19620r
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTIIO� N DIVISIONJ- JOB INSPECTION RECORD
A ST
JOB ADDRESS IIX GY %7S`",+.L S UNIT # -LOT #
OWNER 0 L-tk ONTRACTOR 5,"A- L fie-.
PERMTT No.
19620
r` , d 1 (✓
CATFM4 y 'CONTROL
M
BUILDING PERMIT INFO
El ® El
INSPECTION.AJE NSPECTOR
N RECORD
'NOTE - A L G�RADINSPECTIONG AND DRAINAGE -
SHALL BE INSTALLED TO COMPLY KITH
.' THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
FOUNDATION PIERS
UFERGROUND I I
- JOB DESCRUMON "
-
_..- 7
/ /� i✓R / / !� ��
PAD/SETBACK-CERT
GARAGE SLA0.S PRECUNITE :
POUR NO CONCRETE UNTIL ABOVE HAS.BEEN SIGNED
UNDERGROUND SLAB
INSPECTION
DATE
INSPECTOR
PLUMBING "
ELECTRICAL
MECHANICAL
'DO•NO'AIP.OURIFLOOR, UNTIL ABOVE HAS,BEEN+`SIGNED""
r -
WOOD FLOOR
PLUMBING
'
MECHANICAL
ELECTRICAL -
• '
'
FRAMING VENTS CLEAR
INSULATION -
•I .b'AC-E,VNO.>SUBF- OOWU IL>AB'OVEV A•SIBEEM%SIG EDs
"
ROUGH
PLUMBING
9
'
TUBS & 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 I I
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
-
EXTERIOR LATH/W-SCREEN
SHOW ER LAT
_
SCRATCH COAT '
IWO'iTAPEIOR BLhSTER UNTIL ABOVE HAS BEEN SIGNED
NOTE: NO FINAL INSPECTION SIIALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE INSPECTOR
"
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
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL " • i "" ; � "` .. - _ ISS A gg ATE J
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR - 1 i'. Id (/ t'e J�g�
ARRANGE FOR INSPECTION BY PHONING 252.4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, 24 HOURS �. y ��IIPprtIRO
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT! ^
PLEASE RFAD REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSULDBY.`^
OFFICE COPY �, /'
APPLICANTT0 FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY ,Ij4
Building Pra'ect identification I
Building s 'kdP
PERMITNO.
19620
nen hen.:
u Sr,,/LE A-mp—s /00
CITY OF CUPERTINOQBUILDING DIVISION
APPLICATION / PERMIT
BUILDINGELECTRICAI PLUMBING -MECHANICAL
A
Z
Contractor's Name: Lic.Ner
5
CATF1'ARY
CONTROL#
Architect/Englruer. Lie. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address:
® ElLICENSED
PERMITISSUANCII
CONTRACTOR'S DECLARATION
Ih.rebyafflrm that l am licenced under provisions of Chapter 9(rommenc-
ingwllh SeRion7000)afDlvislon3ofthe Buslneeaand Professions[ndc, and my
B le In luRf and R(ect. `QQ l'�
License Claes full
2/ 4-'
Contrecror
ARCHITECTS DECLARATION
I understand my plans shall be used as public records.
Licensed Proressknsl
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law firths
following reason.eSeaton 70315, Business and Professions Cade: Any city or
which nary Ice a permit to construct, alter, improve, d ennikh, or repal r
anystrocture priorto its Iseuance, also regWresthe applicant for such permit to
file a signed statement that he Is Retooled pursuant to the provisions of the
Contractor's License Law (Chapter 9(comnameirg with Section 7000) of Divi-
sion3ofthe Budnemand Profealoru Code)orthathekemmpttherefmmand
the basisfor the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjecutheapplicant to a civil p.nalty of not moro Hun
five hundred dollars ($500). 1
❑I,a. owner ofthe property, or my employees with wages as their sale
compensation, will do the work, andthestructure Is not intended or offered for
sale (Sec 7064, Bu.buss and Pmfessums Code: The Contractor. License Law
does not apply to an owner of property who builds or improves thereaRand
does such work himself or through his awn employees, provided that such
improvements are not intended oroffered for sale. If, however, the building or
improvement ksrld within oneyearofecmplelion, the owner-builderwRl have
tir*rden of proving that he did not build or improve for purpose ofoak.).
L j I, as owner of the property, am exclusively contracting with licensed
contractors to mrutruct the project (Sm 7044, Business and Pro/eaeWns Code:
The Con rmtor's License Law does nae apply to an owner of property who
Wilde or improves thereon, and who contracts for for such pfojewith a
egn4actor(s) Ilmosed pursuant to the Contractors License Law.
