15840 I _ -
1 POST THIS CARD NEAR FRONT OF BUILDING gRMiT rvuMeER ,
CITY OF CUPERTINO 15840
INSPECTION DIVISION,
' JOB INSPECTION RECORGe-
MI�1�P/�Aye� C(�1 \ - 2 PERMIT EXPIRATION
JOB ADDR ESS `` •/� / ��^T'� T �' UNIT#' _LOT# ` 1Z
&Cp„Ep F . . PERMIT EXPIRES IF WORK
OWNER �,�_''v_KK QyV- CONTRACTOR 1�K�SIC�R'`C��JL( - ISNOT STARTED WITHIN I
INSPECTION DATE INSPECTOR INSPECTION RECORD leo DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION
y- NOTE: LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE _ TO COMPLY WITH THE APPROVED PLANS ANACITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS. �I11 \J
Qr�`
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB X101 f- E
PLUMBING,
ELECTRICAL ��y Ot ISSUANCE DATE .
tlLOG ELECT. "PIG. ,
MECHANICAL MECH
00-NOT POUR FLOOR Up ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING'
MECHANICAL - 194*540
ELECTRICAL - 4 - PERMIT 11
FRAMING SFDw L
STORIES TVPE CONSTR,
INSULATION
qpUCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
s7),E FL OR nREA—TOTtLACFEnGE
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 3047 ,
BOILDIUSE
ROOF SHEATHING _ REs Irvn CON
oN Pe om..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ASSESSORS PARCEL NO.
ROUGH SAN.N ,.
PLUMBING ELECT.ENERGY "�•'r _�ti
TUBS 8 SHOWER PAN Lf-� PLUMBING ENERGY *Kaci No. PARCEL No,
TUBS&SHOW,0�
MECHANICAL - MECH.ENERGY 8098
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMINGELECT.FINA L TEST zoNlNc ENG,SITE NO.
INSULATION PLUMBING
GAS TEST GAS
• - - MECHANICAL - FIRE SPRINK, ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . Y L N L ` L NL
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE :A,L UC,.
INTERIOR'SHEAR - FIRE DEPT. - v NL v L NL
.SHEETROCK —Z - GRADE - - FEE SUMMARY
EXTERIOR LATH- BUILDING . ,
INTERIOR LATH ^�j TEMPO RARY.APPROVALS • BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
.. GAS FFE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY • SEISMIC FEE
13.65
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC 71 13'
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 73.13
PLEASE GIVE JOB ADDRESS WHEN PHONING:
Z '
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX +
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
•. BU I LOING PROJECT I DENTIFICATI ON I i -PERMIT NUMBER
BUILDING APPLICATION & PERMIT [ /� 0
ADORE. Lot an J '#
11597 Cedar Spring Court BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
ONER'S PLAN CHECK VALIDATION
NAME WGregoryY' Group, inc. & OTY, •, ELECTRIC PERMIT - FEE
x Ahmanson Dev. 4,147595-2100
CONTRACTOR'S
NAM UTLETS-SWITCHES-RECEP 10.00/1.00
hregory Group, In.& NDB-430097 ILIGHTING FIXTURES 10.00/1,00
CONTRACTORS ppp L, APPLIANCES-RESIDENTIAL 4.00
AOOC 94066C Twin Do1DI111��Dr210 PANELS 10.00 DATE OF APPLICATION
ARRCH�IITEE,(Ci /SIY'IE5 IJ 5 PANELS (OVER 200 AMP) 20.00 -PLAN CHECK FEE P.C.NO.
ENGINEER Aram Bassenian, AIA & Asso
LIC,NO. SIGNS TRANS. 3.00
ARCH.OR ENG' rc ar r. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS 2031
Santa Ana Hts. CA. 9707 EMP.METER OR POLE INS, 20.00
APPLICANTS
ADO
MOTORS SEE FEE SCH.
0 C Twin Dolphin Dr.RWC 9406E SERVICE CHANGE 20.00
w
00 LICENSED CONTRACTORS DECLARATION
a i W I hereby affirmthat I am licensed under provisions of Chapter 9 ISSUANCE GATE
a a (commencing with Section 7000)of Division 3 of the Business andEECTPLG. MECH.
