19536 w
POST THIS CARD NEAR`FRONT OF BUILDING,— PERMITNO.
19536 . .
:INSPECTION
, ' L ACITYOF CUPERA
INSPECTIONDIVISION- JOB INSPECTION.RECORD ` e.
JOB ADDRESS�B LU ST' ' ( C.r'k�. -j�l�l . UNIT# SLOT tl - FcA7uoev,w. ' CONTROL«
1 _ :•`BUILDING PERMIT INFO,—' ,W
OWNER d)C-�i�-oL. IA-•A.W� - CONTRA_CFOR h: —'
INSPECTION,.' i t' I a ` DATE.'`, INSPECTOR INSPECTION RECORD f
FOUNDATION/PIERS r° 'NOTEALLCRADINCANDDRAINACE`•• Lam•
UFERGROUND - 7 ' .SI FALL BE INSTALLED TO COMPLY,MTTI JOB DESCRIP11ON
PAD/SETBACK-CERT, n-IE APPROVED PLAN'S AND CITY OF ,
.. - '
CARAGESLABS PRECUNITE. cDrcxnno5TANDARDS.
- "
.POUR NO'CONCRETE'UNTIL'ABOVE HASIBEEN SIGNED'Y r
UNDERGROUND/SLAB '. INSPECTION- DATE NSPECTOR
. PLUMBING - - -
ELECTRICAL
MECHANICAL
-DO.NOT POUR FLOOR UNTIL ABOVE HAS13EEN SIGNED,
WOOD FLOOR
PLUMBING
MECHANICAL '
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION
PL'ACE.NO'SUBFLOOR-UNTIL''ABOVE HASIBEEN'SIGNED,
ROUGH
PLUMBING - • - -
TUBS kSHOWER PAN
MECHANICAL '
ELECTRICAL ACUZZI BOND _ -
` FRAMING STAIRS
INSULATION/VENTILATION -
.. EM ERC:EGRESS-
;.� SEWER WATER -
' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED'' -
EXTERIORSHEAR FIOLD DOWN ,
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATFI/W-SCREEN -
`
SHOWER LATH. • -
SCRATCH COAT
` .NO•TAPEIOR PIASTERUNTIL•ABOVE HASIBEEN'SIGNED
NOTE:NO FINAL INSPECTION SHALL BE'MADE BEFORE
TFIE CONSTRUCTION TAX IS PAID
- -FINALS DATE INSPECTOR
SAN.ff -
.. ELECT.ENERGY
i
PLUMBING ENERGY
MCCFL ENERGY
BUILDING'ENERGY
- i ELECT.FINAL TEST
PLUMBING
GAS TEST
MECHANICAL
HEATING
ELECTRICAL RELEASE - .. .
` FIREDEPT.
GRADE
OCCUPANCY
" TEMPORARY APPROVALS . . • C ,. -
9
ELECTRIC.
GAS : '
BUILDING, '• - - ISSUANCE DATE -
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL '"
BUILDING FINAL IS SIGNED BY BUILDINC,INSPECTOR - .PAID
ARRANGE FOR INSPECTION,BY•PHONING 252-4505 BETWEEN
. 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,2%4 HOURS JAN P, ?,
BEFORE REQUIRED INSPECTION, IOB,ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING. =^^IfinR
IMPORTANT! i J `
'PLEASE READ REVERSE SIDE BEFORE CALLING .FOR FINAL-INSPECTION . d� 'DBY
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Prded Identification - PERMIT NO.
Building Addmas: - — - 1 9 5 3 6
nen Phone: ,A
6 CITY OF CUPERTINOiBUILDING DIVISION
APPLICATION I PERMIT Z
C tractor's Name '^ Llc. o: -
BMDING-ELECTRICALMUMBING-MECHANICAL CATEGORY CONTROL N '
e /Frillnedlo
Lie.No,
a 'a— 6Nl • `- t°• - 1 .b '' ) r.,;; BUILDING PERMITINFO',
�,'^_^ . . QTY!,, IkF)t EL-ECTRIC,PERMIT I+,„ 11 {PFCE r { ` - ' .I' . .
