14972 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUNIBEq
:
CITY OF CUPERT�VO
INSPECTION DIVISION 14972
JOB INSPECTION RECORD
1TA !-•��C,1 { ��/ PERMIT EXPIRATION
.JOB ADDRESS � D I" 1 `�'-•uy `''1 ' 11Y'"1� ' UNIT'# - _ LOT#
PERMIT EXPIRES IF WORK
'awNEq ' I ou CONTRACTOR - IS NOT STARTED WITHIN
IN PECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
FOUNDATION. -ILIA NOTE: '+
UFER _IL _ ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
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 _36—
ELECTRICAL - rssunrvet'-uATe
MECHANICAL BLDG. ELECT, PLG. MECH,
d� o 0 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - ILDING PERMIT
FORMATION
.WOOD FLOOR , VALUATION SIFT..-
PLUMBING
. O
MECHANICAL C
ELECTRICAL
1E.1111 TO
' � .
FRAMING. .i
INSULATION - _ STORIES TYPE CONSTH.
2 5PMR.
- UCC GROUP RES UMTS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3
S(].IT rLoo11AVEA rOTAL ACREAr.F
HOOF . NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
+ O
E THCONSTRUCTION TAX IS PAID
'2263
DIAPHRAGM
ROOF SHEATHING �p�,l p RES IND BUILDING USE CON PB 01,.•,
APPLY•NO'ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Q 0 El . El 0
ASSESSORS PARCEL NO.
ROUGH , SAN.N. Vj Q
PLUMBING, - ELECT.ENERGY' - TRAM No. PARCEL No
TUBS 8 SHOWER PAN PLUMBING ENERGY _
MECHANICAL MECH.ENERGY _ .9
ACC.DATE ACC.FILE NO
ELECTRICAL . BUILDING ENERGY -;o,
FRAMING 11 ELECT.FINAL TEST
INSULATION
ZONING ENG SITE NO_JA .
_ a C PLUMBING
GAS TEST ,Z GAS _'P�' .�• FIRESPRw1c ENERGY r.za +
MECHANICAL _
COVER NO WORK UNTIL 0 E HAS BEEN SIGNED HEATING _
FLOOD 70NE A.L.Uc.
E X TE R I OR'S H E AR Py(ury<C -z-9,% E LECTRI CAC RELEASE v � N� � I] ' N0
INTERIOR.SHEAR . 1' _12_ FIRE DEPT.
SHEETROCK- GRADE - FEESUMMARY
EXTERIOR LATH, • /. BUILDING - W
INTERIOR LATH -r,yy�T/ TEMPORARY APPROVALS - 916 00
BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
'GAS F•EE (pno— AMP
I. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCYsEISMIc FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. 53
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
04 o� ONE WORKING DAY BEFORE,REQUIRED INSPECTION. rMECHANICAL
MBING
Z PLEASE GIVE JOB ADDRESS WHEN, PHONING. 68.GA
= SEE PERMIT FOR EXPIRATION DATE — 68 SAIMPORTANT! T.TAX 288.24
PLEASE READ REVERSE SIDE BEFORE OTAL 500.01
CALLING FOR FINAL INSPECTION. . -
OFFICE'COPY
CERTIFIGAOF COMPLETION
BUILDING I�{SPECTOR'S OFFICE
CITY OF CUPERTINO I
DATE / 1923-' t_ BLDG, PERMIT NO.
�y. THE BLDG. LOCATED AT
1 ~ C4 ,O�V C CI r�
OWNED BY O
.HAS BEEN FLET FOR USE AS
(ALTERED)
i
i
i
i
i
i
UlJ�fl /
BUILDING INSPECTOR
APPLICANT TO FILL IN INFORMATION WITHIN RED LIMES - L13P-BALL POINT PEN ONLY
"
- BUILDING PROJECT lDENTIFICATION PERMIT NUMBER
;4APP41CATION & PERMIT
a° p even prings ourt 14972
ADDRE56
I Lot 122 Plan 2C BUILDING-ELECTRICAL�P�.UMB,ING -MECHANICAL
OWNER'6 f1�Y.,vow� PLAN CHECK VALIDATION
NAME Gregory `a , Inc. & Nymnson - QTY. ELECTRIC PERMIT FEE
DTRACOpments A)5E595-2100
NAMERACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Grsoup, INC- uc.No.B-430097 LIGHTING FIXTURES 10.00/1.00
DRESS vi
Rs
ADORER, n In . PPLIANCES-RESIDENTIAL 4.00
AD
94065 415-595-2100 PANELS 10.00 DATE OF APPLICATION
OR RCRrtECT ASSOC. PANELS (OVER 200 AMP) 20,08 PLAN CHECK FEE P.C.NO,
D
ENGINEER pys� ' .
