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19467POST THIS CARD NEAR FRONT OF BUILDING r' CITY OF CUPERTINO INSPECTION DIVISION,�- JOB INSPECTION RECORD JOB ADDRESS_D 4%YId a�r.S4 o�XUNIT# LOT# Q��MD OWNER P% (I CONTRACTOR S"V Pis X PIULMIr NO. 19467 APPLIGARONSUB 9nTjAtDA w L ONTROL%7v7/ BUILDING PERMIT INFO INSPECTION DATE INSPECTOR INSPE ION RECORD NOTE ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY VBTH THE APPROVED PLANS AND CITY OF CUPERTINOSTANDARDS. (Q'v V� FOUNDATION/PIERS UFER GROUND JOB DESCRIPTION fJ PAD/SETBACK-CERT GARAGE SLABS/PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED INSPECTION DATE INS C OR UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL A' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING MECHANICAL I" Ie X 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 SF-IEAR EXTERIOR LATI-I/ W -SCREEN SHOWER 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 INSPECTOR SAN.# ELECT. ENERGY PLUM 15ING 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 JAN J 1p )ytjU BEFORE REQUIRED INSPECTION. JOB ADDRESS AND PERMIT # ARE NEEDED WHEN PHONING. Cjt, �� r,J qm0 IMPORTANT! , I✓Y �+ Lt:' U PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUED By, OFFICE COPY /0: SD APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification Bulldu ^ Addmis: a r -7.41 '7 Rc;�.q w,� y NtJFEP T n/ o c /� RJ O/ `� PERU NO. , 19467 neva ante:y(p Phone: APPUCATT07MMOTIA, A 03 CITY OF CUPERTINO-BUILDING DIVISION APPLICATION I PERMIT BmDINGFI.ECnUCALPLUMBINGMECHANICAL — r Contractor'sName, Lac. Ne,. S✓P/2A PG�LJIS 3-S��SI CATEGORY CONTROL .7r (6 y^ I ArehRett/Engineer. a Lie No: I� O QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address / 2. k(= N �I�e. PERMATISSUANCE ?.6D LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am Licensed under provisions of Chapter 9(commenc APPLIANCESRESIDENIIAL JOB DESCRIPTION PANELS ingwith Section7000)of Dlvlaloa3 ofthe Bmiinessand Pro(asdomCednand m license is in full forqLand effect. License Ch. .,a' 3 ont_ Date 41, L�-y 1�C._ontraator ARCHITECTS DECLARATION I understand my plane shall be used as public record. 701-1000 AMPS OVER 1000 AMPS SQ. FT. FLOOR AREA 5/ FT. SIGNS ELECTRICAL Licensed Professional SPECIALCI{CUIT/MlSC OWNER -BUILDER DECLARATION I hereby affirmthat I am exempt fmm the Contractor's License Law for the TEMP. M= OR POLE INST. following reason. (Section 7031.5, Business and Professions Code: Any city or oarntywhtch requlresa permit wcomtmd, alter, Improve, demolish, orrepdr anystrueb,rcpriortoitsIssuance,alsorequirestheapplicantforsuchpermitto file a signed statement that he 6licensed pursuant to the provisions of the Contractor', License Law (Chapter 9 (commencing with Section 70M) of Divi- ,ion3 a(lhe Business and Profenlons Code) orthrt he 6 eumpt therefromand POWER DEVICES ' SWIMMING POOL ELECTRIC 0.40 VALUATION the basis for the allegM exemption. Any violation of Section 7011.5 by any applicant fora peord,ubj to theapplictim to a civil penalty of nab .. than OUTLETSSWHCHFS FRXTURES/, Q�(J NEWRESIDENIIALELECTR SQ.FT. five hundred dollars (SM. ❑I, as owner of the property, or my employees with wages as their sok compensatlon,willdo the work, and thestructure 6 not Intended or offered for STORIES TYPE CONSTRUCTION sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who W lids or improves thereon and whoaoesentsan notdorough h!ow ale.IL oweertheathatsuch improvements ithinomyearffcredfor sale.tMh OCC.GROUIa RFS.IWTIS TOTAL: 00 nv-buUdeulldinave improvement o proving within he did n t Wild or Imp ove for purpose of flI sahave ttLurden owerof the proeeWnot bund orlmpwvefarpng with ofsale.).QTY. u 1, as owner of the property, am.exclusively Busi mntnd Pro with nt Crude: contractors to construct project (Sec. nen and Proprop rt PLUMBING PERMIT FEE