19333 POST THIS CARD NEAR FRONT OF BUILDING PERM TNO:
-
CITY OF CUPERTINO A 19333. .A A
INSPECTION DIV ION- JOB INSPECTION RECORD
n
J06 ADDRESS b � � UNIT# LOT # CATEGORY coNrROrx
OWNER CONTRACTOR I BUILDING PERMIT INFO
INSPECTION DATE INSPECTOR1 PECTION RECORD L'LU , ❑
NOTE ALL
FOUNDATION/PIERS GRADING AND DRAINAGE LX
UFERGROUND SHALL BE INSTALLED TO COMPLY WITH JOB DE9CRIPDON,
PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF
Cl1['FltTWOSTANDARDS
GA /SETB ABS PREGUNITE 1 `•�' `It< J
POUR 7V0 CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB INSPECTION DATE INSPECTOR
PLUMBING
ELECTRICAL `
MECHANICAL . - -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR
PLUMBING -
MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR
INSULATION -
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING -
TU13S&SHOWER PAN
MECHANICAL -
ELECTRICAL ACUZZI BOND
FRAMING STAIRS -
II SULATION/VENTILATION
EMERG.EGRESS - -
r� SEWER WATER -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREEN -
SHOWER LATH
SCRATCH COAT
NO TAPE OR PLASTER UNTIL A13OVE HAS BEEN SIGNED
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE IINSPECTOR -
SAN.#
ELECT.ENERGY OGG e -
PLUMBING ENERGY
MECH.ENERGY
BUILDING ENERGY
ELECT.FINAL TEST -
PLUMBING el I,
GAS TEST
MECHANICAL , -
HEATING
ELECTRICAL RELEASE
FIRE DEPT.
GRADE -
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING
OCCUPANCY OF BUILDING IS NOT 4INCTOIR
1 A DATE
BUILDING FINAL IS SIGNED BY B117
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
NOV a 81989
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND cit, p4 n..n nrtjlt(y
PERMIT# ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUED'BY..
OFFICE COPY 71
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
B.Ild[ng Project IdentificationPERMRTNO.
Building Address: v- 19333
wnero phone: APPLICATION A
TMIr
(!Q Air V EIN N I AI CITY OF CUPERTINO-BUILDING DIVISION
. C.ntadm.Name: Lie,N.: APPLICATION /PERMIT
p
CV I GuLIc.Nz BUILDINGELECTRICAI.13LUMBING-MECHANICAL CATEGORY CONTROL
Archlt /Enginesr.
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
PLUMB M�H
Address: PERMETISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am Bcmad under provisions of Chapter9(cmmne. APPLIANCESRESIDENTIAL )OB DESCRIPTION
ice..1.1.ionWE 7000).(Divifect. the Businessand Pro(calonsC,.de,and my ^I V ,
License Is In fuB r.rtx end affect. PANELS 1
Llrense Clam — Lic.p `D ri rd
VryI Q/N
lI1TJ U v_`
Date GHlador
ARCHITECT'S DECLARATION 2014030TUU MJ'S
0ZO ]understand fans shag be used public records OVER IOW AMPS
p rnYP P SQ.FF.FLOOR AREA 5/SQ.FC.
�j Licensed Professional SIGNSELECTRICAL
OWNER-BUILDER DECLARATION
7E, I herebyarfirmthat l am exempt fromthe Contradorb License law for the Sr+p,CIpLCIltCNT/MISC
q❑❑ mrfollowing reason. 7031.5,Business and Professions Code:An tl or
F t'� county which requimso permit toutruct,alter,Improve,demolish,orrepair TE.4P,MEIER ORPOLEINSP.
