15830iPOST THIS CARD NEAR FRONTOFBUILDING "
CiT`OF•:CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
" - ��+'//`` ,,,,,,,, ( �, •�' -
JOB ADI)RESS � � � "vim 5P�1 �\ 'UNIT # _LOT#_L,
4�I %,n,., n.� !] /
OWNER �IF4 - CONTRACTOR C -j W- � C'1F� �Jejoa
,' eaMlrNumBER..
130
PERMIT EXPIRATION '.
PERMIT EXPIRES IF WORK .
IS NOT.STARTED WITHIN
180 DAYS OF PERMIT ISSU,- ,
ANCE OR '180 DAYS FROM.
- LASTCALLED INSPECTION.'
" INSPECTION DATE INSPECTOR
INSPECTION RECO
FOUNDATION_ -��
NOTE:'
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
UFER
PREGUNITE s
PEHN+n VALIDATION.,
• ,
t '
Y ISSUANCE DATE
GARAGE SLABS'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
'. UNDERGROUND/SLAB'"
PLUMBING I F},.
P �*.�T
ELECTRICAL - -
MECHANICAL
BLDG +.ECT.
PLG. .MEEK.+
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
-. - ..
,ty
B�I���I,T�pING
BIRPORMATI
PERMIT
ON
' WOOD
Vn[.UAI ION" SIFT.
PLUMBING
-
MECHANICAL - - '+",
ELECTRICAL
'-- '•
YERhlli TO
+c nit +'
FRAMING, -
INSULATION '.
snnaes
2
.. IF CONSTR.
_
- • •
OCC.GHOUP
- '-
RES, UNITS
PLACE.NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' - ROOF
NOTE: NO FINAL INSP!SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID_
,. +.. .- I -.
SO. FT -FLOOR AREA
TO AL CREAGE '
.
DIAPHRAGM -
ROOFSHEATHING •' m +
,RULED ING USE
'O 'INLD Ory .; R
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE' INS P.
nssessoas PARCELNo,
//
3" `�
ROUGH
`',�
SANS 80 BF
PLUMBING —
ELECT. ENERGY, - "'
TUBS & SHOWER PANt
PLUMBING ENERGY
TRACT NO.
PARCEL No,
MECHANICAL', - ..7 ''�
'MECH.ENERGY-'
• A . ATE
ACC, FILE NO.
-
,I
ELECTRICAL • .+^3 X75 . ,
BUILDING ENERGY -
FRAMING s-kk -91 O W5
ELECT: FINALTEST -
ZONING
-
ENG. SITE NO.
•
INSULATION 'y �-y� (,y(y7�
PLUMBING "-L,
GAS TEST - Z - r
GAS
FIRE SPRINK
Y.O N
ENERGY T.]i
v 0 r NL
'. .. -
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
FLOOD z°NL
Y L NO
a.L.u,c, -
'Y L N❑
EXTERIOR SHEAR
ELECTRICAL"RELEASE-S '
n
INTERIOR SHEAR -N,
y�
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH .'�•-'2�l Q, -
BUILDING —
BUILDING
PLAN CHECK"
FEE
SEISMIC FE
15.50
INTERIOR LATH —l` -K
TEMPORARY APPROVALS*.
SCRATCH COAT
ELECTRIC -
_
GAS
NO TAPE OR PLASTER UNTIL ABOVEMAS BEEN SIGNED
OCCUPANCY
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505;
I ONE WORKING DAY BEFORE REQUIRED INSPECTION:"
O� PLEASE GIVE JOB. ADDRESS WHEN -PHONING:
Z
—SEE PERMIT FOR _EXPIRATION DATE =
eLEcraic
PLUMBING
73.13.
MECHANICAL '
CONST. TAX'
288-9
IMPORTANT!
.:"PLEASE READ REVERSE SIDE BEFORE,
' CALLING FOR FINAL INSPECTION..
TOTAL .
..OFFICE COPY_
O
Z z
F'O•
CC N
LU >
C 0
Uo
LL I-
O Go
GOGO
tl
APPLICANT TO FILL IN INFORMATION WITHIN, RED LINES -USE BALL POINT PEN ONLY
,BUILDING PROJECT IDENTIyIC;11iYOD1
APPLICATION &PERMITA
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
.
PERMITNUMSER I
15830
Eo
.at
11604 Oak Spring COUrt
OWNER'S
NAME G e or IS oup I
A�imans�n Bev.' 211 -69 2100
QTY. ELECTRIC PERMIT FEE t
PLAN CHECK VALIDATION
-
DATE OF APPLICATION'
CONTRACTOR
"AME Gregory'GroupInc. B-430097
UC. rvo..:
OUTLETS - SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
f-orviR SS Toos 'L20 -C Twin Dol' h'Sn Dr. '
a� 94065 PH E5-595-2100
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT
ECi Aram Bassenian ,.. AIA &Assoc
OR
O
ENGINEER.
:LIG. NO. C-8345(_
2000
PANELS 200 AMP) .
PLAN CHECK FEE
'
SIGNS TRANS., � 3.00 '
ARCH. OR ENG. rC. ar r.
ADDRESS.
',f Santa Ana• HtS. CA., 2,2707
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION 4
-
2
8�/
EMP. METER OR POLE INS. 20.00
APPLICANTS
aooREs
�L20 C Twin Dolphin Dr.RWC 940
IMOTORS - . SEE FEE SCH.
SERVICE CHANGE, 20.00
-LICENSED CON'[RACfORS DECLARATION
I hereby-afll no Ihat 1 am licensed under provisions of Cha pier 9
x U t
O - ISSUANCE DATE
(commencing with Section.7000) of Division 3 of the Business and
Professions Code, aoAmy license is in full force and effect.
