15832 (2) i
71_ POST THIS CARD.,NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 15832
INSPECTION DIVISION ' 1.
JOB INSPECTION RECORD
1 (fir ///�a��,` PERMIT EXPIRATION '
JOB ADDRESS `� �� 5P�1 1' + UNIT# - LOT ^"_4 Y �- i
C1 .� �• 1pp / G, -^ PERMIT EXPIRES IF WORK ;
owNeR' AI, V�V•_ -'.CONTRACTOR •,�7,+�C.l IS NOT STARTED WITHIN '
INSPECTION DATE INSPECTOR INSPECTION REC RD 180 DAYS OF PERMIT ISSU�
FOUNDATION - - , ANCE OR 180 DAYS FROM
NOTE: LAST,CALLED INSPECTION..
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
•"' PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VA+,mATIM7
_ CUPERTINO STANDARD S.'
GARAGE SLABS
+ POUR NOTONCRETE UNTIL ABOVE HAS BEEN SIGNED
•-
UNDERGROUND /SLAB
J
ELECTRICAL ISSUANCE DATE
MECHANICAL _ :; ,• .BLDG.. ELECT I PEO. MFC"..
FRI
DO.NOT POUR FLOOR UNTIL ABOVE'HAS BEEN SIGNED - f- o;�9a BUILDING PERMIT,
'T INFORMATION
WOODFLOOR+
PLUMBING 1 O vn wnnom SIFT
MECHANICAL '.' - - O` CUOet�\� 4� 40
ELECTRICAL
PERMIT TD'
• � _ _ _ _ '"AL
FRAMING
INSULATION ': - "" - LS TYPE CONSnv. .r
p
.. - • OC(..GROUP TS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
•ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sov.,vLooR ARen roTnL hElEAC1.1 ;
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID _ 3047
• - ., _ BUIL DING.USE _
\ ROOF SHEATHING a, RES IN CON PB OI ..
APPLY NO ROOFING UNTIL,ABOVE HAS BEEN SIGNED. FINALS ' DATE INSP.' ❑ ❑ El 1:11
- TSSl550R5 PAR CEL NO
. - ROUGH . .SAN.# 6
:P
LUMBING %' ELECT.ENERGY +
THnCT NO. PARCEL NO,
TUBSBSHOWER AN - V PLUMBING ENERGY
MECHANICAL. MECRENERGY ACC DATE: ncc.FILE rvol
ELECTRICAL `1j'1 f3tO5 BUILDING�ENERGY
1
+ j FRAMING ,1 %UtS ELECT.FINAL TEST '
ZONINC, ENG.SITE NO. ,
INSULATION Zg PLUMBING
GAS TEST O „ GAS
FIRE SPRINK ENERGY T.SC
MECHANICAL
COVER NO WORK UNT L ABOVE HAS BEEN SIGNED • HEATING, Y ❑ NE] ' �"❑ N[]
EXTERIORS ELECTRICAL RELEASE -FLF r' N❑ a,L,u.c'N
❑
N
❑ ;
' INTERIOR SHEAR '• FIRE DEPT. +�
SHEETROCK - �,, , . GRADE FEE SUMMARY
' EXTERIOR'LATH U{, - BUILDING. '
' INTERIOR LATH 5-2 C(� C- TEMPORARY APPROVALS BUILDING
SCRATCH COAT" �/-/ff'�{; ✓ ELECTRIC � • ' FEEN CHECK IrJ.1JO
GAS.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - - SEISMIC FEE '
OCCUPANCY OF BUILDING IS NOT,PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM . '
'ARRANGE FOR INSPECTION,BY PHONING 252-4505, ELECTRIC
Lu
/ ONE WOR KI'NG'DAY BEFORE'REQUIRED INSPECTION.' PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING. '
Z
. - SEE PERMIT FOR EXPIRATION DAT - MECHANICAL
E 73
IMPORTANT!
CONST,TAX
PLEASE READ REVERSE SIDE BEFORE 3•
CALLING FOR FINAL INSPECTION. .TOTAL
OFFICE COPY /�r�,/ /
APPLICANT TO FILL IN INFORMATIONVITHIN RED LINES - USE BALL POINT PEN,ONLY', F
'Il`BUI LDI NG PROJECT 1 DENTI FICATI ON -PERMIT NUMBER
Dalt.°IND o an APPLICATION & PERMIT ' �I �p �12
ADDRESS - I 0 3
1 ILDING ak Spring Court
BUILDING'- ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
�( �U'e s Gregory Group Inc&Ahmanso T1. -' ELECTRIC PERMIT FEE i
415N--,595-2100
CONTRACTORS •
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Gregory-Group', Ingci,o.8-430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS 220-C Twin Dolphln'Dr. • PPLIANCES-RESIDENTIAL 4.00
ADDRp p{WW5.5C `
vF°NA15-595-21 PANELS 10.00 DATE OF APPLICATION
ARCHITECT ram assenlan'AIA&Assoc. PANELS (OVER 200'AMP) 20.00 PLAN CHECK FEE •P.G."°.
