19617 (2) POST THIS CARD NEAR FRONT OF BUILDING PFAMITNO.
19617
- ;CITY OF CUPERTINOAPPLICA nON sUBmffT-Ar5-Al7
INSPECTION DIVISION- JOB INSPECTION RECORD _ S_ y �,
JOB ADDRESS_ a sr'Y f S a-�l.l`L ��rd UNIT# LOT# CATEGORY CONTROL#
OWNER_
k �'e lA CONTRACTOR - BUILDING PERMIT INFO
'INSPECTION "r' DATE'•C•, INSPECTOR INSPECTION RECORD
FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE
UFERGROUND SHALL RE INSTALLED TO COMPLY VATH JORDESCRIPTION
PAD SETBACK-CERT THE APPROVED PLANSANDCITYOF
.CUPERTINO STANDARDS.
GARAGE SLABS PREGUNITE U
':POUR'NO',CONCRETE UNTIL ABOVE HAS BEEN SIGNED,'
UNDERGROUND/SLAB 7 INSPECTION DATE IN PECTOR
PLUMBING
ELECTRICAL
MECHANICAL '
DO NOT POUR,FLOOR UNTIL ABOVE HAS:BEEN SICNEW
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL -
FRAMING VENTS CLEAR
INSULATION Alp
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING -
TUBS&SHOWER PAN
MECHANICAL '
ELECTRICAL ACUZZI BOND
FRAMING STAIRS
INSULATION/VENTILATION
EM ERG.EGRESS
• SEWER WATER
COVER•NO.WORKcUNT1L ABOVE'WAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SI IEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREEN
SHOWER LATH
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.#
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 I
BUILDING
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL �•lI 11 JCE DATE
• BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN FE.R Q D 19911
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS ANDt r�rJAinO
PERMIT# ARE NEEDED WHEN PHONING:
IMPORTANT!
PLEASE READ.REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUED By: 1 \ 0 1 ' U r_ t 1 ` Y,
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Protect identification PEILMIT NO.
Building Address: 19617
i 8 1 Sce
Tera ams. Phone:
Q. B CITY OF CUPERTINO-BUILDING DIVISION r�
• ane:Y•Nam Lic.No: APPLICATION / PERMIT Z— C
3V770 PU)M
BUILDINGS.ECTMCAL- BINC-MECHANICAL CATEGORY CONTROL N
AftAdW1EngEILer. Lic.Na
i ! QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: s PFRMITISSUANCE
�l LICENSED CONTRACTOR'S D.CLARATION
Ihereby affirm that l am licensed under provisions of Chapter 9(comenenc APPLIANCES-RESIDENTIAL 6 . Do JOB DESCRII'TfON
Ingwlth Sedion7OW)o(DiW.ion3ofthe BuslnessandPro(mslonsCode,and my
licenselsinful rce deflect PANELS
Llcensc Chss ={_LIc.# 3 A -)7 Q
Date tr�a�DA Contractor �•`f �e..�a'�b �B
---��ARCHITECPS DECLARATION - 701-1ODOAMPS
X I understand my pknss he used as public records. OVERIODDAMPS SQ.EI'.FLOOR AREA S/SQ.Fr.
O
Licensed Profemiowl SIGNS ELECTRICAL
<6 OWNER-BUILDER DECLARATION
a F7 SPECIAL CE2CUIT/M75C
Zt, owinghemasonnthatiam31.5,Bfrom
esthe
sad Pmfinorb ,icausaCode;LawAny forthe
citor
folkwing mason.(Section 7001.5,Business and Professions Code:Any city or
F t. TPMP,METIX ORIOLE INST.
- emstywhlch reiortois issuanrocoo requiesthemprovgdemsuch,ermit to
IM
any structurepdementshmance,also sed Pursuant t the ro such of the POWER DEVICES
t5�a� file a signed statement that M Be licensed pursuant m the provisions of the
W6 3 o, Contractor's License law(Chapter 9(rommendug with Section 7000)of Divi- SWIMMING POOL ELECTRIC
SOS sion3 ofthe Buslnessand PmfcxdJmxCode)mthat he is exempt therefromand VALUATION
Gthe basis for the alleged exemption. Any violation of Section 7031.5 by any OUTLETSSWITCHESFIXTURES 4. 00
F,
for a permit subjects the applicant to a civil penalty of not moreth mv
$ five hundreddollars
erofth500). NEW RESIDENTIAL ELECTR SQI-r. S701i1. TYPE CONSTRUCTION
�n ❑7,as owner of the property,or my employees with wagesas thetr wk
(Sec.70K
,willdothework,andions Code:Th not Intended License,
for
O sale(Sec. pply to alnowandf propoty Code:The or Improvntractof es
Licenselaw
S$ docs net apply toenowner o!propertywhonlidsarImprovesded that such
OCCCROUP RIS.UNITS
who dossmetsworkd int elorthrough his own employees,provided thatsects
Improvements arewHntendneyearoeeed plebe.IQh,vuer-, ilderwillhe building or
have
TOTAL: 6 -SV
Improvement Esold within one yvarof compinlory the owner W Bderwlll have
