15107 (2) POST THIS CARD NEAR FRONT OF'BUILDING,
' PERMIT NUMBER
CITY OF C.UPERTINO 15107
INSPECTION DIVISION.
JOB INSPECTION RECORD
t -
yt JOB ADDRESS I I�v tuesfshore colk Ti UNIT# OT# I f�� RATION
/' PERMIT EXPIRES IF WORK
OWNER v "rw CONTRACTOR V�L;,V (J IS INOT,STARTED WITHIN
INSPECTIO DATE INSPECTOR IN EC ION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR, 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING,AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLO,MIT VALIOATIUN
CUPERTINO STANDARDS-.
GARAGE SLABS '• - PAID _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,i A0 fukL(_L'l
UNDERGROUND /SLAB AUG 9 ''1988 '
PLUMBING
ELECTRICAL City.of CupertinD �ssuANCE untE
MECHANICAL
BLDG ELEECnCT• PLLGnG MecR
W W 44
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING VALUATION SIFT.
"
MECHANICAL - X121�71a$
ELECTRICAL PERrm TO
FRAMING SFOU
INSULATION STORIES TYPE CONSTR.
2
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3 I
sn 4T r10011 AREA TOTAL ACReAre
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE li
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 1954
_V f' ROOF SHEATHING O 2_ RES IND LoCON USE Om,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. El El E
ASSESSORSPARCEI.NO.
ROUGH SAN.# 5X0 J�E
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT,FINAL TEST
ZONING ENG.SITE N0.
INSULATION PLUMBING
GAS TEST 2 -22'" GAS
PIRESPRINK ENERGY T 24
MECHANICAL .• - YE] NE] Y ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR, O 2. ELECTRICAL RELEASE Z — FLOODZONE A U
INTERIOR SHEAR FIRE DEPT. - V "� Y ❑ N�
SHEETROCK -�,/�? GRADEFEE SUMMARY
EXTERIOR LATH •2,/�. BUILDING
INTERIOR LATH ..1-2-6-lel TEMPORARYAPPROVALS/ BUILDING "W
SCRATCH COAT ELECTRIC FPLADJEEL 8PCK 4290%
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE 9L�1
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. �.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, r ELECTRIC 49.81
t H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 49,81
o PLEASE GIVE JOB ADDRESS OR PHONING.
Z MECHANICAL 49,8
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT. CONST.TAX 288 9.1
PLEASE READ REVERSE SIDE BEFORE TOTAL I *241011
CALLING FOR FINAL INSPECTION.
i OFFICE COPY - -
APPLICANT TO FILL IN INFORMATION WITHIN REb LINES - USE BALL POINT PEN ONLY _
�• • 13UI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
AooAENs an APPLI/''ATION & PERMIT
I 82 Westshore Court BUILDING-ELEG�RICALiPLUMBING-MECHANICAL 15107
OWNERS regor,yY roup, Inc. PLAN CHECK VALIDATION
1Chmanson OeV. 41 -2�t�o�o DTV. ELECTRIC PERMIT FEE
PHONE L RR&AX90
NAMEBncTORs OUTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group, Inc. LIc No B-430097 . LIGHTING FIXTURES 10.00/1.00
CONTRACTORSA4065-C Twin Dolph'D 95 PPLIANCES-RESIDENTIAL 4.00
0 PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PANELS (OVER 200 AMPI 20.00 PLAN.CHECK FEE P.C.NO,
DR
ENGINEER Aram Bassenian, AIA.&
LICNo. SIGNS TRANS. 3.00
ARCH.OR E - PERMIT VALIDATION
ADDREaa `�031 OrcUhard Dr. /i100 SPECIAL CIRCUIT 5.00
San a na ts. CA Zn,92707 TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADORE Q
X20-C Twin Dolphin Dr. RWC 94C&5-SERVICE CHANGE 20.00 d IQ IQQ
w ¢;z p .CJ 1 CJU
Foo LICENSED CONTRACTORS DECLARATION 1{-
Q U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
H c w (commencing with Section 7000)of Division 3 of the Business aW BLDG. ELECT. . PLG. MECH.
