13779 (2) POST THIS CARD NEAR FRONT.OF BUILDING
}. /�• '� ;,�. PERMIT NO ER
CITY OF' CUPERTINO
,INSPECTION'DIV,ISION 13779
JOB INSPECTION RECORD
�(� • $ -' .,, -. PERMIT EXPIRATION
JOB ADDRESS, KzcP.�RzNG- G7 UNIT# - LOT# PERMIT,EXPIRES IF WORK -
OWNER ts/cr p-r� �KOU ./q/C. CONTRACTOR - IS NOT STARTED WITHIN
INSPECTION bATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- '
FOUNDATION - ANC. OR 180 DAYS FROM "
LAST CALLED INSPECTION. '
UF,ER .
PREGUNITE - PERM IT VALIDAT10N -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - <
UNDERGROUND /SLAB ost) ' 2
,. PLUMBING °; 4
ELECTRICAL 411 W ISSUANCE DATE
M HANICA pLDG. ELaT. PLC, mECR'
co
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION -
WOOD FLOOR VALUATION $/F T.
,PLUMBING '
MECHANICAL. '
ELECTRICAL 4' PERMIT TO
FRAMING,
STORIES ' TYPE CONSTR„
• 'INSULATION
y
OCC GROUP - RES.UNITS
PLACE NO SUBFLOOR-UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT,FLOOR AREA ,TOTAL ACREAGE
BUILDING USE
RES' INDD CON PB Otne,
APPLV,NO ROOFING UNTIL ABOVE-HAS BEEN SIGNED '❑ ❑ El . ❑
ASSESSORS-PARCEL NO.
-
ROUGH. -/7'--
,. PLUMBING
GAS TEST ) - Alor #6
TRACT NO, PARCEL NO.
' ' � -
MECHANICALJJA
7 T ys'
ACC.DATE ACG FILE NO,
ELECTRICAL - FINALS DATE INSP.- '
FRAMING SAN * zoNuaG ENG.SITE No.
INSULATION'- PLUMBING
GAS S- .. '
MECHANICAL �/• FIRE SPANN ENERGY T24.
IN Y
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING„
F LOOD ZONE - A.L.U.C.
LATH-INTERIOR _ ELECTRICAL '
' ERIOR - � ' v❑, ni❑ v❑, N❑LATH=EXTE .
SHEETROCK (1 'd c?_ 1� GRADE - FEE SUMMARY
SHEAR INTERIOR... BUILDING
SHEAR EX
TERIOR' - (,- 'j.- TEMPORARY APPROVALS - BUILDING A
.FIREWALLS ELECTRIC PLAN CHECK «•-
GAS -S-f .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED loccuPANCY . - . SEISMIC FEE t '
- OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
I t ."
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
LU� ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING i- a
0 PLEASE GIVE JOB ADDRESS WHEN PHONING. .r
` Z - SEE PERMIT FOR EXPIRATION DATE - . MECHANICAL. ( ,
IMPORTANT! F CONST.TAX tx ,. c'
x '
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING•FOR FINAL INSPECTION.
- ,;OFFICE COP
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•. { w I Irl Y ` ',t ,x � 1 `� t �.K.,, � :'
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I` APPLICANT TO FILL IN INFORMATION WITHIN-RED LINES - USE BALL POINT PEN ONLY
" BUILDING PROJECT IDENTIFICATION - PERM IT NUMBER
AOILm.G Sunset Springs .,Court
APPLICATION & PERMIT
ADDRESa '(Lot 74 - Plan 2CR 13779
BUILDING.-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME of - I QTY. ELECTRIC PERMIT FEE
Gre or . Grou Inc: PHGNE 595-2100
croRs
NA.E OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME .
Gregory Group, -Inc,. Lm.No. 430097 LIGHTING FIXTURES 10.00/1.00 F 0
CONTRACTORS '220 Twin Dolphin �Dr,' . "C 3. PPLIANCES-RESIDENTIAL 4.00 a
ADDRESS /�,/�,, 11
Redwood - -UFYNE 595-2100 / PANELS 10.00 J 0 DATE OF APPLICATION
ARCHITECT Aram Bassenian, A. I .A. PANELS (OVER 200 AMP) 20.00 . PLAN CHECK FEE P.D.No.
