19553 POST THIS CARD NEAR FRONT OF BUILDING PER•MITNO.
CITY OF CUPERTINO 19553
A
INSPECTION DIVISION- JOB INSPECTION RECORD
`JOB ADDRFSS�
_ /7 7� rYJO�✓�COV�/9 UNIT q- LOT# CATEGORY CONTROL
OWNER CONTRACTOR - BUILDING PERMIT INFO
INSPECTION DATE JINSPECTOR INSPECTION RECORD
FOUNDATION PIERS NOTE ALL GRADING AND DRAINAGE
LIFERGROUND SHALL BE INSTALLED TO COMPLY WITH JOB DESCRII'DON
PAD/SETBACK-CERT THEAPPROVEDRTISTANMANSRDS. CITY OF
CIJ['EIiTINO STANDARDS.
GARAGE SLABS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED INSPECTION
UNDERGROUND/SLAB 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 SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROUGH
PLUMBING
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
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR -
EXTERIORLATII/W-S REEN
SHOWER LATH
SCRATCH COAT
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE '
THE CONSTRUCTION TAX 15 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 ISSUANCE DATE
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN PAM
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING.
IMPORTANT! "Y r s C/l n 'ry0
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEDBY �
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
BnBd dsreys oAt9ov A 19553
rs date: Phone: A
5 -, .� q �. 253—�� CITY OF CUPERTINO-BUILDING DIVISION
Contractor's N : Lm.No: APPLICATION /PERMIT
BUTLDINGELECTRICAT PLUMBING-MECHANICAL CAT-GORY CONTROL
A hltect/Engineer. Llc,No:
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Address: PERMITISSUANCE ® 1:1 ® ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provIsimA0fChapter9(mmmenc APPLIANCESRESIDENTIAL JOB DESCRIPTION
Ingwith Se Uon7000)of Dlvlelon3o(1he Buslnenand ProlesntoruGoaeand my
Iiceman la In full f and effect. t� PANELS
License Ctss Lk.M 9r yM.M�O f7�yYr( 'C;�
Dale Contractor .ft}7Q7! � UPT02DOANTS
ARCHITECTS DECLARATION IIfY tL�• 201-10DOAMPS
aO z
p l understand my plans.hall be used as public records. OVER I ODO AMPS SQ.FT.FLOOR AREA $/SQ.FT.
hi o(/ Licensed Professional - SIGNSELECTRICAL
<a: OWNER-BUILDER DECLARATION SPECIALCIRCUIT/M1.9C
Z f,YAa (hereby affirm that l am exempt from the Contractor's License Lew for the
oo folkwtg
Section 70315,Huntress and Pnefessiorn Code:Any city or
O Z.. TEMP.METER OR POLE INST.
K� countywhich rcqulroapermi[tomnstrucl,ilter,Impmve,dertnWh,orrepalr
anystruRure pdortolta Issuance,alorequiresthe applicant for such peernitto POWER DEVICES
rNE file a signed statement that he Is licensed pursuant to the provislom of the
O w Contractor's Licerue Lew(Chapter 9(co.rcing with Section 7000).f Divi.
SWIMMING POOL ELECTRIC
Or^ tlo3
nofthe Buslneuand Profeniom Code)orthat he is exempt therefemand VALUATION
5yyf�05 Q the basis for the alleged exemption. Any violation of Section 71131.5 by any O U
O OU77"ETSSW[TCfiFSFI%711RE5
applicant ora permit subjects the applicant to a civil penalty of not nre than
room OAU
fivehundred dollars(¢5007.