License Class D Lic. Number_4-30097
-
-
• BLDG.
r'�r
n�
MECH.
Cly
_ ,
Dutc - Contractor.
a a
-
BUILDING PERMIT
OWNER -BUIL -DER DECLARA'T'ION'_
`MISC.;
• I hereby affirm that 1 um exempt front the Contractor's License
Law for the following rc...... (Sce. 7031.5: Business and Professions
Code: 'Any city or county which re4uiresa permit 1.cmotruct, alter.
Improve, demolish, or repair any structure, prior to Its Issuance, also
requires the applicant for SOClh peribil to file a signed statement ilial
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he'is exempt then_from... d
the basis for'the alleged exemption. Any violation' of Section 7031.5
INFORMATION
- REFER TO ORD
VALUATION
'
194,540
1
SIFT,
PERMIT ISSUANCE' 10.00
ELEC.CONTR. LIC. NO.
ELEC.
TOTAL
,PERMIT TO .
-. SFDwLt
'
QTY. PLUMBING PERMIT FEE i
STORIES
TYPE CONSTR.
by any applicant for a permit , subjects the applicant to a civil penalty
of not more than five hundred dollars (S500):):
C' 1, as owner of the ..mperry, or my employees with wages as
their.sole compensation, will do the work, and tstructure is not
gLTER-DRAIN&VENT-WATER (EA.) 5.00
. 2
5NhR
BACK FLOW PROTECT. DEVICE - 4.00
DCO. GROUP
RES. UNITS
. DRAINS -FLOOR, ROOF, AREA,COND. 5.00
intended 'or 00'ered for sale (Sec. 7044, Business cit,[ Professions
Code: The Contractor's License Law dues nor apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own cnpiloyees, provided that such improve-
mentsarenotintendedorofferedforsale.If, however, the building
R-3
1
FIXTURES - PER TRAP 5.00
so. FT. FL -OR AREA
3047
TOTAL ACREAGE
-
'
GAS -EA'.SYSTEM -1INC. 4 OUTLETS 6.00
Or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or ice-
'Prove for purpose of sale.). -
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: 'I'lie Contractor's License Law does not apply
to on owner of property who builds or improve, thereon, and who
GAS - EA. SYSTEM -OVER 4 IEA.) 2.00
BUILDING USE
RES IND CON PB other
_
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 IEA.) .X1.00
ASSESSORS PARCEL NO.
,
3�'� -o�_
^PARCEL
contracts for such projects with u c ntractous) licensed pursuant to
it,, Contia,or's License Law. ty
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
NO.
❑ lam exempt lender See - ,Ii.&I'.C. for this
reason
WATER HEATER W/VENT. 6.00
6096
Owner Date "'
WATER SYSTEM 5.00
ACC. DATE
'ACC. FILE NO..
WORK ERS'COMPENSA'I ION DECLARATION
WATER TREATING EQUIP, 5.00
hereby affirm that I have a certificate of Consenllo sel Ginse":
or a certificate of Workers' Compensation Insurance, or a <erlificd
ZONING
ENG. SITE NO.
_
copy Ihereof (Scc. 3800, Lab.C.United Pacific:
Policy No Coni Pnny .-
_
-
'FIRESPRINK,
v Q N❑
ENERGYT•-24
Y ❑' No
❑❑�, Cr 'd copy is h ereby furnished:. -
Cf( CCT:If:cd copy is filed with the city inspection division.
Applicant
MISC. - REFER TO ORD.
CERTIFICATE 01° EXEMPTION FROM WORKERS'
.PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
PLO. CONTR. LIC. NO.
PLG. .•
TOTAL -
' COMPENSATION INSURANCE
(Phis section need not be completed if the permit. is for o ! c
YE]'N�
v� N�
OTY. MECHANICAL PERMIT FEE
-
FEE SUMMARY
hundred dollars IS 100) or Ic,,L
I Certify that in Bre performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
BUILDING
972.00
become subject to the Workers' Compensation Laws of Culifomiu.
Date Applicant
ALTER OR ADD TO MECH. 5.00
NOTICE TO APPLICANT: 11, after making its Certificate of Ex-
ef,,hou, you Should hccolne subject to the Worken-'Compcnmtion
_ -
APPLIANCE 5.00
PLAN CHECK,
15.50
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked. -,
FEE /ener
62.00
AIR HANDLING UNIT (TO 10,000C.F.M.), 4.00
AIR HANDLING UNIT (OVER 10=C.P,M.)6.00
SEISMIC FEE
13.65
CONSTRUCIONLENDINGAGENCY
1 hereby affirm that there is a construction lending agency ]or
the performance of the work for which 'this permit is issued (Sec.
3097,Civ.Ct.
am ' e U lj" ty Pacif
Lender's Name- DdT'bC� h-fY�
Lenders Address �-
EXHAUST HOODO(WITH DUCT) 5.00
MICROFILM
_
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.19.50
ELECTRIC
]',3.13
1 certify Thar I Imve read this application a� that the above
information is correct. I agree to Comply will, all city and county
ordin nces andstme laws relating to building elmsGueli...L and
VENTILATION FAN (SINGLE) 4.00
PLUMBING -
73.13
e BOILER- COMP(3'H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP (0Wr100,0009TU)SEE FEESCH.
'MECHANICAL
73.13
Ilcrchy�authoriz,, representatives o1' this city to enter upon the
above-mentioned property for inspection purposes.
MISC. - REFER TO ORD.
(We) g,CC to save, indemnify and keep harniless the City o1'
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against mid City in couence of thenscq
ranting of [his p� .'
CONST.
CONST. TAX
ISSUANCE 10.00
MECH. CONT. LIG NO.
MECH.. .,
'
TOTAL 1
TOTAL
Signaume ofA (cant/Contructur Date
OFFICE COPY