19422 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NO.
CITY OF CUPERTINO. AmUCATiON sUBM19.422rrrAr7KTr_
INSPECTION DIVISION- JOB INSPECTION RECORD
JOB ADDRESS be. CYYL-Z4 UNIT# "LOT# - CATEroR4 CONTROL
OWNER a. CONTRACTOR W- BUILDING PER INF
:INSPECTION',' • - 'DATE" INSPECTOR - INSPECTION RECORD
FOUNDATION/PIERS NOTE:ALL GRADING AND DRAINAGE
UFERGROUND SHALL BE INSTALLED TO COMPLY WITH )OB DESCRI.110N
PAD/SET BACK-CERT THE APPROVED PLANS AND CITY OF
GARAGE SLABS PREGUNITE CU PERTINOSrANDARDS.
.^+;
POUR^NO CONCRETE UNTIL.ABOVE"HAS.BEEN SIGNED
UNDERGROUND/SLAB INSPECTION DATE I SP CTOR
PLUMBING -
ELECTRICAL
MECHANICAL - -
.DOLNOT"POUR.FLOOR UNTIL ABOVE HAS BEEN SIGNED -WOOD FLOOR q
PLUMBING I' `'L�
MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR
INSULATION
,PLACE,-NO"SIIBFLOOR;UNTlL ABOVE;HAS'BEEN SIGNED -
ROUGH -
PLUMBING
TUBS&SHOWER PAN
MECHANICAL -
ELECTRICAL/JACUZZI BOND <CD
FRAMING STAIRS
INSULATION/VENTILATION -
EMERG.EGRESS -
•� SEWER WATER. .
'COVER NO`;WORK'UNTIL ABOVE,HAS'%llEEN SIGNED.
EXTERIOR SHEAR HOLD DOWN _
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR ,
"- EXTERIOR LATH/W-SCREEN
SHOWER LATH -
SCRATCH COAT -
1WO,TAPEiOR,PLASTER UNTIL ADOVE4+HNSXBEEWSICNED
NOTE:NO FINAL INSPECTION SHALL,BE.MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS - DATE INSPECTOR -
SAN.#
ELECT.ENERGY -
PLUMBINC ENERGY
MECH,ENERGY- J!
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING -
GAS TEST - -
MECHANICAL - -
HEATING -ELECTRICAL RELEASE - • "
FIRE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS '
ELECTRIC
GAS
13UILDING -' ISSUANCE DATE -
OCCUPANCY OF BUILDING IS NOT PERMITTED IL
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR'; _ PAID'
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS JAN 057990
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND C' Clroe
PERMIT# ARE NEEDED WHEN PHONING. It14o
IMPORTANT! .Ll''ff
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTIONI AISSDE
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
- Building Project identification PQLMIT NO.
Building Address:
19422
6Oj�gp 5-. 77E 9gnLZ A BLVD.
era p9,4yry , �. Phone:
4.4R91' FA.1VX%dF �416.4aF5! CITY OF CUPERTINO-BUILDING DIVISION
Gontrartor',Nam= Lhc.No: APPLICATION 1 PERMIT
Architect/Engi;Fneer. Lic.Na BUILDINGELECTRICALPLUMBINGMECHAMCAL CATEGORY CO
; BUILDING PERMIT INFO
QTY
ELECTRIC PERMIT FEE
Aaaren:?_W p,,f IL�tL qua— pyo` PERMITISSUANCE � 1:1 El 1-1LICENSED CONTRACTOR'S DECLARATION
I hereby affUm that l am licensed under provisions of Chapter 9(commenc APPUANCESRRSIDENTIAL JOB DFSCKR']ION
Ingwith Smtfon7000)of Dlvision3ofthe BuM...nd Prafe.don.Code,and my
I1a .is$full for¢and affect. PANELS
License Chss Llex
Date Contractor -1. I
ARCHITECPS DECLARATION 201-I000 AMPS
9OCC lues p I s1a06eusada�ityBareards OVERI000AMPS SQ.Fr.FLOOR AREA $/SQ.Fr.
0 U Lice Profen nal SIGNS ELECTRICAL
6OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC
IM1ercbya(tlrm that l am exempt from the Contractor's License law for the
following reason.(Secilon 70315,Business and Professions Code:My city or
O TEMP.METER OR POLE INS(.
P4 3, countywhirh rcqubesapermittacontruct,alter,lmprove,demolbhorrepalr ,
yy Q .nyatm=.prlort.ibi,uanee,aborequlreatheappllanifasuchpermltm POWER DEVICES
K V file a signed statement that he is licensed pursuant to the provblon of the
Contractors License (ChapterLaw 9(commencin with Seethm 7000)of Diel- VALUATION
R SWIMMING POOL ELECTRIC
9o0ofthe Business and ProfessloroCode)orthat hats exemp[therelromand
Q the basis far the alleged exemption. Any violation of Section 7MIS by any OUTLETS-SWITCHES-FIXTURES
applicant for a permit subjedsthe applicant to a civil penalty a net morethan �!
