13803 POST THIS CARD NEAR FRONT.OF BUILDING
• PERMIT NUMBER
CITY OF CUPERTINO • 13803
INSPECTION DIVISION
1 JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS ,I •� �'-� Cc-�u�T�Y �✓F'^� ` UNIT# LOT# �b
I /�,./�, 1 .}�� PERMIT EXPIRES IF WORK
OWNER Y t-{�a.� -VK C. CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR' INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LASTCALLEO INSPECTION.
UFER '34 PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL:ABOVE HAS BEEN SIGNED .
UNDERGROUND /SLAPON p_
PLUMBING �,�fa' l����
ELECTRICAL s . I~ ss NCE DATE
T. PLG. MECH.
MECHANICAL ,u
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED G PERMIT
INFORMATION
WOOD FLOOR VALUATION s/FT.
PLUMBING - fY ;• l"t
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING
STORIES TYPE CONSTR.
INS CATION n '
.3
OCC.GROUP RES.UNITS
::PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
o"f
- SO,FT,FLOOR AREA TOTAL ACREAGE
ROOF
• Dh*PHRAGM -L
BUILDING USE
RES IND CON PB 0"...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED D
ASSESSORS PARCEL NO.
ROUGH ,
PLUMBING TRACT NO. PARCEL NO.
GAS TEST
1
MECHANICAL ^�-]-
ACC.DATE ACC.FILE NO.
ELECTRICAL -/ ��fILLpp,, FINALS DATE INSP.
FRAMING !, �T/v G SAN #t`ZZ
ZONING ENG.SITE NO.
INSULATION, PLUMBING 0 O
GAS
FIRE
MECHANICAL Y ❑ NE Y ❑ ISPRINK ENERGY N
COVER NO WORK UNTIL ABOVE HAS BEEN,SIONEO HEATING �
aooD ZONE aL U.C.
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR ' FIRE DEPT. Y NO Y I] "�
SHEETROCK 971 GRADE FEESUMMARY -.
SHEAR INTERIOR - BUILDING, - "
SHEAR EXTERIOR. - G TEMPORARY APPROVALS
BUILDING -
FIREWALLS ELECTRIC PLAN CHECK
FEE r
ILA
GAS
NO TAPE OR PLASTER UNTIL BOVE HAS BEEN SIGNED OCCUPANCY I -SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. _ MICROFILM
ARRANGE,FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
oPLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - MECHANICAL ( _
- SEE PERMIT FOR EXPIRATION DATE -
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
7� BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
°DISG 11523 Country Spring Court APPLICATION & PERMIT
ADDRESS
13803
Lot 101 - BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OINNERS
NAME .L PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
Gre or Group, InCProNE 595-2100
CONTRACTOR'S
NAME LLTOUTLETS-SWITCHES-RECEP 10.00/1.00 �
Gregory Group InC1,IC.N0.430097 LIGHTING FIXTURES 10.00/1.00C,ONTRAC3
ADDRESS 220
220 Twin Dolphin Dr. , IICII 3 PPLIANCES-RESIDENTIAL 4.00
Redwood City, CA PHON695-21 0 PANELS 10.00 DATE OF APPLICATION
ARCHITECT Aram Bassenian, A.IA. PLAN CHECK FEE P.C.NO..
OR . PANELS (OVER 200 AMP) 20.00
ENGINEER
' 81 Associates LIC.No. SIGNS TRANS. 3.00
ARL..°RENG.3990� Westerly Pl . , #170 SPECIAL CIRCUIT 5,00 PERMITVgLIDATION
ADDREss
N zl EMP.METER OR POLE INS. 20,00
nooliiss Ts 220 Twin Dolphin Dr. , IICII MOTORS SEE FEE SCH. ,gyp
Redwond City CA 94n6S SERVICE CHANGE 20.00
r02 o a LICENSED CONTRACTORS DECLARATION ,y
<u t I hereby affirm that I am licensed under potvisions PhChapter 9 U
,Ha Q n (commencing with Section 7000)of Ulvisiort:3 of th<ODMness and ATE
r w i Professions CcAc,and my license is in full for' pI�I f el.zo i w o License Class-),$ Lia bomber-4.
ELECT. MECH.
�p�l
L H j Dafe Contractor YJ
¢ ¢ El
w o OWNF.R.BUILDER DECLARATION - BUILDING PERMIT
MISC.- REFER TO OR
_ INFORMATION
X ;u w I hereby affirm that I am exempt from the Contra, License VALUATION $/FT.
� uoj Law for the following reason.(Sec.7031.5,Businessand Professions pERMlT ISSUANCE '
7 w> Code:Any city or county which reyuirdsa permit to construct,alter, 10.00
¢ ¢ ¢ Improve,denl°hah,nr ttpalf any slNCtpre,prl°r Io ilS ISSnanCC,aIs. ELEQ CONTR. LID.NO. ELEC01 // ✓ s/
w d mu requires the applicant for such permit to file n signed statement t / PERMIT TO
e w he is licensed pursuant to the provisions of the Contractor's hat TOTAL License
HiQ Law(Chapter9(commencing with Section 7000)of Division3of the (+ � w/,.
