13780 (2) y POST THIS CARD NEAR FRONT OF BUILDING`
PERMIT NUMBER
CITY:. OF CUPERT(NO 13780
INSPECTION DIVISION
• r' . JOB INSPECTION RECORD
S"I1 PER EXPIRATION
JOB ADDRESS ` N,�- `Q��� UNIT# - LOT# ��
PERMIT EXPIRES IF WORK
OWNER C`, � � ', i •-..CONTRACTOR
IS-NOT STARTED WITHIN
.INSPECTION• - DA E INSPECTOR "' - "INSPECTION'RECORD - 180 DAYS OF PERMIT ISSU
FOUNDATION ANCE OR 180 DAYS FROM
• LAST CALLED INSPECTION.
UFER - -
PREGUNITE ' PERMIT VALIDATION r .r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ✓`
,UNDERGROUND /SLAB MP ' t :;�.,r ,• ,�;'
PLUMBING - - y' �y`r'
ELECTRICAL E e IGAPkE OATS
BLDG. ELECT. .'PLG., MECK
MECHANICAL '
a, 0 d* tai � a q.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
" WOOD FLOOR VALUATION S/ET.
PLUMBING
MECHANICAL '
PERMIT TO
ELECTRICAL r N
• 'FRAMING ',
' sTONles rvr[l CONSTR.
INSULATION
G ,
OCC.GRouP RES.uNlrs
PLACE NO SUBFLOOR UNTIL'ABOVE HAS BEEN SIGNED
. ' ROOF EO'FT,FLOORAREA TOTAL ACREAGE
DIAPHRAGM ,
BUILDING USE
HES INDCON PH ED Orh,,
ED
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED �' E]
_ ASSESSOR SPAPCEL NO.
ROUGH
_ PLUMBING. ` .. p. -
GAS TEST TRACT No, PARCEL No.
'MECHANICAL - -8� ' -
ACC.DATEACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMINGSAN # Z'S'Z J,
" ZONING ENG.SITE NO.` i .
INSULATION - (p_ao_188 PLUMBING - • a
10 -MA6 GAS
FIRE SHRINK ENERGY T.24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SI t NEO I HEATING NC] N[]
LATH-INTERIOR 7-a/_ ELECTRICAL FCOODZOIBE `A,L.u.C.
LATH-EXTERIOR - - FIRE DEPT. . - F v v Q Nv IN[]
SHEETROCK -�„-_ GRADE •w„ ' FEE SUMMARY
SHEAR INTERIOR j- _8$ BUILDING - r'.
- ''BUILDING �.V+�•`„
•.
SHEAR EXTERIOR 5-z3_ c- TEMPO RARY.APPROVAL _
FIREWALLS ELECTRIC r - PLAN CHECK'
7� GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR. MICROFILM
.. 'Y • r
ARRANGE FOR INSPECTION BY PHONING 252.4505; ELECTRIC > ,
0�, ONE WORKING DAY. BEFORE REQUIRED INSPECTION PLUMBING '
PLEASE GIVE JOB ADDRESS WHEN PHONING. ; • r, MECHANICAL',
SEE PERMIT FOR EXPIRATION DATE -
,*+" CONST.TAX
IMPORTANT!-
a 3
i PLEASE READ`pEVERSE'SIDE BEFORE41,
TOTAL
CALLING,FOR FINAL INSPECTION. Ole
- " OFFICECOPY
I
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER -
BUILDING 11505 Sunset Spring Court APPLICATION & PERMIT..
ADDRESS 13780'J O 0
BUILDING -ELECTRICAL-PLUMBING -MECHANICAL I J (V'
OWNER'S _ PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
re or .Grou Inc.PHONE 595-2100
CONTRACTOR
NUTLETS-SWITCHES,-RECEP 10.00/1.00
AME
Gre or •Grou Inc.LIC.No-430097 LIGHTI NG FIXTURES 10.00/1.00
CONTRACroRs 220 Twin Dol n,'"'CII PPLIANCES-RESIDENTIAL 4.00, `
ADDRESS
Redwood Cit SANE 595-2100 PANELS 10.00 J0 DATE OF APPLICATION
ARCHITECT Aram Bassenian, A.I .A.. PANELS (OVER 200 AMP) • 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
&' ASs dated LIC.No.. SIGNS TRANS. 3.00
ARCH.OR E`43990: Westerly PI , #170 SPECT ALCIRCUIT 6.00 PERMITVA L(DATION
ADDRESS e
Newport Beach. CA IIP 92660 EMP.METER OR POLE INS. 20.00 1a�1
ADDRESNrs ,"Cu MOTORS SEE FEE SCH.
