19492 POST THIS CARD NEAR FRONT OF BUILDING, . r xMlTNoq.
94
CITY OF CUPERTINO : 1 L
INSPECTION D ISION- JOB I PECT16N RECORD �/ J
JOB ADDRESS 0_k,,g UNIT,# L'OT,#" cA DRY ` coNUTROLx l �
PETM Mr,
OWNER • CONTRACTOR- 0 i .II S"tBU1 LDING PERMIT INFO 1; "
- INSPECTION' '' ", .DATE,1. INSPECTOR INSPECTION RECORD •I '
FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE ' Lc
'UFERGROUND .1 .• SHALL BE INSTALLED TO COMPLY WITH OBDESCR11MON-
PFE SETBACK-CERT THE APPROVI*D PLANS'AND CITY OE•. '
CUP UNO STANDARDS:
GARAGE SLABS PREGUNITE - .. - -i- A ,
-POUR NO CONCRETEUNTIL ABOVE HAS BEEN SIGNED'.
UNDERGROUND/SLAB " INSPECTION DATE ,INSPECTOR'
PLUMBING
ELECTRICAL cntII w
MECHANICAL `
DO-NOT POUR'FLOOR"'UNTIL'ABOVE HAS BEEN'SICNED.
WOOD FLOOR
PLUMBING - - -
MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR -
INSULATION
PLACE.NOrSUBFLOOR UNTILABOVE'HAS'BEEN.SIGNED'
•* ROUGH - '
NUBS&SHOWER PAN' - AT
MECHANICAL Al
E ACUZZI BOND �9b
U2MMSTAIRS -2- U
] ION/VENTILATION -- - _
EMERG.EGRESS - •-
' SEWER WATER ,
COVF-R NO WORK UNTIL ABOVE HAS-BEEN SIGNED
•EXTERIOR SHEAR 14OLD DOWN - - -
.INTERIORSHIAIi/HOLD DOWN
- 'SHEETROCK/SHEETROCK SHEAR.- _
EXTERIORLAIH/W-SCREEN
SHOWER LATH - -
SCRATCIi COAT
NO TAP&OR PLASTER'.UNTIL ABOVE HAS`BEEN SICNED -
NOTE:NO FINAL INSPECTION SHALL BE MADE.BEFORE - - - •-
THE CONSTRUCTION TAX IS PAID
,FINALS DATE INSPECTOR
TA-N.#, .. - .. -
ELECT.ENERGY - - -
PLUMBING ENERGY -- -
MECH.ENERGY.
BUILDING ENERGY -
ELECT.FINAL TEST -
PLUMBING
GAS TEST '
MECHANICAL
HEATING
ELECTRICAL RELEASE
FIREDEPT. '
GRADE - - - -
OCCUPANCY - -
TEMPORARYAPPROVALS i -
ELECTRIC - - -
GAS
BUILDING' . {
OCCUPANCY OF BUILDING IS,NOTTERMITTED UNTIL ISSUANCE DATE
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR,' ' PAID x '
J , . ARRANGE-FOR INSPECTIONBY PHONING 252-4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH.FRIDAY,24 HOURS ' JAN 101990
BEFORE.REQUIRED INSPECTION. JOB"ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING. Citi of,C1IvBlfinn
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION 's`U Dev:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pm'ect Ideml(icatlon - 7 Pl,R TNO.
Building Addre? - 19492
nets ase: hone: - ADATEp?679//• CITY OFCUPERTINO-BUILDINGDIVISION (�
C radior _sN � LIe.Ne: ' APPLICATION / PERMIT
'
ArndummattEnglocer. Lic No: tlU1LDINGELECTRICAUPLUMBING MEC[IAMCAL CA9if30RY CONTROL N�dQ c
jN T 'R /+W - t I '' t' • !BUILDING PERMITIINFFO�,!
tQT'Y � �ECBCTR[C PERMIT s FEL
,t
Addmc PLUMB II
PEIMTISSUANCE " �p 17 �... .f� '�jI ❑
LICENSED CONTRACTOR'S DECLARATION j�L
Ihcmby affUm that l am licensed under provisions o(Chapter 9(rommene- APPLIANCFSRFSIDENTIAL JOBDPSCRR'ITON
ingwlthfiectim 7000)ofDivlsion3 ofthe Businnsand ProfeseloreCods,and my -
license is In(un f and offset. PANEB
License, ns p—Co pc.� h /
Date_/ - I CFVTECTntacter' 4, [•u/ _ 111 Vep or•/e
CF The C RATION 201'1000 AMPS l V` a� V
rx 0 ZO d my p a be dTajpubllc re.H.. OVER 1000 AMT'S SQ.FI'.FLOOR G f/SQ.FT.
