17720 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT
177201
CITY OF CUPERTIIVO
INSPECTION DIVISION
QL� /
JOB INSPECTION RECORD
• JOB ADDRESS//9 / � SH44;74 5;' ��C� Zr 2 L PERMIT EXPIRATION
UNIT# _LOT#✓✓�
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:
' UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUPJITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGESLABS 14f•t!!.7
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED G
UNDERGROUND /SLAB {\y 8 3 1989a•'a' /
PLUMBING S! •�r,_'►
ELECTRICAL Of k"m ISSUANCE DATE
MECHANICAL BLDG ELECT InLLI "ICH
® JoW Q
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
MECHANICAL 1D'I�:lIV
ELECTRICAL PERnRT TD
FRAMING
INSULATION STORIES TYPE CONSTR
2 sm
\tvwre2sdzv)cc-7-1 OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3
SQ,{T FLOOR ARTA TOTAL ACREAGE ,
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 3W7 ( i
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING 2 REs IND CON PB OI...,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El 1:1 ED E]ROUGH SAN.H ASSESSORS PARCEL NO
7-1
PLUMBING OUT--- ELECT.ENERGY � ' -+�•LG��`J'✓'"'Q�
TUBS&SHOWER PANPLUMBING ENERGY tRACT NO PARCEL NO
m
MECHANICAL 1 MECH.ENERGY
ELECTRICAL N ACC DATE —ACC FILE-NO
Z.LS BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION IPLUMBING 77N'NG ENG.SITENO.
GAS TEST GAS
MECHANICALFIRESPRINK ENERGY T.za
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑- N[j ` ❑ NF]EXTERIOR SHEAR ELECTRICAL RELEASE FLOODIONE ALUC
INTERIOR SHEAR ^Z FIRE DEPT. - Y❑ N❑ v ❑ N❑
SHEETROCK Ct,D GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING 972.CO
SCRATCH COAT JELECTRIC PLAN CHECK 15.50
GAS FEE Stem w.m
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 13,61
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ED ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC , 73.13
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
�� PLEASE GIVE JOB ADDRESS WHEN PHONING. 73.13
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE - 73.13
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
BUILDING PROJECT I DENTIFICATION PERMIT NUMBER
BDILDING APPLICATION & PERMIT -' ^0
aDpRE55 G
_fl
BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S Gregory J Inc. PLAN CHECK VALIDATION
NAME Gregor ) 1. 415/595-21 QTY. ELECTRIC PERMIT FEE PHONE
CONTRACTORS
" ` ` J ry ,NAME I UTLETS-SWITCHES-RECEP 10.00/1.00
UC.NO B-4397 LIGHTING FIXTURES 10.00/1.00
ADD.CONTRACTORS 220-C Twin Dolphin Drive APPLIANCES-RESIDENTIAL 4.00
CONTAS�Ir�
a CA 94065 PHONE4151595-2100 PANELS 10.00 DATE OF APPLICATION
ARCHITECT Bassenlan/Lagonl krtitects PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No.` ryCa-8395" SIGNS TRANS. 3.00
ADDRESS ENG. 2001 OrIch rd Drive #100 SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ARCH OR LV5 VI 1.1 ISI U UI W
Santa Ana Hepidts, CA ZIP92707 TEMP.METER OR POLE INS. 20.00 f�� I
ADDRESS 220-C Twin Dolphin Drive MOTORS SEE FEE SCHE
. l � -
M CA 94065 SERVICE CHANGE -20.00 yS1 I
oaz -��1
F
09 LICENSED CONTRACTORS DECLARATION
au 1 hereby affirm that I con licensed under provisions of Chapter 9 ,
z i ISSUANCE DATE
w a (commencing with Section 7000)of Division 3 of the Business and
H = i d mBLDG. ELECT. PLG. MECH.
Professions Code,, y license is in full force a,{Iyy��,,��jjj�yy{{'1�},, I
o 0 o License Claxs_(5 Lit.Number
Date Contractor
Wxy-x{r„ ot cape ^
1lBl
W
w a OWNIi R-BUILDIiR DECLARATION BUILDING PERMIT
a o A INFORMATION
X ; ti I hereby Llshot I am exempt from the Contractor's License MISC.- REFER TO ORD
LL ons o j Law for the following reason.(Sec.7031.5,Business and ProfessiVALUATION $/FT.
