14943 POST THIS CARD NEAR FRONT OF BUILDING . ,
� f1U PERMIT NUMBER
CITY OF CUPERTINO '1493
t 0• ..
INSPECTION DIVISION
JOB INSPECTION RECORD
,
. - • 1 N,^Y PERMIT EXPIRATION
/ 7
JOB ADDR//E11 SSZS``I/JJr�`(^/' Y�� e'(' UNIT.# ' LOT# /� r PERMIT EXPIRES IF WORK
OWNER- L-r'�C�.�Q V,V/C/ CONTRACTOR 61ej_�,C IS NOT STARTED WITHIN .
INSPECTION ATE INSPECTOR INSPE IONRE RD 180 DAYS OF PERMIT ISSU-
/ '.ANC. OR 180 DA VS FROM
FOUNDATION � NOTE: � ' '
LIFER 'ALL GRADING AND DRAINAGE`SHALL'SE INSTALLED ;LAST CALLED INSPECTION. -
PREGUNITE- TO COMPLY WITH THE APPROVED'PL'ANS'AND CITY OF PERMIT VAI.IDA.7 N
CUPERTINO STANDARDS.
GARAGE SLABS
et .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
r
UNDERGROUND /SLAB . ✓�
- PLUMBING. _. . . i' ..' .9- . . •1 �r r;orf r
z
ELECTRICAL • `;N . ISSUANCE LATE '
MECHANICAL _ a ELEcr: PLG MEo,.
_ —:ate g ,o o
DO NOT POU rL_0'OOR-UNTIL A OV HAS B IGNED I�1Q��NFORNG PMAi TION
WOOD FLOOR 1�.d VALUATION s s/FT.
'PLUMBING - _ - .
MECHANICAL o 122 (X10
ELECTRICAL EEPEu Eni11lr TO
FRAMING -- - JWI,..t
yTG.IES, ATYPE CONSTR.
INSULATION �p_Z _ - 2
� D OCGGFOUP RES,UNITSttv
PLACE NO'SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - R-3 I
O SO.IT FLOOR AREA TOTAL ACREAGE
ROOF - NOTE:NO FINAL(NSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAXIS'PAID
` UILDMG USE
ROOF.SHEATHING �`•� ,RES IND CON PB Omr,
' ;APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE. • INSP, 1-1 E ❑ "
_ ASSESSORS PARCLL NO.
ROUGH SAN.N /4
PLUMBING ��_��_ ELECT.ENERGY '
, THACT NO. PARCEL,NO.
TUBS 8 SHOWER PAN - PLUMBING ENERGY P SX7' „
MECHANICAL . MECH.ENERGY•
ACC.DATE 'ACC.FILE NO.
ELECTRICAL - - _ ti - -L - BUILDING ENERGY'' '•(1 Q,
FRAMING - (kO'2 ELECT.-FINAL TEST "
ZONING ENO.SITE NO.
INSULATION _ PLUMBING _
GAS TEST- 2 t2e, GAS -
EIRE SPRINK ENERGY T.2a
MECHANICAL - Q,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v 00 n. n,. (L Uc.
NEI
zorvt:
EXTERIOR SHEAR - �Z�� - ELECTRICAL RELEASE
INTERIOR SHEAR. FIRE DEPT. Y ❑ N0 Y L. N�
SHEETROCK + ' GRADE - - - FEESUMMARY
EXTERIOR LATH .BUILDING —
INTERIOR. LATH •TEMPORARY APPROVALS BUILDING
SCRATCH COAT,(/ ELECTRIC
FEE71r CA
PLACHECK 15.50
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEi MI E
OCCUPANCY OF.BUILDING IS NOT PERMITTED UNTIL.BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ,MICROFILM
, ,, w'`. ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�, ;� H- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING '
0�, PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - MECHANICAL
SEE PERMIT FOR-EXPIRATION DATE -
CONST.
IMPORTANT! 2m 21
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. 240.42
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date ;TPN;x� --1..................... 191H..--. Building Permit No. j4iLt3
The Building Located at A..
Owned by ....
.... ... .. .......................I......................................
Com let
Has Been For Use As: 1-5.fl)............... .. .................................. . ....
(Altered)
............ .....................................................................................................................................
...............................................................I----------------------------- -- ............ ............ ..........
..............- ....... ...................................................... .... . ........................................
-------------------------------- .........
PD-7 BUILDING INSPECTOR
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LD1 NG PROJECT I DENTI FICATION - - PERMIT NUMBER_.
= B943
UILDING APPLICATION & PERMIT ' q A
ADDRESS 11550 Lake Sprinngg Wirt 1-, BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 14
Lc ,56 Plan *IA Q
` N0 NE AMER Gregory pf Inc. & knnson PLAN CHECK VALIDATION
r Developmnts A15-595-2100
QTY. ELECTRIC PERMIT FEE
CONTRACTORS OUTLETS-SWITCHES-RECERc 10.40/i.00
NAME Gregory.Group, Inc. B-430097
LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR's 220 C Twin Dolphin Dr. APPLIANCES-RESIDENTIAL 4.00
ADDRESS
RVC CA.'94065 PH.415-595-2100 PANELS 10.00 DATE OF APPLICATION
ORRcmTECT ram ssenlan, socid s PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.O.NO.
