19464•• -
.� POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CU'PERTINO ,
INSPECTION DIVISION - JOB (INSPECTION RECORD'
JOB•ADDRESS .�. `�"S a/� c. S t �+"' r �. UNIT # LOT
S• #�.t�� -
OWNER'- .0L -bc ,�_- 6--Rr 1' CONTRACFOR..&XVjtk 4136 ra N
PP-RMITNO.
19464,
A
CATEGORY
CONTRgFx
/NFO
,i;,BUILDING PERMIT I
.INSPECTION • k;
DATE
INSPECTOR
- INSPECTION RECORD
NOTE ALL GRADING AND DRAINAGE
SHALL BE INSTALLED TO COMPLY WITH
THE APPRovPD PLANS AND CITY OF
curERnno STANDARDS.,
r
ED •� '❑ "''
FOUNDATION /PIERS -
UFER'GROUND
JOB DESCRII'DON
-
.
PAD SETBACK -CERT
-
GARAGE SLABS/ PREGUNITE
POUR NO CONCRETE UNTIL ABOVE
HAS'BEEN
SIGNED -
INSPECTION
DATE
INSPECTOR
UNDERGROUND /SLAB '
PLUMBING
ELECTRICAL -
-
MECHANICAL
-
-
DQ NOT POUR FLOOR UNTIL" ABOVE,HAS
BEEN
SIGNED
WOOD FLOOR
-
-
PLUMBING ':}
- -
, . .., ,
'
MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR
INSULATION
PLACE NO SUBFLOOR'UNTIL ABOVE
HAS BEEN.S
/GNED
ROUGH
PLUMBING - --
-
TUBS & SHOWER PAN -
MECHANICAL
ELECTRICALIJACUZZI 13OND•.
FRAMING /STAIRS.
-
INSULATION /VENTILATION`
-
- -
-
-
EMERG. EGRESS
-
SEWER WATER
COVER. NO WORK UNTIL ABOVE HAS'BEEN
SIGNED
EXTERIOR SHEAR HOLD DOWN
'
-
-
INTERIOR SHEAR /HOLD DOWN
SHEETROCK /SHEETROCK
SHEAR
-
EXTERIOR LATH/
W- SCREEN
SHOWER LATH
-
'SCRATCH COAT'•-
NO, TAPE', OR,PLASTER. UNTIL''ABOVE
HAS'BEEN
SIGNED
NOTE: NO FINAL INSPECTION SHALL BE MADE BEFORE,
'THE CONSTRUCTION TAX IS PAID
- ,
-
FINALS
DATE
INSPECTOR.-
-
..
SAN.#
ELECT. ENERGY
- -
PLUM RING ENERGY _
MECH. ENERGY
-
BUILDING ENERGY
ELECT. FINAL TEST
- ' •
-
..
PLUMBING
-
GAS TEST
MECHANICAL
HEATING
ELECTRICAL RELEASE^
-
.
.FIRE DEPT.
GRADE -
- ••
'
.00CUPANCY
TEMPORARY APPROVALS -
ELECTRIC- -
GAS .
BUILDING ISSUANCE DATE
OCCUPANCY•OF BUILDING IS NOT PERMITTED UNTIL
BUILDING FINAL: IS SIGNED, BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252 -4505 BETWEEN ", C
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, 24 HOURS
BEFORE REQUIRED INSPECTION. jOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING" '
IMPORTANT!
PLFASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION "' ISSLTEDBY: 7nit- Gl,
OFFICE COPY
c
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification -
ae� °s'3o S -1- ¢ CAN,
- PEIMTNO.
19464'
C971, came: - Phone:
CITY
OF CUPERTINO-BUILDING DIVISION
APPLICATION -/ PERMIT
BUILDINGELECTRICALPLUMBING -MECH
LAICAL ,
APPLICAIIUN ,
Co�ador'� ante: t ua. Net
CATEGORY
CO L
Architect/Engineer: - Llc. No:
QTY.
t
ELECTRIC PERMIT
;f PCG
� ,BUILDINGPERMIT INFO,.
