15825 POST THIS CARD NEAR,FRONT OF BUILDING "
PERMIT
1NUMBER
5825
CITY OF CUPERTINO "
INSPECTION DIVISION
JOB INSPECTION RECORD
1l,., �p PERMIT EXPIRATION
JOB ADDRESS `�/ `�"'�T`� UNIT# _LOT# '
`QCDU�
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR 4gvm�-'� •IS NOT STARTED WITHIN '
INSPECTION DATE INSPECTOR INSPECTION RECORD leo DAYS DF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
LIFER •,/, ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE Dare '
MECHANICAL BL
D
G ELF , PLG. NECH.'
DO NOT PIOUS FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
W - INFORMATION .
WOOD FLOOR
OV VALUATION .SIFT.
PLUMBING 14 `
MECHANICAL' -- •865 L
PERMIT TO
ELECTRICAL I134
_
FRAMING 1,1 SFDU H, -
STORIES TYPE CONSTR.
- INSULATION
2
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
lU,lT.FLUORAHEA TOTAL ACREAGE
ROOF - NOTE: NO FINAL INSP,SHALL BE
TAX IS PAID ADE BEFORE 2917
DIAPHRAGM THE
eulLnlrvc USE
ROOF SHEATHING '2)41 • o Rki ES IND ❑N 11 ED
NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS :. DATE INSP. Assessoas PARCEL No
ROUGH SANAf
PLUMBING -zQ-9wi ELECT.ENERGY' 3&w -1 I
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY. 8098
ELECTRICAL - Q BUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING _ _ Ln ELECT,FINAL TEST
ZONING ENG SITE N0.
INSULATION PLUMBING
GAS TEST. - -RR GAS
FIRE SPRINK ENERGY T 24
MECHANICAL Y No Y 11 m0
COVER NO,WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR , ELECTRICAL RELEASE - FLOOD zorvE ALuc
INTERIOR SHEAR �,3 FIRE DEPT. YC � NE Y ❑ N❑
SHEETROCK - C� GRADE FEE SUMMARY
EXTERIOR LATH -�j- BUILDING >•
INTERIOR.LATH - q TEMPORARY.APPROVALS BUILDING SCRATCH COAT - ELECTRIC - PLAN CHECK 15.50'
GAS FEE 62.00
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC F1302
EE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. ' MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
`
UJ
ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. 70.39
— SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! coNST.TAx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY /S39Ao-
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN.ONLY
y_BUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER r
a9DIQLq°EI"�G o an APPLICATION & PERMIT 15825
1°IbLa7 Cedar Sprtng Court BUILDING -ELECTRICAL-PLUMBING=MECHANICAL r
0;MER'a----Gregory Group, Inc. & PLAN CHECK VALIDATION
Ahmanson Dev. 41�ZA95-2100 OTY. ELECTRIC PERMIT FEE
a CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group,InipIL,NP-430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S - win Dolphin Dr. APPLIANCES-RESIDENTIAL 4.00 '
ADDREShwc 94065 PHONE415-595-21 U PANELS 10.00 DATE OF APPLICATION
on
ARCHITECT Aram Bassenian,AIA&Assoc. PANELS (OVER 200 AMP,) 20.00
20.00 PLAN CHECK FEE ?.C.NO.
ENGINEER
LID.ND.0-8395 SIGNS TRANS. 3.00
AARCH.OR
DDRESS ENG. 2031 Orchard Dr. 100 SPECIALCIRCUIT 5.00 PERMIT VALIDATION
Santa Ana Hts. CA. 92707 EMP.METER OR POLE INS. 20.00
AP�PjMU1CpAjNr'$ - MOTORS SEE FEE SCH.
ALGV=C Twin Dolphin Dr.RWC94065 SERVICE CHANGE 20.00
D o O LICENSED CONTRACTORS DECLARATION
a v C I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
m< H (commencing with Section 7000)of Division 3 of the Business and BLDG.. ELECT. PLG. MECH.
o Professions Code,a m license is in full force a
Z, i N
w License Class Lic.Number 4 UUy]
F m H J Date Contractor
a se a < BUILDING PERMIT
¢ OWNER-BUILDER DECLARATION ��
a Q u,U INFORMATION '
w3 a I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
r =o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VugT[ION S/FT.
Code:Any city or county which requires a permit to construct,alter, •'SI �k�OJ((J
u,Q Improve,demofish,or repmr any structure,prat to its Issuance,also ELEC.CONTR. LIC.NO. TELE C.
-U u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions or the Contractor's License ( Cupertino
Hz> Law(Chapter 9(commencing with Section 7000)of Division 3 of the SFDUJL
Q Business and Professions Code)or that lie is exempt therefrom and QTY. PLUMBING PERMIT FE
r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
La by any applicant for o permit subjects the applicant too civil penalty ALTER-DRAIN III VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).) 2 5NHR
CI 1.as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 CC.GRO
OUP 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,AR EA,COND. 5.00
Cade:The Contractor's License Law does not apply to an owner of R-3 1
property who builds or improves thereon,and who does such work FIXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
�� menu.me not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 2917
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES- IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 T�
Cl 1,as owner of the property,am exclusively contracting with 11 ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business 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 - w/p
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 ��rr
the Contractors License law. TRACT NO. PARCEL NO.
❑ .I am exempt under Sac,-,B.&P.C.for thisreason WATER HEATER W/VENT 6.00 '8098
Owner Dale WATER SYSTEM 5.00
ACC.DATE -ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate orconsent to self-insure, ZONING ENG:SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(See.3ROO,Lab.C.1'United Pacific
Policy No. Company
10 ❑ Cetliliedcopyisberebyfurnished. FIRESPRINK ENERGY T24
Z Z X Certified copy is filed with the city inspection division.
O Applicant - - MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
Fy
CC - CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
Lu > I COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG,
d O ('chis section need not be completeo if the permit is for one TOTAL Y[:] IN C] Y ❑ ry❑
Z 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 I- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
O y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 940.50
} w
NOTICE'FO APPLICANT: If,after making this Certificate of Ex-
F Z caption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 5.5D
provisions of the Labor Code, you must forthwith comply with FEE /energy U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 62.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 13.02
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,Cv C.). Security Pacif;c HEATING UNIT(TO 100,000 B.T.U.) 8.00
Landers Name 70.35
Lenders Addrer��1-"CQ�TTT -1 HEATING UNIT(0 100,000 B.T.U.19:50 ELECTRIC '.
I 1 certify that I have read 5 appfdreW;d state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING ]0.35
ordinances and state laws relating to building construction, and BOILER-COMP13 H.P.Pr 100,000 B.T.U.) 6.00
hereby'authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 STU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
.(We70,15
) to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperfino against liabilities,judgments, costs and expenses which CON T. AX0 j
ayx,in any way
accrue again t said City in consequence of the PERMIT ISSUANCE 10.00 -
inn6ngofthispermit MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL '
Signature of Apphc onttactor Data
OFFICE COPY � 9�-