A _ PIUMITISSUANCE El
❑ ❑ -
li
CF.NSEDC TRACTOR'S DEG LA RATION
I hereby afflrmthat lam licensed under provisions of Chapter9(commene- APPLIANCFSRESIDENTIAL ]OB DESCR11MON
ingwith Section 7000)ofDivislon3ofthe Buainemand Profetl sC.de,and my - - -
Ilceheelalnfullfor ;�N�JLpYEfM. -go 4J PANUS . 'n
Date CoLifien
n'N �;,. 201-1000 AMPS •:�`''� \
reOZpq Iunderstan�dl'mmyy plaruahall be need as publlererords. OVER1000AMPS SQ.Fr.MOOR AREA 5/SQ.FT.
��U Licensed Professional SIGNSELECTRICAL -
• 6 - OWNER-BUILDER DECLARATION S'ECIALCIRCUIT/MLSC
yr~ Iherebyaffirm that am exempt fmn the ContiactoesLicense Law for the
oo following reason.(Section 7071.5,Business and Professions Code:Any dty or
TEMP.M=OR POLE INST.
F4, county which requires pertmttoror,strum,alter,Impmve,dennllah,orrepalr ,
11 I anystmoture pdorm its issuance,eb,requimtheappRant forsuch permit o POWER DEVICES
W U en
file a signed statement that he Is licensed pursuant to the TmwIdoro of the
3µ Contractor's License Law(Chapter9(cornoweclng with Section 700D)of Divi-
oon3 of the Business and Perfemloru Code)orthat he LsemmpttherefromaVALUATION
SWIMMING IDOL ELECTRIC
6$, the basis for the alleged exemption. Any violation of Section 7071.5 by any OUTLETS-SWITCHES-FIXTURES
fora permit subjects the applicamto a dvll penalty of mat marethan
live hundred dollars(MO).
❑I,as owner of the roe NEW RESIDENTIAL ELECTR SQFT, STORIES 'IYPECONSrRUCTION
property,sty,or.my employees with wage as their sole
ttX, c mpensatlon,wBldo the work.and lhestructure b not Intended or offered for -
,V O sale(Sec.7044,Busmen and Professions Code:The Contractors License Law -
$$ does not apply to an owner of property who builds or improves thereon,and OCCCROUIs - RFS.[INRs
who deassuchwork himseltorthrmgh hisownemployes,provided thatsuch
Improvements are not Intended oroffered for sale.If,however,thebullding or TOTAL:
Improvement bwtd withlnoneyeara/complelbn,themseer-buRderwill have ,
it Altoof proving that heard not bund or Improve for purpose of sale.). QTY, +�;'�'PLUMBING,PERMIT; d - I ,i:FEE ):lppp yplYE AEN
tyL as owner of the property,am exclusively contracting with llreneed PERMIT ISSUANCE
'contractors to coomm d the pmjed(Sec.7044,Business and Professions Code: '
The Contactors License law don not apply to an owner of property who ALTER-DRAIN VENTWATER(EA)
builds or Imrove d - -pthereon,and who commas for such p(oje
s with a �•.'FEE SUMMARY",
cj5ador(s)]lensed pursuant to the Contractors License Law. i,;
I amexempt under Sec. B&P C for this reason BACK FLOW PROTECT.DEVICE
I'l ES
Owner Dae DRAINS FLOOR,ROOF,AREA,COND. SANITARY Y_ N
RECEBT p
WORKMAN COMPENSATION DECLARATION FIXES.PER TRAP SCIiOOLTA% Y_ N
❑I hereby affirm that I have a certificateenc of consent to self-insum,ora RECEIPT N
3800,Lab of Workeri Compevatlonlrourance orarenified copytherm((Sec. GAS FA.SYSTEM-1 INCA OUTLETS PARKFEE Y N
3800,Lab C.I
Pollry p GAS EA.SYSTEM-0VER 4(EAI TANG Dr p -
Com any - BUT DIVISION IT ES
Certified mpy is here furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCFIECK FEE
�a1 Ceniled mpy Is filed with the sty Irepedlon divides.
