19576 (2) POST THIS CARD NEAR FRONT OF BUILDING PrXMITNO
CITY OF CUPERTINO II ����
IIIALDArff-
INSPECTIIIOON DIVISION- JOB INSPECTION RECORD
• JOB ADDRESS f �I.7 �C�!/^�� 'UNIT# LOT# -CAlK Ry CONTROL Y
r— f BUILDING PERMIT INFO
OWNER r=0/�/ CONTRACTOR
N RECORD
FOUNDATITION/PIERSnumb M�H
INSPECONDATE IR No>E nacanDINSPECTlOi cnND DRAINncE E -
UFERGROUND SHALL BE INSTALL ED TO COMPLY WITH JOB D6 RumON
PAD/SETBACK-CERT THE APPROVED PLANS AND aTY OF -'
CUPERSINO STANDARDS.
GARAGE SLABS PREGUNITE
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 FLOORPLBING
- - ^'�} { 1
MECHAN CAL �\ �T' (A
17 1 Rl L� 1 I I 1
ELECTRICAL
FRAMING/VENTS CLEAR
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ,�,,,oFi310t� OEPARTM-3k�. "
ROUGH
PLUMBING 81-1�•�'f; - OF CUr
TU13SkSHOWER PAN
MECHANICAL
ELECTRICAL ACUZZI 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 -
EXTERIORLATH/W-SCREEN
SHOW ERATIJ
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 IINSPEcTOR - -
SAN.#
ELECT.ENERGY ..
PLUMBING ENERGY -
MECH.ENERGY - -
BUILDING 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 BYBIIILDING INSPECTOR
Lo
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.
IMPORTANT! ^
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINALINSPECTION ISSUED BY.
QFFICE COPY
APPLICANT TO FILL-IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BuildingPm'ect Identlflratlon I'F7LWTNO.
Build oddn1� � - 19576
,roll: A, _
0/✓T� ',7 CITY OF CUPERTINO-BUILDING DIVISION
cmtracto e _ L
N. APPLICATION / PERMIT
BUILDINGELECTRICALPLUMBINGMECHAMCAL CATEGORY CONTROL
AmhltectFaxoncer. LV:
CITY ELECTRIC PERMFF FEE BUILDING PERMIT INFO
Add.
PERMITISSUANCE ❑ ❑ ❑
LICENSED CONTRA
I hereby aHkm thatlan llcevedu erprov a APflIANCF5R19DEMIAL JOBN
ingwlth SMbn70p0)oIDWWan3ofthe Bu,Ircaaand Pm tlmuCode,and
like.is In full force and Erect. PANES
Lkewe Class Lk.Y
Dae ConVactor UP TO 200MIPS
ARCHITECT'S DECLARATION -I0B0 AMPS
�2 Iunderstand my plamshall be used as public records. OVERIODOAMI'S SQ.FT.FLOOR AREA VSQ.FT.
Illyyy O
L Fj Licensed Pro(mbrul SIGNS ELECTRICAL
OWNER-B UILDER DECLARATION SPECIALCIRCUR/MLSC
t.., / owing re ..(ScctlamesemptfromtkC I rof orb Llnrde Mydty.e -
Oz -� foBowingn uNqu ell e7 wBualn®and Profps e, C ld h,yrepar
OGi:.� TF2.4':ME[FR OR POLE INST. n B(F,
F mu ntywhkhnquireapemdte,mr stmctireathlmprwgdemolbh,ormit to
S���[[�a any amctun statemutorto ent
that
he is abo reed pursuant
Bunt forwch rOWFRDEVICIS tt
K 1 U fiY a signed Yatemen,that he b,9(coon punuan Pio the tkm M))oof permit
h II 1}I I I I
O�Fj Contndora Lkenue law(Chepter9(commencing with SMbn 70W)of qW- I 11
IS .f the
basis
for
o Bueinm and exemption.
