15845 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 1-5545
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS tern d /' ./�KR�- *IA/C— CT UNIT# _LOT,# 3 PERMIT EXPIRES IF WORK I
OWNER (f ito J 2, CONTRACTOR ` 0 IS NOT STARTED WITHIN
INSPECTION DA E INSPECTOR INSPECT N RECOR 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
UFER eZ ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS PND CITY OF P[:RMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS 2
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED RR
UNDERGROUND /SLAB _tL ESTI U rR "QQ -
PLUMBING
ELECTRICAL �,u , ISSUANCE DATE
MECHANICAL MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT.
'
MECHANICAL
ELECTRICAL PE"rnt r°
FRAMING ern $L.
INSULATION STORIE TYPECONSTR
OCL ROUP ITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE S -r LOOP AREA TOTAL CREAGE
DIAPHRAGM I THE CONSTRUCTION TAX IS PAID 211611
RUILUINGUSE
ROOF SHEATHING � -L�1C RES IND CONvu
APPLY NO ROOFING UNTIL ABOVE HAS BEEN-SIGNED FINALS DATE INSP. ® ❑ ❑ ❑ ❑
Q A bSLSpSOHS PARCEL NO
PLUMBING SOUGH. - ELECT.ENERGY 3�6-
TUBS&SHOWER PAN - �' PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL 5'(�!, (per MECH.ENERGY 8a9`8
ELECTRICAL 'S• �{ y l0 BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING C;- ELECT.FINAL TEST
INSULATION Y, PLUMBING - J zONINc ENG SITE NO.
GAS TEST GAS
MECHANICAL FIRE SHRINK ENERGY,T.zR
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, Y ❑ N❑ . ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD LONE ALUC.
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑ N❑
SHEETROCK GRADE
FEE SUMMARY
EXTERIOR LATH 0lat3 BUILDING �
INTERIOR LATH ))E' S TEMPORARY APPROVALS n6 00
BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOTPERMITTED UNTILBUILDING FINALISSIGNED so
BV BUILDING INSPECTOR.
' MICROFILM
LU
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. Ccr
PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
G
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ,
BUILDINGPROJECT I DENTIFICATION 'PERMIT NUMBER,
"°"°INE Lot 316 2A APPLICATION & PERMIT
ROCHEs 11801 Sierra Spring Court BUILDING-ELECTRICAL-PLUMBING -MECHANICAL .15B45 C
OWNER'S PLAN CHECK VALIDATION
"AMe Gregory Group, Inc. & OTY. ELECTRIC PERMIT FEE
Ahmanson Develo men1PHONE415 595-2100
NONE croRs UTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group, Inc. I.C.NO B-430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
S oR's22D-C Twin Dolphin Dr. PPLIANCES-RESIDENTIAL 4.00
CO
RWC 94065 PH..E415 59 - PANELS 10.00 DATE OF APPLICATION
OR
CHiTECT Aram Bassenian, AIA & - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
ASSDCiat@sLIC.NO. C-8395 SIGNS TRANS. 3.00
ARCHDDRESS ENG.2031 Orchard Dr., . #100 SPECIALCIRCUIT S.QQ PERMIT VALIDATION
°°RE55
Santa Ana Hts. CA ,02707 EMP.METER OR POLE INS. 20.00
APPLICANT s- MOTORS SEE FEE ADDREl
22055C Twin Dol hin Dr. RWC 94065 SERVICE CHANGE 20.000.00
Of.
0 z M /
FOO LICENSED CON'T'RACTORS DECLARATION its
a u I hereby affirm that I on licensed under provisions of Chapter 9
2 w ISSUANCE DATE
y a % (comnuasing with Section 7000)of Division 3 of the Business and
r H z Professions Code,a{{{��pI my h,craw is in full fo¢u 1 DG. ELECT, PLG. MECH.
Z O m Date
e('�1 � hie.Numbs 0� 7
Date_JJ _ Contructor__.
