13768 (2) POST`THIS.CARD NEAR',FRONT OF BUILDING
1' PERMIT NUMBER
CITY- OF CUPERTINO "
'INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
C
JOB,ADDRESS
OWNER l�J,l 1 "�U��IS�' �I •UNIT# ,LOT# �^' ,1 x
.PERMIT EXPIRES IF WORK .a'+2 Fsc � C �[)L1 CONTRACTOR IS NOV STARTED WITHIN.
•" '-1 C'
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n - -INSPECTION ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION , ' c[=� .- LAST CALL EDfNSP ECTI ON.'.
` UFER it
PERMIT VALIDATION
PREGUNITE ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL' SUANCE DATE
MECHANICAL L LEcr. .PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI ING P?RM1T I
x , WOOD FLOOR INFORMA ION
PLUMBING . 1 VALUATION, - S/RT.'
'..
MECHANICAL '
' 'PERMITTO
ELECTRICAL .'47
00M
FRAMING
INSULATION 'STORIES J TYPE CONSTR.
CC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
2:
'
ROOF SO FT FLOOR AREA TOTAL ACREAGE 'DIAPHRAGM ,l - ' R-3 '
BUILDING USE
?-(88l Ac
ZM IND CON TEl p-p'e
r•
APPLY110 0 ING UNTIL ABOVE HAS BEEN SIGNED
ROUGH W F ASSESSORSPARCELNO,
M �y a
- PLUMBING '
- s!• TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL - - 104 -
-ELECTRICAL - FINALS DA E S �Acfcr�.O'nrE ACC.FILE No.
FRAMING :- '' - _ _ SAN # '' {ZONING - ENG,SITE NO.
' INSU LATION;'.•�. PLUMBING
'6-.2 A GAS S i
MECHANICAL FIRESPRINK ENERGY '2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED , HEATING Sdd Y "� °•� "�
LATH-INTERIOR ,CT-$� ELECTRICAL y__ FLooO zoNE - A.L.u.c.
LATH-EXTERIOR �.?, .f FIRE DEPT. -Y❑ - N� YI]" N❑'
SHEETROCK •: . GRADE. FEE SUMMARY
SHEAR'INTERIOR - BUILDIN
SHEAR EXTERIOR 2.,:�i A&A TEMPORAIIY APPROVALS, BUILDING yf"^]� �
FIREWALLS, f. ELECTRIC - PLAN CHECK ! ;,•
. GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE /,• �'�
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM -
"ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC /e
o� tONE WORKING DAY BEFORE REQUIRED INSPECTION PcuMBiNG.
Z :,'..PLEASE GIVE JOB,ADDRESS''WHEN PHONING ,,"
MECHANICAL �J
—
SEE PERMIT FOR EXPIRATION' DATE — n
IMPORTANT! '•, CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. ' _
_ - ',OFFICECOPtl _ -
an, R, y _ . ;i �` :fa- .•,.„ 1 'i 4 r - � Ufa
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_ APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES - USE BALL POINT PEN ONLY
. ., BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
.A DO . APPLICATION & PERMIT ^ ^�-
AOORESS 11511 Sunrise Springs Court I I b
(Lot 66 - Plan 4CR BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S I , PLAN CHECK VALIDATION
"s NAME - - OTY. ELECTRIC PERMIT FEE ` -
�. Gregory Group, Inc. PHONE 595-2100
CONTRACTOR'S
NAME 119 UTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Groups Inc. LIC N0.430097 LIGHTING FIXTURES 10.00/1.00 2
ADDRESS 220 220 Twin Dolphin Dr., Ste. C 3APPLIANCES-RESIDENTIAL 4.00 12
RedAOOd City, CA '94065 PHONE 595-2100 1 PANELS • 1 10,00 '1n DATE OF APPLICATION
ARCHITECT am Bassenian, A.I.A. & Assoc . PANELS (OVER 200AMP). 20.00 PLAN.CHECK FEE P.C.NO.
OR
ENGINEER
' LIC.NO.92660 SIGNS TRANS. 3.00
ARCH.OR ENG.3D90 LM170. SPECIAL CIRCUIT, 5.00 PERMIT VALIDATION
ADDRESS 39% Westerly Place, /
NeIsiport Beach CA zip EMP. METER OR POLE INS. 20.00 .
ADDRESCANT's 220 Twin Dolphin Drive, Ste: C 6 MOTORS', - SEE FEE SCH.
