196390
•
•
POST THIS CARD NEAR FRONT OF BUILDING
if
CITY OF CUPERTINO
INSPECTION DIVISION - JOB INSPECTION RECORD
JOB ADDRESS �j��-5� �'/i�l�r UNIT # LOT #
OWNER CONTRACTOR C%
PER.MITNO.
19639
A
-)-^. O - -,/o
CAncoav
CONTxOL 0
BUILDING PERMIT INFO
INSPECTION DATE INSPECTOR
INS ECTION RECORD
NOTE ALL GRADING AND DRAINAGE
SI LILL BE INSTALLED TO COMPLY VATH
THE APPROVED PLANS AND CITY OF
CIIPERTINO STANDARDS.
Ld
FOUNDATION/PIERS
UFERGROUND
JOB DESCMI.11ON
PAD/SETBACK-CERT
GARAGE SLABS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
INSPECTION
DATE
INSPECTOR
UNDERGROUND/SLAB
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
TU13S & SHOWER PAN
MECHANICAL
ELECTRICAL/JACUZZI 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
w
SHOWER LATH
SCRATCFI 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
PLUM 131NG ENERGY
MECH. ENERGY
13UILDING ENERGY
ELECT. FINAL TEST
PLUMBING
GAS TEST
MECHANICAL
HEATING
ELECTRICAL RELEASE
HRE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING - ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMUTED UNTIL
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR C'
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 IISSUED BY:, 'l
OFFICE COPY
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification
PERMIT NO.
Bulkjing Address:
M44117'01
19639
Owner's Phone:
Ar Pew ",y /
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BUILDINGELECTRICALPLUMBINC-MECHAMCAL
p p
h Q
C
n O
CATEGORY
CONTROL"
ArchRM/Engineer. Lic. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address
PERMITISSUANCE .Z.DD
❑ � ❑ ❑
LICENSED CONTRAROr DECLARATION
I hereectionrm that I am pr
MPLIANCESRESIDENML
JOB DESCRII'I'ION
PANELS
UP TO 2DOAMM
ingwft]Joe..h to to. efeon3otthe Businesaand ProlesionaCode, and my
license la In fuB Toren and effect.
License Cl —/� Lie"__%y($%
Date Cuomo,o7 t�n�E�f�' -
ARCHITECT•SDECLARATION
I understand my plamshall be used as public records.
20140DOM"[PS O
OVER1000AMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
SPECIALCIRCUIT/MISC
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law fee the
TEMP. METER OR POLE INST.
•a
POWER DEVICES _ 7C
following reason. (Section 7(13 1.5, Business and Professions Code: Any city or
countywhich requiresa permit reconstruct, alter, improve, demolish,or repair
anystructum priorto its issuance, also requlresthe applicant for such permit to
filo a signed statement that he Is licensed pursuant to the providers of the
SWAI1v9NG POOL ELECTRIC
Contractors License Law (Chapter9 (commencing with Section 7000) of Divi-
slon3 ofthe Buslnessand ProfessionsCode) orthat he is exempttherefromand
VALUATION
the basis for the alleged exemption. Any violation of Section 70315 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
t)- OUTT,E'ISSV✓ITCFIESFl%TURES �y�
4
five hundred delta. (5500).
❑ I, as net of the property, or my employees with wages as their sole
NEW RESIDENTIAL ELECTR SQFI.
STORIES
TYPE CONSTRUCTION
compensation, will dothe work and the structure Isnot intended or offered for
sale (Sec. 7046, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who Wilda or improves thereon,and
whodoesuchwork hlmseRorthrough hiaownemployms, provided that such
Improvements are not Intended oroffered forsals. If, hnweveq thebuilding m
OCC.GROUP
RFS. UNITS
M
TOTAL: . W
Improvement Issold withmoneyearofcompletter,the, owner-bullderwlll have
tFTsburden of proving that he did not build or improve for purpose of sale.).
LJ S as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec 7044, Business and Professions Code:
QTY. PLUMBING PERMIT FEE
FIADDZANE
APN
PERMIT ISSUANCE
Tire Contractor. License Law does not apply to an owner of property who
Wilda or Improves thereon, and whocontracts for such piojecte with a
"q➢!(actor(s) licensed pursuant to the Contractor's License Law.
