14987 (2) :.POST THIS CAR D'N EAR FRONT OF BUI LD I'NG
PERMIT NUMBER
. . CITY OF CUPERTINO`
i INSPECTION DIVISION 1498'
JOB INSPECTION RECORD '
' '' �� c-'� •4''• • PERMIT_EXPIRATION
JOB ADDRESS � � 30 / J`.4gk CT - `UNIT# _LOT#��! T
n �• `n-�J � //''"� PERMIT EXPIRES IF WORK
owNER-,•. IY -6 diQ >3-i2p C/ CONTRACTOR CT4e�Q' •6;ea { ' IS NOT STARTED WITHIN ;
INSPECTION ATE I INSPECTOR INSP TION RECORD 160 DAYS OF PERMITISSU-`.
FOUNDATION - = -�j NOTE: - ANCE OR 180 DAYS FROM
UFER. d LAST CA L L ED I NSP ECTI ON.
7-p�.p-$S ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNLTE. - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. '
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Vi t•<, '4k h
'" • 'UNDERGROUND /SLAB
PLUMBING
ELECTRICAL " -
ISSUANCE DATE
MECHANICAL - - - 'BLDG, .ELECT. PLG' 'MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ _ BUILDING PERMIT
WOOD FLOOR INFORMATION.'
VALUATION $SFT,
PLUMBING -. � - ` - -
MECHANICAL
ELECTRICAL
FRAMING
INSULATION - - _ STORIES TYPE CONSTR.
. . OCC.GHOUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 3 I
- - ROOF 'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE - so.rT PLoaR AREA TOTAL ACReACE
DIAPHRAGM ,THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING. 6���T �. I RES IND ILO
CON USEPBO'l—
APP-LY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS, DATE INSP- ❑ ❑ ❑ ❑ ❑
'
ASSESSORS PARCEL ND.ROUGH -� � 'SAN.k / S-0 - �� '
PLUMBINGJL.2r. 4v/. ELECT.'ENERGY - '
TUBS&SHOWER PAN III.Ze PLUMBING ENERGY ?RACT NO. PARCEL NO.
MECHANICAL -��- J- .MECH.ENERGY•'- _
ELECTRICAL - h BUILDING ENERGY Acc.DATE ACC FILE NO
FRAMING ELECT.FINAL•TEST
INSULATION : ,. - _ 0 PLUMBING ZONING ENG.SITE NO,
GAS TEST _ GAS. _
MECHANICAL :FIRE$PRINK _ ENERGnraa.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ ° ❑. N❑"
EXTERIOR SHEAR " - 1.� ` ELECT R ICA L RELEASE FLOODZONE A.L.U.0
INTERIORSHIEAR FIRE DEPT. " . - v❑ N❑ ° ❑ N❑;
SHEETROCK. �. I-a. GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - -
INTERIOR LATH- . - TEMPORARY AP OVALS' BUILDING
,SCRATCH COAT ELECTRIC - -PLAN CHECK 18:60
` GAS - FEE /a raV 69
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY L - SEISMIC FEE rc ;
OCCUPANCY OF,BUILDING ISNOTPERMITT EDUNT ILBUILDING FINAL ISSIGNED BY
BUILDING INSPECTOR. MICROFILM' '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC '
��. ONEWORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING .
Z PLEASE GIVE'JOB ADDRESSWHEN PHONING:' . 73-11
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL,
IMPORTANT!.. CONST.TnX .288.24'
PLEASE READ REVERSE SIDE BEFORE
'CALLING FOR FINAL INSPECTION. TOTAL 1670.78'
OFFICE'COPY i
APPLICANT TO FILL IN INFORMATION'WITHIN RED LINES - USE BALL POINT PEN ONLY
..BUILDING PROJECT IDENTIFICATION ., PERMITNUMSER
APPLICATION &PERMIT
11643 Bridge Park Court "J
ADDRESS
Lot 179 Plan 4A 14981
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL k.
OWNER'S
NAME Gregory Group Inc. & Ahmansifty. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
- -
CTDP's
'--4'1
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group, InFl.No 13-4300 LIGHTING FIXTURES 10,00/1.00
CONTRACTOR'S
220 C Twin Dolphin Dr. RWV APPLIANCES-RESIDENTIAL 4.00 ,
ADDRESS
94065 PANELS 10.00 DATE OF APPLICATION
ARCHITECT Aram Bassenian, AIA ASSOC. PANELS (OVER 200 AMP) 20.00 PLAN LHELK FEE P.C.NO.
