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19318 POST THIS CARD NEAR FRONT OF BUILDING PERMITNO. CITY OF CUPERTINO18 193 A � A A INSPECTION DIVISION- JOB INSPECTION RECORD J06 ADDRESS 11'70 —� l cam{--tr,0 )C� UC UNIT# OT ft caTEcoav coNTFcq);n OWNER \— S U CONTRACTOR UN 1" \ YLI. BUILDING PERMIT INFO INSPECTION ❑ DATE INSPECTOR INSPECTION RECORD [rJj ❑ FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE UFERGROUND SHALL BE INSTALLED TO COMPLY WITH JOB DESCRIPTION PAD/SETBACK-CERT - THE APPROVED PLANS AND CITY OF GARAGE SLABS/PREGUNITE CUPERTINO STANDARDS' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED "e `1 ` UNDERGROUND/SLAB INSPECTION DATE INSPECTOR 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&SHOWER PAN MECHANICAL ELECTRICAL ACUZZI BOND FRAMING/STAIRS INSULATION/VENT]LATION EM ERG.EGRESS • SEWER WATER - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED i EXTERIOR SHEAR 14OLD DOWN INTERIOR SHEAR/HOLD DOWN SFIEETROCK/SHEETROCK SHEAR EXTERIOR LATH/W-SCREEN SI LOWER LATH SCRATCH COAT NO TAPE OR PLASTER UNTIL ABOVE HAS 13EEN SIGNED NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID FINALS DATE INSPECTOR SAN.# ELECT.ENERGY PLUMBING ENERGY MECI-1.ENERGY BUILDING ENERGY ELECT.FINAL TEST PLUMBING GAS TEST MECHANICAL HEATING ELECTRICAL RELEASE FIREDEPT. GRADE OCCUPANCY TEMPORARY APPROVALS ELECFRIC GAS BUILDING OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE DATE . BUILDING. FINAL IS SIGNED BY BUILDING INSPECTOR PAID ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS NOV ° 2 BEFORE REQUIRED INSPECTION. JOB ADDRESS AND PERMIT# ARE NEEDED WHEN PHONING. citr "s ^r�?I{jB0 IMPORTANT! r PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEDBY. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. BnlldinlryA/dress: 0 5�2 .o n 19 318 MrsName: Phone: A A Wvd-yy/v p �;S 37 n CITY OF CUPERTINO-BUILDING DIVISION Contradoe'e Name: I Lic.No APPLICATION I PERMIT L / Ll BUILDINGELECTRICALPLUMBING-MECHANICAL CATEGORY CO Architect/Engineer. Lic.Na. QTY ELECTRIC PERMIT FEE BUILDING PERMIT INF Addres PERMITISSUANCE ❑ El CONTRACTOR'S DECLARATION I hereby affirm that l am lkerad under provisions of Chapter9(commnc APPLIANCES-RESIDENTIAL JOB DESCRIPTION Ingwith Seahm7000)of Division 3o1fthe Businessand Profwsloas Code,and my license ls inCla s .......l force effect. PANELS � `� f.., Licence Gass Lk.p 4 k 1, ,` l` Date Contactor IAC.. Ll ARCHITECTS DECLARATION 211-10DOAMPS 7. I understand my plans shah be used a,public records. OVER I ODO AMPS SQ.FT.FLOOR AREA S/SQ.FT. CO MwLicensed Professional SIGNSELECTRICAL t & OWNER-BUILDER DECLARATION SPFO]ALCIRCUIT/MISC CC � Iherebyaf@m that lam exempt from the Contractor's License lawforthe XO following W.I.(Sectlon7MIS,Businenand Pmf.ions Code:Anycityor O Z i_ quimsatocanstruct, TEMP.METER OR POLE INST. F4 county prcortoits a ane,alsorequi stheaprovntfor demolish, er ttr 9 Y any atmcturc tatements that is aicensed ursuanppLicem provisions of t e POWER DEVICES EE[OE g file a signed statement that he(Chapter 9(cont Fuming it the tion 70 ) of the u, Contractor's of Licensee Lawwrofessions Commendngwltexealon7000)orn and 30In tvt- s' SWPSMINCIWLELECfI4IC ron3of the Business and Professions Cde)orthat he exam Nerefromand VALUATIONI, a Y.' the basis for the alleged exemption. Any violation of Section 70315 by any I 000 O U 0a applicant for permit sub' stheapplicant toot civil 1 ofnot more than OUTLETS-SWITCHES-FIXTURES PP R )actpenalty five hundred dmllzn(5500). I,as owner of the e y employees gas NEW RFSIDGNTLAL ELLCIR Com¢ compensation,wi)lelotheworkand rthestmctute is non Intended or offeredfar �'�' STO FS TYPE CONSTRUCTION 5 M sale(Sec.7044,Business and Professions Code:The Contractors Lt..Law j$$ docs not apply to an owner of property who builds or improves thereon,and who doessuch work himself orthrough his own employees,provided that Such OCC.GROUP R1S.UNITS Improvements are not Intended oroffered fw sale.If,however,thebuilding m TOTAL: Improvement