19353 (2) POST THIS CARD NEAR FRONT OF BUILDING PThO'
19353
CITY OF CUPERTINO
S INSPECTIONDIVISION- JOB INSPECTION RECORD
'JOB ADDRESSJ. GLr
UNIT# LOT# cATFf.ORY CONTROL af.•.7 .
OWNER C`l-CV�CV� CONTRACTOR BUILDING PERMIT INFO
INSPECTION DATE INSPECTOR INSPECTION RECORD
FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE
U FERGROUND SHALL BE INSTALLED TO COMPLY MTT-I JOB DESCRII'ITON
PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF
GARAGE SLABS PREGUNITE cuPERnNo sr^nvARos.
l ` CIP
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 -
WOODFLOOR - -
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION
PLACE NO SHBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
^ PLUMBING _ - -
m '-TUBS&SHOWER PAN
MECHANICAL
ELECTRICAL ACUZZI BOND -
FRAMING STAIRS
INSULATION/VENTILATION _
EMERG,EGRESS -
SEWER WA! R -'-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCKSHEAR
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
PLUMBING ENERGY '
MECII.ENERGY .
BUILDING ENERGY - FPECTOR
- `
ELECT.FINAL TEST
PLUMBING iGAS TEST
MECHANICAL'HEATINGELECTRICAL RELEASEFIRE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALSELECTRIC
GAS•
BUILDING .l y0OCCUPANCY OF BUILDING IS NOT PERMFTTISSUANCE DATEBUILDING FINAL IS SIGNED BY BUILDING IN Q"d��9�'
:} ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
DEC 06 IK3
y. 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEDBY-. i'la L:tG r ..
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —.USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
Building Addmaa: 19353k
Owner (455' -
t Phone: -
/� -r-2 7.1,7 CITY OF CUPERTINO-BUILDING DIVISION ^ Gj
c°nn . ,Name: LIc.No: APPLICATION / PERMIT
GiatlG Ic/TCNA/yS Yr/ 7S_2, BUfLDINGELF-CTRICA PLUMBING- CATEGORY CONTROL 3Q
Architect/Engineer. - Lk.No: PLUMBING-MECHANICAL 7
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: / �3�C/ S. S�!! 97O6.a //i/ // PERMITISSUANCE �.pp Y1ZS �( X
LICENSED CONTRACTOR'S DECLARATION YJ` f�—
Ihereby
atfbmthatlamlicensed under provisions of Chapter 9(commenc- APPLIANCES-RESIDENTIAL JOB DESCRIPTION
Section 7000)of Division 3 ofthe Business and Profession,Code,and my - -
license isinfull and effect. ' PANELS ('/7C/7/F/Y
License Class Lick 54/'x.32 lLPraDorrG'
Date Contractor_y
ARCHITECT`S DECLARATION - 201-1000 AMPS
�OCZ Iyryfemtand rrry plaPe aha116eYeeed es public remrdx - OVERIOJOAMPS SQ.FT.FLOOR AREA $/SQ.FT.
NO z tf nosed Profeasia�Lnal( ,a��4 1 a' JW7 SIGNS ELFL7RICAL ,
�6 OWNER-HOLDER DECLARATION SPECIALCIRCUIT/MLSC
z L., [hereby afOrmthat lam exemptfromthe Contractors License Law for the _
OR p following reason.(Section 7031.5,Business and Professions Code:Any ctty or
5�i-. countywhich requlresa permittomnstruct,alter,improve,demolish,arrepair TEMP.METER ORPOLE INST.
