19313 POST THIS CARD NEAR FRONT OF BUILDING rERnuT No.
CITY OF CUPERTINO
19313
INSPECTION DIVISION- JOB INSPECTION RECORD1
3
•. JOB ADDRESS 1 U LJ S C,a C T UNIT# `' LOT# CATEGORY CONTROL
c
OWNER V V2_ e_ 'S6�� CONTRACTOR BUILDING PERMIT INFO
INSPECTION DATE INSPECTOR INSPECTION RECORD - BL1:1 _1_1FOUNDATION/PIERS NOTE E
ALL GRADING AND DRAINAGEIs
UFERGROUND SHALL BE INSTALLED TO COMPLY WITH JOB DESCRIPTION
PAD SETBACK-CERT THE APPROVED PIANS AND CITY OP
CUPERnNOSTANDARDS'
GARAGE SLABS PREGUNITE - - - C
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
•FRAMING VENTS/CLEAR-
INSULATION
EN75 CLEARINSULATION -
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- -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED -
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR - .
EXTERIOR LATIN/W-SCREEN -•,: '
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 INSPECTOR
SAN.#'
ELECT.ENERGY
PLUMBING ENERGY -
MECH.ENERGY. ' - • ' - - f - -
BUILDING ENERGY - -
ELECT.FINALTEST ` -
PLUMBING
GAS TEST
MECHANICAL -
HEATING - -
ELECTRICAL RELEASE• -
FIREDEPT.
'GRADE
OCCUPANCY.
'TEMPORARY APPROVALS -
.ELECTRIC - - -
• 'GAS - ..
BUILDING
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUH�G:DATE `�•
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR CC'' AAdd
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN NOV N 11983
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND C{tr rl ^u^ rf a6
PERMIT#ARE NEEDED WHEN PHONING. '
IMPORTANT! yy
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION if:l DBY.
OFFICE COPY'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY
Building Project Identification - PERMIT NO.
Baud mas:ILAdd . .
': � ' 19:313
ner1//�ante: - Phone:
YL ti( 2uo/l '/][���^[J'�OFCUPERTINO-BUILDING DIVISION
Contractor's Name: • Lle.No: ,•, /" a APPLICATION /PERMIT:
ArcfiBect/Engineer. BUILDING-ELECTRICALPLUMBING-MECHANICAL CATEGORY CONTROL If
_ LIc No:
QTY ELECTRIC PERMIT' FEE BUILDING PERMIT INFO
Address: 101 y� C�SS P1, CUPF duo e,4
PERhf1TISSUANCE I� ❑.' ❑
LICENSED CONTRACTOR'S DECLARATION I-II
I hereby affirrathat l am licensed under pmvederesof Chapter 9(examclicar- APPLIANCES-RESIDENTIAL JOB DESCRI'C[ON «
ingwith Se on7000)of Dlvisim3ofthe Busimmand ProfesdonsCode,and my - -
itcense Ia In full force and affect. _ PANELS ,
Dale - Contracto( w
ARCHITECTS DECLARATION 2014000 AMP"'
q�+oZ I understand my plana shall be used as Public mounts. OVERI000"I'S - - SQ.FT.FLOOR AREA sm.IT.
K Lirensed Professional - SIGNS ELECTRICAL
�¢6 OWNER-BUILDER DECLARATION SI'ECIALCIiCUIT/MLSC f I
•Ihereby affirmmntract
that I aexempt fromthe Coors License Law for the
Z,.,QQ p�p following means.(Section 7031.5,Business and Professions Code:My city or -
'�z W enuntywhich requires a pertNt tomrutruR,alter,Improve,demolish,orrepalr '141P.METIR ORPOLE[NST.
