13749 POST THIS CARD NEAR FRONT OF BUILDING
y ~CITY OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION 13749
i- JOB INSPECTION RECORD
p /� PERMIT EXPIRATION
JOBADDR �SO O c/ UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER /✓ CONTRACTOR IS NOT STARTED WITHIN
INSPECTIOW DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION I%-4.k-ft ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1PAID,
UNDERGROUND /SLAB
PLUMBING DEC3 01987
ECTRICAL ISSUANCE DATE
CHAN ICAL ,`E ipy�, Im, Pa ME.
D11�Y 5L+JMIV
DO NOT POUR ri nnA_IIIQTIf ABOVE HAS BEEN SIGNED LJ BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $/FT.
MECHANICAL $970000.0
PERMIT TO
ELECTRICAL
FRAMING ..-
STORIES TYPE CONSTR.
INSULATION
1A to 'linor3�-.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 50 FT FLOOD AREA TOTAL ACREAGE
DIAPHRAGM
RDILD USE
RES IND CON
P8 Olhxl
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ Cl ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST ' TRACT NO.
MECHANICAL
PARCEL NO
I..f!�
ACC.DATE .ACC.FILE NO.
ELECTRICAL ? Q dc FINALS DATE INSP.
FRAMING1rj p SAN n ao3
INSULATION 7-9-
PLUMBING ZONING ENG,SITE NO.
yd GAS
MECHANICAL ��i FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING i Y ❑ NC] Y ❑ IN
LATH-INTERIOR
ELECTRICAL _ FLOOD ZONE A.LU.C.
LATH-EXTERIOR - FIRE DEPT. Y❑ N❑ Y❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR :%+, BUILDING
SHEAR EXTERIOR -),ll ,.0 007
TEMPORARY APPROVALS BUILDING 424.00
FIREWALLS - P
ELLECTRIC LANEE CHECK
160.00
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 7 6.79
UCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUIL DING F INAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM f .
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ml-6
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL Alm
IMPORTANT! CONST.TAX 282.68'
PLEASE READ REVERSE SIDE BEFORE TOTAL $ 1.0434.07
CALLING FOR FINAL INSPECTION.
OFFtCDCdPY - '
APPLICANT TO Fi,LL INJNIF013MATION WITHIN RED LINES - USE BALL POINT PEN ONLY
ye BUILDING PROECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER
A.1OENO LOT //44 PLAN lAR
' x5
115 _
' 1 83 Mornin Sorin Court ` BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13749
h OWNER'S • PLAN CHECK VALIDATION
NAME GREGORY G (415/ROUP, INC.
QTY. ELECTRIC PERMIT FEE
PHONE 494 -2100
NAME CONTRACTORs 86 UTLETS-SWITCHES-RECEP 10.00/1,00 86.00
NAME
Same LIG NOB
-430097 18 LIGHTING FIXTURES 10.00/1,00 18.06
ADORE crags '22pp_CC 3 APPLIANCES-RESIDENTIAL 4.00 12,00
aRWCS CA294065Twin Dolph' E05- 1 PANELS 10,00 10.00 DATE OF APPLICATION
ARCHITECT ARAM BASSENIAN, AtAvu PANELS(OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER CIATES
Lt..NO. ISIGNS TRANS. 3.00
ARCH.OR ENO. 3990 Westerly Place 170 SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
Newport Bch CA. z P 92660 TEMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS 6 MOTORS SEE FEE BCH, '6.0 JUd7 �JL�
SERVICE CHANGE 20.00 �+J`
w O o LICENSED CONTRACTORS DECLARATION 9 01987
¢ u u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
z m Scommencing with Section 7000)of Division 3 of the Business and g�pG PLG. MECH.
w Professions Code,Bid my license is in full force and effect. wr s•E! ❑ ❑
2 °=- License Class Lic.Number 7 x� .•h•
9 w H ° Date_ Contractor LJ
¢ m ¢ a a
OWNER-BUILDER DECLARAT BUILDING PERMIT
lE d u INFORMATION
X H I hereby affirm that I am exempt from the
Contractor's License MIBC.- REFER TO ORD
a D.D VALUATION SIFT.
