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19352 POST THIS CARD NEAR FRONT OF BUILDING PERMITNO. CITY OF CUPERTINO 19352 A INSPECTION DIVISION- JOB INSPECTION RECORD JOB ADDRESS 77- I1f0 D CI L.-V UNIT# LOT# CATEGORY CONTROLXS 73 OWNER - E 1 6 jh, CONTRACTOR S W.-2 BUILDING PERMIT INFO INSPECTION FOUNDATION/PIERS DATE INSPECTOR NOTE ALL GRADING AND INSPECTION RECORD UFERGROUND SHALL BE INSTALLED TO COMPLY%TTH JOB DESCMI'IION PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF CIIPERTINO STANDARDS. GARAGE SLABS/PREGUNITG 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 nt INSULATION PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROUGH PLUMBING - 1••# IS TUBS&SHOWER PAN \ I r q MECHANICAL ! ,•� l 21`" ELECTRICAL/JACUZZI 13OND4—. FRAMING STAIRS �� r`� ll�+ � A INSULATION/VENTILATION \// EMERG.EGRESS i , SEWER WATER COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIOR SHEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN SHEETROCK/SHEETROCKSHEAR EXTERIOR LATI-I/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 PLUMBING ENERGY MECH.ENERGY , 13UILDING ENERGY ELECT.FINAL TEST PLUMBING GAS TEST MECHANICAL HEATING ELECTRICAL RELEASE ' FIRE DEPT. GRADE OCCUPANCY TEMPORARY APPROVALS ELECTRIC GAS BUILDING OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL - ISSUANCE DATE BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR {SAM ARRANGE FOR INSPECTION BY PHONING 252.4505 BETWEEN 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS BEFORE REQUIRED INSPECTION. JOB ADDRESS AND PERMIT# ARE NEEDED WHEN PHONING. (It t n•ingr\= PLEASE RE BEFORE CALLING FOR FINAL INSPECTION SSUEDBY: IMPORTANT! EAD REVERSE SID4 a i OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PlSRMiT NO. Build fg Add max; 19352 were ante: hone; q FkARkl x1�7RLED RC44 a S7- il$ CITY OPCUPERTINO-BUILDING DIVISION Contractor's Name: Lic.N. APPLICATION /PERMIT BULLDINC ELECTRICA4MUMBING-MECFIANICALCATTOORY CONTROL .3 1---- Ambitect/Engineer. Lk.No: QTY- ELECTRICPERMIT FEE BUILDING PERMIT INFO Address PERMIT ISSUANCE ❑ ,❑ ❑ LICENSED CONTRACTOR'S DECLARATION Ihereby ion70that lamsiolicensed ftheBu provisions Pro Cha ssions9(ie,and c- APPLIANCFSRFSIDENTIAL JOB DESCRIPTION Ingwith Section force and effect. (the Business and Pro(esalonsCode,and my lianscle In full force and effect. PANELS -Irk ense Class D —UP TO 2DOAMPS PtTy co M� Date Contractor ARCHITECTS DECLARATION 201-IODO AMPS �O ]understand my plansshallhe used as public records. OVER 1000 AMPS SQ.Fr.FLOOR AREA g/SQ.FT. Licensed Pmfesaloml SIGNS ELECTRICAL t< OWNER-BUILDER DECLARATION 1n 3 SPECIAL CIRCUIT/MISC z p., Iherebraformthatlam exempt from ContnRor'a License Law for the ' following sawn.(Section 70115,Business and Prelesslons Code;Any city or 1- TQ.1P.MEIFR OR POLE INSf. 02—, cwntywhkh requlreaapemdt to comtrvct,sites Improve,demoWh,.r repair anystructure priorto its iasuancu,aborequires theappliant forsuch permit to file.signed statement that he Is licensed pursuant to the provblom of the POWERDEVICES Op„ Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi. 3 SWIMMING POOL ELECTRIC OJ elon3 ofthe Business and PmfesslonsCode)orthat he Is exempt therefromand VALUATIOFj � Eh G the baste(or the alleged exemption. Any violation of Section 7031.5 by any OUTLETSSWITCHESFIXTURES O D 1 (f appaont(ora permit subjects theapplkam to a ciWl pevlty of nct more than 1(vepundred dollen(ySgO. NEWRESIDEM1ALELECTR SQ.FT. STORIES TYPECONSrItUCT10N �n 1,es owner of the property,or my employees with wages as their sole com osadon,wllldothe work and thestructure is not Intended or offered for qsale(Sec.7044,Business and Prefesslons Code:The Contract.?,Lle.me law $$ does nes apply to an owner or property who builds or improves thereon,and OCC.GROUT' HIS.UNITS who doessuch work himselforthrough his own employees,provided that such Improvements arc not Intended oroffered tarsale.If,however,thebuliding ce TOTAL: Improvement b sold within