F m z Pro'essin ne Code,end I cense is in full force a f �7
z o m- License Cass_ Lic.Numher
w w Date_4_��eGG _$_Contractor pp� ,�,{{p
rc m a ¢ OWNER-BUILDER DECLARATION Y1 VI.Ca nitro BUILDING PERMIT
¢w u INFORMATION
w I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION
FLLO.¢ Law for the following mason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 p $/FT.
T
Code:Any city orcounty which requires a permit to construct,alter, 121 780
2 IS 4 p improve,demolish,.r repbir any structure,prior to its issuance,also. ELEC.CONTR. LIC.NO. ELEC.
n a O u requires the applicant for such permit to rile a signed statement that TOTAL PERMIT TO
w $m he is licensed pursuant to the provisions of the Contractor's License
F 2 a Law(Chapter 9(commencingwith Section 7000)of Division 3 oftlm SFDU
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
M r the basis for the alleged exemption.Any violation of Section 7031.5 / STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($5000.): 2 , 5NHR
❑ I,as owner of the property,or my employees Willi wages as BACK FLOW PROTECT.DEVICE 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 Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law dues not apply to an owner of R-3 1
property who builds lir improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO,FT, T,AREA O TOTAL ACREAGE
himself or through his own employees,provided that such improve-
m
MT
,AREA
are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is Sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or an- - . BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with U ❑ ❑ ❑ Cl
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 IEA.) 1.00
contracts for such projects Willie co nm tor(sl licensed pursuant to
the Conlmet.r's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec: .B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACF FILE NO.
WORKERS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure' ZONING ENG.SITE NO.
ora certificate of Workers'Compensation Insurance,or a certified
copy thereof(S 3600,Lub.0 I y,�,.1
Policy Nn.,_D_Company Jlnite V_Pddf 1-CL-
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified c q is ed w'rl lL{:ily"Inspeclion division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑. Y ❑ N❑
CC v2 PERMIT ISSUANCE 10.00
- CERTIFI ATE OP - ION FROM WORKERS' FL000 ZONE A.L.U.C.
U COMPENSATION INSURANCE; PLG.CONTR. LIC,NO. PLG.
CL
Cl (This section need not be completed'if the permit is for one TOTAL Y[:] N[] ❑
Y❑ N
hundred dollars($1001.,less.
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
UF mit is issued,1 shall not employ any person in any nanner so as in
O W become subject to the Workers Compensation Laws of California.
Date Applicant BUILDINGCH. 5.00
716.5
a ALTER OR ADD TO ME
>_ an NOTICE 'TO APPLICANT: If,after making this Certificate of Ex-
L.. ? emption,you should become subject❑s the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE Ener
U such provisions or this permit shall be decnntd revoked. AIR HANDLING UNIT(TO 1Op00C.F.M.) 4.00 9Y 62.0
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000.F.M.) 6.00 SEISMIC FEE 8.5
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(Sec. MICROFILM
3097,CivR.' e u it PaCif HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Ndme -rrr -r.hET•0- &0
Lender's Address rW 14hfl-rte HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRI 49.8
I certify ilia l l havl'real Ild,apphealori andstatc l hat the above VENTILATION FAN (SINGLE) 4.00 3
information is correct.I agree to comply with all city and county PLUMBING �'� 49.8
ordinances and state laws relating to building construction, and BOILER-COM P(3 H.P-or100,000B.T.U.) 6.00
I hereby authorize representatives of this city to enter upon the 1 S
above-mmulioned properly for inspection purposes. BOILER•COMP(Over 100,000 BTUI SEE FEE SCH. MECHANIOlCL e." 49
(We) agree to save, indemnity and keep harmless the City of MISC.- REFER TO ORD. ,yq s• pp
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX' ' 288.9
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
rantingof erpemt MECH.CONT. LIC.NO. MECH.
r - G ,89 TOTAL TOTAL 1 ,241 . 1
Signatuh of Applicl"+ACrrrfractor Date
OFFICE COPY