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19504 POST THIS CARD NEAR FRONT OF BUILDING. rewwTNoq' CITY CUPERTINO A 19504 TTAL INSPECTION /DIVISION/- JOB INSPECTION RECORD JODDRESS G �/ /1 UNIT# LOT CAx RYr. y coNTROI.x OWNER CONTRACTO&4&t BUILDING PERMIT INFO INSPECTION FOUNDATION/PIERSDATE INSPECTOR 'NOTE:LLGRADi GAND DRAI?,, UFERGROUND SHALL BE INSTALLED TO COMPLY WITH JOB DESCRIPTION PAD/SETBACK-CERT - THE APPROVED PLANS AND an OF GARAGE SLABS PREGUNITE CUPERIINO STANDARDS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - DATE INSPECTOR UNDERGROUND/SLAB INSPECTION 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 ACUZZI BOND FRAMING STAIRS INSULATION/VENTILATION EMERG.EGRESS -� SEWER WATER COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIOR SHEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN SHEETROCK/SHEETROCK SHEAR EXTERIOR LATH/W-SCREEN - SHOWERLATH SCRATCH COAT NO TAPE OR PLASTER UNTIL ABO S BEEN SIGNED NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID FINALS DATE INSPECTOR SAN.# ELECT.ENERGY PLUMBING ENERGY MECH.ENERGY BUILDING ENERGY ' ELECT.FINAL TEST PLUMBING GAS TEST MECHANICAL HEATING ELECTRICAL RELEASE H RE DEPT. GRADE OCCUPANCY TEMPORARY APPROVALS ELECTRIC GAS BUILDING OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE DATE. d, BIIILDING FINAL IS SIGNED BY BUILDING INSPECTOR r I 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 ISSUED BY.- OFFICE COPY C APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building FWed Identification PERMITNO. Building Addmss: 19504 I O rI5 E. ST ens a ��C hone: a A jE{ 1 k7 CITY OF CUPERTINO-BUILDING DIVISION Contractor's Name: �pk ^/Y (�Lk.No: APPLICATION / PERMIT " —MS Ca-CO- 1 OI CA a COMROL ArchRect/En n r BUILDING-HLECTRICALI'LIIMBING-MECHAMCAL Ri ee� Lic.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Add.,. LICENSED CONTRACTOR'S DECLARATION o PERhTISSUANCE lhereby fllicensedderprrovLnsOfChnc APPLIANCESAFSTDENML ingwthSt.n7000)ofDiWslo3oftheBusne,s..d Prro(eashmsCde,andmy licensO'sIn fullf d effect. PANELS"' - ❑ ❑JOB DESCRI❑'TIO N License Claes l'.. Lie.If (•'-1*13hD1 �`�^Or^M/�.1�—� Date 1 O Contractor ARCHITECI-S DECLARATION 201-IOOOAMPS Oreob I understand my plans shalle used as public records. OVERIOIIOAMPS .FT.FLOOR AREA 5/9Q.FT. NdC U Licensed Profenloal SIGNSELECTRICAL 6a OWNER-IJUILDER DECLARATION SI'ECALCIRCUIT/MISC t'�dG I hereby af0ren that am exempt from the Contractors License Law for the O�Hrx following reason.(Section 7MIS,Bust.®and Professions Code:Any city or TEMP.METER OR TOLE INST. rbc u c ntywhichrequiresapert ttowmtmd,Oter, pmve,demolbh,ormpalr a anyslructure pdorto its issuance,also mquiresthe applicant for such permit to POWER DEVICES o.V fil...igned statement that he is licensed pursuant to the provisions of the 3 w Contractors License law(Chapter 9(commencing with Section 7000)of Divi- SWIMAtINC POOL ELECTRIC F�0¢ sion 3 ofthe Businessand Profession Code)orthat he is exempt therefromand VALUATION �'•,-] the Wats for the alleged�ects the exemption. Any applicant tolacivi of Section net m by any applicant for apealle ed ext ption. Anyvioationofaltyof7MIS by hanany OUT['ETSSWITCHE'FIX7URF5 it//I Vrnv) n. five hundred dollars($500). NEW RESIDENTIAL ELECTR ✓" (�?�n ❑I,as owner of the property,or my employees with wages as their Bole eSQXT. STORI� TYPE CONSTRUCTION C r36 compensation,will do the work and the structure is nes intended or Offered for a�`❑ sale(Sec.7044,9u1lness and Professions Code:The Contractors Licence law r„)$$ does notappey to an ownerofproperty who builds or impmvesthemon,and who doessuchworkhlmseeforthrvugh hisown employees,provided thatsuch OCC.GROUP RIS,UMTS Improvements are not intended oroffered formle.If,however,thebuilding or - TOTAL: improvemenlissold wlthinoneyeamfcompeetion,lhe owner-builderwlll have thr�iuden of proving that he did not