19402 POST THIS CARD NEAR FRONT OF BUILDING TERM TNo.
_
CITY OF CUPERTINO 1902
A
INSPECTION
,DIVISION- JOB INSPECTION RECORD • ' tj
•� JOB ADDRESS I D�D I 56ce. ? f UNIT# - LOT# ^ CATEGORY i CONTROL#
OWNER AFfLg 6oH CONTRACTOR LYWcdnl XeI . BUILDING PERMIT INFO •.
INSPECTION
TIION/PIERS NOTE ALL GRADI G
DATE INSPECTOR RECORD
FOUNDATION/ DRAINAGE Tx ❑ ❑ ❑
UFERGROUND SHALL BE INSTALLED 7O COMPLY MTH JOB DESCMPION
PAD SETBACK-CERT - THE APPROVED PLANS OF /
GARAGE SLABS PREGUNITE CLIPERTTNO STANDARDS,. ` L..-Yh O
POUR NO CONCRETE,UNTIL ABOVE HAS BEEN SIGNED DATE INSPECTOR
UNDERGROUND/SLAB INSPECTION
PLUMBING
ELECTRICAL
MECHANICALt
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
TUBS&SHOWER PAN
MECHANICAL-
ELECTRICAL/JACUZZI BOND
FRAMING STAIRS -
INSULATION/VENTILATION ,
EM ERG.EGRESS
• SEWER WATER ..
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN -
INTERIOR SHEAR/HOLD DOWN'
SHEETROCK/SHEETROCK SHEAR -
EXTERIOR LATH/WSCREEN
SHOWER LATH
SCRATCH COAT- "
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED -
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE -THE CONSTRUCTION TAX IS PAID
FINALS - DATE IINSPECTOR. - _ -
SAN.#
ELECT.ENERGY _
PLUMBING ENERGY
MECH.ENERGY
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GASTEST
MECHANICAL - - -
HEATING
ELECTRICAL RELEASE -
HRE DEPT.
GRADE _
OCCUPANCY.-
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING
OCCUPANCY OF BUILDING 15 NOT PERMITTED UNTIL
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR - J
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN �j'198 a
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS city Of No
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND cityOf G'+C?14V�
PERMIT# ARE NEEDED WHEN PHONING. ¢,
IMPORTANT! S
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUGDBY: '�
OFFICE COPY
APPLICANT TO FILL IN'INFORMATION WITHIN RED LINES '-'USEl�ALL' POINT PEN ONLY
Buildln Pro'ect Id - PERMIT NO.
Bn�diYg nald..ss: , - 19402
DI
n _ ams: Phone:
er. G , CITY OF CUPERTINO-BUILDING DIVISION
top
On a °Name: Lit.No: APPLICATION / PERMIT Q `
BUILDING-ELECTRICA4MUMBING-MECHANICAL CARY CONTROL X
ArcActed/Engineer. Llc.No: 1
;QTY• ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: 1 y0 •i, 1210 PERMITISSUANCE ❑ 11 ❑
LICENSED CONTRACTOR'S DECLARATION -
' IherebyaRtrmthat l am licensed under provisions of CAapter9(comment. APPLIANCES-RESIDENTIAL - ]OB DESCRIPTION
inence1Section fix.and affect. o(the Business and lsrofesalonsCode,and my - - Vv• a
license 1s In full force and d(. '. PANELS d
LlrenseCk® LIcX �I �Ai b_ ^
Date C°ntraao�-"�
ARCHITECI'SDECLARATION 201-1000 AMPS
aO zC I understand my plans shall be used as public records. OVER 100E AMPS SQ.FT:FLOOR AREA S/SQ.FE
odU Licensed Professional SIGNS ELECTRICAL
�< ol
6F8 OWNER-BUILDER DECLARATION SPECIAL CIliCUIT/MLSC -
Zoa' Iherebya(Brmthatlamexempt fromthe Cmdradoes License taw for the .
o following reason.(Sedlon 7031.5,Business and Professions Code:An d or
OZy:� g Y city TEMP.METER ORIOLE INST. I .
CE countywhfch requ4esaperMtroroorequialter, aprovgtforsuah,orto
C'a anystrocture priereestatement
that he I,also sed pursuant t the provisionsch
ofpermit e POWER DEVICES
r Co a signed rtcens eLa that he k Ilreneed pursuant mmencing it the tion 7T ma of ilia
Oo,
Contractor's License law(Chapler9(ae)ortathehumpthem)of Divi- SWIrIMINC IOOLI7.ECCRICsio .VALUATION
3 0 the basfthe Bu a alleged
d exemption.Any violation if exemp there(romany
vvvEv5� the liens for the alleged exemption. Any t tola civil
o(na tion no m re any - `- .`
0 five hundred a permit doll..($500).
