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15119AP,PLIC,UT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY - - BUILDING PROJECT I DENT[FICATf6N-:d_ I - 'APPLICATION &PERMIT - • BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 1 [q 1 (] I J I 1 J num°E8 Lot 289 Plan'"'12A 1.1'673° Westshore Court OWNER'S Gregory Group, Inc. & NAME /1PHB Ahmanson Dev. 45-595-2100 _ DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION NAMERACTofls ' Gregory Group, Inc,, NB, B-430097 UTLETS- SWITCHES -RECEP 10.00/1,00 ILIGHTING FIXTURES 10.00/1:00 CONTRACTORs AOOR�,5�5'C Twin R865V1 959r100 APPLIANCES - RESIDENTIAL 4.00 PANELS _ 10.00 .D C ``�tEE�� DATE OF APPLICATION ARCHITECT OR ENGINEER Aram' Bassenian, AIA & Assoc LIC NC -8395 - PANELS (OVER 200 AMP) 20.00 PLA(d CNECK FEE P.C. No. SIGNS TRANS. ' 3.00 ARCH pR ING(11( 0o ADDA S Dr. �/1QQ707 'SPECIAL CIRCUIT ej,DD PERMIT VALIDATION METER OR POLE INS. 20,00 anta2flna HishaEg yL _ aIEMP. �^ (�I RI 8 1 CD( -1 APPLICANTS - RWC94065 ACORESt20-C Twin Dolphin Dr. MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CON 'I'IIACTORS DECLARATION Aa I hereby affirm that I ten licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and ny license is in full foreg f License Class_ __-t5. Cin. N actor- r} Datoa Contractor --Contractor ISSUANCE DATE BLDG. ELECT. PLG. MECH. ® El ID vq- BUILDING PERMIT INFORMATION OWNER -BUILDER DECLA ION I hereby affirm that I mil exempt from the Contml License Law for the folnowingreason.(Sec. 7031.5, Business and Professions Code: Any city or county which requirespermit to construct,alter, ,306 improve, demolish, or repair any structure, prior In its issuers also requires tile m e applicant for such permit to file a signed statementInst he is licensed pursuant to the provisions of the Contractor's License Division3ofthe Law (Chang 9(commencing with Section is exempt Business and ProfessionsCode)xempt or that he is exempt therefrom and MISC.- REFER TO ORD PERMIT ISSUANCE10.00 VALUATION 138 _ $/FT. ELEC. CONTR. LIC. N0. TOTAL TOTAL _ DTV. PLUMBING PERMIT FEE PERMITTO lk SFDU STORIES 2 TYPE CONSTR. 5NHR the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant lora permit subjects S500).licunt toacivil penalty of not more than flue hundred dollars fS500).): ALTER-DRAIN-WATER(EA.) 5.00 ❑ I, 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 ROOF, AREA, COND.. 5.00 Intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR, Code: 'file Contractor's License Law does not apply to anowner of R-3 .1 FIXTURES - PER TRAP 5.0050. GAS -EA. SYSTEM -1 INC.INC.4 OUTLETS 6.00 FT. FLOOfl Afl EA 2?V* TOTAL ACREAGE property who builds or improves thereon, and who does Such work himself or through his own employees, provided that such improve. mLy ents are not intended or offered for sale. if however, tile e building or improvement is sold within One year Of completion, the Owner builder will have the burden of proving that he did not build or im- prove for purpose ofsale.).INDUSTRIAL ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CDN PB Othar ® ❑ ❑ ❑ ❑ WASTE INTER. 3000 . licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly 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 a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. ❑ I um exempt under Sea ,11.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC, FILE N0. WATER TREATING EQUIP. 5,00 I WORKS RS'COMPENSATION DECLARATION I hereby affirm Hot I have u certificate ofcoment to self insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof(Sec. 3900, Lab.C.). United PacifiQ Policy No. - Company m Certified copy is hereby furnished Certified c y dee ru city inspection division. Applicant FIRE SPRINK J V ❑ N❑ ENERGY T2a V ❑ N❑ MISC. - REFER TO ORD. ' CCR - CATH OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This section need not he completed if the Permit Is for one Y ❑ N ❑ y ❑ N❑ PLG. CONTR. LIC. NO. PLG. TOTAL hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per. mit