OR
ENGINEER - '
rvo. C-8395'"' ISIGNS TRANS. 3.00
ARCH. ENG. rC ar r. 100 SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDRESS OR
Santa Ana. Hts.CA. 99,707 TEMP.METER OR POLE INS'' 20.00 -�
APPLICANT'S - e D
A1122D-C Twin Dolphin Dr. RWC94065 MOTORS SEE FEESCH.
SERVICE CHANGE 20.00 1 198
H
02 LICENSED CONTRACTORS DECLARATION-
¢ u u 1 hereby affirm that I am licenud under provisions o(Chapmr') NCE DATE
n a N (con forajog with Section 7000)of Division 3 al'the Business and L PLG. MECH.
p D z Professions Code,mM my license is to full force4l
i 0N - License Class D Lic,NortherVU7/ KJ
o - Date Contractor -
F
a y a I BUILDING PERMIT
¢ w ¢ OWNER-BUILDER DECLARATION INFORMATION
" MISC:- REFER TO ORD
w 3 u w 1 hereby tiff nn that I am exempt Dom the Contractor's License
Is 04 Law fur the following reason.(Sec 7031.5,Busmessand Professions PERMIT ISSUANCE - 10.00 VALUATION .$/FT.
� -v, � Code:Any city or county whichrnluiresupermittocomtruct,alter. - 194540
IF Q¢ lE Improve,demolish,or repair any Structure,prior to Its Issuance.also ELEC.CONTR. LIC.NO. f
ELEC.
O¢ requires the applicant fur such permit to file asigned Smtemmtl that TOTAL PERMIT TO
a,w he is licensed pursumrt to the pruvisiune of the Contractor's Liacno, -
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 o(tbe SFDU :
Business and Professions Code)or thuf,he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ I=- Dp the basis for the allcgcdcxcrlliun.Any v iolationofSection7031.5 STORIES TYPE CONSTR.
by anyupplicam lora permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.)'5.00
of not more than five hundred dollars(S500r) - 2 5NHR .
❑ h as owner of the property,of my cnmloyces will,wages as BACK FLOW PROTECT. DEVICE - 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the struclure is nut
immured 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 un owner of
property who builds or improves thereon,and who does such work F IXTURES-PER TRAP 5.00 SD,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such immme-.
meats are not intended or offered for sole:If,however,the building GAS-EA.SYSTEM-111NC.40UTLETS 6.00 3047
or improvement is sold within one year of completion, Ole owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 'BUILDING USE
builder will have the burden of proving that he did not build or int- ,RES IND CON PB Other
move for purpose ofsalc.). - INDUSTRIAL WASTE m INTER.' 30.00 1f��11
❑ I,as owner of the property,aexclusively contracting with yy ❑ ❑ ❑ ❑
licensed contractors Io construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codc:'I lie Contractor's License Law don not apply ^ �y
I to an owner of properly who'builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 �V 4 '-O z
contracts for socli with contractors)licensed licensed puuunt m
License
the Contractor's Licensee Law. a ' SEWER-SAN ITARY-STORM EA.200ft/10.00 THACT NO. PARCEL NO.
L -'
O I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 8098
(e'JY
Owner
Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKI!RS'COMPENSATION DECLARATION - WATER TREATING EQUIP. - 5.00 -
I hereby affirm that I have a certificate of consent to self-insurc. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a cer(ificd
copy Ibere dt(See.3Beo,Lab.C.).United PacifiCl '
Policy No. Company ,
O Cl Certified copy is hereby famished. FIRE SPRINK ENERGY T 24
ZZ ry Certified copy is filed wfit, the city inspection division.
O Apmicamt MISC.-, REFER TO ORD. Y ❑ N❑ Y ❑ N❑
N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O.
Ql > _ COhIPENSATION INSURANCE PLG.CONTR. LIC NO. PLG.
CL O (this section need not be completed if the permit'is for one _ TOTAL Y❑ "❑ Y❑ N❑
:D Z hundred dollars 1$10()or less.)
L) O 1 certify that in the pcdurmance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
mit is issued,I shall 1101 employ any pecan In any manner So as m
U become subject to the Workers'Compensation Laws of California.
O w Dye Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 972.00
} y NOTICE 10 APPLICANT: If,after making this"Cerffcate of E.-
f" Z eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 15.50
pm visions of the.Labor Code, you most f..thwilh comply with
U such provisions or this permit shall be deuced revoked. - AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE /energy
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOQEM.) 6.00 SEISMIC FEE , 13.65
I hereby affirm that there is a construction 11 in agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this pencil is issued(Sec. MICROFILM
3097,Civ.C.). city Pa - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name Sec-u C.1f1C HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC 73,13
Learner's Ad dresIs a C ({ ro-4th-f-1-r-
/J - I rereify that have read A,Os a fl♦: i4 randw
sat that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING 73.13
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
/ hereby authorize representatives of Ihis.cily to enter upon the BOILER-COMP 0.,100,000BTLISEE FEESCH. MECHANICAL 73.13
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless OIc City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments. costs and expenses which CONST.T
may in any way accrue against said.City in consequence of the PERMIT ISSUANCE 10.00 O
' ranting IT this »' MECH.CONT. LIG NO, MECH.
TOTAL TOTAL
Signature of plicam/Contractor Date - -
OFFICE COPY