19385 POST THIS CARD NEAR FRONT OF BUILDING. PM- wT NO.-
19385
CITY OF CUPERTINO . A A
INSPECTIO VISION-') B INSPECTION RECORD ✓,. .� I'
JOB ADDRESS �• '/'n -UNhA
LO # CA RY CONTROL M
BUILDING PERMIT INFO
OWNER CONTRACTOR
INSPECTION DATE' INSPECTOR ON RE RD'. TTI/f� ❑.+'
FOUNDATION/PIERS - NDINCAND RAINAGE '�-
UFERGROUND SLLEDTOC MPLYMI IOBDESCRIPITON
77iE APPROVED PLANS AND CITY OF J
PAD/SETBACK-CERT CUF=NOSANDARDS.,
GARAGE SLABS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED B INSPECTION DATE INSPECTOR
UNDERGROUND/SLA
PLUMBING
ELECTRICAL
MECHANICAL - -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ -
WOOD FLOOR
PLUMBING
-
MECHANICAL
ELECTRICAL
FRAMING VFNTS CLEAR
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING ,
TU13S&SHOWER PAN -
MECHANICAL
ELECTRICAL ACUZZI 13OND
FRAMING STAIRS ;Iltom yus -
INSULATION/VENTILATION - -
EMERG.EGRESS
iSEWER WATER
iCOVER.NO WORK UNTIL ABOVE HAS BEEN SIGNED - -
EXTERIOR SHEAR" HO"DOWN .
-
INTERIOR SHEAR/HOSHEETROCK/SHEETREXTERIOR LATH/W-SCSHOWERLATH ..
SCRATCI I 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 - - -
PLUMBING ENERGY '
MECH.ENERGY �-
BUILDING C•NBRGY - _ -
- ELECT'.FINAL TEST
PLUMBING . -
GAS TEST '
MECHANICAL
HEATING
ELECTRICAL RELEASE
11 RE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS - -
ELECTRIC -
GAS - -
BUILDING ISSUANCE DATE'
OCCUPANCY OF BUILDING IS NOT PERM- D
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR - PAID
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN �!
12:30 PM ANDA:30 PM MONDAY THROUGH FRIDAY,24 HOURS u
BEFORE REQUIRED INSPECTION. JOB ADDRESS-AND „
PERMIT # ARE NEEDED WHEN PHONING. pjrl r'^nnvjPO
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUED BY.
OFFICE COPY �'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY /
Building Prate Identification 7 I'IRYITNO.
Ball �giAddres,:? � ,ej0 AJ
19385
Ownerjme: honeA ` A A L
2S3- CITY OF CUPERTINO-BUILDING DIVISION -
Ca tracta�N1
N — ,.X 46 5 1 /No, APPLICATION PERMITAdlbk Gnr�Coa CONTROLN
b BUILDING -PLUMBINGMECHAMCAL
Architect/En Lic.No:
------ A?,V+q 3 - QTY � ELECTRIC PERMIT' FEE BUILDING PERMIT INFO
Address: PERMITISSUANCE PLUMB M�"
❑ ❑
CONTRACTOR'SLICENSED under DEC RATION
I lath bdifbm ).f vsi=3 dheBusi .alora,of Chapter9(commenc APPLIANCESRESIDENI'IAL JOB DESCRB'1lON
Ingwllh .full 9(100)f foul
efslon3 ofthe Bu,Ineseand Pr$(evlonsCode,and my -
licensIsInfou dd effect. , 0(0 PANELS
License Cla LI[.N 7
Date ContractorUP10200AMPS
ARCHITECTS DECLARATION XII-1000A.MPS
o4z (understand my plansshalbe used upubtic records, OVERIOOOAMPS SQ.Ff.641 $/SQ.Fp.
HE Licensed Professional SIGNS ELECTRICAL
z
1n<<nt OWNER-BUILDER DECLARATION -
°N
t", anSPECIAL CItCU1T/MISC
nnthtlamfromtheCoactr'sLfcenssLawfothe
7ofolowingre"on(Seaton9031-5,Businessand ProfessionsCode:AnydtyorMq ,
'
TMP,METERORPOLEINSI'.
�
countywhlchrequlre,aper tWmms d,alteplmprove,demolish,ormpair
�4p�:I anystrudurepdortoIts essuance,alaorequirestheapplfcantforsuchperMtto POWER DEVICES ,
file a signed statement that he Is licensed pursuant to the provisions of the
&3 1 Contractor'sLicense Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOLELECTRIC, VALUATION
O sfon3 ofthe Business and Professions Code)orthat he Is exempt therefconand
the basis for the alleged exemption. Any violation of Section 7m I.S by any OUTLETSSWITCFIESFIXTURES -
1r5, <� applicant fora permit subjects the applicant to a dvil penalty of not more than alw
p, five hundred dollars($500). NEW RESIDENTIAL ELECTRSQFr.
