19319 rl ,POST THIS CARD NEAR FRONT OF BUILDING P��� PERMITNO.
19319
CITY OF CUPERTINO , 0 2 ,8 A
INSPECTION DIVISIO`yN- JOB IIINSPECTION RECOR 0
]OB ADDRESS CDL 3 �J v�i`' "l UNIT k �It LOT-d Ft� Y
� � CATEGORY 'tl
OWNER CONTRACTOR - BUILDING PERMIT INFO
:^INSPECTION. '` ` 'f7; DATE " INSPECTOR INSPECTION RECORD
FOUNDATION/PIERS NOTE.ALL GRADING AND DRAINAGE
UFERGROUND BHALL REINSTALLED TO COMPLY WITH JOB DESCRIPTION
PAD/SETBACK-CERT THE APPROVED PLANS AND CJTYOF
CUPERTIN05TANDARDR.
GARAGESLABS PREGUNITE
?POUR-'NO'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
r
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
EMERG.EGRESS .
• SEWER WATER'-: - -
' 'CO-VEWNO:WORK+UNTIL ABOVEWASIBEF-N SIGNEDli'
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCKSHEAR _
EXTERIOR LATI I/W-SCREEN
SHOWER LATH - - - -
,SCRATCI-ICOAT
.wooTi1`PE-6R PLASTER UNTT ,ABO.VE:HAS"BEEN'SIGNED
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE -
THE CONSTRUCTION TAX IS PAID
FINALS - DATE INSPECTOR - -
SAN.#
ELECT.ENERGY
PLUMBING ENERGY '
MECH.ENERGY
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GAS TEST -
MECHANICAL -
HEATING
ELECTRICAL RELEASE
FIRE DEPT.
GRADE '
OCCUPANCY
TEMPORARY APPROVALS - -
` ELECTRIC -
GAS
BUILDING .. _ ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL
BUILDING FINALIS SIGNED BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN n
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,,24"HOURS,
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN'PHONING.
IMPORTANT! J11ti �J jI
PLEASE READREVERSESIDE BEFORE CALLING FOR FINAL INSPECTION SSU'D BY: -
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Bulldin Project Identification PERMiTNO.
BuUding Add ress: e
11 0' P3 i', . - 19 319
Owner'sName: Phone:
L d CITY OF CUPERTINO-BUILDING DIVISION
Co trectorsName: LI .No: APPLICATION / PERMIT _//a 2z 'q —/
i�. itect/ nBUILDINGELECTRICALPLUMBINGMFf}1AMCAL CATEGORY
Ar eer. Llc.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: PERMITISSUANCE El El ❑ El
CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(comoncru, APPLIANCESRES[DENTIAL TOB DESCRg'TION
Ingwlth5mc on7000of Dlvblon3ofthe Bussinaem�annddjPmfe =sCode,and e
license Is In fug force an dfect. .� 3/-p6 Q PANELS - 1��
License Clam Lle M
Date Contractor d
ARCHITECTS DECLARATION 1014000 AMPS
Z I understand my plans shag be used as public record OVER 1000 AMPS SQ.FT.FLOOIPtQF.4� S/SQ.FT.
O I�++((•�1��
byLicensed Profmloral SIGNSELECIMCAL
2:t 61 by OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MLSC NVV2219E3
�� Ihereaffirm that l am exemptfrom the Contractors License Law firths
METER OR POLE INST.
following reason.(Rection 7031.5,Business and Profmbna Code:Any city or
'@� muntywhlch requires•peaNtto mratruct,alter,Mprove,demolish,arrcpalr TEMP.
S anystmc ru priortolbLsmame,aLsorequlrestheappBcantforsuchpermltto POWER DEVICES Citi R{ "1T^9(fy
ill
L5 file a signed statement that he is licensed pursuant to the provisions of the
3w� Contract.?.LicarusLaw(Chapter9(mmmerdngwith&-Men 7000)of LIM- SWIMMING POOL ELECTRIC VALUATION
X 0 3 pe basis for
Busbmand Pro(mioAny .dationhat of
theref70312 by and ��
O the Want for the allegedjchiteexemption. Any violation of Section elect
co re any OU7LE•I.SSN7•ICIIFSI7X.I•UREq
applicant fora permit subjectdthe applicant to a civil penalty cant not momthan
jai live hundred doll..C$500.
