19514 0.
POST THIS CARD NEAR FRONT OF BUILDING rERMIT nt g5t 4
CITY OF CUPERTINO bUbMl I I A
INSPECTION DIVISION- JOB INSPECTION RECORD , pl
JOB ADDRESS (bTO Q Q, �tAz-PA.�`2A ?j1-NJD UNIT/#�� LOT# CA'I=r RY CONTROL#
OWNER !'1'6Q� CONTRACTOR 6JS`\ F�3'tiT�. BUILDING PERMIT INFO
INSPECnON
ECORD TTrRT--MTrFI7—
FOUNDATION/PIERS DATE INSPECTOR NOTE ALL GRADING INSPECTION AND DRAINAGE El
UFERGROUND SHALL BE INSTALLED TO COMPLY VATH 1 BDESCRIWN
THE APPROVED PLANS AND CITY OF N
PAD/SETBACK-CERT - CUPERT'INO STANDARDS.
GARAGE SLABS PREGUNITE
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
PLACE NO.SUBFLOOR. UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
ELECTRICAL/JACUZZI BOND
FRAMING STAIRS IV
INSULATION/VENTILATION
. EMERG.EGRESS
. SEWER WATER
' COVER NO WORKUNTILABOVE HAS BEEN SIGNED -
EXTERIOR SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATI-I/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
PLUMBINGENERGY .
MECH.ENERGY
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 IS NOT PERMITTED UNTIL
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR PAIP
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
.12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS .JA .1 '( 1990
BEFORE REQUIRED INSPECTION. 'JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING. of CnnartiBD
IMPORTANT! 55 nev: 'N
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION r
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
lldin MI
I'Wed Identification PERT NO.
Building Address:
C :. 00 Q� /a2JZ /) 19514
vers hone: p
CITY OF NPERTIN0.6UILDING DIVISIONLCATD=WRY
ll ��. q„
APPLICATION 1 PERMIT 1 C V
fJ 'C BUR.DING-ELECTRICALM' BING-MECHAMCAL CONTROL#
Archised/Engineer: Lie.No:
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
IELDG
Addreac 7/ �- �(«'� Y^J A. PQ(MHIS5UANCE .0() ❑ V —i ❑ ❑
LICENSED CONTRACTOR'S DECLARATION v _�
I hereby affirm that l am lleduesi under provisions of Chapler9(commuse. APPUANCMRESIDENTIAL JOB DLSCRI'Hf21V
Ingwith5 dion7OOD)ofMvislon3ofthe Buslnemand PrmxxtwnsC e,and my
license is In fun force and effect. PANELS
Licenre cLys b.x f � Y637 {�.� '�G C
Data_-.//(l Co...., /' y�f..C/J 0 i__ L.i( v-[ a l
ARCHITECT'S DECLARATION 201-1000 AMPS /
Q CO I understand my plans shall be used m public record& OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT.
Iz(/ Licensed Professional SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC
XI hereby affirm that l am exempt from the Contractor'sLimmu Law for the
b
qqqq following renon.(Section 7031.5,Business and Prelessna Code:Any city or
9 cwntywhichmqulmsaper ttoconslwa,altepimprove,demolbh,orrepalr •fEMP.METER ORIOLE INST.
°"1 anystrudure priorto its leeuance,also requlresthe applicant forsuch permit to
file a signed statement that he Is licensed pursuant to the provisions of the POWER DEVICES
3O Contred°r.License Lew(Chapter9(commencing with Section 700D)of Divi- SWIMMING POOL ELECTRIC
Mon3 of the Business and Professions Code)orthat he is exempt therefrom and p VALUATION
the basis for the alleged exemption. Any violation of Section 7MI.5 by any OUTT.ETSSWITCHES.FU(TURES /r
applicant fora permit subjects the applicant to a civil penalty of not morethim
five hundred dollars($500). SQ. STORIES TYPECONSIRUCTION
AIi NEW RESIDENTIAL ELECIR FT,
7 Q
1,as owner of the property,or my employees is with wages r offered
sob
compensatlon,wllldolha work.and lhestwclure boot Intended or a(f Law �J �1ta_TOIL 49,00
O sale(Sec.7044,Business and Professions Cede:The Coneractor' Licerae Law X
$ doesnaapplytoanowner.property who builds or Improved thereon,and ' �.! M /a+ O OCC.CROUIs RES.UNITS
who doaseuch work hlmeelorihrough hidown employees,pr°videdthatwch
impmceodmtaare not Intended oroffered fee sale.If,however,thebullding or TOTAL:
Improvement hisoldwit is oneyearofcompldlen,the owner-bullderwill have 9�'l -ate
