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19584 POST THIS CARD NEAR FRONT OF BUILDING PBRMIT NO. 19584 CITY OF CUPERTINO INSPECTION DIVISION- JOB INSPECTION RECORD -1 , + 7(,JOB ADDRESS 1.x!!I% , w�.. u _z aaE UNIT# LOT# CATEGORY 1 CONTROL w OWNER KO�•R-�S6� CONTRACTOR KYi�J v-�� BUILDING PERMIT INFO INSPECTION DATE INSPECTOR INSPEC71ON OUNDATION/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 CUPERTINOSTANDARDS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND SLAB INSPECTrI 'DATE INSPECTOR PLUMBING ELECTRICAL MECHANICAL DO NOT POUR FLOOR UN77L ABOVE HAS 13EEN SIGNEIX WOOD FLOOR PLUMBING IV I MECHANICAL \\ ELECTRICAL - FRAMING VENTS CLEAR INSULATION PLACE NO SUBFLOOR UNTIL ABO 'HAS BEEN SIGNED ROUGH PLUMBING TUBS&SHOWER PAN MECHANICAL ELECTRICAL ACUZZI BOND FRAMING STAIRS INSULATION/VENTILATION EMERG.EGRESS SEWER WATER COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIOR SIJEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN SHEETROCK/SHEETROCKSHEAR EXTERIOR LATFI/W-SCREEN SHOWER LATH SCRATCH COAT NO TAPE OR PLASTE 'UNTIL ABOVE HAS BEEN SIGNED NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID FINALS DATE INSPECTOR SAN.# ELECT.ENERGY PLUMBING ENERGY MECH.ENERGY BUILDING ENERGY ELECT.FINAL TEST PLUMBING GAS TEST MECHANICAL HEATING ELECTRICAL RELEASE FIRE DEPT. GRADE ' OCCUPANCY TEMPORARY APPROVALS ELECTRIC CAS BUILDING OCCUPANCY OF BUILDING 1S NOT PERMITTED UN77L IS DATE 131111DINO FINAL IS SIGNED BY BUILDING INSPECTOR ►-«- �' ARRANGE FOR INSPECTION BY PHONING Z5Z-4505 DETWEEN A0 z a 199 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS Vol BEFORE REQUIRED INSPECTION. JOB ADDRESS AND d C+?, PERMIT# ARE NEEDED WHEN PHONING. IMPORTANT! ; 1:E �•) xr ' PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION TAYL%BY` OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Prn'ert Identification PEjfhUT NO. Butldleg Awdmen:119584 Z. �« r a Nam: Phone: A 0A) "'eat5'OA) (`f/S J3/— b33Z CITY OF CUPERTINO-BUILDINGDIVISION 1 C dM. Lk.Na: APPLICATION / PERMIT II �1 fte S 0// D BUILDING-ELECTRICALPLUMBINC-MFLHANICAL CATEGORY CONTROL B Archltea/Engloser. Lie.No: p/J�� QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Add...L26 ...... C PERNOTISSUANCE 1:1 ❑ ❑ LICENSED CONTRACT 'S DECLARATION D Ihereby af(Irnlhnt l ser licensed under provisions of Chapter court APPLIANCESRESIDENTAL JOB DESCRII'ITON IngwhthSad1on7000)rf DlWelon3o(theBusineuand Pro(esslonsCode,andmy le I. PANELS licena� se ful effect [.i r�rV arae�J LlrenxC ml(cM D ISI - �a[� •I t Date f/Z— ConlraRar fL//ll/ A-4sKr VA ♦`Q ARCHITECPS DECLARATION 301-1000AMPS 9 0 2 I understand my pore shallbe used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT. O �j Li creed Pmfo.ienaf SIGNS ELECTRICAL � r < DOWNER-BUILDER DECLARATION SPECIALCItCUIT/MISC i., Ihereby affirm that l am exempt from the Contractor's License law for the QQ pp followingreas quimsapemiitw Buslnessalt Ptmp ome=lWhnydtyor criantywhich require.apermltrocomtrod,alter,Impeove,demolbh,orrepair TEMP.METER OR POLE INST. anysrudure priorto Its Issuance,alsorequlresthe applicant far such permRto POWER DEVICES Nd a file a signed statemert that he h licensed pursuant to the provisions of the t:in Coofmdor'e License Law(Chapter 9(comerencing with Section 7000)of Divi- SW�pUNG POOL ELECTRIC SOS aum3o(the B.shmsand Pm embw Cade)orthathehe amp themfromand I VALUATIOIJ G 5 the lanais for the alleged exemption. Any violation of Section 7ML5 by any applicant fora permit subjects the applicant to a civil penalty of not morethan OITILETSSW[TCIiESE%TURFS �J five hundred dollars($SOD). I,as owner of the property, NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPECONSTRUCTION �n ❑ P ork and my employees net intended as for compensation,Basin the sol Profs thesC durehn Contractor orofferedw a O ask(Sec 7044,to alnow and I property rops ty Code:The uilds mr lenprov.thereon law Gj $ does nonsucht.ppty torn ownermprough his o nernporlmproovidedreon,and OCC.GROUP RIS.UNIT'S ff�• who doeeeuchwork himselforlhrough hleownemployeea,provided thalwch improvernerts