r D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE V 'v
¢f m [he basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a;.. by any applicant fora permit subjects the applicanuoucivil penalty
ALTER-DRAIN 5.00
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as
ot BACK FLOW PROTECT,DEVICE 4.00
Iheir sole compensatioq will do the work,and [ structure is n
intended or offered for sale(Sec. 7044, Businessss - ,COND. 5.00 OCC.GROUP RES.UNITS
and Professions DRAINSFLOOR,ROOF,AREA
Cade:The Contractor's License Law docs not apply to an owner of '
property who builds or improves thereon,and who does such work Ja FIXTURES-PER TRAP 5.00 SO FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for 1.as ownerose
of the.). INDUSTRIAL WASTE INTER. 30.00 I❑ ❑N ❑ Other❑
❑ d as owner of the properly,he 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: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 / 6-17- ,? 31�,,,�?
contracts for such projects with a contractods)licensed pursuant m Y �r
the Contractor's License Law. I SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ [am exempt under Sec..BAP.C.for this
reason - I WATER HEATERW/VENT6.00
Owner Data
WATER SYSTEM 5,00 5�
ACC.DATE ACC FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I 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 thereof(Sec.3800,Lab. )
Policy No. CompanyUn]_ted_Paci-f_i-c/Re-1
O ❑ Certified copy is hereb furnished.
Z Z CX Certified copy the city inspection division. FIRE BPRINK ENERGY LYa
F p Applicant MISC.- REFER TO ORD. Y E] NEI v N�
cc CERTIFI ,OF AEMPTIONF B1I WORKERS' PERMIT ISSUANCE 10.00 in FLOOD ZONE A.L.U.C.
Lu MPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
tl O (This section need not be completed if the permit is for one TOTAL ��� Y❑ N� Y ❑ N�
Z hundred dollar,0100)or IessJ
U Q I certify that in the performance of the work for which this per- QT,. MECHANICAL PERMIT FEE FEE SUMMARY
F mit
LL is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'C°mpensation Laws of California.'
0°1. Date Applicant ALTER BUILDING 5C
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex OR ADD TO MECH. 5.00 s
F. ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 r-' p
provisions of the Labor Code, you must forthwith comply with U / V3
V such provisions or this permit shall.be deemed revoked AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00 FEE
PLAN CHECK
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOQEM.) 6.00 SEISMIC FEE O d/
I hereby affirm that there is a construction lending agency for I EXHAUST.HOOD(WITH DUCT) 5.00 s
the performance of the work for which this permit is issued(Sec.
3097,Civ.C.), I HEATING UNIT(TO 100,0MICROFILM
00 B.T.U.) 8.00
Lender's Name Security Pacific
Lender's Address HEATING UN ITgFAN (SINGLE)
0,000 B.T.U.)9.50 ELECTRIC
I certify that l It sae is app Ica ton and�IS t al the he above VENTILATION 4.00.D.-nation n correct.1 agree to comply with all city and county BOILER-COMP(3 ,000 B.T.U.) 6.00 PLUMBINGordinances and orate laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOI LER-COMP BTU)SEE FEE SCH. MECHANICAL (p/
above-mentioned property for inspection o (h purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way acerae,against said City in consequence of the PERMIT ISSUANCE 10.00
granting of[his MECH.CONT. LIC.NO. MECH. In
J 1' TOTAL 00 TOTAL S�xd
Signatu� nt/C (tractor Dal
OFFICE COPY
BUILDING:INSPECTORI OFFICE
CITY OF CUPERTINO Bldg.Dept.
Offi,e Copy
❑ Backflow Device
iSanitary Permit No.
O Sewer Connection
Plumbing Permit No.
❑ Plumbing Final
Lot No.
l Owner or Tenant
i — G- �OiQ-4 �i-QOII�
Ar III ri—23 Co�uT �V SPf2 i Aga R
Tract
Date Connected OGT, (U
19�� DatenFina�loe-- t eO
,— , _19
' PLUMBING INSPECTOR ,f
I
I CERTIFICATE OF COMPLETION
° ^ BUIItDING INSPECTOR'S OFFICE
CITQY OF CUPERTINO
DATE 9 V BLDG. PERMIT NO..(
THE BLDG. LOCATED AT S23 CaU(J-Ry
OWNED BY— PC E CS(Z\/ G-Ezp�
HAS BEEN (COMPLETED) FOR USE AS
(ALTERED)
i
ti
I
BUILDING INSPECTOR
t
FFIE
CITY OF CUPERTINO COPY
GAS SERVICE NOTICE
' 9
4
I To 0
You are hereby authorized to connect the GAS service for
Owner or Tenant 6-PI✓ c9.00�Y -1Q"OJP
At ( ( �i? r'ncIZV 5m Lo'(-
/ J
New Service X
}}}; No. of Meters I Reconnect
No. of Add. Meters Move Service 1I
Move Meter
PLUMBIC 'NSPECTOR
T�
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
19 _
ToF1`.
}You are hereby authorized to Connect electrical service for
i
kfi
'Owner or Tenant � 6"�l) .tM— �
1� , c�i�a�l r (fir—iyT nT- 10!
- No.of Wires Size of Wires Size of Switch
'j
Motor Load Voltage Phase
fHeating Load K.W, Voltage
Noof Meters
Light 110New ServiceR�on 1111
.
I
Hear 120 Three Wrte More Service
No.of Add. Meters Power Three Rho se Move Meter
�M ELECTRICAL INSPECTOR 4'%J