19366 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NO.
CITY OF CUPERTINO XPPLICAnoNsusmirr=193.6
INSPECTION DI S[ - JOB INSPECTION RECORD !z
JOB ADDRESS UNIT# LOT# CA - RY j5 CONTROL N
T—.
OWNER CONTRACTOR _
BUILDING PERMIT INFO
INSPECTION DATE. , INSPECTOR TSP •N RECORD KOU ELEC1 PLUMB ."'I
El
I ❑ ❑
FOUNDATION/PIERS NOTE:ALL GRADING AND DRAINAGE
'UFERGROUND SliALL BB INSPALLFD TO COMPLY M H 1' BDLSCRII'710N
PAD/SETBACK-CERT - In MAPPROVEDPLANSAND CIN OP
cUPERTINo srANDAR6& //•• �
GARAGE SLABS PREGUN[TE - - � F'f',� C.Jr Pi
POUR NO CONCRETE UNTIL AB HAS BEEN SIGNED DATE INSPECTOR
UNDERGROUND/SLAB. INS' CTION
PLUMBING
ELECTRICAL. - - -
MECHANICAL - - -
tDO.NOT.'POUROTLOOR UNTIL."ABOVEIIHASoBEEMSIGNED -
WOOD FLOOR
PLUMBING -
MECHANICAL -
ELECTRICAL ,
FRAMING VENTS CLEAR "
INSULATION - -
PLACE'NO 5 fQFLOOR,IINTILIABOVE.HAS BEEN'SIGNED' _
ROUGH
PLUMBING - • -
TU13S&SHOWER PAN _ ... -
- MECHANICAL -
ELECTRICAL JACUZZI 13OND
FRAMING STAIRS ,
INSULATION/VENTILATION
EM ERG.EGRESS
' SEWER WATER
-COVER'N6OiWORK UNTIL,ABOVE.HASBE NSIGNED,r''
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR -
EXTERIOR LATH/W-SCREEN -SHOWER LATH
SCRATCH COAT
.NO.TAPE bR'PLASTER UNTIL ABOVVHAS'UEEMSIGNED "
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE IINSPECTOR ,
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 `
EPLFA'SF
FINAL IS SIGNED BY BUILDING INSPECTOR
RRI
ARRANGE FOR INSPECTION BY
NING
2-4505
30 PM AND 4:30 PM MONDAY THROUGH FRIDAYB 4 HOURS � ( �l
EFORE REQUIRED INSPECTION. JOB ADDRESS AND
ERMIT # ARE NEEDED WHEN PHONING. !
IMPORTANT!
READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION 11 DBY.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Bulldin Pru ea IdenHflaatIwt PERMIT NO. ,
Building Address: 19366
l n ^ ('k 9
C/I and /N I VM3
neva ame: I / Phone:
nul:ge SCi<'r
M P -iss--0 CITYOFCUPERTINO-BUILDING DIVISION A
co ora .Nacpn� —� -` / �Lpk.No: APPLICATION /PERMIT 511
aV m PY /QCT Y/ S-5?5-I BUILDING-ELECTRICAT PLUMBING-MECHANICAL CATEGORYOONTRCIL#
rchEect/Engineer, Lk.No: 1
,QTY .'ELECTRIC PERMIT 'FEE BUILDING PERMIT INFO
Adtlreca: PE2hITI55UANCE F-1 ❑. 1:1LICENSED CONTRACTOR'S DECLARATION
' IMrcby affirm that lam llcrnsed under provisions ofChapter9(rommrne- APrllANCESRESIDENTIAL ]OB DESCRE'fION
ingwlth&dion7DOO)ofDlvlalon3ofthe BualnemandrrofusimsCode,and my -
IicenmislnfuLL rce and a(ect. PANES PJUD
License Cho _ Llnp S / P /`
Date Contractor - P'N D ' -'N�/ `h 4•v9 e
ARCHITECTS DECLARATION X11-1(1W AMI'9a a•.V f.A ✓
�q
re0 Z I understand my plana aMI re
be used as public cords. OVER 1000 AMPS •" SQ,FT.FLOOR AREA $/SQ.FT,O
Fi Licensed Professional SIGNS ELECTRIf.�A:n4 Arra
6 OWNER-BUILDER DECLARATION
aSPECIALCIRCUIT/MISC
Iherebyaffim that l am exempt from the Contractor's License law for the
following reason.(Section 70'31.5,Business and Professions Code:Any city or
O ,=. TEMP.METER OR POLE INST.
K� cmntywhkh requlresa person,c,o mqu loathe aprovgdennlbh,ormitto
$g any.signed
prior tostatement
Its that
he is also req pursuant to the provisor ions
of the POWER DEVICES
file a alined statement that he t r9licensed
re pursuant to the tion 70M) of the -
3m Contrectorb LiceveLaw(CMpter9(rommencing with Section70M)
and SWIMMING POOL ELECTRIC VALUATION
SOS slon3 ofthe Business and Prefessimo Code)orthal hebexempttherefromand
O 5 the basis for the alleged exemptlon. Any violation of Section 7031.5 by any OU7LEISSWITC7{ESFIXTUI2F5 ��
applicant for a pernot subjects the applicant to a civil penalty of not room than
five hundred dollars($S00). NEW RESIDENTIAL ELECIR IT.
