15121 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 15121
INSPECTION DIVISION
�7�J�Orj{B/,/INSPECTION�R/E`CORD
JOB ADDRESS_ 111.2I 5 - `5hpfe CotIn a75 PERMIT EXPIRATION
rAwUNIT# _LOT#
//'�) Q/` PERM] IF WORK
OWNER 6r2 V CONTRACTOR chf IS NO AR E WITHIN
INSPECTION DATE INSPECTOR INSPECTION RE ORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
GARAGE SLABS CUPER71N0 STANDARDS. PAID
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB . AUG 9 - 1988
PLUMBING p,}�
ELECTRICAL City Of Cupertino IssunmcE DATE
MECHANICAL BLDG ELECT PLC; MEC.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VAILATION SIFT.
MECHANICAL 152
ELECTRICAL Pennur TO
FRAMING SFDU
INSULATION STORIES TYPE CONSTH
2
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• .ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sa rr PLaaR RHEA roTAL ncR eACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID �9
ROOFSHEATHING . _ BUILDING USE
RES 'NO CON PB O+nrr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS
DATE INSP. r
n❑
❑
PLUMBING ROUGH SAN.k 71
1 SON❑ARCELNp
ELECT,ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY t rRncr NO. PARCEL NO
MECHANICAL MECH.ENERGY
/ .
ELECTRICAL BUILDING ENERGY Acc DATE ACC.FILE NO
FRAMING —/ - �G. ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITE NO.
GAS TEST GAS
MECHANICAL _ _7 RE svRINK ENE++cv T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -$ .a Y ❑ N❑ Y ❑ No
EXTERIOR SHEAR ELECTRICAL RELEASE a FLDoo ZONE AL Uc.
INTERIOR SHEAR \_�.Lb FIRE DEPT. `_g v❑ N❑ � ❑ N❑
SHEETROCK GRADE
EXTERIOR LATH FEE SUMMARY
BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING 825.00
SCRATCH COAT ELECTRIC PLAN CHECK 15050
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 10.71
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
_ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 60.35
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. 60.95
- SEE PERMIT FOR EXPIRATION DATE - !STHANICAL
IMPORTANT! . TAX 86.95
PLEASE READ REVERSE SIDE BEFORECALLING FOR FINAL INSPECTION. OTAL 183.21
OFFICE COPY
_). PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT 1 DENT]FICATI ON PERMIT NUMBER. -'
=NG Lotan 3B APPLICATION & P2RMIT-
11721 SOuthshore Court BUILDING-ELECTQdAL-P15121
LUMBING-MECHANICAL 2
owNER'a GREGORY GROUP, INC. & WC
PLAN CHECK VALIDATION
NAME ELECTRIC PERMIT FEE
• AHMANSON DEV. 4JH�N-E595-2100
CONTRACTOR'S
NAME -SWITCHES-RECEP 10.00/1.00
Gregory Group, Inc.LIC,N�-430097 FIXTURES 10.00/1.00 %fl�1XIX�X1
CONTRACTOR 220-C Twin Dolphin Dr.
A s ES-RESIDENTIAL 4.00
C� 94065 ..&15-595-21010.00 DATE OF APPLICATION
ARCHITECT Aram Bassenian, AIA &Assoc. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER C-8395ANS. 3.00
uc.No.
ARCH.DR ENG, 2031 Orchard Dr. 100IRCU IT S,QQ PERMIT VALIDATION
ASanta Ana Hts. CA. P,?707
I EMP.METER OR POLE INS. 20.00 -
APPLICANT "rr
AMOTORS SEE FEE SCH. 1fv1 11VVrAlLl�y+S�_��
aaO-C Twin Dolphin Dr. RWC SERVICE CHANGE O .VI-
062 �I I
Foo LICENSED CONTRACTORS UECLA kA 10
a v 1 hereby affirm that I am licensed under provisions of Chapter 9 '
y Q a ,commencing with Section 7000)of Division 3 of the Filminess and ISSUANCE DATE
F w i Pmflssions Code,and my license is in full lone and e(fecl • BLDG. ELECT. PLG. MECH,
z a�n- License Clan 1-ic.Number Fel fXl
s N o Date_4 cyntracloT_ City of Cupertino J L FXI
X Y E J
2 6 6U OWNF:k-tl UILUIik DECLARATION BUILDING PERMIT
w °;LL y I hereby affirm that I am exempt from the Contractor's License IMISC.- REFER TO ORD INFORMATION
LLoe Law furthe following reason, 7031.5,Business and Professions VALUATION a/Fr.
