13778 (2) IF
POST THISCARD'NEARFRONT OFBUIL�DING ,
I -
III i RMIT NIIMIIER -
_ _ CITY OF - CUPERTINO 1:3.778
IT 1 NSPECTION DIVISION
JOB INSPECTION,RECORD
t 1 PERMIT EXPIRATION
'JOB-ADDRESS 11'� "4 -su "'I — `� UNIT# -LOT# -`� -
'PERMIT EXPIRES IF WORK
' OWNER._I� JK � IRFLI-I . J4. CONTRACTOR • IS NOT STARTED WITHIN
INSPECTION ATEINSPECTOR ' ' INSPECTION RECORD 180�13AYSOFPERMIT ISSU. -
" - ANCE OR 180 DAYS FROM'
FOUNDATION LAST.CALLED INSPECTION.
LIFER i
PREGUNITEPEHMIr;vnuonnON
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND./SLAB,
PLUMBING -' _ - ,r aI' ;I' ' yy /
ELECTRICAL' - g ISSUANCE DATE
M CHANCAL II BLDG. ELECj. PLG' MECH.
D NOT POUR FLOOR UNTIL ABV HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR ". INFORMATION
PLUMBING - - /VALOR SIFT.
MECHANICAL - 4 QS•Ay '(,+-'1J'.
ELECTRICAL PERMIT TO G� ki-L
;h FRAMING - -
INSULATION , - STORIES TYPE CONSTR.
UrA0 :2' t.
- 1 ` OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF' _ 50.1'L FLOOR AREA TOTAL ACREAGE
DIAPHRAGM -
• - BUILDING USE.
- RES' IN CON .PB 00.,Ii
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED _ ❑ 1. '❑ ❑ ❑l ❑
ROUGH. ' - ' - ASSESSORS PARCEL.NO.
PLUMBING of ,-ENnI1' - - TRACT NO., PARCEL No,- -
GAS TEST' - - - - - ,l, -. '
MECHANICAL - .
ACC.DATE. ACC.FILE NO.
ELECTRICAL - ' FINALS DATE .NSP.
FRAMING SAN # IZZ _
INSULATION +'' PLUMBING ' zoN ING ENG-I I ..SITE NO.
d' �•d6 GAS ,.I
74 JALO i
FIRE SPgINK ENERGY T-24
z . I MECHANI A ' Y El- .13, _
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED j HEATING
LATH-INTERIOR.' ^�'^ 13-$$ ELECTRICAL - i FLOOD ZONE A.L.u.c.
LATH-EXTERIOR l
i
FIRE DEPT. °-T. --'I - v ❑ � "❑' •9 ❑ N❑
SHEETROCK 10& - - _2K GRADE FEE SUMMARY
SHEAR'INTERIOR, TjL BUILDING -
SHEAR EXTERIOR' .o$ C - "TEMPORARY APPROVALS eulLDlivG 1 '
L FIREWALLS - ELECTRIC„ „PLAN CHECK ..,
.FEE ay'
- GAS _ _
NO TAPE OR LA TER UNTIL A OVE AS BEEN SIGNED OCCUPANCY,'"F SEISMIC FEET
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDIN&INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC e, :"I'l .
H� ONE,WORKING DAY BEFORE REQUIRED INSPECTION t, PLUMBING. y,Jo - l„�• ;
z PLEASE•GIVE JOB ADDRESS WHEN.PHONING,.
— SEE P..ERMI,T FOR EXPIRATION,DATE '— ' MECHANICAL . 6!�-G
�„
IMPORTANT! _ covsT.TAx ,✓e re
PLEASE READ REVERSE SIDE BEFORE . a TOTALS r_I
CALLING FOR FINAL INSPECTION.
