13775 I _ _
POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTINO 137?5
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS lel-1-13 UNIT# SLOT#
6_A0
` - - - PERMIT EXPIRES IF WORK
OWNER �Q CT/CO`f/ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION ATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE PERMrt VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB
PLUMBING _
ELECTRICAL - ISSUANCE DATE '
MECHANICAL a EC CT. PLG. , MECH.�. o
DO NOT POUR FLOOR UNTIL ABO E HAS BEEN SIGNED - ,/NG PERMIT
FORMATION'
WOOD FLOOR VALUATION lAHFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING - J✓,/1�
.STORIES TYPE CONSTR.
INSULATION
yak
N x 3 6 O� OCc.GROUP RES.UNITS
T 1 �
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF $O'FT.FLOOR AREA TOTALACREAGE
DIAPHRAGM
BUILDING USE
' HES IRU CON PB Olney
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED '11 El 0 El I
ROUGH
ASSESSORS PARCEL NO.
• ` _ �s
PLUMBING d - - '
GAS TEST -/ - TRACT NO PARCEL NO
MECHANICAL
ELECTRICAL FINALS E IN P. ACC.DATE ACC.FILE NO.
FRAMING - - -.�� SAN #/,jam
INSULATION PLUMBING
3 !?" ENING NG SITE NO.
L-sS 2/. GAS, 74<6 S
(,� C: MECHANICAL FIRE SPRINK ENERGY T 2
Y N❑ Y E] NQ
COVER NO WORK UNTIL ABOVE HAS BEEN IGNED HEATING .d•
LATH-INTERIOR - - ELECTRICAL FLOOD zorvE A,_.0.c.
LATH-EXTERIOR FIRE DEPT. Y❑ NE] Yo No
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR s BUILDING -
SHEAR EXTERIOR J` TEMPORARY APPROVAL BUILDING
FIREWALLS ELECTRIC PLAN CHECK -
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE z
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY 8 WILDING INSPECTOR: MICROFILM
uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
+ 1-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
. Z PLEASE GIVE JOB A16DRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL !
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL. "
CALLING FOR FINAL INSPECTION.
OFFICE COPY -
- ARPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING 11513 Seven Springs Lane APPLICATION & PERMIT
ADOREss
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL(lot. 72-Plan 2AR J
OWNER'5 PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
Gre or Group, Inc. PHONE 595-2100
NOMERAcroRs ka UTLETS-SWITCHES-RECEP 10.00/1.00 L
Gregory Group, Inc. LIC.ND. 430097 LIGHTING FIXTURES 10.00/1.00 l
CONTRACTORS 220 Twin Dolphin Dr. , IT" PPLIANCES-RESIDENTIAL 4.00
ADDRESS
Pcirlixinind City, CA: PHONE 595-2100 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE ,C.NO.
OR Aram Bassenian, AIA & Assoc PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.No, SIGNS TRANS. 3.00
ARCH.SS E"a. 3990 Westerly PI . , #170 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
Newport Beach CA zIP 92660 TEMP.METER OR POLE INS. 20.00
ADDRESS u I MOTORS SEE FEE SCH. /f
ADDRESS 220 Twin Dolphin Drive, C
Piedwood City, CA 94065 SERVICE CHANGE 20.00
,02
oo LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 wr ISSU ATE
Nay (commencing with Section 7000)of Division 3 of the Business end BLDG PLG. MECH.
D Profemions CWc,and my license is in full forp:.gg t.
i o v2 License Class D Le.Number '�tbt
Q m H Date Commctor
PO
-a BUILDING PERMIT
se Q OWNER-BUILDER DECLARATION INFORMATION
d o A ea =1SC7REFER TO ORD
w ; LL F I hereby affirm that I am exempt from the Contractors License VALUATION S/FT.
H u o t2 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter, /
oimprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELE0. CFb
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
was
he is licensed pursuant to the provisions of the Contractor's License
i Law(Chapter9(commencing with Section 7000)of Division 3 ofthe V
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 SeUion 7031.5 - STORIES TYPE CONST
a ; by any applicant for apeurnit subjects the applicant to a civil penalty ALTER-DRAIN&.VENT-WATER (EA.) 5.00 �,ny ,A(�
.fact more than five hundred dollars(55101.): ` \
❑ I,as owner of the properly,or my employers with wages az BACK FLOW PROTECT. DEVICE 4.00 DCC.GROUP RES.UNITS
their sole compenmtion,will du the work,and the structure n not /
intended or offered for sale (See. 7144, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 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 FIXTURES-PER TRAP 5.00 5o.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsareGetintendedoroffered 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- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
budder will have the burden of-proving that he did not build or RE IND CDN PB Omar
im-
prove for porpose of salt.). 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 p �_31 3.1 33
contrthe Conefor suchprojectswith acontnetnrts)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Cast sfo such
Liccrue Lew.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSA'TION DECLARA'IION WATER TREATING EQUIP. 5.00
I hereby alfrm that I have a certificate ofconsent to self-insure.
or a certificate of Workers'Compensation Compensation Insurance,or a certifwd ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.`,
Policy No. jun -ted_P_ac%Relaa.n
O ❑ Certifiedcop eba tishod. FIRE SPRINK ENERGY T 24
Z Z (X Certified n the city inspection division. MISC.- REFER TO ORD.
O Applicant_ - _ Y ❑ N❑ Y ❑ N❑
CC N - CERTIFIC Ii OE EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.LU.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC,NO. PLG. Y,❑ N❑ Y❑ NE]
O (This section need not he completed if the permit n for one TOTAL
Z) Z hundred dollars CS 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 I- mit is issued,I shall not employ any person in any manner so as to
Ow become subject to the Workers'Compensation Laws of California:Date Ali
BUILDING
a ppcant ALTER OR ADD TO MECH. 5.00
} w NOTICE '1'O APPLICANT: If,after making this Certificate of Ex'
FZ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE 3S1.3,j
CD such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M,) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE /0
1 hereby affirm that there is it c- atructlon lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. MICROFILM
3097,Civ.C.). Security Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50Zs
Lender's Address San-Fra nC�CA ELECTRIC
I certify that I 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
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize repre,cmatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL
abum-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep hamiless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX c K
may in an way accrae•against mid City in consequence of the
Plantln "� MECH.CONT. LIC.NO. MECH.
� TOTAL. / TOTAL 2 S�
Signa l west pontmctor i,Tc L/C�_ t
OFFICE COPY