is issued. I shall not employ any person in any manner so as to GTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING 7.76. D become subject to the Workers' Compensation Luws o(Cnlifornia. Date - ApplicantALTER "TO OR ADD TO MECH. 5.00 NOTICE APPLICANT: If after making this Certificate of Exw sorption,you should become subject to the Workers' Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or. this permit shall he deemed revoked APPLIANCE 5.00 AIR HANDLING UNIT (TO 10,000QF.MI 4.00 PLAN CHECK FEE encu 1.5.5 62. AIR HANDLING UNIT (OVER 10MC.F.M.) 6.00 'SEISMIC FEE 9.731 C'ONSTRUC'TION LENDING AGENCY 1 hereby affirm that [here is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). Securit_y__ PACIFIC Lender's Namefip LendersAddre.s or -o -f -4th -f-1-- MICROFILM HEATING UNIT 170100,000 B.T.U.1 8.00 HEATING UNIT 100,000 B.T.U.) 9.50 ELECTRIC 55.50 1ZY{ 1 certify that I have read this applica ion and state that the above information is correct. 1 agree to comply with all city and County ordinances and state laws relating -to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING 55.50 BOILER -COMPO H.P. or 100,000 B.T.U.) 6.00 gOILER•COMP (Ov.,100,000BTUISEEFEESCH. MECHANICAL 55.50 hereby authorize representatives of this city to enter upon tilt above-mentioned properly for inspection purposes. (Wc) agree to save, indemnify and keep hmnrless the City of Cupertino against liabilities, judgmems, costs and expenses which ay in any way a true against said City in consequence of the tanning of [I+4 per `� MISC. - REFER TO ORD. CONST. TAX 288.95 PERMIT ISSUANCE 10,00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL 1,318.68 SignaOue tyAppIicNU4qonVactor Date OFFICE COPY POST THIS CARD NEAR FRONT OF . -BUILDING.' CITY -OF CUPERTINO - PERMIT NUMBER 15119 INSPECTION DIVISION JOB INSPECTION RECORD "�`�^^"'"D`"'Q�g PERPIRATION 14pL6)( JOB ADDRESS UNIT-EtLOT# //� PERMIT EXPIRES IF WORK /I/n.�� OWNER V CONTRACTOR VI - k IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPE TI N DATE INSPECTOR INFSPECTION RECORD FOUNDATION - NOTE:' ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVEWj,A(�AND CITY OF UFER PREGUNITE PERMIT VALIDATION . CUPERTINO STANDARDS. ��DD ` •� ` I -° IssuarvcE uar GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED AUG UNDERGROUND/SLAB PLUMBING City of Cupertino ELECTRICAL MECHANICAL IN &t Dic.jp BLDG ELECT. PLG, MECH. svwm�g� 111601098-c"ice DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED (o -S9 10+. Icy OK, e CJT 'VY10. e� BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING `VALUATION 1381 38 306 SIFT. MECHANICAL - ELECTRICAL .. - PENM11 TD STORIES-TYPEE CONSTR. 2 5NHR FRAMING INSULATION - OCC, GROUP RES UNITS R-3 1 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE _ THE CONSTRUCTION TAX IS PAID sn. ET FLOOR AREA zjifY TOTAL ACREAGE DIAPHRAGM - ROOF SHEATHING BOLDING USE RES IND CON PB 091 - ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.N jqI56S' . ASSESSURS'PARCEL NO - PLUMBING kzapenNP ELECT. ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY t TRACT NO PARCEL NO MECHANICALMECH.ENERGY� ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE No FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG. SITE NO, GAS TEST — . g GAS MECHANICAL FIRE SPRINK Y ❑ N❑ ENERGYT24 Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR /z' -20 -�y ELECTRICAL RELEASE FLOOD ?ONE Y ❑ N❑ A L u c V ❑, N❑ INTERIOR SHEAR _ _ o` �. FIRE DEPT. SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING 776.00 INTERIOR LATH `L- TEMPORARYAPPROVALS SCRATCH COAT — ELECTRIC PLAN CHECK . FEE eneP62.00 15.50 GAS - SEISMIC FEE 9.73 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 55050 LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. I PLUMBING 55. �j0 C) PLEASE GIVE JOB ADDRESS WHEN PHONING. I MECHANICAL 55.50 �r SEE PERMIT FOR EXPIRATION DATE = J_ eebNST. TAX 288.95, IMPORTANT! TOTAL I PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. 1,316.68 OFFICE COPY