15809 (2) CITY OF CUPEKTINO
cCERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE j
I uu cQ
Date .........
........... ...................1 19..6-1.... /1 hBuilding Permit No.
The Building Located at .._�...�..L7 ......U...l`! ----5.. ... ...............
IOwed by . QZ��.A.q2.. . ...... w. ................... ........ ..... .............
Has Been Altered) For Use As: .......� Y
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PD-7 BUILDING IASPECTOR I
II
r POST THIS CARD NEARIF-RONT. OF BUILDING,:_ - {
PERMIT'NUMBEH ,
CITY OF CUPERTINO
- � , 15809. ,
I
' INSPECTION DIVISION ;
Hrr JOB INSPECTION-RECORD - '
� `, PERMIT EXPIRATION
S?,�y'pyt JOB ADDRESS '�' "' �—'�'F UNIT
# - LOT
JJ Lk?p{� -,T ; /. .�r--�.. PERMIT EXPIRES IF WORK
-OWNER \J7=V• CONTF�ACiOR 1�tiCR�\l.c..\ lAl\V IS NOT STARTED WITHIN
.. . , INSPECTION DATE INSPECTOR _ INSPECTIONRECORDq 180 DAYS OF PERMIT ISSU. i
i .. ANCE OR 180 DAYS FROM
T FOUNDATION —2 AI \ C ' NOTE: . LASTCALLEDINSPECTION. :
UFER' ' —'L 1— y ALL GRADING AND DRAINAGE SHALL BE.INSTALLED .' .
' PREGUNITE. h' .t _ TO COMPLY WITH THE APPROVED PLANS AND.CITY'OF Perrnvi vALI AnoN '
CUP,ERTINO'STANDARDS.
GARAGE SLABS. —
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,`, L .4 �, • ,;,•,, �:
;UNDERGROUND /SLAB
PLUMBING -
ELECTRICAL (� ' ISSUANCE DATh
BIUG. ELECT_. PLG. . MLCR '
MECHANICAL •- - _ ' V.
.DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �( ; \�euILDING�PERMIT,
WOOD FLOOR - •�• T�Ti INFORMATION ,
1A.UATIGN
PLUMBING
178 281
' MECHANICAL' ' .• >f
_ PERMII To
r I
ELECTRICAL - I - e
SFDUll
ST-0RIEs TYPE CONSTR.
INSULATION.....
'
. 00C GROUP 'RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - R-9
' - $O.IT.FLOOR AREA :TOTAL AC.EAGL
• ROOF',. NOTE:NO FINAL INSP.SHALL BE MADE BEFORE i
• DIAPHRAGM - r' - - THE CONSTRUCTION TAX IS PAID; •'n' -
µ' BUILDINGUSE
ROOF SHEATHING •• - uE ' PB -1
11
APPLY NO ROOFING UNTIL ABOVE HAS BEEN'SIGNED FINALS DATE INSP. - SE El.
n55E550R l Cf'LNO.
ROUGHSAN.H L- ' LLQ..
PLUMBING - - ELECT.ENERGY -
�TRAGI NO. 'PARCEL NO.
TURS&SHOWER PAN 3-7 3 . - PLUMBING ENERGY, —
MECHANICAL j,�-� MECH.ENERGY 8098 '
ACC.LATE. ACC.FILE NO,
ELECTRICAL. BUILDING'ENERGY
FRAMING —�— ELECT.FINALTEST-
20RING / -ENG.SITE NO.
INSULATION ' 17- Jbck q.X5Cj PLUMBING
GAS TESTGAS
FIRE SPRINK ENERGY L.24
` - ' MECHANICAL ' _
COVER NO WORK UNTIL ABOV HAS BEEN SIGNED .HEATING v NE Y U N�
EXTERIOR SHEAR t - ELECTRICAL RELEASE FLOOD ZONE A,L.u.c.
