15818 (3) �- POSTT.HISCARD NEAR FRONTOF BUILDING
PERMIT NUMBER
-
r ,.,
�CIT.Y OF :CUPERTINO 15$18
'INSPECTION DIVISION -s I
JOB INSPECTION RECORD
`2
PERMIT EXPIRATION .I
� 'JOB ADDRESS ` `���' -' ! ' �1� �' UNbT# LOT# ..` )I4''
P,n►,p ..� ^ yam,( �r PERMIT EXPIRES IF WORK ;
OWNER �7CL`l gON .,` CONTRACTOR'S G1020" �.% ISNOT STARTED WITHINFf
,
INSPECTION DATE INSPECTOR INSPECTION RECORD 180'DAYS OF PERMIT ISSU.
ANCE OR 180 DAYLLEDINSS FROM
FOUNDATION - ^g�7 • NOTE: OR
UFER - ALL GRADING AND DRAINAGE'SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PER mIr,vA i.iunrroN
PR EGUNITE •CUPERTINO STANDARDS. ' "
t^S� GARAGE SLABS - '- - +
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB .:PA[D. •"
PLUMBING.. - - - .r - . . f• + ! "�
ELECTRICAL '-„ V 1 'msUANCE UA rE
MECHANICAL Bwc, ccEc4r rL •mECR.�
DO NOT POUp FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
- INFORMATION'
WOOD FLOOR ,..- .. - VALUA71ON SIFT.. -.
PLUMBING ^
MECHANICAL- 1 A5 864 .'
ELECTRICAL wl�ERIVTIH TO
FRl;MING
SFOU'
INSULATION - . sroRus _ TYPE coNs'n+. ;
�• UCC.GROUP RES UNITS
a. 1 _. _
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _ �- � � � �I>
ROOF NOTE:NO FINAL NSP_SHALL BE MADE BEFORE' so.l r, o AREA ro*AL Ac 'AGE
DIAPHRAGM -. c' .. THE CONSTRUCTION TAX IS PAID 7917 '
+ - .BUILDING USE
ROOF SHEATHING - - HE IND CON PB D
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS D ❑ E] E] ElATE INSP.. ASSESSORS PARCEL NO.
• ROUGH
N # / 6" '-
PLUMBING
�'=7 - �3 ELECT'ENERG -
TUBS&SHOWER PAN PLUMBING ENERGY _ TRACT NO. PARCEL No.
O-Ff�l
MECHANICAL3 7-ycl f �MECH.ENERGY - - -
ACC.onre
ELECTRICAL. BUILDING ENERGY , - ACC.EILF.No,
FRAMING %Diulj ELECT.FINAL TEST — Q'
_ ZONING ENG.SITE NO
INSULATION- PLUMBING4
GAS TEST &-oa- GAS _ _
_ gRE'$PR IN K LNE RG,'R44 ,
• - -
MECHANICAL Y.❑ N❑, ❑ ; 'N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -
EXTERIOR SHEAR ELECTRICAL RELEAS - FLooD zoNE ' aL.u,c.
INTERIOR SHEAR ,r�_a,l �' �Oi FIRE DEPT. .1 v❑ NE] , ❑, • N❑'
SHEETROCK 7^ _E GRADE - FEESUMMARY
EXTERIOR LATH BUILDING j
INTERIOR,LATH - Z '= "N TEMPORARY APPROVALS - BUILDING.
940,fif
SCRATCH COAT - q EC
GELTRIC FEEN CHECK 15.5(
AS
PL
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE -
OCCUPANCYOFBUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BYBUILDING.INSPECTOR. MICROFILM
w ARRANGE FOR INSPECTION BY PHONING. 252-4505,
ELECTRIC
I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. „ PLUMBING '
O� PLEASE GIVE JOB ADDRESS WHEN PHONING'' 70
Z ' MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! coNST.TAx
PLEASE READ REVERSE SIDE BEFORE TOTAL /;
CALLING FOR.FINAL INSPECTION. . •
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.PERMITNUMBER -
,�'� _ 'BUILDING PROJEQT IDENTIFICATION ; APPLICATION & PERMIT - q C Q�,
ADDDRESS Lot 1! 227 Plan `3A 15 818
• 11594 Oak 5 ria " COU, BUILDING-ELECTRICAL-PLUMBING-MECHANICAL .,
OWNER$ regory Group, Inc. - PLAN CHECK VALIDATION
Ahmanson, Dev. 41�Z0 95-2100 . DTV. ELECTRIC PERMIT FEE
CONTRACTOR - OUTLETS-SWITCHES-RECEP 10.00/1.00
NA"�regory Group, 1nCt1C:No B-430097 LIGHTING FIXTURES 10:00/1.00 _
CONTRACTOR S p2p C Twin 1 n . ApPLIANCES-RESIDENTIAL" 4.00
AD RWI. 94065 4��,' �21UO PANELS - 10.00 "DATE.OF APPLICATION
ARCHITECT PLAN CHECK FEE P.CNO.
OR Aram Bassenian, AIA &' AssD PANELS (OVER 200 AMP) 20.00
ENGINEER -
uc.No. _ SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADDRESS 2031 Orchard Dr. #100 SPECIAL CIRCUIT 5.00 - -
fj Santa Ana Hts. CA. 927071P ITEMP.METER OR POLE INS. 20.00
APPLICANTS " P ,1,
MOTORS SEE FEE SCH.