❑ NEW RESIDENTIAL ELECTR__SQ,PI',
�n I,as owner of the property,or my employees with wages as their sole IES TYPE CONSTRUCTION
compensation,will do the work and the structure is not Intended or offered for
5.90 mak(S.70K Buslnan Professima Code;Th.Cordract e.License Lew
T/ R doer not apply to an owner of property who builds or improves thereon,and OCC.CROUP RFS.UNITS
CC who doeseuch work hlmselfwra
lhugh his own employees,provided that such
Improvement are nat Intended oroffemd fw uie.If,however,the buildingor TOTAL:
improvement 6wid within amyearofcompletlon,the owner-bullderwlll have
thii burden of proving that he did not build or Improve for purpose ofsale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
E][as owner of the property,am exclusively contracting with licensed pgg7,IlT 1 CE
contnctora to construct the project(Sm 7011,Business and Pro(realom Code: /1,00
The Contractor's License Lew does not apply to an owner of property who ALTER-DRAIN kVENT-WATER(EA)
Wilds or Improves thereon,and who contracts foe such p(ujecte with a
cgB(Tactorts)licensed pursuant to the Contncmr'a Ltcenx Lew. BACKFLOW PROTFLT.DEVICE FEE SUMMARY
LII am exempt under Sec. B k P C for this reasonOUTRIDE
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N_
Owner Data RECEIPT 1
WORKMAN COMPENSATION DECLARATION FD(TURFS.PER TRA 2 SCHOOL TAX Y N
MI hereby affirm that I have a certificate of consent to seythe of ora 1 W RECEIPT N
3800 Lab ofWorkers'Compematlrnlnuranceoracertlfkd copythemof(Sec. GAS EA.SYSTEM-1 INCAODTLE75
3801[46 CJ ` PARK FEE Y_ N_
Pollrya G 2UfZiS��6 AF7CEI'TB
Co. an _ !J GAS EA.SYSTEM-OVER4(EA)
Y BUILDING DIVISION FEES
Certified copy Is hereby tid. GRFASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
�Certlfied copy t filed withh the the city inspection division.
CERTIFICATE OF FREMPTION FROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCE SEWEI-SANITARY-STORM EA.200FT. Date Recel tN
(Thlesection need nut be completed if the permit t Is(Drone hundred dollars
($100)or leu.? WATER HEATER W/VENT/FI FI`TR ENERGYFEE Y N
I comlythat in the performance of the work for which this pemJt is Wued, —
I shall not employ any person in any manner an as to become subject to the WATERSYSTEM/TREATING
Workers'Comperutkr Lew.of California.Data PAID
ZZ Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Recei HI
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you
Hshould become.ubject to the Workera Compensation provisions o(the Labor TOTAL:
N Code,you must forthwith complywlthauch provisions orthis permit shall be
W y deemed revoked. UG ELE
1 G CONSTRUCTION LENDING AGENCY _ SEISMIC FEE
Thercbyafflmrthattheretecontmctlon leadingagencyforthe perform TOTAL: ELECTRIC FEE
Z ....(the work for which this permit Is Issued(Sec.3097,Civ.C.7 O
eu O Lender'.Names ' PLUMBING FEE
O
LL F Lcnder'sAddrem QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW Icertltythatlhave read thisappBcalknand kaMthatthe above lnformutlan
S iscorrect.l agrettocomplywith allcityand countyordinancesand statelaws PERMIT ISSUANCE FEES PAID:
). N misting tobullding construction,and hereby authorlae representatives of this -1y-4V
Z city to enter upon the abovcmentiuned property for inspection purposes. ALTER OR ADD TO MECH. Date Recei IN
V — (We)agree to move,IndenW(y an d keep hamdees the City of Cu Perrino
against liabilities,P dgments,costs and expenses which may In any way aceme AIR HANDLING UNIT(TO I BODO CFM) SUBTOTAL:
ASA that mid City In conuquence of the granting of this permit.
AIR HANDWNG UNIT(OVER lO,OW CFM) CONSTRUCTION TAX
Slgnatureof Applicant/Contractor Date EKHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Willtheapplica rat orfuham budding occupant store or handle haaardoun HEATING UNIT 7710 I OO,ODO BTU) Date RBCEI tN
material as defined by the Cupertino Municipal Code,Chapter 9.1$and the
Health and SafetyCade Section25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: 67.J`9'D
❑Yes &ff No
Will the applicant&It building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air contanurants as defined by the Bay Area Ate n
Quality Management District? BOILER-COMP DH POR 700,0(0 BTU) �.
4Yea mad the eN.o
havcniaHeath&SlafetyCde,Sercqusmment5533anChapter 6.95of BOILER-COMP(OVER 100,000 OTU)
the California Health bSa(ety Code,Sections 755 te.nd25831.1 j11-;1 Fez J 1:'
understndlhaUfthebullding does Trot corrcntlyments tenan[that I.met NEW RESIDENTIAL METH. SQ.FI
Frio lb ndltythe occvpa of the torments which at he met
pdorl nu o(eCe at C;tt Tao MIT'nrtmQ
Owkr?,autfurrimd Date ISSUEDBY:
TOTAL:
OFFICE COPY