My orthaheb Sump,tkrtmmany SK'AIMINGIOOLItlELECTRICI, 1 VALUATION
L •]] tM bash for.p alleged esempt,.p B violation of.iibn.0 by any
p<5 appBandred collars wbjMsmeappllcanttoa dull penaltyof na mnntHn OITILCTSSWI7C}iESFTKTIIRES
a flue hun11,as
owneron(epro NEW R®FN77AL ELECIR sQFI. yOWIS TYPE CVN57RUCfION
❑ersaowrcr ldothe property,orthe emoaryenwlihwege utheredfo
c mnnperua en,Buain,kw,nkNamt�edr:Throtwemtderce.0 r BIDS. INSPQTION.DEPARN 'L
5 dalesnot 7044,tosineeandfhofmbra Cade:The orImp Dors Lenon Taw
3� and
whodoes not apply toanawner of pmpertywhonempoymprovnikrmM1uchGl1Pu`�TlNt7. OCCGRoup RIS UNITS
whodocswchw mjnte do .r ffc hbownemployen, ,the provided that such
Impmvememsarem,iht omo rofcorrylsale.I(howevbuOderi In ve TOTAL:
Unpmvemeni b Bold wHhln one yerofcomplEbM the owntrluilderwBl have
rden of pro ngthatheddno,lrulldorlmpmefarpurpoatofadle). Qn. PLUMBING PERMIT FEE
FLOOD ZONE
4 as owner of the property,amexclusivelym
exclusively ntracwtg with Ikumedexclusively
PFRMRISSTIANCE d0
tranm to mmUud the proleet(SSt 7014,Buiness and Prdmbv Code:
The Comnctars License Law doe not apply to an owner of property who
Wilde or Improve thereon, and who contracts for uaeh p,*U with a ALTER-DRAINIs VENT-WATER(EN �
ryN(+d . Banned pursuant to the co actor's[.)arose Law. FEE SUMMARY
IJ I a aempt uMrr Set B Is P C for this rescan BACK FLOW PRO=.DEVICE
er Dae DRAINS'FLOOR ROOF,AREA,COND. SANITARY Y_ N_
NI�fr RIQat O �ATION DEC IA ATION
❑I enby/oBkm t a 1 have cenifiate of consent to self-insure,or a 1'DOlIRFS PER TRV' SCHOOL TAX Y_ N_
cenificatea rken'Compevalon lrcuranaora anified Copy thneof(Set G .SYSE -I Y40 . 1RECEIPT
mai,Lbc) K FM
Y_ N_
Policy) CAS EA.SYSTEM-OVER 4 MAI RFLQI'I'Y
Co��mppaany BUILDING DIVISION FEES
I ICenNed copy is hereby furnished. CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
LYJ�CenBled copy b filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP
COMPENSATION INSURANCE PAID
-
(This FA.'20QFT. Date Recei tic
( section need not be completed If the permit bfa one hundred down
(sI m)ororlm) WATER HEATER W/VENT/ELEM ENERGY FEE Y N
Ianlfy that tithe performance of the work for which this pemdtbbwed,
I dull na<empby any person
Waken'CompewtbnlawsofG Womb:Date any manner a u to become cable¢to the WATER SYSTEM/TREATING PAID
O Z Appliont - NEW RESIDENTIAL PLMB. SOFT, Date Reeel t#
Z O N'OTICETO AI'IrLICAM:if,aher making thb CenBkate of Eaemptbn.you
N mould become wb}'ct to the Wonkan'Compeusabn provbbrc oftht labor r TOTAL:
Code,you roan fonhwkh amply with such proWsbm ormb permN shall be
LU doomed revoked. .TLLl.[LDING FEE
LU
G CONSTRUCTION LENDING AGENCY SEISMIC FEE
I herebysfBrm Hut then b a construction lending agency for the perform- eo ELECTRIC FEE
7 = a nonoftheworkforwhkhthbperM bis, 5m3O97,Civ.C) TOTAL
LLO fender,Name FEE
F Lender.Addis„ QTY. MECHANICAL PERMIT FEE MECHAMC L FGE
OW I anitythat l have reedthbapp11ationaodst.tether tht above lnfonrution
1 bmrna.I agree to comply wlthW city and county ordinances and state law, PERMIT ISSUANCE FEFS PAIV.
} N relating tobullding conaroaion,and hereby auth�npresentativesofthisC
ed` 7
[— Z city to entupro the abovamentbn[d property for inspectionER
pection purposes. ALTORADDTOMECYL Date Reeel ill
— (We)agree to save,indemnify an d keep harmless the City of Cupenm
l
against liabilities,Judgments,aosts.ed espeme which may to anywayamue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL'
agaimt said City in consequ enc a the gn ming d this pc.u.
AIR HA NDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Sigvtureof Applicant/Contractor Date - EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
.Will the appBant or loran building occupant Wore or ha to haaardw, HEATING UNIT(TO I N,"BM Date Recei Hl
material as defined by the Cupertino Municipal Code,Chapter 9.1 Z and the
Health and Safety Code Section 25337(.)1 - HEATING UNIT(OVER IMAM BTU) TOTAL:' �/ e
❑ Ye , No
WBltheappBantw tunbuildtngoccopantudeequiprnent ordevkcd VENDLATIONFAN(SINCLERESID) ISSUANCE DATE
which emit h.andous sir cantaMvnts as defined by the Bay Ana Air
Qu21ty MJgtmem Dktrkt? WaZR-COMP OHP OR 1W,"BTU)
Ye F�No
love mast theh rws materials requimmenb under Cha pier&95 of BOR-ER-COMP(OVFR lO0,000 BTU)
the Glif. balth&Safety CM,Sectbnu255O5,7 3and23534. I
undine,. tllthebu Odingdoemat ntlyhaveatenant,thatltbmy NEW RESIDENTIAL h1ECH. SQ.FT.
respom tonoHtytheoccupant enquiremem, rtwtbemrt -
prior t na d fiats of W my.
/- z
Ow0-
utror.w 'ad agent Date
TOTAL: ISSUED B
OFFICE COPY