ADDRESS 220 Twin Dolphin Dr. , -," - -
Redwood City. 4065 ISERVICE CHANGE 20.00 q�
o o LICENSIiD CONT'RACT'ORS DF.CI.ARA'r[ON
5 v v 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y a "' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F- D i Professions Co ,and my license is in full for xW pj'(J
io_ License Class Lic.Number_4..7U.VyL-
Is
QyL r ww Date Contractor
1
¢ ¢.a OWNER BUILDIiR DECLARATION- BUILDING RMATIOPERMIT,
- INFORMATION
� � MISC.- REFER TO ORD
X a.w I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
H LL O j Law for the following reason.(Sec.7031.5,Nosiness and Professions PERMIT ISSUANCE 10.00
N Code:Any city or county which requiresa permit reconstruct,alter,
QQ ¢ improve,demolish,or repair any structure,prior to It,Issuance,also ELEC.CONTR. LIC.NO. ELE0.
or
O LL requires the applicant for such permit to file a signed statement that TOTAL PERMI I I U
n w m he is licensed pursuant to the provisions of the Contractor's License
H'zLaw fChapler 9(commencing with Section 7000)of Division 3 of the ���(,[/L
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ n-Q 0 the basis for the alleged exemption.Any violation,of Section 7031.5 STORIES TYPE CONSTR.
ng _ by any applicant for a permit subjects the applicant toacivil penalty " ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars
❑ 1,as owner of the property.or in,employees with wages as BACK FLOW PROTECT. DEVICE 4.00 ocC.CROUP RESUNITS
their sole compensation,will do the work,and the structure is not - S.l
intended or offered for sale (Sec.7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 �- 3 /
Code:Thm
Tire Comemr's License Law does noan t apply to owner of _ -
propertywhobuildsorimprovesthereon,and who does such work J 3FIXTURES-PER TRAP .5.00 SO.FT PLOOR AREA TOTAL ACREAGE
himself re of rote his own employees.Provided leve such improve-
ments
'
mems are not intended or employeeffered for,provided that such
building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 10
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 owner'
RE IND CON PB Other
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the properly,am exclusively•contracting with ❑ Cl ❑ ' ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. -!6.00 ASSESSORSPARCEL NO.
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 _j4
contracts for such projects with a comractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 y /
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER WIVENT 6.00 7yyS�
reason
Owner bate WATER SYSTEM 5.00 ACC.DATE ACC.FILENO.
WORKF.RS�COMPENSATION DECLARATION WATER TREATING'EQUIP, + 5.00
1 hereby affirm that I have a ctetificate of consent ro self-insure, - - ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.b�II itPA
,,11 '',�,.,,pp 1
Policy No. Company_1j.nJ_LCIl_Pat" _Re-11.3n -
0 ❑ Certified CO isI byf t bed FIRESPRINK ENERGY T 24
Z Z pl Cerhfie fit I th flf gpeceion division., MISC.- `REFER TO ORD. ❑ ❑ ❑ 0
Q : APPIiCuo( _ Y N V N
CC rn � - PERMIT ISSUANCE 10.00 /
� - Cli CATF:OF li%1>MI'TION FROM WORKERS' ' C) FLOOD ZONE 0.L.u.C.
LU > COM PHNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Q (This Section need not be completed If the permit is for onC TOTAL / Y❑ N❑ Y❑ IN
t.• D Z hundred dollars($100)or le".) '
0 1 certify that in the performance of the work for which this per; QTY. MECHANICAL`PERMIT FEE FEE SUMMARY
LL H mil is issued,I shall-not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. �'a
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE'f0 APPLICANT: If,after making this Certificate of Ex. -
• Z emption,you should become subject to the Workers'Compensation APPLIANCE `• 5.00 PLAN CHECK
provsiar s of the Labor'Code,,you must forthwith comply with FEE
U such provisions or this permit Shull be deemed revoked. AIR HANDLING UNIT(TO 1000011F.M.) 4.00
CONSTRUCTION LENDING AGENCY, AIR HANDLING UNIT(OVERI0=CF.M.) 6.00 SEISMIC FEE
'1 hereby affirm that Ihere is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued fSec. MICROFILM
3097,Civ.C.). 1 I HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name SBCL rl ty PaCl fIC HEATING UNIT(OVER 100,000 B.T.U.19.50
Lender's Address-CIH F�iic-i.sco-;C-A ELECTRIC
I cerlily that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
in fonnallon is correct. 1 agree to comply with all it,and county - PLUMBING
e ordinances and.seate laws relating to building construction, and , BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 /
hereby authorize represenlalive, of this city Io enter ,Pon the
above-mentioned property forinspection purpBOILER-COMP(Over 100,000 BTU(SEE FEE SCH. MECHANICAL �J /
oses.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and-expenses which - CONST.TAX f b
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00. r)
granting of isp r it. / MECH.CONT. LI0.N0. MECH. TOTAL'
TOTAL -.i
Signal pp¢ant/Contractor tL
b J
OFFICECOPY -