0 � D \
F N F
FF
¢ ¢w a OWNER-BUILDFR DECLARATION Q BUILDING PERMIT
Dd misc.- REFER TO OR e INFORMATION
w g a-w 1 hereby affirm that 1 am exempt from the Contractor's License
u O j Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
- PERMIT ISSUANCE 10.00
Code:Any city of county whichrequiresapermit to construct.alter. O p C
¢ ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 136 306
K m u requires the applicant for such permit to file a signed statement that TOTAL
w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
R z a
Law(Chapter 9(conlmencing with Section 7000)of Division 3ofthe
4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE SFD I-
¢ I- o the basis for Ole alleged exemption.Any violation of$ectiui1703 LS STORIES TYPE CONSTR.
u ; m by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN IEA.) 5.00
Elf not more than five hundred dollar,(4500)): 2
❑ I,as owner of the property,lir my employees with wages as BACK F LOW PROTECT. DEVICE 4.00
SNHP
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for all (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: file Contractor's License Law does not apply to an owner of R-3 1
property who builds lir improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.Fr.FLOOR AREA TOTAL ACREAGE
himself'or through his own employees,provided that such improve-
ments are not intended or offered for sale,lf,however,the budding GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 2161
builder will have the burden of proving that he did not build or'im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the properly,and exclmisChl contracting with
licensed contractors to construct the project(Sec. 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professionstors to eCtruct the License Law does not apply �yr
to un owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 �`
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec..,B.ABC.I'or this
reason WATER.HEATER W/VENT 6.00 ���
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK liRs'coNPENsn1ION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate of consent to selbinsure.
or a certificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See.3800,Lab.C)L United PaCI_f l-G.`
Policy No. Company
O ❑ Certified copy is herehy furnished.
Z Z �Cert'�eiy',qpy '4`1'
�Ii�CJ wipI the city inspection division. FIRESPRINK ENERGY T-24
An0''cmrt �r}'�IL,�/� MISC.- REFERTO ORD. Y [] No YE] NC]
17
~ O •/f) PERMIT ISSUANCE
O- N CISk'I'I PICA'1'Ii ENSAEI PTINSU RObI W'ORRF:kS' 10.00 FLOOD ZONE A.L.uC.
W � COMPENSATION INSURANCE PLG.CONTR, LIC,NO. PLGCL .
0 (This section need not be completed it the permit is for one TOTAL Y❑ N Y N(]U ZO hundred dollars($100)or less.) -
Icertify that in the performance of file work fur which this per- OTV MECHANICAL PERMIT FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to FEE
O ED become subject to the Workers'Compensation Laws of Californin.
n. Dat` Applicant ALTER OR ADD TO MECH. 5.00 BUILDING $776.00
} to NOTICE TO APPLICANT;Applicant
If,alter making this Certificate n(fix J,
(- Z emption,you should become subject to the Workers'Compensation APPLIANCE 500 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with . CsO
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 FEE Ener UXIX/
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE $9 73
I hereby affirm 0mt mere is.'construction lending agency forWU
UST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec.
3097,CN.C.). NG UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name_SeCU It Fa''Clf C _
Lcndar's Addresser�.� th�1.1-:._- NG UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC
I certify❑tat I have read thrs application and state that the aboveLATION FAN (SINGLE) 4.00information is correct 1 agree to comply with ell city and coon I, PLUMBING
ordinances and state laws relating to building construction, and -COIVP(3 H.P.01100,000 B.T.U.) 6.00hereby authorise representatives of this city to enter upon-theabove-mentioned property for inspection purposes. R-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep boneless the City of REFER TO ORD.upertino against liabilities,judgments, costs and expenses whichCONST.TAX
ay in any way accrue against said City in consequence of theT ISSUANCE 10.00 297.D^
ran of this r nnl1. LIC.NO. MECH.vitTOTAL TOTAL
ignaNre ofAppl¢a tConector Date1326.76
OFFICE COPY