15114POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
PERMIT NUMBER
15114
INSPECTION DIVISION.
JOB INSPECTION RECORD
I �J �r��f �(/�j,�l
�l U� Alli„L �0
PERMIT EXPIRATION
JOB ADDRESS U/,���IyT-p#
/�{�7_LOT#
..NE. Gr i CONTRACTOR (/I e o U
PERMIT EXP ES IF ORK
IS NOT STA ' HIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
INSP CTI N DATE INSPECTOR I SP CTION RECORD •
FOUNDATION NOTE:
LEER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED
LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF
PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED P
UNDERGROUND/SLAB
p tt�
AUG -8
ELECTRIICAL -
ISSUANCE DA TE
MECHANICAL •^;t
N
BLDG
ELECT
PLG, MEC..
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
WOOD FLOOR
INFORMATION
PLUMBING
�- VALUATION
SIFT,
MECHANICAL
ELECTRICAL'
v RnnT TD
FRAMING
INSULATION -
STORIES
TYPE CONSTR.
OCC GROUP
NITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE, NO FINAL INSP. SHALL BE MADE BEFORE
5 - �,LOOR AREA
TOT ACREAGL
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
Rift
ROOF SHEATHING �
BUIunmN USE
RES IND CON Pe oM.,
❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ROUGHSAN.k j7ll%% 11 gJ5b j
ASSESSORS PARCEL NO
PLUMBING ELECT. ENERGY
TUBS &SHOWER PAN PLUMBING ENERGY
TRACT NO
PARceL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY a_ _g
Acc. Dnre
Acc. FILE NO
FRAMING ELECT. FINAL TEST
INSULATION PLUMBING_ q
20NING
ENG. SITE NO.
-
GAS TEST GAS
I MECHANICALFIRE
a,/3
SPRINK
Y ❑ N❑
ENERGY T 2A
❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING `g
O
EXTERIOR SHEAR ELECTRICAL RELEASE
FLOODZONE
v ❑ N❑'
ALUC.
v ❑ N❑
INTERIOR SHEAR - FIRE DEPT.
SHEETROCK GRADE -
FEE SUMMARY
EXTERIOR LATH BUILDING Z- _�
BUILDING
TEMPORARY.APPROVALS
INTERIOR LATHjUNTILABOVE
ELECTRIC �,--3 _g
SCRATCH COAT,jSIGNED
PLAN CHECK
FE
FEE
5.50
GAS
NO TAPE OR PLASTAS BOCCUPANCv I ISEISMIC
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
55.50
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
PLUMBING
55.50
MECHANICAL
55.50
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!
CONST. TAX
288.95
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
..ql- --
OFFICE COPY
,,, PLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL -PLUMBING - MECHANICAL
.PERMIT NUMBER
151-14
Aeon15G LLot 26 Plapq2A
167I Southshore lOUrt
OWNER" Gregory, Group, Inc. &
Ahmanson UeV. vH rv' Jt.5-595-2100
OTY' ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
AANAAA
Una&
DATE OF APPLICATION
CONTRACTOR
NAMGregory Group, Inc. B-430097
LIC. NO.
UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
ADDRESS 220-C Twin Dolphin Dr. Ds
A
RI4C 94065 PRONE 415-5
APPLIANCES -RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT
OR Aram Bassenian, AIA &
ENGAgSOCldtes C. NO. C-8395
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
.
'
SIGNS TRANS. 3.00
ARCH. ORENG.
ADDRESS 2031 Orchaard Dr. #1 0
Santa Ana Hts. GA. 2707
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
,.�,�1
_nkI
✓IC� I l.J(�
ISSUANCE GATE
BfL�DG1. ELECT. PLG. MECH.
TEMP. METER OR POLE INS. 20.00
APPLICANT s
AE 5
0-C Twin Dolphin Dr. RWC 9406
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONT TACTORS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Cnd,, un my license is in full I'nrcr and elfeat
Limnw Class Lic. Number lt3AUG
Date_ Contractor_L` _
OWNER -BUILDER DECLn RA ON
1 hereby u(Nnn that 1 are exempt from the Contractor's License
Law for the hollowingreasoa(Sec. 7031.5, Businessanll-roiconons
Code: Any city or county which requires a permit to construct, alter,
improve, demolish, or repair any structure, print to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed ursuant to lite
p provisions the)o f'D¢mts License
of Division 3 of the
Law (Chapter 9 enCod with Section is exempt
Business and heProfession,allegdCode) or that he is exempt therefrom and
the basis for the alleged exemption Any violation of Section 7031,5
by any applicant fora permit subjects the applicant toacivil paudty
ictally
of not more than fohrpdonors(5500).):
❑ Lf
as owner of theeproperty, or my employees with wage as
their sole compensation,.
wwill do the ork, and the structure is not
intended or u11'e,ed for sale (Sec. 7044. Business and Professions
Code: 'rhe Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
mentsarenotintendedoroffeted Roselle. IC however, the building
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with
contractors In construct the project (Sce. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves Ihercon, and who
contracts for such projects with a contractors) licensed pursuant to
the Contractor's License Law.
