14934 POST THIS CARD NEAR FRONT OF BUILDING PERMITNOMBER
CITY OF CUPERTI�NO1
INSPECTION DIVISION 14934
' JOB INSPECTION RECORD
( (� PERMIT EXPIRATION,
JOB ADDRESS �� � iNTRFL �R/N6- GT UNIT,# _LOT# S J
�. PERMIT EXPIRES IF WORK
OWNER, �cc't�-O/2 VD CONTRACTORE6-dR (Ticpd IS NOT STARTED WITHIN
INSPECTI DATE INSPECTOR INSPE TION REC RD 180 DAYS OF PERMIT ISSU.
FOUNDATIONr ANCE OR 180.DAYS.FROM
6 NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PR EGUNIT E CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED To
UNDERGROUND /SLAB Pfiv Olt
PLUMBING
ELECTRICAL + 'SUANCE DATE
MECHANICAL - ELECT PLG. . Meal
t'e..r-ems
P DO NOT POUR FLOOR UNTIL ABOVE HAS Bt4N SIGNED C, -BUILDING PERMIT
WOOD FLOOR ' INFORMATION$
VALUATION $/FT.
PLUMBING -
MECHANICAL en 00 -
ELECTRICAL eRn+n To
FRAMING
INSULATION _Z -YK sumu TYPE CONSTR
12- man
OCC NOUP 71=1177NITS
.,,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
5( LOI]R ARF,A—7-0-Tyl ALfiFACL '
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID IM4 "
l� BUILDING USE
1, ROOF SHEATHING HES IND CON Pe ow..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Q ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.N O
'PLUMBING /p-// ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL No
MECHANICAL /,� MECRENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING 12 ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING 2•29E,• 88
1.
GAS TEST GAS .z �
MECHANICAL PlReSEE INK ENEr 24
' Cl N❑ YID❑ N❑
'. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 1•6,f/•
EXTERIOR SHEARELECTRICAL RELEASE02 FLOOD ZONE: A.L,Uc.'
❑ N❑ Y --I N❑
INTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH ` BUILDING 1,
INTERIOR LATH Z.G- TEMPORARY APPROVALS BUILDING
SCRATCH COAT 2 _ U ELECTRIC PLAN CHECK
GAS FEE Ic KA
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEI MIC FEE .
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING.FINAL ISSIGNED BY-BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
OF
HONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 60.35
PLEASE GIVE JOB ADDRESS WHEN PHONING._ MECHANICAL
-SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! 60.36
CONST. TAX -
PLEASE READ REVERSE SIDE BEFORE TOT'A'L ��
CALLING FOR FINAL INSPECTION. .0
OFFICE COPY
kJ
CITY OF CUPERTINO
CERTIFICATE OF COMP-LETION
BUILDING INSPECTOR'S OFFICE z_ AS-7
Date ... .......Y...,... Q...... 119'l0�" Building Permit No.A7I""..�� .
'I The Building Located at
Ownedby ... ...... 4. c=........... - .............._................ -
Com lete
Has Been (Altered) For Use As: ._. ....._ \................................_........
..................................................................................................................................................
..................................................................................................................................................
I .................................................................................................................................................. "
PD-7 BUILDING INSPECTOR
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
• * _BU I LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER r
v AD, °,NG., - APP6.ICATION & PERMIT '
A°�REsa C 4934.
Lot 157 Plan *3A
BUILDING-ELECTRICAIa-PLUMj11NG-MECHANICAL
OwNER'S PLAN CHECK VALIDATION
NAME Gregory Group, Inc. & Ahmanson CITY. ELECTRIC PERMIT FEE
vel E :
CONTRACTOR'S
Nftory Group, Inc. B-430097 OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC,NO. LIGHTING FIXTURES 10.00/1.00
C,ONTRACTORs win pin .' APPLIANCES-RESIDENTIAL 4.00
"°°REaE 94065 415-595-2100 PANELS 0.00
'HONEDATE OF APPLICATION
ARCHITECT J - PLAN CHECK FEE P.C.NO.
