14924 (2) POST THIS.CARD NEAR FRONT OF BUILDING PERMIT NUMBER
1
CITY OF CUPERTIN-O 4'94
INSPECTION DIVISION
JOB INSPECTION �ECORID
PERMIT EXPIRATION
GTUNIT
JOB ADDRESS # -_LOT#
PERMIT EXPIRES IF WORK
OWNER CONTE p U CONTRACTOR �QU IS NOT STARTED WITHIN
INSPECTI DATE INSPECTOR INSPE TION RE RD 180 DAYS OF PERMIT ISSU-
FOUNDATI ON . -I"J�8 ANCE OR 180 DAYS FROM
NOTE: 'LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAUDAlU0N .
CUPERTINO STANDARDS.
GARAGE SLABS
A
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ;� �:.6�LCG �� OA ['t�,•E . . .` i� '
UNDERGROUNDJ'SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - I ELECT I'LC,, MFCfA
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .. O DING PERMIT
WOOD'FLOOR INFORMATIQN
PLUMBING VA SIFT
MECHANICAL
ELECTRICAL PEHMIT 10 .
FRAMING sm
INSULATION - - STORIES TYPE CONSTR
Q 2
• OCC GROUP, RES UNITS
R-9 I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
y uaOI USE
ROOF SHEATHING - RO- s IND CON Po 0++,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP7 0 ❑ El ❑
nssr.ssORS PnRCEI,No
ROUGH SAN.k !4 O -
PLUMBING ' P.9 'Q� (p!D' ELECT.ENERGY I
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO�7
MECHANICAL Q- (3-IM MECH.ENERGY
ACC DATE Acc,FILE No
ELECTRICAL azi
BUILDING ENERGY
FRAMING' - ELECT.FINAL TEST
INSULATION D-�-�9- 4A9c, PLUMBING _ _ ZONING ENC,SITE No,
GAS'TEST GAS otz_Is._
' - - FIRE sv, N EY RGV Toa
MECHANICALE]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING om-a_ v NE ° [:] "❑
EXTERIOR SHEAR
ELECTRICAL RELEASE - FEoou eon.E u,c.
INTERIOR SHEAR eio-R FIRE DEPT'. v ❑ "❑ v ❑ NEI
SHEETROCK GRADE FEE SUMMARY,
EXTERIOR.LATH — BUILDING if, _
Pr A
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK `. 15�SO
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCURANCY SEISMIC FEE
OCCUPANCY OF;BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDINGMSPECTOR. MICROFILM.
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICLU
_
~o. -ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
55.50
Z \MECHANICAL
'- SEE PERMIT FOR EXPIRATION DATE - � r�T
IMPORTANT! >♦ q`o,NST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. R TOTAL
OFFICE COPY _,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATIONI -PERMITNUMBER e v
BUILDING APPLICATION & PERMIT
ADDRESS
Lot 166 Plan 2A 14924
(�y�� r� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NFNERS `"J I+, nc. & Nmanson " '•�- PLAN CHECK VALIDATION
- • �eveloprerrts 415-595-21 QTY. ELECTRIC PERMIT FEE
vgorvE
CONTRACTOR'S
NAMEGregOI,y Group, Inc. 8-4397 OUTLETS-SWITCHES-RECEP 10:00/1.00
LIC NO. LIGHTING FIXTURES 10.00/1.00
co�NT�R`AcrOR's y_'j�Of�cy❑-C Twin.Dolphin APPLIANCES-RESIDENTIAL 4.00 '
A"""S J """' PHONES-595-2100 PANELS 10.00 DATE OF APPLICATIONOR
'.
ARCHITECT , - S PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE 'P.C.NO.
