19632 (2) POST THIS CARD NEAR FRONT OF BUILDING rrxM Tn 19632
'
A CITY OF CUPERTINO
INSPECTION DIVISION- JOB INSPECTION RECORD _
JOB ADDRESSe,�A/jr,wtg2Aj/,tUN3T # LOT# CA 'RT '(ONTROLI
OWNER � I AS S E TV CONTRACTOR C0K/2� Q/I-2FD PL�.K BUILDING PERMIT INFO
N !-
INSPECTION
FOUNDATION/PIERSDATE INSPECTOR NOTE ALL GRADING AND DRAINAGE � "r
fik 1:1
UFCRGROUND SMALL BE INSTALLED TO COMPLY WITH •` JOB DESCRIPTION '
THE APPROVED PLANS AND CITY OF. l p1�
PAD/SETBACK-CERT ' CUPERTINO STANDARDS, 4::: AIJ
GARAGE SLABS PREGUNITE - ` - r
.POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED INSPECTION ~ '
UNDERGROUND/SLAB -t T DATE INSPECTOR
PLUMBING
ELECTRICAL - -
MECHANICAL
'DO.NOTWOUR FLOOR'UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR '
PLUMBING - -
MECHANICAL• -
ELECTRICAL -
FRAMING/VENTS/CLEAR .
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED. -
ROUGH
PLUMBING - II A
-
TUBS&SHOWER PAN.
MECHANICAL -
• ELECTRICAL ACUZZI BOND - -
FRAMING STAIRS
INSULATION/VENTILATION
EMERG.-EGRESS - -
SEWER WATER
COVER WO WORK IINTII.ABOVE HAS ➢EEN;SIGNED
EXTERIOR SHEAR HOLD DOWN - -
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCKSHEAREXTERIORLATFI/W-SCREFIJ - -SHOWER LATH -
SCRATCH COAT " •' ,
NO TAPE OR PLASTER UNTIL ABOVE*HAS BEEN SIC ED -
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS, DATE', INSPECTOR -
SAN.# -ELECT.ENERGY - -
PLUMBING ENERGY
MECH.ENERGY -
BUILDINGENERCY• -
ELECT.FINALT6ST - -PLUMBING .
GAS TEST .. ,
MECHANICAL - -
HEATING -
ELECTRICAL RGLEASE' -
FIRE DEPT. '
GRADE ..
OCCUPANCY
.TEMPORARYAPPROVAL S
ELECTRIC
GAS -
BUILDING
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL -' IUAf ICE DATE
• BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, .
ARRANGE FOR INSPECTION BY PHONING.252-4505 ISETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND C�J,I f` P'�� rJirt4
PERMIT# ARE NEEDED WHEN PHONING. '
IMPORTANT! :I
PLEASE READ REVERSE SIDE BEFORE CALLINGIFOR FINAL INSPECTION ISSUED BY.
OFFICE+COPY I '
.) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN'ONLY:
Building Pm•ecl Identification
Building Address: 9 C 3 Z,
'Gex10 �✓� I o
ere me: Phmu: ',. A A
INO
�-{- j CITY OF CUPERT -BUILDING DIVISION
Lle'Ne: APPLICATION /PERMITA.I�Arll .'
l BUILDINGELECTRICAGPLUMBINGEC
-MHANICAL CATEGORY/ CONTR%.A-
Architect/ neer. Lie.No:
ELECTRIC PERMIT 'FEE BUILDING PERMIT INFO'
`�.
AddressA�A .Y" 1' ^.:' '. '
` PERMITISSUANCE' El ❑ � '.'TI ❑
LICENSEDCONTRACTORS ECLARATION,, �( ,
Thereby eRlrm[borism Bcenaed underp Talons o(Chapter9(commenc- APPLIANCES-RESIDENTIAL JOB DESCRIPTION
Ingwith Sed1on70W)o(Dlvielon3 !he BusI aeon (esalonaCode;and my,
license Is In full d died 1'"' ` PANELS . . y
License Clava coLicp- UPTOOOAMPS -. n
nate_2,_�- contractor
ARCHiTECI`S LARATION -
`gw�rO. I understand my plans shall be used as public records OVER 1000 AMPS - ESQ FT.FLOOR AREA - ,$/SQ.FT.
" k F s Licensed Profen local - SIGNSELECTRICALj
G,GuS, , - - OWNER BUILDER DECLARATION
/
� 4 - SPECWI1Cl2CUIT/MISC.,,
f,N b I hereby af0rmthat l am a pt fromthe Contract rs License Law for the
OZ p fo0owing reason.(Section 7031.5,Business and Professions Code:Any city r -
� l"W countywhich rea permittoconstruct,alter,Improve,demolish,ormpair TEMP.METER OR
quires POLEINST. -
°� anyatmcture prior[ its issuance also requirmiheapplicantforsuch permit to .'POWER DEVICES"
g p
F O Q file a signed statement that he b (contencing pursuant it the tion 7000) of the _ —
Wj Conlradora License Law(Chapter9(mmmencing with Section 7000)of Divi VALUATION _
Off^ sion 3 of the Buslnessand Pmfvadors Code)orthat he is exempttherefmmand SWIMMING POOL ELECTRIC
Q the basis for the alleged exemption. Any violation of Section 7031.5 by any OUTLET'SSW[TC[iFSFIXTUAES . '
�uW95] appEcant for a pernit sub)ects the applicant to a civil penalty of not more than'—
five hundred dollars($500).
