195370
•
POST THIS CARD NEAR FRONT OF BUILDING
- .: •' �
CITY OF CUPERTINO
INSPECTION DIVISION - JOB INSPECTION RECORD
JOB ADDRESS c-IrN/V'l UNIT # LOT #
OWNER CONTRACTOR D \Id kA -
PERMIT NO.
19537
A . I I AL DA 11
J
A
CONGNCTROL#
BUILDING PERMIT INFO
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INSPECTION 1 1', DATE INSPECTOR
NOTE: ALL GRADING AG DRAINAGE
RE INSTALLED TO COMPLY WM
THE APPROVED PLANS AND CITY OF
CLIFERTINO STANDARDS.
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POUNDATON/PIERS
UFERGROUNDSHALL
JOB DESCRIPTION
.�'
PAD/SETBACK-CERT H.E HE
GARAGE SLABS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
INSPECTION
DATE
INSPECTOR4
PLUMBING
ELECTRICAL
MECHANICAL
.H -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
'
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL
-
A-
_
FRAMING/VENTS/CLEAR
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED'
ROUGH
PLUMBING
TUBS & SHOWER PAN -
MECHANICAL -
ELECTRICAL/JACUZZI BOND
FRAMING STAIRS -
INSULATION /VENTILATION,
EM ERG. EGRESS
_
-
SEWER WATER - -
COVER`NO WORKIINTIL ABOVE HASIBEEMSIGNE&',C", = t
-
.
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
-
EXTERIORLATFI/W-SCREEN -
SHOWER LATH
SCRATCH COAT
NO',TA"PE OR PLASTER'UNTIL ABOVE,HAS BEEN SIGNED
NOTE: NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX 19 PAID
FINALS, DATE INSPECTOR
-
SAN.#
ELECT:ENERGY'
PLUMBING ENERGY '
MGCH:ENERGY
-
BUILDING ENERGY
ELECT. FINAL TEST
PLUMBING
GAS TEST
MECHANICAL
-
-
HEATING - -
ELECTRICAL RELEASE -
-
-
FIRE DEPT.
GRADE
OCCUPANCY
TEMPORARYAPPROVALS
ELECTRIC '
GAS' I- -
13UILDING
SNCE DATE
OCCUPANCY OF BUILDING 1S NOT PERMITTED UNTIL In. S¢UAvN ,
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN inl I in I. IjSJ
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, 24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND Cli'I II` fN—dinrl
PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUiDBY: �� k. v I`- L. v.. i'.7,•y
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Addalss:
calrv-4
PERMITNO.
19537
re aame: Phe:
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BUILDINGELECTRICAL.PLUMBING-MECFIANICAL
APPLICATION SUUM11-IAL DATE
�pDcat
Z Z
uc.Na:
CATEGORY
CONTROL
L
Ar-cAvite�at /Engineer. L .No:
Not "
,'Qrr ELECTRIC PERMIT - FEE
BUILDINGPERMIT INFO
Addresw' • 1
�Jj ❑ 1:1 El
1�i1
PERMITISSUANCE'
CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provlslone of Chapter 9(rommen
ingwlth Se ian7000)0f Di lsion3ofthe Bugr and PrufessionsCode, and my
Ltramis In full form and e. #
License Clam Lk.M
Date Contractor
ARCHITECTS DECLARATION
-[�y�und/entan la ehallye used as public retards.
(y¢k�j - ^ `�
OWNER -BUILDER DECLARATION
I herebyafflrm that I am exempt from the Contractor's Licenselaw for the
following reason. (Section 7031.5, Business and Professions Code Any city or
rountywhichrequiresapermittomrut alter,Impmve,dennlbh,orrepair
anystruchme prlorto It issuance, alsorequires the applicantfanuch permit to
file a signed statement that he Is licensed pursuant to the provisions of the
Contractors Llcome,Law (Chapter 9(commencing with Section 7000) of Divi-
slop 3 ofthe Business and Profeselom Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjecs the applicant to a civil penalty of not morethan
five 1, as demodollarthepr.
I, as owner of the property, or he employes with wages r thele dole
compensation, will Bothe workandthestmcturc boot Intended or offered for
Gds: The C imptoves thereon, Law
Business and f property
sale (Sec. apply
doesnotappiytoanownero(prough his o eempuilds orimprothat and
w Improvementsam khimeelf ed oroughedow ale. IL yam, ertheprovided that such
Improvement am not Intended earofredforsale.thh er-pthebulllI have
Improvement tools within oneyearo(complellon, the owner-buBtlerwlll have
thg_�urden of proving that he did not build or improve for purpose of sate.).
" L as owner of the property, am exclusively contracting with licensed
to consumer the project (Sec. 7044, Business and Profemloms Code:
The Contactoe. License Law does not apply to set owner of property who
builds or Improves themes, and who contracts for such pSojeds with a
Cg1Lt[actor(s) Bmnsed pursuant to the Contractor's License Law.
Lf I am exempt under See B k P C for this reasonOUTSIDE
APPLIANCES -RESIDENTIAL
JOB DESCRIPTION
PANELS
UP TO 200 AMPS
—
101.1000 AMPS
OVERIn00AMPS
SQ. FT. FLOOR AREA
E/SQ.IT. '
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC
Tp2,(p MEl'QR OR POLE INST.
