15106 A PJ.ICANT TO FILL IN INFORMATION WITWJIN kf D LINES - USE BALL POINT PEN ONLY
• ' BUILDING PROJECT IDENTIFICATION .PERM NUMBER-
BUILDING APPLICATION & PERMIT q q O
A116 LWestshot 283 Plan *1A BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
11662 Westshore Court
NAMERa regory roU , • PLAN CHECK VALIDATION
Ahmanson Dev. ,RJk5-595-2100 QTY' ELECTRIC PERMIT FEE
CONTRACTOR'S
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group, Inli,l NaB-430097 LIGHTING FIXTURES 10.00/1,00
CONTRACTORS
pp C Twin DO hln Or PPLIANCES-RESIDENTIAL 4.00
AOOi �$� 94565 9-5954100 .,PANELS_ 10.00 DATE OF APPLICATION
ARCHIKKTE,jCT 94v 5 dN2 PLAN CHECK FEE P.C.NO.
DR SSOCla es - PANELS (OVER 200 AMP) 20.00
ENGINEER
Lc.No. C-8395 SIGNS TRANS. , 3.00 '
ADDRESS ENG. 2031 rC ar Dr. , OO SPECIALCIRCUIT 5.00 PERMIT VALIDATION
Santa Ana Hts CA
zIP92707 TEMP.METER OR POLE INS. 20.00 A�
APPLICANTS
on ICANTs ,M, MOTORS SEE FEE SCH. 1 IQ`k
0-C Twin Dolphin Dr.RWC94065 SERVICE CHANGE 0.00' C7IVI � QQ
woo LICENSED CONTRACTORS DECLARATION C..7 '"' LTO
< u U I hereby affirm
that 1 am licensed under provisions of Chapter'( ISSUANCE DATE.
w,m (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
M i Professions Code,a911 my license is in full forc4 �-p�'p{IF ❑ ❑ ❑ ss.,
AUG 9
o D W - License CP9�yss_O Lic.Number Y V V J/_ r u
I=L L C Datc_(..�f Conlmctor S2(/� Cft W,J .L .•f CU,�{.
4 se 2 , v+ BUILDING PERMIT
4 OWNER-BUILDER DECLARATION
0 d D INFORMATION
X R H 1 hereby affirm ilial I am exempt from the Contractor's License MISC.- REFER TO ORD
w _oJ Law for the fallowing reason.(Sec.7031.5,Bicamessand Professions PERMIT ISSUANCE VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter, 10 00 121 ,788
2 2¢ improve,densolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO.
ii:- O u re(Jtlires the applicant for site))permit to file a signed statement that TOTAL
w as w he is licensed pustmnl to the provisions of the Contractor's License PERMIT TO
r z t Law(Clapmr9(commencing with Section 7000)of Division 3 al'life SFDU
4 a Business and Pmfbseions Code)or that he is exempt therefrom aul QTY. PLUMBING PERMIT FEE
s r m the hasls for the alleged exemption.Any violation of Section 7031.$ STORIES -TYPE CONSTR.
a3 _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 2 SWHR
of not more than five hundred dollars($500y):
❑ I,as...,it 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 far sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 R-3 I
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,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- 1 per,_
mems arc of through
his oroffered emploees,sale.provided
that slhenprovg GAS-EA.SVSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA) 200
builder will have the burden of proving that h - . . .
e did not build or am- BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
0 I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 . ® ❑ ❑ 0 0
licensed contractors In 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 Trot apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ttI10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec..,B&P.C.Iior this WATER HEATER W/VENT 6.00
reaswl
Owncr Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE No.
WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to scl Glnsurc, ZONING ENG.SITE NO.
or u certificate of Workers'Compensation Insurance,Gr u certified
copy thereof(Sec.3800,Lab.C.)United Pacific
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z Z Certified c y filed wi the city inspection division.
O Applicant �- - MISC.I REFER TO ORD. y N[] v [] N�
~ 9 -� PERMIT ISSUANCE 10.00
� CIiRI'IPICA'I'Ii OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
d O (This seclirin need not be completed if the permit is For one TOTAL Y N[:) Y [] NE]
Z hundred dollars($100)m less.)
