19451 (2)ul
0
0
_., . POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO ,
INSPECTION DIVISION - JOB INSPECTION RECORD
JOB ' ADDRESS 0 b7 aUNIT # LOT #
OWNGR t9 l�OR'
PFxMITNO.
19451
CATF�GORY •
CONTROLN
BUILDING PERMIT INFO
BLDG hLtUl PLUMB M��
DATE" INSPECTOR
INSPECKON
NOTE ALL GRADI CAND DRAINAGE
SHALL BE INSTALLED TO COMPLY WRH
THE APPROVED PLA NS AND CITY OF
CUFERTWOsrANDARDs.
TOUNDATION-PIERS
UFERGROUND
JOB DESCRII-ZION
PAD/SETBACK-CERT
GARAGESLABS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
INSPECTION
DATt
INSPECTOR:
UNDERGROUND/SLAB
PLUMBING -
"
ELECTRICAL.
MECHANICAL
DO.NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL
'."_-
FRAMING VENTS CLEAR
_ ,.
INSULATION
PLACE NO SUBFLOOR`UNTIL ABOVEWAS,BEEN SIGNED
-
ROUGH
PLUMBING
TUBS&SHOWER'PAN
MECHANICAL-
'
ELECTRICAL ACUZZI BOND
FRAMING STAIRS
INSULATION/ VENTILATION
-
89
EMERG. EGRESS
SEWER WATER
- -- , -
.COYERWO' WORK UNTIL ABOVE HAS BEEN. SIGNED :-
SHEAR/HOLD DOWN
BLDEXTERIOR
O.INSPECiION D EPARTMU
Ldu bw"
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/ W -SCREEN
SHOWER LATH
-
SCRATCH COAT
iJ WTAPE`OR PLASTER UNTIL AllO.VE HAS%BEEN SIGNED
NOTE: NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE IINSPECTOR
SAN.#
.ELECT. ENERGY
PLUMBING ENERGY
MECH.ENERGY
BUILDING ENERGY
ELECT. FINAL TEST
PLUMBING
-
GAS TEST
MECHANICAL
-
HEATING -
ELECTRICAL RELEASE
FIREDEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS _
ELECTRIC
GAS
BUILDING /^ d
OCCUPANCY OF BUILDING IS NOT PERM IL ISSUANCE DATE
BUILDING FINAL IS SIGNED BY BUILDING IN ECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN A �' �^ �; l,
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 IISSUEDBY:
OFFICE COPY /��
-1
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification-
Building a:
PF]tbITNO.
19451
Here ame:S n Phone:
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BUILDINGELECTRICAL-PLUMBING-MECHANICAL
c cto ,Nam: _ Opus. yp:
E� Ow/.fi. off a6S��
CATEGORY
CONTROL
Architect/Enginer. Lie N.
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
Addream O Q// �
",I,, E]❑ ❑
LJ
PERMIT ISSUANCE
C
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm am that l licensed under provisions of Chapter9(mmmnc
tngwlthSe on7o00)ofDiNtlm3oftheBusin MdPmfnp Code,andmy
limnsels In tuR fo and it ' O i/At/
Date Class - LIc. R 7C 7
Date Confit � j/UP
ARCHITECTS c/
APPLIANCESRESIDENIAL
]OB DESCRIPTION
,,,///���/?�Lyc
.fir
'?Mol /
r
PANELS
TO 2DUAMPS
201-IODOAMPS
OVERIOWAMPS
SQ. Fr. FLOOR AREA
$/SQ.Fr.
:CLARATION
I understand my pees shall be used as public mcords.
SIGNS ELECTRICAL
Licensed Professional
Spp-CIAL CIItCUIT/M1SC
OWNER -BUILDER DECLARATION
I hereby affirmthat l am exempt froutthe Contractor's License law for the
TEMP. METER OR POLE INST.
following recon. (Section 7031.5, Businessand Professions Code: Any city or
muntywhlchrequlrnaper ttommtmd,al,nlmprove,de=Ush,orrepalr
anypmMmpnortolts Wuance,ahorequireslbesppUmntforsuchpemdtto
Ne a signed statement that he is Bernard pursuant to the pronnoom of the
POWER DEVICES
Contractor's License Law (Chapter 9 (mmmentlng with Section 7000) of DIA-
Sion3 afthe Bupnemand Profess oesCode)ord rt he h exempttherefromanal
VALUATION
the basis for the alleged exemption. My violation of Section 7011.5 by any
applicant fora permit subjects the applicant to a civil penalty of not more than
O
-aw-
-
fivehundreddollam($500.
