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19451ul 0 0 _., . POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO , INSPECTION DIVISION - JOB INSPECTION RECORD JOB ' ADDRESS 0 b7 aUNIT # LOT # OWNGR t9 l�OR' PFxMITNO. 19451 CATF�GORY • CONTROLN BUILDING PERMIT INFO BLDG hLtUl PLUMB M�� DATE" INSPECTOR INSPECKON NOTE ALL GRADI CAND DRAINAGE SHALL BE INSTALLED TO COMPLY WRH THE APPROVED PLA NS AND CITY OF CUFERTWOsrANDARDs. TOUNDATION-PIERS UFERGROUND JOB DESCRII-ZION PAD/SETBACK-CERT GARAGESLABS PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED INSPECTION DATt INSPECTOR: UNDERGROUND/SLAB PLUMBING - " ELECTRICAL. MECHANICAL DO.NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING MECHANICAL ELECTRICAL '."_- FRAMING VENTS CLEAR _ ,. INSULATION PLACE NO SUBFLOOR`UNTIL ABOVEWAS,BEEN SIGNED - ROUGH PLUMBING TUBS&SHOWER'PAN MECHANICAL- ' ELECTRICAL ACUZZI BOND FRAMING STAIRS INSULATION/ VENTILATION - 89 EMERG. EGRESS SEWER WATER - -- , - .COYERWO' WORK UNTIL ABOVE HAS BEEN. SIGNED :- SHEAR/HOLD DOWN BLDEXTERIOR O.INSPECiION D EPARTMU Ldu bw" INTERIOR SHEAR/HOLD DOWN SHEETROCK/SHEETROCK SHEAR EXTERIOR LATH/ W -SCREEN SHOWER LATH - SCRATCH COAT iJ WTAPE`OR PLASTER UNTIL AllO.VE 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 - GAS TEST MECHANICAL - HEATING - ELECTRICAL RELEASE FIREDEPT. GRADE OCCUPANCY TEMPORARY APPROVALS _ ELECTRIC GAS BUILDING /^ d OCCUPANCY OF BUILDING IS NOT PERM IL ISSUANCE DATE BUILDING FINAL IS SIGNED BY BUILDING IN ECTOR ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN A �' �^ �; l, 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, 24 HOURS BEFORE REQUIRED INSPECTION.• JOB ADDRESS AND PERMIT # ARE NEEDED WHEN PHONING. IMPORTANT! PLEASE. READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION IISSUEDBY: OFFICE COPY /�� -1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification- Building a: PF]tbITNO. 19451 Here ame:S n Phone: CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDINGELECTRICAL-PLUMBING-MECHANICAL c cto ,Nam: _ Opus. yp: E� Ow/.fi. off a6S�� CATEGORY CONTROL Architect/Enginer. Lie N. QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Addream O Q// � ",I,, E]❑ ❑ LJ PERMIT ISSUANCE C LICENSED CONTRACTOR'S DECLARATION I hereby affirm am that l licensed under provisions of Chapter9(mmmnc tngwlthSe on7o00)ofDiNtlm3oftheBusin MdPmfnp Code,andmy limnsels In tuR fo and it ' O i/At/ Date Class - LIc. R 7C 7 Date Confit � j/UP ARCHITECTS c/ APPLIANCESRESIDENIAL ]OB DESCRIPTION ,,,///���/?�Lyc .fir '?Mol / r PANELS TO 2DUAMPS 201-IODOAMPS OVERIOWAMPS SQ. Fr. FLOOR AREA $/SQ.Fr. :CLARATION I understand my pees shall be used as public mcords. SIGNS ELECTRICAL Licensed Professional Spp-CIAL CIItCUIT/M1SC OWNER -BUILDER DECLARATION I hereby affirmthat l am exempt froutthe Contractor's License law for the TEMP. METER OR POLE INST. following recon. (Section 7031.5, Businessand Professions Code: Any city or muntywhlchrequlrnaper ttommtmd,al,nlmprove,de=Ush,orrepalr anypmMmpnortolts Wuance,ahorequireslbesppUmntforsuchpemdtto Ne a signed statement that he is Bernard pursuant to the pronnoom of the POWER DEVICES Contractor's License Law (Chapter 9 (mmmentlng with Section 7000) of DIA- Sion3 afthe Bupnemand Profess oesCode)ord rt he h exempttherefromanal VALUATION the basis for the alleged exemption. My violation of Section 7011.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than O -aw- - fivehundreddollam($500. ❑ L as owner of the property, or my employees with wages as their sole , NE ENTIAL ELECTR STORIES TYPE CONSTRUCTION compenution, will do the work and the.tucture h not intended or offered for sae (See 70K Bualnm and Professions Code: The Contractor's Umrue law y., 9r+ does not apply to an owner of property who Wild. or Impmvn thereor, and whadoesuchwork himselforthrau hhisown em 1 B If, however, Improvements not Intended (pleas. ILhowever,theerlldlng or P TIDN D n OCC.GROUP RFS. UNITS Improvement haold