applicant too dull penalty of no more(ban OU7LETSSWITCIIESFIX7'URES W
five hundred dollars($SOPA. ' NEW RESIDENTIAL ELECTR SQFT. STORIES. TYPE CONSTRUCTION
�n I,as owner of the property,or my employees with wages as their sok
compensation,will do the work and the structure Is not Intended or offered for n
Osale(Sec.7044,Business and Professions Code:The Contradoe.Licerue Taw
3 does not apply to an owner of property who builds or improves thereon,and -OCC.GROUP RES UNIIS
who doessuchworkhimselforthrough hisown employees,pmvidedthatsuch
improvements are not intended oroffered formle.IL however,thebuildingor TOTAL:
!imprimprovement is sold within one yea r of compl etion,the owner-builder will have -
ovement
of proving that he did not build or improve for purpose ofsakJ. QTY, PLUMBING PERMIT FEE - PLOOD TDNE APN
u L as owner of the property,am exclusively con..""g with licensed PERMIT ISSUANCE -
contractors to construct the project(Sec.7040 Business and Profemlom Code:
The Contractor's License law does net apply to an owner of property who ALTER-DRAIN&VENTWATER(EA)
Wada or Improves thereon,and who contracts for such pWoets with a -InFEE SUMMARY
ador(s)Bcemed pursuant to the Contradev's License Law. BACK pLpW PROTECT.DEVICE
I are exempt under Seo - B&P C for this reason
DRAINS FLOOR,ROOF,AREA,COND. SANRARY Y N
Owner Date RECEIPTX
WORKMAN COMPENSATION DECLARATION FIXTURE-SPERTRAP SCHOOL TAX Y N
❑I hereby affirm that I have a l certificate of consent d self-insure,ora RECEIPT X
certiflate ofWorkeri Compewatlwlnuuranre oracertl(kd copy thereof($ec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N
3800,lois C.) t��
Polryp B�r{{JU CAS FA.SYSTFM-OVER4fEA) DINGRECEIV
Com any BUILDING DIVISION FEES
❑P Certified copy le filed
the city GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
❑Certified copy b(fled with the tlty inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STURM EA 200Ff Date Remi t#
(This section need net becompleted Bthe permit Isfor one hundred dollars
($1 I0)or Rem.) WATER HEATERW/VENT/ELECTR ENERGY FEE Y--N—
I
Ill net emplothat y
the person
any manner
so as to become
permitI.Ito the
I shat not employ any person In any manner ro as to become wbjed to the T
TREAING
Workers Compensation Laws of CaBfornla.Date WATER SYSTEM/ PAID
ZZ NOTICApplicaE NEW RESIDENTIAL PLMB. SQ.FT. Date Recei t#
O NOTICE TO APPLICANT:If,soar nuking this Certificate of Faemplion,you
should become subject to the Workers'Compereatlon provisions of the Labor _ TOTAL:
W Code,you at forthwith comply with such provisiau ce this permits hall be
W > deemed revoked. BUILDING FEE a
a c CONSTRUCTION LENDING AGENCY SEISMIC FEE
Iherebya(firmthat there is a corotrecdon lending agency forthe perform ELECTRIC FEE n
� 0 once of the work for win(h`thispC l b issued(Sec.3097,Civ,Q TOTAL:
L) _ 4ned,ea Name 1 PLUMBING FEE
LL I— Lenders Address QTY.
MECHANICAL PERMIT FEB , MECHANICAL FEE
O W I rertifythatI have readthisappllationand extethattheabove ln(ormatl°n
C iecorred.I agree to comply with all cityand county ordinances and state Raves PERMITLSSUANCE FEES PAID:
} relating to building corutmction,and hembysuthorize representative°.(this
F Z
city to enter upon the above-mentioned property for inspection purposes. ALTER OR ADD TO MFCH. Date Ri t#
— (We)agree to save,indemnify an d keep barrettes,the City of Cupertino -
against liabilities,judgments,costs and expenses which may in anywayacmre AIR HANDLING UNIT CTO 10,000 CFM) SUBTOTAL:
agal [ultl City t
l `conscryenre o(tbe granting of this permit.
n 1mit. .j AIR HANDLING UNIT(CvER 10,000 CFM) CONSTRUCTION TAX r
Signature of Applicant/Contractor at
EXHAus'e How(vv/Dum) CONSTRUCTION TAX PAID:
HAM RDOUS MATERIALS DISCLOSURE l
Will the applicant or future building occupant store or hand le hazardous HEATING UNIT(TO 100,ODO BTU) Date R2Ce1 t#
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
Health and Safety Cagle,Section 25532(a)7 HFATING UNIT(OVER 100,00)BTU) Of
AL:
❑ Yee `}�1i No _
WBllhe appllantor ..,Wilding occupant use equipment or devices VENTILATION PAN(SINGLE RESID) ISS ANCEDATE
which emit hazardous air contaminants as defined by the Bay Area Air
ualfty Managemen 'strld7 BOILER-COMP(3HPOR100,IXq BTUI RnSCC J 1
Y y •'
Yes No iI%L.I
haveread the hazy °u°materlals requirements under Chapter 6.95 of BOILER-COMP(OVM 100,00)BTU) (
the Cali(omia Health&Safety Code,Sections 25505,25533 and 25534,I /tf /!itlsOrl j�jlt
understand that ifthe building does not currently have a tenant,that it k my NEW RESIDENTIAL MECH. SQ.FT. &1 1
responsibility to notify the occupant of the requirements which at be met
prior to Issuance of a Certificate of Occupancy.
Owner or authorized a gent Date ISSUED BY: ' oy C
TOTAL:
OFFICE COPY