17561 POST THIS CARD NEAR FRONT OF BUILDING
LERA11NUMRER
7561
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
F�j /Q1� PERMIT EXPIRATION
Z7�j
JOB ADDRESS-7-7;5!6 „ 8 /N ��' •' tlI y U N I T# - _LOT# Z <,
PERE IRES IF WORK
OWNER 4-,j5Ue-(v 1. Ik t1 CONTRACTOR � IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - Z NOTE: - ANCE OR 180 DAYS FROM
UFER _ �_ ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERN11T VALIDATION
GARAGE SLABS .. CUPERTINO STANDARDS. PAID.-
POUR
AID POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB 81989 /
PLUMBING •V (�,�, � T7�,;, ur•r• /
ELECTRICAL ft�� � "'., ISSUANCE DATE
MECHANICAL "LOG ELECTP LG I VECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
WOOD FLOORINFORMATION
z u4iISNO 3/F T.
PLUMBING -. i .•/ t..' Q,(vJ
MECHANICAL •,
ELECTRICAL Lf
A. PERMIT lu y".w p
FRAMING �` V V Udil-` 101 ,•vrU
INSULATION - _ 3 ` P`L h, STORIES TYPE CONST"
C. OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL-ABOVE HAS BEEN SIGNED -
OR EA TOTAL ACREAGE
y-R
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.Fi FLO
r1, /A
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID J( 7/`
ROOF SHEATHING - L RES INpuILDCONu ,TO O
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH . SAN.ft
ASS ESSORSFARCELNO
PLUMBING. 70 ,� ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY .TRACT NO PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL ACC.DATE ACC.FILE No
1 BUILDING ENERGY
FRAMING i ELECT.FINAL TEST
INSULATION ZONING ENG SITE NO.
�- _ , PLUMBING -
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T24
-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - ° ❑ -ED Y ❑ ' N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLoaO ZONE ALU.O.
INTERIOR SHEAR - - FIRE DEPT. Y❑ . N❑ Y ❑ NO '
SHEETROCK xcl�l GRADE FEE SUMMARY
EXTERIOR LATH =(,d•kPI BUILDING (t
BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CLIECK
GAS. E -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCYSEISMIC FEE 3 L
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ,DQ Il
LU
ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PCuMBINcp,OQ
PLEASE GIVE JOB ADDRESS WHEN PHONING:
— SEE PERMIT FOR EXPIRATION DATE = • MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL•
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PFSMIT NO, 0
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL Vl
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DATI
•778'7 o0ckill/l w , 3o, 97
eA
TOWN 'NAME: ; ONE: #f�ybZ CONTRACTOR'S NAME: LIC NO: N/C CONIItOL#
A CHITECT/ENGINGER: LIC It%•J' ADDRESS: ❑
CONTACT: - PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG - ELECT PLUMB MSCI
❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION QTY. ELECTRIC PERMIT, FEE
I hereby affirm that 1 nm licensed under Pmvisinnn of Chapmr,9(emm�teneing .. JOB DESCRIPTION
050 with Section 9000)of Division 3 of the Business and Profenssions Code,and my license is
{�O O PERMIT ISSUANCE
in full force sad eBect.
y.Wls FDWL -1 KITCHEN RCMODEI.
aUp License Class Contract.,
APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
yty Dote Contractor
ARCHITECTS DECLARATION []MULTI-UNIT TTSTRUCTURAL
ZOr" mw
Z IundenJ my plans.,hull he used ac pwrote,meos PANELS - MODIFICATION
pZr3� UP TO 200AMP5
El INTERIOR ❑CHIMNEY REPAIR
Licensed Professional 201-IOMAMPS_ IMPROVEMENT E]SWIMMING POOLS
. OWNER-BUILDER DECLARATION OVER IWO AMPS D BATH REMODEUREPAIR El DEMOLITION
�yRy�dd PP44 I hereby uff rte that I nm exempt form the Contractor's License Law for rho
{y'3(Owj fs,E Iellowio,ou..a(Section7031.5,Businessand Professiens Code:Any only or county SIGNS ELECTRICAL DOTHER ^w
Oy which requires a permit to construct,alley.improve,demolish,or repair any stmemre AA�,ee, _ -
f�6 prior to its issuance,alsorequirexthe applicant forsuch permit HR.,ignedslatement SPECIAL CIRCUIT/MI$C.
yrs that he ix lioensedpursuentto the provisions of the Contractor's Lice nse Low(Chapler9
rd (codmencingwith tio
Secn 70W)of Division 3ofte hBmss
ineand Prnl'essionx GdTEP.
e)or MMETER OR POLE INST.' COMMERCIAL:
.F C that he is exempt therefrom and the basis for the alleged exemption.Any violation of ElNEW BLDG/ADDITION D DEMOLITION
'^ Section 9031S by any upplicsnl forapermil subjects lheapplicvnitnacivil penallynf POWER DEVICES
TT
w ❑
TENANT FOODSERVICE
ZZ not more than five hundred dollars($500).
