15115 (2) POST THIS CARD NEAR FRONT OF BUILDING
• PERMIT NUMBER
CITY. .OF CUPERTINO 15115
INSPECTION DIVISION
JOB IN�ySS�PECTIIO//N RECORD -
JOB ADDRESS 'IL��O'- 1,je5`�5� o e,COCI UNIT.# _l0T# PRivT EXPIRATION
In�VO D PERMIT EXPIRES IF WORK
OWNER V I (:, IS NOT STARTED'_WITHIN
CONTRACTOR
INSP CTI N DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- "
FOUNDATION ANCE OR 180 DAYS FROM
,NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE LI
INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROV ND CITY OF PERMIT VADATION -•
CUPERTINO STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED AUG
UNDERGROUND /SLAB
cof Cupertino
PLUMBING -
ELECTRICAL ISSUANCE DATE ~
MECHANICAL BLDG ELECT PLG: MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
PLHMIT To
ELECTRICAL
FRAMING - sm
STORIES YPE CONSTH"
INSULATION
F
GCC Gf UP UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO"V F OR PREP -TO L ACREFCE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 17—
DIAPHRAGM
•s•-DIAPHRAGM THE CONSTRUCTION TAX IS PAID
-M•BUILDING USE
�<. ROOF SHEATHING ;L 26 RES" IND CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. \ ❑ '❑ 1:1 1:1
ROUGH SAN.a 15 ASSESSORS PARCEL NO
PLUMBING ELECT,ENERGY
TUBS B SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH.ENERGY
FILE NO.
ELECTRICAL BUILDING ENERGY � ACC DATE ACC. ,
FRAMINGELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG-,SITE NO.
GAS TEST - _ ,p+p Jh>,E�/ GAS
MECHANICAL ^/ FIRE SPR INK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ ° E] NC]
EXTERIOR SHEAR ELECTRICAL RELEASE Z^ FLOOD ZONE A,LUC.
INTERIOR SHEAR. FIRE DEPT. Y❑ N❑ . Y LI No
SHEETROCK 12,"z• - - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH _ TEMPORARY APPROVALS" BUILDING
SCRATCH COAT �2. ELECTRIC , FLAN CHECK I5•
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC E `
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
"l - ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
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 .
BUILDING PROJECT IDENTIFICATION •PERMIT NUMBER
BD,LD,NG APPLICP,-TION & PERMIT 1511 5
• AooREss of 2 2 Pan 2B �J
11672 Westshore Court
BUILDING-ELECTF \L"-FLUMBING-MECHANICAL °",
4, OWNER'S PLAN CHECK VALIDATION
NAME Gregory Group, Inc. &
AN DTV. ELECTRIC PERMIT FEE
Ahmanson Dev. PHD.A15-595-210
T,� NAMEPAGTVegory Group, Inc. UTLETS-SWITCHkkk
ES-RECEP 10.00/1.00 "
oc.N(B-430097 LIGHTING FIXTURES 10.0011.00
�C�.00pNNqTT@RREACTOR'S � pin o pR in Dr. PPLIANCES-RESIDENTIAL 4.00
tt Wl,as 940 5 PHO
IT 5-595-210) PANELS 10.00 DATE OF APPLICATION
ARCHITECT yy•aarrdr� PLAN CHECK FEE P.C.NO.
on
4f1'A'`. � nian,AIA & PANELS (OVER 200 AMPI 20.00
ENGINEER JJ JJJJ VV LIC.NO -8395 SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS 2031 Orchard Dr. #100 SPECIAL CIRCUIT 5.00
Santa Ana -Hts. CA. 2192707 TEMP.METER OR POLE INS. 20100
APPLICANTS -
MOTORS - SEE FEE SCH.
AnD�F�(� C Twin Dolphin Dr. RWC 9406 ) SERVICE CHANGE .0010� {
' Foo
LICENSED CONTRACTORS DIeCLARA'TION
a v G I hereby affirm that I um licensed coder provisions of Chapter 9 ISSUANCE DATE
Z lu (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.-
7 z Professions Code, d my license is in full fore- f
0 T= o License Class ¢� Lia Number City,d�Ilperti 0
Hw Date nseCIA ' _I( Cnntmctor_ 1Y IM M
DO
P ,2 BUILDING PERMIT
¢ S,w u OWNER-BUILHRDECLARATION INFORMATION
sou MISC- REFER TO ORD
X3: LL m I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT.
F w o J Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00
f m>f Code:Any city orcounty which requires a permit to construct,alter, 138,306
2 ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ,
y W m LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License SFDU
F z c
Law(Chapter 9(commenciagwith Section 7000)of Division 3 of the
4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
a F the basis for the alleged exemption.Any violation ol'Section 7031.5 STORIES TYPE CONSTR.
i '3 - by anion.cantflail
for.five
lhe00.)i am to acivil penalty ALTER-DRAIN -WATER (EA.) 5.00 2 5NHR
of nal more than fore hundred dollars the applicant
p.1:
❑ 1,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(Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 R-3 1
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FTy Ey�sp BREA TOTAL ACREAGE
himself or Through his own employees,provided that such improve. 'fL�('B'I
mems are not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6,00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 200 BUILDING USE
builder will have the burden of proving that he did not'build or im- . . .
RES IND CON PB Other
prove for purpose of sole.). INDUSTRIAL WASTE INTER. 30.00
ClI,as owner DI the property,am exclusively contracting with ® ❑ ❑ ❑ ❑
licensed contractors rn 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 I'or such projects with a conlracoms)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
Om Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COM PENSA1lON DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent m self-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C,).U n i ted Pacific
Policy No. Company
Q ❑ Certified Copy is hereby furnished - FIRE SPRINK ENERGY T 24
Z Z Cenil'ied py led IrtYle city inspection division. MISC.- REFER TO ORD.
0 Applicant Y❑ N❑ Y ❑ ry❑
~ rn PERMIT ISSUANCE 10.00
LU - CER CCOI OF fAX IO PINS PROA1 WORKERS' FLOOD ZONE A1.u.c.
W � COMPIiNSA1'ION INSURANCE PLG.CONTR. LIC.NO. PLG. - -
a. Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
hundred dollars IS 100)or less.)
U 0 I certify that in the performance of the work for which this per. OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shell not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
y Date Applicum ALTER OR ADD TO MECH. 5.00 [FEEtnergy
ILDING 776.OD
} N NOTICE TO APPLICANT: If,after making this Certificate of fix
FZ - emption,you should becomesuhjacl to the Workers'Compensatinn APPLIANCE 5.00 Afy CHECK 15.50
provisions of the Labor Code, you must forthwith comply with 62.DD
suh provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 ISMIC FEE 9,73
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sea. CROFILM
3097,Civ.C.). p HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nume Se U it ]Pa'a�Crx�g1_'Fp .*Hy HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ,_ •vL F-,.�. .pU -L-lr. ELECTRIC 55.50
1 certify that l have lead this application and alae hl,t heabove I VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING 55 5D
ordinances and stale laws relating to building construction, and BOILER-CONP(3H.P.or.100,000B.T.U.) 6.00
hereby authorize representatives of this city to anter upon the BOILER-COMP(Over 100,000 BTU)SEE FEESCH. MECHANICAL
obove.mcntioned property for inspection purposos,
(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 288.95
-may in any way accrue against said City in consequence of the
ranting of ' pen L 1,-� -�� MECH.CONT. LIC.NO. MECH. TOTAL 1 ,318.68
G tTOTAL
Slgnatur o pplicant actor Date -
OFFICE COPY