1,as owner of the NEW RESIDENTIAL ELECTR_SQFr. —of1r'PE CONST RUCTION
corn�n property,or my employee.with wages as thele dole
pen.7044tion,B.M.do hework,des theproctureh not Intended assoffered Law
D sale(Sec.apply
to alnow and Pro(ml.ns Code•.The Contractor's License Law
rims whoclotaucin torn owner ofproperty
rough whonempoyImproves
ovidedreortAnd OCC.CROUP RES.UNITS
EE wuN work himself
tended through his own cwevrotheb ildinghat h I r
Improvementsarenolinlendedor.liercdptelo theh evegthebulilI have TOTAL:
Improvement Iswldwlihlnoneyearofcamplplon,<heowner-bugderwlll have
diLlI udenof proving that he did not build or improve for purpose ofsale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
Lj L as owner of the property,am exclusively contracting with Licensed pptMlT ISSUANCE
contractors to construct the project(Sec.7046,Business and Professions Code:
The Contractor's License Law does nae apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA)
Wild.or improves thereon,end who contracts far such pnojecb with• FEE SUMMARY
c9upctor(Olicensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE
L j I am exempt under Sac. B Is P C for thisremon
DRAINS.FLOOR BOOP,AREA,GOND. ouTsHIE FEES
SANITARY Y N_
Owner Date Rp,C}7PT s
MTI/ WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
(Qa nereby orkers that I have o mrURcate of consent to opythereof ora RFGF9'f M
certlgcate of Worken'C.mpensagonInsurance oradrifted copy thereof(Bees GAS FA.SYSTEM-1 INCAOUTLETS PARK FEE Y N
3800,Lab C.)
Pdiry a GAS EA.SYSTEM-0VRR 6(FA) DING RECEDI N
Com BUILDING DIVISION FEES
Cert a py 1,h_eabyume
Certified copy b(Lied with the
ccity Inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR' PLANCHECK FEE
city '
CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASETRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM FA 200Ff Date RCCeI f#
(Thlswdionneednmbecemplee Ifthe Ne tIsforomhundreddollars
(Slm).rlm.) WATER HEATER W/VENT/EI.ECTR ENERGY FEE Y -,N
I certifythat In the performance of the work forwhich this permit is Issued, _
I shall not employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING
Worken'Comna...tun Law.of California.Date PAID
O Z N077CAppficant - NEW RESIDENTIAL PIMB. SQ.FT. Date ReCet t#
Z O NOTICETO come PbICt to If,
After reakinglhIsCednKateo(omofttbn,you
C do , become to the plyk ll Compensation ovbig omit,Labor TOTAL:
W CodGyourrwatfadhwith comply with each providlons orthb permlbtellbe
W ] deemed revoketl. BUILDING E
a c CONSTRUCTION LENDING AGENCY SEISMIC FEE
hereby afganthattbere bameaitu tion Eandingagency W,Civ.C.) perform- TOTAL. ELECTRIC FEE
L) Z Lair(Nwork(.r which this permit In Issued(Sec 3097,Civ.C.)
() O �lender'e Name PLUMBING FEE
LL F- Lendre.Addreas QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OO Imdifythall have read this appllentlonand statethat theaboveinformatien
CIscomed.I agreeto comply with all city and county ordinances and pate laws PERMIT ISSUANCE FEES PAID:
>- W relating to building mnstrucdor,and hereby authorize representative.ofthis
F Z my to enter upon the Above-mentioned property for inspection purposes. ALTER OR ADD TO MRCH.V Dale RL'CClist#_ (We)agree to save,indemnify an d keep harmless the City of Cupertino
Against liabilities,judgmenb,mpsand expenses which may in any way accrue AIR HANDLING UNIT CTO 10,000 CFM) SUBTOTAL'
ag.inst said City In conau)uence of the grant log of this permit. CONSTRUCTION TAX
AIR HANDLING UNIT(OVER 10,000 CFM)
Signature of Applicant/Contractor Data EXHAUST HOOD fW/DUCT) CONSTRUCTION TAX PAID: ,
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant More or handle hazard... HEATING UNIT(TO 100,000 BTU) Date Recei t#
material as deg reed by the Cuperg no Municipal Co ic,Chapter 9.12,and the
Heath rod Safety Code Section 2M32(a)T HEATING UNIT(OVER 1(10,000 BTU) TOTAL:
RYrs M No
llltheapplicantorfuturebuilding.ccupantuseequipment ordevims VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which end havrdous air contaminants as defined by the Bay Area Air ��p
Quality Management District? BORER-COMP OHP OR 100,0W BTU) M�''P 6rz'< 1
4Yea ❑Na T
2haveread the t &Safetmode,Serequlremenb5533 and 25Sr6.95.f BORER-COMP(OVER 100,000 BTU)the ` 1 -
un iforrierstandt Health b ildin Code,SMiowntly h ve at and 75536.1 J T
unP..Bbilitbmlfthe b nor currentlyhavehick that Itlsmy NEW READFNTIALMEIN. SQFI.
'reap.ns3Mlityl ifytrtfiq pa fits requlremenbwhich must be met
prior to Lss oma Certlgca f 'nry.
1/_ �.
Ow ror auth reds a Date ISSUEDBY:
TOTAL:
OFFICE COPY