L j I am exempt under Sea B h P C for this reason
- -El
APPLIANCESRESIDENTIAL
JOB D6- R8'7TON
PANELS
201-1000 AMPS
OVER 1000 AMPS
SQ. FT. FLOOR AREA
'
$/SQ. FT.
SIGNS ELECTRICAL
Sl+p-CULCIRCNT/MISE
'IEMP.MEfTR OR POLE ]NST. 0 as
POWER DEVICES
SWIMMING POOL ELECTRIC
_
OUTLETSSWITCHFSH)(TURES
VALUATION
NEW RESIDENTIAL ELECTR —SQ'Pf.
STORIES TYPE CONSTRUCTION
,
TOTAL:b0
QTY- PLUMBING PERMIT FEE
OCG GROIRa RES. UNITS
FLOOD ZONE MN
PERMIT ISSUANCE
ALTER -DRAIN AVENT- WATER H'N
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
nt]Tq[nP FF.
DRAINS FLOOR ROOF, AREA, CONTI.
SANITARY -Y_ N_
RECEBR' #
Owner Date
WORKMAN COMPENSATION DECLARATION
❑I herebbyy affirm that I have a certificate of consent to self-lnsur., or
cortificmeofWorken'CompensaflonInsuranre ora certified copy thereof (Sec.
3800jobC.)
N
pD(TURES PER TRAP
SCHOOLTAK Y_ N_ _
RFLFR'C tl
GAS EA. SYBTEM-1 INCA OUTLETS
PARK FEE Y N_
tl
RECRGAS
EA. SYSTEM -OVER 4 (EA)
Co11ry
Cm any -
DING Df
BUILDING DIVISION FE ES
copy is herebyth the cid.
Certified copy V (Ikd with lM city inspection division.
CERTIFICATE OF EX EMPTION FROM WOR KERS'
COMPENSATION INSURANCE
RhlsseRlon need net W completed R[W permit blarom hundrtd dollars
($100).shus.)
I cortlfylhat In the perfomunceof the work forwhich this permit is issued,
1 *hall not employ any person in any runner an u to become abject to the
Wmi,crs'CompensC
atlon toward Ifarnk. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
.hold become subject to the Workers' Compensation provisions of the Labor
Code, you moot fart hwlth comply with etch provbiom or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency forthe perform
arm of the work for which this permit k lowed (Sec. 3697, Civ. C.)
Le
Leder'* Name
Lander'.Addre..
I ceridylhatl have read thisappRcalion and slatethattheabove information
tommn. l agree to comply with all cltyand county ordinances and shale laws
relating to building construction, and hereby authorize representative ofthis
city to enter upon the abovcmenlioned property for inspection purposes.
(We) agree to save, Indemnify an d keep hamdess the City of Cupertino
against lkbilltlea,judgment., colla and expenses which may In anywayamue
against said City In conecryence of the granting of this permit
GREASE/WDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
PAID
Date Recei t#
GREASE TRAP
SEWRR-SANII.ARY.STORM EA 20oPr.
WATER HEATER w/VENr/ELECTR
ENERGY FEE Y N
PAID
Date Recei t#
WATER SYSTEtd/TREATING
NEWRESIDENTIALPLMB. SOFT.
-
TOTAL:
13UILDING FEE
TOTAL:
SEISMIC FEE 1'
ELECTRIC FEE
on MECHANICAL PERMIT FEE
PERMIT ISSUANCE
PLUMBING FEE
MECHANICAL FEE
FEES PAID:
ALTER OR ADD TO MECH.
Dale Recei t#
P
AIR HANDLING UNIT CFO 10,ODO CFM)
SUBTOTAL:
AIR HANDLING UNIT (OVER 10,000 CFM)
CONSTRUCTION TAX
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Hkallh and Safety Code &Rion 2SD2(a)?
RYe. No
111thc applicant or .Wilding occupant use equipment or device.
which emit hazardous air cents edranta as defined by the Bay Area Air
Quality Management District?
M Yes No
have lead the Fara oetsymaleria requbements under Chapter 6.95 of
the California Health k Sid Code, Sections 25505,75533 and 25534. 1
understand that lithe Wlldingdoes not currently have a tenant, that it B my
reponsi ty to notify the occupam of the requirements which must be nue
prion n ora Certificate of octvp.rcy. �T �j
C J �J.C.�C.✓LA� —2 x— D
—went
EKHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
.
HEATING UNIT (TO 100,000 BTU)
Date Recei-t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VENIILATION FAN (SINGLE MID)
ISWANCE DATE
"0 19%
q J
^ /a
city nt.1 ur)�Ti'inN
ISSUED I
BOR.ER-COMP (3HP OR 100,000 BTU)
BOILER -COMP (OVER 100,000 BTU)
NEW RESIDENTIAL MECH. SQ.FT.
