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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BhyLL-POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION
APPLICATION & PERMIT
PERMIT NUMBER '
15121
BU'I RIIN Lot 90 Pan 3A
AD
11723 Westshore Court
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
.
OWNER'S TT yy'�
Greg8R Gro(�g5-�L1�-2100
".A"hmanson e [41 9
CITY. ELECTRIC PERMIT FEE
PLAN CHECK VALI DATION
.
vnorvE
Plan 3 A
DATE OF APPLICATION
CONTRACTORS
NAME Gregory Group, Inc
LIc, FaD. B-430097
OUTLETS -SWITIIJHES�-'F7ECEP 10.00/1.00
LIGHTING FIXTURES ..10.00/1.00
ONTRAOTOms
A - Twin Dolphin Dr.
DDRES W^ 94065 4"6595-2100
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT
°ENGINEER Aram Bassenian, AIA & Assoc
PANELS (OVER 200 AMP) 20,00
PLAN CHECK FEE P.C..NO.
-
ISIGNS TRANS. 3.00
LIC.NO.0-8395
ARCH. OR ENG,
PO Orchard r.
mita Ana Hts. CA. 92 07
ZIP
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
� AM-r-F��`
lU L,11�
<]
�I
EMP. METER OR POLE INS. 20.00
APvucarvr's
A°°"Eaa 220-C Twin Dolphin Dr. RWC
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
940
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, angmy license is in full Ibrc�I a�µ�N
License Class ❑ Liu. Nunhher 4.311_00 (
Date- Contractor _(�`
-ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
® ® ❑ XX
BUILDING PERMIT
INFORMATION
OWNER -BUILDER DECLAR ION
I hereby affirm that I ton exempt from the inc Contractor's License
owioamly whichn. G.703L permit tocnd Professions
Low lot the city
Codec Any city or county which structure permit to construct, alter,
structure, prior signed s ate... c t also
improve, n, applicant
or repair h y Permit
requires fes the app rsua for such permit to file a Signed statement ase
he is licensed pursuant to the provisions of the Contractor's License
Division3 unit
Law (Chapter 9(comons Cod)or Section is exempt
Business and Professions or that he is exempt and
�X
MISC.- REFER TO R
VALUATION
1 52, 727
S/FT.
PERMIT ISSUANCE 10.00
ELE_O. CONTR. LIC. NO.
_
TOTAL
TOTAL
PERMIT TO
SFDU
DTV. PLUMBING PERMIT FEE
STORIES
2
TYPE CONSTR.
5NHR
xempt action 70
the basis for Lite alleged exemption. Any violation t to action malty
subjects 5500the licant toacivil penalty
by any hare
fora hundred
of not more Than five hundred dollars (5500).):
ALTER -DRAIN VENT -WATER (EA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC, GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code; The Contractor's License Law does not apply to an owner of
R-3
I
FIXTURES - PER TRAP 5.00
GAS-EA.SVSTEM-11NC.40UTLETS 6.00
50, FT. FLOOR AREA
TOTAL ACREAGE
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
mems are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that lie dirt not build or int-
prove for purpose of suit.).
El 1, as owner of the property, am exclusively contracting with
GAS - EASYSTEM •OVER 4 (EA) 200Iff
. . .
BUILDING USE
RES IND CON PB Omer
El O O O O
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
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 - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
contracts for such projects with is contractur(O licensed pursuant m
the Contractors License Law.
SEWER -SANITARY -STORM EA. 200ft/10,00
TRACT NO.
PARCEL NO.
13 I am exempt under Sec.., B.&P.C. for this
reason
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5,00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSATION DECLARATION
1 hereby affirm that I have a certificate ofconsent to self -insure,
or a certificate of Workers' Compensation Insurance, or o certified
ZONING
ENG. SITE NO.
copy thereof (Sec. 3800, LabL.)' United Pacific
Policy No. Company
FIRE SPRINK
Y [:) IN [D-
ENERGY T 24
•-.-+Y Q' N[D
❑ Certified copy is hereby furnished.
y}(J1 Certified hs whtl se"chy inspection division.
A (hhlicam E�+��
MISC. - REFER TO OR
CERTI Alli 01' EXEMPTION FROM WORKERS'
COh1PF:NSATION INSURANCE
(This section need not be completed if the permit is for one
PERMIT ISSUANCE 10.00
FLOOD ZONE
Y ❑ NO
A.L.U.O.
V O NO
PLG. CONTR. LIC. NO.
PLG,
TOTAL
hundred dollars (5100) or I.x)
I certify that in the performance of Inc work for which this per-
out issued, I shall not employ any person in any manner sn is to
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
825.00
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption, you should become subject to the Workers' Compensation
provisions of the Labor Cade, you most forthwith comply with
such provisions Or this permit shall be deemed revoked.
