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15116 POST THIS CARD NEAR FRONT OF BUILDING , CITY OF CUPERTINO �' PERMIT NUMBER15116 INSPECTION DIVISION JOB INSPECTIONRECORD II IIa W6910(e Lo i c PERMIT EXPIRATION JOB ADDRESS j) r, j�,/ I Y - UNf�IT#a T /� LOT 4t PERMIT EXPIRES IF WORK owNERVIV `��L�"" co"rRncroR, L6rl.- I/� (�� IS NOT STARTED WITHIN INSPItTioN . DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION NOTE: - • ANCE OR 180 DAYS FROM UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. TO COMPLY WITH THE APPROVED�W.4WD CITY OF PERMIT VALIDATION PREGUNI?E CUPERTIN_ O STANDARDS. pfflo GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - +•�- - ' �� -� ILx.�I, UNDERGROUND /SLAB PLUMBING ulty of w—peffRO ELECTRICAL- ISSUANCE DATE MECHANICAL - HLDG ELECr. I PLG MECH. o 5� Q W DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .. BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING � VALUATION SIFT. MECHANICAL 1389306 ELECTRICAL - PERMIT TO FRAMING SFIIII INSULATION STORIES TYPE CONSTR 2 SNHR OCC GROUP DES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3 ,.'1 - 5p Pr.1'1,DOH THEA ,rOTAL ACHIiAGE ! " ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM - THE CONSTRUCTION TAX IS PAID Bw LDI'NG ON use ROOF SHEATHING lots IND rPE APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Rl ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.N 14qj PLUMBING ELECT.ENERGY - TRACTNO. PARCEL NO. 1 TUBS B SHOWER PAN PLUMBING ENERGY of C MECHANICAL MECH.ENERGY ACC DATE ACC.FILE NO I. ELECTRICAL BUILDING ENERGY t✓ .,' FRAMING ELECT.FI NAL TEST ZONING ENG SITE NO. INSULATION G PLUMBIN GAS TEST GAS MECHANICAL FIRE sPRIIN ENERGY T 24N COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 2 _g e ' ❑ . "❑ ° C] ' ❑ ' EXTERIOR SHEAR ELECTRICAL RELEASE Gk- P LORD IONF AI.UC INTERIOR SHEAR _ _g& FIRE DEPT. ❑ N❑ ❑ N❑ SHEETROCK 012.2w GRADE FEE SUMMARY EXTERIOR LATH t2.21- F9 BUILDING 5-5-3-s cl 17L INTERIOR LATH -a•-$ C' TEMPORARY APPROVALS , - BUILDING MOO SCRATCH COAT ELECTRIC- PLAN HECK 1 +ajQ GAS 6 (�o NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCYSEISMIC FEE 9,73 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 55.60' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 55.50 Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! . CONST.TAX 288,95 PLEASE READ REVERSE SIDE BEFORE TOTAL 1.318,68 CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER BUILOWG - APPLICATION & PERMIT " "'� ADDRESS o re 5 11712 Westshore Court BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER Gyeyuyy Group, Inc. & PLNNi CHECK VALIDATION "Amanson DeY. 415-595-21.00 QTY. ELECTRIC PERMIT FEE , PHONE CONTRACTOR'S y N E OUTLETS-SWITCHES-RECEP 10.00/1.00 gXXX Vregory Group, Inc. LIC NO.B-430097 LIGHTING FIXTURES 10.00/1,00 CONTRACTORS 220-C Twin Dolphin. Dr. APPLIANCES-RESIDENTIAL 4.00 RWCa 94065 PH9N 415-595-21 0 PANELS . 10.00 DATE OF APPLICATION ARCHITECT ram assenian, A PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEEP.C. ENGINEER Associates - - LIc.N9. C-8395 SIGNS TRANS. 3.00 ARCH OR END PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 Santa na Hts. at ^ 2231 OrchaE� Dr.. #1 p �2707 EMP.METER OR POLE INS. 20.00 AS - MOTORS - SEE FEE SCH. ADDRESS 220-C Twin Dolphin Dr. RWCR VICE CHANGE fl�II0.00 woo LICENSED CONTRACTORS DECLARATION u w I hereby affirm that I air licensed under provisions of Chapter 9 As.� ISSUANCE DATE e, a 'w (commencing with Section 70007 0(Division 3 of the Business and ,4 BLDG. ELECT. PLG. MECH. I- y Z Professions Code,andmy license S in full force pR�1 qq VV ❑ ❑ ❑ Z D v, - License Class 6D Lic.Number Y.J. . 7 as� X X X o - Dale_ �Contrucmr p.�of CUP �I N~ J !1111 Y //gy�pp a m ¢ ¢ OWNIiR-B UILDF:R OECLARA ON g^' BUILDING PERMIT a o a" - - MISC.- REFER TO ORD INFORMATION w g LL y " I hereby at Ihet I am exempt from the Contractor's License VALUATION $/FT. H LL O 4 Law for the following reason.