15000 POST THIS CARD NEAR FRONT OF•BUILID ING PERMIT NUMBER'
CITY::OF CUPERTIN0 - = 15040-�'`
°r INSPECTION,DIVISION
JOB INSPEC'iION RECORD
,PERMIT EXPIRATION
JOB ADDRESS � - (`"� - �I I ��'S%(k-r'` ; `�' 'UNIT# _LOT#
PERMIT EXPIREVIF WORK
owrvEN 'C 1 L � �[ ��� CONTRACTOR, i n ISNOT STARTED WITHIN
INSPtCTION DATE I INSPECTOR ^INSPE^TIO RECORD 180,DAYS OF PERMIT.ISSU
FOUNDATION, ANCE OR 180 DAYS FROM
NOTE:. LASTCALLED INSPECTION.--
LIFER 8 - - ALL GRADING AND.DRAINAGE SHALL BE INSTALLED -
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF ,PONC1u VALIDATION
CUPERTINO STANDARDS. - -
GARAGE SLABS -
' ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,.
'UNDERGROUND /SLAB - " ,,' ti , 1�0- '( •T �%
PLUMBING �2-' -� . ,
- ELECTRICAL - 15SI."DAiE
- MECHANICAL ility, BLDG 'FLEcr. PLO. mcCH.
• _
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED c..' BUILDING PERMIT[X
INFORMATION
-WOOD FLOOR• VALUATION SIFT.
PLUMBING : I '
MECHANICAL r r -
. M1III i0
ELECTRICAL
FRAMING
. sroNlFs rvPE corvsrN. -
INSULATION
- _ 2 m
OCC.GROUP NES.UN l 15
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3 • .L
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE So' r `LOON AREA rorAL ACREAGE
DIAPHRAGM' . THE CONSTRUCTION TAX IS PAID, 6
ROOF SHEATHING `� .. C N"SE
RES' IND
CON- P9 OR-,APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS � . DATE INSP. � 1-1 L L 11
n55E550NS PARCEL NO
• ROUGH - SAN.# _
PLUMBING ..I 2 L ELECT.ENERGY: K y. '" "
TU �SHOWE P PLUMBING ENERGY
- rNnci NO, PARCEL No
MECHANICAL . .. - MECH.ENERGY , ACC.wle No
ELECTRICAL BUILDING ENERGY
FRAMING - _ - • ELECT.FINAL TEST zowNc ENG.SITE No.
INSULATION ,. �' - PLUMBING
y- GAS TEST rj_ " GAS
_ FIRE SPRINK LNLNGV I 24
MECHANICAL
' COVER N WORK UNTIL ABOVE HAS BEEN SIGNED HEATING • y A❑ V t]'• NL
:
EXTERIOR:SHEAR ELECTRICAL RELEASE aooD ZONE AL.U.C.
INTERIOR SHEAR FIRE DEPT. - - v �L L 'NL
SHEETROCK. O GRADE _ FEE SUMMARY
EXTERIOR, LATH O "• BUILDING -
,INTERIOR LATH 9 cic6i TEMPORARY APPROVALS ' BUILDING'
. 'SCRATCH COAT ELECTRIC PL"A N,CHECK -916.00 I
FEE
. GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ,` SEftefff 62
.00
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 12.53
ARRANGE FOR'INSPECT.ION BY PHONING 252-4565, ELECTRIC-
Lu
LECTRIC
< F- ONE .WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING •58
in o�' PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL 68,58
SEE PERMIT FOR EXPIRATION DATE,=
IMPORTANT! ' . CONST.TAX 6.8'.58
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION-. TOTAL
OFFICE'COPY 10.
APPLICANT TO FILL IN INFORMATION WITH IN.RED LINES,-, USE BALL POINT PEN ONLY
BUILDING PROJECT4 DENTI FICATION PERMIT NUMBER
APPLICATION'& PERMIT
ADORE55 11708 Olive Spring Court 1' _�.� 00
nDNG,
_ - BUILDING - ELECTRICAL-PLUMBING-MECHANICAL k
regory broup Inc. PLAN CHECK VALIDATION
NAME
Ahmanson Dev. 41QTY. ELECTRIC PERMIT FEE
,5Ho�E95-2100 .
r CONT ACTORS
NAME OUTLETS-SWITCHES-RECEP, 10.00/1.00
Gregory Group Inc. L,C NO,B-430097 LIGHTING FIXTURES 10.00/1.06
CONTRACTOR'S - - win0 p In Dr. APPLIANCES-RESIDENTIAL 4.00
,. ADDRESS RWC 94065 415J/5�5/2100 PANELS 10.00 DATE OF APPLICATION
OpIN
CRrTECT Aram' Bassenlan,AlA &. A(s,soc.. PANELS (OVER 200'AMP) - 20.00 PLAN CHECK FEE P.C..NO:
ENGINEER LIC C-8395
c.rvo / iSIGNS TRANS., � 3.00
AARCH OR DDRESS ENG 2031 Orchard Dr. #100SPECIALCIRCUIT 5,60 PERMIT VALIDATION
Santa Ana Hts,CA. • 92707, TEMP.METER OR POLE INS.- 20.00
APPLICANTS' MOTORS ' - SEE FEE SCH.
