19618 POST THIS CARD NEAR FRONT OF BUILDING PEILMIT NO.
CITY OF CUPERTINO19618
APPLICATION SUBMnT=.
INSPECTION
ODIVISION- JOB INSPECTION RECORD
. JOB ADDRESS I-D 1rL° D I- UNIT# LOT# CATEGORY CONTROL 0 `1
p r
OWNER VV S - CONTRACTOR K-l� ' ' BUILDING PERMIT INFO '
INSPECTION DATE INSPECTO INSPECTION RECORD BLDG ELECI IT= M��H
FOUNDATION/PIERS NOMALLGRADINGANDDRAINACE &j x a
UFERGROUND SHALL BE INSTALLED TO COMPLY%VITT[ )OBDESCRII'nON PAD/SET 13ACK-CERT 7HEAPPROWDPLANSAIYDCHYOF
CUPERTINO STANDARDS.
GARAGE SLABS PREGUNITE ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND SLAB. INSPECTION ` ' SPECTOR
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&SHOWERPAN
MECHANICAL
ELECTRICAL ACUZZI BOND ..
FRAMING STAIRS
INSULATION/V ENTI LATION .
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
SffWER LATH -
SCRATCH 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 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
PAID OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL , . P_A CE
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
. ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN FED V 19911
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND Cit, of C-m-runn
PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT! P
PLEASE READ REVERSE SIDE.BEFORE CALLING FOR FINAL INSPECTION
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pmreat Identification PERMIT NO.
Ming Add. 19 618
9i 2 .
Name: one:
ISE:. CITY OF CUPERTTNO-BUILDINC DIVISION
® CmnRofsNa r k No APPLICATION / PERMIT
BUIIZgNGELECIRICALIR.UMBINGMECHAMCAL CATEGORY CONTROL I
Anhiten/Englnmr. Lie.Nu,
_ QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: I'FRI.ETISSUANCE �a OD
LICENSED CONTRACTOR'S DECLARATION
IMrtby affirm that l am lkm l under pravWme of Chapter 9(conomeme. APPLIANCES-RESDENML JOB UISCRIPTION
Ingwlth Section 7000)of Division 3ofthell"neseand ProfeWonsCode,and
It..b In full form and efmoR PANELS
Ce Llcs
DatecW
Date CoMrvdor QJC..
ARCHITECT'S DECLARATION 701-1000 AMPS
SPO I udeeaaod my P6- hall be used as publle records. OVER IWO AMPS SQ.FT.FL ARFA 5/9Q.FT.
Lkenscd Profeskmal I SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION mae'CIALCIRCUIT/MISC
71.., G I herebyaffirm that lam exempt from the Contractor's License Law for the
p following reason.C3eNon 7Qi15,Bualnm aria Prof.lo..Code:My dry or
O g TEMP.METER OR PORE INST.
muntywhkhrryulreapermlt tommtrun,alter,impmve,dermlbh,arrtpa)r
anystmu mpA tolbL amealmrequ4 theappUmntfineochperndtto LL Pol;TR DEVICPS 5_1�
a file a signed statement that he b Iloersed pursuant to the pmvbbls of Ne
Cantra¢or'e L4eme law(Chapter 9(mmmendng with SeGlon 7000)of DIW-
F5�5 um,3ofthe Budnsand PmfeadounsCode)orthat heb exempt therefmmand SWEdMING POOL ELECTRIC
eVALUATION
Q the Weis for the alleged exemption. Any violation of Section 7m15 by any _2,0
Q / 7(
Viad9+: 'd appllantfor&permB subpctatheappilemtto a eivil penalty ol no morelhan OUTLEISSWITCHESFIXTURFS
^ � lW�buas od owner
lars ofthe M.pro NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPE CONSTRUCTION'
I a owner of the property,or he employee with wage r their sale
rompcncatier,0K B-hers-ruledo the esnd lhcaWRTheC mde orm.Loffered far
p sale LSen apply to
o an ow and Profulaa Code:The or unpmrs Llceae Taw
$� does not apply roan owner dprapertyrough is builds eoy.,provrewes tWrtesoa OCC.GROUP RES.AMTS
0.
