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19473 PERMIT NO. POST THIS CARD NEAR FRONT OF BUILDING (] 7 CITY OF CUPERTINO J A INSPECTION DIVISION= JOB INSPECTION RECORD It� JOB ADDRESS ( b. D : S'o LJe YY'VC Ztl �wlSNIT# LOT# CATEGORY - . . mNTROL x OWNER CONTRACTOR U4 'F QC_ BUILDING PERMIT INFO ,INSPECTION' DATE INSPECTOR INSPECTION.RECORD - •� FOUNDATION/PIERS NIOTE ALL GRADTNC AND DRAINAGE LIFER GROUND SHALL RE INSTALLED TO COMPLY WITH JOB DESCRIPTION PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF CU13ERI INO STANDARDS. GARAGE SLABS PREGUNITE _ TOUR NO-CONCRETE UNTIL ABOVE HAS',DEEN SIGNED - - UNDERGROUND/SLAB INSPECTION DATE FINSPECTOR f PLUMBING - - ELECTRICAL - . MECHANICAL - - i O.NOT POITIRTLOOR-UNTIUABOVE:HAS BEEN SIGNED WOOD FLOOR " PLUMBING MECHANICAL - ELECTRICAL ' FRAMING/VENTS/CLEAR INSULATION "ELACE.NO:SLfBFIOOR UNTIL ABOVE WAS BEEMSIGNED ROUGH PLUMBING - - - - TU135&SHOWER PAN MECHANICAL -ELECTRICAL/JACUZZI BOND - FRAMING STAIRS INSULATION/VENTILATION . EMERG.EGRESS ' SEWER WATER fG VER•' O:WORK:UNTIL ABOVE`•HAS�BEEMSIGNED, EXTERIOR SHEAR HOLD DOWN. INTERIOR SHEAR/HOLD DOWN SHGPTROCK/SHEETROCKSHEAR - - EXTERIOR LATH/W-SCREEN ' SHOWER LATH _ - SCRATCH COAT - (NO`T `TAPEE bW PLASTER UN7TUABOVE.`HAS'➢ EN SIGNED NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE - THE CONSTRUCTION TAX IS PAID FINALS " - DATE 1INSPECTOR 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 - OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL __ a ISSUANCE DATE' BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR ' ' PAIR ARRANGE FOR INSPECTION BY PHONING 2524505 BETWEEN ' 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY;24 HOURS - JAN. h 5 199U BEFORE REQUIRED INSPECTION. JOB ADDRESS AND , PERMIT # ARE NEEDED WHEN PHONING. My of CB4RIff110 IMPORTANT! ' PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ;6ueDBY . f:,, t ✓� 1 OFFICE COPY APpLKANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bulldln Pro'ect ldentlflcatlon7 PERMIT NO. Building Address: `O o 5 . p� `z.,� K96 . _ --r - 19473 Phone: ' weirs y. �5a✓ 6e'SGN CITY OF CUPERTINO-BUILDING DIVISION A Contractor's Name: Lit.No: � L d �— - / APPLICATION /PERMIT / K C I L 6 BUILDING-ELECTRiCAI.PLWBING-MECHANICAL CATEGORY CON7 0L p A veer. /] QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address:. �- � SIO I'FRhIITI55UANCE ',�� ❑ ® ❑ ❑ LICENSED CONTRACTOR'S DECLARATION - - Ihereectionrmlhatl iv licensed underprovisionsof CheonsCmmmmenc- APPLIANCFSRESIDENI7AL ]OB DFSCItIi'770N InenseISection 7000)o(Diviled ofthe Businessand ProlessloneCode,aid my license le In full d led - PANELS . - - Ltogue Clam V Lla k Date Contra ARCHITECPS DECLARATION 201-IODOAMPS a2 ]u dermtaaypdd mypla shallbsuselaspubitcrerorda OVERIMOAMPS -' SQ.FC.FLOOR AREA po+, 00 laz r tc.a4,� E� Licensed Professional' SIGNS ELECTRICAL << OWNER-BUILDER DECLARATION rnSPECLYLCIRCUIT/MISC [hereby of@mthat Iam exempt from the Contractor's Lienfie law for the pp following reason.(Section 7871.5,Business and Professions Code:My city or O'Z'� TEMP.METER OR POLE[NSC. r 4 mantywhlch requlresapermittoronstinct;alfep Improve,demolbh,arrepalr anystructur,prlorto Its Issuance,also requlreatheappllrant forsuch permit to 15 POWER DEVICES file a signed statement that he Is licensed pursuant to the provisions of the 3w� Contractor'.Liteme Law(ChapterI(commencing with Section 7001 of Dial, SWIMMING POOL ELECTRIC VALUATION N O alon3 ofthe Buslnemand Professlmis Code)mthal he is exempt therefromand the basis for the alleged exemption. Any violation of Section 7031.5 by any D OUTLETESW[TCHESFIXfURES I Q a D applicant fora permit subjects the applicant to a civil penalty of not=in than five hundred dollars(¢500). NEW RESIDENTIAL ELECTR SQFf. SfOIIIFS TYPECONSTRUCTION �n ❑I,as owner of the property,or my employees with wages as their wk compensation,will do the work and the structure la not intended or offered for Osale(Sec.7014,Business and Professions Code:The Contractols License Law $ does not apply to an owner of property who Wilda or Improvm thereon,and OCC.GROUP RES.UMTS who does