19437 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NO.
19437
CITY OF CUPERTINOA A A .
INSPECTION DIVISION- JOB INSPECTION RECORD
• JOB ADDRESS I b 1 Z3 - Iq/`�.ce - SS UI�T# LOT# CATEGORY• - CONTROL#
OWNER A-- " CONTRACTOR a�- BUILDING PERMIT INFO
INSPECTION i I"DATE INSPECTOR , - INSPECTION RECORD - '
FOUNDATION PIERS NOTE ALL GRADING AND DRAINAGE. D
UFER GROUND _ SHALL BE INSTALLED TO COMPLY WITH OB DESCRIPDON
APPROVEDPAD SETBACK-CERT THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
GARAGE SLABS PREGUNITE ^a .
- POUR NO�CONCRETE UNTIL ABOVE HAS BEEN SIGNED .
UNDERGROUND/SLAB INSPECTION DATE INSPECTOR
PLUMBING -
ELECTRICAL '
MECHANICAL -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED '
WOOD FLOOR
PLUMBING
MECHANICAL,^
ELECTRICAL "
FRAMING VENTS CLEAR
INSULATION -
PLACE NO SLIBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROUGH - •
'PLUMBING
TU13S&SHOWER PAN. - #
MECHANICAL +
ELECTRICAL JACLIZZI BOND _
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 -
SHOWERLATH -
SCRATCH COAT -
N T P OR PLA5TER UNTIL AAO H S IIEEN 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. . or
GRADE -
OCCUPANCY -TEMPORARY APPROVALS
ELECTRIC
GAS. r .
BUILDING I , ISSUANCE.DATE'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL - 1
• BUILDING FINAL IS SIGNED BBUILDING INSPECTOR ' - • P�
Y
ARRANGE,FOR INSPECTION BY PHONING 252-4505 BETWEEN JAN v`J
'12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,'24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT #•ARE NEEDED WHEN PHONING.' Gth�nt / m?rtrnb
IMPORTANT! 7
INSPECTION
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL I P ssueoBYy'
OFFICE COPY J5 ,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Bulletin Pro en tdenlifintlan �� PERMITNO.
Building Address: Ji�.7
n�!C a �s �� 19437
rensame: I Phone: APFUCALION SUBMUTAL DAM,
-
W, dt CITY OF CUPERTINO-BUILDING DIVISION q
• CoNi ..Name: �./ Lic.No: APPLICATION /PERMIT
BUILDINGMFICTWCALPLUMBINC-MECFIAMCAL CATEGORY CONTROLN
Arlec[O ghee f __ a gL f Lk.Na:
C �j� 2 BUILDING PERMITIN O
C/ 7°7 Y v/S;� ` QIY ELECTRIC PERMIT FEE
Add – PERMIT ISSUANCE d� ❑
LICENSED CONTRACTOR'S DEC ns ofCh
7hthSy ..7000ffiren atlamlcensed 3ofthe underprovisionsf.Wa n$ od(comment, APPLIANCES-RESIDENTIAL JOB DESCRIPTION
in ease is In fon 7000)of d of elon3o(the Bukneuand Pro(eulonsCade,and my
license Ie in full forte and effect. PANELS '
License Class LIc.N
Date Contncior r Z
ARCHITECPS DECLARATION 201-1000AMPS
^02, I understand my plans shall be used u public records. OVER 100D AMPS SQ.FT.FLOOR AREA $/SQ.FT,
{7dvl. Licensed Profeubrul SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC
�zf., Iherebya(Rrmthatlam exempt(romthe Contrac[or'eLicenee law fmthe
O 2following reason.(Section 70315,Business and Professions Code:Any city or p META;OR POLE INST.
rr � muntywhich roViesa perMtwoonstruh alter,Improve,demolbh,orrepalr '
TEM
$$$ anydtruciure priortoib Issuance,alsoreptinutheappBantfor such permit to POWER DEVICES
O file a signed statement that he Is licensed pursuant to the provisions of the
3 O Contractors License Iaw(Chapter 9(commencingwith Section 7000)of Divi- SWIMMING POOL ELECTRIC
< kebasis for
the
Profession Any)viothat lation f exempt therefrom and
TP
the basis for the rmit su exemption. Any violation o(Sedion not ex by any ave hundredspears($5bjedethe eppllcanttoe tivll penaltydnd more than OUTLETSSW[TCI-IFSFI%711AE5
five hundred dollars($500).
1,as owner of the roe NEW RESIDENTIAL ELECTR SQFI. STORIES TYPE CONSTRUCTION
compensation,w�n p p sty,or, employees with wages r their door
.1.(Sec.
