19581 POST THIS CARD NEAR FRONT OF BUILDING PERMITNO.
r _ 19581
i- CITY OF CUPERTINO A A A
INSPECTION DIVISION- JOB INSPECTION.RECORD
JOB ADDRESS o�� ? (—i=--1 e D ti` b UNIT# LOT# CATEGORY CONTROL a
OWNER tS �V' d� CONTRACTOR BUILDING PERMIT INFO
INSPECTION DATE INSPECTOR INSPECTION RECORD
FOUNDATION/PIERS NOTE:ALL GRADING AND DRNNAGE ON DESCRII ON
UFER GROUND SHALL BE INSTALLED TO COMPLY WITFI 1
PAD/SETBACK-CERT C�RTINOYSIDAPNDDARDS. CITY OF
GARAGE SLABS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB INSPECTION DATE INSPECTOR
PLUMBING
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION
PLACE NO SIIBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
ELECTRICAL ACUZZ113OND
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 LATIN/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 IINSPECTOR
SAN.#
ELECT.ENERGY
PLUMBING ENERGY
MECH.ENERGY
13UILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GAS TEST
MECHANICAL
HEATING
ELECTRICAL RELEASE
FIRE DEPT.
GRADE
OCCUPANCY
TEMPORARYAPPROVALS
ELECTRIC
GAS
BUILDING
OCCUPANCY OF BUILDING 1S NOT PERMITTED UNTIL 1 DATE
• BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN JAN 2 91990
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND citj of f 1inP►t[no
PERMIT# ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUED BY: V ' A �, T
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Fro'en Identification PER.WTNO.
Building Address:
19581
Hera ante: Phone: • p p A
i-111, Tr 73(,'327$' CITY OF CUPERTINO�BUILDING DIVISION C
c. m.Name LIc.N.: APPLICATION %PERMIT �— Z
Adft r a 3662 p 1 BUILDINGELECTRICATlPLUMBING-MECHANICAL CATEGORY CONTROL
ArcIter[/Englnee Llc.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
l
Address: S Q. W
PERMIT ISSUANCE ❑ ❑ _V ❑
LICENSED CD TR under SDECnsof Cl ON
IhthSyon7Olhatlamsic 3ofheBud rovandPffhms9 c,andn MI'hIANCESRESIDEN'I'IAL JOB DESCRUTION
inensei Sea[Ion force of Dlvect. ftheBusinnsand ProfeaslonsCode,and my
license is In full force and effect baa>� PANELS ^
License Ckm-t,-36 Lie.py-4_p=(9I (F'�) I'
Date 1 -161�a^,Jn Contractor �\aA,tl C
—T ARCHI=1 DECLARATION 201-10DOAMIS
ce0 Z I understand my plana shall be used as public records. OVER IOOO AMPS SQ.FT.FLOOR AREA $/SQ.Fr.
OCC
U Licensed professional SIGNS ELECTRICAL
<nt OWNER-BUILDER DECLARATION
Fd SPECIAL CII6CNT/MLSC
L., owing r afi n.(Sect on 7 31.5,B fromthe d professions
License Law for the
09:6 following reason.(Section 7Qi1.5,Businessand Pro(esslona Code:Any city or TEMPMETERORPOLEINST.
Wpp county which requlresa permit tomestruat,alter,Improve,demolkh,oreepair
.'tn anystructum priorto its tssuance,aiso requireatheapplicant forsuch permit to POWER DEVICES
F w file a signed statement that he k licensed pursuant to the provisions of the
Contractors License Law(Chapter 9(commencing with Section 7(K)())of LEA. SWIMMINCPOOLELECTRIC VALUATION
O don 3 ofthe Business and Professloes Coic)orthat he is exam therefromand
Y.'