BLDG. ELECT.r w i Professions Code,and my license is in full force and effect. - PLG 11��
z0 0 w o License Class-B-Lic.Number_(�3009-7 ® ® 151 lPA
f w H j Date Comracmr -
a BUILDING PERMIT
¢ ¢w OWNER-BUILDER DECLARATION INFORMATION
w3 I hereby affirm that I am exempt from the Contractor's License MISC.- REFERTO ORD
c rn T4TTION $/FT.
u.o ¢ Lvw for the following reason.(Sec.7031.5,Businessund Professions PERMIT ISSUANCE 10 1 9$q 94 540
f � > F Code:Any city or county which requiresa permit to construct.alter, � ,
¢ s a 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.N0. ELEC.
i O ar requires the applicant for such permit to file a Signed statement that - TOTAL PERMIT TO
w $ m he is licensed pursuant to the provisions at the Contractors License ertlnu SFDU)
Hz >
Low(Chapter 9(commencingwith Section 7000)ofDivision 3 of the
¢ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER-IEA.) 5.00
of not more than five hundred dollars(S500).): . 2 5NHR
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP RES.UNITS
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
Code:The Contractor's License Law floes not apply to an owner of R-3 1
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
'• himself or through his own employees.Provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11 NC.46UTLETS 6.00 3047
or improvement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or ire RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE'INTER. - 30.00
❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors m 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 property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant toze&_
r
the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 8098
reason
Owner Date, - WATER SYSTEM' 5.00
ACO.GATE ACC.FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. - 5.00
I hereby affirm that I have a certificate of consent to sel6imure, - ZONING
or a certificate of Workers'Compensation Insurance,or a c
lertified ENG.SITE NO.
copy(hereof(Sec.3800,Lab.C.). United Pacific '
Policy No. Company
Q ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z Z . $1 C- Y N
licunl V ❑. N❑Certified copy is riled with the city inspection division.
O AgMISREFER TO ORD. ❑ ❑
K to CERTIFICAT12 OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
L �_ COh1PF.NSATION INSURANCE PLG.CONTH. sec.No. PLG.
IL O (This section need not be completed if the permit is I'or one TOTAL Y❑ N❑', Y ❑ N❑
D Z hundred dollara($100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
- LL 8- mit is issued, I shall not employ any person in any manner so as to
O w become subject to the Workes'Compeasation Laws of California. BUILDING 972.00
y Date Applicant A licaALTER OR ADD TO MECH. 5.00
.} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLANfHECKgy 1 rj Cj�
provisions of the Labor Code, you must forthwith comply with FEE ener 6Z o
U such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10X0 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GEM.) 6.00 SEISMIC FEE 13.65
1 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 Securit Pacific
Lender's Address p7 it}�f_1- HEATING UNIT(OVER 100,000 B:T.U.)9.50 ELECTRIC 73.13
d ithi
Iccrtily thatl have ream'i'antl nate that the above VENTILATION FAN (SINGLE) 4.00 73.13
information is correct. 1 agree to comply with all city and county BOILER-CUMPI3 H.P.Dr 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, unit
hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes. 801 LER-COMP (Over 100,000 BTU(SEE FEE BCH. MECHANICAL 73.13
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperlino against liabilities,judgments, costs and expenses which CONST.TAX
ay in any way accrue against .Said City in consequence of the PERMIT ISSUANCE 10.00 Oj
ranting of this permit. MECH.CONT. - LIC.NO. MECH.
TOTAL TOTAL '
Signature of Applica ontractor Date
dFFICE COPY `t7
BUILDING INSPECTOR'S OFFICE `"o;.°°cop
CITY OF CUPERTINO
`k ❑ Bockflow Device_
ti Sanitary Permit No. ^� �
;r ❑ Sewer Connection Plumbing.Permit No.
•'rJ. Plumbing Final Lot No.
Owner or Tenant lY� � �O�\/ C-QO()p
At lI S9 � Tfna� SP2t �T
Tract
sDate Connected 19_Date Final '1—GG`ZJ 19
"• r VJ�n�S
o.
PLUMBING INSPECTOR
� r
t CITY OF CUPERTINO PC a e
COPY
GAS SERVICE NOTICE
c
, 19
To
You are hereby authorized to connect the GAS service for
r Owner or Tenant
a—7 &(?C)JFI
At I I C For � 1 i �F � r
` NewServiceX
No. of Meters Reconnect
,a
No. of Add. Meters Move Service
Move Meter
PLUMBING INSPECTOR _ '�C��S @�
I
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
i
To ? d � . 19
You are hereby authorized to Connect electrical service far
Owner or Tenant—, 6,\L -F9��1� y 6YC[_0UF'"
At
No.of Wires Size of Wires Size of Switch
Motor Load Voltage Phase
Heating Load K.W. Voltage
SFFP
No.of Meters ( L'ght 110_New Service Reconnect
OJ Near 140_Three Wire More Service
No.of Add.Meters Power Three Phase Move Merer
0• ELECTRICAL INSPECTOR