tF,SjIurden of proving that ha did not bund or Improve for purpose ofsale.). QTY, PLUMBING PERMIT FEE
Lj L as owner of the property,am exclusively contracting with licensed FLOOD ZONE APN
contractors to construct the project(Sec.70K Busmen and Professions,Code: PERMIT ISSUANCE
The Contractor's License Law doe•no apply to an owner of property who ALTER-DRAIN k VFNf-WATER Q'-N
Wilds or Improved thereon,and who contracts for such p(ujects with a FEE SUMMARY
cq➢3(actoHs)licensed pursuant to the Contractor's License Law. BACK FLAW PROTECT.DEVICE
LJ I am exempt under&c. B k P C for this reeeon
FEES
DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y NOUTSID_Owner Date RECEIPT p
WORKMAN COMPENSATION DECLARATION PER TRAP SCI TAX Y N
111rm I hereby a(flthat I have•certificate of consent to ml(-InwFIXTURES
re,or RECEI'C#
certl(icate olWorkers'Comperuatlon Wuranceora certllM copythereof(Sec. GAS EA.SYSTEM-1 INC4 OUTLETS PARKFEE Y N
38 bC.rys p906
Poll RECEIPT
N r'•- 7 CAS G.SYSTG3-0VER4(FA)
Com BUILDING DIVISION FEES
Certined copy b hereby furnished. GREASEANDUSIRL WASTE INTERCEPTOR PLANC14ECK FEE
Certlled copy b filed wIN Iha city InspMlan division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE
(Thio wcilon need raa Wcompleted lithe permit lsforonehundreddollars SEWER-SANITARY-STORM EA.20071. Date Recei t#
(B100)otifyth WATER I[EATER W/VENT/ELECTR ENERGY FEE Y N
I certify thatinthe person
any
mhe anner
so as to which
permit is owed,
I shall not employ any person in any manner n as to become subject to the WATER SYSTEM/TREATING
Worken'Compensatlon Levo of Gll°mla.Date PAID
z Z Applicant NEW RESIDENTIAL PLMB. SQ.Ff. - Date Recei t#
Z O NOTICE TO APPLICANT.If,after making this Certificate of Exemption,You
should become subject to the Worker•'Compensation provisions of the Labor TOTAL.
fD
Code,you must forthwith comply with such provisions orthb permit shall be B
UILDING FEE
W 0 deemed revoked.
d. CONSTRUCTION LENDING AGENCY SEISMIC FEE
I herabyalBrmthat there is a construction lend Ing agency forthe perform, TOTAL: ELECTRIC FEE
D Z an ofthe work forwhich this permit is Issued(Sec 3D97,Clv,C.)
OO lender.Name PLUMBING FEE
LL 1= Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW Ioaiilythat l have read thbappllcationand statethatthe above information
1 Lscoctea.l agree to complywilh all city and county ordinances and date laws PERMIT ISSUANCE FEE'S PAID:
�. relating to building construction,and hereby authorten representatives ofthia
N city to enter upon the above-mentioned property for Inspection purposed. ALTERORADDTOMECH.
Z (We)agree to save,Indemnity an d keep harmlem the City of Cupertino Date Recei t#
V against liabilities,judgments,cods and expenses which may In anywayac<mc AIR HANDLING UNIT(TO 10,ODO CFM) SUBTOTAL:
against said City In comnapa,nen of the granting of this permit.
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signature of Applicant/Contractor Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the a ppllcad or future building occupant store or hand le hazardous HEATING UNIT(TO 100,()DO BM Date Recei t#
material as dell sed by the Cupertino Municipal Code,Chapter 9.12,and the - 2G5�
Healt a and Safety Code,Seclloon 2553200? HEATING UNIT(OVER IDg00)BTU) TOTAL: J�
Yes
Ill the applicant or-P No
equipment ordevicm VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management DbMd2 BOILER-COMPfJ)I'DR 100,000 BTU) ftzy
4Yed ❑❑No
have read the th&Sftmatcrl Sections
2555,2553 .Chapter G95°3 BOILER-COMP(OVER 100,000 BTU) /
theCalifornia Health building
Code,Sectlonsntly have
a tenant,nd
1 JAN •x /y
understand that lithe(tify the oc does of
tere .1 have arena It that b is my NEW RESIDENTIALMECH. SQ.L7. 1 ( j990
folliry to notify thew ant of the requlrc s It must 6e met
priort Wuanceofa Cerl(I sofOccv n .
/7 9 �Ca(`hrQQof_frr�lD°/fi_nm_
to authorized agent ate ISSUEDBY:
�+ `� tI 1 ~
TOTAL:
OFFICE COPY