19531fai
•
•
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO '
INSPECTION )IVISION - JOB INSPECTION RECORD
JOB ADDRESS 5 ( UNIT # - LOT # -
OWNER CONTRACTOR
PERMITNO.
DAL9531E
CATEGORYl
coNr,( i/I
1, c
,,,�� BUILDING PERMIT INFO
INSPECTION 'DATE INSPECTOR
INSPOTTION
NOTE: ALL GRADING ARND ECORD DRAINAGE. ^
SHALL BE INSTALLED TO COMPLY WITH
THE APPROVED PLANS AND CITY OF
CUPER17NO STANDARDS.
-
FOUNDATION/ PIERS
UFERGROUND,
JOB DESCRIPTION
4v.�f,(v .g�.(, j/`Erhih+�1L�:��'
PAD/SETBACK-CERT
_
GARAGE SLABS PREGUNITE •'
POUR NO•CONCRETE UNTIL ABOVE HAS BEEN SIGNED
INSPECTION -
DATE
INSPECTOR
UNDERGROUND/SLAB
PLUMBING -
- -
��-
ELECTRICAL
MECHANICAL
-
DO•NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING
-
-
MECHANICAL -
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING'
TUBS&SHOWERPAN
MECHANICAL
ELECTRICAL/JACUZZI BOND
FRAMING STAIRS
INSULATION/VENTILATION -
EMERG. EGRESS .
SEWER WATER
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED:.,
EXTERIOR SHEAR 1 -TOLD DOWN -
INTERIOR SHEAR/ HOLD DOWN - -
SHEETROCK/SHEETROCKSHEAR
-
EXTERIORLATH/W-SCREEN
SHOWER LATH -
SCRATC1 I COAT -
- '
WOITAPE OWPLASTER"-UNTIL•+` IR)VE`•HAS BEEN SIGNED
NOTE: NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE IINSPECTOR.-
/
li
/
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 Y
ELECTRIC
GAS
BUILDING- ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT E ITTED UNTIL
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR - PAID
ARRANGE FOR INSPECTION BY PHONING 252-4505 BET EN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, _ OURS JAN 1 J l,�;,J
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING. �If/ of r'IJngrf� o t`
IMPORTANT! — '1.
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEDBY:� % k,l
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
BuBding Add¢,,:
PEKMITNO.
19531
- �-
ws ante: phone.
A LALL All,
�I?Ci��Se�. y�lG --fStG
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
1_ —q
,�joi✓�
contractor a Name: ' Lic. No:
r
BNLDINGELECIRICALI'LUMBING-MECHANICAL
CATEGORY CO
ArcMtect/• 81.mr. Lic. No:
QTY ELECTRIC PERMIT
FEE
BUILDING PERMIT INFO
Address:/l7/y(/ �[( a
1:1 1:1❑
PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
Iherebyafflrm that lam licensed under proviucosof Chapter9(rommenc
ingwith Sedton7000of DiWslon3ofthe Buslneaand ProfesslonsCode, and my
Ikena is in m8 (oj and dies. l�
Clxss1 Lic. p /3/%�
Date Ya' Contactor :;4,1/ /J�t .dh�.-a//!UP
APPLIANCF&RESIDENTAL
)OB DFSCRU'17
PANELSLicense
TO 200ANIPS
201-1000 AMPS
ARCHITECTS DECLARATION
'I.ynderstandmypi. ., deep � x rdc
OVER1000AMPS
SQ. FT. DOR AREA
S/SQ. .
SIGNS ELECTRICAL
Li1•cce Professional
SPECIALCIRCUIT/MLSC
OWNER -BUILDER DECLARATION
I hereby affirmthat I am exempt from the Contractor's License Law for the
TEMP. METER OR POLE INST.
following reason. (Section 7671.5, Businessand Profealons Code; Any dtyor
coontywhich requires a perro t to rommuct, alter, Improve, demolish,orrepalr
anystructure pectin Its lora Me,also requires the appHant fm.uch permit to
file a signed statement that he, 6licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9 (commenting with Section 7000) of Divi-
s1on3o(the Business and l'rofemloru Code) o.I.tkmelsexempt
ROWER DEVICES
SWIMMING POOL ELECTRIC
VAIaVAT10N
the basis for the alleged exemption. Any violation of nalt on 76715 by any
703I.5therefrom by..y
applicant for a permit subjects the applicant to a dull penalty of not rrore than
OUTLETSSWITCHES-FIXFURES
�il%�/ygl/�/�
NEW RESIDENTIAL ELECTR SQ.FT.
five hundred dollars
❑I, as ownero(the he property, or rtry employees with wages as their sok
STORls
TYPE CONSTRUCTION
compensation, will do the work and the stroeture 6 not intended or offered for
sale (Sec. 7014, Bualna. and Professions, Code: The Contractors License Law
does not apply to an owner of property who Wilda or improves thereon,and
does such work himxlforthrough his own employees, provided that such
CX:C.GROIIP
RFS. UNITS
Improvements am not Intended oroffered for ale. If, however, thebullding or
Improvement b sold within oneyearofcompldioq the owner -W Ilderwill have
TOTAL:
tl�jnrcen of proving that he did not Wild or improve for purpose ofsale.).