q anystmct mprortoitaismance,❑sorequimslheappBmntforsuchpermittoO POWER DEVICES
O Ud
E o file a signed statement that he is licensed pumuant to the provisions of the
w Contractor's License law(Chapter 9(commencing with Section 7000)of DIA-
30�' slon3 ofthe Business and Pro(emionsCode)orthat he leexempttherefromand SWBe(MING POOL ELECTRIC VALLI ON
Gthe basis for the alleged exemption. Any violation of Section 7031.5 by any A
O applimntforaper tmbjectstheapp0nnttoadviipemltyofnotm mtMn OUTLETSSWITCI{ESEXTURES OQ
live hundred doloft NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPE CONSTRUCTION
e
ML as ownerner of the
property,or my employees with wages ae their sok
ro
¢, compenmtIon,wRldotheworkandthestructurelsnotintendedorofferedfor
O sale(Sec.7044,Business and Professions Code:The Contractors License Law
S� does not apply to an owner of property who Wilda or improves thereon;and OCC.GROUT' RES.UNITS
who d.essuch work himselforthmugh his own employees,provided that such
Improvements are not intended oroffered for sale.](however,thebuildingor -- TOTAL: 400 /Z 4F5/O!I'arr!refK-
'i prownsenthsold within.myearofcomplefiomtheowner-buiderwill have
tt�urden°f proving that he did not build or improve for purpose ofsalej. QTY. PLUMBING PERMIT FEE p3ppD17ANE APN
u 4 as owner of the property,am.7044,Busivelyness
=trading and Pro emi Licensed PERMIT ISSUANCE �t-DD
contractors to construct the project(Sec. Buslnex and of prop rt Code: 4
The Contmctorti License La d apply to an owner M Property who ALTER-DRAW&VENT-WATER(EA) 0 0
Wilds or improves the on a d o contrarn for each p(ojecta with a
W
Pu at °ntractor',License Law. FEE SUMMARY
I am exempt and r B &P C for this reason BACK FLAW PROTECT.DEVICE QIlT%Un,
DRAINS FLUOR ROOF,AREA;COND. SANITARY Y ' 'N
s Owner Date _ RECEIPT k
WORKMAN COMPENSATION DECLARATION FD(TURF.S PER TRAP SCHOOL TAX Y N
eel�I hereby affirm that I have a certificate of consent to self-Insure,ora RFG®'1.11 ,
flfliBcareofWorkeri CompensationlmunnmoracertBledmpythereof(Sec. GAS EA. INC.40UTLET5 �1 ww PARK FEE Y N
3000,Lab C.) tis �`
Poli y k RECEIPT n
GAS EA.SYSTEM-OVER 4(PA)
Cam anyQ `/�.JN�n BUILDING DIVISION FEES
[�Certl(le mpyV emby furnlaheA. GREABE/INDUS'fRL WASTE INTERCEPTOR PLA CK FEE
�Certaied mpy b Ned with the ctty impaction division. �,
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SAMTARY STORM EA 200FT ate Recei of
(Thiase tion need not be completed lithe permit bfor one hundred dollars
($1M)orloss.) WATER HEATER w/vENT/E.ECTR ENERGY FEE Y N -
I certOythat In the performance ofthe work f.rwhlch this permit is issued,
I shall not employ any person to any manner ro as to become subject to the WATER SYSTEM/TREATING
Workers Compensation Laws of Cellfomla.Date PAID -
0 Z Applicant NEW RESIDENTIAL PLMR SQ.FT. Date Remi til
Z 0 NOTICE co eSUbje"oche after
orlem' ompeng r stics,pro is Exemption,you '
shwld become eubkct to the Workem'Compensation provisions.(the Labor TOTAL:
cN Code,you mu at forthwith comply with ea ch provisl.ns rthis permit shall be NG 1 OV
W > deemed revoked. FEE
tL C CONSTRUCTION LENDING AGENCY SESMIC'FEE V
IherebyafBrm that there te amnstruction lending agency for the perfomm TOTAL: /) •ELECTRIC FEE
Z ance of the workfor which this Pardo, su
Lsed(Sec.3097,Clv.C.) ,D
V O L.ender'sName - PLUMBING FEE -OD
IL F LenderaAddre,a QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW Icertifythatl havereadthls application and statethattheabovoinformation I - 'II aaysae0
1 la correct.Iagree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
} N relating t°building construction,and herebyauthorize representativesofthis _a�j 2qZ
F— Z city to enter upon the above-mentioned property for inspection purposes, ALTER OR ADD TO MECH. a/'
z (We)agree to save,Indemnify an d keep harmless the City of Cupertino Date Reeeiptil
a gainstllabilltkre,judgments,costsand expenses which may In anywayacaue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
a s aid City in ronarryen s«.of me graining of Rtes permit - AIRHANDLING UNIT(OVER I0,000CFM) - CONSTRUCTION TAX
natured p0mnt/Cartract°r 1WY r Arel•)Date EXHAUST HOOD(W/DUCT) 6'I r0 CONSTRUCTION TAX PAID:
HAlAADOUS MATERIALS DISCLOSURE _
Will the applicant°rfuture building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU)
material as defined by the Cupertino Municipal Code,Chapter 9.12 and the Date Reeei tp
Health and Safety Code Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
❑Yes —,No ,
Will the applicant 11re building.cmpant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air mntaminanb as defined bythe Bay Area Air
Quality Management District? - BOILER-COMP(3HPOR 100,000 BTU)
4Yes ❑❑No
have sad the ha ardousmaterials requirements under Chapter6.95 of BOILER-COMP(OVER 100,000 BTU)
the Cellfernia Health&So fety Code,Sect Ions 25505,25533 and 25534.] DEC Un- 198J
understand that if the building does not currently have a tenant,that it is my NEW RFSIDENIIAL MECH. SQ.FT.
responsibility to notify the occupant ofthe requirements which must be met
prior to issuance of a Certificate ofeccupancy, r f`a P, ^ mina
Owner or auth.rimd agent Data
TOTAL: ISSUED BV Lt.
OFFICE COPY