13784 (2) POST THIS CARD NEAR FRONT OF BUILDING
- CITY OF CUPERTINO PERMIT NUMBER
137ER
INSPECTION DIVISION
84
JOB INSPECTION RECORD
-(� PERMIT EXPIRATION
JOB ADDRESS d 7 v�LVE'�S�,Q i^/C— G7_UNIT## LOT#
nn I - PERMIT EXPIRES IF WORK
OWNER ETjQ� �Q,C V C CONTRACTOR IS NOT STARTED WITHIN
INSPECTION ATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
8. LASTCALLED INSPECTION.
LIFER
PREGUNITE
PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED avI
UNDERGROUND /SLAB
PLUMBING _ _ O, IDE 2 g X987
ELECTRICAL
UANCE DATE
ME HANICAL ^`�yy vLG. MECR.
Ny Q'. f-1
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT '--h
WOOD FLOOR INFORMATION
PLUMBING VALUATION $/FT.
MECHANICAL
ELECTRICAL PERMIT To
FRAMING -- i✓ L
INSULATION STORIES TYPE CONSTR.
OCC.GHOUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT FLOOR AREA TOTAL ACREAFE
MARWRAGM
BUILDING USE
RES No CON Pg Otl,e,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
SE
ASS SOBS PARCEL NO.
ROUGH _ ,
PLUMBING _ 7- - -
GAS TEST ovov 760
TRACT NO. PARCEL N0.
MECHANICAL IL3,d7 ,
ELECTRICAL -a - FINALSDATE INSP. ACC.OATE ACC FILE NO.
FRAMING 2 -o SAN s-
INSULATION -3 PLUMBING d797ZONING ENI.SITE NO.
�7 GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
LATH-INTERIOR ELECTRICAL _ FLOOD ZONE A.LLLC.
LATH-EXTERIOR -II-' 5.C° FIRE DEPT. _ Y❑ N❑ rl] N❑
SHEETROCK ��a- GRADE
SHEAR INTERIOR FEE SUMMARY
BUILDING -�
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JUCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC f f
Oo� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANTI 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
I BU I LDING PROJECT IDENTIFICATION
PERMIT NUMBER
aUIL-no' 11527 Si Iver Spring Court APPLICATION & PERMIT
ADOREaa (Lot 82 - Plan 1A 13784
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
Gregory Group, Inc. ,„UNE595-2100
CONTRACTORS
NAME /0I UTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group, Inc. LIC.No 430097 LIGHTING FIXTURES 10.00/1.00 a
CONTRACTORS Dr. n 1 APPLIANCES-RESIDENTIAL 4.00
Redwood CitDolphin y, CA HONE595- 100 PANELS 10.00 a DATE OF APPLICATION
ARCHITECTon PLAN Bassenian, A.I .A. & PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
Associates LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. 990 We erly P1 , $170 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
tgewport each, l H 9266( EMP. METER OR POLE INS. 20.00 �O
AGPLIORcSS TB 220 C Twin DO1 hin Dr. MOTORS SEE FEE SCH.
AooREssD
Redwood City, CA 940 5 SERVICE CHANGE 20.00
w
02 LICENSED CONTRACTORS DECLARATION
a U u 1 hereby affirm that 1 am licensed under provisions of Chapter 9 •HPCE DATE
z w (commencing with Section 7000)of Division 3 of the Business and
t.¢'� ELECT. PLG. MECH,
Professions Code,sand m license is in full fare pp aa{p�qq (icy
Z 0 v-,o License Class_D y Lic.Number 4.J.0 .`1!
Date Contractor
Q y j
¢ S,w a OWNER-BUILDER DECLARATION BUILDING PERMIT
w 3 y I hereby u(finn that I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
ac Law for the following.....(Sec.7031.5,Business and Professions pERMIT ISSUANCE VALUATION SIFT.
mj Code:Any city or county which requires a permit to construct,alter,
10.00
¢ ¢0 improve,demolish,or repair any structure,prior ro its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O LL requires the applicant for such permit to file a signed statement that TOTAL /
w $ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
i
Law(Chapter 9(commencingwith Section 7000)o(Division 3 ofthe
Business and Professions Code)or that he is exempt therefrom and WQTY. PLUMBING PERMIT FEE v
$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
UI 3 - by any applicant for a permit subjects the applicant tox civil penalty
of not more than five hundred dollars(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as 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 Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 k- 3 /
Code:The Contractor's License Law does not apply to an owner of
® property who builds or improves Ihereoo,and who does such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 I NC.4 OUTLETS 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 an- BUILDING USE
prove 1,as ownerose
of theJ. INDUSTRIAL WASTE INTER. 30.00 RES IO CON 0 Other
❑ Las owner of the property,am exclusively contracting with
licensed contractors to construct (lie project(Sec.7044,Business 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 3 6-C�3� /
contracts for such projects with a conjurations)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this W
reason ATER HEATERW/VENT 6.00 7 f-
OwnerDme WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO,
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy mereof(Sec.3800,Lab.C.)United Pacific/Re
Policy No.-Company
-
0 ❑ Certified Copy is hereby f vnished.
Z Z ❑ Certified c _ 1 Eh' h the oily inspection division. FIRE SPRINK ENERGY T 24
FO Applicant MISC.- REFERTOORD. Y0 N� Y � NEI
CCy CF-RTIFI F;OIr EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O.
W d PLG.CO
J COMPENSATION INSURANCE NTR. LIC.NO. PLG.
O (This section need not be completed if the permit is for one TOTAL Y N� Y N�
2 hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
0
become subject to the Workers'Compensation Laws of California. q�
D. Datc Applicant BUILDING N �4
} NOIlt
'ICI! TO APPLICANT: If,aer making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
W / N
2 cmption,you should became subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
It
visions of the Labor Code, you must forthwith comply with
U sucoh provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE O
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE �=
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the workfor which
this permit is issued(Sec. MICROFILM
3097.Civ.C.). Se Pacific ) HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name -aI rt-a HEATING UNIT 100,0008 T.U.)9.50 /6'10
Lenderi Address C.LSCQ�-C}� ELECTRIC
® I certify that 1 have read this application and state that the above 3 VENTILATION FAN (SINGLE) 4,00
information is correct. I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 (�
hereby authorize representatives of this city to enter upon the 801 LER-COMP IOver 100,000 BTU)SEE FEE SCH.
above-mentioned property fativsp of this
purposes. MECHANICAL fP
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. /
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX t(
may in any way accrue against said City in consequence of the 10.00
grantin 's miL MECH.CONT. LIG NO. MECH.
TOTAL TOTAL
Signal a Applicant/Contractor Ydtif
OFFICE COPY L