Lf I, ate owner of the property, am exclusively contracting with Ilmnxd
rontmcma to construct the project(Sec. 7614, Business and Profealons Code:
PLUMBING PERMIT
FEE
QTY,
PERMIT ISSUANCE
FLOOD ZONE
APN
The Contra tore License law does not apply to an owner of property who
Wilda or Improves thereon, and who contracts for such injects with s
�bactor(s) licensed pursuant to the Contractor's License Law.
I am exempt under Sec. B & P C for thls reason
ALTER -DRAIN &VENT- WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTStDfZ
DRAINS. FLOOR ROOF, AREA, COND.
MTURES. PER TRAP
SANITARY Y— N _
RECEIPT it
Owner Date
WORKMAN COMP ENSATION DECLARATION
❑I hereby affirm that I have o lmumne of consent d py self -insure, ora
3800�vdiL bofWorken'Compewtlanlvuranceora certlfled ropythemo(l5ec.
3800, Lab CJ
Polity p
SCI IDOL TAX Y_ N
RECEIPT is
GAS F.A.YSTFM-I INC.d OUTLETS
PARK FEE Y_ N_
p
GAS EA. SYSTEM -OVER 4 (FA)
_
old-3�u
Company �bpyis
DING DC
HUILOING pi VISION PEES
fa
❑Cert (led copy is by comm city
❑Certified ropyis ]led with the city ivpedion division.
GREASE/INDUS/RL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThissMlon need one becompleted lithe permit V foror�e hundred dollaa
PAID
Date Recei tN
SEWER-SANHARYSTORM E.A.20IFe
($100orlestj
]certify that in the performance of the work for which this permit is issued,
WATER HEATER W/VENT/ELECTR
ENERGYFEE Y N
1 shall not employ any person In any runner so as to becume subject to the
Workers' CompewHon Laws of Cal fernb. Date
WATQt SY57EM/TRGTING
PAID-
AIDApplicant
Applicant
NOTICE TO APPLICANT: If, after nuking this Certificate of Exemption, you
should become subject to the Workers' Compensation provisions of the Labor
Date Recei tN
NE'WRESIDENTIALPLMB. SQ.FT.
TOTAL:
Code, you Trust forthwith comply with such provisions orlhis permit shall be
dermad revoked.
BU I FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that there it;construction lending agency for the perform-
ance of the work for which thls pevNt 6 busted (Sec. 3097, Civ. C.)
TOTAL:
ELECTRIC FEE
QTY. MECHANICAL PERMIT
PERMITISSUANCE
FEE
PLUMBING FEE
Lenders Name
Lender's Address
I certifylhat I have readthis applicatlonand statethatthe above Information
V comed. l agree to comply with all cry and county ordinances and state laws
MECHANICAL FEE
FEES PAID:
retail ng to building rommaction, and hereby authortm mpresentatNa of this
ALTER OR ADDTO MECH.
city to enter upon the above-mentloned property for Inspection pu ryoses.
(We) agree to ave, Indemnify an d keep harmless the City of Cupertino
Date Recei t>I
SUBTOTAL:
against llabllities,.dgments, cons and c.pnnses which may In any wayaccrus
against ald City In consequence of the granting of this permit.
AIR HANDLING UNIT (TO 10,000 CPM)
AIR HANDLING UNIT (OVER 10,000 CFM)
CONSTRUCTION TAX
Signature of Applicant/Contractor Date.
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PA ID:
HAZARDOUS MATERIALS DI SCLOSURE'
Will the applicant or future building occupant store or hand to havardous
material as defined by the Cupertino Municipal Code, Chapter 9.1 2, and the
/1 ��S
/L�/ (R/I
HEATING UNIT CID 100,000 BTU) -
Date Recei [N
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
4feaith and Safety Cade. 5ecyon 25532(.)7
❑ Y. No
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
PAD
Will the appilcant or tore building occupant use equipment or devices
which emit haeardous air mntammants as defined by the Bay Area Air
(�iality Mawgement DLt -
HOILER-COMP OH' OR 100,000 BTU)
Yes
4 No
BOILER -COMP (OVER 108,000 BTU)
have aw oto
read the hmaterials requirements underChapter6.95 of
the California Health&SafetyCode,Senlons 25505,25533 and 25534. I
JAN f�
NEW RESIDENTIAL MECH. SQ.FT.
understand that if the building d.c.mn currently have. tenant, that It is my
�e%p}IV
responsibility to notify the occupant of the requirement, which most be met
Prior to uarm ofa Cort! to"of_0�party.
1. IB9rt_IRt
r o u horiud agent - Date
%/
ISSUED BY:
TOTAL:
OFFICE COPY