�aKr1 �j Limmed Professions _ggSIGNSELECTRICAL
OWNER-BUILDER DECLARATION SPFGIALCBRC[fIT/MIS, '
"I hereby afRrmthat l am exempt from the Contractor's License Law for the
pp following reason.(Section 7031S,Buslness and Professions Code:An ct
Cz county which requires a permit tomostruct,alter,impmve,dereolish,or repair 'TGMP.METER OR POLE[NST.
gU .x anyst dos prior to Its Issuance,also requlmthe applicant for such permit to
t5 c. file a signed statement that he is licensed punuant to the provisions of the POWER DEVICES -
3K� Contradict.License Law(Chapter 9(commencing with Section 7000)of Divi- SWPIMING 100E ELECTRIC
F OS cion 3 ofthe Business and Professions Code)orthat he is exempt thereIfromand - VALUATION
the bash for the alleged exemption. Any violation of SecHan 7m L5 by any
oGapplicant for a permit subjects the applicant to a civil penalty of nor more than OUTLETSSW[TCfiFSEXTURLS c/i_7 v .
mf< five hundred delta.($500). NEW RF SIDEMITALELECTR
�n ❑1,as owner of the property,or my employees with wages as their sole aeQ'Fr. STORIES TYPE CONSTRUCTION
C compensation,wllldo the work,and the structure b not Intended or offered for ,� t/ •1(h/'r
5 q. sale(Sc<.7014,Bueinese and Profeeslons Code:The Contractor's Llmnse Law U
does not apply toan owmro(pmpeny who Wilds orlmprovestherme,and OCC.GRORFS UNITS
whodoessuchworkhirnself orthwgh hlsownemplaym,pmvided that such UP(-
t Improvementsare not intended orof(ered for sale.If,howevep the building or TOTAL:
Improvement is sold within oneyearofcomplMiory the owner-bullder wlil have
t1r*rden of proving that he did not Wos
build or Improve for purpose of sale.). QTy, :-7-14PLUMBING PERMIT[i.tr. . , FEE � PCODD ZONE APN
UL as owner of the property,am exclusively contracting with licensed
mntracten to construct the projM(See.7074,Business and Pre feeslons Code: PERMIT ISSUANCE 190
The Contractor.License Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) '
Wilds or Improves thereon,and who contracts for such pRojm;with •D O n- .` IFEEtSUMMARY t
cq➢t actor(A)licensed punuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE
(_J f am exempt under Sec. It&P C for this reason
'
DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y N Owner- Date RECEIPT If
WORK MAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL FAX Y N
❑1 hereby affirm that I have o certif,Imu ane of consent to copy
themed ora -� RIiElPT N
MOD,coniLab ofWOrkeri Compensatlonlnsurance oracenl(Ied copythereo((Sce. CA&EA SYSI'EMI INC4 OUTLETS PARK FEE Y N
38f0,lab CJ - .
C.mPoliry n - GAS EA.SYSTEM-OVER 4(EA) - RECEB'I'X
Y d� BUILDING DIVISION FEES
Cenfrel copy is hercbyth the cid. CREASE/INDUSHRL WASTE INTERCEPTOR PLANCHECK FEE
cenined ropy v pled with the city inspem.n arolm...