i° u O¢ Law for the follower reason.(Sec.7031.5,Business and Professions T 10.00
H w ! PERMIT ISSUANCE
E w> 2 Code: e,demolish,
cor ntyir any requires ep prior ttoconsuancalter, $9J 000.00
2 ¢ ¢ O improve,demolish,or repair any structure,phos to its issuance,also ELEC.CONTR. LIC.NO. ELEC. s
wteU. requires the applicant for such permit t0 file a signed statement that TOTAL 142.00 PERMIT TO
m a he is licensed pursuant to the provisions of the Contractor's License
H z a
Law(Chapter 9(commencing with Section 7000)of Division 3 of the If/=AW�
f 4 ° Business and Professions Code)or that he is exempt thercfrom and QTY. PLUMBING PERMIT FEE
X H B [he basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 - by any applicant fora permit subjects the applicant oacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 �N
of not mote than five hundred dollars($500L).
11I,as owner the property,army my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
(S
inter sole compensation,will the work,and the structure is net
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply loan owner of
property who builds or improves employees,
pr and who taus such work 11 FIXTURES-PER TRAP 5,00 55.0 SD.FT.FLOOR AREA TOTAL ACREAGE
himselforthrough his own employees,providedthat such improve' 1 GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 6.D
mems are not intended or offered y sale.If,mpleveD the builder
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he ted not built or int- BUILDING USE
prove for purpose of lief' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Olnat
❑ d as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct for project(Sec. 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 gSSESSORS PARCEL NO.
and Professions Cote:The Contractor's License Law does rat apply /
toan trowner ofproperty who builds trimproves thereon,and who LAWN SPRINKLERS-OVER 5IEA.1 1.00 36 �- 3 �Oi 33
contracts actor's h projects with a contractora)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00
the Contractor's License Law. 1 10,0 TRACT N0. PARCEL N0.
❑ I am exempt under Ser..,B.&P.C.for this 1 WATER HEATER W/VENT 6.00 'I6(�f1
reason / /
Owner Date 1 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 of Consent to self-Insure. ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a Certified
copy thereof(Sec.3800,Lab.C, At / Q
Policy No. Company United Pacific
0 ❑ Certified copy is herby tum shed, FIRE SPRINK ENERGY T-24
Z ZO p; Cerii(ied file)_ he city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Ap-plican[ ' V N Y N
Lo CERTif Thi 01:EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 10.0 FLOOD ZONE A.L.u.C.
L COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
::) Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per. OTV 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 Workers'Conhpensation Laws of California.
a Dale ApplicantBUILDING
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 42400
? emption,you should become subject to lite Workers'Compensation 4 APPLIANCE 5.00 20 PLAN CHECK 275.60
provisions of the Labor Code, you must forthwith Comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 Fnprqy 160.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.FM.) 6.00 SEISMIC FEE 6.79
1 hereby affirm that there is a construction lending agency for I EXHAUST HOOD(WITH DUCT) 5.005.0(-- ;. -
the performance pf the work for which tpis permit is issued(Sea MICROFILM -)
3097,Civ.C.). JaCy`g(OentO SjyL H EATING UNIT(TO 100,000 B.T.U.) 8.00 ---
Lender's Name H EATING UNIT(OV ER 100,000 B.T.U.)Lender's Address i ELECTRIC 14„2.00
I certify'list I have sea S 1pp la bn a I sae hal the above2 VENTILATION FAN (SINGLE) 4.008-n
information is correct.I agree to comply with all city and countyPLUMBING 92,.00
ordinances and state laws relating to building construction, and BOILER•COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTUI SEE FEE SCR. MECHANICAL
above-mentioned property for inspection purposes. '511.00,
(We) agree to save, indemnify and keep bmmlCss the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses which CONST.TAX 282 68
may in any way accrue against Said City in consequence of the PERMIT ISSUANCE 10.001 1 Of
granting of thispet il. MECH.CONT. LIC.NO. MECH.
/ A / TOTAL 51.00 TOTAL $ 1 ,434.07
Signature olOpplicam'/Contractor D e l
OFFICE COPY