the task for the alleged exemption. My violation of Sectio703L.5 by any OUTLETSSWITCHESFIXTURES
applicant fora permitsubje theapphcantloadvi1pemltyana neorethan
five hundred dollars($500). NEW RESIDENTIAL ELECTR
e$pt' SQ.PT. STORIES TYPE CONSTRUCTION
.-'fin ❑L as owner of the property,or my employees with wages as there sole
7 0 mmpemation,wha dothe k,and zea or
D sale(Sec.7064 Busie.and Professicurs,Code:The Contractors License Law _
docs not apply to an owner of property who builds or improves thereon,and OCC.GROUP RFS.UNITS
who doessuchwork himselforlhrough his own employees,provided that such
improvementsarenot Intended oroffer d forsals.If,howeveq thebuilding or TOTAL:
Improvement issold within oneyearofcompinion the owner-W Oderwiil have
the turden of proving that he did not build or improve for purpose olsakJ. QTY. PLUMBING PERMIT FEE FLOODZONEAPN
M 4 as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
mntract.n to construct the project(Sec 7044,Business and professions Code: ()
The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN kVENT-WATER(EN
Wilds or improves thereon,and who contracts for such Inejects with a FEE SUMMARY
c7N(actorse(a)licensed pursuant to the Contractor.License Law. BACK FLOW PROTECT.DEVICE
LJ I a n exempt under c. B A P C for this reasoneree
DRAINS FLOOR,EDGE,AREA,CONE. SANITARY Y_ N_
Owner Date RECEI T Y
WORKMAN COMPLNSATIONDECLARATION PC pIXT SpBR TRAP D,OD SCI l00L TAX Y_ N_
❑I hereby affirm that I have a certificate of consent to self-insure,ora RECER4 X
certificate o(Worken Comperualion lesuranm or a certified copy thereof(Sec. CAS EA.SYSTEM-I INC4 OUTLETS PARK FEE Y N
3800,Lb C.)
RECOPT
M
Polity p GAS E.A.SYSTEM-0VER 4 MA) BUILDING DI VISION FEES
Com any
eeffled copy k herebyfumiahed. GREASE/INDUSIRL WASTEIMFRCFPTOR PLANCHGCK FEE
crtNed copy is(Ikd with ted dty W pe tion division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.230Ff. Date Remi t#
(Thoseti.n need not be completedBthe permit kfor one hundred dollars
($1000orless.) WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_
I certify that in the performance of the work forwhlch this permit is issued,
I shall not employ any person In any runner so as to become subject to the WATER SYSTEM/TREATING
Worker!Compensation Lawsof Caftfomk.Date PAID
Z Z NOTICE TO APPLICANT:If,after making t his Certificate of Exemption,you licant NEW RESIDENTIAL PIMB. SQFT. Date Remi t#
O should become subject to the Workers Compensation provisoes of the Labor TOTAL:
N Code,you moat forthwith comply wlthsuch provisions mthis permit shall be --- BUILDING FEE
W j deemed revoked.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
ll � I hereby affirm that there Is a construction lending agency for the perform- TOTAL: 3'J .(1 ELECTRIC FEE
:3Z ane,of the work for which this permit k ee 3097,Civ.Q /�
02 lander,Name PLUMBING FEE Z vU
LLF Lender's Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
Q Iccrlfythatl have readthis application and sktethat the above Information
O LUiscorrect.I agree to comply with all city and county ordinances and orate laws PERMIT ISSUANCE F ESF�P},1ID;_O
>_
Mating tobullding construction,and hereby authorize repreaentatters.f this
I.- N city to enter upon the abovnmentioned property,for inspection purposes. ALTER OR ADD TD MECH.
? (We)agree to save,Indemnify an d keep harndess the City of Cupertino Date Receipt#
V ,,.inns Ilitlea,judgments,coslsand expenses which may in any way seems AIR HANDLING UNIT(TO 10,XX0 CFM) SUBTOTAL: at Do
agai i mait ���1�aa+n�tlegofmicepHANDLINGit'
AIR HANDLING UNIT(OVER IO,ODOCFM) CONSTRUCTION TAX
Signa a fA phcant/Contractor Date D(I-IAUS'r I IOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAIL ARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or hand le hacardous HEATING UNIT(TO 100,"BTU) Date Reeel t#
material as defined by the Cupertino Municipal Code,Chapter 9.1 2,and the -
Ilealthand Safety CedeSection 25532(a)I [MATING UNIT(OVER IOg000BTU) TOTAL: ].a OD
❑Yea M No
Will lheapplicant odours,building occupant useaqulpment or devices VFNMLATION FAN(SINGLE RFSID) IS5],12�JH11$DATE
which emit hazardous air cont¢cdnants as dented by the Bay Area Air t�''+'
Qua lity Ma nagemcet DLetrid2 BOILER-COMP(311P OR 100,000 BTU)
4Yrs N.
haveread the h amateriakrequirements under-Chapter 6.95of BOILER-COMP(OVER100'"BM) IAN O 1990
the Ulifomia Hmlth&Safety Code,Setions255P5,25533 and 25534. I d a/
understand that if the building does not currently have a tenant,that it kmy NEW RESIDENTIAL MECH. SQ.FT. p
responsibility to notify the ocmpa at of the requirements which must be met 4Cal Of C;IIM(�
prior to Issuance of a Centfiate of Occupancy. BU
Owner or authorized agent W to ISSUED BY: V CL(_
TOTAL:
OFFICE COPY
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NOISIAIO NOII33dSNI
ONI183dno 30 .1110