tl%,jurden of pmving that he did not build or Improve for purpose of ask.). QTY, PLUMBING PERMIT FEE FLOODTDNE APN
u L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
�•s
contractors to construct the pmO(Sec.7014,Business and Professions Code: �_DV -
TTe Contractor's License law does next apply to an owner of property who ALTER-DRAIN&VENT-WATER @N
Wilds or Improves thereon, and who contracts for such projects with. - FEE.SUMMARY
ec
affactor(s)licensed pursuant to the Contnnor'a License Law. BACK FLOW PROTECT.DEVICE
L�I am exempt under SB k P C for this mason
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N ,
• Owner - Date RECEIPT N
WORKMAN COMPENSATION DECLARATION p0(TtRdES.PER TRAP OV SCHOOL TAX Y_ N
❑l hereby orf m that I have o lmum to of consent to aeifdnere ora RECEIPT N
certl(Irate o(Workeni Compematlonlmunnce ora certified ropythereo((&c. GAS EA.SYSTEM-I INCAOUTLETS PARKFEE YN
REE3800,Lab CJ f1
Po11ry N S I S'-_I o_O S EA.SYSTEM-0VERE
4( A) DING DT N
GA
BUILDING DIVISION FRES
�CenlRed copy is hercbyte GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
QCcrtliled mpykfiled withh the city
tylns)section division. J) 4—� b
CERTIHCATE OFU MPT[ON FROM WORKERS' GREASE TRAP ' PAID 27 V S�4u9 (•
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 700FT Date RCcei I#
(This section need not be completed if the permit b(orone hundred dollars
($100) WATER HEATER W/VENT/ELECTR ENERGY FEE Y N
I certifydify that In the performance of the work for which this permit is Issued, —
I shall not employ any person In any manner w as to become subject to the WATER SYSTEM/TREATING
Workers'Compereation Laws of California, Date PAID
Z ZNOTlicant
ICE TO APPLICANT:If,after ma king this Certificate of Eiempdon,you NEW RESIDENTIAL PLMB. SQ.FT. Date Recei t#
FO should become subject to the Workers Compemat ion provisions of the Labor , TOTAL:
N
Code,you=at forthwith comply with such provisions or this permit shall be
WC deemed revoked. BUILDING DO
CL CONSTRUCTION LENDING AGENCY SEISMIC FEE 1 7
I hemby afOrm that there is a construction lending agency for the perform, ^ w ELECTRIC FEE !
7Z .once of thewmkm1m which this permit Elsmed(Sec ll(W,Civ.Q TOTAL: O�Y. D 3p.
SV
V O lender's Name PLUMBING FEE x D
F Lender's Address QTY. MECHANICAL PERMIT FEE
O w I.dtfythatlhavereadthuapplimtbnandYatethattheabovelnformation MECHANICAL FEE
1 bmingt Iagree to comply with all ndtyand
yauthmloe ordinances and date
e;oftlaws PERMITISSIIANCE (at -!9D FEES I°/�ID'
>. rety to enter
obupon t construction,
reptionpurpo of this - D.
>. T �-0
�- 2 cityW)aree to ate,Indemnify an
property for Wpe City
onCuer ALTER OR ADD TO MECH.
(We)agree m save,Indemnify an d keep harMem the City of Cupertino Date Receipt#
a Ilablllties, dgments,coatsand expenses which may in anywayaccrue AIR HANDLING UNIT 90 I0,000CFM) SUBTOTAL:
gslnet Id Clty comequ sof the granting olty spemnit. -
t. yo
AIR HANDLING UNIT(OVER I0,000CFM) CONSTRUCTION TAX
Situbum of Applice racier ✓[�N/ Date IXFIAUST I IOGO(W/DUCTI - SQ CONSTRUCTION TAX PAID:
HA tDOUS MATERIALS DISCLOSURE JL
Will the applicant or future building occupant store or handle hanrdous - HEATING UNIT(TO 100,000 BTU) Date Remi t#
material as defined by the Cupertino Municipal Code,Chapter 9.1 7,and the
licalth and Safety Code,Se� 75537W)P HEATING UNIT 100,0110 BTU) TOTAL:
❑
III
t v�N
Wthe luxa ndapplicant or futumbuilding ocmpam use equipment or devices ' VFN'IIIA770N FAN(SINGLE RFSll)) LI• �In ISStp.NUDATE
whkheMthagemunt abcontaminamsaa dented by the Bay Area Air ' 1 V t+ ,u
Quality Marugemcnt Dlstrict7 BO(LFR-COMP pHPDR 100,000 BTU)
4hYea FEB u
ave read Health
a Tet rCodeIsis requimmenhundcr Chapter. 1 of BOILER-COMP(OVER IW,000 BTU)
the Califunderstand
t Health building Safety Code,Sections 75505,ve a i and 7:539. I
understand that if the notifyheexupurt not erequire have tenant.that It met NEW RESIDENTIAL MEC,[. SQ.FT.
re omlblllty nallytheoccupanto( parry.lremv:ntswhkhmuatbemet City of Cunartino
rio exllmua � ola Certl care o(Ompanry.
erorauthurlu Dace ISSUEDBY: VZ16V�vC�
TornL: .�3,•p�
OFFICE COPY