build or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLODDTDNE APN a LUI I, as Owner of the property,am exclusively contracting with Iteemost PEWIT ISSUANCE contractors to construct the project(Sec.7044 Business and Professions Code: The Contractors License law does not apply to an Owner of property who ALTER DRAIN k VENT WATER(EAI Wilds or Improves thereon,and who contracts for such poO)ects with a 9114aao4e)gaved Pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY L_j I am exompt under Sec B k P C for this reason OUTSIDE Owner Dam DRAINS FLOOR ROOF,AREk COND. SANITARY Y_ N_ WORKMAN COMPENSATION DECLARATION RECEIPT s ❑1 hereby affirm that I have a certificate of cement to seg-Insure,or a FIXIlIRFS PER TRAP SCHOOL TAX Y_ N certificate Of Workers'Compensation Insurance ora certified copy thereof(Sec. RECEIPT M 380,Ub C.) GAS EA.SYSI'EM.I INC 4 OUTLETS PARK FEE Y N Policy N Cam ny GAS EA.SYSHM-0VER 4(EM BUILDINGDIVISIONFE[5 ECertified copy is heed with the ed.city GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE Ej Certified copy V flied with the airy inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE U'hisuction need not becomploted lftheperndt isforone hundred dollars SEWER-SANITARY-STORM F.A.200Fr. Date Re i t# (51I comlev) WATER HEATER W/VENT/ELECTR ENERGY FEE Y N Ill not that o the person uncenf tmanner an as to b this become ctI.to ti , 1 Whale not employ any person In any manner at a9 to become subl'M to the WorkepSnsauon[a }o/-Cal_ifornia.Date--A 11—G D WATER SYSTEM/TREATING PAID C' Z Applicantmt__-JpHAI Z O should ETO p..b)ettothe,after maklompenCtion preo(Ens of the ,you NEW RESIDENTIAL PLMB.__SQFr, Date ROcei t# F sode,yo comst forthwith the Workers'Comperuatlomor this permit s Lab be TOTA U) Cade,you must forthwith comply with such provlslOa or this permit shall be W > deemed revoked. B ILDING M CL p CONSTRUCTION LENDING AGENCY SEISMIC FEE = Z I hereby affirm that there is a matmetion lending agency for the perform- TOTAL: ELECTRIC FEE ance of the work for which this permit 0 309 Issued(Sec. 7,Civ.C.I U O Lender.Name PLUMBING FEE IL F UoderWAddress QTY. MECHANICAL PERMIT FEE O W 1 conifythal l have readthb appgcationand state that theabove information MECHANICAL FEE 1 scorrea.I agree to comply with all city and countyordlnances and state laws PERMIT ISSUANCE F ES PA >. W mlatingto building construction,and hereby authorize representative,of this Z city to enter upon the above-na,mloned property for Inspection purposes. ALTER OR ADD TO MECH. (We)agree to save,Indemnify an d keep harmless the City of Cupertino t Receipt# a g.WtllabNtle"pal nb,cows and expenses which may in anywayaccrue AIR HANDLING UNIT(TO 10,000 CFM)) SUBTOTAL: yl - dCilylt equence f the granting M this permit. O AIR HANDLING UNIT(OVER I,000CEM) CONSTRUCTION TAX of Appllcani/C .et dorDate EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE e applicant or future building occupant store or handle hazardous 'I HEAENC UNIT(TO 100,000 BTU) material as defined by the Cupertino Municipal Code,Chapter9.IZ and the Date Reeei f# li� and Safety Code,Section NI n 2553](a)7 HFATING UT(OVER 100,000 BTU) YanTOTAL: Will the applicant or future building Occupant use equipment or devices VENITLATIONFAN(SINGLERESID) 1$SU CE DALE which emit naement iitrict? minanrsaadefined by the Bay Arca Air r \ •y, Quality Management District? BOILER-COMP(3MP OR IDO,IXq BTU) 4 yes T7 No haveread the hazes om materiale nqui 25505, 5533 and 255 .1 of BOILER-COMP(OVER i00,000 BTU) the Califomla Health k Safety Code,Sections 25505,5533 and 25534.I understand that if the building does not currently have a tenant,that it is my NEWRESIDENTIALMECH. SQ,FT, responsibility to notify the occupant of the requirements which must be met prior to usuance of a Certifiate of Occupancy. ` Owner m authorised agent Date TOTAL: ISSUEDe � OFFICE COPY