15109 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER '
17
CITY OF CUPERTINO 15109
INSPECTION DIVISION
JOB INS�{PyyECTI]]ON RECORD QQyl�p�p
/^' I�LJII(L - CiT UNIT# _LOT# O" q I��nx+ IRATION
JOB ADDRESS /q� PERMIT EXPIRES IF WORK
OWNER Vr ar bro CONTRACTOR '�/re. �1 Vu' IS NOT STARTED WITHIN
INSPECT16N DATE INSPECTOR INSPECTION RE ORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER NOTE:
GRADING,AND DRAINAGE SHALL BE INSTALLED
I TO COMPLY WITH THE.APPROVED PLANS AND CITY OF PERMIT VALIDATION
PR EGUNITE CUPERTINO STANDARDS.
GARAGE SLABS 'PAID
_ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDAUG f±
UNDERGROUND /SLAB AUG
. PLUMBING �� ^..cup�y�� C.vI
ELECTRICAL ci{V.d Ild ISSUANCE DATE
MECHANICAL - -• 'BLDG ELec T, PLC. MBCH.
to 2a.2o Lu E%A, a %AA
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION
-
MECHANICAL
ELECTRICAL BRMn ro
I
FRAMING -
INSULATION sraRiES PE:CONSTII.
O, .GROUP WAITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.11FWJ!I REA TOTA AU3FAGL
ROOF NOTE:NO FINALINSP.SHALL BE MADE BEFORE /
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
I
ROOF SHEATHING DILDING USE
—�yy CI° RES IND . CON PB Co",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE . INSP. ❑ ❑ ❑ ❑
ASSESSORS PARCF.I.NO
ROUGH SANA /q5g3
PLUMBING A. ELECT.ENERGY ,
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN, PLUMBING ENERGY
MECHANICAL ,� MECR ENERGY
ELECTRICAL ,Q, BUILDING ENERGY ACC DATE Acc,FILE No
AE FRAMING - A . ELECT.FINAL TEST
INSULATION Ta PLUMBING ZONING ENG SITE NO.
GAS TEST GAS'
MECHANICAL. FIRE SPRINK ENERGY T]C
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING °❑ N'❑ ° ❑ No
EXTERIOR SHEAR '0;, ELECTRICAL RELEASE 'FIE000ZONE ALUC.
INTERIOR SHEAR `I FIRE DEPT, - Y❑ N❑ YL. N❑
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH — BUILDING
.INTERIOR LATH \• TEMPORARY APPROVALSBUILDING
SCRATCH COAT ELECTRIC PLAN CHECK I5:5O
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE NAS BEEN SIGNED OCCUPANCY SEISMIC FE
OCCUPANCY OF BUI LDING'IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 49'68
ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLUMBING ' 49.8f1
z° PLEASE GIVE JOB ADDRESS WHEN PHONING..
— SEE PERMIT FOR EXPIRATION DATE — MECHAN CAL
IMPORTANT! CONST.TAX 288.95
PLEASE READ REVERSE SIDE BEFORE TOTAL 1 0241.13
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENT[FICATI ON - PERMIT NUMBER ,
a°1e°'"° o an B APPLICATION & PERMIT 15109
aOORE s BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
1 663 Westshore Court
NAME regory roup, nc. - '� - PLANCHECK V ALIDATION
Ahmanson DeV. 415- OTY. ELECTRIC PERMIT FEEY�Yxy�u
PHONE
CONTRACTORS
10,0011.00
NAMEGregory Group, Inc.e,No,B-430097 OUTLETS GHT NG FI-SWXTURES TCHES-RECEP 10.0011.00
CONTRACTORS 220-C twin Dolphin Dr. APPLIANCES-RESIDENTIAL 4.00
ADDRRESS
WC 94065 ARAI5-595-210 PANELS - 10.00 DATE OF APPLICATION '
OPRC"RECT ram assenian, PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER Associates C-8395
LIC.ND. SIGNS TRANS. 3,00
ARCH.OR
A°°RESR E"G Orchard Dr. #100 SPECIALCIRCUIT 5.00 PERMIT VALIDATION
Santa Ana Hts. CA i�2707 EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS 0-C Twin Dolphin -Dr. RWC9406 SERVICE CHANGE PAUM0
o
C
Foo LICENSED CON'T'RACTORS DECLARATION
Fz w I hereby affirm that I am licensed under provisions of Chapter 9 e ISSUANCE DATE.