'.IOFFICECOPY, _ ^
APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN•ONLY
BUILDING PROJECT I DENTI FICATI ON •• I PERMIT NUMBER
aDILDING ,-,... `APPLIC!ATION &PERMIT ,
ADDRESS 115114 'SUnSet$pri ngs`Court BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .13778
OWNER'S - PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
Gregory 'Group, Inc. PROW 595-2100
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Gregory Group, Inc. LIC."0.430097 LIGHTING FIXTURES 10.00/1,00
nooess.- 220 Twin Dolphin Dr. , IICI 3 APPLIANCES-RESIDENTIAL - 4.00 a
Redwood Ci ty PRONE595-2100 PANELS 10.00 J n. DATE OF APPLICATION
ARCHITECT Aram Bassenian, A. I .A. PANELS IOVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
$ Associates 'LIC.NO. SIGNS TRANS. 3.00 '
ARADDRESS CH.OREN1 3990 Westerly Pl . , #170 SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
New ort Beach CA zu,92660 TEMP.METER OR POLE INS. 20.00
ADDRESS a 220 Twi n''Dol phi n Dri ve, tiCl MOTORS SEE FEE SCH. I-nm
ADORE55Redwood Cit CAt. 94065 SERVICE CHANGE 20.00 /�7
002 LICENSED CONT'RACTORS DECLARATIONJ
¢ u v I hereby affirm that 1-am licensed under provisions of Chapter 9 E DATE
N ¢vWAi (commencing with Section 70001 of Division 3 of the Business and ECT. PLG. MECH.'
H n z Professions Cork-,and my license is in full farh'e�q eJJes 1. r�
2 v,m w License Class-D.Lin.Number 4-Sll-Y! '!'J-N
H w Date Contractor
¢ y f -
¢ ¢w OWNER-BUILDER DECLARATION BUILDING PERMIT
w3 a w 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
LLoa Law forthe followingreason.(Sec.7031,5;'flusinessund Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Q� - Code:Any city or county which requiresa permit demolisstructure, wco'nstrucl,almr,
Q Q Improve, h,Or repair any stcture,prior t0 its Issuance,also FLED.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL J PEHMIT TO
A ea m he is licensed pursuantto the provisions of the Contractor's License
HiQLaw(Chapter 9(commencing with Section 7000)ofDivision3oftbe S�
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ F $ the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR.
by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than live hundred dollars(4500).):
❑ .1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
" intended or offered for sale(Sec. 7044,'Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 G O SO,FT:FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided,that such improve
menus are not intended or Offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 6.00
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 im- RES IND CDN PB Omnn
er
prove for purpose ofeale.). v` - INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner Of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 - 3 '6-p-313X JJ
contracts for such projects with a contracomps)licensed pursuant to SEWER-SANITAfl Y-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ l am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date I WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
' WORK Ii RS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to self-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lah.C,l.
Policy No. Company ni_te�lPa.C_./.Re_l i.a.nC
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z X Certified f rith t inspection division.
O Applicant MISC. REFER TO ORD. ❑ N❑ V ❑ N❑
- V
cc: W CERTIF TE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.O.
LU COMPI:NSATION INSURANCE' 7 PLG.CONTR. LIC.NO. PLG. l
d O (This section need not be completed if lhu permit is for one " TOTAL Y❑ N❑ I V❑ N❑
- Z hundred dollars($100)or less.)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,I s1m11 not employ any person in any manner so as to
Ubecome subject to the Workers'Compensation Laws of 1:31ilbrnia. F,93a Date Applicant ' ALTER OR ADD TO MECH. 5.00 BUILDING
to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
} Z emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK fe
provisions of the Labor Cade, you must forthwith comply with FEE C
C..) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10D000.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MIC.F.M.) 6.00 SEISMIC FEE di lob
flueI hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
performance of the work 1'or which this permit is issued(Sec. MICROFILM
3097:Civ.C.). SQCUrI ty' Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name '
- . n HEATING UNIT IDV ER 100,000 B.T.U.)8.50 ELECTRIC
Lender'sAddress
San Fra nc s eo-6r1
m I certify that l have read Ibis application and state that the above VENTILATION FAN'(SING(SINGLE) 4.00 a
information is correct I'agtee to comply with all cily and county PLUMBING
oNinances and state laws relating in building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.)' 6.00 I/J
1 hereby authorize representatives of this city to enter upon,the
above-mentionedproperty I'or inspection purposes' BOILER-COMP(Over 100.000 BTU)SEE FEE SCH. MECHANICAL 6 U=
4� T . .
(We) agree im'save, indemnify and keeplmrmless the Cityof MISC:- - REFER TO ORD. p
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 (7 CONST.TAX
may in any way accrue against said City in consequence of the OL -�
granting of er il. MECH.CONT. LIC.NO. MECH.
TOTAL• TOTAL /tf
Signature plicartr7kontractor Dat
OFFICE COPY
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