15821 POST.THIS CARD NEAR FRONT OF`BUILDING' PERMIT NUMEER
-CITY OF CUPERTINO 15821
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADD ESS '�l (a S'� Oft-l�-Sy�R ihi C' CT UNIT# _LOT,#�aa'o':` . '
��E&OQKp , PERMIT EXPIRES IF.WORK
+ OWNER' /lil L+ A CONTRACTOR
INSPECTION IS`NOT STARTED WITHIN.
INSPECTOR D
'
.DATE - INSPECT ON RECOR 180 DAYS OF PERMIT ISSU-
- - ANCE OR 180 DAYS FROM i
FOUNDATION .7 NOTE:' ` LASTCALLED INSPECTION. '
LEER 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 - , pR� ISSUANCEDATE
MECHANICAL , .. - - RLOC eLccr. PLG. MI:cH.
{ Z v 1 JM :
DO NOT POUR-FLOOR UNTIL ABOVE HAS BEEN SIGNED. aowG PERMIT
.Ot BfUI�U1NFORMATION
WOOD•FLOOR _ 1 _ VnwanoN SrFT.
.. PLUMBING
.MECHANICAL - - ' " '185 8615 '
- _ - PERMIT TO
ELECTRICAL
FRAMING -:r. .' - SFOU.IL .
r INSULATION - STORIES TYPE CONSTR.
2 - 5NHR
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR✓UNTIL ABOVE HAS BEEN SIGNED - - -
`
ROOF- NOTE NO FINAL INSP.SHALL BE MADE BEFORE ` -str,rr.FLooF AREA TOTAL FEncE
DIAPHRAGM - "A'' THE'CONSTRUCTION TAX IS PAID. ._ 9917
BUILDING USE
5` ROOF SHEATHING ,, - - - RES IND CON PB o
APPLYNO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. '
ASSESSORSPARCEL NO! "
• ROUGH . - SAN.N �
PLUMBING : v'lC _
/; ?3Z l9� ELECT.,ENERGY S'.
TRACT NO. PARCEL NO,
TUBS 8 SHOWER PAN 1$•$ PLUMBING ENERGY
MECHANICAL , 4.15
n Jw-iF '
ACC.FILE No.
- ELECTRICAL BUILDING ENERGY
FRAMING. - '31..8 ELECT.FINAL TEST '
ZONING ENG.SITE NO'
INSULATION. I PLUMBING - • . _
GAS TEST =z• �' GAS _
FIFE SPHINK ENERGY L}a .
MECHANICAL- --
_ COVER NO WORK UNTIL ABOVE HAS BEEN IG` EO HEATING _ [3 NO -I E]•, NE]
EXTERIOR SHEAR 3 ELECTRICAL RELEASE FL E):OOO zoNE A,L.u,c.
INTERIOR SHEAR FIRE DEPT. Y - N❑ vL N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING ' -' ' - -
BUILDING
' INTERIOR MATH .r'TEMPORARY APPROVALS '
SCRATCH:COAT . l[ ELECTRIC - PLAFEE CHECK 15,50
GAS' 2.
NO TAPE OR PLASTER UNTIL ABOVE HAS,BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY;OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ELECTRIC
uJ ARRANGE'FOR INSPECTION BY PHONING 252-4505,. 7Q 35.
l ' ONE WORKING DAY, BEFORE REQUIRED INSPECTION. PLUMBING
' O� PLEASE GIVE JOB ADDRESS WHEN PHONING.;
Z' MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE .=
IMPORTANT! coNST`Tnx . .
• PLEASE READ REVERSE SIDE BEFORE TOTAL ,
• - CALLING FOR FINAL' INSPECTION. '
.,: OFFICE COPY Z ,
APPLICANT TO FILL IN INFORMATIONVITHIN'RED. LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT IDENTIFICATION PERM IT rvumBER
no
'o°i"ss 3 an APPLICATION & PERMIT R/A1
11655 Oak Spring Court BUILDING-ELECTRICAL-'PLUMBING-MECHANICAL 1582
OWNER'S - PLAN CHECK VALIDATION
fQAN'E Gregory Group,' Inc.. SI CITY. ELECTRIC PERMIT FEE
Ahmanson Deva 4115'«695-210
CONTRACTORS - OUTLETS-.SWITCHES-RECEP, 10.00/1.00
"^""Gregory Group, Inc. B-430097
"LIGHTINGFIXTUR EB (' 10.00/1.00 . ,
CONTRACTOR
T4C
ADDR[(b�r s 220 C Twin Dolpphin Dr. APPLIANCES 2RESIDENTIAL 4.00
94065 P4D116-595-2100 PANELS - .10.00 DATE OF APPLICATION y
f ARCHrtECT PLAN CHECK FEE , P.C.NO.
OR Aram Bassenian, AIA & ASSU . _ PANELS (OVER 200 AMP) '20.00 -
ENGINEERu '
' c,No. C-8395 - SIGNS.TRANS. �' 3'.00 '
` PERMIT VALIDATION
ADDRESS ENG. 2031 Orchard Dr. #100 SPECIAL CIRCUIT 5.00 -
Santa Ana-' Hts� CA- Q97n7 EMP.METER OR POLE INS. 20.00 ID
APPLICANT S
ADDRESS MOTORS SEE FEE SCH. -
220-C Twin Dolphin 'Dr.RWC 9 065 SERVICE CHANGE 20.00.
0.
O LICENSED CONTRACTORS DECLARATION rL C
¢ u v I hereby aftinn that I mn licensed under provisions ol'CW"I"9 t - E DATE
H Q w (commencing with Section 7000)of Division 3,of the Business and B G. ELECT. PLG. 'MECH.
