15861 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO '9861
INSPECTION DIVISION
JOB INSPECTION RECORD
�,1��• PERMIT EXPIRATION
JOB ADDRESS �` UNIT# _LOT#
/� PERMIT EXPIRES IF WORK
OWNER 1G/ <31 CONTRACTOR � tIn+\ �""1 IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 1 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
Z• . NOTE: LASTCALLED INSPECTION.
UFER eZ -e.M ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF P,:IiMIT VALi DATION
CUPERTINO STANDARDS.
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB J
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL T„ - ELECT PEG: MECR
23
a a
DO NOT P UR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1\\BUILDING PERMIT
(UUU INFORMATION
WOOD FLOOR 1�V U,
PLUMBING VALUATION SIFT.
MECHANICAL ,0
ELECTRICAL - PERMIi TD
FRAMING �p
INSULATION STORIES TYPE CONSTR,
OCC GROUP R ITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED P-14 11
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT DOR ABEA TOTAL ACREAGE
DIAPHRAGM �J THE CONSTRUCTION TAX IS PAID }
y-{�" BUILDING USE
ROOF SHEATHING Res IND CON PB ml_"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Z ❑ ❑ ❑ ❑
nSSEBBORS PARCEL NO
ROUGH _AN.k (meq j// //
PLUMBING ..('Z `C.� ELECT-ENERGY 36 6— 3 /3� 33
TUBS 8 SHOWER PAN Cj--)Z PLUMBING ENERGY QTRACT NO Pn CEL NO
MECHANICAL G MECH.ENERGY 0 o
ELECTRICAL G BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING - —lw ..L, ELECT.FIN AL TEST
INSULATION PLUMBING _ OgO"ING ENG SITE NO.
GAS TEST GA
MECHANICAL iRESPRINK ENERGY T.EA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 0 ° ❑ "❑ ° ❑ N❑
EXTERIOR SHEAR �•Yy ELECTRICAL RELEASE FLOODZONE A.LUC
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y NO
SHEETROCK 37 lxs n LAOGRADE
FEE SUMMARY
EXTERIOR LATH BUILDING '
INTERIOR LATH 1Cj TEMPORARYAPP OVAL ` BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK t5��
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNE DBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU 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 TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NQ PROJECT IDENTIFICATION BUILDING
PERMIT NUMBER
APPLICATION & PERMIT
11791 Sierra Spring Court -
AIDES =
UI
Lot 315 3A BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S
NAME WegoryUrap, Inc.
ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
. Ahmanson Development PHONE 415/595-21 GTY.
NAM>ERACToas UTLETS-SWITCHES-RECEP 10.00/1.00
(7
Gregory 'oup, Inc. LIG.No. B-430097 LIGHTING FIXTURES 10.00/1.00
ADDES TOR'B win In PPLIANCES-RESIDENTIAL 4.00
RWC 94065 PHONE415/595-21 PANELS 10.00 DATE OF APPLICATION
AORRCHITEGT aft ssenian, PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER Associates uc'N C-8395
SIGNS TRANS. 3.00
ARCH,OR END
SPECIAL CIRCUIT S. 0, PERMIT VALIDATION
Santa Ana Fits. CA ZIP 92707 TEMP. METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH.
A oRs
Turin Dolphin Or. M94065 SERVICE CHANGE 20.00
Foo LICENSED CONTRACTORS DECLARATION
a U I hereby affum (hat I-am licensed under provisions of Chapter 9 ISSUANCE DATE
In
(commencing with Section 7000)of Division 3 of the Business and
BLDG. ELECT. PLG. MECH.
F y z Pro(cssiona Code,al my license"in full f RC43CWt.
z 0 w - Licsense I Lie.Numhe � Nr
F w UAte_i.4. - Contractor_t71/\/•y�/ _
M ac OWNER-BUILDER DECLARATION' O Y,' Q BUILDING PERMIT
I p INFORMATION
w ;a-y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
.. o a Law for the followin reason(Sec.7031.5,Businessand Professions VALUATION $/FT.
