19621 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMITNO.
19621.
CITY OF. CUPERTINO A A DALE
INSPECTIONDIVISION-•JOB.INSPECTION I;ECQ D
JOB ADDRESS . �•-� LIE' �y,��1tir. Rr IT p_ .t� � - CATEGORY CONTROL N,'
a� BUILDING PERMIT INFO,
OWNER_ CONTRACTOR �-(.'
INSPECTION %
FOUNDATION/PIERS 'DATE- INSPECTOR NOTE:ALL GRADING AND DRAINAGE,ECORD 0 E
UFERGROUND. v SHALL BE INSTALLED TO COMPLY WITH .�'1 TOB DES CRI191ON
PAD SETBACK-CERT - THE APPROVED PLANS'ANDCITYOF.� ' -
I
CUPEMNO STANDARDS.
GARAGE SLABS PREGUNITE -POUR,NO CONCRETE UNTIL ABOVE HAS.DEEN SIGNED'
UNDERGROUND/SLAB` INSPECTION,, ' DATE INSPECTOR '
PLUMBING - - -
ELECTRICAL "
MECHANICAL - -
DO NOT POUR FLOOR UNTIL ABOVE.HAS BEEN SIGNED,
WOOD FLOOR '
'PLUMBING
MECHANICAL Al r - -
ELECTRICAL _
FRAMING VENTS CLEAR. -
INSULATION'
PLACE NO SIIBFLOOR UNTIL ABOVE HAS BEEN SIGNED I -
ROUGH. '
PLUMBING. .'- . .
TUBS&SHOWERPAN -
MECHANICAL - _
ELECTRICAL ACUZZI BOND -
FRAMING STAIRS - _ -
INSULATION/VENTILATION
EME RG.EGRESS ( ,
SEWER WATER '-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED'.
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/FIOLD DOWN
SI-IEETROCK/S 12ETROCK SHEAR , -
'EXTERIOR LATH/W-SCREEN '
SHOWER LATH -
SCRATCH COAT
NO TAPE OR PLASTF,R'UNTIL ABO VF. HAS BEEN SIGNED -
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS,PAID, '
FINALS • . DATE INSPECTOR
SAN.N
ELECT.ENERGY' -• .t - - _
PLUMBING ENERGY -
MEChI.ENERGY.
BUILDING ENERGY. -
ELECT.FINAL TEST ,
.PLUMBING - -
GAS TEST
MECHANICAL -
HEATING
ELECTRICAL RELEASE - - ,•� I .'.
FIRE DEPT.
GRADE. - -
OCCUPANCY
TEMPORARY APPROVALS - -
ELECTRIC '
GAS
BUILDING - •• . ..165 ANTE DATE .
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL � � 9".!•11t.,d
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR .. , "` - -
ARRANGE FOR INSPECTION.BY PHONING 252-4505.BETWEEN- FE Q O J 1990
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY 24 HOURS
BEFORE REQUIRED INSPECTION..JOB ADDRESS ANDroghltl0
".PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING 'FOR FINAL INSPECTION ssueD°Y'
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WiltlU LINES — USE BALL POINT PEN ONLY
Building Projekt Identification PERMIT NO.
Bulletin Address: �.`-�Y�. _ 19621
a
wnerI. ante ,Phone: -
CITYOFCUPERTINO,BUILDING DIVISION
APPLICATION I PERMIT `
BUILDINGm, TRICALML BING-Mp.CI-IAMCAL CATEGORY CONTROL If
r tc /'nglneer. o;
E i BUILDING PERMIT IN FO,
- (r� QTY ''"ELECTRIC PERMIT -',FGEI - '
Add.2 I �(„L,t PER)ATISSUANCE I�.D DIS ❑
LICENSED CONTRACTOR'S DECLARATION Ilk
,Ihereby affirmthat lam licensed under provisions of Chapter 9(commmc- APPLIANCESRE4DEM10kl JOB DtiSCRE'DON
Ingwith Sccttun7000)of Dlvlslon3 ofthe Buslmssand ProfessionsCods,and my - ��� � s
licenm b in tali(rce d d(ect. PANELS - .
License Claw _ LICM y�
Data Conlndor //IL
ARCHITECT ECGRATION 201-1000 AMPS
qw�O Zp ]understand my plan shall be used as public records OVER 1000 AMPS SQ.RC.FLOOR ARG S/SQ.FT..