OR
ENGINEER C-8395
LIC.NO SIGNS TRANS. 3.00
ARCH OR ENG. 2031 Orchard Dr. #100 PERMIT VALIDATION
AooPEss L JJ 11 SPECIAL CIRCUIT � 5.00
Santa Ana Hts CA i EMP.METER OR POLE INS. 20.00
APPLICANT'S220 C Twin Dolphin Dr. RWC MOTORS SEE FEE SCH. � J
ADDRESS
CA. 94065 SERVICE CHANGE 20.00
w00 LICENSED CONTRACTORS DECLARATION Y['
¢ v u 1 hereby affirm that I am licensed under provisions of Chapter 9 _
w 2 w ISSUANCE DATE, -
a u (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
Z, i x
H y i Professions CodeCode-Andmy.license is in full for it seU,f,f�e,c,t.
a License Class_[} Lia Numbe
< m �J Date.Contractor I
¢ ¢w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
w- u INFORMATION
o 3:A I hereby al lion that I am exempt from the Contractor's License MISC.- REFER TO
t- u-00< Law for the fallowing reason.(Sec.7031.5,Business and Professions ALUATION $/FT.
� u,0� Code:Any city or county which requires a permit toconstruct,alter, PERMIT ISSUANCE ,00 DOO
re ¢ <O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. �tiE 1 i
ELEC. pp V
O u requires the applicant for such permit to file a signed statement that TOTAL W
A w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Hii Law(Chaplet 9(commencingwith Section 7000)ofDivision 3 ofthe SFDU
14 ao Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE '
¢f$ the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
a ; - by any applicantfor a permit subjects the applicant to acivil penally ALTER-DRAIN -WATER (EA-) 5.00
of not more than five hundred dollars(5500).): 2 CMLn
❑ 1,as owner of the properly,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 DCO.GROUP :d YRl65R.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,AR EA,GOND. 5.00 R-3 1
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 50.FT,FLOOR AREA TOTALACREAGE
( himself re through his awn employees,provided that such improve-building
orments
improvemenotnt
or within
on yearor o If,however,the the owner-
GAS-EA,SVSTEM-11NC.40UTLETS 6.00 2445
bu improvement is sold within ane year of lie didtio t the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.,SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
Prove furs coene,of tire.), RES IND CON PB OrM1ar
❑ L as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 36.00 ❑ ❑ ❑ ❑ ❑
` licensed contractors to re Comm the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions grope The Contractor's p License Law does not apply
to tr owner of property who builds t r improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts ct such projects with a cnntractor(s)licensed pursuant m _
Inc Contractor'spt under
Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,b.&P.C.for this
reason WATER HEATER W/VENT 6.00 8067
Owner Date WATER SYSTEM - 5.00
ACC.DATE ACC.FILE N0. s
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or z certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). United Pacific - .
Policy No..Company
O ❑ Certified Copy is hereby furnished. FIRE$PRINK ENERGY R24
Z Z ❑ Certified Jed with the city inspection division. y N Y
F0. Applicant N[]MISC.- REFER TO ORD. -
GrN CERTI CATF-OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG_
CL CI ('nor section need not be completed if the permit is for one TOTAL YE] Ng Y N�
0 Z hundred dollars(S 100)or less)
L) 0 1 certify that in the performance of the work for,which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
W F- mil is issued,I shall not employ any person in any manner so as to -
O become subject to(he Workers'Compensation Laws of California. '
0 n Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 972.00
>_ W NOTICE TO AI'PLICAN'I': If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN HECK
provisions of the Labor Code, you must forthwith comply with FEE Ferrer 62.DD
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.rl 4.00 gy
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.RM.) 6.00 SEISMIC FEE 13.65
I hereby uffhor that them is o construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
tire r
e perfomance f1�prn wo k .),1This permit Is issued(Sec, MICROFILM
3097,Civ.C.). eCl1L"1 1/ 1'dC.1T lc HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name- -_j(3aY'Ga _Iqth fir.Lender's Address_Sf _1 HEATELECTRIC
ING UNIT (OVER 100,000B.T.U.)9.50 73.13
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 li
Information is I agree gree to comply with all city and county
ordinances and stale awalretating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING 73.13
herebhereby authorize representatives moves of this city to enter upon the BOILER-COMP(0vm 100,000 BTU)SEE FEE SCH. MECHANICAL 73.13
y
authorize
ned property forinsp of th purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which
may in aCONST.TAX
tiny way accrue-against said City in consequence of the PERMIT ISSUANCE 10.00 ' 288.24
coming of th MECH.CONT. LIC.NO. MECH.
B8 TOTAL TOTAL 1570.78
Signature o licant/Contractor to
OFFICE COPY