H m z Professions Code arq1QQ my licatse is in full force'( ,{([,(t,, ® P ISI
Z o m - License Class_D_Lie Nmnhcr 4I,J(Jey./ - - [ {..
o H w Dute Contractor _ t' -
aUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION IN
MISC. " f REFER TO ORI
w LL H I hereby aftinn that I am exempt from the Contmclor',License VALUATION
$/FT.
H LL O¢ Law for file following reason.(Se<.7031.5.Business and Professions • - PERMIT ISSUANCE 10.00
Code Any city or countywhich requires a permit to construct,alter,
' oCp R C
¢ ¢ a O improve,demolish,or repair any slructum,prior to its issuance,also ELEC.CONTR. LIG NO. _ ELEC City 0� GI Li6§6`/.
requires 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 Licenhu
oftse SFDUV L
s
iii Law(Chapter 9(commencing with Secliun 7000)ofDlvision3
OTY. 'f
a Business and Professions Code)or that he is exempt LhcrcGom-and x - PLUMBING PERMIT FEE' -
io
¢ H G the basis for the alleged exemption.Any violation of Section 703L5 STORIES TYPE CONSTR.
u3`= by any applicant l'or.I pemiit suM1jects the appliconnuucivil penalty ALTER-DRAIN&VENT-WATER-(EA.) 5.00 . . Z SNHR
of not more than I'ivc hundred dollars(5500).): -
❑ I,as owner of the property,or my employeeswith wages as BACK FLOW PROTECT. DEVICE- 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not ,
intended or offered lin sale(Sea 7044, Business and Professions DRAINS-FLOOR,'ROOF,AR EA,COND. 5.00
Code: The Contract.,'.,License Law does not apply to an owner of R-3 l
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himselfm et adends o'W.)o
mredforxsle.If,ed howevr,thbuildin GAS`EA.SYSTEM:1 INC.4 OUTLETS 6.00mms ore not in is soldoroffered for sale.IL however,the building 2917
.r imr will h v is soldwhin ane year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.1 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im RES IND CON PB DOI.,•.
prove 11,aso nee of the
INDUSTRIALWASTE INTER. 30.00
❑ d as owner of the property,he exclusively ec ( contracting with '❑ ❑ ❑ ❑''
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
and n owner of Codeproperty Conbuilds 's License s til docs not apply - p to tr owner of,property who builds tr improves then pursuant
who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 �' 6-O
contracts for such projects with a contructorls)licensed pursuant to
' the Contractor's License Law. - SEWER-SANITARY-STORM EA..200ft/10.00 •TRACT Na. PARCELrvo.
❑ tum exempt under Sec. .B,kRC.for thii' WATER HEATER W/VENT' 6.00 -
reason 8098
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPI:NSA1ION DECLARATION WATER TREATING EQUIP. .5.00
I hereby alfnn that I have a certificate of consent la sel Ginsure. - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a'certifieA -
copythe,e.f(Sec.3800,Lab.C.).United Pacific
Policy No-C.ntpany - -
O ❑ Certified copy is herebylu m,hs d. FIRE SPRINK ENERGY T24
Certified coy is fled with the 6q.inspection division.
Z p Applicant !? J MISC.- :REFER TO ORD. • - Y ❑ N❑' Y❑ N❑
f- rn "• PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u,O.,
ir - CIiRT'1I%CATIi OE EXEMPTION FROM WORKIiRS' t
LU > CONiPENSATION INSURANCE PLO.CONTE. LIG NO. - PLG. - Y❑ ra❑ Y ❑ N❑
CL 0 Inns section mi not he completed it the permit is for one - TOTAL -
D Z hundmddollars(S100)orlcss.)
U O 1 certify that in the performmace of the work for which Ibis pera QTY. MECHANICAL PERMIT FEE- - FEE SUMMARY
LL r- mit is issued,1 shall not employ any person in any Runner so as to _
U hecome subject to the'Workers Compensation Laws ul'Culifumid 94D.5D
O ku Date Applicant ALTER OR ADD TO MECH. ' 5.00 ' BUILDING
} W NOTICE TO APPLICANT': If,after makins this Certificate of fix- '
F Z eruption you you should become Subject mfile Wark,D'C.mPensatian APPLIANCE r ,"', -,5.00 - PLANCHECK- 15.50
provisions of [tic [.an., Code, you nmst IirrlhwiOl comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 %ener 62.00
CON'STRUCT'ION LIiNDING AGENCY AIR HANDLING UNIT(OVER 10)D000.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 perform:utce of the work for which this permit is issued(Sec. MICROFILM
3097.Civ.C.). Security Pacific - HEATING UNIT(TO 100,000 B.T.U.) '8.00. -
Lender'sName HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 70.35
Lender'sAddress_ -@�y�yy�(y�'.���r-M--/�fa _ _.
I ceNity that lhave read fills appllcationuW state that the above VENTILATION FAN (SINGLE) ",4.00 . -
information is correct. I agree to comply with all city'and county - PLUMBING• 70.35
ordinwtces and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
Vhereby aSlhmmc representatives of this city to enter upon the BOILER-COMP lover 100,000 BTU)SEE FEE SCM. MECHANICAL.
above-mentioned property for inspection purposes. _ 70.35
.(We) agree to save, indenmify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs aflWCATcnsw which PERMIT ISSUANCE i0 10.00 ' CONST.TAX
may in any way accrue against said City in conseyuenee•of the70
granting of th r L f ;
MECH.CONT. LIC.NO. - . MECH.
-
�" TOTAL . TOTAL
Signature of A pplicant/Contractor Data
OFFICE COPY