�eerrmaulhori Date
TOTAL:
OFFICE COPY p �J
r
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTIIO� N DIVISIONJ- JOB INSPECTION RECORD
A ST
JOB ADDRESS IIX GY %7S`",+.L S UNIT # -LOT #
OWNER 0 L-tk ONTRACTOR 5,"A- L fie-.
PERMTT No.
19620
r` , d 1 (✓
CATFM4 y 'CONTROL
M
BUILDING PERMIT INFO
El ® El
INSPECTION.AJE NSPECTOR
N RECORD
'NOTE - A L G�RADINSPECTIONG AND DRAINAGE -
SHALL BE INSTALLED TO COMPLY KITH
.' THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
FOUNDATION PIERS
UFERGROUND I I
- JOB DESCRUMON "
-
_..- 7
/ /� i✓R / / !� ��
PAD/SETBACK-CERT
GARAGE SLA0.S PRECUNITE :
POUR NO CONCRETE UNTIL ABOVE HAS.BEEN SIGNED
UNDERGROUND SLAB
INSPECTION
DATE
INSPECTOR
PLUMBING "
ELECTRICAL
MECHANICAL
'DO•NO'AIP.OURIFLOOR, UNTIL ABOVE HAS,BEEN+`SIGNED""
r -
WOOD FLOOR
PLUMBING
'
MECHANICAL
ELECTRICAL -
• '
'
FRAMING VENTS CLEAR
INSULATION -
•I .b'AC-E,VNO.>SUBF- OOWU IL>AB'OVEV A•SIBEEM%SIG EDs
"
ROUGH
PLUMBING
9
'
TUBS & 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 I I
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
-
EXTERIOR LATH/W-SCREEN
SHOW ER LAT
_
SCRATCH COAT '
IWO'iTAPEIOR BLhSTER UNTIL ABOVE HAS BEEN SIGNED
NOTE: NO FINAL INSPECTION SIIALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE INSPECTOR
"
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
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL " • i "" ; � "` .. - _ ISS A gg ATE J
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR - 1 i'. Id (/ t'e J�g�
ARRANGE FOR INSPECTION BY PHONING 252.4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, 24 HOURS �. y ��IIPprtIRO
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT! ^
PLEASE RFAD REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSULDBY.`^
OFFICE COPY �, /'
APPLICANTT0 FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY ,Ij4
Building Pra'ect identification I
Building s 'kdP
PERMITNO.
19620
nen hen.:
u Sr,,/LE A-mp—s /00
CITY OF CUPERTINOQBUILDING DIVISION
APPLICATION / PERMIT
BUILDINGELECTRICAI PLUMBING -MECHANICAL
A
Z
Contractor's Name: Lic.Ner
5
CATF1'ARY
CONTROL#
Architect/Englruer. Lie. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address:
® ElLICENSED
PERMITISSUANCII
CONTRACTOR'S DECLARATION
Ih.rebyafflrm that l am licenced under provisions of Chapter 9(rommenc-
ingwllh SeRion7000)afDlvislon3ofthe Buslneeaand Professions[ndc, and my
B le In luRf and R(ect. `QQ l'�
License Claes full
2/ 4-'
Contrecror
ARCHITECTS DECLARATION
I understand my plans shall be used as public records.
Licensed Proressknsl
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law firths
following reason.eSeaton 70315, Business and Professions Cade: Any city or
which nary Ice a permit to construct, alter, improve, d ennikh, or repal r
anystrocture priorto its Iseuance, also regWresthe applicant for such permit to
file a signed statement that he Is Retooled pursuant to the provisions of the
Contractor's License Law (Chapter 9(comnameirg with Section 7000) of Divi-
sion3ofthe Budnemand Profealoru Code)orthathekemmpttherefmmand
the basisfor the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjecutheapplicant to a civil p.nalty of not moro Hun
five hundred dollars ($500). 1
❑I,a. owner ofthe property, or my employees with wages as their sale
compensation, will do the work, andthestructure Is not intended or offered for
sale (Sec 7064, Bu.buss and Pmfessums Code: The Contractor. License Law
does not apply to an owner of property who builds or improves thereaRand
does such work himself or through his awn employees, provided that such
improvements are not intended oroffered for sale. If, however, the building or
improvement ksrld within oneyearofecmplelion, the owner-builderwRl have
tir*rden of proving that he did not build or improve for purpose ofoak.).
L j I, as owner of the property, am exclusively contracting with licensed
contractors to mrutruct the project (Sm 7044, Business and Pro/eaeWns Code:
The Con rmtor's License Law does nae apply to an owner of property who
Wilde or improves thereon, and who contracts for for such pfojewith a
egn4actor(s) Ilmosed pursuant to the Contractors License Law.