Addrens: ..
❑ K]j ❑ ❑
L/=
PERMITISSUANCE ,.
LICENSED CONTRACTOR'S DECLARATION
Ihereby aff irm that l am licensed under provlsionsofChapter9(commenc
ingwlth SectI.O7000)of Dividon 3 oRhe Budoessand Professions Code, and my
Licene Clae V
Livens is In fun (arse giiek effect. '3 6 x7.3
" ARCHITECTS DE RATION -
I understand my plans shall be used at public records.
Licensed Professional
OWNER - BUILDER DECLARATION
I herebyafR,mtMt I am exempt from the Contractors Llcene law for the
followingreeson.(Section 7031 .5, Business and Professlons Code: Any city or
cauntywhlch requlresa permit McomtmM alter, impmve, demolish, orrepair
anystmcture priorm its Issuance, alxorequlresthe applicant forsuch permit to
file a signed statement that he Is licensed pursuant to the Inowi ions of the
Contractor's License Law (Chapter 9(rommencleg with Section 7000) of Divl-
'slop 3 of the Business and Professions Code) .,that he is exempttherefromand
the basis for the alleged exemption. Any violation of Section 70313 by any
sthe applicant to a civil penalty ofnot ore than
applicant for a permit subject m
fivehundred'dollaro($500). -"
❑ 1,'as owner of the property, or my employees with wages as their sole
compensation, wOTdo the work andthe structure is not intended or offered for
min (Sec. 7044, Business and Prefesalona Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and
who doessuch work himself or through his awn employees, provided that such
Improvements are not Intended oroffered for sale. If, however, thebuilding or
Improvementbsoldwlthinuneyearo fcomplellon ,the owner- bullderwill have
thr*rden of provingmat he did not build orbnpeom for Purpose ofsab.).
I, as owner of the property, am exclusively contracting with licensed
contractors to rom uct the project (Sec. 7044, Business and Etched.. Code:
The Contractor's License Law does not apply to an .weer of property who
huBds or Improves thereon, and who contracts for such ptojee ls with a
to-p(factor(s) licensed pursuant ro the Contractors Limn Law.
IJ I am exempt . under See. B A P C for this reason
APPLIANCESRESIDEMIAL
JOB DESCRIPTION
•
PANELS. r' —
r
2014000AMP5'
OVERIOOOAMPS
SQ. FT. FLOOR AREA
-
'
$ /SQ. FT.
u
-
SIG NS ELECTRICAL -
5PPGIALGItCUIT /MLSC
TEMP.MET[ROR POLE INSf:
_
POWER DEVICES
SWndFING IDOL ELECTRIC
OUTLETSSWITCFTFSH%TURES
VALUATION
-
NEWRFSIDENTIALELECTR SQ.IT.
_ ''
— STORIES
�4 .' Q
�+;-.
.QCC. GROUT'
.TYPE CONSTRUCTION
..
RIS.UNRS',
-
'�F.
L�sOC
QTY.
TOTAL:
.,
PLUMBING)PERMIT,`P`,• •
�teo
` FEE"
FLOOD
APN -
A-
PERMIT ISSUANCE
- -
ALTER-DRAIN &VENT WATER IPA)'
_
'�" 'FEE SUMMARY
�''', '15 "• .....
BACK PLOW PROTECT. DEVICE
7
"
DRAINS FLOOR ROOF, AREA, COND.
FIXffiRES PER TRAP
SANITARY Y_ N
I RECEIPT N
Owner - Date
WORKMAN COMPENSATION DECLARATION I
F11 hereby affirm that I have a certificate of cement to serf -insure, or a
certificate of Workers Compens re
ation Insurance Ora certified copy theof(Ste.
3800, Lab C.) -
Policy p
SCHOOL TAX Y_ N_'
RFC ®PLY.
