19398 _ PERMIT NO.
POST THIS CARD NEAR FRONT OF BUILDING 19398
CITY OF CUPERTINO A
INSPECTION DIVISION- JOB INSPE(7J`�FION�E CORD q -.
JOE ADDRESS_2 3 SJr �2 �UNIT 11 LOT q CATEGORY i CONTROL a 4�7 EA
OWNER CONTRACTOR '1 �.yr• BUILDING PERMIT INFO
FOUNDATION/PIERS SPECTION DATE INSPECTOR INSPECTION NOTE ALL GRAblNG AND DRAINAGE '❑ ' W �•
UFERGROUND SHALL BE INSTALLED TO COMPLY WITH J BDESCRII'IION
PAD/SETBACK-CERT THE APPROV ED PLANS AND CITY OF
CUPERTINO STANDARDS.
GARAGE SLABS PREGUNITE • �•T_ ,
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
ROUGHPLUMBING BLDG. INSP
TUBS&SHOWER PAN am BE raum,—
MECHANICAL
ELECTRICAL ACUZZ113OND
FRAMING STAIRS
INSULATION/VENTILATION
E•MERG.EGRESS
. SEWER WATER ,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN - -
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR -
EXTERIORLATH/W-SCREEN
SHOWER LATH
SCRATCH COAT
NO TAPE OR PLASTER UNTIL ARO VE HAS BEEN S/GNED I'I ✓ 1 :; "-'� -
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE - - . •�
THE CONSTRUCTION TAX IS PAID . t
FINALS - DATE IINSPECTOR
SAN.#
ELECT.ENERGY
PLUMBING ENERGY
MECH.ENERGY -
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GAS TEST
MECHANICAL ,
HEATING
ELECTRICAL RELEASE
FIRE 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 5ssucDBw is
OFFICE COPY �� r
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Bufldlnz Proe'.IdentificationPEFt.MIT NO.
'.sliding giddiness: ZQ �, bEANZa4 ��U0 19398
' ` 'FSa�lo6 14 " X74' ZFjb
0
wnero ams. Phone: A A
CITY OF CUPERTINO-BUILDING DIVISION
C°Ram ."• _ Lic.No: APPLICATION /PERMIT
BUILDING-ELECTRICALPLUMBING-MFGHANICAL CATEGORY CONTROL
Architect/Engineer. J 1 Lic.No:
G' QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
?<o o tylo7
(• Address: G9+MAIg G PERMITISSUANCE ❑ ❑ ❑
V1PLUMB M�11
LICENSEDCONTRACTOR'S
pr DECLARATION
l/(v wJthSrthm70I hereby affirm lhatlam Bcrn3 ofthe usices Woes of Chapter9(commrnc APPLIANCFSRESI)ENML JOB Dfl 141]11TON
(b Ine.sa l.Mion7000)O(Dlvfect* (the Buslnmand (nsionsCode,and my
1 Date Is in fu1� ( and efreC. .// PANELS
rWy�[p Lime. lam Lt.p '1'—�
Date Contractor?/.psi l,,& j lj j. T_ j �I
ARCHITECT'S DECLARATION NII-10DUAMPB
O Zp l understand my plane shall be used m public records. OVERIOOOAMPS SQ.FT.FLOOR AREA $/SQ.FT.
Fi Licensed Profem.onl SIGNS ELECTRICAL
<6 OWNER-BUILDER DECLARATION
Ia SPECIAL CIRCUIT/MLSC
Z F' 21Thereby af(Irtnthat]em nempttromthe Contra'.ora Llcenm law(orthe
F F"� following reason.(Section 7031S,Buatnem and Professions Code:Any city or
cmntywhichrequimapermitrocomtmmaiteplmpmvedemi) h,ormpalr P.METLRORI'OLE INST.
