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194660 0. ' POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION - JOB INSPECTION RECORD �Lf (�7 // �7 JOB ADDRESS ��D 12ti_ � UNIT # LOT # f �!/'Lt-/J-Kd �_%L �/ CONTRAC_FOR PERMITNO.19466 CATEGORY CONTROL p BUILDING PERMIT INFO ' DATE INSPECTOR INSPECTION RECORD NOTE ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLA NS AND CITY OPCUPERTINO STANDARDS./�rBS f-1 1-I Lam' El, /PIERS =INSPECTION D . IOB DESCRIPllON /�"/ s/ ^."; i 4 ' K -CERT PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SICNED UNDERGROUND SLAB INSPECTION DATE INSPECTOR PLUMBING - - - ELECTRICAL MECHANICAL DO NOT •PO R FLOOR UNTIL ABOVE HAS BEEN SIGNED I WOOD FLOOR - PLUMBING MECHANICAL ELECTRICAL FRAMING/VENTS/CLEAR INSULATION - PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROUGH PLUMBING - - TUBS&SHOWERPAN MECHANICAL ELECTRICAL/JACUZZI BOND FRAMING STAIRS INSULATION/VENTILATION - - - EMERG.EGRESS SEWER WATER COVER NO WORK UNTIL ABOVE HAS "BEEN SICNED EXTERIOR SHEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN - SHEETROCK/SHEETROCK SHEAR - - LXTERI OR LATH/ W -SCREEN SHOWERLATH 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 PLUMBINGENERGY - MECH.ENERGY BUILDING ENERGY ELECT. FINAL TEST PLUMBING - GAS TEST MECHANICAL HEATING ELECTRICAL RELEASE FI RE DEPT. GRADE OCCUPANCY TEMPORARY APPROVALS - ELECTRIC GAS BUILDING - ISSUANCE DATE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL - BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN 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 ISSUED BY- C` ! �- • OFFICE COPY ��" APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project IdentificationPERMITNO. Building Address: ��r 12 � N z z `el 19 4 6 6 ner. ante. Phone. - _ e up " CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BULDINGELECTRICALML BINC-MFCRAMCAL C, nnr'/N-�ame: Lic,NoQ - � /m .✓S ��a�T' �'� �/ CATEGORY CONTROLa A Itect Eng/neer. Lk. No: 2 - G j6 QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: S" �� P L LEj BLDG ULCI FLUMB MUCH j ❑ Li PERIOTISSUANCE LIC ENSEDCONTRA OR'SDECLARATION I herebyaffirmthat Lam Bceeeedunder provtslona,f Cs.imx9xl,ard c in ease 1 1. Ittu to. and dieon3,fthe BueinroeandlProfnel,neCode,and m license lelns force and ef(eo. License Clave- Llc.# Data Contractor APPLIANCES -RESIDENTIAL JOB DESCRIPTION e/ �J �J _r v PANELS UP 702DO ANTS//ITirrr 201-1000 AMPS ARCHITECTS DECLARATION I understand my plane shall be used as public records. OVER 1000 AMPS SQ. FT. FLOOR AREA $/SQ. FT. SIGNS ELECTRICAL Licensed Professional - - SPECIAL CIRCUT/MISE OWNER -BOLDER DECLARATION I herebyaf lmathat I am exempt from the Contractor.License Law for the TEMP MEIPR OR POLE INST. fofi,wing reason. (Semon 70315, Business and Professions Code: Any city or countywhich requ ns a permit to mmtmd, idler, Improve, dem,ltsh,or repair anystmoumpeormltetsmance,aLwrequimtheapplimntfRsuchpermitto file a signed statement that he ts licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Seaton 7000) of Divi- slon3 of the Bustnes.and PrefeabnsCode) orthat hats exempt therefromand POWER DEVICES SWIMMING POOL ELECTRIC VALUATION the basis for the alleged exemption. Any violation of Section 70315 by any applicant for a permit sub)cdsthe applicant to a civil penalty of net more than OUTLETSSwarms-FT%TURES NEW RESIDENTIAL ELECTR SQFf. Ovn hundredsowner of the 00). ❑ I, a. owner of the property, or my employees with wages a door STORIES TYPE CONSTRUCTION compensation, will do work and ffelr mteactoIntended offered for ole (Sec. Business Professions,he Business Code: K Code:TM L License Law TOTAL: a a ot apply to of or improves w os oe;.0 ly torn owner of property who nem or lm, provies ded edtheeor,that and whodoementsach orkhimself nded orwgh his owneraffered for . If,ha es, xr the buildisuch or improvement issoldre Intended oneyearofoompletionthe oweveglhebrwilI