15118 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
` CITY OF CUPERTINO 15118
INSPECTION DIVISION
JOB IINSPEC;TIONRECORD
JOB ADDRESS '�I�) " e < r C / UNI;T.# _LOT# �� PERMIT EXPIRATION
//-1� �1 1r L�,� - NIT4 PERMIT EXPIRES IF WORK
OWNER vrG V'J 6 CONTRACTOR Or •" IS ION NOT�RTED WITHINa
INSPE TION DATE INEC
SPECTOR INSPTRECORD 78o DA PERMIT ISSU-
FOUNDATION • - ANCE OR 786 DAYS FROM
NOTE: LAST CALLED INSPECTION.
LIFER ALC GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVGq BLgpIG AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. PAlb
GARAGE SLABS -
' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - AUG: 1988 ' ,,' /`•Iti ;U,I-1 .�{
UNDERGROUND /SLAB _
PLUMBING City of Cupertino
ELECTRICAL ISSUANCE DATE
MECHANICAL - - FLOG ELECT PLG. MECH.
bc�oe¢laewnt a e wL at_ �.
ED
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED q-$i ma5fcr I 8U1 DING IJERMITX
WOOD FLOOR
INFORMATION
- jVALUATION S/FT.
PLUMBING
MECHANICAL
To
ELECTRICAL I Ir
FRAMING '
INSULATION Sr TYPE CONSTR.
OC2 GROUP MIJR UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so OOR AREA TOT+L ACREAGE
DIAPHRAGM THE.CONSTRUCTION TAX IS PAID =-• '
BUILDING USE
ROOF SHEATHING ❑ IND❑ ❑N 11 ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL No
ROUGH - SAN.p .
PLUMBING ELECT.ENERGY
TRncT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY `
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING - ELECT.FINAL TEST
ZONING ' ENC.SITE NO,
INSULATION PLUMBING
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 0 N❑ O NO
EXTERIOR SHEAR —9- (j ( ELECTRICAL RELEASE FLOOD ZONE ALUC
INTERIOR SHEAR f ,,, ..�(i FIRE DEPT. YO NO 'Y ❑ - NO
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - TEMPORARY APPROVALS BUILDING I.
SCRATCH COAT ELECTRIC PLAN CHECK 776.00
GAS FEE
NO TAPE OR PLASTER UNTIL ABGVE HAS BEEN SIGNED OCCUPANCY S&s'$1CVE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 9.73
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING SS.�SO
o� PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE'— MECHANICAL
IMPORTANT! . CONST.TAX,, -ST•50
PLEASE READ REVERSE SIDE BEFORE I' TOTAL 68.95
CALLING FOR FINAL INSPECTION:
OFFICE COPY lei U*011
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BIL POINT PEN ONLY
BU LDING PROJECT IDENTIFICATION - .PERMIT NUMBER
PDIDRESS o an APPLICATION & PERMIT
11713 Westshore Court BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'a PLAN CHECK VALIDATION
rvAME Gregory Group, ,Inc. & ELECTRIC PERMIT FEE
Ahmanson Dev. PHO,A15-595-21TY.
Dame acraRs UTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group, Inc., B-430097 LIGHTING FIXTURES 10.00/1.00 OXR
DDR
ADDRESS DRESS 's 220-C TWln Dolphin Dr. APPLIANCES-RESIDENTIAL 4.00 R 'R
ADDRESS
t RWC 94065 Pmu,915-595-21 0 PANELS 10.00 DATE OF APPLICATION
I' ORRCHITECT ram Bassenian, A A PANELS (OVER 200 AMP) 20.00 .PLAN CHECK FEE P.C.No.
ENGINEER AssociatesC-8395
uc..O. SIGNS TRANS, 3.00
ARCH.OR ENG. - 'PERMIT VALIDATION
ADDRESS2031 Orchard Dr.#100 SPECIAL CIRCUIT 5.00
Santa Ana Hts. CA. ZIP 92707 TEMP. METER OR POLE INS. 20.00 A'1 � ��
APPLICANTS MOTORS SEE FEE SCH. '�w
ADDRESS
220-C Twin Dolphin Dr. RWC SERVICE CHANGE 20.00
w a zU [JCS
Hoo LICENSED CONT'RACT'ORS I)ECLARAYAWbb PAID
rt u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
yC' (commencing with Section 7000)of Division 3 of the Business and
¢ y BLDG. ELECT. PLG. MECH.