wlthinoneyearofcompletioMthrowner-builderwllt have earo(co tF�arden of Provingthat he did nm build or Improve for purpose of ulnJ. LJ L as owner of the property, am exclusively cont,...... with Ilm — mntractorstomutruRtheprojed(See7aK Buslneamd Profealou Code: QTY, L Id0wWwWal FEE PERMIT ISSUANCE FLOOD ZONE APN The Contractor's License Law does not apply to an owner of property who Wilds or.mpeuvei thereon, and who commes for such IrWocis with • oplIamoral licensed pursuant to the Contractor's License Law. L-iI am exempt under Sec B k P C for this reason ALTER -DRAIN kVENT-WATER (FA) FEE SUMMARY .AIX FLOW PRO'T'ECT. DEVICE DRAIN3FLOORROOF,AREA,COND. SANITARY Y_ N_ RECEIPT M Owner Data WORKMAN COMPENSATION DECLARATION ❑I hereby !firm that I have • certificate of consent to self -Inure, or cerlillois ofWorF{n Campeuatlanluuranceoracertl!led mp(yJthereof Cee. 3800, Lab C.) �,/i• 03/445'S O/7 PoliryM Cofan��t� ( Certified copyh led w mlehed. PCertlfled copy h (fled with the tlty inspection division. FTXIURFS PER TRAP SCHOOL TAX Y_ N_ RECEI NM GAS, EA SYSTEM -1 INCL OUTI.EIS - PARK FEE Y N RECEIPT« GAS EA.SYSTFM-0VER4(FA) BUILDING DIVISION FEES CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ' GREASETRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID COMPENSATION INSURANCE (This section need not be completed If the permit h forom hundred dollar SEWER -SANITARY -STORM EA 2001T.Date Reoei t# WATER HEATER W/VENT/dFLTR ENERGY FEE Y_ N_ ($100)orless.) I cenot that the performance this permit is Wued, WATER SYSTEM/TREATING o any mariner an as to I shall not employ any prawn In any mariner at u to become subject to 1st Workers' Compensation laava of California. Date PAID 11-,2 Applicant NOTICE TO esub)eAM:IL afire makingthisCertificate become subjectto the Workers'Comprovison proof Exemption you Lab or NEW RESIDENTIAL PLMB. SQ.FT. Daft Recti t# TOTAL: BUILDING FEE !ry or this peions rmit hall Cade, you must forthwith comply with such provhlou or this permit shall be Code, deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE • O Iherebysffirm that there is a construction lending agency for the perform- ance of the work forwhich the permit h hued (Sec. 3097, Civ. C.) bender'.Nana Lmdre.Addrea I ceplfythat I have readthh applicationand patethattheabove In(ormatlon hcorrect.I agree to comply withal) city and county ordinance and state laws TOTAL: ELECTRIC FEE PLUMBING FEE ' QTY. MECHANICAL PERMIT FEE MECHANICAL FEE PERMIT ISSUANCE FEES PAID: relating to building construction, and hereby authorize representatives of thh city to enter upon the above-mentioned property for Impaction purpose,. Me) agree to save, indemnify an d keep harmless the City of Cu pen Ino against Ilab.l.lken e, Ocigmts, cepa and expense which may In any way accrue ALTERORAODIOMECH. Date Receipt# AIR HANDLING IIMT (TO 10,000 CFM) SUBTOTAL: against acid City In consequence of the granting of this permit. AIR FUNDuIvc UNIT (OvFR l(IIxbCFM) CONSTRUCTION TAX Signature of Applicant/Contractor Date EXHAUST HOOD(W/DUCT) CONST RUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO 100,000 BTU) Date Recel t# Will the applicant orfuture building occupant store or handle huardous material as defined by the Cupertino Municipal Code, Chapter9.12, and the Health and Safety Code n25532(a)7 HEATING UNIT (OVER 100,000 BTU!) - TOTAL: r-1Yea Will the applicant orfuure bu llding oaupmt use equipment or devices VENTILATION FAN (SINGLE RESID) ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management Dh[rl 7 Yes o have read the haza�.mate'rials requirementsunderChap.er6.95 of BOILER -COMP OHP OR 100,0(0 BTM BOILFRLOMP(OVE2100,000 BTU) the Califemla Flealth k SafetyCode, Sectio.25505, 25533 and 755M. I understand that if the building does no mrrently have a tenant that It h my _ NEW RESIDENTIAL MECH. - SQ.Fr. res' ox bilitylonmlfytheonupant afthe imrnentswh.chmustbemet PH umce of a Cemil f ISSUED nerora Ived agent Date - TOTAL: OFFICE COPY AV