CERTIFICATE OF EXEMPTION FROM WORKERS' - GREASE'IRAP PAID
COMPENSATION INSURANCE - - _
(This ionneednol Wcompl&cd Btheper tis(oronehundreddolian SEWER'SAMTARY-STORM EA'2(pFT. Date- RCC,
($100).r lOseJ WATER"EATER W/VENT/E•ECTR ENERGYFEE Y
I certify that In the performanm ofthe work forwhlch thio permit laissued, —
I shall not employ any person In any manner an as to Wrome subject to the WATER SYSTEM/TREATING
Workers'Compm,.6on laws of California. Date - PAID
O Z - Applicant
Z G NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you INTW RES3DFNTIAL PLMB._SQ.FI'. Date Rete) t#
should bmme subject to the Workeri Compensation provisions of the Labor TOTAL:
N
Code,you=at forthwith comply with such provisions or this permit shall be
> deemed evoked. BUILDING FEE 0
LU
O CONSTRUCTION LENDING AGENCY SEISMIC FEE
I herebyafOrm that then is a construction lending agency for the perform r�I ELECTRIC FEE
7
Z. .a.of the work for ch this permit is issued(Sec.3097,Civ.C.) TOTAL: 0.DD
V O Ie.der'x Name .� PLUMBING FEE - 0.0
1. lender's Address QTY. +MECHANICALPERMIT` "FCE• MECHANICAL FEE
O W I cenifythatl have read this appticatlonand rtatethauheabove information
rrei.I agree to comply with all city and countynrdlnances and state laws, PERM ANCE FEES PAID:
C relating to building construction,end hereby authorize mpresentativee of this -
F N city to enter upon the above,mentioned property for Inspection purposes. ALTER OR DTO MECH.
? (We)agree to live,Indemnify an d keep harmlm the City of Cu pen Inca Date Rete) t#
V against Babilitles,rydgmenis,c sen expenses which may In anyway accrue AIR IiANDW [JNIT'(f010,00 Fns) SUBTOTAL: D
- .gat sa CI nsequen f granting of permit / AIR HANDLING (OV B,"CFM) CONSTRUCTION TAX
�+yjQ fl/-y'/-�+p �/r o�40
- Slgnaturc of Applic�t/Cootmcror ✓ Date allAUsrHOOD DU CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant store or handle haeardous HEATING UNIT(TO 1 ,000 BTU) -
material as defined by the Cupertino Municipal Code,Chapter 9.1 2,and the Date Remi t#
Health and Safety Code Se 1..25532(.)7 HEATING UNIT( ER1 ,000 BTU) TOTAL: •V
❑Ys Yj No
Will the applicant or future building emupant use equipment mdevices VENMATTONAN(SING •REBID) ISSUANCE DATE
which emit havrdous air contaminants as dented bythe Bay Area Alr - pp
Quality Management Dut 17 BOILER-CO P(311POR100,0 BTU) - RAOJ
4 Yn /INo
have read the h ousoeterials requlements under Chapter 6.95 of BOILER MP(OVER 100,000 ) ��^� u 'ni7�
h� the Callforn la I lealth&Safety Code,Sect ions 25505,25533 and 25534. I 1• JJ
understand that lithe building does not mrrently have a tenant,that It is my, NEW IDENTTALMECA. SQ.PI'. '
imponslbllitytonotifytheom pant of the equmments which must W met - /t�ssrr�fpp n..y'�
priorto eS Of ific of Occupancy. City.t9.L.Ompfifte
Owner or /s o/9a
gent Date , ISSUED Y.
�� v
'TOTAL: —
OFFICE COPY
r
sp�qoximate scale: 20:1
APPROVED
IN ACCORDANCE V.JITH 'fI1E CffY 01
CU 'ERTINO CODES AFiJ Of:Dih:Fli4CES
DATE,
Th i :et of p:^rC> .1!'I p'?:,', oE. MIUS1
be ked rn i c ; s un • C�,
lav fultc n
sa,
on sa .e w,i.
the br iic nu
Thi s'3n a ncstions W
SH 11 PLi; Oc ��o p! m:: .-i io bo an V1 V
apI ro,ai d ilia vi n 'A any provisions
m C iy 0 u.r,:.,ce or State Law. j •
Q
1
21 r3
� � 3
a
48
cabinet
� 1 15� QUL� D
with doors
o and 2 shelves
sink JAN 101990 I I
_ � 15"
oLDG. INSPECTIDN DEPART �/
13 ILL25 CIiY of GUPERTINQ
37
o p
sink,
@20. Q
0
51 9
shower 3
30 �- - - -
25