19527 POST THIS CARD NEAR FRONT OF BUILDING I Prxhv'r No.
..
CITY OF.CUPERTINO• . . APPLI(A IIUN hUBMI II AL UA Ih .
',INSPECTION DIVISION- JOB INSPECTION RECORD �1
JOTS ADDRESS 2 Z-� •I l j .(.'si P 1`1, UNIT# LOT# _ I I cATLGOxv coNTROI.
OWNER • AA_0_k/rA' CONTRACTOR L\,,N.-P I +;"'.BUILDING PERMIT INFO
I
INSPECTION ,,,: DATE''• INSPECTOR INSPECTION RECORD �`x�y�• . u.� mo
I FOUNDATION/PIERS " , I NOTE ALL GRADING AND DRAINAGE I �� m
'I UFER GROUND " ' I SHALL RE INSTALLFD TO COMPLY WITH IODU RII'rl - i r
THE APPROW PLANS ANDCITYOP °, t `p�AA!0' II
I PAD/SETBACK-CERT I cuPExnNO STANDARDS.. �1� 1�,
I•GARAGE SLABS/PREGUNITE � / ff�e;, EI
I POUR•NO CONCRETE UNTIL ABOVE'HAS BEEN SIGNED -�1"�
UNDERGROUND/SLAB " . _ I INSPECTION, DATE 1NSPE TOR '
I PLUMBING - 'I
ELECTRICAL
.I MECHANICAL
1 ,
I'DO,NOT POUR FLOOR UNTIL ABOVE,HAS'•BEEN'SIGNED I -
I WOOD FLOOR
I PLUMBING . .. I .. .. -
I MECHANICAL"
I ELECTRICAL I'
IFRAMING/VENTS/CLEAR I '
I INSULATION I I,
I,PLACE NO SUBFLOOR UNTIGABOVE,HAS BEEN SIGNED I -
IROUGH
I PLUMBING •I" L .. .j i - '
[TUBS&SHOWER PAN'._
I MECHANICAL
I ELECTRICAL/IACUZZI BOND
FRAMING/STAIRS I I'. I•
— 'I INSULATION/VENTILATION I I
IEMERGrEGRESS . P -
i%I SEWER/WATER"
COVER NO WORK UNTIL ABOVE HAS'BEF-N.SIGNED
EXTERIOR SHEAR/HOLD DOWN
I INTERIOR SHEAR%HOLD DOWN I'
- ISHEETROCK/SHEETROCKSHEAR
EXTERIOR LATH/W-SCREEN
I SHOWER LATH -
I SCRATCH COAT I ; • • I I -
NO.TAPE OR'PLASTER UNTIL ABOVE WAS REEN SICNFD'I
THE CONOSTRUCTION TAX IS PAIDALL'BE MADE BEFORE
I FINALS DATE INSPECTORI
I SAN.#
I ELECT.ENERGY -
I PLUMBING ENERGY
I MECH.ENERGY
BUILDING ENERGY b. -
I ELECT.FINAL TEST
• I PLUMBING
GAS TEST I
I MECHANICAL
I HEATING
I ELECTRICAL RELEASE
'I FIRE DEPT. •I - ' . I.
IGRADE -I I I ,• -
'I OCCUPANCY ,. .1
I TEMPORARY APPROVALS I •I - •I f
' I ELECTRIC
I CAS I. I
,.-.. —,I BUILDING ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL PAJO
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR '•I „u .
'ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN JAPI 8 Tga) ,
12:30 PM"AND 4:30'P1�4 MONDAY THROUGH-FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND Wy of gn?I{fR(�,
PERMIT# ARE NEEDED :WHEN PHONING;
IMPORTANT! .
I_ PLEASE READ REVERSE SIDE'BEFORE CALLING, FOR FINAL INSPECTION ' I ISSUEDRY'
OFFICE COPY.
APPLICANT TO FILL IN,INFORMATION WITHIN RED LINES- USE BALL POINT'PEN ONLY
Building Pro,I Identification 'PERMIT NO. /�
BuuaingnAddonss: l/ra l C'/.']
