19395 (2) PERMIT NO. -
POST THIS CARD NEAR FRONT OF BUILDING 19395
CITY OF CUPERTINO
-INSPECTION DIVISION- JOB INSPECTION RECORD
]06 ADDRESS `�(� ��t O N_� - UNIT# LOT.# cATEcoRv
OWNER C-IZ.I�CILIJ Ii1iV CONTRACTOR O2/1✓6l-+T • BUILDING PERMIT INFO
INSPECTION:` :DAT IN P OR INSPECTION RECORD
N/ •R .NOTE ALL GRADING AND DRAINAGE
FOUNDATIO ®" ❑ ❑
UFERGRTIO SHALL BE INSTALLED TO COMPLY WITH JOB DESCRIPIION
PAD/SETBACK-CERT, THE APPROVED PLANS AND CITY OE -.
GARAGE SLABS/PREGUN1 - - euPeannosrwNDwaos. ,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- �B -
UNDERGROUND/SLAB INSPECTION- DATE -I SPE TOR '
PLUMBING -
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - -
WOOD FLOOR .-
PLUMBING `
MECHANICAL
ELECTRICAL ml AM
FRAMING/VENTS/CLEAR
INSULATION
-. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGI-1. - - -
PLUMBING _ ^
TUBS&SHOWER-PAW
MECHANICAL
ELECTRICAL'/JACUZZI 13OND - -
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 - -
EXTERIOR LATH/W-SCREEN - '
SHOWERLATH -
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.# -
ELEC .ENERGY -
PLUMBING ENERGY - -
MECFLENERGY
BUILD NG ENERGY Y -
ELECT.FINAL TEST
PLUMBING
GAS TEST. - -
MECHANICAL - -
HEATING 'I
ELECTRICAL RELEASE - -
FIRE DEPT. _
GRADE - s OCCUPANCY-
TEMPORARY APPROVALS
CCUPANCYTEMPORARYAPPROVALS
` eeecrRlc .
GAS
BUILDING - - - - ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL t�pB�
RUILDING FINAL IS SIGNED BY BUILDING INSPECTOR - ICCa�YYYY
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN r J
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS-AND
PERMIT # ARE NEEDED.WHEN PHONING. II�
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION issusnov:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pra'ed Identification - PERMITNO.
Building Address: . 1'9 3 9 5
7£5(0 ortlo,J
cure ante. pho3 (9 A
Ct2ge—k-kJC-+ 7_5-x,4
CITY OF CUPERTINO-BUILDING DIVISION
coruatorawme: ue.No: APPLICATION if PERMIT
T'• VGI ITIZ65,03 BUILDING-D.ECTRICALPLUMBiNG-MECHAMCAL CATEGORY. C O N
Architect/Engineer. Lk.No: '
I ea
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: PERMIFTISSUANCE - r��X-a��
LICENSED CONTRACTOR'S DECLARATION �J El0
I hereby affirm that lam hernsed under provotionsof Chapter9(commenc- APPLIANCESFESUENTIAL JOB DCSCRITION -
IngwlthSect1on7000)of Dlvlslon3 ofthe Businessand ProfesslonsCode,and my
]kens,lCtaw an PANELS
SD3 PANEISLlmD A
Date lass 1 ContrUP TO 2DOAbMS e-CK/ --boy- sm
Date 2-s7� CHITE T S.DECLARATION
LN.-N•� 20I1000AMPS r
ARCHITECT'S DECLARATION OVERIOOOAMPS - SQ.FT.FLOOR AREA $/SQ.FT.
N
0 7 I understand my plan shall be used a publicrecoNs
uw
�O �-
K z Licensed Professional
SIGNSELECTRICAL
a OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC
7,
� 'I herebyarRrm that l am exempt from the Contractor's Lovew Law for the .
O F following recon.(Section 7031.5,Routine.and Pro/essions Code:Any dty or TEMP ME ER OR POLE INST. _
rountywhich requires a permttlomnslruct,alter,improve,demolbh,oreepalr
Q anystructure priorto its bsuance,also requirestheappBcam for such permit to POWER DEVICES
J U file a signed statement that he b licensed pursuant m the provisions of the
Contractor's License Law(Cha(Chapter 9(commencin with Section 7000)o/Divi- VALUA'II�N
a<n N R SWIMMING POOL ELECTRIC 6 f
O thesioallegrel
ProfessionsAnyviolhionat of exempt therc(romand �� s
6'S th,buanfor thermitsu exemption. Anyviolationtolacivi of Section nor more
OUTLETSSWI7CHFSF3%TIRtES 1 9 0
y appllantfor a permit subjects the applicant los civil penalty of net rtnrc Hun �YYYJJJ/
m five hundred deWn($.50B.