m�m .Qu anystmcturs prorto its Issuance,also reqrc
u. sthe applicant forsuch permit to POWER DEVICES
5 V file a signed statement that he b licensed pursuant to the proom visiof the O
3 u G Contractor's License Law(Chapter 9(commencing with Section 7000)of DIA- SWIMMING POOL ELECTRIC VALUATION
sbn3oftW8us.nnsand ProfmiamCode)orthat hebexempttherefromand
Gthe basis for the alleged exemption. Any violation of Section 7MI5 by any OUTLETSSWITCHESFIXTURE9
appRmntforaper tsubjdstheapplicanOo.lvilpemltyana=mthan I
or—
five hundred dollars ISM, NEW RESIDENTI �
.Q I,as owner of the property,or my employees with wages as their sok c"O'IT' STORIES TYPE CONSTRUCTION
compensation,wBldolhe work nse and thestructure is not Intended or offered for _. Y y
p sale(Sec.70K Business and Professions Code:The Contractors LiceLaw
does not apply to an owner of property who Wild,or Improves thereon,and wtil _ OCC.GROUP RES.UNITS
who doessuch work himself or through his own employees,provided that such
Improvements are not Intended orotfered forsale.If,however,the buildingor TOTAL:
improvement banal within oneyearofcompletlon,Ne owner-bu.lderwill have
t1iLle rden of proving that he did not build or Improve for purpose ofsals.). QTY, PL N lff Wy FEE FLOOD ZONE APN
LI L as owner of the property,am exclusively cont..'.....with Ikansed
contractors to construct the pmje t(Sec.7044,Business and Professions Code: PERMIT ISSUANCE
The Cmdeadoe.Limnos law does net apply to an owner of property who ALTER-DRAIN k VENT-WATER(FA)
builds or Improves thereon,and who contracts for such plojecia with a FEE SUMMARY
oplIa'.or(s)Bceneed pursuant to the Contractor's Lt..I.. BACK FLOW PROTECT.DEVICE
LII am exempt under Sec B It P C for this reason
OUTSI DE'FEES
ORA1N RROOP,AREA,CO ND. SANITARY Y N
. Owner Date RECEIPT
WORKMAN COMPENSATION DGCLARATION SCHOOLTAX Y N_
❑7 hereby af(Irm that I have•mrtl0cate of consent m se161nevrc,ora RECEIPT 0
wiitiale of Workers Comperoatlen insurance or a mrtifiad ropy thereof(Sec. G `1 (TiIM
PARK FEE Y N
Policy
lab C.I / RECEIPT M
I'ollryY �.j r�1]
Com v T.n�j OTs i G ��`Y�'p') BUILDING DIVISION FEES
�Cebi ed copy is hereby famished. i ---�—' CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE?30 so
Allied copy I.tiled with the city pe'.Ion vdon. "
1 '
CERTIFICATE OF EXEMPTION FROM WORKERS' G PAID 2l -12-84 S3 m
COMPENSATION INSURANCE -gA Y - Date Recei t#
(Thiele'.Ion need noise compl'.edIlthe permit hundred dollars ENERGYFEE Y N ,S'dp- TJ i
(4100ardlm.) p
MNQ
I sonify that o aha peva no In an the caner wan to become
permit is issued, WATER HEATER W/VENT/EI,ECTR
1 shall not employ any person In any manner n m to become subject to the O tl
Workers'Compensation laws of California.aAT IZ SYSTEM/TREATING PAID
la.Date Z�12- n
C' Z Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Recel til �4
`Z Q NOTICETO APPLICANT:a after rs'Co per anion ateof Exemption,you
Qu
should
you atforject hwith comply
Workers'Comprovisinprovbionrmit s Labor TOTAL:
W W Code,you=at forthwith mmpiy with each provisions orlhb permit shall ba BUILDING E d/01.Sb
WC deemed rooked.
aCONSTRUCTION LENDING AGENCY SEISMIC FEE
thereby afRrmlen
that there la a construction diagagenry forthe perform- TOTAL: ELECTRIC FEE
Z
an ofthe work for which this permit b issued(Sec.3097,CIv.C.)
V O lander.Name PLUMBING FEE
LL F Landers Address OTY. MECHANICAL PERMIT FEE MECHANICAL WE
OW I mrtlfythat l have readthb appLotlanand statethatthe above informa0on
a bcorreci.I agree to comply with al city and county ordinances and state laws PERMITISSUANCE FEE$PAID:
} relating to building construction,and herebyauthorlurepresentativesofthis
N city to enter upon the ahovo-mentioned property for Inspection purpose. ALTERORADDTOMECH.
Z (We)agree m save,indemnify an d keep harmless the City Of Cupertino DateRa ecx� eipt#
V
against liabilities,Iodgmenb,mussed expenses which may In anyway accrue AIR HANDLING UNIT(TO 10,WCFM) SUBTOTAL'
against said City in consequence of the granting°(this permit.
NR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX
Signature of Applicant/Contractor Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfuture building occupant store or ha cad to haaardous HEATING UNIT(TO 100,000 BTU) Date RL ei til
material as defined by the Cupertino Municipal Code,Chapter 9.12 and the
Ilea lth and Safety Code Sea Jy4i53](a)1 HEATING UNIT(OVER 100,000 BTU) TOTAL: F
Yeao
.Il the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which endt havard...air coma rmaox as defined by the Bay Area Air
Quality Management Dlstrl'.7 BOILER-COMP OHP OR 100,000 BTU) ^^
Yes
Ihavcreafiazar °
d the us materials requirements under Chapter G95 of BOILER-COMP(OVER 100,000 BTU)
the Calitomi.I lealth A Safety Code,Sections 25505,25533 and 25534.1
end cretand that if the building don not currently have a tenant,that it Is my NEW RESIDENTIAL MECH. SQ.FT.
respo Cyto notify the occupant of the requirements which at be met
prior o uance of a CertiRcam ofOttvpanry.
a._dzfr—
Owner or aulhorind agent DateTOTAL: ISSUED B
OFFICE COPY