13809 POST THIS CARD NEAR FRONT OF BUILDING PERM IT NUMBER
CITY OF CUPERTINO
13809
„ INSPECTION DIVISION
1 - JOB INSPECTION RECORD
JOB ADDRESS \ -""� YJ.,A PERMIT EXPIRATION
��`-'��"I UNIT# LOT# ,�
'n /+ 'vr PERMIT EXPIRES IF WORK
OWNER �.�(- ]012'C L-jLY,( N,SF.• CONTRACTOR IS NOT STARTED WITHIN
INSPECTION 15ATE INSPECTOR fir? INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM FOUNDATION
UFER LAST CALLED INSPECTION.
,'j--�, ,
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PAS ✓
UNDERGROUND /SLAB
PLUMBING 4 Rr
ELECTRICAL ISs EDATE
MECHANICAL PLG, MECR.
Q" ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING '
MECHANICAL '
PERMIT TO
ELECTRICAL - - _• e,„+,V
FRAMING
INS CATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
ROOF 50.FT.FLOOR AREA TOTAL ACREAGE
OVIIDI USE
' jPES IND CON
PB Otte•
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑ ❑ ❑ ❑
ROUGH - ASSESSORS PARCEL NO. -
PLUMBING - 6.- A `-I-rls -
GAS TEST - TRACT NO PARCEL NO.
MECHANICAL I
ELECTRICAL ACC DATE ACC.FILE NO.
J' FINALS�;+;j�^ DATE INSP.
FRAMING -Z SAN *1'Z
T ZONING ENG.SITE NO.
INSULATION PLUMBING -�- G
{ _ GAS
FIRE SPRINK ENERGY T24
MECHANICAL Y Q No Y ❑ NEl
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING /. . -$,; !
FLOOD ZONE A.L.u.c.
LATH-INTERIOR ELECTRICAL Q+ v� N� .v I] rv❑
LATH-EXTERIOR FIRE DEPT. _
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR -g. BUILDING - - - �:
SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING
FIREWALLS - ELECTRIC PLAN CHECK i
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 'I
LU. ARRANGE
WORKING DAY BEFORE REQUIRED INSPECTION. ' PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL t "
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
! "BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT PERMIT NUMBER
eUu1OING a
ADDRESS 11583 Country Spring Cour BUILDING-ELECTRICAL-PLUMBING-MECHANICALPlan(Lot 107 13.80
9
OWNER'S PLAN CHECKVTION 1,
NAME OTY. ELECTRIC PERMIT FEE
egory Group, Inc. PNONE 595-2100
NnmigCTOR'S OUTLETS-SWITCHES-RECEP 10.00/1.00 Z
Gregory Group, Inc. L,C.NO. 430097 A50GHTING FIXTURES 10.0011.00
CONTRACTOR'S 220win DO pin Dr. #C PPLIANCES-RESIDENTIAL 4.00 0..
AReE�wood City, CA PHONE 595-2100 1 PANELS 10.00 DATE OF APPLICATION
ARCHITECT ram assenlan, A. I.A. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER Associates
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENGAEsS . 3f190 Westerly Place 17 SPECIALCIRCUIT 5.00 PERMIT VALIDATION
Newport Beach, CA ZIP k 6D TEMP.METER OR POLE INS. 20.00 P"
APPLICANT'Swin 0 p In r. MOTORS SEE FEE SCH.
ARedwood City, CA 94065 SERVICE CHANGE 20.00
DE04k
woo LICENSED CONTRACTORS DECLARATION nY
a u
L, I hereby affirm that I am licensed under provisions of Chapter 9 TE
vA (commencing with Section 7000)of Division 3 of the Business and
s2 BL EL P MECH,
7 Professions Code, Id m license is in full forv� rX1, IITfsll
o i w o License Class Y Lic.Number�{�UUy.(
Date Contractor
er y f BUILDING PERMIT
M rt w OWNER-BUILDER DECLARATION INFORMATION'
we N I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD vALunTlOry
a_o g Law for the following reason.(Sec.7031.5;Business and Professions PERMIT ISSUANCE 10.00 / S/FT.
Code:Any city or county which requires a permit to construct,alter,
a ¢¢.O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. EL EC.
a. wO u requires the applicant for such permit to Fide a signed statement that TOTAL PERMIT TO
$n he u licenud pursuant to the provisions of the Contractor's License ;U/1I- z> Low(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE
M H$ the basis for the alleged exemption.Any violation u(Section7031.5 STORIES TYPE CONSTR.
il ; .. by any applicant for hundred
subjects the0).): am toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 p
of not more than five hundred objects the applicant
p li tT
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 D _ � /
Code:The Contractor's License Law does not apply to an owner of /_
property who builds or improves thereon,and who
does such work 1 FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
Plentsarenotintendedorofferedforsale.It,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
at improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 200
builder will have the burden Of proving that he did not build or in . . .
t BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
13 . .
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 6 ASSESSORS PARCRO.9
and Professions Code:The Contractors License Law does not apply ! s V lip
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ` b -9-yJ
Contracts for such projects with a wntmetor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the exempt
License Law: TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATERW/VENT 6.00 79f �
reason
Owner Oen' WATER SYSTEM _ 5.00 5 ACC.OATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to seer-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy them.f(Sec.3800,Lab.C.�nited Pacific/Re
Policy No. Company
0 ❑ Certified cop ter 'fury�y'� FIRE SPRINK ENERGY T 24
Z Z ❑ Certified '1-11 e city inspection division. MISC.- REFER TO ORD.
O Applicant y❑ ry❑ y ❑ ry❑
fL T CF.RTIFI ATE OF EXEMPTION FROM WORKERS, PERMIT ISSUANCE 10.00 / FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE PLG.CONTR. LIF NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
hundred dollars IS 100)or less.) _
0 O 1 certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL j- mil is issued,1 shall not employ any person in any twiner so as to
0 W became subject to the Workers Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
emption,you should become subject to the Worked Compensation APPLIANCE 5.00 PLAN CHECK p
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNITIOVER 10p00C.F.M.) 6.00 SEISMIC FEE 0a9
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name Security Pacific
Lender's AddrcNan rrl FICINUU, k1h HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 76 �
,1,certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING (b
ordinances and state laws Tainting to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 1/3
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) Agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 O CONST.TAX
may in any way accrue against said City in consequence of she
grantmgo I rt. MECH.CONT. LIC NO. MECH.
�/e 7 TOTAL . TOTAL
Signa ur ppleant/Contractor
OFFICE COPY '