14978 ' POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY. OF CUPERTINO 14978.,.
INSPECTION DIVISION
JOB INSPECTION RECORD �w '
�y PERMIT EXPIRATION
. JOB AD DR ESSI� /_7 CD UNIT# _LOT#�._
r• , p PERMIT EXPIRES IWWORK
' OWNER'. 41' J!51I`f6ft/0 " CONTRACTORP,- IS NOT STARTED WITHIN
INSPECTION - DATE INSPECTOR I NSPECTI ON RECORD 18oDAYS OFPERMITISSU-
-- - - ANCE OR 180 DAYS FROM
FOUNDATION �7 NOTE: `
LIFER7 ALL GRADING AND DRAINAGE SHALL BEINSTALLED
LAST CALLED INSPECTION. .
TO COMbLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS. .
GARAGE SLABS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - `"%L •'"'`-r`•^'
UNDERGROUND /SLAB
PLUMBING _ -
ELECTRICAL' r 'ISSUANCE DATE
_ MECHANICAL - BLDG, ELECT. - Pm. MECy.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ppb BUILDING PERMIT
INFORMATION
WOOD FLOOR 1 1 UATION SIFT.
MECHANICAL P \UN 1950000
J �u I PER M1IIi
- ... .ELECTRICAL � - 'C1�7 01 up6 TOSFOU ..
FRAMING
STORIES TVP[CONSTR.
INSULATION
OCCGROUP RES UNITS.
PLACE NO'SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - R-3 1 '
SO.IST FLOOR AREA TOTAL ACREAGE:
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID` 2445
RUILDING USE
ROOF SHEATHING - .1a 0195 FRES IND CON. PR U
APPLY NO ROOFING'UNTIL ABOVE HAS BEEN SIGNED FINALS ' IDATE INSP, ASSESSORS PARCEL NOROUGH SANA /y<S8
PLUMBING , - ELECT.ENERGY
• TRACT NO., PANCEL NO,
TUBS 8 SHOWER PAN =:u/ /J- rf ' PLUMBING ENERGY ? _
MECHANICAL _ 061 MECR ENERGY
ACC-DATE ACC.FILE NO
E LECTRICAL _ yqjT7 BUILDING ENERGY
FRAMING ?o'xL - ELECT.FINAL TEST zoNlNc ENG.SITE No:
INSULATION PLUMBING
GAS TEST GAS Z.•9.
' FIRE SPRINK ENERGT'T-14
MECHANICAL.,. ,y -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED .HEATING y h❑ Y N�
EXTERIOR SHEAR I ,2' ELECTRICAL RELEASE ,9, FuioD>ONL A.L.u.c.
INTERIOR SHEAR FIRE DEPT. . - `" 'N❑ . ❑ N
SHEETROCK /p ZS(- GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING 97� 00,'
' INTERIOR LATH - e,,ft TEMPORARY APPROVALS
y , .SCRATCH COAT - -'tB♦' ELECTRIC 1 •J' ' PLAFEEN CHECK 15.50
GAS
, /Pnprqy 62 00;
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ,.
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION.
♦— PLUMBING '. . 7.8.13;
O0 ` PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z ' - MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX 288.241
PLEASE READ REVERSE SIDE BEFbRE. TOTAL 1570.78
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BJL POINT PEN ONLY .
BU I LDING PROJECT I IDENTIFICATION PERMIT NUMBER
BWLDmG -Lake prang - our BUILDING - ELECTRICAL-PLUMBING-MECHANICAL APPLICAT.ION'& PnMIT- n
ADORE Lot 143 Plan 4C r
OWNER'S PLAN CHECK VALIDATION
NAME . Gregory Group, 'In;. & ftmn$on 'QTY. - ELECTRIC PERMIT - - FEE .l
co v
6 2100
NAME . OUTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group, Inc. LIC NO B-430097 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S 220 C Twin Dolphin
�1Br. RC APPLIANCES-RESIDENTIAL 4.00
I M5 415-59`5z7ZI00 PANELS 10.00 DATE OF APPLICATION
ARCHITECTAM , AIA & ASSTIMESPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
' uc.No. SIGNS TRANS. 3.00
ARCH OR ENG.' vim- PERMIT VALIDATION
AD - ' SPECIAL CIRCUIT 5.00 '
-Wta Ma HtS. 92707!
. -. /• zIP. EMP.METER OR POLE INS. 20.00
AEMOTORS SEE FEE SCH.
ADDRESS BS 220-C Turin Dolphin Dr.
RWC 0/{, 940fj5 SERVICE CHANGE 20.00
r O o LICENSED CONTRACTORS DECLARATION
Q U V I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N Q H( commencing with 8teliou 7000)of Division'3 of the Business and - BLDG. ELECT. PLG. ' MECH.
H w z Professions Code.and my license is arfull force and effect - ryt
om 2 License Class _p!,c.Number.
m r as Dalc mdor_ _ `\
a s • - * BU ING PERMIT
Q.w 'OWNER-BUILDER DECI.n ION - RMATION
w3_d y I hereby affirm that l'am exempt from the Contractor's License .MISC.- REFER TO ORD VALUATION $/FT.