POWER DEVICES'
SWIMMING POOL ELECTRIC
OUTLET&SWITCI IS -FIXTURES
VALUATION
C� �1 /9 D 0
J V (/
NEW RESIDENTIAL ELECTR SQ.FT,
STORIES
TYI'ECONSIRIJCTION'
,
TOTAL:
QTY, PLUMBING PERMIT FEE
OCC.GROUP
RfSUMTS
'
-TPN—
PERMIT ISSUANCEcontractor
ALTER-DRAINkVENT- WATER (EA)
FLOOD ZONE
-
FEE SUMMARY
I
BACK FLOW PROTECT. DEVICE
IT FS
DRAINS FLOOR ROOF, AREA, CONI.
pIXNRES, pRB TRAP
SANITARY ' Y_ N_
RECEIPT R
Owner Date
WOR KMAN COMPLWSATION DECLARATION
E31 hereby affirm mmte that I have a rtlRof consent to self-Insure, or
artlflmteof Workers'Comper tionlmumnmoramrtifl mpythemof6ec.
3800, Lab C.)
Policy N
SCHOOL TAX Y_ N
RECEIPT N
GAS EA. SYSTEM-1INC./OUTLETS
PARK FEE Y N
RECEIPT a
CAS EA. SYSTCM-0VER 1(EA)
Gm any
BUI LDING DIV] SION FE IS
Certified copy Ls hereby dwith the city
Certified copy t filed with the city Irupectlon dlvltlon.
CERTIFICATE OF E%EM MON FROM WORK ERS'
COMPENSATION INSURANCE
(This section need not M completed If the permit b (or one hundred dollars
(5100)nifyth
]snot thatlnthe person In any manner for hlch this tobeomermltbbroed,
I shall not employ any person In any manner so u to beams subject to the pkm
Applicant Compcnsatlon Lawe o(GII(omla. Date
NOTICE
NE TO
NOTICAPPLICANT;H, after making this Certificate at Exemption, you
should become subject to the Warken'Compentatlon provtlosu of the Lobar
Code, you swat forthwith comply with such provisions mthb pemdt shall
deemed revoked.
CONSTRUCTION LENDING AGFT'CY
]hereby affirm that there is a construction lending agency forthe perform,
onceof the work for which this permit t issued (Sc. 3097, Civ. C.)
Lender's Nae
Landers Address
I mrtifythat I have read this applimtlonand statethat theabovelefornnotlon
Is tomcat.I agree to comply with all cityand county ordinances and state laws
retting to building costmction, and hereby authorlu reprexntatives of thio
cityto enter upon the above-mentioned property for Wpection purposes.
(We) agme to save, indemnify an d keep harmless the City of Cupertino
.gam, ;jad menta, roat end e.pensawhlch ma yin anywayaccrue
P.,t.ldCi In moque the gr of this permit
o p t/ ntmctor Date
R )OUSMATERIALSDISCL SUREtheapp antorf lure building oaupant store rhandleharardous
material as defined by the Cupertino Municipal Code, apler9.lZandthe
I fralth and Safety Codlon 75532(.)?
F1Yes No
Wil l t he applicant or future building occupant use equipment or d evices
which emit h..M..a air contaeUmnta as deRmd by the Bay Area Air
Quality Management District?
4 We j}��No
have read the haz�Fiious materials requirement under Chapter 6.95 of
the California I Iealth A Safety Code, Sections 25505, 25533 and 75534. 1
understand that ifthe building does not currently have a tenant, that it is my
ility to noU the occvpa to(the rcquirerrmnt which must be met
p
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
Date Recei t#
�l
GREASE TRAPPAID_�1-3`25?
SEWER-SANITARY-STORMEA 200FT
WATERHEATERW/VENT/M TR
ENERGYFEE Y N
PAID_ sr
!� 101
Date Recei t#
WATER SYSTEM/TREATING
NEW RESIDENTIAL PLM B. SQFr.
TOTAL:
BIL ING FEE
2. S2. v4
SEISMIC FEE
TOTAL:
TOTAL:
ELECTRIC FEE
QTY. ME HANICAL PER T FEE
PLUMBING FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID: -
ALTERORADDTOMFOH.
Date Receipt#
AIR HANDLING UNIT CFO 10,000 CFM)
SUBTOTAL•
q T
AIR HANDLING UNIT(OVER 10,000 CFM)
CONSTRUCTION TAX
EXHAUST HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
HEATING UNIT (TO 100,MO BTU)
-
Date Recei t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
6
VENTILATION PAN (SINGLE RESID)
IS9UA - DATE '
Jn�J
li N 3 IZ)jl]
�It! nF �II'+gIf10� -
75SUEUBY:"' ` — A If
BOILER-COMP(3HP OR 100,000 BTU)
BOILER-COMP(OVER 100,000 BTU)
NEW RESIDENTIAL MECH. SQ.FT.
r author red agent Date /
TOTAL:
OFFICE COPY