CERTIFICATE OF EKEMPT[ON FROM WORKERS' - ' GREASETRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.20017. Date RCCL'1 t#
Qhis section need nat be completed if the permit at for one hundred dollar P
($10()orlesv.) WATER HEATER W/VE NT/ELECTR ENERGYFEE Y, N
I¢nify that N the performance of the work forwhich this permit is Issued,
I shall not employ any person In any manner m as m become subjectto the WATER SYSTEM/TREATING
Worken'Compenution laws of GlllornG. Date PAID
licant
.Z 0 NOTICE TO APPLICANT:If,after making this Certificate of Exemption,You NEW RESDIlAL PLMB. SQ.FT. Date Recei t#
should become subject to the Workers'Compersrtlon Provide.of the Labor TOTAL:
N Code,you must forthwith comply with such provisions or this permit hall be U NG
W >' deemed revoked. ILII FEE
FEE-
CL CONSTRUCTION LENDING AGENCY SEISMIC FEE-
T hereby affirm that there Is a corutmm ctlon lending agency for the perform- ELECTRIC FEE
Z aace of the work for which that permit Is Issued&c.3097,Co.C.) TOTAL: -
O O Lander.Name - - - — PLUMBING FEE ' _
LL F Le.der.Address - QTY, MECHANICAL PERMFr. MECHANICAL FEE
OW Ienifythatl havereadthlsappllationand state that theabove information
1 brorred.lagreeto complywlthall cityand countyordlnancesand state laws PERMIT ISSUANCE ,JO FEES PAID: ,
} relating tobullding construction,and hembyauthoAae mpresentativesof this
Zcity to enter upon the abovenvoAloond property for inspection purposes. ALTERORADDTOMECH. UL)
(W e)agree to save,Ind room ty and keep harndess the City of Cupertino .. Date Recei t#
•V against llabllltiea,judgments,cost end expeneea whichmaylnanywayaccAm AIR HANDLING UNIT(TO 10,000CF&D SUBTOTAL:
ag nstuld CRyin ronsequenc f the gra nt infidthlspermI "
�Z�Q� AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX
Btgra m.fApp is nt d ---I-DAA r-"— Ex}uusr HOOD(W/DUCT) - - CONSTRUCTION TAX PAID:
HA RDOU ATERIAL'�ss DISCLOSURE '
Will the applicant or forum building occupant stare or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recei-t#
material as defined by the Cupenloo Municipal Code,Chapter 9.1 2,and the
I With and Safety Code Section 25532(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL:
❑ Yen QNo - -
Will the appliantorf.tum building occupant use equipment or devices VENTILATION FAN(SINGLE RESD) ISSPNJE•DATE
which emit haurdom air rontaminanta as de0ned by the Bay Area Alr A ay
QuIlly Management D rid? BOILER-COMP(3HP OR 100,W0 BTU) '
Yet, NO t2 (y
Thaw, ad the hazara.U,materials requimmetsunder Chapter6.95of BOILER-COMP(OV[R100,000BTU)' JAN 2 `x' 1990 •
the California Health&Safety Code,Sections 25505,25533 and 25534.L _
understand that if the building doe not currently have.meant,that it Is my NEW RESIDENTIAL MECH. SQ.FT. s '• .y
nspoasibilityto not lty the. ant of the requirements which must be metLC•'I "IIT rt1`Ifln.
pdo t i .ance ofa Ce Ail ofocntpadry,, �,
er oC dat Date ISSUE
UIIrLIJ
7YJTAL: 1.2 U�
OFFICE COPY "