19334 POST,THIS CARD NEAR FRONT OF BUILDING PERMIT NO.
- 19334
CITY OF CUPERTIINO AFFLI�HUN SUBMITTAL DA IE
INSPECTION DIVISI J B NSiz,
RECORD 4C�
JOB ADDRESS LOT# CATEGORY coNTxot x
OWNER CONTRACTOR SCS �N.'P BUILDING PERMIT INFO
INSPECTION FOUNDATION/PIERSDATE INSPECTOR INSPECTION NOTE ALL GRADING AND DRAINAGE Ej .D 1
UFERGROUND SHALL BE INSTALLED TO COMPLY VATH JOB DESCRIPTION
PAD/SETBACK-CERT 'nim APPROVED PUNS AND CITY OF
CUPERIINO STANDARDS.
• GARAGE SLABS PREGUNITE
POUR,NO CONCRETE,UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND SLAB INSPECTION DATE .INSPECTOR
PLUMBING ,
ELECTRICAL
MECHANICAL
4DO:NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED `
WOOD FLOOR
PLUMBING „
MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR -
INSULATION
PPLACENO SIIBFLOOR'UNTIL ABOVE:HAS BEEN SIGNED
ROUGH
PLUMBING
TU13S&SHOWER PAN
MECHANICAL
ELECTRICAL/JACUZZI 13OND
FRAMING STAIRS
INSULATION/VENTILATION
EMERG.EGRESS
�. SEWER WATER
'COVERNO'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 UN77L 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 `
III BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GAS TEST
MECHANICAL
HEATING '
ELECTRICAL RELEASE&
FIREDEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING - ISSUANCE DATE
OCCUPANCY OF BUILDING 19 NOT PERMITTED UNTIL -
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR - PAI®
'�• ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS )AN l iyiw
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT#.ARE NEEDED WHEN PHONING. of, 7nodiB0
IMPORTANT! . 'V ,l r F n
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUED BY: i I 'a•1r
OFFICE COPY
APPLICAI�TTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
0r0 men IdentificationPERMIT NO.
B.RdIW 1Wdms} - 19334
I
Here ams: Phone:15 ri e CITY OF CUPERTINO6BUILDING DIVISION
Contmdor'sN we.No: APPLICATION /PERMIT
BUILDING ELECTMCAI.PLUMBING-MFGEIAMCAL CATEGORY CONTROL M�x r^
ten/Fe—)qp asgicerIr AM#&i Lis N : a—.\
a Q ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Addred: ❑ ❑ ❑
q O PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
Iherebyaffire,that l am licensed under provisions of Chapter9(common APPLIANCES-RES[DENIIAL JOB DESCRIRION
IngwlthSeMan7000).f DlvLdan3olthe Budnmand Pro(eulonsCode,and my
hike selsC I. 0 torte ane dGeM. PANELS
Date Contractor /
ARCHITECPS DECLARATION 201-1000 AMPS
a0 2 I understand my plans shall be used as public reads. OVER 1000 AMPS SQ.Fr.FLOOR AREA $/S(2.FT.
Z-) Licensed ProfessionalEGNSELECTRICAL
OWNER-BUILDER DECLARATION SPECIALCI(CUIT/MISC
Ihereby affirm a
that I inn exempt the Contractor's Lieee law for the
oo following reason.(Section 703 IS,Businessand Professions Code:Any city or
F 2 r couTEMP.METER OR POLE INST.
ntywhich requlma perndttommtma,alter,Improve,demaihh,orrepair
4 .� an yatmMmpriortolhL ame,aLwrequimtheappUr tforwchpermltto TOWER DEVICES
8 Ills a signed statement that he is licensed pursuant to the provisions of the
3 w G CmuraRota License law(Chapter 9(commencing with Section 7000)of Divi. SWIMMING OL EIEC IC� VALUATION don3 of theaudnmand Pmfmnsh
bCode)orthat he therefromand ,
the basis for the alleged exemption. Any violation of Section 7m1.S by any OUTLETSSWITCHESEXTURES -
applicant fora permit subjectas the applicant to a civil penalty of not nnre than
five hundred dollars 000.
�n ❑I,asowarofthe property, NEW RESIDENTIAL ELECTS SQ.FT. STOru TYPE CONSTRUCTION
p perty,.rmy employees inwithwagn as[Mirsok
compSe.7M4,B..lon h and Pr and ionsthesCode:
Theh net intra des License
Law
O for
doe(Am cup 6y to alan and f property
Co builds or Improves
License law
�,I $ don not apply tom owner of property who builds or Improvn thertrory and OCC.GROUP RES.UNITS
CC
who doementsa orktIntendedorwgh hl sow ask.