have Improvement ts sold within oneyearo(complolon, the owner-bu0der will have OCC. GROUP RES. UNITS t ,den of proving that he dal ns. build or improve for purpose of sale.). I, as owner of the property, am exclusively contracting with licensed monsoon to construct the project (See 7044, Business and Professions Cade: QTY, PLUMBING PERMIT FEE PERMIT ISSUANCE• ap FLOOD ZONE APN The Contractor's License Law don net apply to an owner of property who builds or Improves thenory and who contracts for such p(ojtaa with • .Astor(.) licensed pursuant to the Contractor's Limnae Law. L-iI am exempt under Sec B h P C for this reason ALTER -DRAIN& VENT- WATER (EA) N FEE SUMMARY BACK FLOW PROTECT. DEVICE DRAINSFI.00R, ROOF, AREA, COND, SANITARY Y_ N_ RECEIPT # Owner Data WORKMAN COMPENSATION DECLARATION ❑I hereby affirm that I have a certificate of consent to .elf-Inmre, or a certificate of Workers'Compensatimelnsunnce ora unified mpythereef (Sec. 3800,Iab C.) Policy# FIXTURES PER TRAP SCHOOLTAX Y— N RECEIPT # GAS EA. SYSTEM -1 INCA OUTLETS PARK FEE Y_ N_ RECEIPT # GAS EA. SYSTEM -OVER 4 (EA) V CamWCray BUILDING DI VISION FEES en ed copy is hereby td. enllied copy is filed withh the e cidty Inspection division. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE GREASETRAP CERTIFICATE OF EXEMPTION FROM WORKERS' PAID COMPENSATION INSURANCE (Thiasedlon need co pleled if the permit h, for one hundred dollars Date RCCCI t# SEWER -SANITARY -STORM EA. 2001717. WATER HEATER W/VENT/ELECTR ENERGYFEE Y N — (510(fiorlres.) 1. Icenlfylha 1 Penh, nm ofthewor eh it Waded, I shall nae to n In any ma nut to the workers 2. .s.0 to a ! PAID Wp.� �,�/TREATING Applicant NOTICE TO APPLICANT: I, after making this Certificate of Exemption, you should became subpect to the Workers' Compensation provblmes of the Labor Date Remi t# NEW RESIDENTIAL PCMB. SOST, TOTAL: Code, you at farthwlth comply with such previsions or this permit 6hall be deemed revoked. BU ILDING FEE SEISMIC FE CONSTRUCTION LENDING AGENCY - Iherebyaffirmthat therei..amsmctl,n kedingagenq forthe pedorm- ance of the work for which this permit ts Wiled (Sec. 3097, Clv. C.) I<nder'a Name Lender. Address I mrtilythall Fuveread this application and stalelhat theabove Information Is co.' .I agree to comply with all city and county ordinances and state laws relating to building constructor, and hereby mthoree representatives of this city to enter upon the abovo-men0omd property for inspection pe rpows. (We) agree to save, Indemnify and keep harmless the City of Cupertino against liabilities, Ptigments, costsand expenses which may In any wayacerus TOTAL, Q ELECTRIC FEE PLUMBING FEE QTY. MECHANICAL PERMIT FEE MECHANICAL FEE PERMIT ISSUANCE d FEE' S_PAU3: y ALTER OR AUDIO MECH. Date Re elpt# AIR HANDLING UNIT (TO 10,00) CFM) SUBTOTAL: against said City in consequence of the granting of this permit. AIR HANDLING UNIT (OVER 101000 CFM) OC CONSTRUCTION TAX Signature of Applicant/Contncror Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO 100,000 BTU) Date Recel t# Will the applicant or future building occupant store or handle hacardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely Code Section 2553200? ❑ Yes No Wlllthe applicant R cure bulldingoceupant useequlpment ordeviece HEATING UNIT (OVER 100,000 BTU TOTAL: VENTILATION FAN( SINGLE RFSID) ISSUANCE DATE which emit havrdom air contaminants ae defined by the Bay Arca Air Quality Management District? YeaNo BOILER -COMP OHPOR 100,000 BTU) BOILER-COMP(OVER 100,000 BTU) havcread the h.2us materials requirements under Chapter 6.95 of the Califon ai4 a7Vth Safety Code, $cations 25505, 75533 and 25534. I - NEW RESIDENTIAL METH. SQ.FT. unders dthat it ebuilding doe��nfffo---tttt currently have atenanL that Itmy naPe Ibllltyto r� tify tea e6,T9gtrQmenta which must be met Erol Wua ,(a Certific ISSUEDB . n nor rut oriud agent TOTAL: �— OFFICE COPY v D,