NEW RESIDENTIAL ELFGTRSQ.FT. STORIESTYPECONSIRUCTION
X ❑compensation ci oner o/the property, my employees with wages as their sole ,
thestrachumbecia Intendrefor offered for
p sale(Sec.70fy Business and Professions Code:The Contractors License Law —
Sg does not apply toan owner of property who buildsor improves thercon,and _ OCC.GROUP RIS.UNITS
whodoessuchwork h envie forthrorgh hlsownemployees,provided that such
improvements are not lntendeciaroff,red force le.If lorweveq thebuilding ur TOTAL:
improvement bsold withinoneyearofewnplel mtheowner-bWlderwlll have
m•5kurden of proving that he did nabundorimproveforpurposeofaale.). QTY. PLUMBING PERMIT FEE
L_j 1,as owner of the property, FLOOD'IANE APN
p perty,am exclusively Business
and Professions
licensed PERMIT ISSUANCE
The Co etoconstructthewdoe(Sec.apply
Businessand Professions Code:
The Coor Improved
License law aces not apply to an owner of property who
ALTER-DRAIN&VENi-WATER(FA)
Wilds it Improvm thereon, and who contracts for License
ptojem with a FEE SUMMARY
Off, mexe exempt
to the Contractors Lk&ae Law. BACK FLAW PROTECT.DEVICE
LJ I am oempt under Sec. B &P C for fhb moon -
DRAINS-FLOOR, SANITARY Y— N—
Owner
Data RECDPPN
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y_ N_
01 hereby affirm that I have a mrtlRote of consent to self-Nsurc,ora RECEIPT N
certiRemeofWorkeri Compereation licuraneeoracerllfiedcopylhereef(Sce. GAS EA.SVSfE]N-I INCA OUTLETS PARKFEE Y N
M00,Lab CO RFLER'I'N
Policy# GAS EA.SYSTEM-OVER 4(EA)
CBUILDING DIVISION FEES
�om any
C,Allied ropy It hereby furnished. GREASEANDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
OCertified copy Is filed with the city Inspection division..
CERTIFICATE OF EXEM PTION FROM WOR KERS' GREASE TRAP PAID
- slam
COMPENSATION INSURANCESEWER-SANITARY-STORM EA.]IIOF I'. Date Recd t# cc
(This section need not tars completed if the permit b for one hundred dollars
($100)orlem.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y_ N_
I certifylhat in the performance of the work forwhich this permit Is loved,
I shall not employ any person in any manner eo as bjgyp the WATER 51,S.1A1/.IAEA.DNG PAID
Workers' o;m tton Lawsoi Califorida.Date 11—`L l5 1
OZ Applicant-'T NtAI LP•rj IR(24,Jt1--1 r NWREADFM ALP Me. SQF.
PDate Recel t#
Z U NOTICE TO APPLICANT.1LaRer making this Certificate of Exemption,you
should billions, ens
lions,subject to the Workers'Compation provisions of the Labor - TOTAL:
N Code,you most forthwith comply with such provisions orthis permit shall be
BUILDING FEE
W eM nrcdre� CONSTRUCEION LENDING AGENCY SEISMIC FEE
M Z Ihereby afBrnthal there ba construction lending agency for the perform TOTAL ELECTRIC FEE
Z ante of thaworkfor which this permit is Issued(See.3097,Civ.C.)
O O I<nder's Name PLUMBING FEE
LLI— Lorder's Address - QTY. MECHANICAL PERMIT F'GE MECHANICALFEE
U IceNfythat l have read thbapplicattonand statethat theabove information
O W isarrmt.l agreeto complywith all cityand county ordinances and tate laws PERMITISSUANCE FEES PAID: -32
C.L
} a relating to building construction,and herebyaulhoraterepreaentativeaofthls 6$
rZ city to enter upon the above-mentioned property for Inspection purposes. ALTERORADDTOMECH.
(Wel agree to save,Ender ally an it keep harmless the City of Cupertino Date Receipt#
V against liabilities,judgments,oustsind expenses which may In anywayamrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
agai vid City in mnaequenceofthegrarling ofthlspreall. '
AIR HANDLING 11hTf K)VER IO,OW CI:N) CONSTRUCTION TAX
^
Sig. marwpputart/ConTra`�-t+o-r� Dale EXFIAUST HOOD fW/DUCT? CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orftturebulldingompant store or handle hazardoud HEATINGUMT(TOIOo,IX70BTV) Date RCCOIpt#
material as defined by the Cupertino Municipal Code,Chapter 9.1 7,and the
Health and SafetyCode Socaon 25537(a)?' HEATING UNIT(OVER I00,000 BTU) TOTAL:
Yea No '
Will theapplicam a. Lure building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE 222
which emit harardous air contaminants as defined by the Bay Area Air p�
• Quality Management District? BOILER-COMP QHPOR 10BOW BTU) PAID
4 yetQ No
hens,read the haaauus matetlab requirements under Chapter 6.95 of BOILER-COMP(OVER 1BJ,0008M t
the California Health&Safety Code,Sections 25505,25533 and 25S34. I `. ; •1 T (
understand that if the building does not currently have a tenant,that It Is my NEW REST DENTIAL MECH. SQ.ET.
responsibility to notify the camps at of the requirements which must be,met p .a
prior to issuance of a Certificate of Occopancy. yyh/ (t��lhnl llRO
Owner or authorized agent Data ISSUED BY:-.
TOTAL:
OFFICE COPY