ENGINEER uC-8395
- c.rvo. "OJJJ ISIGNS TRANS. 3,00
ADCKORENG. a #100 SPECIAL CIRCUIT S.00 PERMIT VALIDATION
Santa a H7 5, ZIP92707 EMP.METER OR POLE INS: 20.00
Goo lOg56y.s 9 in Dolphin Dr. MOTORS SEE FEE SCH. ��_,
ttWl. SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION .�0�9(0 O
a v U 1 hereby affirm that I zm licensed under provisions of Chapler 9 - IS CE DATE
N a N (commencing with Section 7000)of Division 3 of the Business and BLpG P MECH.
r O z Professions Code,andr{ny license is in lull force un 7 + ,�'Via\
oz o Dl.te Class_D_Lia Nmnber_ v
_ m f j Uate Conlratlor zi KI
F e, J
w a OWNER-BUILDER DECLARATION - 1- .L PERMIT
ca MISC.- REFER TO ORD Yl NFORMATION
X ; °' n I hereby affirm that I am exempt from the Contractors License
Fuoa Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Pw >3 Code:Any city or county which requires a permit to construct,alter, ,139 rye
se ¢ a D improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ,
o rt requires the applicant for such permit to file a signed statement that TOTAL
a >, ry y Ile is licensed pursuant to the provisions of the Coninctors License PERMIT TO
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe SMUL
i o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
in
u, r the.basis for the alleged exemption.Any violation of Suction 703 LS STORIES TYPE CONSTR.
i 3 .. by any applicant fora permit dollars the($500).):
toacivil penally ALTER-DRAIN 5.00
of not more than five hundred dollars(my co : 2 SMiR
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 OCC.GROUP ,- RES.UNITS
.. their sole compensation,will do the work,and the structure is not '
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3 l
Code:The Contractor's License Law does not apply to an owner at
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsamnotintendedorofferedforsale.If,howeveq the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of coomiction,Inc owner- 1740
GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER: 30.00 itES I❑ ❑N 1PB] O❑
❑ I,as owner of the property,am exclusively contracting with rL%:J,
ther
licensed contractors to construct the project(Sec.7044, Business LAWN SPRINKLERS-1 INC 5 V.B. - 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conlraclor(s)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,li.&P.C.tirt this
reason WATER HEATER W/VENT 6.00 8i7
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORKFRS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that I have a certificate ofconsenl to sel Ginsure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
COPY IImmol(See.3800,LahC.). United Pacific
Policy No. Company
O sir Certified copy is hereby furnished. FIRE$PgINK ENERGY T-24
Z z -A/T Certified copyy�,��jj''II•d with Inc city inspection Aivision.
FO Applicant /l��j Misc.- REFER TO ORD. V[] NE] Yo NEI
• CC W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLo0020NE A.L.U.C.
LU > COhIPE-NSATION INSURANCE PLG.CONTR. LIC.NO. PLGCL 0 .
CL z (This section need not he completed if the permit is for one TOTAL' V❑ N Y❑ N
V O hundred dollars($100)or less.)
I certify that in the perfunnanm nl'the work for'
or which this per- DTV. MECHANICAL PERMIT 'FEE FEE SUMMARY
LL H mit is issued, I shall not employ any person in any manner so as to
O L) become subject to the Workers'Compensation Laws of California.
LU Date' Applicant BUILDING 776;W
>_ NOTICE TO APPLICANT: 11,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
z emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
prosthions of the Lahnr Code, you must forthwith comply with FEE /energy r
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) - 4.00 � 62.01'
CONS'T'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10 C.F.M.) 6.00 SEISMIC FEE 9.73,
1 hereby affirm that there is a construction)ending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of it wrn f se �l tYigpermiI ix issued ISec. MICROFILM
3097,Civ.CJ. J(rCU�ly �dC111C HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name �
Lender's Address ,_f ham_- HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 55.50
I certify that l have readlJi pp is}di Gan stole lhut tho above VENTILATION FAN (SINGLE) 4.00
information is cormel. I agree to comply with all city and county PLUMBING 55.50
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.1 6.00
hereby authorize representatives this
Of ths city to enter upon Inc
above-mentioned property for inspection purposes.
BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL Pq' Fin
(We),agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10'.00 CONST.TAX 288.24
mey in any way accrue against said City in consequence of the
ranting of this MECH.CONT. - LIC.NO. MECH.
TOTAL TOTAL 1,317.97
a]"atureo cant/Contractor to
OFFICE COPY