Buffiedothework,andthes ructure Code:Th Contractorot intended or offered for. P
q sale(Sec 7044,Bu sinessandf property
Code:Thr or improves
stheme Law
does net apply to an owner of property who Wlide or improves thereory and OCC.GROUP RFS UMTS
who doessuch work himself or through hisown employees,provided that such
improvements are not Intended oroffered forsale.If,however thebullding or TOTAL: O
improvement saWdwithinaneyearofcompldbrylheowner-bulderwlll have
to burden of proving that he did not build or improve for purpose ofsale.). QTy, PLUMBING PERMIT FEE FhpOD7DNE --,TN
-
7 L as owner of the property,am exclusivelycontvcting with licensed PERMR ISSUANCE
contractors to construct the project(Sec.7044,Bukneu and Professions Cade:
The Contracture License Law does not apply to an owner of property who ALTER DRAIN&VENT WATER(EN
Wilds or Improves thereon, and who contracts for such plojeds with a
ogRt��ctonist licensed pursuant to the Contractoes License Law. FEE SUMMARY
LJ I am exempt under Sec.. B&P C for this reason BACK FLOW PROTECT.DEVICE FES
Owner DRAINS.FLOOR ROOF,AREA,COND. SANITARY Y N
. Date
WORK MAN COMPENSATION DECLARATION RECEIPT#FIXTURES,PER TRAP SCHOOL TAX Y N
❑i hereby affirm that I have o certificate of consent d del/theum,(Sa RECEIPT M
38MIL.eofWorker Compersatlonlruuranremacerti(kd copythereo((Sec. GAS F.A. YSTEM-I INC41OUTLETS PARKFEE . Y— N
3500,IabC " RECEIPTp
Pollry p T
Campanyi GAS F.A.SYSTEM-OVER4LEA) BUILDING DIVISION FEES
�.2Ertlled pyb ereby th th.dty GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE 76. "
❑Certlled copy tr filed with the tlty Wpecilon division.
CERTIFICATE OF E'XEMPFION FROM WORKERS' GREASE TRAP PAID�z zs�
COMPENSATION INSURANCE SEWER-SAMTARY-STORM EA 2ourr. Date Remi tri
ffhts aedion need rat be completed If the pemNt bfor one hundred dollars
($100)orlessJ WATER HEATER W/VENT/ELECTR ENERGY FEES Y N
I.net that employ
the person i any he manner so as to
lhts permit issued,the
I shat not employ any person In any manner so u to become eubjeci to the WATER SYSTEM/TREATING
Workere'Compevatbn laws of California.Dale PAID
OZ Applicant
Z O NOTICE TO APPLICANT.,If,after making this Certflate of Exemptbn,you NEW RESIDENTIAL FLMS.__SQFT, Date Recei t#
Hshould become subject to the Workers'Compensation provisions of the Labor TOTAL:
W Code,you must forthwith comply with such provisions ortbb permit shall be B WING
> deemed revoked.
(LC CONSTRUCTION LENDING AGENCY SEISMIC FEE —•
Ihereby
workfrwthem ispermhudbnlendingd(Sec. agency 097,Ovor the perform TOTAL: ELECTRIC FEE C
Q O anceof the work for which this permit is Issued(Sec. C1v.C.I PLUMBING FEE
(� 'Lender's Name '
IL I= Lender's Addre.a QTY. MECHANICAL PERMIT FEE MECHANICAL FEE V'
O W 1 certifythatl have read thisapplatfonand statethatlheaboveinformatim q
LU Is correctI agreeto complywith all cityand county.mhu ou.nd state laws PERMTTISSUANCE F 00 FEES PAID:
} N relating tobuilding construction,and hereby authoree representatives of this
F Z city to enter upon the above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. Daft R2Ce1Pt#
031 so 6
— (We)agree to save,Indemnify an d keep harmless the City u Cupertino
against liabilities,lodgments,coke and expeassawhich may In anyw upertiue AIR HAND(.1NGUMT(TO 10,000 CFM) SUBTOTAL• .
against said City In consryuence of the granting of this permit.
- AIR HAN•OLINGUNIT(OVER la(M00,M) CONSTRUCTION TAX
- Signature of Appllant/Contractor Date EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PA ID:
HAZARDOUS MATERIALS DI SCLOSURE
Will theapplant or future building occupant store or hand le huardous HEATING UNIT(TO 100,000 BTU) Date - ReCei t#
material as defined by the Cupertino Municipal Cade,Chapter 9.12,and the
Health and Safety Code Section 25532(.)7 ]-(EATING UNIT(OVER 100,000 BTU) TOTAL:
_]Yes ffI No
Will the applicant orfuture building occupant use equipment or devices VENTILATION FAN(SINGLE MID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area At, EMD
. silty Management District? BOILER-COMP DHP OR 100,000 BTN If"d`YY ,
Biu Yea ('�No
Thave read the boa on materials requirements underChapter 6.95 of BOILER-CDMP(OVER 100,000 BTU) /(�{t) j .; �� "
the Glifomfa Health&Sa( Code,Seciiono 25505,25533 and 25534.] Al V
understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT.
responsibilitytondifytheompantofthemquime ntswhichmstbemet ,y
priortotsa nmofa rtifcate of Oc Esrey. Cltd Of rll^oa RIRD
X14- - �� %t-X-- •�
neroraulhorizedagent Date ^ Y "4. �l V�
TOTAL: ay.Q ISSUED BY: ki/L/
OFFICE COPY