19637 POST THIS CARD NEAR FRONT OF BUILDING PERMITNO.
CITY OF CUPERTINO �T r
INSPECTION DIVISION- JOB INSPECTION RECORD
JOB ADDRESS 77177 �LS,.�1-�o 1 i E' ` UNIT# LOT# CATE.GORY CONTROL 0
OWNER_ V. t4 C &j-ft CONTRACTOR BUILDING PERMIT INFO.
'INSPECTION - DATE* INSPECTOR INSPECTION RECORD
FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE
UFERGROUND - SHALL RE INSTALLED TO COMPLY WITH JOB DG4CRIP1I0N
PAD SET BACK-CERT - TINE APPROVED PLANS AND CITY OE. �
CUPERTINOSEANDARDS.POUR A
GARAGESLABS CONCRETE
UNDER ROUNCRETE IIM'IL ABOVE HAS BEEN SIGNED DA INSPECTOR
IR
UNDERGROUND/SLAB - 'INSPECTION
PLUMBING
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR -
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR
INSULATION
"PLACE NO SIIBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
ELECTRICAL ACUZZI BOND
FRAMING STAIRS - -
INSULATION/VENT]LATION
EMERG.EGRESS
•" SEWER WATER "
" 'COVER&ND iINORK`"L1NTlC'AUOVE•'HAS BEEN;SIC.NEDI:'`
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN "
SHEETROCK/SHEETROCKSHEAR
EXTERIOR LATH/W-SCREEN "
SHOWER LATH
SCRATCH COAT
iNOdTAPE`OR.,PLASTER�UNTIC ADO"VV HASaBEEN SIGNED'
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS I DATE INSPECTOR
SAN.#
ELECT.ENERGY - -
PLUMBING ENERGY _
MECH.ENERGY
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GASTEST'
MECHANICAL
HEATING
ELECTRICAL RELEASE
FIREDEPT. '-
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE
SSUNCE DATE
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN VF Q 0 8 'ji � "
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE. CALLING FOR FINAL INSPECTION SSvensv
OFFICE COPY - {
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PIRMH NO.
Building Address: 19637
`►�'1 S7"R O !? d 1.. C� , Iva soIy
s,ners `n Phone: -
� I � A•G� CUPERTINO-BUILDING DIVISION
Contractors Name: Lk:N°: APPLICATION I PERMIT ( V
Architect/Engineer: BUILDING-ELECTRICAI.PLUMBING-MEC}IANICAL CATEGORY CONTROL
LIc.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLUG
Address: PERMiTISSUANCE �.DO ❑
LICENSED CONTRACTOR'S DECLARATION
I herebySecliol 70M)ol licensed alnnsolChapter
ssion.9(mmmenc AI'I'IIANCESRESIDENTIAL OR DFSCRO'fION
In ease i Sectfon force and dieon3oftM1e Bus] and Prolesalon.Code,and my
license Is In full foss and effet. PANELS T I P r.s�
i License Claes Lic.a 1T— -rfJ
0 AMPS
Date Contactor UP 2DOAMPS
ARCHITECTS DECLARATION
reO Z I understand my plans shall be used as public records. OVER 1000 AMPS SQ.11.FLOOR AREA S/SQ.Ff.
OC
(/ Licensed Professions) - SIGNS ELECTRICAL
�6�° OWNER-BUILDER DECLARATION SPECGLCEtCNT/MISC
ZE, � Iharebyafflrmthat lam exempt from the Contractors License Law for the
following reason.(Senlon 7031,5,Business and Pmfenbns Code:Any city or
O ti TEM P.M=ORPOLEINST.
rr,� county which rcqulresa permktocorutmct,alter,Improve,demolish,arrepalr
anystructure priortoftabsuance,also requirsthe applicantforsuch permitto POWER DEVICES
[v file a signed statement that he b licensed pursuant to the provlslons of the
Om Contmaor's License law(Chaptar9(commencing with Section 7000)of Dlvl-
E,V1OS sI.n3.fIh.B.,Wsn;ard Prefessima Codc)orthat helsexempttherefromand SWIMMING POOL ELECTRIC
q - VALUATION
0 the basis for the alleged exemption. Any violation of Section 70315 by any /' OUTLETSSWITCHES4IXTURFS
applicant for a permit suot m
bjectsthe applicant to a civil penalty of nore than
$ five hors dollsrs(y500).
