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19544 (2) POST THIS CARD NEAR FRONT OF BUILDING ruaM rNo. r 19544 CITY OF CUPERTINO INSPECTION DIVISION- JOB INSPECTION RECORD �) JOB ADDRESS O -I 3 O S D be �-L Z✓ B `UFIIT# 'LOT# - CA RY CONTROL x OWNER W'Vl- Gp CONTRACTOR �:. BUILDING PERMIT INFO '.INSPECTION, DATE INSPECTOR INSPECTION RECORD ❑ ❑ O FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE UFER GROUND SHALL BE INSTALLED TO COMPLY MTTH JOB DESCRIPTION PAD SETBACK-CERT THE APPROVED PLANS AND CITY OF GARAGESLABS PREGUNITE CUPERTINO STANDARDS. f POIIR No CONCRETE LENTIL ABOVE HAS BEEN SIGNED �c1.I UNDERGROUND SLAB INSPECTION DATE INSPECTOR PLUMBING ELECTRICAL MECHANICAL DO NOT-POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING - , MECHANICAL - ELECTRICAL - FRAMING/VEN15 CLEAR INSULATION - PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED DATE ROUGH PLUMBING TU13S&SHOWER PAN MECHANICAL ELECTRICAL ACUZZI 13OND ' FRAMING STAIRS INSULATION/VENTILATION GMERG.EGRESS ' SEWER WATER (CO.VER1N01{NORK UNTIGABO If HAS BEEN SIGNED EXTEMORSHEAR HOLDDOWN INTERIOR SHEAR/HOLD DOWN . SHEETROCK/SHEETROCK SHEAR EXTERIOR LATH/W-SCREEN SHOWER LATH SCRATCH COAT NO TAPE OR PLASTER UNTIL ADO 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 FI RBDEPT. GRADE OCCUPANCY - TEMPORARYAPPROVALS ELECTRIC - GAS BUILDING OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL - ISSUANCE DATE BUILDING,FINAL IS SIGNED BY BUILDING INSPECTOR - MD ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS i0l 3 1 y� BEFORE REQUIRED INSPECTION. JOB ADDRESS AND PERMIT #ARE NEEDED WHEN PHONING. Clt' ^II^""rfino IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEDBY:__�I OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY Build Bin ProMat Identification PERIdITNO. ulldi tlreBu "i :. s . �� �2ic� : 19544 weer. ams: PhAPPLICATIONSUBMITrAr one: U u CITY OF CUPERTINO-BUILDING DIVISION qA' c°""a `°''"e`NIB Lic.No: APPLICATION / PERMIT4 — 2- Z3 BUILDING-ELECTRICA4PLUMBINGMECHAMCAL CA RY CONTROL# . Architect glneer. Lk.No: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Addeeac �P Nl FERMITISSUANCE _ ❑ O ❑ m LICENSED CONTR under DECLARATION Lam} ]hereby afflmnthatlam licensed underprovlslone of Chapter9(mmmmc- APPLIANCESRESIDENTIAL JOB DESCRIPTION mgwith Sccd..7000)o(Dlvision3 ofthe Eusimasand Professions Code,and my license is In ruR farce and effect. - PANELS IN IQ 2DO AMPS po License Clam Lic.p� `c— L Date I12r1T�Cor ARCHITECT'S DECLARATION 401-1000 AMT'S' . O CZO Iundroused my plamshallbe used as pubBeremrds. OVER1000AMPS SQ.FT.FLOOR AREA $/SQ.FT. Z, Licensed Pro(essioml SIGNSELEC ICAL -�6 OWNER-BUILDER DECLARATION ZF, � Ihereby affirm that lam exempt fromthe Centrad.e.License Law fee the SPECIAL CIRCNT/MIST - O 99 F- following recon.(Section 7011.5,Business and Professions Code:Any city or p� cmntywhkhmquiresaper tbmwhud,ilter,bnpmw,demolath,orrepair TFMP.METER ORPOLE INST. qa ny structure pew to its issuance,also requires the applicant for such permit to K1 O (ne a signed statement that he is licensed pursuant to the provisions of the POWER DEVICES I - Wb p, Contractor's Lkerse Gw(Chapter9(mmmencingwith Sedhm7000)°r Divi- !I �O sion3o(the Buslneeeand Profems mCade)orthatheisommpttherefromand SWN4MiNGPOOLELECTAIC LUATIO ,;2 the basis for the il4ged exemption. Any violation o(Sectbn out by any OUILETSSW[TCHFSH%TURES -- m t`C appliant(ora permit ubjectatheappgcanttoactvil pemlty olnot ration flue hundred dollars($500). NEW RESIDEN'ITAL ELECTR �n ❑I,as owner or the property,or my employees with wages as their sole SQ.FL STORl[S TYPE CONSTRUCTION compensation;w111dothe wwk,andtbestucNrebnoHe ded or oiferetl for ^w 1p q sale(Sec.7044,Buslmae and Profembm Code:The Contract Wmrrte Law VA �pV F $ does not apply to an owner orproperty who builds or improv.thereon,and OCC.GROUT' RFS.UNITS whodoessurh workhimsel(orthrough hisownemPloyeea'P pided tbatuch Improvements are not Intended muffered forsale.If,howevei,tbebuiWing Winger TOTAL: Improvement ls sold within