are not Intended oroRered for sale.It however,thebulMing or TOTAL: OyI,a L improvement issuld wlthlnoneycaro(comptdioNtheowner-builderwW have `��a.LG�i 77{�/ bp-t tlj,LIIuMen of provingthat he did not build or improve for purpose of wk.). Q7y, PLUMBING PERMIT FEE FLOOD ZONE APN Lj L as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7094,Business and Pretensions Code: PERMITISSUANCE The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) basis or Improves thereon,and who comment for such pto)ecb with a FEE SUMMARY 151am arensed pursuant to the Contndk ots License Law. RACY FLOW PROTECT.DEVICE am exempt under Sec. B P C for thin reason OUTSIDE FEES Owner Date DRAINS FLOOR,ROOF,AREA,CONS, SANITARY Y_ N_ WORKMAN COMPENSATION DECLARATION BCE FIXTURES.PER TRAP SCI IDOL TAX Y N R— NM I hereby affirm that I have a certificate of consent to self-Imure,ora RECEIPT M ca ) k/I Compematlonlmuraner ora¢rtlfkd copy theeeof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N 3BOq lab bcte CJ /I ad �-q,U Policy �e� p 7 /C tom, GAS EA.SYSTEM-OVER 4(EA) RECEIPT Com any BUILDING DIVISION FEES o"fled cohhereby(umlahnd. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE erialed copypy L filed with the city Inapedion division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID INSURANCE NSURANGB SEWER-SANITARY-STORM EA.300FT. Date Remi t# (Thlseedlan need net be completedpermit h(Drone hundreddollars (SIM)arless.) WATER HEATER W/VENT/ELECTR ENERGY FEE Y N I mmlythat In the perforreanm of the work forwhich the permR is heed, — 1 shall not employ any person In any nmnner so as to be..subject to the WATERSYSTEM/T Workers'Compensation Laws of California.Date REATING FAID Z NOTcant ICE TO APPLICANT:If,after making thin Certificate of Exemption,YOU NEW RESIDENTIAL PLMB. SQFT. Date Reml t# Hshould become sub)ect to the Wrrker.'Compemation provisions of the Labor TOTAL: W Code,you=at forthwith comply with such provisions Delhi permit shall be 7 deemed revoked. BUILDINGFEE W CONSTRUCTION LENDING AGENCY SEISMIC FEE a Ihereby affirm that there is a construction lending agenq for the perform ELECTRIC FEE M Z an ce ofthework(orwhichthisp.,Mth Wued(Sec.3097,C(v.C.I TOTAL: V O lender.Name PLUMBING FEE - IL F Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW Imdifythat l have read thhapplicatlonend statethatthe above information IL homord.Iagree tocomplywlth all city and county ordinances and date laws PERMIT ISSUANCE FEES PAID: W relating to building comtmction,and hereby authonLm representatives ofthis F- U) city to enter upon the above-mentioned property for Inspection purposes, ALTIRORADDTOMECH. Date ROCei t# — (We)agree to save,indemnify an d krep harmless the City of Cupertino against liabilities,I.dgrmnh,.9.and expenses which my In any wayaccrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL' against said City in cor.sryence of the gra ruing of thin permit. AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTIONTAX Signature of Appacart/Contractor Date EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future bu0dingeocupartatoreorhandle hamrdmus HEATING UNIT(TO IW,"RTI)) rraterialasciefined bythe Cupertino Municipal Code,Chapter9.1Z and the _ Date Remi l# Health and Safely Coda Ion 25533(x)7 HEATING UNIT(OVER IW,000 BTU) L: 4 ❑Yen No SC Will the applicant-At Lure building occupant use equipnmet or devices VENITLATION FAN(SINGLE RESID) ISSU - ATE which emit hazardous air cont.coner a as defined by the Bay Area Air Quality MamgementD t dT BOILER-00MPCIHPORI00,000BT1Z .�S`y f3 y ��C'� 1�'I Yes No (+ l the read Healthe h Ia Safety Code,Se tface 2menh Sunder S33 and 2M 4.I of BOILER-COMP(OVER 100,000 BTU) the Cal t.ad h He alth k building Coesnot com35505,ve a tand35534.1 understand that notify the ocgdoea notcureq.1nhavea tenant that Rhmy NEW RESIDENTIAL MEGI. SQ.IT. I�i1T1 •(IQ^l8n'7 responsibility to nilly the occupy cat o(ihe requlrerrenb which at be mel Com— --'• prior to issuance of a Cedlfcate o/Ompanry. ��a��`•�)` Owner or authorized agent Date 3OF- -Pt TOTAL: ISSUED BY: OFFICE COPY