r,`4nystmdumpdormiw Wuance,alurequi theappbcantf....ch permit to
€5 ryE file a signed statement that he is Bmnsed pursuant to the provisions of the POWER DEVICES
Contactors Ecense law(Chapter 9(m rma ncing with Section 7000)of Divi-
doSWIMMING IDOL ELECTRIC n3 of the Bustnesaad ProfessionaCede).rthat he IB exempt therefromand VALUATION
C' the basis for the alleged exemption. Any violation of Section 7031.5 by any
OS applicant fora permit subjects the applicant to a civil penalty of not mare than OUTLETSSWITCHESEXTURES
w m flv,..S€j�himdred dollars(MNEW RESIDENTIAL ELECTR
�n LJ I,a owner of the property,or my employees with wages as their sole — _sQpr. BIF)w6 TYPE CONSTRUCTION
compensation,will do the work and the tlmeture is not Intended or offered for
O sale(Sec 7040 Business and Prefesshsro Code:The Contactors License Law
$ does not apply to a owner of property,who Wilde or improves thermn,and
whodocseuchworkhim lforthr.ughhis wnemploymprovldedthatmch OCC.GROUP RIS.UNRS
Improvements arc not Intended oroffered for sale.IS however,thebuilding or TOTAL:
Improvement Issold withnoneyearormmplebgthemner-bullderwlll have
thgkurden of pmving that he did not build or improve for purpose ofsale.). Qty, PLUMBING PERMIT FEE ---
LI L as owner of the properly,am exclusively contracting with licensed PERMIT ISSUANCEmntadors to mrutruct the pmject(See 70K R.elnessand ProfessionsCode: 2..27 0
The Contractor's License Law docs not apply to a owner of property who ALTER-DRAIN kVENT-WATER ffA)
Wilda or Improves therea
on, d who contracts for such pkojecb with a
cgRjT+tlor(s)IkensN pursuant to the Contractors License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
LJ I am exempt under Sec B k P C for this reason
OUTS]UP ELL
Owner Data DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y N—
WORIQfsfAN COMPENSATION DECLARATION RECEBT X
1 ❑I hereby affbm that I have a metificate of consent to self-Inureor a FD(TURES PER TRAP 0 Z$ SCI400L TAX Y N
mdtfluteofWork m'Compe tlmlr wmoramrtifiedmpythereof(Sec. RECEIPT8
3800,Ian C.) GAS F.A.SYSTEM-1 INCA OUTLETS PARK FEE Y_ N_
Pnhry 0 GAS LA.SYSTEM- RECEIPT p
Com yOVERd(FA) BUILDING DIVISION FEES
CertOied ropy V riled with
the❑Certified copy b herebyfurnished.city d.ly Iropc<ion division. GREASE/INDUSML WASTE INTERCEPTOR PLANCHECK FEE
�
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCE
(Thimactionneednat bec.mplcted if the permit bfor.a hundredd.11.rs SEWER-SANITARY-STORM EA.MOFE Date Recel t#
($100)"yth WATER HEATER W/VENT/E.ECTR ENERGY FEE Y N
[certify that In any person
in any manner so a to b co eertrdt is lamed, —
I shall caw employ any peaon In any manner n a to become object t.the WATER SYSTEM/TREATING
Worketd Compensation lawn of California.Date PAID
O Z Applicant
Z O NOTICE TO APPLICANT. ager making rx'C.nthls .it..poeof&z.fthaLyou NEV RESIDENTIAL ELMS. SQ.Pf. Date Reeei to
sh.uldbu=at forthwith
co Workers'Comp rovidnprothis pro(the Labor pis TOTAL:
� N deemed nook t(othwith comply with such provlslom orthla permitahall be I\l � BUIL I G —
IL deemed revoked.
d G CONSTRUCTION LENDING AGENCY SEISMIC FEE —'
I hereby affirm that there i a erout I construction dl ding(Sm. agency for the perform, TOTAL: "�
� 2 arm
er'.Nwork for which this permit is Lasued(Sea 3097,Civ.CJ ELECTRIC FEE
O O Ianaer's Name PLUMBING FEE
LL ~ Lendcr's Address QTY. MECHANICAL PERMIT 'E MECHANICAL FEE
O W Icertlfythat7 have resdthbappBcatlonandstatethat theabovelnfo.tlon
Escorted.l agreeto comply with all city and county ordinances and state laws PERMITISS'UANCE FEES PAID: '/
NrelatingtobulldingmatrucHon,and herebyauthodeerepresentativesorlhts (.Y
F— Z city to enter upon the above-mentioned properlyforimpedion purposes, ALTERORADDTOMECH.ee Date Recei t#
_ (We)agrto uWve, emnify an d keep harmless the City of Cu pertlno P
against liabilities,judgment.,coasand expenses which may In any way accrue AIR HANDLING UNIT CIO 10,"CFM) SUBTOTAL,
aga Wt mid City In consequence�q�the granting of this Permit. •
X' /t✓w /A� ' 'I.-aC� AIR HANDLING UNIT(OVER 10,000 CRD CONSTRUCTION TAX
Signature of Applicant/Contra-dGorr !/ Date IXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
.HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future bulldingoavpant store or handle haeard.us HEATING UNIT(T0100,00)BTU) Date Recei tq
material as defined by the Cupertino Municipal Code,Chapter 9.17,and the
Health and Safety Code Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOT
r-
❑ Ye MN.
Will the applicant orfuture building occupant use equipment or devices VENTI LATION FAN(SINGLE RFSID) IL$�$$UANCEDATE
which emit haeardms air contaMrante as defined by the Bay Area Air 1 IrA j 'di , tl
Ility Management District? BOILER-COMP DHPOR 100,!X10 BTU) �l VFir to 1.106
I I
y-
rl No
have read the haw ous materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU) r r, n
the California health k SafetyCode,Sections 75505,25533 and 2554. I 1170 J V A01J
`
understand that if the building does not currently have a tenant,that It is my NEW RESIDENTIAL MECEI
resporeiblllty to nceitythe occupant ofthe requirements which must be and
prior to Issuance of a Certificate of Octtupa nry.
Owner or authorized agent - Date ISSUEDBY
TOTAL:
OFFICE COPY