INTERIOR SHEAR FIRE DEPT. r❑ N ❑ NLtj
SHEETROCK , t5LL15 - GRADE .FEE SUMMARY i
EXTERIOR LATH '�-'�.'].�Q BUILDINGS
,INTERIOR>LATH . TEMPORARY APPROVALS BUILDING916.00
SCRATCH COAT _ ELECTRIC '
PLAN CHECK .15.50,
GAS, - FEE/en0gy 62-00
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILD ING'ISNOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM F;
'.ARRANGE'FOR INSPECTION BY PHONING 252-4505, ELECTRIC' 68.58'
LU ONE WORKING DAY BEFORE REQUIRED-INSP.ECTION. PLUMBING
O'� PLEASE GIVE JOB ADD.RESS WHEN PHONING. 68.58;
MECHANICAL 68.5¢8:
— 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
• BUI L-DI NG PROJECT I DENTI FICATION - - - PERMIT NUMBER.
.s,nD1 c APPLICATION & PERMIT 15809
AODRt�so t 2O P1 do 2A .
11624 Oak prim Court BUILDING,-ELECTRICAL'-PLUMBING-MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
AME Gregory Group, Inc. & OTV. ELECTRIC PERMIT FEE h
Ahmanson Dev. 415P„25-2100
CONTRACTORS - UTLETS-SWITCHES-RECEP 10.00/1.00
NAM
Gregory ;Group, InGL1C N 8-430097 LIGHTING FIXTURES 10.00/1.00
r-ONTRACTOR's220-C-Twin Dolphin Dr. PPLIANCES-RESIDENTIAL 4.00 -
ADDRESS _
RWC •94065 . . 141,5-595-2100 PANELS x 10.00 DATE OF APPLICATION '
ARCHITECT Aram Bassenian, AIA & Assoc_PANELS (OVER 200 AMP) .20.00 PLAN CHECK FEE !P.c.No.
OR
ENGINEER -
LIC.No. SIGNS TRANS. 3.00
ADDS ESS ENG.2031. Orchard Dr. #100 .S,PECIACCIRCUIT � 5.0D PERMIT VALIDATION
Santa Ana Hts. CA.,�: ,,92707 TEMP.METER OR POLE INS. 20.00
APPLICANTS . . - . - MOTORS SEE FEE SCH. PA
II
A°� �-C Twin`Dolphin Dr. RWC94065 SERVICE CHANGE 20.00
gov w o o - LICENSED CONT //��RACTORS DRCLARATIONa:'' - V
G u U I hereby affirm that I am licensed under,provisions of Chapter 9 ISSUANCE DATE
z,w00)
- (commencing with Section 7000)of Division 3 of the Business and Cit 01 }ECT. PLG. MECH.
r i Pmley,was Cnd,,a I my license is in full force a J effect. ® ® .
z 0 w- License Class B Lic.Number_4�0097 -
9 zw-a, Det, _ Contractor _
F
¢ a_fy,, BUILDING PERMIT
¢ ¢w a
OWNER-BUILD ISR DECL'ABA'PION• - INFORMATION
oALI a - MISC.- REFER TO ORD
w 3 u y I hereby collo that I am exempt from the
Contractor's License VAw ATIOry $/FT.
HLL04 Law for the following reason.(Sec.7031.5;Businessund Professions PERMIT ISSUANCE - 10.00
Coda,Any city orcounty whichrcluiresapcjmittoconstrucLaltcq 178 281
2 C, Q 0 improve,demolish,or repair,any structure,prior to its I...ance,also ELEC.CONTR. .LIC.NO. ELEC.,r f '
- O ¢ requires the applicant for such permit to file a signed stalentent that TOTAL - PERMIT TO
E
m L. he is licensed pursuant to the provisions of the Contractor License _
Hzi Law fChaptcrglconuncncingwith Section 70001nf Division3 of the -
a Business and Pmfessiuns Code)or that he is exempt therefrom and OTV. - PLUMBING PERMIT FEE L..• '
ic F the basis for the alleged exemption.Any violation of Section7031':5 - STORIES TYPE CONSTR.
