19578 POST THIS CARD NEAR FRONT OF BUILDING rrxM TNo.
19578
CITY OF CUPERTINO AMUCATIONSUBMIIIALDAM,
INSPECTION DIVISION-;JOB INSP �1� D
JOB, ADDRESS' z,Z 3 4 �,C!/ry�,�� q(_ LOT# �CA'I10DRY - CONTROL x
IBUILDING PERMIT INFO,
OWNER L "°cL��� CONTRACTOR �—CT�TI �'E�C � I ,�
INSPECTION 3INSPECTION EORD
FOUNDATION/PIERS DATE', INSPECTOR • NOTE ALLCRADINC ANO DRAINACE ❑ -
UFERGROUND• _ - SHALL BE INSTALLED TO COMPLY VATH JOB DESCRIPTION
THE APPROVED PLANS AND CITY OF - - .,,� j
•
PAD/SETBACK-CERT- - . ,''CUPERTINO STANDARDS. �--� j6'� � .
GARAGE SLABS PREGUNITE .r .
11-
POUR-NO CONCRETE UNTIL.ABOVE.HAS BEEN SIGNED
UNDERGROUND/SLAB INSPECTION- DATE INSPECTOR
PLUM13ING
ELECTRICAL - -- -
MECHANICAL.
DO NOT POUR FLOOR UNTIL ABOVE HAS 13EEN SIGNED• -
WOOD FLOOR
'PLUMBING - -
., MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR -
INSULATION
PLACE 7NO'SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROUGH
PLUMBING- -
TUBS&SHOWER PAN -
MECHANICAL
ELECTRICAL/JACUZZI BOND'- `
FRAMING STAIRS - '" "
INSULATION/VENT]LATION
` EMERG.EGRESS - ..
r• SEWER WATER - -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED,e
EXTERIOR SHEAR 1-IOLD DOWN I I - -
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR - -
EXTERIORLATH/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 INSPECTOR
SAN.# - -
ELECT.ENERGY
PLUM BING ENERGY '
MECH.ENERGY - - -
13UILDING ENERGY '
ELECT..FINAL TEST
PLUMBING -
GAS TEST
MECHANICAL
HEATING
• ELECTRICAL RELEASE
TIREDEPT.
GRADE -
OCCUI'ANCY
TEMPORARY APPROVALS • - "
ELECTRIC - -
GAS .,
BUILDING ' Y " 1S�[1J,ILJ
' OCCUPANCY OF BUILDING IS NOT PERA7ITTED UNTIL � CE DATE
BUILDING FINAL"IS SIGNED BY BUILDING INSPECTOR -
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
I FIE Q 0 j 195
12:30 PM AND 4:30 PM MONDAY THROUGHTRIDAY,24,HOURS .
BEFOREREQUIREDINSPECTION. JOB"ADDRESS AND �lrl flE f, lr�TFinQ
PERMIT# ARE NPF,DED WHEN PHONING.
IMPORTANT!'
PLEASP READ REVERSE SIDE BEFORE. CALLTNG FOR'FTNAL INSPECTTON:. : fimDBY : -il. h r
OFFICE COPY .
APPLICANT TO FILL IN INFORMATIO IN RED LINES — USE BALL POINT PEN ONLY '
Bui],Aing Probe Identification
Building Apdna.: n
234$ aATLT �, `J
578
me: Phone: - ^
^�C,� l(� L.(_• CITY OF CUPERTINO-BUILDING DIVISION. o.I C �1 c°ntraa°isName: Lie.No: APPLICATION / PERMIT ( (J
T_ C I'26BUfLDINGELECTRICALMUMBINGMECHANICAL CATEGORY - CONTROL N
ArcIteet/Englneer. Lie.N.
5YM4 caww0FSA M
QiY�'-•;�,'-ELECTRICPER,INIT � 'FEE� BUILDING PER -�ITINFO
Addrc.s:7_66S t!. M�Ay�� .rj• a• PcahnTlssuANCc
LICENSED CONTRACTORS DEion, fC ON
.pi -
]hereby affirm that lam licensed under prwisionao(Chaptcr9(carnmenc, APPLIANCFSRESIDEMTAL . 19U JOBD RB'HON .
Ingwith Sactlon 7000)of Dlvision3oflhe Bu.inmandPmfmionsCode,andmy _
Beer.is In full force and effect. PANELS eJ O, l •'1`
Llrenae Class C I O Lic.N ZIO 1 SIS -
Date�r'.4!�_Q_ContraRar_ '( (L{(�
ARCHITECTS CLARATION 201-1000 AMPS ! ✓/ 4-
�7. I understand my plans shall Musedas publlerecords. OVER]ODO AMPS SQ.FT.FA RAREA $/SQ.FT.
