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19596 POST THIS CARD NEAR FRONT OF BUILDING PERMIT No. .� 19596 CITY OF CUPERTINO A INSPECTION DIVISION- JOB INSPECTION RECORD ( p '® JOB ADDRESS - l of l�7 IG VM)f 1,-W, UNIT# LOT# CATEGORY CONTROL e - OWNER ptoc, CONTRACTOR SF1U�1 `BUILDING PERMIT INFO ECORD FOUNDATION/PIERS "DAT&: INSPECTOR INSPECTION NOTE ALL GRADING AND DRAINAGE UFERGROUND SHALL BE INSTALLED TO COMPLY WITH JOB DESCRIPTION PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF CUP M- nNO STANDARDS. GARAGE SLABS PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED INSPECTION DATE INSPECTOR UNDERGROUND/SLAB . PLUMBING ELECTRICAL - MECHANICAL - FINALFn DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR c IT 12 PLUMBING ' MECHANICAL ELECTRICAL FRAMING/VENTS/CLEAR - INSULATION - - �LVQ "PLACE NO SUBFLOOR UNTIL ABOVE HAS0BEEN IndU400 . O _ ROUGH PLUMBING TUBS&SHOWER PAN MECHANICAL ELECTRICAL/JACUZZI BOND FRAMING/STAIRS - - INSULATION/VENTILATION EM ERG.EGRESS - - SEWER WATER COVER NO WORK UNTIL ABOVE S,B EN SIGNED EXTERIOR SHEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN SHEETROCK/SHEETROCK SHEAR - - - EXTERIOR LATH/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 " PLUM BING ENERGY MSCI-I.ENERGY - BUILDING ENERGY ELECT.FINALTEST - - PLUMBING , GAS TEST MECHANICAL - HEATING ELECTRICAL RELEASE HREDEPT. GRADE OCCUPANCY'- TEMPORARY APPROVALS ELECTRIC GAS BUILDING - - - ISS�t JJDATE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL � � - �,,//��1 - BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR .9 ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN1ggQ, 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS (1 BEFORE REQUIRED INSPECTION. JOB ADDRESS ANDIrprtin0 PERMIT# ARE NEEDED WHEN PHONING. IMPORTANT! m PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION TUEDBY. .IC Fi .W OFFICE COPY a APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bnudln Probe Idennl(Icatlan PERMIT NO. Bing Address: a'V14 , 19596 lwnere ame: phone: - A LCC ass-8783 CITY OF CUPERTINO-BUILDING DIVISION c°79Jt Na�^ Lk.�"°p: APPLICATION / PERMIT L �J v q '• /fC/� SGtUSSPY BUILDING-ELECTRICALPLUMBING-MECHANICAL CATEGORY CONTROL ArchltM/Engineer. Lk.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: PERMITISSUANCE 1_al ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION Thereby afllrm thatlam lkeneed undcrprovislona of Chap[er9(commenc APPLIANCE&RESIDENTIAL BDLSCRB''HON Ingwlth Section 7000)of Dlvision3 ofthe Butlnenand ProfessionsCode,and my license la In full(ora anti effM. / PANELS L201-Iianas ss C/O Lieh L--�71' Date_ .Q—�_Contractmr ayY'=(_��-Nc�. 12 IQ 200 AMPS f 2,Sb ARCHITECTS DECLARATION OVER0ODOAS ppppb�..aO Zp Iunderstand my plane shall be used as public mounds. - OVER 1000 AMIr5 SQ.IT.FLOOR AREA $/$Q.FT. E ob� Licensed Professional SIGNSELFLTRICAL �6 OWNER-BUILDER DECLARATION SP@CIALCIRCUIT/MISC IherebyafRrmthailamexempt(romthe Contractor's Llanm Lawforths O following reason.(Section 70)1.5,Business and Professions Code:Any city or TEMP.MEM OR POLE INST. F� ceuntywhich rcqulresapermitto corslwct,alter improve,demolish,orrcpalr anystm=mpdat°Bsiswance,alwrequlrnetheappllcantforsuchpermltto POWER DEVICES O file a signed statement that he is Ranted pursuant to the provBiom of the Contractor's 3 License law(Chapter 9(commencing with Section 7000)of Divl- vi p 1n sion3 of the Bd unessand ProfeaWrsCodel orthat he le exemptthere(romand SWIMMING IDOL ELECTRIC VALUATION 6 the basis for the alleged exemption. Any violation of Section 7MLS by any OUTLETSSWITCHFSFIXTURES applicant fore permit subjects the applicant to a civil penalty anot more than five hundred dollars($SW). NEW RESIDENTIAL ELECTR �n ❑I,as owner of the property,or my employees with wages as their woe SQ'T' S70WLS TYPE CONSTRUCTION mpcnsatim,will do the work and the structure is not Intended or o(fcmd for Osok(Sec.7DM,Busbmas and Professloru Code The cmm a.e.License Law I?jS$ does not apply to an owner of property who builds or Improves thereon,and who does suchwark himself or through his own employees,provided that such ^ OCC.GROUP