ADORES
` X20-C Twin Dolphin Dr. RWG 94 �/,v�e2f:�-'tom-•
P SERVICE CHANGE 20.00
w'o o LICENSED CONTRACI'Ok5 DIiChARKf10N
Q U v 1 hereby affirm that 1 am licensed under provisions of Chapter 9 'DEC 13 r� ISSUANCE DATE
vi G m Icu,nmene,ng with Section 7000)of Division 3 of file Business and ,,, BLDG. . ELECT, PLG. MECH. _
H Piz. License Cls Code,anA.8 license is in full force an3d crfe9c 7�-
z o H - Liccnsc Clan Lic.Numhcr
om F w Date Contractor_ City
¢ m MIT
z sr OWNER-BUILDER DECLARATION. _ BEV 'CUpQ�I BUILDIRMATING N
s o a° MISC.- ' REFER TO ORD INFORMATION
wLL y 1 IcebY affirm that I am exempt from the Contractor's License
u0a Law for the following reason.(Sec.7031.$,Businessand Prol'esslons PERMIT,ISSUANCE 10.66 VALUATION'
� - Code n
Anycity nrcounty whichrequiresapermit loconstru ,alter, '178 281
a,< 2O m
improve,deolish,or refill any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC, 1 '
n
- O¢ requires tint applicant for such permit to file a signed statement that TOTgL PERMIT TO
wm he is licensed pursuant to the provisions of the Contractor's License - - �C.,y
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe I W -
- a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ Fo 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 -WATER IEA.) 5.00 2 'SNHR
of not more than five hundred dollar,(S500).),
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GHOUP RES.UNITS
their sole compensation,will do the work,and the structure,s not -
intended or offered for sale(Sce. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND.. 5.00 R-3 ' 1
Cade:The Cnn toavHu',A.icense Law docs not apply to an owner of -
propertywhobuildsorimprovesthereon.and who does such/Work FIXTURES-PER TRAP'-' 5.00 SO.FT.FLOOR AREA TOTALACREAGE
\ himself or through his own employees,provided that such improve- 1NC.40UTLETS 6.00 2726 .
�. menu are not intended or offcrcd for sale.If,however,the building GAS:EA.SVSTEM-1 _
or improvement is sold within one year of completion.the owner-
1 GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
bulder will have the burden of proving ihm he did not build or im-
proveforpurposeofsale.). ' - INDUSTRIAL WASTE INTER.. . 30.00 RE IND coN ve� Omer
❑ I,ns owner of the property',am exclusively contracting with - _ ❑ -El1:1 El
licensed contractors to 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 _ Q
to an owner of properly who builds or improves thereon,amt who LAWN SPRINKLERS-OVER 5 IEA.) 1'.00 '3 6 '/-'3' / 3�- 3
contracts for such projects with a contractons)licensed pursuant to
the C'ontractor's License Law. SEWER-SANITARY-STORMEA.'200ft/10.00 TRACT NO., PARCEL NO.
❑ Iumexemplunde'sce. ,B.&P.C.I..this WATER HEATERW/VENT 6.00 8098
Owner nate WATER SYSTEM - 5.00 - ACC.DATE ACC.FILE NO.'
WORKERS'COMPENSA I'ION DECLARATION WATER TREATING EQUIP. 5.00 -
I hereby alfirm tlmt 1 Imve it certificate of consent to self-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(See 3800,L.b.C.). United Pacific -
Policy No. Cnl..party
Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z'Z �( Certified copy -Ie the city.inspection division. . MISREFER TO ORD.
O AI�pTcant - _ C.- "V❑ N❑ Y ❑ No
CC rn CP.RI']FICA' 1,"01;Ii XI',MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A:L.uA.
W 7 COMPISNSATION INSURANCE ( PLG.CONTR. LIC.NO. PLG. Y❑ NE] Y ❑ NE]
O This section need not be connpleted if the permit is for one _ TOTAL
2 hundred dollars 1$100)or less.)
U O '1 certify that in the performance of the work fin which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Wnrkefs'Compunsution Laws of Calif.,, ip. BUILDING
U,WDale Applicant 916.00
W ALTER OR ADD TO MECH. 5.00
} m emptioli you
should beef: If,.jeer to the ork ys'Certificate of lix-
f- Z emotion,you should Labor
Co e, you
to the Worker,Compensation APPLIANCE 5.00 PLAN CHECK 15.50
provisions io the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10)000OF.M.) �4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 12
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) - 5.00
the ,Cion.). of tLg tam 1f£yw)yadich on it is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
the Civ C.). Jt66 6 YY l•
Lender's Namc-One-EBbareadero 4th-flr HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC 68.58
Lender's Address-I §.F
f pA-fyq.I l-
I certify
it
l have read f msafp cellon an state that the above VENTILATION FAN (SINGLE), . 4.00
inicrmation is correct. I agree to comply with all city and county PLUMBING
o dinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.)=6.00 68.5
hereby authorize representatives of this city to enter upon the BOILER-COMP lover 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property lot uspectioa purposes. 68-98
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino .,.just liabilities,judgments, .,is and expel....which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
granting of this en nit. a MECH.CONT. LIC.NO. MECH.
�� 1 TOTAL TOTAL
Signature of pheam/Contractor )ate
OFFICE COPY