1] SPECIAL CIRCUIT 5.00 0New ort Beach zl EMP.METER OR POLE INS. 20.00
�DOLICAT5 Is 220 C Twin Dolphin Dr. MOTORS SEE FEE SCH. IL
Redwood City, CA 94065 SERVICE CHANGE 20.00 o.
w¢ Z
Hoo LICENSIiD CONTRACTORS DECLARATION V"
i u v I hereby affirm that I am licensed under wnevisi2n,of Chapter 9
<i ISSUANCE DATE
(commrncing with See 70007 of Diviwdn'3 of h`c Business end SLOG ELECT. PLG. MEC".
o '^ Professions Code and m Ikenle is in full force l
a• o}'{ License Class_g._Y LIc.Number_�jb 7
o mw Date Contractor
t
art w OWNER-BUILDER DECLARATION
BUILDING PERMIT '
MISC.- REFER TO ORD INFORMATION
w ' H I hereby affirm thus I am exempt from the Conlracl or's License vA LUNFON SIFT.
w o Law for the following reason.(Sec.703 T.1,Businm and Pm(euions 10.00
PERMIT ISSUANCE
fw� 3 Code:Any oily or county which requlrtsvpermit wconstrucl,alter, / )
a < O Improve,demolish,or repair any structure,pdnr to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. ->
wM u ,Byre:,.the applicant for such permit to file a signed statement that TOTAL 'b PERMIT i0
w he h licensed punuant 10 the provisions.(Ilia Contractor's License T�
F z < Law(Chapter 9(tommencin{wlth Section 7000).(Division 3 ofthe s�� icy
4 Business and Profaubns Code)or that he is e,empl therefrom and DTV..y. PLUMBING PERMIT't FEE•"
z � � the basis for the alleged exempllon.Any vlolallon of Section 7071.5 '.)x„ 4-'• y '"° ,'M-AYR . aT'L' -- ' � STORIES TYPE CONSTR.
c ; - by any applicant for a permit subjecla the applicant too civil penally
of not more than five hundred dotlara(SS00).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 r � S�
❑ 1.a u owner at the property,or my employes with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP S.UNITS
their sole compensation,will do the work,and the structure h no( /
Mended or offered for Role(Sec. 7044, Business and Professions I DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -3
Code:The Contractors License Law does not apply to an owner of
propeRy who builds or Improves thereon,and who does such work I FIXTURES-PER TRAP 5.00 ea ET,Loon AREA TOTAL ACREAGE
Imsel(or lhwu{h his own employees,provided that inch Improve-
ments are not intended or offered for sale.If.however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
Z`. 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 Role.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Conn
❑ I,a owner of the properly,am exclusively contracting with
licensed c.ntraclon to construct the project(Sec. 7D4q Businrn LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
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 4 �p- -3/ 3, 33
contracts for such projects with a conlractons)licensed punuant 1. /
the Contractor.License Law. SEWER-SAN I TAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iamexempt under Sec. ,B.&P.C.for thisI WATERHEATER'W/VENT 6.00 � �'9 (
,town
Owner Date WATER SYSTEM 5.00
,5 ACC.DATE - ACC.FILE NO.
WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cerlifMate of consent to rel&Insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,l b.C)
Policy No. Company3nited-Pac.i-f is/.Re
0 ❑ Certified copy h by f nlsh
Z Z ❑ Certifkd cop m Illy Inspatinn division. FIRE SPRINK ENERGY T�]a
F, O Applicant _ MISC.- REFER TO ORD. Y❑ N❑ Y ❑ NE]
N CERTIPICA 'F.XF.MPTION:'ROM WORK CRS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.0.C.
W CO PENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG. _
(1 O (This section deed not be completed I( the permit Is for orle TOTAL Y❑ No Y ❑ N�
= hundred dollars($100)or leo.)
U O 1 certify(hat in the performance of the work for which this r- FEE SUMMARY
FF mit is Issued.I shall not employ an ruin in an manner.w.1110 �TM' MECHANICAL,PERMI7 b. {
0 Ed become subject to the Worken'Compenwtion Laws of California. "r nrO �'-P'i" }FEE''y
Ed Date Applicant ALTER OR ADD TO MECH. R` 5,00 BUILDING (}q
} 2 NOTICE TO APPLICANT: IL after making thisCerlificale of Ex-
F' emption,you should become subject to the Workers'Compensntrm APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you moist forthwith comply with
Rosch p `3�o
U rovilmas.1 Ihh permit shall he deemrd revoked. AIR HANDLING UNIT(TO 10,OODC.F.K) 4.00 FEE
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GF.M.) 6.00 SEISMIC FEE ��
I hereby afOnn that there is a coastruitlnn lending agency for EXHAUST HOOD(WITH DUCT) 5.00 !l
the performance .f the work for which his permit is hulyd IS,,. MICROFILM
3097,CIv.C,I. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Namc Securitv�-c-ifi-c
Lender's Address 9f1-F1"BfIC'1'SHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC p
SCO-CTA-
I Certify that I have read this appllntinn and role;-
the.hove VENTILATION FAN ISINGLE) 4,00 PO
•
In
Is correct. I aee to Comply with all city and county PLUMBING o .�
ordinances aco
nee
state laws relating to building construction, and BOILER-CONPI3 H.P.or 100,0008.7.11) 8.00 O a
hereby authmentioned
,.,,Iyrepresentatives of this city es enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL _
above-mentioned properly for purposes.chi purposes. (P
(We) agree to save, Indemnify and keep harmless the City of MISC.- REFER TO ORD. .
Cupertino against liabilities,judgments, costs and expenses whichCONST.TAX
may in any way cerue against told City In consequence of the PERMIT ISSUANCE 10.00
granting of granting of lhf MECII.CONT. LIC.NO. MECH.
Signature of cool/Conlraclo, U/�t ]�7 TOTAL TOTAL
OFFICE COPY