NEW RESIDENTIAL ELECTR
sownere(the property,°r my employesWith wage or offered
�'�' SIYJWiS TYPE CONSTRUCTION
compensation,willciothe work and the structure The
not Intended or offered for
dile(notap144,to alnowner of Profession
Cob:The Contractors License Law
r3$ docs not apply to an himself
of property who builds or Improves thereory and OCC.GROUP RFS.LINITS
who doementsam work t intended or°ugh ffered own employees,
everthe
dedeb building
orhat such
Improvements lntendrayearfemdforsale.ILM1ower-builderwill have TOTAL:
Improvement bsold wilhinoneyearofcompitlorytheowner-bullderwlllhave
Ujtj;urden ofpmving that he did not build or4nprove for purpose olsale.). QTY. 'PLUMBING PERMIT FEE FLOOD9DNE AIN
V f 1,as owner of the property,am exclusively contacting with licensed PERMIT ISSUANCE
contractors to construct the project(Sec.7014,Business and Prolessl°ns Code:
The Contractor's Limine law dos not apply to an owner of property who ALTER-DRAIN A VEM-WATER IFA)
Wilds or Improves thereon, and who contracts for such p(ojects with a
OffcgR{pcmr(a)Brenand pumuant to me Contractor.Llmnee Law. BACK FLOW PROTECT.DEVICE ' FEE SUMMARY
l='am exe pt under Sec. �L B k P C for his reason
gheh,tg�glas,�a..;.Ii'�LX1II s, DRAINS-FLOOR ROOF,AREA,COND. SANCCARY Y_ N
Pune a VORKMA COMPENSATION DEDCLARA 1IO� p E�pgg TRAP 2r SCHOOLTAX Y��tl
❑I hereby affirm that I have a certlRote of consent to self-Insure,ora V D
RECEIPT x-
rertiflrab ofWorkers'Compensatlonlnsumnceoracertified copylhenroftSec. GAS EA.SYSIEM-11NC4 OUTLETS
Policy Lab CJ PARK FIT Y_ N
Policy tl — RECEIPT p
Com an GAS EA.SYSTEM: VER4(EA)
Y BUILDING DIVISION FEE
edified copy b herebyfurnished.necity GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
�CertJied copy b Ned with the city Inspection division. '
CERTIFICATE OF EX EMPTION FROM WORK BR S' GRFASETRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 20OFf Date RCCCI t#
RMsaetlon need not be completed i(the permit b forone hundred dollars
(81I cardless.) WATER HEATERW/VENT/ELEGTR ENERGYFEE Y N
I ll not that ti the Person in an lhe weakcamner so a to b co eermit b Issued,the —
I shall not employ any Person in any manner n s to become mbject to the WATER SY5TEN/TREATING
Workcrv'C.mpensatlon laws of Callfornb.Dine PAID -
0 Z Applicant
Z O NOTICETO APPLICANT:If,after making thin CertRlete of Exemption,you NEW RESIDENTIAL PLMB._SQF7. Date Recel t#
should become subject to the Workers'Comperuatlon provisions of the Labor TOTAL:
(/) Code,you moat forthwith comply with such provisions.,this permit shall be
> deemed revoked. BUILDING FEE
W G CONSTRUCTION LENDING AGENCY SEISMIC FEE
a l berebyafOrrt that there is a construction lend Ing agency for the perform- ELECTRIC FEE
Z arm of the work for which this permit is Issued(Sec.3097,Civ.C.) TOTAL: _(7D E7-r
(,) O larder's Name - PLUMBING FEE
LL f Lender's Address QTY. MECHANICAL PERMIT, FEE - MECHANICAL FEE
OW ,Imdllythat l havem.d this application and statethat theaboveinfor atlon
1 Is correct.legroom comply with all city and county mclirarms and state laws PERMIT ISSUANCE Z'
} relating to Wilding construction,and hembyauthorlx representativsofthl, � sVl
F ttytoenterupa"the above,mentioned propertyInspection Inspection purposes. ALTERORADDTOMECH.
Z —Date Retei t#
(We)agree to save,Indemnify an d keep harmless the City of Cupertino P
against llabilltdgme s,costs and x nn e.which mayinanywayaccrue AIR HANDLING UNIT(TO I(L000 CFM) SUBTOTAL:
.g.m,taald Cl I.... th anting of Is perm .
io• t AIR HANDLING UNITE(OVER 10,000CFM) CONSTRUCTION TAX
mof Applic t/ .stator -/Date EXHAUST HOOD(W/DI1C'D -� CONSTRUCTION TAX PAID:
HA DOUS MATERIALS DISCLOSURE
Willthe applicant or futurebuilding occupant stomor handle hazardous HEATING UNIT(TO 100,000 RTU) Dale Recef 1#
material as defined by the Cupertino Municipal Code,Chapter 9.I2,and the
He.hhand SafetyCode Section 255320)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: DD
7 YsM No
Witlthe applicant or funambullding occupant use equipment or devices VENTILATION PAN(SINGLE RESID) ISSUANCE DATE
which emit W aardous air contaminants as defined by the Bay Area Air P IUL)
Quality htaivagement D❑lsWt7 BOILER-COMP(3ED'DR IW,O(D Bill)
4 Yna N No
have is lih.th& fm n.de,Sb requirements under d 22534.15 of BOILER-COMP(OVER 100,000 ETD) E 6 U 199U
the GltandtatIfthebSafety Code,Sot currently
have
a tend,that
r J
understand that if the building does not curzenlly havealewrL that ltlsmy NEW RESIDENTIAL MECN. SQ.Ff.
responsibility to notify the occupant of n qulrermsts which the met
prlorto us nc of aCe c eo( ancy. pf PI po -
c, � � a� City srfinn
r aulhoriu a nt Date
TOTAL: / ISSUEDBY: _
OFFICE COPY