ADDRESS D v(.✓'e,-IlJ -
Redmd Cft CA 94065 - SERVICECHANGE 20.00 pp�qq
w o O ' LICf:NSCD CONTRACTORS DECLARATION q TYe�+'f
be v u I hereby affirm that I am licensed under provisions of Chapter 9 �l �� ISSUANCE DATE/
4 r z w (commencing with Section 7000)of Division 3 of the Business and
¢ n BLDG. ELECT. PLG. MECH.
.F Z,i Professions Co and my license is in full fort t.
z 0 0o- License Class_ Lic.Number
9 w r o Date - Contractor
i ¢ m f BUILDING PERMIT•
le Ie ¢ OWNER-BUILDER DECLARATION
o d u INFORMATION
X ; LL y I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD, uq
HLL � a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE - 10.00 '10
Code:Any city or county which requires permit to construct.alter,
SE Q ¢ 0 improve,demolish,"or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC, ooCC y�
n -y 0 ¢ requires the applicant for such permit to file a signed statement that TOTAL 186.00 EMIT TO
w he is licensed pursuant to the provisions of the Contractor's License
rz>
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe '
¢ Business and Professions Code)or that be is exempt therefrom and QTY. PLUMBING PERMIT FEE Sp I'M
¢ r $ the basis for the alleged exemption.Any violation of Section 7031.$ 1 STORIES SP I YPE CONSTR.
by any applicant for a permit subjects the applicant t0 a civil penalty ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars($500).): 2
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 DCC.GROUP PES.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
Code:The Contractor's License Law does not apply to an owner of R-1 property who builds or improves thereon,and who,does such work 13 _ FIXTURES'-,PER TRAP ' 5.00SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
meets are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1•INC.4 OUTLETS 6.00 6' 244D
or'improvement is sold within one year of completion,the ownGAS-EA.SYSTEM-OVER 4 IEA. .00
el. ) 2
builder will have the burden of proving that he did not build or im- 2' BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting w . .
with 9N ❑ ❑ ❑ ❑
licensed contractors 10 construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 6 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-�r-3/ 3�
contracts for such projects with a contractor(s)licensed pursuant t0 /CU
the Contractor's License Law. SEWER-SAN ITARY-STO RM EA.200ft/10.00 TRACT NO. PARCEL NO.
O lam exempt under Sec. ,B.&P.C.I'or this - WATER HEATER W/VENT 6.00
reason'
Owner Date WATER SYSTEM 5.00 5 ACC:DATE ACC.FILE NO.
WORK ERS'COMPENSA7'[ON DECLARATION WATER TREATING EQUIP. 5.00 ,
I hereby affirm that 1 have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See,3800,Lab.C.thlted PaCi /rt„11a�Ce�
Policy No, Company /RC
❑ Certified
'Op l' he' yForn' cd1 FIRE SPRINK ENERGY T-24
)b Certified ed . action division.
, Z p Applicant 'y MISC .REFER TO ORD. Y❑ N❑ Y ❑. N❑
~ w PERMIT ISSUANCE 10,00 10 FLOODZONE A.LU.C.
s CERTIFI E OF EXEMPTION ROM WORKERS'
Lu > COMPENSATION INSURANCE PLG.CONTE. LIC.No. PLO.
Z (This section need not be completed if the permit is for one TOTAL 115.00 Y❑ N❑ Y C] N❑
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
d Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING' �" J•-
},m NOTICE TO APPLICANT: If,after making this Certificate of Fi - �.1
Fz emption,you should become subject to the Workers'Compensation 4 APPLIANCE 5.00 20 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shalt be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 FEE 3
CONSTRUCTION LENDING AGENCY- - AIR HANDLING UNIT(OVER 10MOCAM.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 5
the performance of the work for which this permit is issued(Sec. o MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) '8.00 O
Lender's NameSerarl co HEATING UNIT(OVER 100,000B.T.U.)9.50
Lender's AJdress�aG�r�a�ll.$CO.CA ELECTRIC
1 certify that 1 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
O ordinances and state laws relating to building construction, and BOILER-COMPI3H.P,Or100,000B.T,U.) 6.00 6 !+.
hereby authorize representatives of this city llo enter upon the BOILEfl•COMP IOni,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. _v
(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 CONST.TAX
may in any way accrue against said City in Consequence of the 10 a
BOAR n tills Penni MECH,CONT. LIC.NO. MECH.
TOTAL
i �7 'S3 TOTAL X93.0.5
Signatiro,btApplicant/Co tractor
OFFICE COPY '