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19560 HIS CARD,NEAR FRONT OF BUILDINGr rewwTNoq. .POST T T "CITY OF CLJPERTINO A 19560 INSPECTION DIVISION- JOB INSPECTION RECORD: -• JOB ADDRESS. 6 C UNIT# - LOT# CATECRY, - CONTROL X OWNER�1�— �I\,tl- CONTRACCOR C-'�� y BUIL% 11DING PERMIT INFO; ` + INSPECTION',.'. :' '.DATE''.INSPECTOR INSPECTION RECORD ^ � . " 1-1Y W FOUNDATION/PIERS.' "NOTF-ALL GRADING AND DRAINAGE UFERGROUND SHALL BE INSTALLED TO COMPLHH'.'� ' ,..)OB DESCRIVEION ' PAD SETBACK-CERTTHE APPROVED PLANS AND CITY OF - _ - ' GARAGE SLADS PREGUNITE CUPFRI'INOSTANDARDS.' • - --,� -, I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' UNDERGROUND/SLAB INSPECTION dXTE ' INSPECTOR PLUMBING - ELECTRICAL MECHANICAL DO NOT POUR,FLOOR UNTIL ABOVE HAS BEEN SIGNED. WOOD FLOOR PLUMBING MECHANICAL _ ELECTRICAL - " FRAMING/VENTS/CLEAR INSULATION PLACEWO SUBFLOOR UNTIL ABOVE HAS,BEEWSIGNED+ - - ROUGI-I PLUMBING TUBS&Sl-IOWERPAN ' MECHANICAL /'•; `' ELECTRICAL ACUZZI BOND- . FRAMING STAIRS - - INSULATION/VENTILATION , EM ERG.EGRESS' vj SEWER WATER - - - COVER NO WORK UNTIL-ABOVE HAS BEEN SIGNED EXTERIORSHEAR 1-IOLD DOWN - - INTERIOR SHEAR/HOLD DOWN t SHEETROCK/SHEETROCK SFIEAR , EXTERIOR LATH/ -SCREEN SHOWER SHOWER LATH I - SCRATCF-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 ,. MECI-I.ENERGY . • BUILDING ENERGY ' ELECT.FINAL TEST Ak - r PLUMBING - GAS TEST MSCI-IANICAL HEATING _ CLCCTRICAL RELEASE FIRE DEPT. GRADE OCCUPANCY "- TEMPORARYAPPROVALS - ELECTRIC:" CAS " + _ - BUILDING - OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL !�S�QCE DATE BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR - •• ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN ;IAN 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS BEFORE REQUIRED INSPECTION. JOB ADDRESS AND �Ir! Oi �,InMFb o, PERMIT# ARE NEEDED WHEN PHONING. ' IMPORTANT! PLEASE READ•REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION I �sucDov W i i r ll+ Ie r I 37 . OFFICE COPY 1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Pru'ed Identification 1'RW I NO, Build Ing Adtlmsa:AQ3tmr �2� - C�r ,�T�,vo. 19560 Phone: APILICAITON AN �/7�sls A CITY OF CUPERTINO,BUILDING DIVISION Ge7V9X e'CO.V ft/. 4�� P7 . APPLICATION / PERMIT C CJ Oft/. BUILDINGELECTAICALPLUMBINGMECHAMCAL CATECARY CONTROL M A� Lic.No - .. � Qiy y y tELECTRICPER&1IT .^ ."! FEEo'BUILDINC PEI;MIT,INfO ,;., ' PERMITISSUANCE U—U ❑ Imo/ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION _ JLJ Ihembyaffirm that l am licensed under provisions of Chapter 9(commene- APPLIANCFSRRSIDEKDAL JOB DESCRIPTIO Ing with Sedlon7000)of Division 3 oft all nnsan ProfeseonsCode,and my liceeec CInss ll force and ic. PANELS .. .. License Class CHI �W l� Date Contractor p ARCHITECTS DECLARATION OVER I00) O7 Iundemtand my platy shall be used as publlcrerords OVER 1000 AMPS SQ.Ff.¢GD AREA 5/SQ.FL OC E d[0 Licensed Pmfeasloml - SIGNS ELECTRICAL !n` I� <Q OWNER-BUILDER DECLARATION ' SPECIAL CIRCUIT/MISC '7Ihereby afflrtnthat lamexempt from the Contractor's License Law for the , p ❑ following recon.(Sedlon 7031 S,Buelnem and Pro(enlons Code:Any dty or K7i��"1s1 county which requires a permit to construct,alter,improve,darrubh,or repair TFMP.MEIPR OR POLE INST. any structure prior to its Issuance,also mqu Ines the applicant for such permit ° POWER DEVICES U file a signed statement that he ls licensed pursuant to the provisions of the ' O�' Contractor's License Law(Chapler9(commencmg with Section 7000)of Divi- : SWAIMING I'OOE¢ECCRIC non3olthe Businassand Profmio®Code)orthathet exemptth.arefromand VALUATIONEl , the basis for the allegedexemption. Any violation of Section 7031.5 by anyv G applicant for a permit subjectsthe applicant to a tlWl penalty dna more than OUTLEP3SWITCHFSFIXTURES c. five hundred dollars(9500). ❑I,as owner of the property,or my employees wit h wages as their sole NEW RESIDENTIAL ELEC7R SQ.Ff. STORIES TYPE CONSTRUCTION CSGcompensation,wll l do the work and the structure t not Intended or offered for _ y ❑ sale(Sec.7014,Business and I'mfessimes Code The Contraders License Law does not apply to an owner of prop"who Wilds or improves thereon,and e. who doeasuch work himelforthtaugh his own employees,provided that such OCC.GROUP RFS.UNITS Improvement arc not Intended orofleredfor estew .r .If,hoever,the building or TOTAL: 4,, —OC improvement is sold within one ye arotcompletlan,the owner-bullderwill have t�a rtlen of proving that he did not build orimprove for purpose clsaleJ. 