- PERMIT ISSUANCE 10.00
� w LA � Cede:Any modish coo nfy whiny requires a prior to construde,also
a 0 improve,demolish,or repair any strucfum,prior ro its issuance,also ELEC.CONTR. LIC.NO. ELEC. 194,540
a m LL requires the applicant for such permit to file a signed statement that TOTAL
n w he is licensed pursuant to the provisions of the Contractor's License PERMIT O
H z
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe SFW
a
s 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ I- the basis for thealleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
pm
d3 _ by any applicant for a permit subjects the applicant to a civil penally gLTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(S500).): 2 5NHR
❑ I,as owner of the property,or any employees will, wages as BACK FLOW PROTECTDEVICE 4.00
their sole compensation,will do the work,and the structure is not . OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Pmfesaions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3 1 -
Code:The Contras W is License Law does not apply to an owner of
•
himspropelf or
huihhis inn employes,provndwhat such improve.
work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such such
o work
ments are not intended or offered for sale.l f,however,the budding GAS-EA.SYSTEM-I INC-40UTLETS 6.00 3047 r1�G 1 'v
w
or improvement is sold within one year of completion,the oner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 G V LJ
\J1
will have the burden of proving that he did not build or im- BUILD USE
Prove l'orpurpose.('sale.). INDUSTRIAL WASTE INTER. 30.00 RES IN❑D C❑ON O pOr
❑ d as owner rs the property,ant exclusively contractBusine h
licensed corns Cod to The Contractor's
project La 7044,Business LAWN SPRINKLERS-1 INC5 V.B. 6.00 ASSESSORS PARCEL NO.
and n Professions ns Code,The Contractor's Li ,ov Law docs not apply
to frowner ofproperty who builds or Improvesthereon,and who LAWN SPRINKLERS-OVER 5IEA.1 1.00 •-a./„/-�5-aQ
contracts for such projects with a contractors)licensed pursuant to �L-(V
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lain exempt under Sec. B.ffiP.C.for this WATER HEATER W/VENT
reason 6.00 8098
Owner Date WATER SYSTEM 5.00
ACC.OATE ACC.FILE NO,
WORK ERS'COMPENSATION DECLARATION' WATER TREATING EQUIP. 5.00
1 hereby uffinn that 1 have u certificate ofcunsent to self-insure-
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.)United Pacific
Policy Nn. Company
O ❑ Certified copy is ltereby furnished FIRE SPRINK ENERGY T
Z Z C Ce lifm c py is filed with til• city inspection division. 24
FO App runt MISC.- REFER TO ORD. Y [:] NEJ Y ❑ N�
Lu
PERMIT ISSUANCE y Cl: '11lCOF EXEMPTION PROM N'ORKIiRS' 10.00 FLOOD ZONE A.L.U.C.
W COM COh1PfiNSAT10N'INSURANCE PLG.CONTE. LIC.NO.
CL C, PLG.
Z ffhis section need not be conydded if the pemut is for one TOTAL Y El N0 Y No
hundred dollars(51007 or lass.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
W U mil ll is issued,I Shunot employ any person IS any manner so as to
O
become subject to file Workers CompensunonLows of California.
O. Dal` Apph`ant ALTER OR ADD TO MECH. 5.00 BUILDING 972.00
} W NOTICE TO AI'I'LICAN'1': If,after making this Certificate of Ex-
F" Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK �/�
provisions of the Labor Code, you must forthwilh comply wiNl 15.50
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10.00DC.EM.) 6.00 SEISMIC FEE 13.65
I hereby uffinn that there is a construction lending agency fur EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000B.T.U19.50 ELECTRIC 73.13
1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
ordinances is correct. I agree to comply with all city and county PLUMBING 73.13
hereby au and a re laws relating to building construction, and BOILER-CUMP(3 H.P.Or 100,000 B.T.U.) 6.00
s hereby authorize representatives of this city to enter.upon the
above- BOILER-COMP(Over 100,000 BTU)SEE FEE SCH,mentioned property for insPedion purposes. 7
3.13
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which
mCONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
panting ofthis permit, MECH.CONT. LIG NO. MECH.
'eI �z3 TOTAL TOTAL
Signature of Applicant/Contractor Date f584
OFFICE COPY 5V