ONCINEEn Aram Bassenian, AIA 7 A$$QCla PANELS 200 AMPI 20.00
LIE.NO, C$3 j SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
Aop fta Alla a Dr. 106 92707 SPECIAL CIRCUIT, 5.00 ' -
JJtltl�l�l1A , i,P _ EMP.METER OR POLE INS. 20.00 q /1
ADDRESS
APPLICANTa 220-C Twin Dolphin Dr. M MOTORS SEE FEE SCH. `-X r '�. ,r -V..., - `i
94065 SERVICE CHANGE 20.00 ,\ /w+vfr{7
T D LICENSED CONTRACTORS DECLARATION - / ( 0 O
aEs u I hereby affirm that 1 am licensed under provisions of Chapter 9 NCE DATE
n z w (commencing with Section 7000)of Division 3 of the Business and
< w T. PLG. MECH.
F H z Profession Code,enemy license is in full force anti, l 9z-
z o m - Liccnsc Class Lic.Numhat [{ ry 7,7
m r Date ComnctorAM
A, a OWNIiR-BUiLDI: DECLAR 11ON DING PERMIT
a o d u INFORMATION
K ; u U 1 hereby aftinn that I ala exempt from the Controctois License MISC.- REFER TO ORD
FLLmt, Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code'.Any city or county which requires a permit to construct,alter, //ya/�x
2¢ improve,demolish,or repair any structure,prior to its iswancc,also ELEC.CONTR. LIC.NO. ELEC, 153,00
O u requires the applicant lot such permit to file a signed statement(hat TOTAL PERMIT TO
K
m he is licensed pursuant to the provisions of the Contractor's License
Hzi
Law(Chapter 9(conmuencingwllh Section 7000)of Division 3 oflhe -
i o Business and Professions Code)or that he is exempt therefrom and CITY.1ce PLUMBING PERMIT FEE
r$ the basis for the alleged exemption.Any violation of Section 7031.5 5T RIES TYPE CONSTR.
by any applicant for aperinit subjects 0m applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00 2 =i
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP REB.UNITS
intended or offered for sale (Sce. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'rhe Contractor's Liccnse Law docs not apply Io an owner n( -
property who builds Or unproven thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
meats are nm ta
intended or 7ercd for sole if,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 8.00 1(�'�
or improvement is sold within one year of completion,lite owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIALWASTE INTER. . 30.00 RES IND CON PB One,
❑ I,as owner of the property,am exclusively contracting with 13 0 ❑ 0 ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:1'lie Contractors License Law does hot apply
to in owner of property who builds or improves Ihereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for inch projects with a contract or(0 licenwd pursuant to SEWER-SANITARY-STORM EA.200ftI10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I'um exempt under Sec. ,B.&P.C.for thisreas
on WATER HEATER W/VENT 6.00 8067
Owner - Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 -
1 hereby affirm that ['have a certificate ofconsent to self-insure, '
or a certificate of Workers'Compunsalion Insurance,or a certified ZONING ENG.SITE NO.
copy t hereof(See.3800,Lab.C.E United Pacific
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z X Certified cop with the city inspection division. ❑ ❑ O ❑
O Applicant' MISC.- REFER TO'ORD. v N - Y N
� N C17RT1171C EOFEXEMPTIONFROMWORKEM, PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
W > COMPENSATION INSIIRANCIi PLG.CONTE. LIC.NO. PLG.
d O (This Section need not he completed if the permit is for one TOTAL Y N y N�
Z hundtnd dollars'($100)or las.)
0 O 1 cenify it,.,in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as Ir
OUbecome subject to the Workers Compesa0on Lows of CaLlornin.
do 0. Dale Applicata BUILDING 825.00
>_ N NOTICE.TO APPIACAN'r: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F emption,you should become subject Io the Workers Compensation APPLIANCE - 5.00 PLAN CHECK Cn
provisions of The Labor Code, you must forthwith comply with FEE 15•SD
V such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10DMC.F.M.) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 62.66
10-71
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the$ark for which this perphit is issued(Sec. MICROFILM
3097,Civ C.). J�,e,4c�U,,r,,,,i,t,,y Pacific HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's bame�n�IJIWIIAdeI AV-4A1T1T- HEATING UNIT 100,000 B.T.U.)9.50
Lender's Address-('�---Asai- l t ELECTRIC 60.35
I I certify Hurt I have r`" eed'trs'app m;tmo and state that the above VENTILATION FAN (SINGLE) .4.00
information is correct. I agree to comply with all city and county PLUMBING
nrlinances and ante laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 60.35
t .1mvey authorise representatives ec this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL'
` ->< above-mentioned property for inspection purposes.
u..' I (We) agree to save; indemnify and keep hornless the City of misc.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00
r ' CONST.TAX
may in any way accrue against said City in consequence of the
• ranting of this e - MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 1382.50
Signator p icant/Contractor le
OFFICE COPY