RIS.UNITS Improvementsarenot intended oroffered forsale.ILhmvevegthebulldingor TOTAL: lmprovementiswldwithinoneyearofcompldlogthemwner-bullderwill have Y<r" t11 nienofpmWng that he did notbuild orimpmveforpurposeofealed. QTY. PLUMBING PERMIT FEE _ FIApp ZONE KPN u L as owner of the property,am exclusively contracting with limmed pp 4,p NUANCE contractors to construct the project(Sec 7004,Business and Pmfesaims Code: The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VENTWATER(CA) Wilda or Improves thereon,and who contract• for such Inojnct - - s with a FEE SUMMARY o=actor(s)licensed pursuant to the Contractor'•Llan•e Law. BACK FLOW PROTECT.DEVICE Lj I am exempt under Sec B &P C for this maven — OUTS I UP FEIN Owner Date DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N • WORKMAN COMPENSATION DECLARATION - RECEIPT ❑I hereby efflrrn that I have a certificate of consent to WFInsure,or FIXTURES PER TRAP SCIiO0LTAX Y_ N_ certiflale of Workers'Compemationlmuanaorattdifl mpythemo((Sec. RECEIPT N 3800,Lab C.) - GAS FA.SYSTEM-1 INCA OUTLETS PARK FEE Y_ N Policy N CAS G.SYSTEM-0VER 4(EA) RECEIPT N Com anY BUILDING DI VI SION FE ES ❑p Certified copy b herebyth the city GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑Certified copy le(Tied with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' CREASETRAP PAID COMPENSATION INSURANCE SEWER-SANITARY-STORM PA 200FI' Date Recel t# ( mseetlon need nor be completed I(the permit b ionone hundred dollen ($1I 0)rarity WATER HEATER W/VENT/ELECTR ENERGY FEE Y N Irertity that In the performance of the work forwhich this permit lehsued, I shall not employ any person In any manner so v o become su ct to the WATER SYSTEM/TREATING Worlicant ltppnatlon Gw �Ilfor�.Date O PAID O Z Applicant d`:(_%a /a•'a e �� NEW RESIDENTIAL PCMB. Date Reoei t# Z O NOTICET APPLICANT: 1,after�l gthisC Certificate of Exemption,you should Wcome subject to the Worken'C°mpewtlon provisions of the Labor TOTAL: cc W Code,you must forthwith comply with such provisions orthls permit shall be j deemed revoked. BUILDING FEE CLC CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby afOrmthat there is a construction lending agency forthe perform- ELECTRIC FEE 7 Z once of the work(arwhkhthb permit Vlswed(Sec.3097,Civ.C.) TOTAL: PLUMBING FEE () X9��: Tenders Name U. F LendcAAddress QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W I mdifythatl have read thisappliallonand statethatthcabove information Ismrmct.Iagratocomp)ywlth all cityand rounty ordinances and gate laws PERMITISSUANCE FEES PAID: 1 relating to building construction,and hereby authoram representatives of this [— N city to enter upon the above-mentioned property for inspection purposes. ALTER OR ADD TO MUCH. ? (We)agree to save,Indemmfy an d kap harmless the City of Cupertino Date Receipt# V against liabilities,judgment;costs and expenses which may In any way acewe AIR HANDLING UNIT CIO I O,ODO CIM) SUBTOTAL: against said City In consequence of the gra^Ung of this permit. MR HANDLING UNIT(OVER 10,030 CFM) CONSTRUCTION TAX Signature of Applicant/Contractor Data EXHAUST HOOD(W/DICT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Wllltheappila^t or futurcbuildingocupant store or handle hazardous HEATING UNTT(T0100,000BTU) Date Recei t# material as defined by the Cupertino Municipal Code,Chapter 9.17,and the Health and Safety Code Sectio^75537(•)7 HEATING UMT(OVER 100,000 BTU) TOTAL: ❑ Yes No Will theappilant uture building oaupant use equipment ordevicos VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air • Qua Wy Ma nagement District? BOILER-COMP OfIP OR l00,"BTU) 4 Yea g No hxvcrcadihehaza ous materials requlrcments underChapterh.9S of BOILER-COMP(OWN 100,000 BTU) � Bf/'It� � � �wg�' the California Health&SafetyCode,Sections 25505,25533 and 75534.I 0 � understand that lithe building does not currently have atenant,that it is my NEW RESIDENTIAL MECH. SQ.FT. responsibility to notify the occupant of the rcyulrements which most be met Prue to Issuance Of ajCcr1IfJEatx of pancy. Job"_01 Num Owncr or authmixed agent Data - ISSLIFD BY. 3be—A TOTAL: OFFICE COPY