omyearofcompldiom the ownerbuilderwlll have thalZurden of proving that hn did not build or Improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD TONE APN Lj L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to construct the project(Ser.7044,Business and Proftniom Code: The Contractor's License Law deea nes apply to an owner of pmperty who ALM-DRAIN&VENT WATER(EA) builds or Improves thereon,and who comnns for such pWjcds with a - FEE SUMMARY C75actor(,)licensed pursuant to the Contractor's Llanee Law. BACK FLOW PROTECT.DEVICE L.J I am exempt under Seo B k P C for this reason DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N Owner Date — RECEIPT N WORID.1 Pa rtifl ON DECLARATION 1BXTURES.PER TRAP SCHOOLTAX Y N_ ❑I hereby affirm that I haus•certl0ate of consent to self-Inwre,or RECENT N anifiateofWorkers'Compematlonlmuranceoraceniftedcopythereof(Sec. 3800,Lab C.) &GAEI.SYSTEM-1 INCA OUTLETS PARK FEE Y N Policy p CAS EA.SYSTEM-0OV 4(EA) RECEIPT N Com any BUILDING DI VISION FEES �Cenlfied ropy b hereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE ❑Certified cepy b filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID (2-4t-&? 7 y COMPENSATION INSURANCE (This sedlon need not be completed if the permit b force hundred dollars SEWER-BANITARY-STORM EA.3WFf. I comDate Recei t# ' (SI lees.)cenitythat In the performance.(the work(arwhkhlhla permit Is heated, WATER HEATER W/VENT/RLECTR ENERGYFEE Y N I shall not employ any person In any manner so as to becomes ct to the WATER SYSTEM/TREATING Workers Compematlool,rsof C,411fornh. atel -� PAID ZZ Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Recel tp O NOTICE TOA CANT:ILah ,Ing 4c CertBiate.(Exemptlan,you Fshould become subject to the Wo dCompematlon provisions ofthe Labor TOTAL: W Code,you must forthwith comply wlthauch provlslons or this permit shall be W j deemed revoked. TNG " O O. o CONSTRUCTION LENDING AGENCY SEISMIC FEE s SIC I hereby afflrre bat there Is a construction lending agency for the perform- ELECTRIC FEE Z an of the for which this permit b Issued(See.3097,Civ.C.) TOTAL: V O Lender's Name PLUMBING FEE LL H Lendc?.Address QTY. MECHAN PERM FEE O W Ianifythatl have rood thicappliation and statethattheaboveinformotion MECHANICAL FEE IL bcomet.I agree to comply with all city and county ordinances and pate laws PERMITIBSUANCE FEES PAID: relating to building construction,and hereby authoman nepmwntatlees.f the, 2 city to enter upon the above-mentioned property for Inspection purposes, ALTE4ORADD ECH. .(We)agree to save,Indemnify an d keep harmless the Clty.f Cupertino Date Reeei til L.I agalmt Eabllldn,Ndgnnnta,costa and expenses which rtuy in any wayacerve AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL' against said City In consequence of the grant Ing of this permit, AIR HANDLING UNIT(OVER IO,ODOCE) CONSTRUCTION TAX Signature of Applicant/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant orfuteno building occupant store or ha nd is hazardous HEATING UNIT(TD I OD,WO BTU) Data Recei tN material as defined by the Cupertino Municipal Code,Chapter 9.13,and the EMYea Safety Cod�S.Jioon25S32(a)7, HEATING UNIT(OVER 100,000 RTU) TOTAL: Will the a ppllcant or forum building occu pant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUAN5 DATE which emit hazardous air contaminants as defined by the Bay Area Air l $ilB Quality Alawgement Wctt BOILER-COMP(IFNDR 100.IX)D BTU) r 4 Yrs B(j No hail ml. the th& e Code,le requirements 255 5,2553 and 255 4.1 of BOILER-COMP(OVER 70D,000 BN) I j;• t� 1 eI�J the California at ift h k Safety Code,Sections currently have a t and 25534.I understand thatlhhn building does not currently haveatenant.that itbmy NEW RESIDENTIAL MECIi, SQ.IT. .yaf responsibility to notify the occupant of the requirements which must be met plpl p e N111a1G1 f13Lq prior to issuance of a Certificate of Occupancy. 1 �a Owner rauthoriu ant - Data J, V�`see�a/CL TOTAL: ISSUED BY: OFFICE COPY