-- F u_o•a`- Law for the following reason.(Sec.703 1.5.Business and Professions ..PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,ahem ]w95 ,Q48
rt ¢Q e
improve,demolish,or repair any structure,prior t0 its issuance,also ELEC.CONTR. LIC.NO. ELEC. L�11J IlltE
ar-A c M requires the applicant for suclir
penh to the a signed stateint nt that TOTAL PERMIT TO
a.
A w se he is licensed pursuant to the provisions'of lire Contractor's License
F z i Law(Chapter 9(commenciagw'ith Section 7000)of Division 3 of the SFW. _
3 Business and Professions Code)or that he is exempt therefrom and, QTY. PLUMBING PERMIT FEE
T r o the basis for the alleged exempti6n.Any violaliou'n1'Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant loacivil penallyALTER-DRAIN&VENT-WATER IEA.) 5.00 2 5NiR
of not more than five hundred dollars(5500).):
1 ❑ I,asowner of tire property,or my employees with wagesas BACK FLOW PROTECT.DEVICE 4.00
their sole com pensalion,will do the work.and the structure is not OCC.GROUP RES.UNITS
intendedoroffs cd'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 an ownerof
properly who builds or'nopunes thereon,and who does such work FIXTURES-PER TRAP _5.00 50.FT.FLOOR AREA TOTAL ACREAGE
Ducatscats are through his ownemployees,sprovided thatsuch improve 2445'
himself a throuhhisot onempld ees,provided
ed thattithe balding GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS -EASYSTEM OVER 4 IEA) 200
builder will have the burden of proving that he did not build or int. - . - . . BUILDING USE
RX IN r
prove for purpose ofiale). INDUSTRIAL WASTE INTER. 30.00 Lr)�JJhh
1.❑-I;is owner of the property,ani exclusively contracting with ❑ ❑ 1:1 ❑
licensed contractors m 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 docs not apply
to an owner of property who builds tr improves thereon,land who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
the C .for such censeprojects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TR CT NO. PARCEL NO.
the Conma eosc License Law.
O taro exempt under Sea.' ,B.&BC.for thisWATER HEATER W/VENT 6.007 .
reason
Owner Dale WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARAT10N WATER TREATING EQUIP. 5.00
'I huehy affirm that l have u certificate of consent it)self insure, ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a Certified -
copy thereof(See,3800:Lab.c-United Pacific
Policy No, COi11Pdn Y'
O - ❑ Critified copy'' xr by furnished. ' FIRE SPRINK ENERGY T-24.
Z Z ❑,Certil red co with the city inspection division. MISC.- REFER TO ORD.
O PIR can - _ - v❑ N❑ v ❑ N❑
Hy - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
' .� CHRTIFIGATE OF EX1iMPTION FROM WORKL'RS'
W > COYIPIiNSATION INSURANCE' PLG.CONTE. OC.No. PLG,
CL 0 (This section need not be compiledif Ihu permit is for ant TOTAL v❑ IN01 Y❑ N❑
_ ::) 2 hundred doll...IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
-LL F mil is issued.1.shall not employ any person many manner sons to
U become subject to the Workers'Compevtsation Laws ofCaluorniu. 972.00
ED Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} w NOTICE TO APPLICANT: IL after making this Ctrtificale of Ex-
F 2 emption,you should hecome subject to the Workers'Conipensatiun APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must fnrlhwitli tum Ny watt' FEE (energy 62.00
CJ such provisions or ibis permit shall be deemed revoked AIR HANDLING UNIT(TO 1Q000C.F.M) 4.00
o CONSTRUCTION LENDING AGENCY ' ' AIR HANDLING UNIT(OVER10)000C.F.M.) 6.00 SEISMIC FEE 13.65
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
Ute performance oC,lne work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). S'ecurity Pacific HEATING UNIT(TO 100,000 B:T.U.) 8.00
Lender's Name_e _ 4,yyr }�• HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC 73.13
Lender's Address CC rrnn� p�7� U1 1
M uxttll W
( certify ilial) fres s ion and stale that the above VENTILATION FAN (SINGLE) 4.00 73.13
information n correct.1 agree to comply with all city'and county BOILER-CCIMP(3 H.P.or 100.0006.T.U.) 6.00 PLUMBING
ordinances and slate laws relating to comply
with all city and co and
hereby nolhorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH, MECHANICAL 73.13
above-mentioned properly for inspection purposes.
(We)-agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD. 2$8.24
Cupertino against Ii.bilRics,•judgninnu, costs and expenses which CONST.TAX
nay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 p
ranting of this'py�[init. -'-' �/� / _ MECH.CONT. LIC.NO. TOTAL 157.70'
/�iG,+�fsr/1�/�J T/�/jV� TOTAL
Signature og%WIf5Rt1C.mtGcto, Datd
OFFICE COPY
CITY OF CUPE-TINO-
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
— - ------- Building Permit No. IYep"V?
Date ----- .....1p. 19a� ...
The Building Located It
Owned by
..........................................
Complet For Use As:
Has Been C2��D
(A t,,e )
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BUILDING INSPECTOR
PD-7