ENGINEER C-8395 SIGNS TRANS.1 3.00
NO.
ARCR.OR ENG. OrchardSPECIALCIRCUIT 5.00
PERMIT VALIDATION
'
A,DRE�$anta Ana Hts, CA. ' 2P2707 TEMP.METER OR POLE INS. 20.00 -^
A220 C Twin.Dolphin Dr. MMOTORS SEE FEE SCH. /J -
ADDRESS
OORESB .
94065 SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION - s7l5��
¢v r., I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
azw
(mmnu'npng with Section 7000)of Division'3 of the Buuness and BLDG. ELECT. PLG. MECH.
0 y i Professions Code,mtd my license is in full force mid effect. ryy
2 o in - License Class B Lic.Number 43W_7
9 Z D Dalc Contrauor -
a BUILDING PERMIT
¢ ¢ w ¢ OWNERBUILDERDLCL r ION
w 3 LL N MISC.- REFER TO ORD INFORMATION
H 1 hereby affirm that I am exempt from the Contractor's License
LLoa Law for the following reason. 703 I.S.Business and Professions PERMIT ISSUANCE 10.00 VALUA ON S/FT.:
Code:Any city or county which require%a permit to constrict,alter,
¢ IC 2 improve,demolish,or repolr any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
to
O ¢ requires the applicant for such permit to file a signed slatecnt that -No.
TO
d w m he is licensed pursuant to the provisions of the Contractor'smLicense
� ¢ Q
Law(Chapter9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he is exempt thercfro n and DTV. PLUMBING PERMIT FEE AID
¢ I-o the busts far the alleged Cxemptlay.Any violvlion ol'Section 7031.51 , TORIES TYPE CONSTR.
a3°1 by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 2
w of not more than five hundred dollars(S500).): 5WR
1 ❑ 1,as owner of life Property,or my emphiy•es.seitb wuycs as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole conipensetion,will do the work,.nnd ihe'strucmre is not
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3 1
Code:The Contractor's License Law docs not apply to Ln owner of
py property who builds or improves ihvnon,and who doesumh work FIXTURES 1 PER TRAP '5.00 - SO.FT.FLOOR AREA - TOTAL ACREAGE
lima If or through his own employees provided that such iinprove.
Tents are not intended or offered for sale IL however,th building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 1515'
or improvement is sold within one year of completion (tic owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will havetli burden of proving that he did not build or im-
pro for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES w0 CON Pa Omer
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors t, construct the project(See 7044,Business LAWN SPRINKLERS- I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who build.v or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a eontmctorts)licensed pursuant to
the Contractor.,License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I ani exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 8O67
reason
Owner ' ' pate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION MCLARAT1oN WATER TREATING EQUIP, 5.00
I hereby cutin.. that I have a certificate of consent to velf-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Inuirun:e,or a ccrlificd -
Copy thcuc.f(Sec.3800,Lab.C.)� United Pacific
Policy No. Company
O' ❑ Certinedcopy isheodt,furnished. FIRESPRINK ' ENERGY T 24
Z Z F�f ccrlificd Copy Ilcd with the city inspection division. MISC.- REFER TO ORD.
O APF'icant r - Y ❑ N❑ 'v ❑ N❑
M Ln CERTIFIC OI-EnMPf10N FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c.
LU > COMPENSATION INSURANCE PLG-CONTR. LIC.NO. PLG.
d O (This section need not be completed if the permit in for one TOTAL Y❑ N❑ -Y ❑, N❑
Z hundred dollars IS 100)or les.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE. FEE SUMMARY
UL H mit is issued,I shall not employ day person in any manner so as to ,
U become subject to the Worker,'C,RuT,,Ii,n Lows of Caldo ufv. 716.50
0. Dam Applicant ALTER OR ADD TO MECH. - 5.00 BUILDING
} Go NOTICE TO APPLICAN"T:,If,after making this Certificate of Ex-
F Z_ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 15.50
U Proviprrvsix of the lhibor CDde, you most forthwith ConlPly with FEE
such permit shall he deemed revoked. AIR HANDLING UNIT(TO 10SMCF.M.) 4.00 .
_ CONSTRUCfIONLENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 •.- SEISMIC FEE . 8.54
1'hereby affirm that there is a construction lending agvncy fm EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sea EATING UNIT(TO 100,000 R.T.U.) 6.00 'MICROFILM '
3097,Civ.C.). It Pacif, H
Lender's Nume_ �
gr
Lender's Address- Cnn HEATING UNIT(OVER 100,000 B.T.U.)0.50 ,ELECTRIC ' 49.88
I certify that I have d this application and state that the above VENTILATION FAN (SINGLE) 4100
information is correct. 1 agree to comply with ail city and county PLUMBING
i
ordinances and state laws relating to building construction and BOILER-WMPI3 H.P.or 100,0008.T.U.) 6.00 49.88
r
hereby au linflic representatives of this city to enter upon the
ty� bovrmentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)BEE FEE SCH. MECHANICAL
-
is - (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX pp
,p7 may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 288.24',
mmingof this 'reit MECH.CONT. LIC.NO. MECH.
/.q TOTAL TOTAL 1240.42
Signature, pplicDmiContractor Du
OFFICE COPY