19452'i. POST THIS CARD NEAR FRONT OF BUILDING PERMIT No. ,
9452
CITY OF CUPERTINO
INSPECTION DIVISION-JOB INSPECTION RECORD
Cn
�• JOB ADDRESS 2,/1, 74P �`v/"�h UNIT# LOT# CATEGORY ,coNrROLx-
OWNER ge-- - CONTRACTOR L` BUILDING PERMIT INFO
OUNDATION/PIERS -. " DATE INSPECTOR 'NOTE ALLCRADI LAND DRAINAGE - "
UFERGROUND' - SHALL BE INSTALLED TO COMPLY WITH - - JOBDESCRIITION
PAD SETBACK-CERT - THE'APPROVED PLANS AND CITY OF .
CUPERIINO STANDARDS.
'GARAGE SLABS PRE UNITE - - {" • ��, J"'
-POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND SLAB INSPECTION'- DATE INSPECTOR
PLUMBING
ELECTRICAL
MECHANICAL' -
DOiNOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING
MECHANICAL '
ELECTRICAL U U. p E C 2.7 1989 -
FRAMING VENTS CLEAR -
INSULATION -
I
PLACEWO SUBFLOOR�UNTIL ABOVE HAS BEEN SIGNED - ,Yl Z LB CUPERTINO
f .
' ROUGH
PLUMBING - - -
TU135&SHOWER PAN
. . - MECHANICAL
ELECTRICAL/JACUZZI BOND
FRAMING STAIRS -, - - ,:.s �,• .,,,_: - ,
INSULATION/VENTILATION - -
EMERG.EGRESS
SEWER/WATER-
COVER
EWER WATER•COVER NO WORK UNTIL ABOVE HAS'DfiEN SIGNED -
EXTERIOR SHEAR 1-IOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR-
EXTERIOR LATH/W-SCREEN -
SHOWERLATH
SCRATCH COAT- -
NO'TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED _ -
NOTE:NO FINAL INSPECTION SHALL DE MADE BEFORE -„ •- -,
THE CONSTRUCTION TAX IS PAID '
FINALS - 'DATE INSPECTOR
SAN.#I
ELECT.ENERGY - - -
PLUMBING ENERGY -
MECH.ENERGY -
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GAS TEST' - - e�
MECHANICAL' -
HEATING - {-c,In - m -
ELECTRICALRELEASE -
RRE DEPT.
GRADE
OCCUPANCY . 4 '
TEMPORARY APPROVALS ,
ELECTRIC
GAS .
BUILDING
OCCUPANCY-5F BUILDING IS,NOT PERMITTED UNTIL ISSUANCE DATE
BUILDING FINAL IS SIGNED BY DU/LDING INSPECTOR
ARRANGE FOR INSPECTION'BY PHONING 252.4505uTWEEN :
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 ULD
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Noted Identification PERMITNO.
BuBdingrtdd..: 22Z 70 uEx9 ,7- C'p�en�.o. c4. 19452
MAC{ ge-"9 Sae 6-^,r. - 730—' 6r•oZ. ,
wners aces: Phone: -
QWcr! ,O�um,3%N 6. C%- toSSr3 CITY OF CUPERTINO-BUILDING DIVISION
C.madors N.me: LTc.No: APPLICATION I PERMIT
BUILDENG-ELECTRICALPLUMBINGMECI{ANICAI CATEGORY CONTROL M.
Architect/Englneer: Lk.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Add_,. PERMITISSUANCE ❑ ❑.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(comment APPLIANCES-RESIDENTIAL JOq DESCREMON
Ingwlth Sedlon7OOO)of Dlvlsim3afthe BuefnessandProfessl...Code,and my `///A
li¢nx is in full Ip 'd effect' PANELS //
License Clam 3 . Ltc.M -;05-526•
Dale / Contrador -
201-IOUOAMIS /
ARCHITECTS DECLARATION
qua m0 QC I understand my piano shall be used u public records. OVER 1000 AMT'S SQ.FF.FLOOR AREA $/SQ.FT.
k Q Licensed Professional SIGNSELECTRICAL "
<� OWNER-BUILDER DECLARATION WMIALCItCUIT/MISC
7�p I hereby affirm that em exempt from the Contrador'.License Law for the
following reason.(Section 7031.5,Business and Professions Code:Any city or
D ,
F 2 H ER OR POLE INST.
county which requlresa permittoconsmact,alter,bm
nprove,deolhh,or repair
a� Q any.tructum Priori.it.bmance,alsorequtmthe applicant for such permit to ro D ES -
V Ole a signed statement that he b
licensed pursuant to the praWloru of the
3w Contradola LlcemeTaw(Chapter9(commencing with Section 7000)of Divl- N
SOS slon3otthe Business and Professions Code)orthat he lsexempt therrefin d VALUATION
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1 "
aagg
pplies.(.,apermlt.0bjed,thiapplic..tto.dwlipenalty ofnotmoretzy SM FIPSH)%T�URES
$ five undredd.11ars(SS00). D� j�EB13:TR�('Ipp
.- 61,as owner of the property,or my employees with wages as their mk ^-"'- 13D.7-SQ' STORIES TYPE CONSTRUCTION
�7a mmpeneatlon,Mild.