issold within oneyearofcompletion,the owner-builderwlll have ih rden of proving that he did not bulla or improve fee purpose ofsale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN Lj L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contrack ra to construct the project(Sec.7064,Businea and Professions Code: Z,UO The Contractor's Llceme Law dots na apply to an owner of property who ALTER-DRAIN AVENT-WATER(FA) Wilds or Improves thereon,and who contracts for such pAojee,with a on r,taBgfador(s)Licensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec. B h P C for this Wasson • ES Owner Date DRAINS FLOOR.ROOF,AREA,COND. SANITARY Y_ N OUTS .. WORKMAN COMPENSATION DECLARATION .t RECEIPT# Ell hereby affirm that I have a certificate of consent mself-insure,ora FIXDIRES PER TRAP . Qb SCI IDOL TAX Y N_ cenlfirate of Workers'C//o/��mperuaHon Iruurance ora certified ropy thereof(Sat. RFGEIPT# Policy LMbCJ�G ,SO I �Q�rj-'-f GAS EA.SYSTEM-1 INC.4OUTLETS PARK FEE Y_ N_ Com nvIt �jyrp�T� GAS[A.SYS'TElrf-OVER4LEA) RECBUILDING VISION FEES �Cenifle i copy e d with t lshd. GREASEANDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑CenOied ropy V Ned with the dry inspection division. CERTIFICATE OF E)(EMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCE (Thissedonneed net becompleted ifthe permit Nforonehundred dollars SEWER-SANTTARY.SIURM FA.xpFI. Date Recei t# (SIIXunifytJ WATER HEATER W/VENT/El TR ENERGY FEE Y N— I unify em[o theperformance per im in an the nnerwork so a tobahls permitbj is bad, — I shell not employ any person in any manner a as to become abject to the Workcra'Compensatlon laws of Cahfomla.Date WATERSYSTEM/TREATING PAID 0 Z Applicant Z O NOTICETO APPLICANT.If, makingthisCeniflute of ExempibI you NEW RESIDENTIAL PLMB. SQ.FF. Dale RCCeI t# FShould become sub)ea to the Workers'Compensation provialons of the Labor TOTAL: NCode,you=atforthwith comply withsh provisions orthb permit shall be W > uc deemed revoked. MPAla. EE , VOa p CONSTRUCTIONLENDINGAGFNCY 1 hereby affirothzuhem b a constmdion)ending agency for the perform- EBO ante of the work for which this permitbLscied(Sec.3097,Civ.C.) TOTAL: O•oba f<ndcr'sName FEE rJ.Ubly - ade:saaarea QTY. MECHANICAL PERMIT FEE AL FEEOW1 unify that l have read thisappllotionand gate thatthe above informationfl incorrect l agreetocomplywith all dtyand county ordinances and gate laws PFRMH ISSUANCE} W relating to building comtmction,and hereby authorize reprsentatives of thioF city to enter upon the abova-mentioned property for Wpection purpo.see. ALTERORADDTOMECH.(We)agree to save,indemnity an d keep harmless the City of Cupertino ReCeip# TMagainst liabilities,judgments,carts and expenses which may in anywayaceme AIR HANDLING UNIT(to 10,0DO CFM) SUBTOTAL: •s s� aga inat said City in consary ence of the gram ing of this permit. AIRHANDLING UNIT(OVER lowocILI CONSTRUCTION TAX Slgwturc of Appllant/Contractor Date IX}WI15'T HOOD(W/DIKT) CON C�TAX : HAZARDOUSMATERIALS DISCLOSUREWill theapplkant orfuture building occupant store or handle hazardous HEATING UNIT CM IOD,ODOBmaterialasdefindby the Cupertino Municipal Code,Chapter 933 and the Date H,,t1thznd Safdy Cade ction 25532(.)7 HEATING UNIT(OVER I00,000 BTU) ❑Yes . MNo TOTAL: Will the applicant orforum Wilding occupant use equipment or devices VENTILATION FAN(SINGLE RFS ID) ]$$[��r•rr-a'A•LE which emit havrdous air u.n.W mob ate defined by the Bay Arca A4 `�f • Quality Management Distrl 7 BOILER-COMP 0HP OR 100,IXD BTU) 4h.Yes No I�oY veread Health ouyCode,materiSections Z505, sunaand 2S53r6.95 of BOILER-COMP(OVFIt1W,000BTU) N6 1-0.. 1M California Health k Safety Code,Sections 25505,25533 and 25534.I underatandthatlfthe building does not currently have a tenant,that it is my NEWRESIDENTIALMECH. eJj,.FT. .y responsibilliitty to notify the occupant of the requirements which must be and Clrf P� O's'?(tIBO prior to Las ncc of a a nificat9 of oc anry. � 19� usvoer-/,dl1r/a-p/vtuhoLrl gentYsY// Date TOTAL: OFFICE COPY