ALTER OR ADD TO MECH. 5.001BUILDING
APPLIANCE 5.00
PLAN CHECK
FEE ener
15.50
62.00,
AIR HANDLING UNIT (TO 10=CF.M.) 4.00
AIR HANDLING UNIT (OVER 10=11F.M.) 6.00
SEISMIC FEE
10.71
CONS'rRUCI'ION LENDING AGENCY
1 hereby affirm that them is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work [or which this permit is issued (Sec.
3097, Civ.C.)._ SeCU1 Pacific
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lemler's Name areadero-4th-f
Lenders Address_��-(�4
I Certify that I M1aVCYdad tl(is aTplItion and state that the above
information is correct. I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and
r HEATING UNIT (OVER 100,000 B.T.U.)9.50
VENTILATION FAN (SINGLE) 4.00
ELECTRIC
60.35
60.35
BOILER-CDMP(3 H.P.or 100,000B.T.U.) 6.00
BOILER-COMPIOver 100,000 BTU) SEE FEE SCH.
MECHANICAL
60.35
hereby authored property tativ sp of ion purposes.
aboveancone representativesofthis city to enter upon the
MISC. - REFER TO ORD.
-
(We) agree to save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
nas
y in any way accrue against end City in comaipicrec of the
matin of is permit. �-
PERMIT ISSUANCE - 10.00
CONST. TAX
2p88.-95
MECH. CONT. LIC. NO, MECH.
TOTAL
TOTAL
383.2'1
ig r fAppficAq1So.rdw5ctor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO,
INSPECTION DIVISION
JOB INSPECTION RECORD
17013 , ` oshbrn cD U/'� n
J08 ADDRESS I (zVC r` UNIT# _LOT# �%6
/�-7�
OWNER G CGNTRACTGF ( ireow� &aup-
PT,RMIT NUMBER
15127
PERMIT EXPIRATION
Pian PI A
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION DATE I INSPECTOR
INSPECTION
RE ORD
FOUNDATION
NOTE:,
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PyQf�Sf,�jD CITY OF
CUPERTINO STANDARDS.
UFER
PREGUNITE
PERMIT vauuATON
�; ��y-'
I ` /D
issuANce DATE I
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
AUG 9 -198A -
UNDERGROUND /SLAB
PLUMBING .
City of Cupertino
ELECTRICAL
MECHANICAL
_
w I dk,
RLnc ELecr
PLc, •MecR.
S a
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
2-3-89 IAt fo, OI< eeocept
[f
13UILDING PERMIT
INFORMATION
WOOD FLOOR
;,VALUATION
'S21y2�
slPr.
PLUMBING' -
a^9- >9 ✓y%oLt CYbc&Ll YA a O
MECHANICAL
ELECTRICAL
-
-SFDU
PERMITTO
FRAMING
INSULATION -
-
STORIES
2
TYPE CONSTR.
5NHR
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
OCC. GROUP
RES UNITS
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
so Fr. n AREA
234+
Torg ACREAGE
'
DIAPHRAGM
ROOF SHEATHING
RES IND COM PB BUILDING USE. bm.,
� 9
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
- ROUGH
SAN.N
.ASSESSORS PANCEL NO.
'
'PARCEL.
PLUMBING
ELECT. ENERGY
TUBS 8 SHOWER PAN .eI
PLUMBING ENERGY
TRACT NO.
NO
MECHANICAL
MECH.ENERGY
ELECTRICAL 12
BUILDING ENERGY
ACO DATE
ACE FILE NO
FRAMING z
ELECT. FINAL TEST
INSULATION -
PLUMBING
ZONING-
ENG. SITE NO.
GAS TEST
GAS
FIRE SPRINK
yo NE)
ENERGY T-24MECHANICAL
Y O NE)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
/•
ELECTRICAL RELEASE
FLOOD TONE
Y ❑ N 1
A L U C
Y ❑ N❑
INTERIOR SHEAR
_ _ r? (•
FIRE DEPT.
SHEETROCK.
o„
GRADE - -
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING 5.00
INTERIOR LATH
- -$
TEMPORARY A PROVALS
SCRATCH COAT
7 -7 -
ELECTRIC
PLAN CHECK 15.50
FEE
SEISMIC FEE 10.71
GAS
NO TAPE OR PLASTER UNTIL ABOVE ANNED
OCCUPANCY I-I
OCC UPANCYOFBUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
LIJ ARRANGE'FOR INSPECTION BY PHONING 252-4505,
o� PLEASE G VEKING IVE JOB ADDRESSWHEN PHONINGDAY BEFORE REQUIRED PECT1oN.
Z
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC 60.35
PLDMBING 60.35
MECHANICAL
60.35
CONST. TAX
IMPORTANT!-
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.,
TOTAL'
OFFICE COPY