❑ L as owner of the property, or my employees with wages as their sole
,
NE ENTIAL ELECTR
STORIES
TYPE CONSTRUCTION
compenution, will do the work and the.tucture h not intended or offered for
sae (See 70K Bualnm and Professions Code: The Contractor's Umrue law
y., 9r+
does not apply to an owner of property who Wild. or Impmvn thereor, and
whadoesuchwork himselforthrau hhisown em 1
B If, however,
Improvements not Intended (pleas. ILhowever,theerlldlng or
P TIDN D n
OCC.GROUP
RFS. UNITS
Improvement haold wlthinoneyearofcompletioMthrowner-builderwllt have
earo(co
tF�arden of Provingthat he did nm build or Improve for purpose of ulnJ.
LJ L as owner of the property, am exclusively cont,...... with Ilm —
mntractorstomutruRtheprojed(See7aK Buslneamd Profealou Code:
QTY, L Id0wWwWal FEE
PERMIT ISSUANCE
FLOOD ZONE
APN
The Contractor's License Law does not apply to an owner of property who
Wilds or.mpeuvei thereon, and who commes for such IrWocis with •
oplIamoral licensed pursuant to the Contractor's License Law.
L-iI am exempt under Sec B k P C for this reason
ALTER -DRAIN kVENT-WATER (FA)
FEE SUMMARY
.AIX FLOW PRO'T'ECT. DEVICE
DRAIN3FLOORROOF,AREA,COND.
SANITARY Y_ N_
RECEIPT M
Owner Data
WORKMAN COMPENSATION DECLARATION
❑I hereby !firm that I have • certificate of consent to self -Inure, or
cerlillois ofWorF{n Campeuatlanluuranceoracertl!led mp(yJthereof Cee.
3800, Lab C.) �,/i• 03/445'S O/7
PoliryM
Cofan��t� (
Certified copyh led w mlehed.
PCertlfled copy h (fled with the tlty inspection division.
FTXIURFS PER TRAP
SCHOOL TAX Y_ N_
RECEI NM
GAS, EA SYSTEM -1 INCL OUTI.EIS
-
PARK FEE Y N
RECEIPT«
GAS EA.SYSTFM-0VER4(FA)
BUILDING DIVISION FEES
CREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
'
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This section need not be completed If the permit h forom hundred dollar
SEWER -SANITARY -STORM EA 2001T.Date
Reoei t#
WATER HEATER W/VENT/dFLTR
ENERGY FEE Y_ N_
($100)orless.)
I cenot that the performance this permit is Wued,
WATER SYSTEM/TREATING
o any mariner an as to
I shall not employ any prawn In any mariner at u to become subject to 1st
Workers' Compensation laava of California. Date
PAID 11-,2
Applicant
NOTICE TO esub)eAM:IL afire makingthisCertificate
become subjectto the Workers'Comprovison proof Exemption you
Lab or
NEW RESIDENTIAL PLMB. SQ.FT.
Daft Recti t#
TOTAL:
BUILDING FEE
!ry
or this peions rmit hall
Cade, you must forthwith comply with such provhlou or this permit shall be
Code,
deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
• O
Iherebysffirm that there is a construction lending agency for the perform-
ance of the work forwhich the permit h hued (Sec. 3097, Civ. C.)
bender'.Nana
Lmdre.Addrea
I ceplfythat I have readthh applicationand patethattheabove In(ormatlon
hcorrect.I agree to comply withal) city and county ordinance and state laws
TOTAL:
ELECTRIC FEE
PLUMBING FEE '
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:
relating to building construction, and hereby authorize representatives of thh
city to enter upon the above-mentioned property for Impaction purpose,.
Me) agree to save, indemnify an d keep harmless the City of Cu pen Ino
against Ilab.l.lken
e, Ocigmts, cepa and expense which may In any way accrue
ALTERORAODIOMECH.
Date Receipt#
AIR HANDLING IIMT (TO 10,000 CFM)
SUBTOTAL:
against acid City In consequence of the granting of this permit.
AIR FUNDuIvc UNIT (OvFR l(IIxbCFM)
CONSTRUCTION TAX
Signature of Applicant/Contractor Date
EXHAUST HOOD(W/DUCT)
CONST RUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT (TO 100,000 BTU)
Date Recel t#
Will the applicant orfuture building occupant store or handle huardous
material as defined by the Cupertino Municipal Code, Chapter9.12, and the
Health and Safety Code n25532(a)7
HEATING UNIT (OVER 100,000 BTU!)
- TOTAL:
r-1Yea
Will the applicant orfuure bu llding oaupmt use equipment or devices
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management Dh[rl 7
Yes o
have read the haza�.mate'rials requirementsunderChap.er6.95 of
BOILER -COMP OHP OR 100,0(0 BTM
BOILFRLOMP(OVE2100,000 BTU)
the Califemla Flealth k SafetyCode, Sectio.25505, 25533 and 755M. I
understand that if the building does no mrrently have a tenant that It h my
_
NEW RESIDENTIAL MECH. - SQ.Fr.
res' ox bilitylonmlfytheonupant afthe imrnentswh.chmustbemet
PH umce of a Cemil f
ISSUED
nerora Ived agent Date
-
TOTAL:
OFFICE COPY AV