14967 ,t POST THISCARD•NEAR FRONTOF.BUILDIN � Rh,IrNUMBER
g -�,•' CITY OF CUPERTIN® , 1.496? r'
INSPECTION DIVISION ,
JOB INSPECTION'RECORD
PERMIT EXPIRATION
JOB,ADDR S'_����� `� — ���G '—yC!•P�UNIT#' =L �# ���
( _ PERMIT EXPIRES IF WORK'.
OWNER CONTRACTOR IS.NOT STARTED WITHIN
INSP TIO DATE INSPECTOR I IE ON RECORb 180 DAYS OF PERMIT ISSU-'
ANCE OR 180 DAYS FROM
FOUNDATION 7 NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PEHIAIT VACIDATION
CUPERTINO STANDARDS.
GARAGE'SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ^ I_6•a-;'^'•�"✓
UNDERGROUND /SLAB' 'a�^%•'CI`
PLUMBING
ELECTRICAL - ISSUANCE OAT
MECHANICAL - 7
BLUG. ELECT. PLC. MECH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDc•;. euaDING PERMIT
RMATION
WOOD FLOOR VAR N S/FT.
- PLUMBING
MECHANICAL - - Pevmn TO .
ELECTRICAL
FRAMING
INSULATION _ - - STPIII: T:PE CONST+. ,
^ OCC.G UP S.UNITS
t
PLACENOSUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' Pa
sO.f G OH nvtA TOTAL CHCAc!
ROOF NOTE:NO FINALION SHALL BE MADE BEFORE -t ;
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
W LDION'
ROOF SHEATHING y vos Imo �.cNry E '.o •.f
s '❑ ❑ .: ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED- FINALS DATE INSP. ASSESSORSPARceLNO.
. - ROUGH SAN.a 3 ' t`� •. . .
PLUMBING . oot 2 ELECT.ENERGY
TRACT NO.. PARCEL NO.
TUBS&SHOWER PAN =L PLUMBING ENERGY
MECHANICAL /p—i/—%,r. MECH.ENERGY 1�*7 `
ELECTRICAL G• -bf BUILDING ENERGY ^cC.DATE ACC,FILE No,
FRAMINGZ_ ELECT,FINAL TEST ZONING ENG�SITE NO, i
INSULATION PLUMBINGo,.i',�:
GAS TEST ' GAS. `
FIRE SPRINK ' ENCRGY T 24 '
` MECHANICAL' y .Z•Apipv0 . N❑ - . ..Q NQ
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .•44
FLOOD LUNE A.L.U,C,
EXTERIOR SHEAR U(05 _ ELECTRICAC.RELEASE - ,jj�', v❑ ,N'❑ ❑ NOI
INTERIOR-SHEAR FIRE,DEPT.�
SHEETROCK" , p— GRADE'. FEE SUMMARY -
EXTERIOR LATH 1p BUILDING :2 • ..e•
BUILDING
INTERIOR' LATH ,-- � ?EMPORARY�APPROVALS 916 00
SCRATCH COAT — — ELECTRIC ',PLAN CHECK 15.60,
GAS FEE
Z •2•�8
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY "SEISMIC F,E -
OCCUPANCYOFBUILDINGISNOTPERMITTEDUNTILBUILDINGFINALISSIGNEDBYBUILDINGINSPECTOR.
MICROFILM
J..
ELECTRIC
uJ , ,ARRANGEFOR INSPECTION BY PHONING 252-450568.58ONE WORKING DAY BEFORE REQUIRED-INSPECTIPLUMBING - 68.58;
00 PLEASE,GIVE JOB ADDRESS WHEWPHONING.Z , . MECHANICAL
SEE PERMIT FOR EXPFRATION DATE =• tIMPORTANT!, CONST.TAX .288.24)
PLEASE READ REVERSE SIDE BEFORETOTAL.CALLING FOR FINAL.INSPECTION. 1500.01
.,OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY < �-
' BVILDINGPROJECT IDENTIFICATION _ PERMIT NUMBER
BUILDING rc err Spring our APPLICAfiION & PERMIT 1 A
AOORE55 19 6 7
- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OW GY,�^- �y UI Wps� • B I1M,�n At 146 PI in 9P PLAN CHECK VALIDATION
NAME U��`` gor 111 W 01 Asa CITY. ELECTRIC PERMIT FEE
Developments X15-595-2100
ON
. CONTRACTOR
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
Gregory Group,' Inc. LIC NO B 430097 LIGHTING FIXTURES 10.00/1.00
CONTNACTOp5?2D-C TwinDol 'n5 _2 PPLIANCES-RESIDENTIAL 4.00
ADDEE
PHONE PANELS 10.00 DATE OF APPLICATION
AR ram SSenlan, Associates PANELS (OVER 200 AMPI 2000 PLAN CHECK FEE P.C.NO.
