19614 PERMITNO.
POST THIS CARD NEAR FRONT OF BUILDING 9j��Q A
' CITY OF CUPERTINO A A �}
INSPECTION DIVISION- JOB INSPECTION RECORD
JOBADDRESS UNIT# -- LOT# CATEGORY coNMOL#
OWNER A P tAp— CONTRACTOR BUILDING PERMIT INFO
•INSPECTION DATE INSPECTOR INSPECTION RECORD
FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE
UFERGROUND - SHALL BE INSTALLED TO COMPLY WITH JOB DFSCMI-IION
PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF .,
CUPERTINO STANDARDS. r
GARAGE SLABS PREGUNITE
POURI NO:CONCRETE UNTIL"ABOVEWAS BEEN SIGNED
UNDERGROUND/SLAB INSPECTION DATE INSPECTOR
PLUMBING
ELECTRICAL
MECHANICAL ,•
DO'NOT POURTLOOR UNTIL ABOVE HAS BEEN SIGNED .
WOOD FLOOR -
PLUMBING
MECHANICAL ,
ELECTRICALFRAMING/VENTS/CLEAR
INSULATION.
PLACE NO SUBFLOOR UNTIL ABOVE HAS=BEEN SIGNED
ROUGH
PLUMBING
TU13S&SHOWER PAN
MECHANICAL
ELECTRICAL ACUZZI BOND
FRAMING STAIRS
INSULATION/VENTILATION
EMERG.EGRESS '
SEWER WATER - -
COVER NO"WORK UNTIL ABOVE HAS D EN.SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN - -
SHEETROCK/SHEETROCK SHEAR LA
EXTERIOR H/W-SCREEN
SHOWERLATH
SCRATCH COAT
NO•TAP OR,PLASTER UNTIL ABOVE 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 - -
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE DATE
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR -
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN, tT
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS +J"
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING.
IMPORTANT! ssUE BY: SCS 1'� j,Ct IGC:
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Bulldin Prn'ea Identification - PERMIT NO. -
BulldingAd� a. 1961 .4
61 1.�.
nen ams: hone: -
.A CITY OF CUPERTTNO-BUILDING DIVISION O
• o Name: L . o: APPLICATION /PERMIT I
NJ etN BUILDINGELECTRICAI PLUMBINGMECHANICAL CATEGORY CONTROL X
Architect/Fegl r. Lac.No:
' QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Addre ,iQ PERMITISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affbmthat l am lensed under provisions of Chapter 9(commmo- APPLIANCES-RESIDENTIAL JOB DESCRIMON
Ingwlth Sedton7000)of DiNsion3ofthe Bulnessand ProferionaCode,and my
limn_Is
In ful forte and effect. PANELS L I
Lkxn_ LICX
Date Contractor —UP TO 2DDANIPS
ARCHITECTS DECLARATION 201-1000AMPS
M CO I understand my phns t b
shae used aspublic remeds. OVER 1 ODO AMPS SQ.Fr.FLOOR AREA $/SQ.Fr.
odu Llmnscd Proferlonal SIGNSELFGTRICAL
N<N OWNER-BUILDER DECLARATION S[+ECULCIRCUfT/MLSC
'7 I hembya(flrm that I am exempt from the Contractor's Limn_law for the
oo following reason.(Section 7BH.5,Business and professions Code:An city or
OZ HCI y h' TEMP.MEUROR POLE INS(. -
F� countywhichrequlresaper ttomnstrdeter,lmpmve,demolhh,ormpair
anystmt mpr rtnits ame,al_requimslheapplimntfmauch permitto POWER DEVICES
O file a signed statement that he Is licensed pursuant to the provisions of the
Contractor's License Law(Chapter 9(commencing with Section 7000)of Dlvi-
3�{a� slon 3 of the Business and Profession,,Code)orthat he h exempt therefrom and SWIMMING POOL EkCTRIG VALUATION
Q^' the basis for the alleged exemption. Any ,violation of Section 70315 by any OUTLETSSWITCI{CSFlXTURES
appRantforapermitsubj u(heappllcantto&dAlpemltyofnolm mthan
live E,an
owndoler
ofth,prars . NEW RESIDENTIAL ELECTR SQ.FT, STORIES TYPE CONSTRUCTION
ME,s owner will
tet properly,or he employees et In wages as thele sole
mm(Sc.7KBook ..he wmkandions Code: hnotintended oroffered(or
O sae(Sc.7061,to alnow and professions Code:The Contractors License Law
does rj$ whodotapply..ch torn owner ofpropertyhiso .em orlmprov Ided that such
OCC.GROUP RFS.UMTS
whodoerauchw not
oroffe his..employee.,If,huea,pro the b ildisuch
impmvementsarenot Intended earofc foresee.I(,h ere theerwgin ere TOTAL;
Improvementhsold wlthin.nsyearo(completion,theowner-butlderw011uve
t4q-tufden'of proving that he did not build or Improve for purpose of sale.). QTy. PLUMBING PERMIT FEE
