19545•
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POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION/�DIVISION - JOBB INSPECTION RECORD
JOB ADDRESS_�l3 73 �K7__Lf k' P I— UNIT # LOT #
OWNER— j A AVX C -,A w CONTRACTOR -3 c1 W.P .
PERMIT No.
9545
APPUCA110N SUB=777A
=A
l S�� Cy o
-�--J
CATEGORY
CONnaOOL"5'e2ff
BUILDING PERMIT INFO
INSPECTION DATE INSPECTOR
ECORD
NOTE: ALL GRADING INSPECTION AND DRAINAGE
SHALL REINSTALLED TOCOMPLY WITH
THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS
, o
FOUNDATION/ PIERS
UFERGROUND
JOB DECRIFMON
I
c / .. .
'('V&4cejo
PAD SETBACK -CERT
GARAGE SLABS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
INSPECTION -
DA
INSPECTOR
UNDERGROUND/SLAB
PLUMBING
— n
—"'!
/
ELECTRICAL
MECI-IANICAL
-
-
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION
PLACE NO SIIBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'
ROUGH
PLUMBING
TU135&SI-IOWER PAN -
MECFIANICAL
ELECTRICAL/JACUZZI BOND
FRAM ING/STAIRS
INSULATION/ VENTILATION
EMERG. EGRESS
SEWER WATER
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SI-IEAR 1-IOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
'
EXTERIOR LATI-I/ W -SCREEN
SI -IOW ER LATH
SCRATCI-I 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 JINSPECTOR
SAN.#
ELECT. ENERGY
PLUMBING ENERGY
MEC1-I. ENERGY
BUILDING ENERGY
ELECT. FINAL TEST
PLUMBING
GAS TEST
MECFIANICAL
BEATING
ELECTRICAL RELEASE
FIRE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERAIITT'ED UNTIL
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 Ml 23 L Wil)
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING. Cit? r` P—ortino
IMPORTANT! ` +` \
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION 'SSUE1)BY:
OFFICE COPY
OZ
z O
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Pru'cc, Identification
BuildingAddress:
hrl
73 I�>Lrcr b itX c ( ero
PrRM1TNO.
19545
ers a phone:
JU{li.J 6. C HA14AM4-R/N LN4,0 LOCAf
CITY OF CUPERTINO, BUILDING DIVISION
APPLICATION / PERMIT
BUILDINGELE)CTRICALML BING-MECHAMCAL
ATR5,79CWTIAFA
(—Z�— Cp a
l
Contractor's Name: Lic. Na
CATEGORY
CONTROL
.] � �E
Amhltm/Engineer. Lk. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address:
RMI
PET ISSUANCE
_
❑ ❑ ❑
LICENSED la CONTRACTOR'S DECLARATION
IMrebyion 7000).famlkmsoftheBrprwland ofChlo..Cocammeno
7W0) of Divifect. the Buslnesand Prolesgone Code, and my
Ingwe Is
liana Is In full forte and effect.
License Class Lk.N
Data Contactor
ARCHITECTS DECLARATION
I understand my plarsshall be used as public records.
Licensed Pm(esbnal
OWNER -BUILDER DECLARATION
I hereby affimthat I am exempt from the Contractors Llanse Law for the
fo0owing reason.fSecilon7(D15, Businessand Professions Code: Any city or
countywhkhrcqulmapermitwmmt Malter,Improve,demolbh,ormpalr
anystmmmpdortolUlwancgaLsorequlmtheappUontforsuchper tto
file a signed statement that he is licensed pursuant to the provisions of the
Contractor'sLicense Law (Chapter9(mmmenciog with Section 7000) of Divi-
Rion 3 ofthe Business and Profeslom Code) orthat he is exempt therefromand
the bask for the alleged exemption. Any violation of Section 7011.5 by any
applicant fora permit subjects the applicant to a civil penalty of net mom than
five hundred dollars (5500).
F1 I, as owner of the property, or my employees with wages s their sole
compensation, will do the work and the structure Is not Intended or offered for
sale (Sec. 7044, Business and Pr k.i.rs Code: The Contractors License Law
don not apply to an owner of property who Wilds or Improves thereon, and
who dm such work hlms fforthrough his own employees, provided that such
Improvement art not Intended or.ffered(orsak. If, howeveq thebulking or
improvement ksold withinoneyearofmmphYlon,the owner-builderwlll have
tl,rden of proving that he did not build or improve for purpose of wk.).
KI L as owner of the property, am exclusively contracting with licensed
contractors to corstruct the project (See. 7044 Business and Professions Code:
TM Contractor's License Law does na apply to an owner W property who
Wthereon, and or Improves thereand who contracts for such jn pacts with a
,,NtRfTelor(s) licensed pursuant to the Contractor's License Law.
rI_J l e a xempt under Sec. B A P C for this mason
r
APPUANCFSRF.SIDGNf1AL
JOB DPSCREr(ION
'
C \x`tk� e k. r
PANELS
MI -1000 AMTS
OVER1000AMPS
SQ. FT. FLOOR AR
5/SQ,FT.