(Sec.7031,5,Business and Professions PERMIT ISSUANCE 10.00 m Code:Any city or county whichrequiresa permit toeodstrucLalter, p a, ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0, ELEC. 138,306. wm le requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License Fri Law.(Chapter 9(commencingwith Section 7000)of Division 3 of the SFDU a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢F o the basis for the alleged exemption.Any violation of$ection 7031.5STORIES TYPE CONSTR. aim by any applicant for a permit subjects the applicant ton civilpenally &VENT VENT-WATER IEA.) 5.00 of not more than five hundred dollars(8500).): ALTER-DRAIN2 5NHR ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 OCC.GROUP RES.UNITS their Sul,compensation,will do the work,and the str cture is not intended or offered for sole (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 R-3 I Code:Tile Contractoi s License Law does at apply to an owner of IyO property who builds or improves'Ilica n,and who docs such work FIXTURES-PER TRAP 5.00 SO. OR AREA TOTAL ACREAGE himself or through bis awn p employees. rovided tlmt such improve- GAS-EA.SYSTEM-11N C.4 OUTLETS 6.00 �� O I), meals are not intended or offered for sale.If,however,Ilse building 1V 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 he did not build or an - . . RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner ol'the property,ant exclusively contracting with ® ❑ ❑ ❑ ❑ licensed contractors to 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 not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractons)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ l am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm Out I have a certificate of consent trselfsinsure. or a carlificete Of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800.Lab.C.). United Pacific . Policy No.-Company- 0 o. Company0 ❑ Ccrtilicdcopy is hereby furnshed. FIRE SPRINK ENERGY T$4 Z Z X3 Certified copy, is d the spection division. MISC.- REFER TO ORD. O Applicant ® Y❑ IN[3 Y ❑ N❑ i � y CE EXEMPTION F-EXEMPTION I°ROM WORKERS' PERMIT ISSUANCE 10.00 - FLOOO ZONE - a.LU.C. LU COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLG. CLaCL Z fl'his section-need not be completed If the permit is liter one TOTAL V❑ N❑ Y❑ N❑ U O hundred dollars(5 100)or Tess.) I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shell not eulpiny any person in any manner so as to O W become subject to the Workers'Compensation Laws of Califomia. y Datu• Applicant ALTER OR ADD TO MECH. 5.00 BUILDING ]76.00 } N NOTICE TO APPLICANT: If,atter making this Certificate of Ex- f" Z emption,you should become subject to Inc Workers'Compensation APPLIANCE 5,00 PLAkCHECK 1 Eja provisions of the Labor Code, you must forthwith comply with FEE Energy 6 00 U such provisions or this permit shall b�dec;ned revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING,AGENCY AIR HANDLING UNIT(OVER IQOXIC.ENL) 6.00 SEISMIC FEE 9.73 1 hereby affirm that there isx construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance yWI the work ffor wW ch this,,ppernil is issued(Sec. MICROFILM 3097,CivC.). JeC Ur1Ly vi fic HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name_1 mbrOrcudl Y.� �y�-�-1T- HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 55.50 Lender's AAdrcss rf��.4f11.h (certify lis correct. read agreesu comply ban I t I d county VENTILATION FAN I5ING LE) 4.00 55.50 information n estate . 1 agree to comply with all oily and county - PLUMBING ordinances and stale laws relating to Building construction, and BOILER•COMP I3 H.P.or 100,000 B.T.U.) 6.00 hereby enlionez, representatives ec this city es enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-meal toned properly for inspection purposes. (We) agree to save, indl:nmify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX 288.95 may in any way accrue against Said City in consequence of the ranting of tryry++'�pe I. MECH.CONT. LIC.NO. MECH. CIA 1 � as, �3e• TOTAL 1 ,318.68 Signal o pp nt/Cont -tar Data OFFICE COPY