O
ra Llcnsed Professional - SIGNS ELECTRICAL
�<6 OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC OD
IM1ercbyalfirtntMllam exempt(romlhe Contractor's License Law for the
pp following reason.(Section 70315,Businessand Professions Code:Any city or
TEMP.METER OR POLE]NST. -
countywhich requiresa permktocoratroct,alteq improve,demollah,or repair _ -
anystrumn,prior to itsissuance,also requlrestheapplicxnt forsuch permit to POWER O DEVICES,file a signed statement that he is licensed pursuant to the provisions of the
3u, Contractor's License Law(Chapter 9(commencing with Section 7000)of Dlvl SWIMMING IDOL ELECTRIC
H OJ sien3of the Bueincaa and Professl°raCodc)arthal hale aemptthercfromand - VALUATION
Yi•7 the basis for the alleged exemption. Any violation of Section 7WIS by any '
6X
applicant fara pereraft subjects the applicant to a civil penalty of ot mare than OUTLETSSWITCHPSEIXTURES I� oD '
n. fivehundreddollarshepr. NEW RESIDENTIALELFGTR SQ,F7', I STORIES TYPECONSFR=ON
I,as owner ll the property,or my employees with wages r there sok
�q7q.Q compensation,willdothe cas and uk,and Proftethest ode:Thure net Intended oroff Law ,
5pd for
0 due(notappy B.iffiin.--w of Professlom Code: or Improves
themor,Law
does not apply to enownero(property who builds orimprovee thereon,and
S� who doessuchwork himself orthmugh hisown employees,provided that such OCC.GROUP RCS.UNITS
improvements are not intended muttered forsale.IL however,thebullding or TOTAL: 3 S 6 D -
Improvement(+sold within oneyearofcompletlon,tM owner-bullderwlll have
th,£.4urden of proving that he did not bund or improve for purpose of sale.). QTY, '. PLUMBINGPERMIT ° FEE'" HADD ZONE APN
L)L as owner of the property,am exclusively mntnRing with licensed
contractors to mnaWd the project(Sec.70K Business and Professions Code: PERMIT ISSUANCE
The Contractors Llcenae Law does not apply to an owner of property who ALTER-DRAIN VENT-WATER
Wilds or improve. thereon,sand who contracts for such ptvjacte with a (EA) _
co ador(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY
I am exempt,under Sec. B&P Cfar this reason BACK FLAW PROTECT.DEVICE
•
.riffs—
DRAINS FLOOR,ROOF,AREA,COND. SANITARY Y N�
Owner Date ,RECEIPTtl
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y N
❑L hereby affirm that I have o certificate of consent to.py tnmre,ora RECEIPT N
certificate olWorkeri Compecaatlonlmurance orarertifled copy thereo((Eec. GAS F.A.SYSTEM-1 INCA OUTLETS PARKFTEE Y N
poli Lab C.) ,
Po11ry N GAS FA.BYSTEMAVER 4(EA) RECEIPT p
Com any - BUILDING DI VISION PEES
Certified copy 6 hereby filed
the cid. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHEC -EE
�Certl(ied ropy la filed with the city inspection division.
KWWWWWlIIIII CERTIFICATE OF EXEM PITON FROM WOR KER S' GREASE TRAP PAID ..
COMPENSATION INSURANCE SEWER-SANITARY-STORM.EA 20OFF Date Recel t#
Rb os section need n°tM<omplcted if the permit bforonc hundred dollars
($100)otifyth WATER HEATER W/VENT/ELECTR ENER YFEE Y N
Icertifythat in the per(ormanreofthe work for which thlsperinitlaissued, —
I.hall not employ any person In any manner so u to bemuse mbject to tM WATER SYSTEM/TREATING
Worken'Compensatloh laws of California.Date PAID
O Z Applicant NEWRMDENTLALPLMB. SQ.IT. Date Recei t#
Z O NOTICE TO ICANT:IL after mating lhfs Certillate of Exemption,you
should Wrome s abyd to the Workers'Compersation prov Woru of the Labor TOTAL:
N Code,you mostforthwith complywtthauchprovlsioraorthls N dtshaIIW
K j deemed revoked, -BUILDING FEE
W p' CONSTRUGP10N LENDING AGENCY.' SEISMIC FEE f _
d Z IherebyafflrmtMt there is a corawctlon lendingagency forthe perform- TOTAL: ELECTRIC FEE .VA-
ance of the work for which this permit is Issued(Sec.3097,Civ.Q
V 4 Lender's Name r PLUMBING FEE
LL Lender.Addre.s QTY. MECHANICAL'PERMIT FEE MECHANICAL FEE
O W Icertify that l have read thi.appliallonand mate that the above information
IsmrrecLlagree tocomply with all city and muntyordinances and statelaws PERMIT ISSUANCE FEESPAID:
r V) relating to building construction,and hereby authorize representatives of this
• ~ N cuytoenterupontW.Wve-mentionodpropertyforlrapectlonpurposes. ALTER OR ADD TO MECH.
? Me)agree to save,indemnify an d keep h.,odc"the City of Cupertino Date Receipt#
O .gal the ties,fadgments,mstsand expenses which may In anyway.ecrue AIR HANDLING UNIT(TO 10,000 CIM) SUBTOTAL:
.gal Id It uence of the grant ing of this'permit
_5_q�
MR FIA NDLING UNIT(OVER i BODO CF.M) CONSTRUCTION TAX
rat/Contractor Date IXtfAWT HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE -
Willtheapplimotorfuture building occapant store or handle hazardous I BATING UNIT(TO I M,ODO BTU) Date Recei t# _
material as deft ned by the Cupertino Mu nidpal Code,Chapter 9.12,and the -
Ikalth a rad Safety Codr�,`ction 25532(.)7 HEATING UNIT(OVER 100,000 BTU) _ -TOTAL:
Yes Q No - -
Willtheapplica., Pleture building oemp.rt.xe equipment ordevices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air cntaminants as defined by the Bay Arca Air /k
• Quality Mavgement DuI'ct7 BOILER-C0MP(3HPOR IW,IXDBTU) PAQdD
4haveYes No (�
read the lama smaterials requirements under Chapter 6.95 of BOILER-COMP(OVIA 100,000 RU) FEIi y(� +I
the CIfernla Ilealth&Safety Code,Sectlom 2550.5,25533 and 25534.I U D. I J�LI
understand that if the building does not currently have a tenant,that it is my NEW RESIDFN77AI.MECH. 'Q.1'1'. ,
r
P. tyi notify theompant of requirements which most met '
P to CeelficateofOccupanry. L`'}II faf VIIPOrtIrIQ
neroraut or agent 'D t� I
TOTAL: ISSUEDBYJ V _
OFFICE COPY