$ five hundred delta.(SM. NEWRI IDENTIALELECTR SQFT. STORIES MISCONSTRUCTION
�n ❑I,as owner of the property,or my employees with wages as their sone ,
compensation,willdothe work and thestmcture hoot Intended or offered for
sale(Sec 7064,Business and Professions Code:The Contractors License Law
�$ does not apply to an owner of property who Wilds or Improves thereon,and OCC.GROUP RES UNITS
who docasuchwork himself orthrough his own employee,provided that such
improvements are not Intended proffered for sale.I(however,thebullding or TOTAL;
Improvement
is withinoneyearofcompletlon,theowner-W flderwllt have
th�a rden of proving that he did not build or Improve for purpose ofale.). QTY. PLUMBING PERMIT FEE
,4 L as owner of the property,am exclusively contracting with licensed FLOOD ZONE APN
contractors to construct the project(Sac.7054,Business and Professions Code; PERMITISSUANCE
The Contractors License Law don next apply to an owner of property who ALTER-DRAIN&VEM'-
WRda 'BP s thereon, and who contracts for such plojuds with a WATER(EA)
�Fjta(a)Ilcens pursuant �o the Contndora License Law. FEE SUMMARY
LJ I am exempt B k P C for this aeon BACK FLOW PROTECT.DEVICE OUTSIny FEES
Drte DRAINS.FLOOR ROOF,AREA,COND. SANITARY NI�I7PT M
WOR CO PENSATION DECIARA ION FD(TURES PER TRAP SCHOOL TAX Y N_
❑1 hereby.Bum th I hive•artl(1®te of consent to self-Inw.,ora RECEIPT x
certificate ofWorkers'Compeaatlon lruu.naara arti(led copythemof(Sec. GAS EA.SYSTEM-1INCA OUTLETS PARKFEE Y N
RECEIPT M
Policy x GAS FA.SYSTEM-OVER d(EA)
Com any tlU1LDING DI VISION FEES
CedNed ropy Is hereby famished. -
❑CertiCREASE/INDUSTRL WASTE INTERCEPTOR PLANCIiECK FEE
fied copy b filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORK ERS' GREASE TRAP PAID /2LO 4`7
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 200h7 Date Rec'el t# b
Uhissectlon need not be completed lithe permit b forons hundred doll..
(SIM)he Ind. WATER HFA•I.Qtly/VEN.I./ELEC.I.R ENERGYFEE '&N
I certify thatl the performarmofthe work for which this permit is lusted,
I uhall n.emttloy any person In any manner so a=01ecome�uq�gr{to the WATER SYSTEM/TREATING Z.Q, <
worker:'1Cr�Jy��en b las o ,", Is.Dale_, ��I� PAID 2' 3 tZ
O Z Applicant NEW RESIDENTIAL PCMB. SQ.Ff. Date Recel t#
Z O NOTICE APPLI ANT:It,afler making this Certiflate of Exemption,you
Hshould become subject to the Workers Compematton provisions of the Labor TOTAL:
V7 Code,you moat forthwith comply with such provision erthb pemdt shall be
LU j deemed revoked. BUILDING FEE
a c CONSTRUCTION LENDING AGENCY SEISMIC FEE I
IherebyaNrm that thea is a contraction lending agency forthe perform TOTAL: ELECTRIC FEE
Z anceofthewarktorwMchthsperMtb(awed(Sea30W,CIv.C.)
U O Landers Name PLUMBING FEE
LL F Lender's Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OWlaAffythatlhavemadthbappllotionandatatethatiheabovalnlornutlon
M bconect.lagrectocomply with all cityand county ordinances and slate laws PERMIT ISSUANCE FEES PAID:
>. relating to building constre won,and hereby authorize npresentativnoftM1b
N city to enterupon the abov=ctioned property for Inspection purposes. ALTERORADDTOMECH.
Z Date Receipt#
V _ (We)agree to save,indemnify and keep harmless the City y Cupertino
against City judgments,chain and ex.nti which may In anyway accrue ATR HANDLING UNIT(TO 10,000 CFM)- SUBTOTAL:
agalm Id City In ronseque t 'gra ntin fNs permit.
_�� AIR HANDLING tIDnT(OVER lo,000cnM) CONSTRUCTION TAX
Xg rep Appica t/Contra or Date DGLAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Wllltheapphes ntorfuwmbuddingeaupantntonorta� ichaza ms HEATING UNIT(TO 10,000 RTU)
Date Recei t#
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
Health and Safety Code SSemon 25532U)7 HEATING UNIT(OVER 100,000 BTU) TOTAL'
❑Yes Ne
Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit haanlou.air contaminants as defined by the Bay Area Air BOILER-COMP pHPDRt BBB PAID
Quality Management District? O, RTU)
Yes ❑No BOILER-COMP(OVER 100,000 BTU) JAN
T2'
4have niaHeath&Safwnuteriabreons255ntaunderChapter6.1 HIY 05 I99U
the California Health building Safety Code,Sections ntly h,ve a t and 25574.I
understand that if nthetheoccupant
ofnot herren0yhavts tenant,that it met NEW RESIDENTIAL MEIN. RQ.FT. '
responsibility to notify the occupant o(Ihe requlrcmenb which moat be met xs
prior to Issuance of a Certificate of Occupancy. City of Nopff no
Owner or authorized agent Date TOTAL: ISSUEDBY: �-
OFFICE COPY /