13747 POST THIS CARD NEAR FRONT OF BUILDING
PFR%IIT NUMBER
' CITY OF CUPERTINO
- INSPECTION DIVISION 13747
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADD S��v ' J, �� '"'�' UNIT# LOT#
'- .- - - - PERMIT EXPIRES IF WORK
OWNER �j(/� CONTRACTOR ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTIO.N RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION -Z2- - lJj �_4O '6��Q7'� ANCE OR 180 DAYBrROMTI
LIFER - _ W ((�� LAST CALLED INSPECTION.
Q RX�.
((11,�� pp PE�RLM,IT�VALIDATION
PR EGUNITE (�...��` O Q,�ry,p•� A✓J.,�4.u.1 ,G'-\ rrr� •
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED LLI _1Q--®® $o[-lEA �U. 0Er. 8`R�
UNDERGROUND /SLAB yac I• n
PLUMBING
ELECTRICA- p ISS ANC ATE
MECHANICAL - RLOG. ELECT. PLG. MecR,
El
D NOTYOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT..
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO ,
FRAMING I-I , •I / /
INSULATION " STO.IRIES -- TYPE CONSTR.
_ J A
OCG GROUP RES.UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 5(l.FI.FLOOR AREA TO TAL ACREAGE
_ BUILDING USE
RES' INDCON PR Olnr,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ❑ ❑
"ASSESSONS PARCEL NO,
ROUGH
PLUMBING
"TRACT NO. PARCEL NO. w
GAS TEST b
MECHANICAL i
ELECTRICAL rJ7-b" FINALS DATE INSP. ACD.DATE ACC.RILENo
-
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION 894PLUMBING �L
nn fl. GAS - - ' ,
Lqjgv MECHANICAL -t,86 FIRE SPRINK ENERGY T-74
COVER NO WORK UNTIL ABOVE HAS EEN SIGNED HEATING Y O NE Y ❑ "�
FLOOD ZONE A.L.U.C.
LATH—INTERIOR ELECTRICAL 6
LATH—EXTERIOR FIRE DEPT. Y❑ N[] Y ❑ NQ
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
455 50
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE If p
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE -t
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252'4505, ELECTRICjAq
O� ONE WORKING,DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN.PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
rr nn
IMPORTANT! CONST.TAX 282.68
PLEASE READ REVERSE SIDE BEFORE TOTAL S 1 ,497.8!
CALLING FOR FINAL INSPECTION.
OFFICE COPY -
�• ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTORS NOTICE
CITY OF CUPERTINO
70
You are hereby authorized
''to Lonnect electrical service for �� 5
Owner or Tenant I �lUb F(:�1..�..GQEF{C SP2lwg cj
At C-a�ha22Q G pcuP
t
No,of Wires Size of Wires Size of Switch
Motor Load Voltage Phase
Heating Load K.W. Voltage
�/
Light J� 1j110 New Servlce ` Reconnect
No.of Meters
.Heat 120 Three Wire More Service
No of Add.Meters Power Three P�has�es , y/� l�j—Move Meter
�"
ELECTRICAL INSPECTOR S — `-�/r
1! OFFICE
CITY OF CUPERTINO COPY
GAS SERVICE NOTICE
0CIT 1 til , 19
To
You are hereby authorized to connect the GAS service for
Owner or Tenant ��A"?y G--poC.) p , .y, , .1
At I ( "roto SF�Zrq,x CT'
J
New Service X
No. of Meters Reconnect
No. of Add. Meters Move Service
IIrr(n� IJMove Meter
PLUMBING INSPECTORVl 'Ca
`� • ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO q (�
oG\ ((1 l . 19 �J✓
To
You are hereby authorized to Conned electrical service for �* S
( Owner or Tenant i 5 'V(l F(� CQF,I,{c Sf'2ifJq cl
At G-EZr 0102 v G-7cl
No.of Wires Size of Wires Size of Switch
Motor Load Voltage Phase
Heating Load K.W. cVoltage
P
No. of Meters Light J �I 10_New Service _ Reconnect
{ Heat 120Three Wire More Service
No.of Add.Meters (1 Power A Three
ePPhase Move Meter
ELECTRICAL INSPECTOR
�( ��
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT ADDRESS Lot AT Plan 2BR
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER s PLAN CHECK VALIDATION
NAME 415- QTY- ELECTRIC PERMIT FEE
GREGORY GROUP, NB
CONTRACTORS
NAME 2100 9D UTLETS-SWITCHES-RECEP 10.00/1.0090.00
Same LID.No. B-430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
°DRESS 220-C Twin Dolphin Dr. GO
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHI CA 94065 • PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMPI 20.00
ENGINEER ARAM BASSENIAN>LIMA & ASSOC<
`sf� SIGNS TRANS. 3.00
..DREn 3990 Westerly Place #170 SPECIAL CIRCUIT -5.00 MITVALIDATION
zIP EMP.METER OR POLE INS. 20.00 /� q
;Nm
NT's MOTORS SEE FEE SCH. C 3 y91J8�
ADDRESS 2 - Twin Dolphin Dr. /L
SERVICE CHANGE 20.00 of
w o o LICENSED CONTRACTORS DECLARATIONISSUAN
a U I hereby affum that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing on wsith Section 7000)of Division 3 of the Business and
a ,aA BLO ELECT. PL❑G, MECH.