suchwork himselforthrough hisown employees,provided that such Improvements are not intended or offered for sale.If,however,the Wilding or TOTAL: s improvementissold wlthinoneyearofcompldtb theowner-buBderwill have tllgkuNen of proving that hedid notWild orlmproveforpurposeofiale.). QTY, PLUMBING PERMIT FEE [.7ppDZONE AP u L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to construct the project(Sec.7044,Business and Professions Code: The Contractor's License law does me apply to an owner of property who ALTER-DRAIN kVENT-WATER(FA) Wilds or Improve thereon,and who contracts for such projects with. FEE SUMMARY co,,IlIlIj ctor(a)licensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE LJ I am(a) under Sec. B It P C for this region DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N Owner Date - RECEIPT WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP Spi00L TAX Y N QI hereby affirm that I have a certi0cete of consent to self-insure,ora gF�)gep p certificate of Workera'Comperaztlonlwurance or a certified copy thereof(Sec. GAS FA.SYSTEM-1 INC. OUTLETS PARK FEE Y N 3800,Lab C.) RECEIPT Pobcyk GAS EA.SYSTEM-OVER 4(EA) BUILDING DIV]SION FEES Com any ffCerttied copy la hereby furnished. GRGSE/INDUSCRL WASTE INTERCEPTOR PLANCHECK FEE ECertlfied copy is filed with the city Inspection division. . CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 200FT Date ReC'el 111 (Thissection need not W completed If the permit b forone hundred dollam ($100)or lee') WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_ I certifythal in the performance of the wink for which this permit Is lasued, - I shall not employ any person In any manner an m to become subject to the WATER SYSTEM/TREATING Workems'Compermillon Laws of California.Date PAID - z Z Applicant NEW RESIDENTIAL PCMB. SQ3rT. Date Recei tin Z O NOTICETO APPLICANT.U,after making this Certificate of Exemption,you N should becomesubject to the Workers'Compensation provisions of the Labor TOTAL: CC 7 Code,you mu at forthwith comply with such provisineamthis permitghallbe B deemed revoked. W G 1JILDING EL CONSTRUCTION LENDING AGENCY SEISMIC FEE d Thereby affirm that there is a construction lending agency for the perfonry TOTAL: FEE D Z an",of the work for which this permit is Lsmed(Sec.3097,Civ.C.) PLUMBING FEE 00 Lender'.Name LL 1— Landers Add.. MECHANICAL PERMIT FEE MECHANICAL FEE OW Icedifythatlhavereadthisappliudonandstatethattheabovelnformation ll iscorred.lagreelocomplywlthallcityand county ordinances and state laws PERMIT ISSUANCE FEES PAID: >_ 0. construction,and herebyauthmice representatives ofthla H in city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH. Date' Rece1P[N Z (We)agree to save,indemnify an d keep harmless the City of Cu pe Lino AIR HANDLING[IMT(TO 10,000 CFM) against habi0 aes,judgments,costs and expenses which may In any way accrue AIR against said City In on ince of th anI of this permit. 4J _ V, I/� AIR HANDLING UMT(OVER IO,ODOCFM) CONSTRUCTION TAX Signature of Appll ant/C ractor L` 1`'/DDaateR+—,i— EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will theapplicant orfuwm building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recei tin material as defined by the Cupertino Municipal Code,Chapter 9.1 2,and the I ealth and Safety Code Section 25532(a)? HEATING UNIT(OVER 100,0D)BTU) TOTAL: MYes M No Will the applicant or future Wilding occupant use equipment or devices VFNHLATION TAN(SINGLE RESID) ISSUANCE DATE which emit hazardous air mntaminanb as defined by the Bay Area Air PAID Quality Management District? BO[LER-COMP(311POR 100,000 BTU) 4Yes ❑No {`'`'3 havereadthehaxa4usmaterials requirements under Chapter 6.95of BOILER-COMPtOVER100,00DBTU) JAN 05 IJJU the California Health k Safety Code,Sections 25505,25533 and 25534. 1 and erstarad that if the building does not currently have a tenant,that It V my NEW RESIDENTIAL MECH: 5Q.FC. reoponsibility to notify the occupant of the requirements which at be met prior to Issuance of a Certificate of Occupa racy. Clay n; rfln9Fbno Owner or authoriand agent Data [$SUED BY: TOTAL: OFFICE COPY