ERrvcmEER C-8395 SIGNS TRANS. 3.00
LIC.No.
ARC H.On ENG.. - PERMIT VALIDATION
ADD Ess -OFUar SPECIAL CIRCUIT _ 5.00
Santa Alla Htst M 9?707 TEMP.METER OR POLE INS. 20.00
APPucnrvrs Wln UUIPHIH Dr. RIC 9406,1 MOTORS - SEE FEE SCH. -
ADDREss
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
a u v 1 hereby affirm that 1 ant licensed under provisions of Chapter 9 ISSUANCE DATE
y a N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG, MECH.
H m z I'rofeselom Codo,m, my licenser:is in I'uIl fi,rcy t4y, t
z o,n - License Classb_Lie.Number y /� z
o z r o Date Contractor_
a u s BUILDING PERMIT
¢
it,w u OWNER-BUILDER DECLARATION INFORMATION
w 3 A I- 1 hereby affirm thut�l.am",....pl from the Contractor's LwcNw MISC.- `• REFER TO ORD
m ATION - $/FT.
U.
Law for the following reason'(Sec.7031.5.Business and Professions PERMIT.ISSUANCE 10.00
Code Any city or county which squires a perm 11 to cnnstruoL alte,
a ¢ O improve,demolish,or repair any structure',prior to its issuance also ELEC.CONTE. LIC.NO. • ELEC. - \� s 000
G¢ requires the applicant for,such penult 10 file:,signed statement that ` TOTAL J y PERMIT TO
u w es u he is licensed Pursuant to the provisions of the Contractor's License pl�8,•�
rzi
Law(Charter 9(commencing with Section 7000)of Division 3 ofthe V '
- ¢ Business and Professions Code)or that he is exenpl therefrom and QTY. PLUMBING PERMIT
¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
dam _ by any applicant for a permit subjccls the applicant hsa civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).): - -
❑ 1,as owner of life property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.G UP 5MRS.UNITS
their sole compensation,will'du the work,and the"structure is nut
intended or offered for sale (See 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: The Contractor's License Law docs not apply to on owner of - _
property who builds or improve%thereon,and who docs such work FIXTURES-PER TRAP 5.00 ser FT.rLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve- - -
poems are not intended or offered for sale.If.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 2263
or improvement is sold within one year(if completion, the owner- 2263
-EA.SYSTEM-OVER 4 (EA..) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or int- RES . IND COM s PB Other
prove for purpose of sale). INDUSTRIALWASTEINTER. 30.00 El ❑ 1:1 C3❑ I,as owner of the Properly,am exclusively contracting with
licensed contractors to construct tie project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codo:The Contr,,tor's License Luw docs not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 '
contracts for such PrujcCls With a Contraclutls)licensed Penuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contract.,',License Law. TRACT NO. PARCEL NO.
O I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason 8067 -
Owner - Date. WATER SYSTEM r - - 5.00 ACC OATE ACC.FILE NO.
WORK ERS'COMPENSA'TION DLCLARAT'ION WATER TREATING EQUIP. 5.00
I hereby o1Dnn Ilia( I have a cerlifmWc of..... .I to soil-in,rue. - . ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or,a certified
ropy thereof(Sec.3X00.1 ab.0 0 'Lett f• .
Policy No Company pa.Cl_ 1C ?
Q DCertified copy is hereby furnished. { - FIRE SPRINK ENERGY T-24Z Z )x Certified c - d with the city`inspection division. ' MC.IS - REFER TO ORD.