oneyearo(complefin_the owner-bullderwlll have ' t ,no of Proving he did not build or Improve for purpea Isabel. QTY. PLUMBING PERMIT FEE FLODD7DNE APN L,f 4'as owner,of the property,em exduslvely contracting with licensed pEgMl'C ISSUANCE contra...toe mtro.the project(Sec9044,Business and ProirstaL Code: The Cont.ctore License Law does not apply to an owner of property who ALTER-DRAIN or Improves thereon;and who contracts for such p(ojects with a DRAIN&VENT-WATER(EA) co,Il[Tador(s)homsed pursuant to the Commentre License Law, FEE SUMMARY LJ I am exempt under Sec B&P C for that reason BACK FLOW PROTECT.DEVICE Owner Date DRAINS FLOOR ROOF,AREA,CONTI. SANITARY Y_ N WORKMAN COMPENSATION DECLARATION RECEIPT# it l hereby eHlrm that I have a mrti0cate or consent to self-inure,or a FIX1UI F PER TRAP SCITOOL TAX Y N_ cfrtift<ate°f Worker,'C.mparanon lruunncewacettitied mpythere°f(Sec. - RECI]PT# S E 3800,Lab C.), GAA.SYSTEM-]INC.4 OUTLETS PARK FEE Y N Poll It Com any GAS-FA.SYSTEM-OVER4(FA) BUILDING RECEIPT FEES [P Certified copy is heubyth the ed.city GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE '❑Certlfled copy at filed with the tlty Inepectl.n division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE (Thissectlon need not becompleted ifthepermit is(oranehundred dollars SEWER-SANITARY-STORM EA,200FT. Date Recei t# ($100)bify that WATER HEATH,W/VENT/ELECTR ENERGY FEE Y N ]certify thatlnthe person nce I-an thewwk.asto hthis ce,sub is issued, — I shall not employ any person In any manner so m to become subject to the WATER SYSTEM/TREATING Worlicant omponensatlfawn or Gll(ornb.Data PAID 0 Z Applicant" Date Z 0 NOTICE TO APPLICANT:ILafter rtuking this Certlieate of Exemption,you NEW RESIDENTIAL FILMS. SQ,FT. Recei t# should become subject to the Workers'Compeneatlon previsions of the Labor TOTAL: fn Code,you moat forthwith mmplywithauch provialomorthat permit shallbe W5 deamedrevoked. BUILDING FE C p CONSTRUCTION LENDING AGENCY - SEISMIC FEE ' I hereby affirm that there ls a construction lending agency forthe perform SEISMIC FEE n O ance of the work for which this permit is issued(Sce.3097,Civ.C.) TOTAL: 02 Lenders Name PLUMBING FEE LL H Lendxrs Addmsa QTY. MECHANICAL PERMIT FEE MECHANICAL FEE UQ O W I.Airythatl h.ve..dthatapplialionandstatethattheaboveinfornuti°n IL lsmrred.Iagree to comply withal)city and county ordinances and state laws PERMTTISSUANCE LOU, FEES PAID: Nrelating to building mmtrudion,and hereby authorize representatives of this //,, - Z city to enter upon the abovementloned property for inspection purposes. ALTER OR ADD TO MECH. 9s (1 v _ (We)agree to save,indemnify an d keep harmless the City of Cupertino Date Receip[# agalnstllabWmenh ties,7,dg ,ma xtsandexpemeswhich neyln anywayacue - AIR HANDLING UNIT(TO 10,ODO CPM) SUBTOTAL- 11 agalmt said City in mry muence of the grant lnkof this permit. C IIja�lcltj AIR HANDLING UNIT(OVER IO,000 CFM) CONSTRUCTION TAX Sigmturc Applicant/Cont actor Mid ,t EXHAUSTHOOD(W/DUCT) - CONSTRUCTION TAX PAID: HAZARD US MATERIALS DISCLOSURE Will the appllcam orfuture building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recei t# material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code Seam 25532(a)i HEATING UNIT(OVER 100,000 BTU) ❑Yea No TOTAL: ,Q Will theappliarilo (uturebuildtngoccvpant use equipment orcievices VENTILATION FAN(SINGLE REBID) ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air }E��pp� Quality Management Dl tj iid7 BOILER-COMP QHPOR 100,000 BTU) PAJ0 4 az Yea ryJ No have mad the ha .us materials requirements under Chapter 6.95 of BOILER-COMP(OVER100,000 BTU) ��� 3 I�y� the California Health&Safety Code,Sections 25505,25533 and 25534. 1 •� underetand that ifthe building does not currently havea temuLthatltlsmy NEW RMDENTIAL MECH. SQ.FT. responsibility to notify the occupant of the requlrceent which must be met a, t ,.F) prior to issuance of a Certificate of Occupancy. CI`•/ nl �.UFIAI I^II� 41L*IA clNo.--- I1 ,I%- ,weerorVthoriudagent C to I ISSUEDBY: 0 TOTAL: �I.Uy OFFICE COPY