GAS EA. 5YS[EM-1 INC.40IJTLETS
PARK PPE V N '
GAS EA. SYSTEM -OVER 4'(EAI
Coat ray '
DING DIVISION
BUILDING DI VISION FE[S
RaCertlfled copy is herebyth the city
�j t crlified copy b flied with the city Inspection division.
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE.
QFis section need not be completed If the permit is forome hundred dolma
($100)rtifyt.) -
!certify employ he penmen In any manner so as to b omm, subject Issued,
I shall net employ any Laws In any manner so as to become subject to the
to the
Workers Compensation laws o(CaOfomla. Date
Applicant
amiCETO APPLICANThe after makiompo CertlflIma FxempWn, you
should become subject to the WOrken 'CompensaUOn provtslow ofthe Labor
Code,you must forthwith complywith such provlsi.rumthis perrud hall be
deemed meaked.
- CONSTRUCTION LENDING AGENCY
Iherebyaffirmthat thereb a mwtmetlon lending agency for the perform-
once Ofthe work for whichthEI permit is Issued (Sec. 3097,CIv.C.)
W
Le.dere Nama
Lende,e Addres
I certify that l have read thba ppba tl onand sOuxThat theabove I.mmution
Isco:red.I agree to comply with all city and county ordinances and state Paws:`.
relaling to bullding constroctlon, and hereby authorize representatives of thls
citytoenterupontheabove- mentioned property for Inspection purposes.
(We) agree to save, Indemnify an d keep harmim the City of Cupertino
against liabilities, udgmenta, roars andexpenseswhlchmayleanywaya¢me
against said City in consequence of the granting of this permit.
GREASE /INDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE `
PAID
Date RCCCj [#
CREASE TRAP
SEWER - SANITARY -STORM EA. 200717.
WATER HEATERW /VENT /ELECTR
ENERGY FEE Y N
i
PAID -
Date' Recei t#
'
-
WATER SYSTEM /TREATING, - t
�
,
NEWRFSIDENTIALPLMB. SQFT.
.'TOTAL:
BUILDING
-
SEISMIC FEE- -
' TOTAL:
ELECTRIC FEE
i
QTY.
y
1* ' MECHANICAL'PERMIT ;.., ,
•• 1FECC
PLUMBING FEE
MECHANICAL FEE
PERMITISSUANCE
FEES PAID: '
-
ALTERORADDTOMECH.
Date Rxei t#
AIR HANDLING UMT(TO 10,000 CFM)
-
SUBTOTAL:'
-
AIRHANDLINGIINH'(OVEf410,000CFM)
CONSTRUCTION TAX
Signamreof Applicant /Commetor Date -
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fu mm building occupant store or handle hazardous
material as defined by the Cupedi no Mu nicipal Code, Chapter 9.12, and the
Ileallh and Safety Code Section 25532(x)?
❑ Yea N N.
Will the applicant or future building occupant use equipment or devices
which emit hazardous air comandriants as defined by the Bay Area Air
Quality Management District?
Yoa;' ❑No
Z4haveresIf thebazardousmate rialsrequiremen tsunderChapter6.95of
the fe ia Health k Safety Code, Seatlons 75505, l!503 and 2:534. I
understand that lithe building does not cerrently have a tenant, that It la my
responsibility to notify the Occupant of the requirements which must be met
priorlois sailer of. Certifiateof Occupancy. ,-
EXHAUS r HOOD(V✓ /DUCT)
.,
CONSTRUCTION TAX PAID:
,
'
HEATING UNIT (TO 100,000 BTU)
-
.Dffie ROCC1 t#
-
HEATING UNIT (OVER 100,000 BTU)
—P
TOTAL:
QS
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
1 2 Q
-
^`� +Qx
1SSUEDBY' yV— A
BOILER -COMP OHPOR 100,000 BTU)
BOILER-COMP (OVER 100,00 BTU)
NEW RESIDENTIAL MECH. SQ.FT.
-
(Tuner or authorized agent Date
TOTAL:
OFFICE COPY '