r, NEW RESIDENTIAL ELECTR SQFr. 'STORIES '•TYPE CONSTRUCTION
❑I,as owner of the property, i my em hure us with wages r their sole
mITFZ.4tZwivafiless and k.and tom Code:
Conte dedo License
sale(Sec.7044;'Business and Profeaslore Code:The Contractofe Llcerue Law
$ does not apply to an owner of property who builds or improves thereon,and
who doessuchwork himself orthrough hisoweempleyees,providecithat such OCC.CROUP - ^ RFS.UMTS
.improvement are not ntended oroffered female.If,however,thebullding or - b"" - TOTAL: _ �^-
improdementbsoldwithl neyearofcompidion,lheowner-buflderwillha e
11rden of proving that he did not build or lmpmve for purpose of sale). QT'y, '`" PLUMBING PERMIT FEE -
' Lf 4 as owner of the property,l,anoexduatvely contracting with licensed H'OODZONE
( 044,Business and Protrusions Code:
PERMITISSUANCE
contractors to construct the project Sec.7 l t i
' The Contractor's License Law does not apply to an owner of property whoALTER- -DRAIN&VENT-WATER(EA) '
Wilds or improves thmon,.and'who contracts for such ptojecta with a -
" tt(actor(s)licensed.pursuant to the Contactw's License Law. BACK FLOW PROT[CT.DEVICE FEE SUMMARY".
I,J f am exempt under Sec; B&P Cdor this reason -
DRAINSFLOO ROOF,ARF GOND., SANITARY Y N
• Owner .. t Date R A, RECEIPT X -
WORKMAN COMPENSATION DECLARATION !J pyy.I.URF_S I'EII7RAP A/1 S IIOOLTAX Y N -
❑I hereby affirm that I have,a cerliRale of consent to self-iname,or (i ,. . (W R -E p
certificateofWorken Compemationlr mnceoramnifiM copythereof(Sec. 1 GAS EA.SYSTEMI[NC.4 OUTLETS - PARKFEE Y T
3800,Lab CJ ,
PolicyX ' GAS F.A.SYSTCM-0OVER 'RECEIPT#
Co. any :: - - IA) , BUILDING DIVISION FEES
ertlfied copy b herebyfurnished.the city
CREASE/INDUSIRLWASTE INTERCEPTOR PLANCHECK FEE
�ertifled copy b filed with the city Inspection division.
4 . ,
CERTIFICATEEXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE
- (TMasectionneed not be compldetl lithe permit Isfor one hundred drllan ShWF,R-SAMTAAY-STORM EA,200FI. - Date Recei IN '
($lMorlese') t - WATER iIEATER IV/VENT/ELECTR- ENERGY FEE 'Y •N
I certifythat inthe performance of the work forwhich this permit ie Issued,
I shall not employ any person,In any manner as as to become subject to the WATER SYSTEM/TREATING' .
Workera'Compensation Laws of California. Date = PAID ,
'ZZ Applicant
.. NEW RESIDENTIA6pLMB. SQ.FI'. ' Date Recei tq '
2.0 NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you
Should become subject to the Workers'Compensation provisions of the Labor - TOTAL:
Code;youmustforthwithmen ly withsuch peoviorei orthb permit Mall be — � BUILDING ' el
> deemed revoked. .
W —p .. CONSTRUCntiN,iwDINC AGENCY -�Qv+a_;'� _ �24QQ SEISMIC FEE
.a Iherebyaffirm thattherebamrutructionloodlegagenry for the perform- ELECTRIC FEE
7 Z sore of the work for which this permit is Issued(Sec.3097,Cle.C.) ,- TOTAL:
U O ]renders Name - - PLUMBING FEE
LL F Lender9Adderss <. QTy, MECHANICAL PERMIT FEE MECHANICAL FBE 'y
O W I certify thatl have read this application and slatethatthe above Information
Iscom cl.I agree to complywlth all city and county ordinances and state laws PERMTTLSSUANCE - FEES PAID: _
} (1 relating to building construction,and herebyauthmine representative.ofthb
F WCity to enter upon the above-mentioned property for Inspection purposes. ALTERORADDTOMECH.
? (We)agree to save,indemnify and keep harmless the Clty°f Cupertino Date ReCelPtlf
V against liabilities,judgements,mks and expenses which may In anywayaccme AIR HANDLING UNIT(TO I0,0D0CFM) SUBTOTAL•
against said City in consequence of the granting of this peomt, 7
AIR HANDLING UNIT(OVER 10,000 CFM) - CONSTRUCTION TAX
Signatursof Applicant/Contractor' Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE -
Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date - ReCej [>f
.. material ae defined by the Cuppppppertino Municipal Code;Chapter 9.12,and the_ - - _ -
,. .Health and SafetyCL.e-Z 32(a)7 '' HEATING UNIT(OVER 100,000 BTU) TOTAL:
,M.Yes No
Will the applicant orous future building occupant use equipment or devices VFN''DLATION FAN(SINGLE MID) ISSI7_ [-F DA•('E
which emit hazardair con rants as defined by the Bay Area Air �J.$
Quality Manageress tD t BOILER-COMPQHPORIDQ000BTU) '
n r'
-. 4have sad the h' ar omomateriabrequlrementsunderChapter6.95of ' BOILER-COMP(OVFRIOQOOOBTU) T' p` ",� �p ,
the Collin nia Healt &Safety Code;Sscfmx25505,25533and25534. I r ,'
understa dthat if t bulidingdo 'not cvrrcntlyhave stenos[,that itbmy NFWRESIDENTIALMECH. SQ.FT,
responsi litytono[fy the occupa of the requirements which must be met ,
,. prio to uanof Certificate of cmpanry. ' 1�'ta III rmnoil.
l - - ..
Own or autho .gen 'Date
TOTAL: ISSUED BY:
p OFFICE COPY,