(hone s5lame Phone: y Nri wlA UUN S�tlmu,A�JHu ,
l e pz2 y P_,kO tl A) - .CITY OF CUPERTINO-BUILDING DIVISION
ly„ . enntraayo�r'.No *}�{a�••�".••�
Lie.No: APPLICATION / PERMIT
�9K1M•U �� JS�6%t•Y BUILDING-ELECTRICAI.PLUMBING-MECHANICAL CATEGORY, "` CONTROLN
Archited/Engineer: ., Lie,No:
' '',BUILDING PERMIT3NF0,
QTY 'ELECTRIC'PERMIT.
Addresszi, 7a/ .✓IV a AUF ' : PERMIT ISSUANCE•i
LICENSED CONTRACTOR'S DECLARATION
Ihereby effirmthat l am licensed under provisions of Chapter 9(commenc-1 APPLIANCESRESIDENTAL A-� JO DESCaRIP1T0
t Ingwlth5 dion7000)ofDivlston3otthe Bu.inessandProressionsCode,and my FV—re°^
license le In four and efred.SS�6/7 /g, PANELS
License Class!Lic.N 7Oe ar�S /•����� W (J/,`LR
Date Contractor _ UP T0200AhSI'$ r �•• -O ,�/"{`✓,Q b `Y L�
ARCHITECPS DECLARATION ]01-1000 AMPS'
qix I understand my plans share be used ai public mounts. OVER 1000 AMPS SQ.FT.FLOOR ARFA I $/SQ.Fr.
CO
MLicensed Professional SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION 'SPECIALCIRCUIT/MISC ,
Iherebyarfirenthetl am exempt from the Contractor's License Law for the - -
.. following reason.(Section 7131.5,Business and Professions Code:Any city or TEMP.METER ORPOLE INST. " I
I" countywhrchr egWresapemutmrorotmc"ter,impmve,dennlbh,orrepair
11 :n+ any strudum prior to Its issuance,also requires the applicant for such permit to POWER DEVICES -
.rG file a signed statement that he is licensed pursuant to the provisions of the -
a O w Contractor'.License Law(Chapter 9(commencing with Seaton 7000)of Dtvl- "
j3 to SWIMMING IXX3L ELECTRIC, VALUATION
O
seen 3o(the 8usineesand Profemlors Code)arlhat hels exempt thercfroman^
6 the basis for the alleged exempffon. Any violation of Section 7031.5 by any / Q 6V.,
applicant for a permit subjedsthe applicant to a civil penalty of not morethan OUTLETSSWITCI{ESFIXTURFS
n five hundred delta.(5500). NEW RESIDENTIAL ELECTR SQ.FL.
j Oo
I,as owner of the property,or my employees with wages as their u^ STOFI{1:5 TYPE CONSTRUCTION-
compensation,willdothework and the structure is not Intended or offemd.ur '
g O sale(Sec.7094 Business and Professions Cods:The Contractor's License La"
r'5 jg does not apply to son owner of property who Wilds or improves thereon,and r l7CC.GROIR' RES.ONTIS
E who does such work himeelrorthecugh his own employees,provided that such
Improvements are not intended or offered for sale.l(however,the building or TOTAL: I4,s
ImprovemenHssold within one yearof completion,the owner-builderwili' ..
t4LtIurden of proving that he did not Wild or improve for purpose ofsale.). L PLUMBING PERMIT' FEE•. FLOOD ZONE APN
Lf L as owner of the property,am exclusively contracting with license..
contractors to construct the project(Sec.7044,Business and professions Code: PERMIT ISSUANCE
The Contactor.License Law does not apply to an owner of property who ALTER-DRAIN -WATER(EA)
builds or Improves thereon, end who contracts for such plojects with a FEE SUMMARY,,,..
m,B(rad.,(.)licensed pursuant to the Contractor's License Law. , BACK FLAW PROTECT.DEVICE
NI am exempt under Sec. B &P C for this reason 0UTtiIIIF F4TS
DRAINS.FLOOR ROOF,AREA,COND. SANITARY Y N
Owner - Date r I, I I RECEIPT N
WORKMAN COMPENSATION DECLARATION, // pf%'IVRES PER TRAP "1 • �i•OD ]SCHOOL TAX Y N_ I
®I hereby.(firm that I have a certiFlcate of consent to eel(-Insure,or a 7 RECEIPT N - —
3SKLate of Workers Compersauen Insurance era ceddl�mpythereof GAS EA.SYSTEM-11NCA.OUTLETS a.'(�p P/'RK� ' � RECER IN
3g00,lab G.y „p � - �/E• 07-'o . I I
'POIIry p ' GAS FA.SYSTEM-OVER 4(EA)
Coco anyQ*m/j r BUILDING DIVISION FEES I
Certified mpyR ruby- mishears CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE '
®Cedibed cepy is filed Mth the city lrlspedion division. ..