FLOOD ZONE nPN ppRg(R ISSUANCE l Liventhe who The Contractors es thee Law dors ort apply m an owner of property who app) to Wilds or Improves thereon, and who contracts for such ptvje b with a ogRt�actor(s) licensed pursuant to the Contractor's License Law. LJ I am exempt under Sec. B & P C for this reasonOUTSIDE ALTER -DRAIN& VFM-WATER (EA) FEE SUMMARY f BAIX FLOW PROTECT. DEVICE vo FEES DRAINS FLOOR ROOF, AREA, GOND. SANITARY RF-CFR'I'N Owner Data WORKMAN COMPENSATION DECLARATIONFIITURrS F-11 hereby affirm that I have a certificate of consent to aeff-inaure, m a certBicee of Workers•Compemabon Insurance ora ortRled copy thereof (Sec. 380D,Lab C.) PER TRAP SCHOOLTAX Y_ N— RECEIPT N ' GAS EA. SYSTEM -1 INCA OUTLETSuD FR PARK FY N — RG M PopolicyN any GAS EA. SYS[FM-0VFR d (EA) tlU1LDINING DI VISION FEESCom ffCertlRed copy 6hercby fum6hed. �Certifled ropy 6 (lied with the city Inspection division CERTIFICATE OF EXEMPTION FROM WORKERS• _ GREASE/WDUSTRL WASTE INTERCEPTOR LANGHEGIC FEE PAID r—y-176 '�..��.pl.r� f �i ID 1 GREASE TRAP SEWER -SANITARY -STORM EA 200FT COMPENSATION INSURANCE (Thissection need no be completed if the permit 6 for onshundred dollars 51M)mlese.) I certify that N the performance of the work forwhlch this permit 66suad, Date Recei EN WATER HEATER W/VENT/F1.FGTR .Z4 CO ENERGYFEE Y_ N_ WATER SYSTEM/TREATING I shall not employ any person In any manner an as to become subject to the Workers Compensation Laws of California. Date PAI D NEW RESIDENTIAL PLMB. SQ.W. APplicm NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should became subject to the Worken'Compessation prov6lons of the Labor Date Rcmi t7! TOTAL: BUILDING •E Code, you meat fort hwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY SEISMIC FEE a07 TOTAL: S('aQ o ELECTRIC FEE I hereby affirm that there 6 a construction lending agency for the perform ante of the work for which this permit 6 issued (Sec. 3097, Civ. C.) lenders Name i.eaaer's Address PLUMBING FEE too,DU QTY. MECHANICAL PERMIT FEE MECHANICAL FEE I cortify that I have read this application and -elate that the above information tiomien.Iagme to comply withal)cityxnd rountyordinanas and state laws Mating to building comuuNon, and hereby authadu represcntativn of this city to enter upon the above-mentioned property for Inspection purposes. (We) agree to save, indemnify an d keep harmless the City of Cupertino against liabilities, Pdgments, costs and expenses which may in any way same PERMETISSUANCE FEES PAIq: I_ Date Receip# ALTFRORADDIOMFCH. AIR HA I1NIT (TO 10, ) SUBTOTAL: act HANDLING UNIT (OVER ) CONSTRUCTION TAX against said City In consequence of the granting of thisPe it. a �»4�aU I i 7/ IaCONSTRUCf10N (Q_��, Sglomo Applicant/Contractor — QK'— I � IXHAUSTHOOD(W/DUC'D TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant orfttere building occupant store or handle hazardous HEATING UNIT (TO 100,000 BTU) CCCt Iq material as defined by the Cupertino Municipal Code, Chapter 9.1$ and the Health and Safety Code Senion75537(a)7 ❑ Y. M No Will the applicant or future building occupant use equipment ordevices HEATING I1N77 (OVER 10000 BTU) TOTAL: ,s. VENTILATION FAN (SINGLE RESID) ISSI.PN4 BATE �'1YILJ which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? YcsNo Ihave read the h.9 us materials requirements under Chapter 6.95 of JAN qq 1990 1 BOILER -COMP PFI' OR l00," BTU) BOILER-COMP(OVER 10,000 BTU) the California I Iealth & Safety Code, Sections 75505, 25533 and 75534. I understand that if the building don nm currently have a tenant, that it is my mipomibility to notify the occupant of the requirements which must be reset p CII' ^` 61"Irt-no NEW RESIDENTIAL MECO. SQ.I•T. prior to issuance of a Certificate of Occupancy. _ (` .11 `y `- v ISSUED 3'14— �)LU agent Date Owner or authorisedTOTAL: OFFICE COPY