CO ❑ 1,as owner of the property,or my employees with wages as their sole comForalion, SWIMMING POOL ELECTRIC IMPROVEMENT
will do the work,and the structure is not Intended or offered for sale(Sec7044,Best noes ❑OTHER
ti13 land Professions Code:The Contraemds License Law does not apply to an owner of OUTLETS-SWU'CUES-FIXTURES '
LL property who builds or improves thereon,and who does such work himself or through 00,
his own employees,provided that such int adoodual,are not Intended or offered for NEW RES IDENT1AL ELECT R SQ IU'. -
sale.If,heweve,the building or improvement is sold within one year of emmpletion.the SQ.FT.FLOOR AREA $/SQ.FT.
owner-builder will have the burden of proving that be did not build or improve for par-
Pe of sale.).
cel,as be,of the property,oro exclusively esmoss ing with licensed umbanms m TOTAL
t swot the project(Sec.9044,Rosiness anJ Professions Code)The Contracncr's Ix -
aseLawdoesnotapplymanownerofpmperrywhobuildsorimprovesthereon,and QTY. PLUMBING PERMIT FEE
who counsels for such protects with o coumctoffs)licensed product to the Contractors '
License Law PERMIT ISSUANCE00
❑ ].mese kinder Sec. ,B&PC forl.hiisoccomon
Owner �' n,.,.7 ?D/f/. ALTER-DRAIN&VP.MP-WA'fBR(BA) VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE'
I creby affirm under penalty ofperlury one office following declarations. ,
❑Ihuve unJ will mainleinn CenifieateofCnnsennn self-in,merm Workers Cempcn- DRAINS-FLOOR.ROOF,AREA,COND. STORIES TYPE CONSTRUCTION
.,tion,as provided for by Section 3700 of the Labor Code,for the performance of Ne -
work for which this petrad is issued. FIXTURES-PER TRAP
❑ i have and will maintain Worker's Compensation Insurance,as required by Section
3900 of the Labor Code.for the performance of the work for which this pamil is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN
My Workers Comp rvolion heman o con ieradd Policy number aw;
Carries Policy No,: GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASE/INDUSTRL WASTE INTERCEPTOR •BUILDING DIVISION FEES
(This section need not be completed lithe permit is porous hundred dollars Afirb ' .s` "
kir less.) GREASE TRAP PLANCHECK FEE
I certify that in the Performance nflhe work for which this Permit is issued,l shall SEWER-SANITARY-STORMBA.200 PT.
not employ any person in any manner so as to become subject m the Workers'Compete- ENERGY FEF,
O Z .,orlon Laws of California.Data WATER HEATER WNENT/F.LECTR
O Applicant GRADING FEF.
fn NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
F become.,object ,,the Worker'sCompensation provisions of the Labor Code,you must WATER SYSTP.M/TRBA'1'ING SOILS FEE
forthwith comply sithdish provisions kir this permit shall le,dennelrevoked. WATER SERVICE
Q
Z CONSTRUCTION LENDING AGENCY NEW RESIDENT IAL PLMB. ` SQ.FC PAID
L)O Thereby affirm that here is a ennui lending agency for the performance of Dol• ceiptIt
W H the.,it for which this permit is issued(See.31)4],Civ.C.) ly.
O Lenders Name q'OTAL:
4UkI Lenders Address 'I OTAL: (h_ ook
a 1 certify that 1 have read this application and state that the above information Is BUILDING P
�.r h corset.l agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT ' -PP.F,
U Z building construction,and hereby authorize representatives of this city to enter upon the SEISMIC PEE
dower-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree to star,indemnify and keep handless the City at Cupertino against BLEC'TBI FF.Iiahtlldes,judgmets,costs and expenses which may in any way so against said City ALTER OR ADD TO MECI I.
in consequence of the granting of this permit. PLUMBINAE -
es
APPLICANT UNDERSTANDS AND WILL COMPLY WIJ'H ALL NON-POINT AIR HANDLING UNI 1,(In IO,OW CIT4) O
SOURCE REGULATIONS. MECHANICA FIiE
AIR HANDLING UNIT(OVER 10,"CFM) CONS rRUCTION TAX
Signature of Applicant/Contractor Dam EXHAUST HOOD(W/DUCT) HOUSING MI'I'ICATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant score or handle hazardous material I TEA'1'ING ONI'1(TO 100,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? 11 EATI NO UNIT(OVER 100,000 BTU)
C]Yea yHo VENTILATION FAN(SINGLE RESID) PAID
J� - Due Receipt#
W11ts'appReam orfuture beilding by
arn Bay se Area
Air
mlity Min.,which BOILER 100,000 B'I'U)
emit hazardous air cmnaminanlx ere de0nai by the Bay Area Air Quality Management TOTAi,:
District?
❑Yes N#���/// -
No BOILERCOMP(OVER 100,1X10 BTU)
ea #
i - .
I have rd the hazardouss materials requirements under Chapter 6.95 of the Cul l- AIR CONDITIONER ISSUANCE DATE
humin Health&Safety Cede,Scctiiiii 115,25533 and 25534.1 understand tem if rho NEW RESIDENTIAL.MUCH. SQ.FI'. 7
building s not currently have a tenant that it is my responsibility m notify @u,ucupant /
.f[h q omenta which must be psi tee of e Cebric le d0ce pancy.
07
.1 calfunfism ager �//1' Date' ISSUED BY: ✓`ter°- /— �/ "' •
OFFICE