'QTY, �'+. "PLUMBING PERMITL aFEE;�t, F10 OZONE APN L�L as owner of the property,am exclusively contracting with Iicansed contractors to construct the project(Sec.7014,Business and Profession Code: pFRMITISSUANCE The Contractor's License Law don nor apply to an owner of property who ALTER-DRAIN&VENT.WATER(EA) Wilds or Improves thereon, and who contracts for such pWjdts with a t m,R¢I am exempt under Sec.actor(s)licensed pursuant to the Contractor's License Law, BACK pfAIy PROTECT.DEVICE ' t-'+t' . FE_E SUMMARY I Ll - B&P C for this remoraOUTSIDE FEES DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_ Owner Date — f WORK MAN COMPENSATION DECLARATION FIXTURES.PER TRAP SCIBOOL TAX Y_RDCELPNa ❑1 hereby affirmorkem that I have o lmura[e of consent difi m self-insum,ora RECEIIT B certifiLab of Worken'Comperuatlonlwurann ora certified copy thereof(Sec. CAS EA.SYSTEM-I INCA OUTLETS PARR FEE Y N 3800. ab CJ 1'oliryp GAS FA. RECEB'TN - Com any - BUILDING DIVISION FEES Certified copy ls herebyth the cid. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCI-IECKFEE Certified copy lsfiled with the ed.IrupMion division. . CERTIFICATE OF EXEM PTION FROM WOR KEBS' GREASE TRAP PAID COMPENSATION INSURANCE SEWER SAMTARY STORM EA 200FT Date - RCceI t# (rhissedlon need not be completed Bthe Families for one hundred dollars ($100)onless.) 1 WATER FIEATER W/VENT/¢FGTR ENERGY FEE Y N' cer I tlfythat In the performance ofthework forwhich this permit is Issued, — I shall not employ any person in any manner eo v to become subject to the WATER SYSTEM/TREATING Workens'CompenuBon Laws of Glfomla. Data PAID licant Z•Z NOTICE TO APPLICANT:IL akar making this CeMtlate of Exemption,you NEW RESIDENTIAL PLMB. SQ,FT. Date Recei t# - O ', should become subjoettothe Workere'Compeiortion provtiosuofthe Labor - TOTAL: W Codgyou nwatlonFwith mmp)yw1th such provlsimuorthis pemdt shall be B I INC W C deemed revoked. d FEE CONSTRUCTION LENDING AGENCY SEISMIC FEE Ihereby affirm that there is a construction lending agency for the perform ELECTRIC FEE,.. Z ance ofthe work for which this permit is tented(Sec.3097,Civ.C.) TOTAL: U O Lendar'sName PLUMBING FEE LL [= Lender's Address QTY, , - 'MECHANICA'L PERMIT FEE MECHANICAL FEE O W Icenifythat l have read thisappiicationand statethat the above information correct.l agree to complywith all cityand county ordinances and state laws PERMIT ISSUANCE FEESPAID:- } I' relating to building construction,and hereby authorize representatives ofthes f" N citytoeWbilifidg ntloned property,for Inspection purposes. ALTERORADDTOMM-L (We) cutifyan d knp harmless the City of Cupertino Date Receipt#agatatnsand expen whlc mayin any ovayamu� AIRHANDWNG fATT(7010,000CFM) SUBTOTAL: �� `Rain c _of the gr n of pit. _/) s� AIR IiANDLING[JMT(OVER IO,000 CFMI CONSTRUCTION TAX igmturc o(Appllcant/ nlrad« Dat EXFIAusn loon(w/Duces CONSTRUCTION TAX PAID:' HAZARDOUS MATERIALS DISCLOSURE' Will the appllcarat orfutum building occu pant store or ha nd le hazardous. I rEATING UNIT(TO I00,000 BTU) Date RCCCI [# material as defined by the Cupertino Municipal Code,Chapter 9.1Z and the - ITeahh and Safely Code Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: Yes No . Ill the applicant or future building attvpant use equipment or devices VENTILATION FAN(SINGLE RESID) ISIBAMDATE which emit ha=rdmis air contaminants as defined by the Bay Area Alr , . Quality Management District? BOILFR-COMP(311P OR 100,000 BTU) n❑ Yes nnNo aa ax 5 199U IhdVemia iealth&7ey Code,Se tioWremcnt5533 and 2S534.I o! BOILER-COMP(OVII21 W,(1W BTU) ''�^� G theerstandtat fifth building Code,Sedlorently have a tenant, understandthat notify the occupant nmarequirhavee tenant;that it beIs myend NEW RESIDENTIAL MECH. SQ.FT. responsibility to nalfy the occupant of the rcqulrement which must be met yjt'//[f rgrspMoll ' prior to issuance ataCertiflcatco(OccupSnry. _ fl I• Owner or authorrdi agent Date ISSUEDBYJ \A ULV'C..Cil TOTAL: OFFICE COPY