anystmeture priorto its essuance,ae. ,,
orequireatheapplicant forsuch permit to POWER DEVICES
O 'fil...igned statement that he is licensed punt rsuato the provie cut,of the ,
w Contractor's License Law 3 (Chapter 9(rommeneing with Section 7000)of Divl-p SWIMMING POOL ELECTRIC
� Joe Business Profeeelons Code)artist Kee.exempt therefromend VALUATION ,
the basis for the alleged exemption. Any violation of Section 7MIS by any 4q OUTLE7SSWITCHESFIXCURES Z a d
p� aPpIlcm,for a Permit subjects the applicant to a civil penalty of net more than
flue h ed dollats($500). NEW RESIDENTIAL ELECTR-
.. is owner of the properly,or my employees with wages all their sale - SFT' STORIES TYPE CONSTRUCTION
compensation,, will do the work and the structure is son:intended or offered for
O sale(Sec.7044,Business and Pmtessiona Code:The Contractors License law
. $ does net apply to an owner of property who builds or improves thereoM and OCC.GROUP FRES.UNITSwho does such work himself or through his own employees,provided that each �3
Improvements are not Intended oroffered forsale.If,however,lhebulldlegor ' TOTAL:
Improvementheoldwithinoneyearofcomple loMtheowner-buBderwBlhave '
tllRkurden of proving that he did not build or improve for purpose of sale.). QTY, PLUMBING PERMFF FEE FLOOD ZONE ApN „
LJ L all owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE -
.atnctaretoconstruct the project(Sec.7044,Bush.and Professions Code: - -
The Contractor's License Law don net apply to an owner of property,who
Wilda or Improves thereon, and who contracts for such projects with a ALTER-DRAIN&VENT-WATER(EA) _
�gR(factor(sl lkensedpunuaatrothe Cmtmdor'sLt nse Law. FEE SUMMARY
LJI am e;e t under Sec B &P C f r this enon` BACK FLOWPROTECT.DEVICE
OUTSIDE FEES
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_ -
Owner s 'Date RECF3PCX
h COMPENSATION DECLARA ON FIBMIF SPER TRAP SCHOOL TAX Y_ N_
❑I he
affirm that I have o certificateno of consent m op thereof
ora RECEIPT X
3certificate 800,Lbo(Workers'Comperuailonlriaurance oracertifled ropythereof(Sec. GAS EA SYSTEM[INCA OUTLET � PARKFEE Y_ N_
3X00,Lab CJ
Poll X GAS BA.SYSTEM-OVER 4(EA) .. RECEI'f X
4' •
Cogs - BUILDING DIVISION FEES
_ MCertlfied copy b herebyfurnished.the city GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE
MCertlficd copy e.(fled with the city Impaction division.
CERTIFICATE OF O(EMFTION FROM WORKERS' GREASETRAP „ " PAID
INSURANCE
COMPENSATION
(Chis ecctlon readout be comp[
COMPENSATION
te.(orone hre
undd dollars SEWEILSANITARY-STORM EA,2[017. Date Recei t#
($10()orlcss.)' WArERHFATERW;/VENT/ELECCR ENERGYFEE Y N
I certify that in the perfarmanceaf the week(orwhich this permit is heated;
I shall not employ any pence In any manner so all to became subject to the WATER SYSTEM/TREATING
Workers'CompensaRan Laws of California.Data - PAID
C✓ ZAppllaant - NEW RFSIDFNTTAL FILMS. SQ}T.` Date Recei t#
Z O NOTICE TO APPLICANT:K,after making this Certificate of Exemption,you _
Hshould become subject to the Workers'Compensation provisions of the Labor TOTAL:'
N Code,youmuetforthwilh complywithauch provifterea rthe.permRshall W BUILDING
W deemed revoked. '
CONSTRUCTION LENDING AGENCY SEISMIC FEE
FEE
tl . 'Iherebyaffirmthat there be construction leading agency forthe perform - ELECTRIC FEE , 0
Z ante o(thework for which this permit e.issued(Sec.3097,CIV.G.) - �'" � ,•70TAL:
0 O Lender's Name - PLUMBING FEE
,LLf Lender's Addreas QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
„O W ImrHfy that have mad this applicatbnand&ami that the above Information -
S Lsmmed.I agree to complywlth all city and county ordinances and state laws PERMIT ISSUANCE FEE$
} Wrelating to building walrusHon,and hereby authorize representative of this
(— Z city to enter upon the abovimenUoncd property for Inspection purposes. ALTER OR ADDTO MECH. Date 'R0Ce1Pt# r
V (We)agree to save,Indemnify an d keep harmless the City of Cu partlno
agabut liabi ties,judgments,rosmand expenses which may In any vay.crnre AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
agai+et sal�C;fty in causeter kie granting of the.permit.
/� � AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
.. SIgnatureoffAApap86cant/Contractor Date IXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
' Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU)
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Date Recei t#
Health and Safety Code Section 25531(a)l HEATING UNIT(OVER 100,000 BTU) TOTAL: e0
F1Yes _ ' Tr,�,.J,No
Willtheappiicant or fu tum building occupant use equipment or devices VFNIIIAT16N FAN(SINGLE RESID) ISO]A(x]'C�DATE
which emit hazardous air contaminants as defined by the Bay Area Air �iA D
(L+ Iity Management D❑lstrict7 BOILER-COMP DII'OR 100,000 BTU)
yes
]have read the baza Nornaterials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU) ' {I{(11( 1- �(]O(1,
the California Health&Safety Code,Sections 25505,75533 and 75534.1
understand that if the building does not currently have a tenant,that it as my NEW RESIDENTIAL MECH. 9Q.FT.
responsibility to notify the occupant of the requirements which moat be met p p .{,
prior to Issuance of a Certificate of Occupancy. City of cupm>RQ
Owner or authorized agent Data ' ' s1,, L
. TOTAL: ,.•' ISSUED BY: J.�� Iyh`UC L./
OFFICE COPY