❑I,as owner of the property,or my employees with wage as their sok SI ES TYPECONSTRUCTION
F] compenwtice,wfll dothe work and thestwcture Is not intended or offeredfor
P p
sale(Sec.7044,Business and Professions Code:The Contractor's License law
j$ doa not apply to an owner of property who Wilds or Impresses thereon,and OCC.GROUP RF5,13NIT5
who does such work himself or through hlsown employees,provided that such
improvements arc not intended or offered for sale.If,however,the building or TOTAL:
Improvement Is sold within one yearofewnpldbn,the owner-bu(der will have -
t"eden of proving that he did not Wild or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD LANE APN
Ll L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contractors to ce.tmct the project(Sec 7006,goal..and Pt fevbns Code:
The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER[EA)
Wilds or Improves thereon,and who contracts for such p(ojeds with a
Oq�[+ xetor(s)licensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
LJ I am a empt under Sec. B& so
P C for this reanOUTSIDE I FES
DRAINS FLOOR,ROOF,AREA,CONT). SANITARY Y N
• Owner Date RECEIVEN
WORKMAN COMPENSATION DECLARATION 1T cruRE5-PER TRAP SCHOOLTAX Y_ N—
RECEIPT hereby affirm that I have a certificate of consent to self-Insure,or a RECEIPT N
cedtficateo(Workers'Commpernattn(I / /lecurpyq�yyra a rtBicdmre
pytheof(Sec.
3800,Tal,C.I 7 CAS EA.SYSTEM-1 INC.6OUTLETS PARK FEE' Y N
b / G - —
RECEPI N
Policy a
Cng_ GASYSTEM-OVER 4(EA) BUILDING DIVISION FEES
Cc fG'`/
S F.A.
CertlEed<op she mished. GRPASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
Pic"A led copy is filed with the city I mpedion division.
CERTIFICATE OF IXEMPFION FROM WORKERS' GREASE TRAP _ PAID _
COMPENSATION INSURANCE " SEWERSANHARYSRTRM EA 2f%IIPI. Date' Reeei t#
(this section need not be completed B the permit b,forons hundred dollars
(S1 W)or lcu.I WATFRFIGTERW/VENT/ELECTR ENERGYFEE Y_ N_
I certify that In the performance of the work forwhlch this permit 1s Issued,
I shall not employ any person In any manner so as to become subject to the WATEt SYSTEM/TREATING
Workers Compensation laws of California.Date PAID
O Z Applicant NEW RESIDENTIAL PLMB. SQ FT. Date Recti t# .
Z O m
NOTICE TO APPLICANT:ILafter making this Certificneo(Eacmption,you
should becoe subject to the Workers'Compensation provIslons of the Labor TOTAL:
N Code,you must forthwith comply with such provIslons or this permit shall be BUILDING FEE _
W j deemed revoked CONSTRUCTION LENDING AGENCY SEISMIC FEE _
a O • Iherebyafflrmthat there is a construction lendingagency forthe performELECTRIC FEE
M Z ante of the work for which this permit Is kcwed(Sec.3097,Civ.C.) TOTAL: .
02 Lander'sName- PLUMBING FEE
LL F Lender'sAddrea, QTY. ' MECHANICAL PERMIT FEE MECHANICAL FEE
U 1certlfythat I have read this application and statethatthe above information
O W Is carred.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
} IL - relating tobullding construction,and hereby authotlae repecountatives ofthis
Zdty,to enterupan the abovonse tfoned property for inspection purposes. ALTTRORADDTOMECH. Date Receipt#
(We)agree to save,Indemnify an d keep harmless the City of Cupertino AIR tfANUONG I1MT(TO 10,000 CFM)
V atrotl bollites,pdgme costa and expenses which may In any wayaccwe - SUBTOTAL:
agsinst City' ca of the gra ntlng of this permit.
AIR HANDLING UNUT(OVER 10'"CIM) CONSTRUCTION TAX
K —J.J/ff
CONSTRUCTION TAX PAID:
Stg�� f Aplin / / to/ IXFiAl15T HOOD(W/DUCT)
HATH RDOUS MATERIALS DISCLOSURE
Will the a pplicani orfutu m building occupant store or ha rad le hazardous 1-IEAIING UNIT(TO t 00,W0 BTU) Date Recel t#
realedal as defined by the Cupertino Municipal Code,Chapter 9.1 2,and the
Iialth and Safety Code Section 2S532(a)t HEATING UNIT(OVER 100000 BTU) TOTAL:
❑ Yes M No P
Will the appllant or future Wilding occupant usecquipment ordeviccs VENTILATION FAN(SINGLE RESID) ISSUANCE'DATE
which emit hazardous air contaminaex as defined by the Bay Area Air
Quality Management District? ' BOILER-COMP OtI'OR IW,IXD BTU) PAID
4Ya ❑No
haveread lheh Nousmaterials requirements under Chapter 6.9iof 110I•EWCOMP(OVE 100"BTU) FF'0
the Calilorals Health&Safety Cods,Sections 25505,25533 and 25534. I Lj ` 1 pp 'I _
aCd �dh tat if Ne b Ich does not currently have a tenant,that it 6 my NEW RESIDENTIAL MECFLSQ.FT. `"� O Lam,OJillty otfyt pa rat of the requirements which must be metssu ofrtl too(Occupanry. N n
I At ir ., tr�rfino
a�atnadzcaa am
TOTAL: ISSUED BY:
OFFICE COPY