If,yen,pmtheedthat such ing or
improvementserenot Intended earolfcceroffereel for sion.thhowever;
ner-bothe
erwill have TOTAL:
improvementbeold wilhinoneyearo(completiorytheowner-bullderwRl have
tlWaens of proving that he did not build or Improve for purpose of axle.). QTY. PLUMBING PERMIT FEE
L1��44 towner of the preperty,am exclusively contracting with licensed FLOOD ZONE APN
contractors to construct the project(Sec.70K Business and Professions Code: PERMIT ISSUANCE
The Contractor's License lAw dere not apply to an owner of property who
Wild.or Improves thereon,and who roman, fee such Ink jeM with a ALTER-DRAIN&VENT-WATER(EA)
ugp(f+tarte)Bcenand pursuant to the Contractor'.License Law. FEE SUMMARY
L_l I am exempt under Sec B Is P C for this reason BACK FLOW PROTECT.DEVICEOUTSIDE CIES
DRAINS FLOOR ROOF,ARG,COND. SANITARY Y N
• — RECEIPT tl
Own WOR COM SATIONDECLARATION 6 ' FD(AINr,FLOOR.
SCHOOL TAX Y N
❑I hereby affirm that I have a certificate of consent to self-insure,ora �Epf 0
3800,LaeofWorkers'Compeaatlonlnsurance oracertlfhd copy Nere((Sm. GAS F.A. YSITM-11NC4 OUTLETS PARK FEE Y N
Polis lab C.) - RECEIPT a
1'e tl GAS EA.SYSlTM-0VER4(EA)
Com any BUILDING DIVISION FEES
❑pc ifiedmpybhembyfumished.rtdlPLANCHECK FEEG �
❑Ceed copy is filed with the city inspection division. GREASE/INDIISIRL WASTE INTERCEPTOR (S��
CERTIHCATEOFEXEMPTION FROM WORKERS' GREASE3RAP PAID
COMPENSATION INSURANCE ISETA'ER-SANITARY-SiDRM EA 2lXIFf Date Remi t#
(This sedan need not be completed if the permit b fmoa hundred dollars
(5100)oriess.)lm.) mce WATER HEATER W/VENT/ELF.CTR ENERGYFEE Y N
IcerdIn the penoanof the week farwhichtmpermitpedt is Issued,
I.ha11 not employ any person In any manner so as to become sub)ect to the WATIA SYSTEM/TREATING
Workers'Compensation law.of CaRfmola.Date PAID
Q Z Applicant NEW RMDENTIALPLMB. SQFT. Date Remi t#
ZQ, NOTICE TO APPLICANT.If,after raking this Certificate.,Exemption,you
should besub ecct to the Workers Compensation provisions of the Labor TOTAL:
CC come N Code,you must forthwith comply with such provisions orthh permit shall be BU G
IL FEE
> deemed revoked.
CL CONSTRUCTION LENDING AGENCY SEISMIC FEE
Iherebyaffirm that there is a construction lendingagenry forthe perform TOTAL: ELECTRIC FEE
M Z ..m.ftheworkforwhichihis permit is Issued&c.3097,Civ.C3
V O Lender's Nara - PLUMBING FEE
H Lender'.Addmn - QTY. MECHANICAL PERMIT FEE
O W I certifythatl have readthbapptiatlonand dm
atethattheaboveinfoatiou MECHANICAL FEE
6 bcorred.I agreetocompiywlthallcityand county ordleancesand date laws PERMIT ISSUANCE FEES PAID:
>. N relating to building construction,and hereby authorize repmentativesof this
F Z city to enter upon the abovormntioned property for inspection purposes. ALTERORADDTOMECH. Date Rmei t#
(We)agree to save,Indemnify and keep harenlm the City of Cupertino
V agalatllabllltin,pdgments,.osis and expenses which Huy In anywayacaue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
ag nst said City In consequence of the granting of this permit. CONSTRUCTION TAX
'_'lp esu AIR HANDLING UNIT(OVER 10,000 CFM)
Signature of Applicant/Contra , Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUSNIATERIALS DISCLOSURE
Will theapplicant or fu embulldingoavpant store orhandle hazardoun HEATING UNIT(TO 100,000 BTU) Date Recei t#
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the -
IlFeealt�lthandSafety Cod Le+Section 75532007 HEATING UNIT(OVER 100,000 BTI) TOTAL: J67Z)"�'
No
Rl]the applicant.r(uture building occupant use equipment ordevices VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Ah
a1alllty Management District? BOILER-CAMP DHP OR 100,000 BTI) PMI)
Ibave read the h.9usomaterials requirements u nder Cha pier Q95 of BOILER-COMP(OVER 100,000 BTU) (}`�'1
the California health&Safety Code,Sen ions 25505,25533 and 25534.1 .JAN 18(y 199U
understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT.
responsibility to notify the occupant of the requirements which moat be met .4
prior to issuance of a Certificate of Occupancy. - CIT!(If e,11RPffino
Owner or autiumsed agent Data ISSUED BY.!- ~' �V
TOTAL:
OFFICE COPY