V O 1 certify that in the performance of the work for which'his per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,1 shall not employ any person in any manner so as to
become subject to the Workers Compensation laws of California.
i Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 716.50
} w NOl'ICE '10 APPLICANT: If,after making this Certificate of fix.
Z eruption,you should become subject m the Workers'Campensutian APPLIANCE 5.00 PL
provisions of the Labor Code, you must forthwith complyt CHECK
with Fit C EC . 62.00
L) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) .4,00 FE
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 8.54
1 hereby affirm that there is a construction lending agency I'.. EXHAUST HOOD(WITH DUCT) 5.00
(le performance of the work for which this pe alit is Issued ftiec. MICROFILM
3097,Ci,C.) SeCUrlty PdCl l.. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nudre s:t mh�`C-a IfST•0-4� T•� HEATING UNITIOVER 100,000 B.T.U.)9.50 49.88
Lender's AdJre J�7�-1 - ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct I agree to comply with all city and c00PLUMBING 49.88
Ordinances and sate lows.relating to building construction, and anA BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
s hereby authorize representatives of this city to enter upon the
above mentioned rout for inspection purposes, BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
properly r P p m 49.88
(We) agree to save, indemnify and keep hamlex the City of MISC.- REFER TO ORD. 288.95
mayit, a against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
ranting of this mit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 1 ,241 .13
Sig ature App ontmctor Uate
OFFICE COPY
1
POST THIS CARD NEAR FWNT�iF BUILDING
CE TNUMaEH
AtT
CITY OF CUPERTINO,
INSPECTION DIVISION 15106
(/, p
JOB INSPECTION RECORD
EXPIRATION
JOB ADDRESS V �LSIJ�DYI. CUG�I I UNIT# :LOT# 083
PERMIT EXPIRES IF WORK
OWNER6fovp CONTRACTOR Gee n o m rD' W IS NOT STARTED WITHIN
INSPECTIFON DATE I INSPECTOR I PE ION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - ANILE OR 180 DAYS.FROM .
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNIT.E
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLWIT VAL DATION
GUPERTINO STANDARDS. �L,
GARAGE SLABS _ PND
POUR NO CONCRETEUNDERGROUND /SLAB BEEN SIGNED AUG 9 ^ 1988 "„' t I I .I Ii_
j it
PLUMBING �
City ,.V,{
ELECTRICAL Cupertino ISSUANCE DATE
MECHANICAL - BLDGELECT. I vLc MECR
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION' SIFT.
PLUMBING
MECHANICAL - L ' lh.788
PERMIT TO
ELECTRICAL ,
FRAMING - SFDV '
INSULATION STORIES 'TYPE CONSTR
2 6NNR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-8
,
ROOF- � NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SOFT FLOOR AREA TOTAL ACRE AGE'
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 1'964 I
BUILDING
USE
PR
IVES INDOtle.,
ROOF SHEATHING
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.# ;! 680
PLUMBING - ELECT.ENERGY O TRACT NO, PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
ACC GATE ACC FILE NO
ELECTRICAL BUILDING ENERGY /o
FRAMING - ELECT.FINAL TEST
ZONING ENG,SITE NO
., INSULATION PLUMBING �
GAS TEST GAS
MECHANICAL FIRE SABINE ENE[D rza
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING a ,p El , NE) ❑ "❑
EXTERIOR SHEAR -1 FLOOD ZONE A L.0 C.
ELECTRICAL RELEASE I
INTERIOR'SHEAR� FIRE DEPT.
ElN❑ ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH If 2• BUILDING
INTERIOR LATH \-� _ ,(� TEMPORARY APPROVALS 71640
BUILDING '
SCRATCH COAT 2, ELECTRIC FLAN CHECK 16.60
GAS
"Infirgy 62 .00
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTEDUNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM'
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC - 49.$8
Iw-� ONE WORKING'DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING. 49.88
1 Z — SEE PERMIT FOR EXPIRATION'DATE — MECHANICAL
{ _?
IMPORTANT! CONST.TAX
288•95
PLEASE READ REVERSE SIDE BEFORE TOTAL 1 241:13
CALLING FOR FINAL INSPECTION. r
OFFICE COPY