A22UsC.Twin Dolphin Dr. RWC 94065
SERVICE CHANGE 20.00
H
o0 LICENSED CONT RACTORS UBCLARATION I ��.' 1 �� d( '�"•t
1 o U 1 hereby uffinn'that I am licensed under provisions of Chapter 9 ISSUANCE DATE "- 1
H ¢
(commencing with Section 7000)of Division 3 of the Business and lll,,,���CDItLF4 TI PLG. MECH.
F
zNF Professons Coer, _mheensi cis. in mfull eforce
o License Class1i
D ppt3pbhUy-IUfryh - ,
Date Contractor
BUILDING PERMIT
OWNER-BUILUHR DECLARATION INFORMATION
D MISC.- REFER TO ORD
w 3 LL H I hereby affirm that I am exempt from the Contractor's License
n o a law for the following reason.(Sec.7031.5.Busioessand Professions PERMIT ISSUANCE 10.00 VALUATION 8/FT. -
� - 0 Code:Any cityor county which requires a permit to construct,alter. '
Q a¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. - 185-865
'
- D¢ requires the applicant for such permit to the a signed statement that TOTAL PERMIT TO
n w m" he is licensed pursuant to the provisions of tat Contractor's License
i I.aw(Chapter 9(commencing withSection70001ol'Division3ofine SFDWL
,w:
Q Business mW Pro(cssions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
Eio
¢ 5 tits,, n, for the alleged exemption.Any app1w,i atoeclion 703L8 1 STORIES",• TYPE CONSTR.
;� by any apr,thafor, un,eddollarsth500).)cuntto,civil penalty ALTER-DRAIN -WATER (EA.) 5.00 e'• ,,2 a 5NHR,
of not mom than five hundred dollars(8500).): '
❑ I,as owner of the property,or my enhpl lyces with wages as BACK FLOW.PROTECT. DEVICE 4.00 OCCGROUP RES.UNITS
their sole compensation,will do the work,and the structure is not . ..
intended or offered for sale (Sec. 7044, Business ,,it Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cod,The Contractor's License Law does not apply to an owner of - R-3,
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT FLOOR AREA TOTAL ACR EAGE ..
himself re through his own employees:provided thin such im Prove
nmnts selfo through
ot onemployees:sale.ovif,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 2917•
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.1 2.00 BUILDING USE
build,,,will have the burden of Proving tint he did out build or int-
prove for purposeofsale.). INDUSTRIALWASTE INTER. 30.00 RES IND CON _PB Otte,
❑ 1,as owner of the property,'am exclusively contracting with [30 ❑ ❑ ❑ ❑
licensed contractors to construct the project(S"..7044,Business LAWN SPR INKLERS-1•INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code.The Contramnr i License Law dues not apply "
to un owner of property who builds or improves Drereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ••�/ /
a contracts for such projects with a contractor(s)licensed pursuant to - tP '
tri Conlmctor,License Law: SEWER-SANITARY-STORMEA.200it/10.00 . _TRACT NO. PARCEL NO. ,
❑ and exempt un der Sec.- .B.&P.C.brthis WATER HEATER W/VENT - 6.00 `. 8098
rc:u n
,sane, Date WATER'SYSTEM '5.00
' 'ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'1']ON DECLARATION WATER TREATING EQUIP. - 5.00
I hereby affirm that I have a certificate of consent to self-insure - -
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.'
copy thereof(Sec.3800.Lab.C.)' United P8Clf 1'C.
Policy No. Company
0 ❑ Certified copy is hereby Furbished, FIRE SPRINK ENERGY T 24
Z_ Z MO Certified copy is filed will, the city inspection division. MISC.- REFER TO ORD.
O Applicant Y❑ N❑ Y ❑ N❑
F rn PERMIT ISSUANCE 10.00
� - CIi R'I'1 FICATIi OP GXEM11 Pl'ION PROM WORKERS' FL00020NE- A.L.u.C.-
LLJ >_ COhIPENSATION INSURANCE - PLG.CONTR. LIC.NO. PLG:-
d 0 (1'his section need'not be completed If the Permit is for one • TOTAL •Y❑ IN ' Y [:] NE]Z hiuufmd dollar,1$100)or less.?
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT " FEE FEE SUMMARY -
LL I- mil is issued,1 dhoti not rmploy any Prison in any Inannci so as to
U become subject to the Workers'Compensation laws of California. 940•5
0 n Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE'f0 APPLICANT': if,after making this Certificate oFET-
caption,
Ex-
caption,you should become subject to the Workers Compensation APPLIANCE •, 5.00 PLAN CHECK 15.5(
provisions of the Labor Code, you must forthwith comply will - FEE"
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.16.00 SEISMIC FEE 13.0
1 hereby affirm that there is a constmvtion 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.). Security Pa.C1fir. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Luhder's Name ' HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Leaders Acidic.ss mba'rcadero-4th-f7T1. 70.3
I certify fisc h�4r a� 'is application and state that the above VENTILATION FAN (SINGLE) , 4.00
inlimnLit inn is Correct. 1 agree to conhply with all city and county PLUMBING
mlln,nccs and state law's relating to budding construction, and ' BOILER-WMPI3H.P.of100,000B.T.U.) 6.00 .. JO.3
Imove- entho ed representative,for ins inspection
this city toemer upon the' BOILER-COMP (0Se,100,000 BTU)SEE FEE SCH. MECHANICAL
abovementioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses whichCONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 03_
•rantingofthis per it MECH.CONT.- LIC.NO. MECH. -
TOTAL 1 TOTAL
Signature co icant/Contractor Date -
OFFICE COPY