the work and the structure b not Intended or offered for
0 sale(See.7046.Bogota....d Pr.fesslro oCode:The ContractorsLl".Law
('j$$ does not apply to an owner of property,who builds or improves themes,and 7i T.00C.GROf1I' REB.O ITS I
EE. who does such work himself or through hlsown employees,provided that such _
Improvements are not Intended or offered for sale.If,hcweveq the build Ing or
CM OF, MOTION--
onprovernest is sold within oneyearofcomplation,theowner-builderwlliinave
tl)9,tu1den of proving that he did not build or improve for purpose of sale.). QTY, PLUMBING PERMIT 'FEE FLOOD ZONE APN
u I,as owner of the property,am exclusively contracting with licensed PERMITISSUANCE tlV
contractors to coratruct the project(Sec.7046,Business and Professions Code:
The Contractor's License Law doea not apply to an owner of property,who ALTER
WildsVENT-WATER(EA) '
Wilds.r Improve thereon,'And who contracts for such pW*u with i - FEE SUMMARY
my}a0W.)homsed pursuant to the Contrador.License Law. BACK FLOW PROTECT.DEVICE
LI f am exempt under Sea B k P C for this rcewnOUTSIDE FEES
Owner - Date DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N—
Owner p '
WOR KMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCI{OOLTA% Y' - N
❑1 hereby af(Irm that I have a rcniOcate of consent to self-Insure,ora RECEIPT#
mrtlRcateofWork,a'Comp..ticaimuran...a mrtlfled copy thertaf(Sec. GAS EA.SYSTEM-]INCA OUTLETS PARK FEE Y N
3800,Lab C.)
Polity N Q�0p 20/Z 4659'• GAS-F.A.SYSTEM-OVER 6(En) RECEIPT N
Com any .aC' e.+, B UILDING DI VI SION FEES
[Certified copy b filed hereby
the dayed. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE
❑Certified copy b(Tied with the Wpe<lon division.
CERTIFICATE OF IX EMPTION FROM WORKERS' CREASE TRAP _ PAID '
COMPENSATION INSURANCE
(iM1lasedian need net he completed lithe permit is forma,hundred dollars SEWER-SANfI'ARYS_ �"Fr. Date RecClpt#
(3100)arfceth) NWA'T'ER HEATER W/VENT/ELECTR - ENERGYFEE Y N—
I
-
Irtlfythat the performance.(tine work for which thio permit 1.blued, —
I sheU not employ any pence.in any runner so as to became subject to the WATER BYBfEM/TREATING -
kvorkers'Compensatmn Lawa.f California.Date - PAID
Z Z NOplicant
TICE TO APPLICANT.If,after making tFi.Certlficateof Exemption,you NEW RESIDEIAj:, Recel t#
should became subfed to the Workers'Compenaatlon provisions ofthe Labor - - TOTAL:
N
Code,you must forthwith comply with such provisions or this permit shall be IjUi NC '
EE
CONSTRUCTION LENDING AGENCY
LU C deemed revoked. -
O. - - SEISMIC FEE
IherebyefOrm that there b a mratroctlon lending agency for the perform ELECTRIC FEE
Z ante 1A.
Ad the work for which this permit is laed(Sec.3097,Civ.C.) - 70TALi QI6
U 0 I.c.der.N.mA - PLUMBING FEE
IL F Lenders Address QTY. MECHANICAL PERMIT FEE. MECHANICAL FEE
OW I,ertlfythat l have mad thisappho0o...dst.mthallheabove information
CL is mrred.I agracto comply with all cityand county ordinances and state lawn PERMITISSUANCE FEES ID:
->- N relating to building and hercbyauthoriz,representatives ofthb ��_R-. 477
city to enter upon the abovcmentloned property for inspection purposes. ALTER OR ADD TO MECH. 1D2te ReCel [#
(We)agice to save,Indemnify and keep harmless the City of Cupertino
V against liabilities,ydgments,mks and expenses which may In anywayaceme AIR HANDLING UNIT(17010,ODOCFM) SUBTOTAL• s
Against said City In consequence of the granting of this permit.
' � AIR HANDLING UFIR(OVER IO,000CFM) CONSTRUCTION TAX
Signature of Applicant/Contractor Date EXHAUST HOOD(W/.
Htiers CONSTRUCTION TAX PAID:
PLAZA MATERIALS DISCLOSURE
Will the applicant or future but llding occupant store or hand le hazardous HEATING UNIT(TO 100,000 BTU)
material.,defined by the Cu Fenlon Mu nicipal Code,Chapter 9.1 2,and the _ Dale RCCe1-t#�
Health and Safety Code Section 25532(a)I HEATING UNIT(OVER 100,000 BM TOTAL:
❑Yea Nr.
Will the applicantmr uture building occupant use equipment or devices. VFNIILATIONFAN(SINGLERESID) ISSUANCE DATE
which emit haurdous air contaminants as defined byline Bay Area Alr '
Quality Management District? 30ILER-CDMP(3HPOR 100,0M BTU)
4 Yn raQ.oNo
e mnbof BOILER-COMP(OVR 103,000BN)
,be
110,
HealthA Safety Code,Sections 2550.5,25533 and 25534. 1
understand that lithe building does not currently have a tenant,that It is my NEWRESIDEMIALMECH.
responsibility to notify the occupant of the requirements which must be met
prior to Issuance.f a Certificate ofOccupancy.
Owner or authorized agent Data ISSUE;
'
TOTAL 4—
OFFICE COPY