ki,io by any applicant for a permit subjects the applicant to a civil penalty oALTER-DRAIN&VENT-WATER.(EA.) 5.00 'L - SNHR
f not more than five hundred dollars(8500).1: -
❑ 1,as owoeoof the properly,Or my employees with wages as BACK FLOW PROTECT.DEVICE' 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work:and the structi re is not - '
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3 1,
Codc:'The Contractor's License Law does hot apply.to un owner of -
property who buildsorimprovms thereon,and who does such work F IXTURES:PER TRAP 5.00 SO.FL FLOOR AREA TOTAL ACREAGE
himself or through his own employers,provided that such improve-
mentsaic,nut intended or offered for sale.It,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 2726
or improvenrent'is sold within one year of Completion,the owr,r- GAS=EAySVSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have.tire burden'of proving that he did not build orinh-
prove for purpose of sale:). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB . Omer
Cl 1,as owner of the property,am exclusively contracting with 0 ❑ El. ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN"SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. ,
and Professions Code. Fire Contractor's License Law docs not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) '1.00 3/' �-0 F
p
contracts for such projects with a contractor(s)licensed pursuant to @
the Contractor's License Law., SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1-an;exempt under Sec: ,B.&P:C.In,this WATER HEATER W/VENT 6.00
reason _ 8098
Owner - Date WATER SYSTEM5.00
- ACC.GATE ACG FILE NO.
WORKERS'COMPIENSATION DECLARATION WATER?REATING'EQUIP. 5.00
I hereby affirm.that I have a certificate of mnsem io sel6incura•,
or a certifierte of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
- copy themol(Sec.3800,Lab.C.United Pacific
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z' ••.1� Certified copy is filed with the,city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O APlhlicant Y N V N
WORK
OF
ccy C - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
� - IiRT'IIICATIi IiXISh1PTION FROMWORKERS' .
UJ > COM PI'.NSATION INSURANCF. PLG.CONTR. LIC.NO PLG.' - v E] rv❑ v ❑ N❑
d O I'rhis section need not be completed if the permit is for Dire TOTAL
Z hundred dollars IS 100)or less.) - ,
U O 1 certify that in tire m
e perforance°(,the work for which As pct OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H or is issued,I shall not employ any pursun Waits manner o as to - ,
U, become subject to the Workers'Compensation_Laws of Culihirnia.
a Dam Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING 916.00
} m
NO[[CF.TO APPLICANT: If.,after making this Certificate of fix-
? eruption,you should become subject to the Workers'Cnnrperimtion r APPLIANCE- 5.00 PLAN CHECK 15.50
provisions of the Labor th
Code, you must,l-orwith comply with FEE'
/ h such provisions or this permit shall be devoted revoked. AIR HANDLING UNIT(TO 10A00C.F.M.) 4.00 /cher62,100
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE 12.53
I hereby affirm that then 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.)., ` Securit Pacific HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name• _ HEATING UNIT ER 100,000 B.T.U.)9,50 ELECTRIC
Lenders Address r_�(ly�` gp7�j-� '4flx�- 68.58
I certify thatlhave read Rapb�' ftktltandslau,Lha,the above VENTILATION FAN (SINGLE) .4.00
infonnatiou i'corruaL9 agree to comply with.all city and county PLUMBING 68,rj8
ordinances and"state laws relating to building construction, and BOILER-OOMP(3 H.P.Or 100,000 B.T.U.),'6.00
hereby authorize repmSenlatives of this city to enter upon the BOILER-COMP(Over 100,000 RTU)SEE FEE SCH. .MECHANICAL 68.58
above-mentioned property for inspection Purposes.
(We) agree to save, indenuti y and keep harmless the City of MISC.- '•�REFER TO ORD. -
upertino against liabilities,judgments, costs and expenses which CONST.TAX
•
may in any way accrue against said City in consequence of the PERMIT ISSUANCE �S 10.00
ratting of it 't MECH.CONT.. . LIQ NO: MECH.
t - •� TOTAL I TOTAL'
Signature icant/Contractor Date
OFFICE COPY