¢ (commencing with Section 7000)of Division 3 of the Business and
BLDG. ELECT. I ,PLG. MECH.
0 w i License Profession,Code,an y license is in full farce Q,rjjgpt,
z G m - License Clas Lic.Number S1U�� /11�of Cu
D r D Date_ Coni reactor Y
a Y f BUILDING PERMIT
E a, w u OWNIiR-tl UILDF-R DECL ATION INFORMATION-
O > I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
'�a.m VALUATION E/FT.
u_o ¢ Law for the following reason.(Sec.7031.5,tlusiness and Professions
r _ PERMIT ISSUANCE 10.00
f 14 4 0 Code: e,dexo y or County whiny mqu tune,esu prior
o its issuance.
uheq
x ¢ ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. 121 ,7BB .
c a ix requires the applicant for such permit to file a signed statement that TOTAL
wm u. he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Fi > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe SFDU
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
E i o
¢ H $ the basis for the alleged exemption.Any violation oto.ction malty STORIES TYPE CONSTR.
a3 _ by any applicant tura permit subjects the applicant toacivil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than live hundred dollars(S500).1: Z SNHR
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCD.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:The Contractor's License Law does not apply to an owner of
himself
who buih his improves
employees,
mplo eereoq and whoadoes t such improve.
work FIXTURES-PER TRAP 5.00 so P�Ea roTaL acREacE
merits are not
ownoffered for
I f,ed howevsuch improve- GAS-EA.SYSTEM-I I NC.4 OUTLETS 6.00
mems are not t is sold
or thin on for aalo.If,however,the building
or improvement is sold within one year of completion,the 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.). REG IND CON PB Orhes
O I,as owner of the property,um excursively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project(Sec.7(144,Business I LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO, PARCEL NO.
C, I inn exempt under Sec.-,BARC.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPF.NSATION DECLARA'I']ON WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to selhinsure,
or a certificate of Workers'Compensation Insurance,or it certified ZONING ENG.SITE NO.
copy lheRof(Sec.3800,La b.C.)United Pacific
Policy No. Company V ,
0 0 Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z �0 Certified out is led w'th the city inspection division.
O Ague."t MISC.- REFER TO ORD. Y0 N� Y [3 NE]
CC LO CERTIF TIi OFIiXEA1 PFION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE a.L.U.C.
OJ > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLC.
CL 0( This seclidn need not be completed it' the pRn°t is to,one TOTAL Y N Y❑ N
hundred dollars IS 100)or less I
0 O 1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not enpdoy any person in my manner ns as to
C) W become subject to the Workers Compensilion Laws of California.
G. Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 716.50
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex.
F z emp(ion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 15.50
provisions of the Labor Code, you must forthwith comply with .Ener
C.) such provisionsor this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10,000C.F.NL) 4.00 FEE 62.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 8.54
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec, MICROFILM
3097,Civ am SeCU 1�"._t,Y_pacifiC,f - HEATING UNIT(TO 100,000 B.T.U'.) 6.00
Lender's Name- -Ifl ro-_4th-FLI HEATING UNIT(OVER 100,000B.T.U.)9.50 49.88
Lender's Address qy-y ELECTRIC �
I certify that 1 have real this upplit� 41 Q th�above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all oily god courtly PLUMBING 49.88
ordronees and state laws relating to building construction, and BOILER-COMPl3 H,P.Or100,000B.T.U.) 6.00
hereby wumrim representatives of this city to ester Ilpon the BOILER-COMP (GVB!100,000 BTU)SEE FEE SCH. - MECHANICAL
above-mentioned property for inspection purposes. 49.88
(We) agree to save, indemnify and keep harmless I City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX 2BB.95
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ranting of 6 p m2 MECH.CONT. LIC.NO. MECH. ,
/ 9 TOTAL TOTAL 1 241 .13
Signat�redA/•p�pI t tractor Llte
OFFICE COPY