LJ I am exempt under Sec. B & P C for this reason
ALTER -DRAIN& VENT- WATER (EA)
FEE SUMMARY
BACK FLAW PROTECT. DEVICE
OUTSIDE FEES
DRAINS FLOOR ROOF, AREA, CONTI.
SANITARY Y_ N_
RECEIPT 0
Owner Date
WORKMAN COMPENSATION DECLARATION
hereby affirm that 1 have a cartlficate of consent to self -Insure, ora
certificate of Workers Compensation Insurance or a certified copythereof(Sec.
3800, LabQ
Pe. 9906S3
WXTlIRFS PER TRAP
SCHOOLTAX Y_ N—
RECED'f a
RECEIPT
GAS EA.SYSTEM-1 INCA OUTLETS
PARK FEE Y N — .
Rim "
Polley"
Cam anv L,Out .i /_I! �i./
GAS EA. SYSTEM -OVER 6 (EA)
BUILOI\CDIVISIONFEES
❑Certified copy is hereby furnished.
fJl Certified copy is tiled with the city inspection division.
Yk'
GREASE/INDUSTAL WASTE INTERCEPTOR
PLANCHECK FEE
GRE-ASE7RAP
CERTIFICATE OF O(EMPFION FROM WORKERS'
PAID
SEWER -SANITARY -STORM EA 200E 1'
COMPENSATION INSURANCE
(This section need not M completed lithe permit Is fm mm hundred dollars
($100)mless.)
I cenifythat in the performance of the work fmwh1ch this permit Is usund,
DaIC RCCCI [M
WATER HEAT'FRW/VENT/ELECTR
ENERGYFEE Y_ N_
WA.IL[tSYSIIM/TREATING
I shall net employ any person In any manner an as to become subject to the
Workms Compcnsatlon Laws of Calffornia. Date
PAID
NEW RESIDENTIAL PLMB, SQ.PT.
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Wmi,eWCompensatlon provisions of the Labor
Date Recei til
TOTAL:
BUILDING ••E
Code, you at forthwith mm ply with such provisions or this permit shall be,
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
I herebyafftrmthm there Is a construction lendingagency forthe perform,
ance of the work for which this permit is Issued (Sec. 3097, Civ. C.)
Lenders Nacre
]enaera Aaaress
TOTAL:
ELECTRIC FEE
PLUMBING FEE
OTT' MECHANICAL PERMIT FEE
MECHANICAL FEE
- I certifythat l have read this applicationand statethat the aboveinformation
is correct.I agree to comply with all city and county ordinances and nate laws
PFRMITISSUANCE
FEES
relating to building construction, and hereby authmbm representatives of this
city to enter upon the above-mentioned property for inspection purpose.
floe) agree to save, Indemnify an d keep harmless the City of Cupertino
abilitlm, pdgmema, sande nm wh ch may in any way cera.
ALTERORADDTOMECH.
(% S 412 �f
Date Receipt#
AIR HANDLING UNIT (TO 10,000 CFMI
SUBTOTAL:
Incon n ofth gr lingo 1 It.
AIR HANDLING UNIT(OVER 10,000 CPN)
CONSTRUCTION TAX
V-11idCity
of Applicant ontract to
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HA7 ROOUSMATERIA SDISCLOSURE
e applicant orfuture building occupant store or handle hazardous
HEATING UNIT(TO IDQ000 BTU)
Date Recei ted
s defined by the Cupertino Municipal Code, Chapter 9.12, and the
Ilmhh and SafetyCode SMiun 25532(a)?
❑ Ym M No
Will theapplicam or future building occupant use equipment ordevlces
HEATING UNIT (OVER IOQ000 BTU)
TOTAL:
VENTILATION FAN (SINGLE RFSID)
ISSUANCE DATE
which emit to rarciom air mntan nants as defined by the Bay Area Air
Qu hty Management District?
4Y% n No
had the haza ous materials requlrcments underChapter 6.95 of
77
BOILER -COMP OHI' OR 100,000 BTU)
BOILER-COMP(OVER100,ODO BTU)
(he California Health & Safety Code, Sections 25505, 25573 and 25534. I
u ndenda cad that if the building does not m rrently have a tens nL that it is my
NEW RESIDENTIAL MECH. SQFF.
'bilityWrotifytheocco ant o(the of which most be met
prior to suanceof a Certificate mu u
ISSUEDB
n nor authodud ager Da
TOTAL:
OFFICE COPY v