r o Z Professions Code,b�ppd my license is Nin full tierce p1 ® ® ®.
z o y- Licensor Clu s_f� _Lic. umber 4. 9'7
4 � H o Dute_�!3p�Conlraclor_Cc
a m E BUILDING PERMIT
s ¢ ¢ OWNER-BUILDER DIICLA 'ION
o to u - INFORMATION
E:
; u m 1 hereby affirm that I am exempt from the Contractor's License MISC.- RE ER TO RD
u, o a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
-a Code:Anycity Clerically which requires a permit lin construct.alter,
l36 006
er Q ¢D improve,demolish,or repair Amy atfOCloor,prior to its Issuance,rIP ELEC.CONTR. LIC.NO. ELEC.
O, requires the applicant for such permit to file a signed statement that TOTAL
n w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
rzi Law(Chapter 9(commencing with Section 7000)o'Division 3 of the SFDU
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
lxo
¢ H $ by basis for the alleged exemption,Any violation ounit cion malty STORIES 'TYPE CONSTR.
by any applicant rive hundred
subjects theapplicant loocivil penalty ALTER-DRAIN -WATER (EA.) 5.00 2 SNHR
of not more than five hundred Aollars(55001.):
❑ I,as owner of tem property,or an,employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP RES.UNITS
their sole compensation,will do ilia work,and the structure is not
intended or offered for 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 docs such work FIXTURES-PER TRAP 5,00 S0.FJ,Fjop�AREA TOTALACREAGE
himself or through his awn employees,provided that such improve- G�_J lr
meats are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.4OUTLETS 6,00
or insprovement is sold within one year of completion.the owner- GAS-EA.SYSTEM-OVER 4.IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he dill not build or im- - RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER: 30.00
❑ I,as owner of the property,am 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 docs 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 contractads)licensed pursuant to SEWER-SAN ITAR V-STORM EA.200fl/10.00
rhe Cnntmclor's license Law. - TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&I'.C.for this WATER HEATER W/VENT 6.00
ellsml
Owner Data WATER SYSTEM 5.00
ACC.GATE ACC,FILE NO,
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, - ZONING
or a certificate of Workers'Compensation Insurance, ,,q c•rj fieri ENG.SITE NO.
copy thereof(Sec.3500,Lab.CJ. United Pac>. >.c
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z )(3 Certified copy f wll ttry inspection division.
0 Applicant n MISC.- , REFER TO ORD, Y❑ N❑ .Y ❑ N❑
N CERI'IPIC :OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c.
LU > COMPENSATION INSURANCE PLG.CONTR. .LIC.NO. vLG.
CL 0 (This section need not be completed if rile permit is for one TOTAL Y❑ N❑ Y ❑ N
hundred dollars IS 100)or I.,0
U O 1 certify that in the performance of the work for which this per- FEE SUMMARY
LL F mit is issued,I shall not employ any person in any mmnner ,:,as to OTV. MECHANICAL PERMIT FEE
0 W become subject to the Workers'Compensation Laws of California.
CIL Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 776.00
>_ to NOTICE TO APPLICANT: II',after making this Certificate of nix
F ? .option,you should become subject 1.the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 0:88:�j00o
provisions of the Labor Code, you must forthwith comply with
U such provisionsur this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=1 .F.M.) 4.00 'FEE Energy 6
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6,00 SEISMIC FEE 9.73
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.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Adde S C retXyyy, Pacific fl� HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lenders Address 1' g4n- 55.50
I certify that I have read t ap Ica o nd slate that the above VENTILATION FAN (SINGLE) '4.00
information is correct.I agree to comply with all city and countyPLUMBING 55.50
Ordinances and state laws telling, to building construction, and BOILER-ODMP(3 H.P.or 100,000 B.T.U.) 6,00
hereby entuarizc representatives ec this city to enter upon rhe BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL 55.50
hereby authorize
orizared properly for inspection putty to,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX 'ZBB 95
may in any way accrue against said City in consequence of the
ranting this rmiL MECH.CONT. LIC.NO. MECH.
_ TOTAL TOTAL 1 ,318.68
Signal 1 ntractor �atn
OFFICE COPY