U 1,as owner of the property,am exclusively mntractteg with licensed HOOD ZONE APN
contractor to construct the project(Sec.7014,Business and Professions Code: PERMIT ISSUANCE
The Contractors License law don not apply to an owner of property,who ALTER DRAIN&VENT WATER ffA)
build.or Improves thereon,and who comram for such p(ojech with a FEE SUMMARY
�gR(�actola)Licensed punuanl to the Contractors License Law. BAIX FLAW PROTECT.DEVICE
L ,I am exempt under Sec. B &P C for Nb reason
Qi ITS]FIE FE US
DRAINS.FLOOR ROOF,AREA,COND. SANITARY Y N
Owner Date RECEIPT X
WORKMAN COMPENSATION DECLARATION ptt�S.PER TRAP SCHOOLTAX Y N
7 hereby ffimkem that 1 have a%I..cartificste of c.n_nt to o y thereof
or RECEFr M
ate of Worken'Compensatlonlnsurance ma certified ropy thereof(Sec. GAS EA.SYSTEM-1 INCAOUTLEfS PARKFFP Y N
3 OI),Lab CJ
Policy RECEIVEN
X
CoGAS EA.SYSTEM-OVER 4(EA)
BUILDING DIVISION FEES
enRed .
copy h hereby furnished. GRCASE/INDUSIAL WASTE INTERCEPTOR PLANCI-IECK FEE
❑Certified copy h filed with the city Inspection division.
CERTIFICATE OFEXETIFHON FROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM F.A.2DaFi• Date Receipt#
(This section need no be completed I the permit hfor one hundred dollars
(E1rfify that
I m - WATER HEATER W/VENT/ELECTR ENERGYFEE Y N '
certify that N the perfomuncealthewmklorwhlch let.permit is h_M,
I shall not employ any person In any manner_as to become abject to the WATER SYSTEM/772PATING
Workers Compensation Laws of California. Date PAID
Z Applicant NEW RESIDENTIAL PLMB._SQFI. Date Recei t#
shoulZO NOTICEco esubjeAM:U,aorlfter makingthhCe[on provisions
of the
Code, becomesubjectit co Worker'such proisinprovhlonsrrtt s Labor TOTAL:
> Ceemneduoust(orthwbh comply with such provisions or this permit shall be BUILDING
deemed revoked.
W > CONSTRUCTION LENDING AGENCY SEISMIC FEE
CL Thereby affirm that there is a construction lending agency for the perform- ELECTRIC FEE
D Z ance ofthe work for which this permit is Issued(Sec.3097,CIv.Q TOTAL:
U O lander.Name PLUMBING FEE
U. I— lander'sAdd. QTY. MECHANICAL PERMIT FEE � �
O W I cortirythal l have read thhapplcatlonand statethatlhe above Information a''� /y, MECHANICAL FEE
C hcorrect.l agree to complywlth al cityand county ordinance and pale laws PERMFr ISSUANCE yW FEES PAID:
} relating tobullding construction,and herebyaulherlumpmsentativesofthls
W city to enter upon the abovorronloned property for inspection purposes. ALTERORADDTOMECH.
? (We)agree to save,Indemnify an If keep harmless the City of Cupertino Date Receipt#
V ag.Wt Liabilities,P dgments,cost...d expenses which may In any way amu. AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL'
against said City In consequence of the granting of this permit. CONSTRUCTION TAX
AIR HANDLING UNIT(OVER 10,040 CFM)
Signature of Applicant/Contractor Data D(HAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant m future building occupant store or hand le hazardous HEATING UNIT(TO 100,000 BTU) t� Date RCCCI t#
material as defined by the Cupertino Municipal Code,Chapter 9.1 2,and the �2t
LI
Healthand Safety Cmkr,�SSectl.n25532(a)? HEATWG UNIT(OVER 10BOW STEEL TOTAL: ds'-t2
F-1 Y. No
Will the applicant orfuwm building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which enut h..mous air cont.minsnts as defined by the Bay Area AU
Qua llty,Management District? BOMER-COMP OHP OR 100,000 SHE,
4Yes ❑❑No
have read the bazrdaus materials requirement,under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
the California Health&Safety Code,Sections 25505,75533 and 25534. 1
understand that If the building does not currently have a tenant,that it is myNEW RESIDFNTTAL MECH. SQFr.
res no
nmlfythe occvpantmthe requbemenI Mthm�is.nibereet
p or to anrcof.CertillcatcofOtcvpancy. 1 1( '
V_�I,gs.
Own TOTAL:orauthorlmd agent �- Date v ISSUED BY:
O
I .
OFFICE COPY