k� Licensed Professional SIGNS ELECTRICAL
GGGG 6 OWNER-BUILDER DECLARATION
I'n SPECIAL CIRCUIT/MLSC
ZFp, a Ihercbyaffirothatlam exempt from the Contractor's License Law for the
OFF.pOj following mature.(Section 7031.5,Business and Professions Code:Any city or
coaq�p,MEfER OR POLE]NST. -
ntywhlchmquimsaperrmtwmnstnct,alter,impmve,dermllsh,orrepalr ,
q �F anystructure priorto its issuance,alsorequiresthe applicant for uch permit to FEWER DEVICES
tlWJ5 rY1 B�1 S file a signed statement that he b licensed pursuant to the provisions of the
3m� Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMNUNG IDOL
�Og ELECTRIC
VALUATION
0 5 the basis for the alleged exemption. Any violation of Section 7MI-5 by any OUTLETSSWETCHESFIXTURFS _ (�
applicant fora permit subjects the applicant to a dull pemlty of no ..than re than
five hundred dollars($500, - NEW RESIDENTIAL ELFCTR FS
❑I;as owner of the property,or my employees with wages as their sale SQ'Fr' 57'OItITYPE CONSTRUCTION
C7a compensatlon,willdo the work andthestomure isna intended or offered for '
'$ ,❑ sale(See 70K Busbuss and Professions Code:The Contractors License Law -
j$$ does set apply to an owner of property who W ildsor improve-themem,and OCC.GROUP RES.19NC1'S
0. who doro•uch work hlmselt orthrough his own employees,provided that such
improvements are notlntended oroffered forsale.Ithowever,thebulldingor TOTAL; S";pD
improvement esold with In oneyearofcompletion,the owear-budderwlll have
th,L�+rdeo of proving that he did not build or improve for purpose of ode.). QTY; PLUMBING PERMIT',' " ' FEE' FLOODZONE APN
LJ L as owner of the property,am exclusively contracting with licensed
contract..to construct the project(Sec.7044,Business and Profetai.ns Code: PERMIT ISSUANCE
The C.ntnctore License Law does one apply to an..at of property who ALTER-DRAIN&VENT-WATER(G)
Wilda or Improves thereon, and who contracts for such projects with a
mact.r(s)Ikensed pursuant to the Contractor's License taw. ''.i t�', FEEAUMMARY
-LI I am exempt under Sec. B&P C for this reason BACK FLOW PROTECT.DEVICE
OUTSIDE FEES
Owner
DRAINS FLOOR,ROOF,AREA,COND. SANITARY Y_ N
WORKINAN COMPENSATION DECLARATION
RECEIPT NARATION FIXTURES.PER TRAP SCHOOL TAX Y N
Of hereby affirm that I have a rlrtum to of c.nxnt to spythmre,or a
3800,Ltb of Workers'Compensatlon lnsuranceora ttkitled ropythere.f(Sec. RECFRY N
3800,Lab C.) GAS EA.SYSTEM-1 INCA OUTLETS PARK IFP. V_ N
policyN GAS G.SYSTDA-GVER4(FA) _ RECEIPT
Cram any _ - BUILDING DIVISION FEES
CertlOed ropy b hereby furnished. GRGSE/INDUSTRL WASTE 94TERCEPTOR PLANCHECK FEE
lBed ropy Is(fled with the
city
inspection division.ty
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE o " SEWER-SANITARY-STORM G.20OFT. Date Reeel t#
. (Thlasectl.nneed not be completed if the permit r'9 for one hundred dollars
($10)).rinsd certify WATER HEATER r'4/NEM/ELECTR ENERGY FEE Y Id
I rtify that in the performance of the work f.rwhlch this permit is Issued,
I shall not employ any person in any manner so as to become subject to the WATCR SYSTEM/TRGTING
Worker'Compensatl.n Lawsof Glitorect.Date - PAID '
licant I
Z Q NOTICE TO APPLICANT.If,a flat ma king this CcAUF-te of Exemption,you NEW RESIDENTIAL PLMIL SQ.ET - Date Reel t#
Hshould bcmmesubject to the Workers'Compensation proetiom ofth,Labor TOTAL:
N Code,you must forthwith comply with such provisions or this permit shall be BUILDING '
deemed rev.knd.
W S CONSTRUCTION LENDING AGENCY SEISMIC FEE
tl Z . Ihereby affirm that there is a rorstructlon lending agency for the perform- _� TOTAL: ELECTRIC FEE
arca of the work for which this permit is issued(See.3097,Civ.C.) Q_
U O Lender's Name PLUMBING FEE
LL 1= Lender's Address QTY. MECHANICAL PERMIT —FEE , MECHANICAL FEE
O W ce
l rtitythat l have mad thisappliave ti.rand statethat theaboinformation -
4 um,.d.lag.e tacomplywithalldtyandrountyordi...ces and state law• PERMIT ISSUANCE FEES PAID:
} relating to building construction,and hereby authorize representatives of this -
Zcity to enter upon the above-mentioned pmperty for inspection purposes. ALTER OR ADD TO MECH. '
V _ (We)agree to save,Indemnify an d keep harmless the City of Cupertino Date 'Receipt#
age net llablities,judgments,costs a rad expenses which may In any way accrue AIR HANDLING UNIT UO 10,000 CFM) SUBTOTAL:
ago Wt City Inco sequence of the this Permit.
Of AIR HANDLING UNIT(OVER l(LaoocFM)' CONSTRUCTION TAX
Signatumot Appliant/ContracolrData EXHAUSTHOOD(W/DUCD ' CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE'
Will the applicant orfutuce building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU)
nuterulasdefn.dbytMCupnino Munidpal C.de,Chapter9.12,andths _ Date Receipt#
Heaith and Saf&y Codd,SPction 2S532(.)I HEATING UNIT(OVER 100,000 BTU) TOTAL:
❑Yes
Will the applicant , uturc building occupant tomequlpment.,devices VENTIGTIONFAN((SINGLE RESID) ItjSU DATE
which emitN
hazardous air comanants as defined by the Bay Area Air j[" "
Quality Management Dist 7 BOILER-COMPpFB'OR10(iDWBTU)
4M1Yea road the ��j}� o FEB 0 Z) 1990
avccath&SafetyCoeriabrcgW25505, under 5533anhapier6.95of BO LHR-CONP(OVR700,000BTU)
the otod Californiais Health&Safety Code,Soolons
curre25505,21533 and 25534. I
understand that tithe building does not currently have atenanp that itEmy NEW RESIDENTIAL MECFL
pr,ort ibllltr-cdlfytM1e meant ofthemqulremenbwhich must be'met C'TMI PI :xel^9(tIB(�
priors arum o(a Certlfla of0 pa
Owner or out odzed agent Date ISSUED BY.. .�- �_ V C 1
TOTALf—
OFFICE COPY