O APPIi<a,it Y ❑ IN Y ❑ N❑
C17RIIFIGITE 01:EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 - FLOOD ZONE" A.L.U.C.
L COMPENSATION INSURA NCE 4 PLG.CONTR. LIC.NO. PLG.
O (This section need not be completed if the permit is for one TOTAL Y❑ IN Y❑ N❑.
Z hundred dollars IS 100)or less.) -
U OI certify that ,n life performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL F e,it is issued,I shall toot employ any Penton in any manner so as to
U become snov,,l No the Workers'Con,pcmalion Luws of C.Ih.rniu.
n Date Applicant ALTER OR ADD TO MECH. . 5.00 BUILDING 916.00
>_ W NOTICE '1'O APPLICANT': If,:offer making this Certificate of lex-
Z
erep Lion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 15.50
provisions of the Labor Code you must forthwith comply with FEE'
U such movisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10/000C.F.M.). 4.00
C'ONS'I'RUC'fION LENDING'AGENCY' AIR HANDLING UNITIOVER 10=C.F.M.) 6.00 SEISMIC FEE L
.1 hereby affirm shat there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 12.53
- theperfarfranc
of t c, ork ,r wppp this p min d(Sec. MICROFILM_
3097.Civ.C.). $eCUrl y �aClT lc Ufle FffbarcadErbHEATING UNIT(TO 100,000 B.T.U.) 8.00
` Lender'sAddn th_f]='F_CA-94111 H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 68.58
I cehily than I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING` 68.58
1 oNinances and slate laws.relating 10 building construction, and BOILER-OOMPI3 H.P.or 100,000 B.T.U:1 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOYer100,0008TUISEE FEE SCH. MECHANICAL'
above-mentioned property for inspection purposes. 68.58
(We) ugree'to save, Indemnify and keep',harmless Inc City of Misc.- REFER TO ORD. '
upertho agas'Inst liabilities,judgments, costs and expenses which - CONST.TAX
ay in any ay.accrue against said City in consequence of the PERMIT ISSUANCE 10.00 288.24
mnting Of tl' icon' MECH.CONT. LIC.NO. MECH.
TOTAL Air.I[ALC7 V TOTAL
Signature pplicant/Contractor /Date/ '1500.01
OFFICE COPY
- -----------
CITY OF CI-fPERTIN0
CERTIFICATE OF COMPLETION TION
BUILDING INSPECTOR'S OFFICE
Date
The Building Located at Building Permit
Owned by .....!FW
Has Been <Com Tete
(Altered) For Use
.. ...................................
................................................................................................................................................................
........... ... .........I.........................I.................................. .............
............... ...................... ......................
...................................................I..................... ........
..........
PD-7
j BUILDING INS�pEOR
BUILDING INSPECTOR'S'- OFFICE
CITY OF C C
UPERTINO Bld
Office9.Dept
❑ Backflow Device.
Sanitary Permit No.
❑ Sewer
/ Connection Plumbing Permit No
P1L;rribjngFin.l
Lot No.
Owner
or Tenant
At
Tract
Date Connected
—————————7-1.9 Date Finoj
19
--��PLUM�BINC5
�I .CITY OF CUPERTINO v� �OPYE
a GAS SERVICE NOTICE
i
-119
To
You are hereby authorized'to connect the GASservicefor -
-Owner or Tenant
At 'S`Ti7'ir✓G' r�T
New Service •/
rNo. of Meters, Reconnect
No. of.Add. Meters Move Service -
- Move Meter'
i PLUMBING INSPECTOR. ��:'--> �./„✓/ pp „
i
l ELECTRIC SERVICE NOTICE? OFFICE COPY �I
BUILDING INSPECTOR'S NOTICE
CITY OF CUPER-two YY
✓z /2 . 19
To
You ore hereby authorized to Connect electrical service for J
Owner or Tenant
At /1<Oe!57/ C TAY/✓GF�� �S fi?/�I/G C 7�
No.of Wires Size of Wires Size of Switch
Motor Load Voltage Phase
Heating Load K.W. Voltage
! /
Light-]10-New Service Reconnea
i No.04 Meters Heat I20 Three Wire More Service
No.of Add.Meters Power Three Phase// Move Meter
&• - ELECTRICAL INSPECTOR