OR
ENGINEER & Associates
LIC.No. SIGNS TRANS. 3.00 -
ARDR.OREND 3990 Westerly Pl . , #170 . PERMIT,VALIDATION -
ADDRESS SPECIAL CIRCUIT - 500
2,,92660 TEMP.METER OR POLE INS. 20.00 P�
APP.ESS s 220 Twin Dolphin Dr. ,. "Ct' MOTORS SEE FEE SCH. ,� �-�'1
Redwood City. CA 94065 SERVICE CHANGE 20.06
w o o LICENSED CONTRACTORS DECLARATION
a is •1 hereby nflirm that] am licensed under provisions of Chapter 9 ISSUANCE DATE
Dto [commencing with Section 7000)of Division 3 of the Business and BLDG. ELECL PLG. MECH.
as Professions Cody-,and my license is in full for$,,lr}ff�f a{l.
Z o w- License Class_[y- Lie.Number-.,jU U4.J
0'z L o Date Contractor LICK
a Y f -a ' BUILDING PERMIT
Ix IS u OWNER-BUILDFR'DECLARATION - INFORMATION
F
0 e N 1 hereby affirm Ilial I ,a�I exempt from the Contractor's License MISC.- REFER TO ORD
ID u VALUATION $/FT.
F u 0 a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE r 10.00 / i� �o
Code:Any city or county whichrequiresapermit to construct,alter, C�
SE W Q improve,demolish,Or repair any Structure,prior to its Issuance,also ELEC.CONTR.' LIQ NO. ELEC.
R0 a requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A w m u lie is licensed pursuant to the provisions of the Contractor's License -
FiQ Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the
B
i 0 usiness and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
KHom the basis far the alleged exemption.Any violation ofSection 7031.5 STORIES . TYPE CONSTR.
a-,2 by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00 Nj
of not more than five hundred dollars(S500).):
❑ 1,as owner of the property,or my employees with wages as -BACK FLOW PROTECT.DEVICE - 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sole (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AR EA,CON D. 5.00 --3 /.
Code:The Contractor's License Law docs Co(apply to an owner of
property who builds or improves thereon,and who does such work t FIXTURES-PER TRAP h 5.00 30.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve
-
mentsarenotintendedorofferedforsale.If,however,the building I GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- 'GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden Of Pmving that he did not build ar im-
prove for purpose'of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON FR Omer
❑ I,as owner of the property,lint exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044, Business I LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor's Llcensc Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ��-
contracts for such projects with acontractions)licensed pursuant to
the Contractor's License Law. I SEWER-SANITARY-STORM EA.200ft/10.00
TRACT N0, PARCEL NO.
❑ IamexemptunJer Sec. .B&P.C.for this WATER HEATER W/VENT 6.00 7
reason
Owner Date WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO.
N'ORKERS'COMPENSA'I'[ON D17CLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofeansent to self-insure, ZONING ENG.SITE NO.
cu certificate of Workers'Compensation Insurance,ora certified
oopy thereof(Sec,3800,Lan.a.l.
PolicyUnited teB Pd C R i i a
No. Company e_-
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-44
Certified Ie th the city inspection division.
Z p' Applicant
Certified
_ - MISC.- -REFER TO ORD. Y ❑ NE] 'v ❑ . N❑
cc CBRI'IFI Ii OP EXEMPTION FROM WORKIERS' PERMIT ISSUANCE 10.00 FLooO ZONE A.L.U,C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y 1:1N❑
hundred Aollaux($100)or less')
U O I certify limit in the performance of the work for which this per- QTY 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'lo the Workers'Compensation Laws of California.
w Date Applicant - BUILDING' S
a . ALTER OR'ADD TO MECH. 5.00 -
} to NOTICE '1'0 APPLICANT: If,ul'ter making flux Certificate of Ex-
F ? ehnption,you should become subject to the Workers'Compensation APPLIANCE ! 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE -
U such provisions or this permit shall be devoted revoked AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE /O
I herebyaffnto That there is a construction lending agency for I EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this per is issued(Sec. - MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00 �}T,
r,
Lendcr's Name Security Pa'.C1 f1C HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Y� -
Lender's AJ ha ss�arn-�.nC1SnCD-C-A 1
I certify that correct.
read agrees application and al c that d above
unty VENTILATION FAN (SINGLE) 4.00 a hl'
in formation a estate. I agree to comply with all city and county PLUMBING
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 Inion the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL,
above-mentioned property for inspection purposes.
(We) agree m save, indemnify and keep harmless the City of MISC._ .REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which .CONST.TAX ���N6
may in any way accrue against said City in consequc • of the PERMIT ISSUANCE 10.00 7
granting of this '' R MECH.CONT. LIC.NO. MECH. -
/� � TOTALb , TOTAL S-yc�S
Signature ofA cant/ ontractor le
OFFICE COPY _