uc.No(.yC�-8395 SIGNS TRANS. 3.00
ARCo.OR ENG. 2031 Orchard fits• 1W SPECIAL CIRCUIT 5,88 PER M IT VALI DATION
AOPRESS UI O�
Santa Ana Nts• CA. iuX707 TEMP. METER OR POLE INS. 20.00
ADDRESSrs 220 C Twin Dolphin Dr. RIAC 94065 MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 ���•OOO ��w�1���`P����r'r/��- '
woo LICENSED CONTRACTORS DECLARATION '(0IYC' • Ir
u w 1 hereby affirm that I am licenwd under provisions of Chapter 9 ISSUANCE DATE
H G a (conunencing will,Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
H
0- Professions Code,anJ r�license is in full force m
ZO z R O License Class Lis Number_
Date Contractor
a r F P BUILDING PERMIT
¢
Or i OWNER-BUILDER DEC 'f N
FORMATION
w3: 1 hereby.affirm that I an,exempt from the Contractor's License MISC.- REFER TO ORD
F LL o 4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 TION S/FT.
m " Code:Anyery in county which reyuiresa permit toconslruct,alter,
ELEC.CONTR. LIC.N0.
¢ ¢ 4 o improve,demolish,m repair any stnteture,prior to its issuance.also ELEC. 17 D
_ D fe requires the applicant for such permit to file a signed s atemenl that TOTALUnity- PERMIT TO
u w m he is licensed'pursuant to the provisions of the Contractor's LicenseIrlitC•LTy 1
F x r Law(Chapwr9(consmencing with Section 7000)of Division 3 of the t -
T o
Business and Professions Codd or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ E. $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i 3 by any applicant for a pcmhit subjects the applicant to civil penalty
of not more than Ove hundred dollars 15500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00 2 �.R
❑ I,.towner of the property.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
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3 1
Code:'rhe Contract.",License Law does not apply to an owner of
property who builds or improves thereon,and who does such work s FIXTURES-PER TRAP 5.00 SO,FT FLOOR AREA TOTAL ACREAGE
® menself re through lin own employers,provided that such ins building
mensare through
ughhis or employeesale.ILhd that s the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 2263
or improvement is sold within one year of completion, the owner - . .
- GAS-EA.SYSTEM OVER 4 (EA) 200 BUILDING USE
builder will have the burden of proving that lie did not build or ins- REB IND CON PB Omer
INDUSTRIAL for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
O. I,as owner of the property,em exclusively contracting with 0 ❑ ❑ 0
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Profmlons Code:The Contractor's License Law dugs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5IEA.) 1.00
Ldnrmcts for such projects with a conrmctorfs)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ 1amexemptundcrScc. ,B.&P.C.I.,Hiis WATER HEATERW/VENT 6.00 8067
rias,n
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
-WORKERS'COMPENSA9ION DECLARATION WATER TREATING EQUIP. 5.00
I herebyy affirm Ihat'1 have a cerlilimle of Consent to self-insure. - ZONING ENG.SITE NO.
or a cerlihleare of Workers'Compensation Insurance,or a certified _
Copy Iherem'(See.3800.Lab.c.). Unit6d Pacific
Policy No. Company '
O Certified copy FIRESPRINK ENERGY T 24
Z Z Cert:Orad co wish the city inspection division.
O A ,cant MISC.- REFER TO ORD. Y ❑ NY ❑ N�
it W CERTIEICA'IT 01'FXEMVIION PROM WORKERS' PERMIT ISSUANCE 10.00 - FLOOOZONE A.L.U.C.
Lu > COMPENSATION INSURANCE PLG.CONTR. LIC.ND. PLG, v[:] N� v El 0
ZQ. (This section need not Isc-completed if the permit is for one TOTAL
hundred dollars I U $1001 or Ices.)O 1 certify that i the perfonnancc of the work for which this Per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I &hull not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
Dale Applicant , ALTER OR,ADD TO MECH. 5.00 BUILDING 916.00
>. rNO NOTICE 10 APPLICAN I': It,after making this Ccud etc of Ex
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
U REvisions&h provisions or this Labor
Code, you
be deco eloTthwith d revoked comply with AIR HANDLING UNIT(TO 10 FEE 1 .5D
pr P'' p00GF.M.) 4.00 en
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVER tOl080C.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 perfonnancc the win (o whifh this permit is issued(See. MICROFILM
3097,Cie C.I l it y �dC1fiC HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Numc_A+e, �M,-
Lendcr'sAdd mss .Y�f- - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 68.58
1certify that 1have read thisa comply and state th at Ilio above VENTILATION FAN (SINGLE) 4.00
information n roarer. 1 agree to comply with all city and county BOILER-CC1MP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING 68.68
ordinances and stole laws elating to building c.nster upn. and
hereby inuthentioed representatives of this rip es enter upon the BOILER-COMP (Ovvr 100,000 BTU)SEE FEE SCH. MECHANICAL 68.58
above-mentioned property for inspection purposes.
(We) agree m save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against Babiliries,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX 288.24
hay in any ay accrue against said City in con ucnce of the
- antinyof - MECH.CONT. LIG NO. MECH. 1500.01
TOTAL TOTAL
"&nature=IicbntiContractor Dafe
OFFICE COPY