CERTIFICATE OFEXEMPTION FROM WORKERS' GREASE TRAP ' PAID
COMPENSATION INSURANCE SEWEH-SANITARY-STORM EA.2IXIFT. Date . Receipt#
Qh.g uiam need not be complded if the permit le forone hundred dollars .
($100)or less.) ' - ENERGY FEE Y_ N
N
I certify that the perform ce an of the work for which this permit is Issued, WATER 1iEATFR W/VENT/ELCCTR 00
I shall not employ any person in any manner so as to become subject to the WATER SYSTEM/TREATING -
_ Workers'Compensation Laws of California.Date PAID -
O Z Applicant NEW RESIDENTIAL PLMB.' SQ.FI'. _ Date Receipt# ' '
Z z NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you
should become subject tothe Worked Compensation provisions of the Labor 1I TOTAL:
CN Cade,you must forthwith mmply,with such provisions or this permit shall be - ]BUILDING FEE i•C.a U" I
W C deemed revoked. - SEISMIC FEE 1 0
a CONSTRUCTION LENDING AGENCY v
I herebyaffirmthal there is a construction lending agency I r the perforcu �ELECTRIC FEE'
TOTAL: ll`' V�Dl '4.
0a2 Lencef thework for which this perMtlaLSVsedl5ec.3097,Civ.CJ irir ance
LL O Lender'.Name //VVGG�` ''CC .I PLUMBING FEE �. . (`/y
LL'H Leader's Add, ]QTY. MECHANICAL,PERMIT, FEE MECHANICAL FEE
U ]rind. tagrI tocom comply with allcityndc county ordiheabuvedgateaaws ^
Q W smrred,buildaecomplywith all dtyandrountyuco representatives elan. I?Qih1IT LSSUANCE Iz:O� FEES PAID:
). O' relating tobuliding mrstmdlon,and hereby authorize represen[advea o(thla
� N. dty to enteruponthe ve-mentloned property for hopedlon purposes. ALTER OR ADD 70 METH. � I
? )agree to sa IndemNfy an d keep harmless the City of Cupertino Date Receipt#
V 1 Ilabilitie cats,msband expenecswhich m ayinanywayareme AIR HANDLING UNIT IT010,000 CFM) • . SUBTOTAL: �O�"•
a laaid Cie uence of the gravy got this permit.
�s"��a� �"f' AIR HANDLING UNIT(OVER 10,000CFM) ',x 'CONSTRUCTION TAX '
• Sigwto_e€/fA IICant/Contractor Date E%HAusTHooD(W/DUC'H' •i CONSTRUCTION TAX PAID:
((// HAZARDOUSMATERIALS/1SCLOSURE '
Will the applicant or future building occupantstomm Inndlehaz..dous HEATING UMT(TO 100,000 BTU) 9 (' s: ^ .
material as defined by the Cupertino Municipal Cods,Chapter 9.12,a ad the t O Date RfCe1Df#
I lealtli and Safety Code Section 25532(a)2 HEATING UNIT(OVER 100,0008TU) •� TOTAL: Ilor'a SDI
M Yes ' M No '
Will the applicant or future building occupant use equipment or devices VENTILATION PAN(SINGLE RESID) + „ISSUANCE DATE .
which emit hazardous air conlandnants as defined by the Bay Area Au _ PAID
Quality Management District? BOILER-COMP pHP OR]00,0(q BTU)
Yes" ❑No
• ,� eve read thehaaardous materials requlremenls under Chapier 6.95 o(, BOR- COMP-CONP(OVFR 100,0(109N)
JAN
the California Health&Safety Code,Sections 25505,25533 and 25534. I V
understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT.
respoesibility to notify the occupant of the requirements which most h__
_ r
prior to issuance of a Certificate of Occupanry. .. :, I }illz!'`of r'!1(jS1'jtign,
Ownerorauihodeedaimm + Data - 00 IISSUEDBY:�I
TOTAL: a( I• I a
OFFICE COPY V Y21Y VLV Y