who doeaeuchwork hlmseB¢thrwgh hbownemp how. r,theb thetwch
Impmvem Mn wrwtihino� yearfteredipleo.I(however,thebulWing¢ TOTAL
Improvemerd beold wdhln orcyearofcompletlon the ownmLulldmwW have
t reienorprovh,gthathedm not bund orlmprove for purpmeoreale.). QTY. PLUMBING PERMIT FEE
I,as owner of the property,am esclusively mntrmting with licensed ---pLOOD ZONE APN
memaders to cd=,oG the period(Sm 70K Burin®arid Pmfeslom Code: PERMIT ISSUANCE
The Commodes Llmrue law does nal apply to an owner of property who ALlI]t-DIUW&VENT-WATER(EA) "
bunds or Improves thenen,and who or ace, for such p(ojei, with a
�ad¢(a)Bmneel pursuant to the Commodes License law. BAacFwwrgorEtT.DEvxe.: ' FEE SUMMARY
UI am exeenpt order Sec B &P C for this reasonOUTSIDE FEES
Owner Date DRAINS FLOOR ROOF,AREA,CONTI. SANITARY Y_ N_
WOKKMAN COMPENSATION DECLARATION RELFllT s
❑1 hereby afrlrm that 1 have a cerdfO m of convent to self-Insure,or FIXNRES_PER MAP l Z•DV SCHOOL TAX Y_ N_
¢rtlOnte of Workeri ComperuaHon Ineuran¢¢e¢sRled ropy thelenf(Sec. RECEB'f a
3800,LabQ GAS E.A.SYSTEM-1 INC40UTLETS PARK FEE Y_ N_
poiLq Com s - - GASEA.SYSTEM-OVER4(FA) RECEIPT# -
y BUILDING DIVISION H.
G2 erlV ed ropy is hertby tome city CREASE/INDUSIRL WASTE BJTF3tCEI'NR PLANGHECK FEE
�eertBied mPy,b rpd with the city inspection alvi.Im,. DD
CERTIFICATE OF O(FAIPTION FROM WORKERS' GREASE TRAP PAID lo17
COMPENSATION INSURANCE PAID
EA.310.7 Date Recd t#
(TMs I..) neM red be<ompined BtM permX bf¢one hundrtd doBan
�lOftffe.) WATER HEATER W/VENT/ELECTR ENERGY FEE Y
I¢nor tlut b the pedorrn in sof the work so as to b thio a mb)b bo the
I mkhalOat employ ay person b any manner so n to become sRbjee to the WATERSYSIEM/TREATING
Worken'Compenaatinn laws ofGWonnla.Date PAIS
PP NEW RESIDENTIAL PLMB. SQFr.
n Bcant
Z O NOTICE Tome,sudC to thff,e
soon makingthb Certificate wisons oftlon,yw Date OTA t#
.hmldbecame subjectitthe Worker'Cu&p em,isinprovl.broofthe Ibe TOTAL:
W~ N deemodonrruetforthwhh mmply with such pmvbba or Nis permit shallW BUILDING O
amrrca rtaakea. SEISMIC E L
a
CONSTRUCTION is a ON L ction ldG AGENCY -
I hereby afRnn Chet tMrt b•ronrructian lending agency for LM perform ELECTRIC FEE
= anmoftheworkforwhlchthbpermhbbsued(Sar.3097,Civ.C.) TOTAL; �p
O O lederb Name PLUMBING FEE Ob
LL ~ Lenders Addle.. QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W Icedifythat l have red this appliatlonard sate thatthe abovelnforn w
b mrn'ei.I agree to comply with all ety and mu ntyardibalcos.nd rate laww PERMIT 14UANCE .Z. db FEES PAID.
} N m191l9 to building mrutruotlon,and hereby authorise representatives of thio
F = city to enter upon the abovcrrcmbrcd property for iapc lurk purpose. ALTERORADDTOMECH. Date Recel t#
_ (We)agree to"w,Wm
erdfy an d keep harmless the City of Cu pe Enc,
-Vamp Mllties,Judgments,mics a rd exper which may In any way acvue AIR HANDING UNTT(TO 10,=CFM)
SUBTOTAL-
.8 not ala cxyul icons gr.mmgdtw pemnu.
AIRHANDLING UNIT(OVER Milne CFM) CONSTRUCTION TAX
Slgnatvreaf Appi1.t/C dcr Date D(HAUST HOOD(W/Dorn CONSTRUCTION TAX PAID:
HAZAR US MATERIALS DISCLOSURE
Will the applicant or futum building a aupant mom or handleW ,,Iuus HEATING UNIT 00 ImpDO BITJ). Date RecCi t#
material as dented by the Cupertino Murddpai Code,Chapter 9.17•and the
I leahhed Safety Cade Section 2433(.)7 HEATING UNIT(OVER 100,000 BI'U) TOTAL: 3 Z
❑ Yes No
Will the applicant or tort building oav pent...equipment or ci vi 1, VENTILATION FAN(SINGLE RESID) (4 SvISSLF4MATE
which emit havrdaus air comaMrurds as defined by the Bay Area Alr
Qualny Management EL rlct7 BOR.FR-ODMP OHP OR 100,000 BTI])
Yes' ❑No
havred the havrdous materials requirements under Chapter 6.9S or BOILFA CVMP(OVFIt 100,000 BTU) F EB U? 1990
the C lifomb Health&Surety Code•Smiam 75505,75533 and 25534.I
uderatad that if the building don rmt arrently luveatenanL that itbmy NEW RESIDENTIAL MECH. :QFT. '
mporuibllity to notify the oavpam of the rcquiremerdswhkh must be met Clty Ef Punnfrflnn
prior to Lsuancc of a Ccrtlrlcate of Ocaparuy. -
Owner or authorlxed agent Date /6 ISSUEDBY:�,)_I -V'k,
TOTAL:
OFFICE COPY