L j I am exempt under Sea B h P C for this reason
- -El
APPLIANCESRESIDENTIAL
JOB D6- R8'7TON
PANELS
201-1000 AMPS
OVER 1000 AMPS
SQ. FT. FLOOR AREA
'
$/SQ. FT.
SIGNS ELECTRICAL
Sl+p-CULCIRCNT/MISE
'IEMP.MEfTR OR POLE ]NST. 0 as
POWER DEVICES
SWIMMING POOL ELECTRIC
_
OUTLETSSWITCHFSH)(TURES
VALUATION
NEW RESIDENTIAL ELECTR —SQ'Pf.
STORIES TYPE CONSTRUCTION
,
TOTAL:b0
QTY- PLUMBING PERMIT FEE
OCG GROIRa RES. UNITS
FLOOD ZONE MN
PERMIT ISSUANCE
ALTER -DRAIN AVENT- WATER H'N
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
nt]Tq[nP FF.
DRAINS FLOOR ROOF, AREA, CONTI.
SANITARY -Y_ N_
RECEBR' #
Owner Date
WORKMAN COMPENSATION DECLARATION
❑I herebbyy affirm that I have a certificate of consent to self-lnsur., or
cortificmeofWorken'CompensaflonInsuranre ora certified copy thereof (Sec.
3800jobC.)
N
pD(TURES PER TRAP
SCHOOLTAK Y_ N_ _
RFLFR'C tl
GAS EA. SYBTEM-1 INCA OUTLETS
PARK FEE Y N_
tl
RECRGAS
EA. SYSTEM -OVER 4 (EA)
Co11ry
Cm any -
DING Df
BUILDING DIVISION FE ES
copy is herebyth the cid.
Certified copy V (Ikd with lM city inspection division.
CERTIFICATE OF EX EMPTION FROM WOR KERS'
COMPENSATION INSURANCE
RhlsseRlon need net W completed R[W permit blarom hundrtd dollars
($100).shus.)
I cortlfylhat In the perfomunceof the work forwhich this permit is issued,
1 *hall not employ any person in any runner an u to become abject to the
Wmi,crs'CompensC
atlon toward Ifarnk. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
.hold become subject to the Workers' Compensation provisions of the Labor
Code, you moot fart hwlth comply with etch provbiom or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency forthe perform
arm of the work for which this permit k lowed (Sec. 3697, Civ. C.)
Le
Leder'* Name
Lander'.Addre..
I ceridylhatl have read thisappRcalion and slatethattheabove information
tommn. l agree to comply with all cltyand county ordinances and shale laws
relating to building construction, and hereby authorize representative ofthis
city to enter upon the abovcmenlioned property for inspection purposes.
(We) agree to save, Indemnify an d keep hamdess the City of Cupertino
against lkbilltlea,judgment., colla and expenses which may In anywayamue
against said City In conecryence of the granting of this permit
GREASE/WDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
PAID
Date Recei t#
GREASE TRAP
SEWRR-SANII.ARY.STORM EA 20oPr.
WATER HEATER w/VENr/ELECTR
ENERGY FEE Y N
PAID
Date Recei t#
WATER SYSTEtd/TREATING
NEWRESIDENTIALPLMB. SOFT.
-
TOTAL:
13UILDING FEE
TOTAL:
SEISMIC FEE 1'
ELECTRIC FEE
on MECHANICAL PERMIT FEE
PERMIT ISSUANCE
PLUMBING FEE
MECHANICAL FEE
FEES PAID:
ALTER OR ADD TO MECH.
Dale Recei t#
P
AIR HANDLING UNIT CFO 10,ODO CFM)
SUBTOTAL:
AIR HANDLING UNIT (OVER 10,000 CFM)
CONSTRUCTION TAX
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Hkallh and Safety Code &Rion 2SD2(a)?
RYe. No
111thc applicant or .Wilding occupant use equipment or device.
which emit hazardous air cents edranta as defined by the Bay Area Air
Quality Management District?
M Yes No
have lead the Fara oetsymaleria requbements under Chapter 6.95 of
the California Health k Sid Code, Sections 25505,75533 and 25534. 1
understand that lithe Wlldingdoes not currently have a tenant, that it B my
reponsi ty to notify the occupam of the requirements which must be nue
prion n ora Certificate of octvp.rcy. �T �j
C J �J.C.�C.✓LA� —2 x— D
—went
EKHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
.
HEATING UNIT (TO 100,000 BTU)
Date Recei-t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VENIILATION FAN (SINGLE MID)
ISWANCE DATE
"0 19%
q J
^ /a
city nt.1 ur)�Ti'inN
ISSUED I
BOR.ER-COMP (3HP OR 100,000 BTU)
BOILER -COMP (OVER 100,000 BTU)
NEW RESIDENTIAL MECH. SQ.FT.
�eerrmaulhori Date
TOTAL:
OFFICE COPY p �J