❑ lam exempt under Sea ,B.&I'.C. fir this
son
PMD
9 19000
MISC. -
BUILDING PERMIT
INFORMATION
PERMIT ISSUANCE 10.00
VALUATION
138,306
ELEC. CONTR, LIC. NQ
FLEC
TOTAL
PERMIT TO
S F D U
OTV. PLUMBING PERMIT FEE
ALTER -DRAIN & VENT -WATER (EA.) 5.00
STORIES
2
TYPE CONSTR.
5NHR
BACK FLOW PROTECTDEVICE 400
.
OCC. GROUP
R-3
RES. UNITS
1
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
FIXTURES - PER TRAP 5.00so.
GAS- EA.SYSTEM-I INC.4 OUTLETS 6.00
GAS - EA. SYSTEM -OVER 4 IEA.) 2.00
F REA
72191-
TOTAL ACREAGE
BUILDING USE
RES IND CON PB Omer
® E) ❑ 13 El
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
SEWER -SANITARY -STORM EA, 2001t/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Dat,
WATER SYSTEM 5.00
woRKF:RS'coMPliNsn970N DECLARATION
1 hereby affirm that I have a certificate of Consent to self -insure,
or a certificate of Workers' Compensation Insurance, or a Certified
copy thereof tsee. 3„oo. Lab.c.). United Pacific
I'ON Company
ACC. DATE
ACC FILE N0.
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO.
n ified copy is hereby funiishcd.
Certified
rx antlificJ 0py file si(II inspection division.
Applicant-
MISC.- REFER TO ORD.
FIRE SPgINK
Y❑ N❑
ENERGY TY4
Y❑ N❑
CERTIFICA71i OF EXEMPTION FROM WORKIiRS'NCE
COMPENSATION INSURANCE
(Tile, scctiiin need not be completed if Lhc pcnnil ix for ofteTOTAL
hundred dollars ( S 100) or less)
I certify that in tile performance of the work for which this per-
mit is ued, I shall nut emloy any penin m any manner so as Iobecomes subject to the W'orkeriCompensation Laws ofCalifornia.
Dam Applicant
10.00
FLOOD ZONE
V ❑ N❑
A. L. U.C.
V ❑ ry❑
t.TRLIC. NO. PLG.
HANICAL PERMIT FEE
FEE SUMMARY'
BUILDING
]]6,00
D TO MECH. 5.00
M1'OTICIi 'I'O APPLICANTS. If, alter making this Certificate of lix-
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply will,15.50
such provisions or this pcnnil shall be deemed revoked.
CONSTRUCT ION LENDING AGENCY
I hereby affinu that there is a construction lending agency for
the performance of the work for which this coon is issued (Sec.
3097, nder's am. Security PacifPic
Lender's Namc---1���
Lender's Address .j�`'��j"��p_�Q_,hl-rte
I certify thin l have JJreffad 0lnapphca undsmtcthat theahove
inlbrmation is Correct. I agree In comply with all city and county55.50
ordinances and state laws relating to building construction, and
hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless tluc City of
upe,lino against liabilities, judgmenls, vests and expenses which
mayCONST.
�in any way acme against Said City in consequence of the
4ianling Of 1 'C'en't.
Ilrr
-�
APPLIANCE 5.00
PLAN CHECK
FEEEnergy
62.00
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
AIR HANDLING UNIT (OVER 10MOC.F.M.) 6.00
SEISMIC FEE
9.73
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
ELECTRIC
55.50
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT(OVER 100,000B.T.U.)9.50
VENTILATION FAN (SINGLE) 4.00
BOILER-CCAV(3H.P.Or100,0008.T.U.) 6.00
PLUMBING
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
55.50
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
TAX
288.95
MECH. CONT. LIC. NO. MECH.
TOTAL
TOTAL
1 318.68
,
taG
Signarc pplica Co actor Date
OFFICE COPY