I,as owner of the property, SQ.' STORIES TYPECONSTRUCTION
p party,orha employees theles ole
C7a compensation,Business
andothe mKandlonat ucturebnountended oroffered med,L(or
O site(Sec.7074,Buelneea and 1'rofeml,m Code:7M Contnaera Llceme law
S does not apply to an owner of property who builds or improves thereon,and OCC.GROLT RESUUNITS
EEEE whodoesmchw,rkNmeelforthrough hiaoweemployees,provided that such
improvements are not Intended oroffered forsale.1(howeveg lhebulldleg or TOTAL:
Improvement bsold within oneyear,fcompletion,theowner-builderwill have ..
t mien of proving that he did not build or improve for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOODZONE APN
LI,ae owner of the property,am exclusively contracting with licensed PERMITISSUANCE
contractors to ro,utruct the project(Sec 7074,Business and Professions Code:
The Contmenes License Lw does not apply to an owner of property who ALTER-DRAIN kVENTWATER(EA)
Wild,or Improves therein,and who moment for such pRojects - -
with a -
actor(s)licensed pursuant to the Contractor's License Law. w .BACK FLOW PROTECTDEVICE FEE SUMMARY
LJ I am exempt under Sec. B k P C for this rean i
•
DRAINS FLOOR ROOF,AREA,CONTI. SANITARY Y N Owner Date
WOR KMAN COMPENSATION RECEIPT#DECLARATION FIXTURES PER TRAP SCHOOL TAX Y N -
QI hereby.(!fern that T have•certificate of consent st opythemof or RECEIPT M
certl(kateo(Worken'Comperaatlon lrauranre,ra mrtitkd ropythereo!(Sec.
3800,Lab C) GAS EA.SYSTEM-1 INCA OUTLETS PARKFM Y N
Policy p GAS EA.SYSTEM OVER 4(EA) RECEIPT x
Com any BUILDING DIVISION FEES
OCertlfled copy b hercbytGREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
OCedNed ropy b filed withh the tM city
Inspection division.
CERTIFICATE OF EXEM PTION FROM WORKERS' CREASETRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 20017. Date Recef tit
R),olues.) need not Mcompleted If the permit is for one hundred dollars
(8100)omlem.I WATER HEATER W/VENT/ELDCTR ENERGY FEE ' Y N
(certify that in the performance olthe work for which this penult Is Issued,
I he 11 not employ any person in any manner an as to become subject to the WATER SYSTEM/TREATING
Workers Cggma�Pr it..L. pl Gs]1 I wae�S'�P9 PAID
O0 NOT(ant All LICANT: S' n� NEw RESIDFMIAL rIMe. SQFT. Date Ratti tk
Z O NOncET�AP�uc^ ANT:If,after akng7LLs Certificate of emptl,n,y„
Hshould become sub)ect to the Wmkera'Compensation provisions of the Labor TOTAL:
W Code,you=at Fort hwith comply wlthsuch provitims or this permit shall be B 1 G
deemed reoked. FEE
W
mvp CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hcmby affirm that there b a construction lending agency for the perform ELECTRIC FEE
Z anceofthe work forwhlchthb permit b blued TOTAL:
icnaer's Name (Sec.3097•Civ.CJ
U PLUMBING PEE
ty r Mnaera Address QTY, MECHANICAL PERMIT FEE MECHANICAL FEE
O W Iced.I toot ogre Mveread lythis with all
l cit and nand
state tornnances and mate
tion —lam
iscorrect.building comply allcityand authorize
rearm andatatelawa PERMIT ISSUANCE FEES PAID:
} U) rey ing toenobuponte.1anxmon,andhereby opertyorifor nsectionpurposalthb
H (A anyto )aree to lhe,indemnify an
property the Cit of Cupertino
ALTER ORADDTO MECH.
Z Date • Ricci tN
(We)agree to save,Indemnify i n d keep harmless the City anyway
crus
V agaimtllabllitles,jidgmenb,sash and expenses which may In anyway sews AIR HANDLING(IMT CFO tO,ODO CFM) SUBTOTAL:
sial Id City In rot a ceo! grantingmthla permit AIR HANDLING UNIT(OVER 10,070CFM) CONSTRUCTION TAX
~ - � CONSTRUCTION TAX PAID:
gwlure,l ApplHAZARDOUSor Date IXFWI15TfIODD(W/DUCT)
HAZARDOUS MATERIALS DISCLOSURE
Will thsdifintt bythfuture rtinobuilding Mundeloccupant ode,Chpmr9.hazardous HEATING UMT(TO 100,000 BTU) Date Reeel tM
natetlalas deity bythe Cupertino Municipal Cade,Chapter 9.12,and the -
I Iralth and Safety Code Seaton 75532(.)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
❑Yrs No
Wiilthezpplicantor um building occupant use equipment or devices VENTILATION FAN(SINGLE RIESID) ISSUANCE DATE
which eMe hazardous air contaminants wnb ae defined by the Bay Area Air I /�•R
• Quality Mawgement District? BOILHR-COMP DEIPDR 100,0(IO BTU) \ll/o(v,11
Y,Yea Tl No 1
havernia Health
ar mmalde,S rcgWrementsunder Chapter,1 of eOR.FR-COMP 100,000 BTU) `�✓
the California Health building
does net conet entlyh have
a tenni,that 1 \\ s
understand that If notify
the
nupant oftcurequiyhaves which
that It boy NEW RESIDENTIAL MECH. $Q.IT.
rmponsibllity to notify the occupant,(the requirements which must bemot
prior uance ofa Cert rate of Oc�Sdancy. — Q '
PKweer or authorized aglat((`J J(YJ R- - •`a/_"? S�Date / ISSUED 6Y:
TOTAL:
OFFICE COPY