L - g PERMIT ISSUANCE 10.00 A��
Code:Any molishcoo nly pair any structure permit toto consuance,also
¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NQ ELEC. `` •�r[� 1
E m ¢ res aims the applicant for such permit to file a signed statement that TOTAL
6 W he is licensed pursuant to the provisions of the CUntractor s License PERMIT TO
H se A Law(Chapter 9(ecmmenciagwith Section 700()of Division3ufthe \�
s¢ 0 Business and Professon
is Codc)or that he isexemp Iherel'rom and CITY PLUMBING PERMIT EE JfIAAJ i
¢ m the basis for the alleged exemption.Any violation ul'Section 7031.5 STORIES TYPE CONSTR.
an 3 _ by any applicant for a permit subjects the applicant toa civil penally F
of not more than five hundred dollars 0500f) ALTER-DRAIN&VENT-WATER (EA.)es 5.002SNiR
❑ 1,as owner of the property,or my employees with wagas BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044. Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of R-3 1
. property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 S0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided than such improve-
inerts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.4OUTLETS 6.00 2 9
or improvement Is sold within one yenr of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with
licensed cn..Imeturs ul construct the project(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 A$SE$SOR$PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves Olereon
.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3� 6_o93 �dd p)
contracts for such projects with a contraclor(s)licensed pursuant to .)J
the Contractor's License Law. SEWER-SANITARY-STORM EA.20011/10.00 TRACT NO. PARCEL NO.
❑ 1 unl exempt under Sem B.&,P.C.for Ibis
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACG GATE ACC.FILE NO.
WORK F,RS'COMPIiNSnT10N UECLA RATION WATER TREATING EQUIP. 5.00
1 hereby affirm (hat I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thertnf(Stc.3800,Lab.C.). United Pacific '
Policy No. Company
0 Cl Certified copy'shereby furnished. FIRESPRINK ENERGYT-
Z 2 J1i[At Cerllfi Ir fit,y-�,�LLII he cilY inspection division. Z4
ATd LC,c e 'er✓�� MISC.- REFER TO ORD. Y[] N Y ❑ No
~ NO PERMIT ISSUANCE 10.00
Ir - CIiR'f1EICA'I'Ii FNSAEXEM111ON NSUROh1 WORKERS' FLOODZONE A.L.U.C.
W COMI'ENSAT'ION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL v N❑ Y E] N❑
Z hundmddollurs(5100)orle.ss.)
I is issued,
math the Ie employ
an of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
0 U mit is issuede 1 shall nal employ any person in any manner so us lO
0 to become subject to the Workers'Compensation Laws of California.
C. Date applicant ALTER OR ADD TO MECH. 5.00 BUILDING 05.�
} US NOTICE TO APPLICANT: It,after making this Cenawme of E.-
F Z emPumn,gnu should become subject to the Workers'Conlpensetiun APPLIANCE 5.00 PLAN CHECK 15.50
provisions of the labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10p00GF.M.) 4,00 FEE Ere 2.00
CONS3R UCTION I.1!NDINO AGENCY AIR HANDLING UNIT(OVER 1000C.F.M.) 6.00 SEISMIC FEE 10.71
1 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.). Mo
NG UNIT(TO 100,000 B.T.U.) 8.00
ndtr,Na,»e_�Secu�r_i_tY Pacific
Lender's nddressLCO�Lt�CYQ�41_QY-- .9411G UN IT(OVER 100,000 B.T.0-)9.50 ELECTRIC s5
I certify(hat 1 have read this application and state(hat the aboutLATION FAN (SINGLE) 4.00information is correct. I agree to comply with all city and countyPLUMBINGordinances andstate laws relatig to building construction, and -COMP(3H.P.or 100,000B.T.U.) 6.00hereby authoredrepresentatives of this city to enter upon Iht -COMP (Over 100,000 BTU)SEE FEE SCH. 'MECHANICALabove-mentioned properlyforinspectionpurposes. LiCn.35
(We) agree tO save, indemnify and keep harmless the City of REFER TO ORD. GVWupertino ngninst liabili[is,judgments, costa and expanses whichCONST.TAX
may in any way accrue against said City in consequence of the ISSUANCE 10.00 X7.03
mpMRgylf lhisp mit. LIC.NO. MECH.\�/���I�� OTALTOTALSignature of Applicant ontractor dam29
$1391.
OFFICE COPY W LJ