SIGNS ELECTRICAL
SPFLULCIRCNT/MLSC
TEMP METER OR POLE INST.
POWER DEVICES
SV-gNMNG POOL ELECTRIC
VALUATI
' L��
OUTLETSSWTTCHFSHXTURES
NEW RESIDENTIAL ELECBR SQ'FT,
STORIES TME CONSTRUCTION
TOTAL:
QTYI PLUMBING PERMIT FEE
PEtMIT1$UANCE
OCGCROUI' RES. UNITS
-
FOOD ZONE APN
ALTFILDRAIN& VENT; WATER (FA)
BAIX FLOW PROTECT. DEVICE
FEE SUMMARY
ES
DRAINS FLOOR ROOF, AREA, CONTI.
pT%Tl1RES PER TRAP
SANITARY Y N
RECEIVE #
-
WORKMAN COMPENSATION DECLIR TION
❑1 reby a(!trm that I have a artNote of consent to self -Insure, ora
certificateofWorken' Compensation Insurance as certified copy thermfakc.
3800, Lab C.)
SCHOOL TAX Y— N_
RECEIPT' N
GAS FA.SYSTFM-11NC.40VILECS
PAIU( Y— N_
GAS EA.SYS EM-OVER4(FA)
CoMs -
Y
DINED IV
BUILDING DIVISION FEES
Ceritfled copy is hereby tarnished.
MCedlfled ropy k filed withh the tk ocity Inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
Rhia Renta need not W completed lithe permit b /Drone M1undred dollen
(f1 I o,mileha
Irnnot thatoy In any Aortvnan the work so as too which co pemnitbto the
I shall not employ any person In any manner at s to become subject to the
worker; Compensation Laws o/GII(ornk. Date
ApplicaNOTICE
NODCE TO APPLICANT. If, ager making this Certificate of Exemption, you
should become subpa to the Workers'Compersatlon provlalors of the Labor
Code, you must forthwith comply with such provisions or this permit shall be
deemed revoked.
• CONSTRUCTION LENDING AGENCY
I hereby affirm that then is acumtruction kodingagency forthe perform,'
of the work for which this permit k Issued (Sec. 3097, Civ, C.)
1<rn ndera Name
Lender'sAddress
1 arti(ythat I have read this applicattonand statethatthe above Information
Is correct. l agree to comply with all cityand county ordinances and gate laws
relating to building mrstmctlon, and hereby authorlre representatives o(thb
city to enter upon the above-mentioned property for inspection purposes.
(We) agree to save, Indemnify an d keep harMes the City of Cupertino
against liabilities, Judgment, cost sand expenses which may In anyway accrue
ga��^^++tWdCit�J in consequence of the gr ming of this perm][.
aga(/,A.�F1 � 1 Av :_ �,21/y�
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECKFEE
PAID
Date Rem to
GREASE TRAP
SEWER-SANTTARY-SIORM EA. L70FT.
WA�E�q�W/VEKr/FLECTR
ENERGYFEE Y N —
PAID
Date Recei til
WATER SYSTEM/TREATING
NEW RESIDENTIAL P11fli. SQ.FT.
TOTAL:
BUILDING FEE
s OD
TOTAL:
SEISMIC FEE
LSD
ELECTRIC FEB
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
MECHANICAL FEE
PFRMITISTIANCE
ALTER OR ADD TO MECH.
AIR HANDUNG UNIT(TO 10," CFM)
FEES PAID
DatC RCCeiptil
$UBTOTAL-
'
AIRHANDUNc uNIT'rovERLo,000cEaf)
CONSTRUCFIONTAX
,Sp
S' Lure of Applicant/Contractor l Date
HAZARDOUS MATERIALS DISCLOSURE.
Willtheappllcant or future building occupant store or handle hazallous
material as defined by the Cupertino Municipal CWd , Chapter 9.12 and the
Ileakhand SafetyCod, Section25532(a)?
Yes � No
Will the applicant or future building occupant use equipment or devices
which emit havardom air contaminant as defined by the Bay Area Air
Quality Management District?
Yea ❑ No
have read the hazardous materiak requirement under Chapter 6.95 of
the Elifornla I iwlth h Safety Code, Sections 25505,25S33 and 75534. I
understand that if the building does not comently have a tenant, that it b my
responsibility to rally the occupant of the requirements which must be reset
prior to Lssuance of a Certificate of Occupa ncy.
EXHAIISTHOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HEATINGUMTGO 1(O,"BTU)
Date Revel tM
HEATING UNIT (OVER 100," BTU)
TOTAL:
�-5
Je
VENA TION FAN (SINGLE RESID)
ISSUANC 4DATE
G� l DA
)AN `T _3
Jin
n 1 a Ca ^es n
1
(SUED BY: N0 '0\k,1
1"1_r
BOILER -COMP DHP Oft 100,0(0 BTU)
BOILER-ODMP rovQ2100,000 BTu)
NEW RESIDENTIAL MECH. SQ.FT.
Owner or authorized agent Date
TOTAL:
OFFICE COPY