so Code:Any city.,,..my whichreyuiresapermi(to construct,alter,
PERMIT ISSUANCE 10.00
ac
4 C improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC NO. 15Z 727
ELEC.
i - c a- requires ilicensed
the applicant for such permit to file a signed statement Li that TOTAL PERMIT TO
K
m m he is licensed pursuant to the provisions of tile Contractor's License
z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe SFDU
z D Business and Professions Code)or tile,he is exempt tlic,cfron.and OTY. PLUMBING PERMIT FEE
6 o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ;m by any applicamfora permit subjects the applicant lois civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
ofn01more than five hundred dollors($500),): 2 5NHR
❑ 1,as owner of the property,or my employees with wages az BACK FLOW PROTECT. DEVICE
Inch sole compensation,will do the work,and the structure is not 4.QQ OCC,GROUP RES.UNITS
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 3 1
Code:The Contractor's License Law does not apply to an owner of R-
property who builds or improves,hereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL A
himself or through his own employees,provided that Such Improve- eneneE
mems are not intended or offered for sale.If.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- .4
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUIL ING USE
Phase for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe One,
❑ I,as owner of the property,am exclusively contracting with M ❑ ❑ EI
contractors to construct tile sl
e project(Sec. 7044,Bunnss LAWN SPRINKLERS-1 INC 5 V.B. 6.00 IN
and Professions Code:The Contractor's License Law does'no,apply ASSESSORS PARCEL NO.
In an owner of property who builds or improves thereon,and whoW
SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(z)licensed pursuant to
the Contractor's License Law. -SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B,&p,C.for thisWATER HEATER W/VENT
reason 6.00
Owner Dote SYSTEM 5.00
ACC,DATE ACC.FILE N0,
WORKFiRS'COMPF.NSATION'URCLARATION R TREATING EQUIP. 5.00 '
I hereby affirm that I have a cerlificale ol'comilm m sen.......
or a certificate of Workeri Compensation Insurance,or a cetlifiedZONING ENG.SITE NO.
copy Uromof(See.3900,LaFC.United Pacific
Policy No. Company
Z ❑ Ceon I, anis hereby lumished' FIRE BPRINK ENERGYT-24Z 2 I$ Certilicd co, is 'led w' the city inspection division.
C- O App icant _ REFER TO ORD. Y ❑ Ni] Y � N�CERTH FE OI'EXEMPTION FROM WORKERS* T ISSUANCE 10.00W COMPENSATION Ih'$URANCE FLOOD ZONE A.L.U.cCL (] LIC.NO. PLG.Z ('Phis section need not he completed if the permit is for oneTOTAL Y NEI Y NoU O hundred dollar,($100)or less)1 certify that h the performance y!the wink fur whichMECHANICAL PERMIT FEE FEE SUMMARY
0 U mit is issued,I shat)not employ any person in any manner sy as(oO w becomesubject to 0m Workers'Compensation Laws of California. OR A DD TO IdECH. 500 BUILDING $25.00
} W NOTICE TO APPLICANT: If,after making this Certificate of Es-
� Z eruption,you should become subject to The Worker,'Co q,,., tionqpp LIANCE 5.00 . PLAN CHECK
U
Provisions
sions ofthe Labor Code, you Rmst forthwith comply with
suchp m [ permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00 FEE Energ 62.00
CONS FR UC IION LE NDING AGENCY AIR HANDLING UNIT(OVER 10=C,EM.) 6.00 SEISMIC FEE 10.71
1 hereby affirm (ha, there is if construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance o,[the work for which (his permit is issued(Sec,
3097,Civ.C.). Jecurity Pacific HEATING UNIT(TO 100MICROFILM
,000 B.T.U.) 8.00
Lender's Name
LcndcrY Address MCrOttT-'f-}j`- - H EATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 60.35
I certify that l have read lhls application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00 60.35
r
;I
hereby aulhoriic represenla(ives u! this city to enter upon the
„�N. above-me tinned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the Coy of MISC.- REFER TO ORD. 60.3
upertino against liabilities,judgments, costs and expenses which
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE iQ 00 CONST.TAX 288.95
ranting of this per MECH.CONT. LIC.NO. MECH.
TOTAL
,go at Daleor yr p}rbca ctOr TOTAL 383.21
OFFICE COPY
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
^�
o CITY OF CUPERTINO
DATJaSl 19-a BLDG. PERMIT NUO_ IT=1
THE BLDu. LOCATED AT ' 1 -7 2� SODUL
OWNEDiBY
HAS BEEN MPLETED FOR USE AS SFP
(ALTERED)
LU p R o-
BUILDING INSPECTOR