13807 ` POST THIS CARD NEAR FRONT OF BUILDING i"'n '
• ' PpHMIT NUMBER
Y - CITY .OF CUPERTINO 13807
INSPECTION DIVISION
JOB INSPECTION RECORD wl
n PERMIT EXPIRATION
JOB ADDRESS �S7a3 � C'd v /7K � .¢iG UNIT# LOT#
/'�, PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION ATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION n-2" a_2A,eg TL GO ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
PREGUNITE %JPERMIT`MAUOATION
It
.POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB 3j 1 -
PLUMBING d_ - er
ELECTRICAL - - IVA
SUANCE DATE
'MECHANICAL It ELECT. I PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD'FLOOR INFORMATION
PLUMBING VALUATION $/FT.
'
MECHANICAL r -
ELECTRICAL PE I PMIl TO
FRAMING ^'
IN ULATION - STORIES TYPE CONSTR,
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEO
ROOF SO,FT,FLOOR AREA TOTAL ACREAGE
T P+APM:rA'GM Ii,- .
BUILDING USE
RES IND CON PB Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0^ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO,
PLUMBING
GAS TEST TRACT NO, PARCEL NO.
MECHANICAL -'a - 7 '• S
ELECTRICALFINALS DATE INSP. ACC.OATE ACc+FILE NO,
FRAMING SAN * /, .L 2
INSULATION PLUMBING ZONING ENG.SITE NO.
��, _
GAS n-2 ,-
sr
MECHANICAL 0' FRES SPRINK ENERGY T-T<
_
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y N[]
LATH-INTERIORELECTRICAL FLOODZONE A.L.U.C.
� d ZO
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ No
SHEETROCK , _ M IGRADE FEESUMMARY
SHEAR INTERIOR ^)r .p� BUILDING -Z
SHEAR EXTERIOR 7-$ . TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS.BEEN SIGNED, OCCUPANCY t 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 r
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
T .
'IMPORTANT! CONST.TAX w
PLEASE READ REVERSE SIDE BEFORE lam•
CALLING FOR FINAL INSPECTION. TOTAL'
• OFFICE COPY
A
ZPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE.JALL POINT PEN ONLY
BIM LDI NG-PROJECT IDENTIFICATION PERMIT NUMBER
aDILDING APPLICATION & PERMIT I
O
ADDRESS 11563 Countr Spring Court BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
nr
OWNER'SPLAN CHECK VALIDATION -
NIdaE QTY. ELECTRIC PERMIT FEE
TnCPHONE
NAMERA on ' UTLETS-SWITCHES-RECEP 10.00/1.00 /0
Gregor Grou Inc. LIC.No430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S 220 IT
1 1,9L,ADDRESS Twin Dolphin Dr. , C APPLIANCES-RESIDENTIAL 4.00
Redwood City, CA 94U5 595-2100 _LiPANELS 10,06 DATE OF APPLICATION
AARRCHITECT Aram Bassenian, A.I.A. PANELS (OVER 200 AMP) 20.00O
PLAN CHECK FEE P.C.NO.
ENGINEER
& Associates LID.No. SIGNS TRANS. 3.00
AflCH.DREN 3990Westerly P1 , #170 SPECIALCIRCUIT 5.00
ADD PERMIT VALIDATION
DRESS
Newport Beach CA ziP92660 TEMP.METER OR POLE INS. 20,00
AS 's N N MOTORS SEE FEE SCH.
ADDRESS
220 Twin Dolphin Dr. , C y1 Redwood City, CA 94065 SERVICE CHANGE 20.00
w o o LICENSED CONTRACTORS DECLARATION
<U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
2 y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
D i Professions Code,and my license is in full force a d effect. ,,,.a.
go - License Class_B_Lic.Number-M09.( (L�
Q L r w Dale Contractor
a Y2 -1 BUILDING PERMIT
2 rt w a OWNER-BUILDF-R DECLARATION INFORMATION
U MISC- REFER TO ORD
E:
;A N I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT.
Hyo4 Law for the following reason.(See.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires permit to construct,alter, / 9 ,IIE 0
ce aa> p improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC. �1 o Ii_l/
A. o u requires the applicant for such permit to file a signed statement that TOTAL I PERMIT TO
E
ce m he is licensed pursuant to the provisions of ilio Contractor's License
Hi>
Law(Chapter 9(commencingwith Section 7000)ofDivision 3 cribs
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
dg ". by any applicant for a permit subjects the applicant too civil penalty rs($ ALTER-DRAIN&VENT-WATER (EA.) 5.00 �" S / //'
of not more than five hundred dollars lCA..-
❑ 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 sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 5 -,j
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon.and who does such work FIXTURES-PER TRAP 5.00 MFT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such mimprove- GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
mes are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM•OVER 4 IEA.1 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ E) 11❑ I,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 does not apply
to an owner of properly who builds Or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 �. 6- 9-,3 I,3'y/ i
contracts for such projects with a contractor(s)licensed mirsuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. PARCEL NO,
❑ I am exempt under See.-,BAP.C.I'or this WATER HEATER W/VENT 6.00 q
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
WORKERS'COMPF-NSATION DECLARATION' WATER TREATING EQUIP. 5.00
1 hereby af0rm that I have a certificate of conunl to self-insure,
or a certificate of Workers'Compensation Insurance,ora certifieZONING
d ENG.SITE NO.
Policy Noeof(See.38Company'U&i_ted_ Pa
ctRela an
0 ❑ Certified copy is hereby FIRE SPRINK ENERGY T-24
Z Z Applicant-Nfied copy d the city inspersion division. MISC.- REFER TO ORD. Y N Y N
o ❑ ❑ ❑ ❑
rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
CC CERTIFIC .OF EXEMPTION FROM WORKERS'
LU �_ MPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG.
1 O (This wo un need nnl he completed if the pe nn it is for one TOTAL ' Y❑ N❑ Y❑ N❑
::) Z hundred dollars($100)oI I.SJ 014
U O 1 certify that in the performance of the work for which this per- OTYMECHANICAL PERMIT FEE FEE SUMMARY
LL N mit is issued,1 shall not employ any person in any manner so as m
U become subject to the Workers'Compensation Laws of California.
0y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of I?x- �T
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 p` PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE ��O
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 -
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT ) 6A6 SEISMIC FEE d-''6
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which thispermit is issued(Sec. MICROFILM
3097.CN.C.). Security Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00 p
Lender's Name Sec HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC 6Q
Lender's Addres �LO, CTA
i I certify that 1 have read this application Ind slate that the above VENTILATION FAN (SINGLE) 4.00 MM''
101information correct. I agree to comply with all city and county PLUMBING O�Vy
Ordinances and stale laws relating to building construction, any BOILER-COMP 13 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purpous. gOI LER-COMP(Over 100,000 BTU)BEE FEE SCH. MECHANICAL /
LO L�
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. / G
g Cupertino against liabilities,judgments, costs and expenus which CONST.TAX (pa
f ` may in any way accrue aF 'rst said City in consequence of the PERMIT ISSUANCE 10.00 L
i glantin �PTll�p it MECH.C°NT. LIC.NO. MECH.
O TOTAL ! TOTAL r-Z
Signa ore pbcant/Contractor Zuta
OFFICE COPY