F �z Professions Cale,a my license is in full foot
z o a`3 - License Class_ _Lic.Number
o m of Date Contractor_
a ><f I BUILDING PERMIT
a ¢ OWNER-BUILDER DECLPION
Z S a' v INFORMATION
A 3 LL H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION S/FT.
F u o`� Law for the following reason.(Sec.7031.5.Bmiaessand Professions PERMIT ISSUANCE 10.00
Code:Any city or tounty which reyuin s a permil to construct,alter,
¢ a Q 0 improve,demolish,or repair any stmclum,prior to its issuance,also ELEC.CONTR. LIG NO ELEC.
o tc require the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
Hii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ F O the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
s ; � by any epplic.at far a permit subjects life applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more Ilion five hundred doll.,(S500).):
❑ 1,as owner of the moperty,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
tended or offered for sale (Sec. 7044, Isusiness mad Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 /� /
Coda'rho Contractor's Licenw law does not apply to un owner of -
property who builds or improves Thereon,and who docs'such work' FIXTURES-PER TRAP 5.00 sa Fr.FLOOH AREA TOTALACREAGE
himself or through his own employees,provided that such haprove-
mcntsarcnotintended or offered for sale.It.however,the building GAS-EA.SYSTEM INC.40UTLETS 6.00
or lder will have
is e b within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the bonen of proving that be did not build or ism- BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 E^ IND CON PB Om.,
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the mmr,t(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 1 ASSESSORS PARCEL NO.
and Professions Code: the Contractor's Litems Law Law does not apply
to on
an owner of property who builds or improves there ,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 -
"a tracts for such projects with a contortions)licensed pun ianl To ` 3
the Contractor,License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARC NO.
❑ Inco exempt under Sea ,B.&P.C.Wr this WATER HEATER W/VENT 6.00 1 y��
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACL.FILE NO.
WORK IIRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate ofmnxnl to wIf.insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified l'
copy thereof(Svc.3800,Iab.C.). * .za1
Policy No. Company_UR-i-�ed-Pae-rf-lc
❑ Certified copy is hereby furnishc FIRESPRINK ENERGY T 24
Z ZQ MISC.- REFER O
CerUf d co Ile the c'ty inspection division. TRD.
O A)3(licant- /`J Y❑ N❑ V ❑ N❑
~ w s PERMIT ISSUANCE 10.00
Lu - CER'rIF COMPENSATION
EKEMPTION PROM WORKERS' FLOOD ZONE A.L.u.c.
W 7 need not be completed
INSURANCE PLG.CONTR. LIC.NO. PLQ • V❑ N❑ Y❑ N❑
Z) Z hundred
section)lr, e J not be completed if the permit n for one TOTAL
hundred dollars IS 1001 or ILvJ
U O 1 certify that in the performance of the work for which Thi Per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL f mit is issued,I shall not employ any person in any manner so as to
O w become subject to the Worker;Compensation Laws of Califomla.
C1. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F.. Z emption,you should become subject to the Workers Compensation A APPLIANCE 5.00 on nr PLAN CHECK
provisions of the labor Code, you most forthwith comply with FE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10MOC.F.M.) 4.00 _
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=0GEM.) 6.00 SEISMIC FEE 77 63-
I hereby affirm that there is a construction lending agency for I EXHAUST HOOD(WITH DUCT) 5.00
the Performance of the work for which this permit is issued(Sec. MICROFILM
3097'Cw.C.). Sacramento 5&L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.19.50 ELECTRIC
Lender's Adder r� sea -or-d-St.- -10 0
information
that RKreada reee to comply and sIflate c ty at d abovecounty VENTILATION FAN (SINGLE) 4.00
information i correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to builJing construction, and BOILER-OOIJp(3 H.P.or 100,0006.T.U.) 6.00
hereby entioedc representatives troves of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE F EE SCH. MECHANICAL
above-mentioned property forinsp of this
purposes.
(We) agree to save, indemnify unit keep Immlless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMITISSUANCE 10.00 CONST.TAX
may in any way accrue,against said City in consequcncc of the 282.68
granting ofthis MECH.CONT. LIC.NO. MECH.
OhoP TOTAL I TOTAL $ 1 ,497.89
Signature of icanf/Contractor at 55.00
OFFICE COPY