21957 1'VJt IC1IJ C.AhU 1V1LHi<1'hV1V1 VI' UUILUIIVIi � � � '
CITY OF CUPERTINO A A
INSPECTION
DIVISION- JOB INSPECTION RECORD
JOB ADDRESS O'�{� �O t`"' L UNIT# LOT q cATccoev CONI'ROLW
)_l' L1_
NNER TIGLT CONTRACTOR 0�'A313ag_ 1,,,n°',t�?BUILDINGPERMIT INFO t Nk
1NSPECTIONi;¢t4?s'z.,r x`l�3 rtt a i i° tDATE °. INSPECTOR INSPECTION RECORD Imo,{,
FOUNDATION/PIER$ �/ J N07EALLGRADINGAND DRAINAGE LLY LD
FERGROUND YT �/ SI TALL BE INSTALLED TO COMPLY"q JOB Df CHJIMON
PAD SETBACK-CERT nIEMPROSTANPLANS AND CITY or �Q4 �4J
CUI'ERTIR O STANDARDS,
GARAGE SLABS PREGUNITE
'POUR'NO.CONCRETEUNTIL'ABOVE HAS-BEEN'.SIGNED
UNDERGROUND/SLAB INSPECTION DATE INSPECTOR
PLUMBING
ELECTRICAL
MC•C{-IANICAL/
NOT POUR'FLOORI UNTIL'ABOVE,HAS�BEEN;SIGNED`
WOOD FLOOR -
PLUMBING _ ( -
MECI-IANICAL -
ELECTRICAL
FRAMING/VENTS/CLEAR
4k -
INSULATION
PLACE NO S1113FLOOR UNTIL ABOVE,HAS+BEEN SIGNED:
ROUGH
PLUMBING
TUBS&SHOWER PAN
MECI[ANICAL
ELECTRICAL/ ACUZZI BOND
FRAMING/STAIRS
INSULATION/VENTILATION
GM ERG.EGRESS
SEWER WATER 42
COVER NO WORK UNTIL.ABOVE'HAS+BEEN SIGNEWLL,.`"
'YTERIOR SMEAR 1-IOLD DOWN
TERIOR SHEAR/I-IOLD DOWN
lcRATCI
iEETROCK/SIIEETROCK SHEAR
TERIOR LATI I/W-SCREEN
OWER LATI-II COAT
NO TAPE•OR PLASTF-RrUNTWfABOVE,HASdBEEN.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 API1ROVALS
ELECTRIC
GAS TeE
BUILDING ISSUANCE A
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL 2
III
ILDING FINAL IS SIGNED BY BUILDING INSPECTOR
A': ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
66 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS ^,;','i { ij 1 � j
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING. Gi Y 4{'
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION IISSUEDBY:
APPLICANT'S POSTING COPY
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
Buld,ngAddreaa '211 957
o S( d w � .,
caner.NM rte: p
CITYOF CUPERTINO-BUILDING DIVISION Z1
Lic.No: APPLICATION / PERMIT l
'✓ BUILDING-ELF MCAf.PLUMBING-MECHAMCAL CATEGORY C
Arohltect/Fsgineer. Lic No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO-:
Address: PERMRTISSUANCE ��(� ❑ .k - ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lam licensed underprovtslons of Chapter9(commenc- APPLIANCESRESIDEMTAL JOB DESCRIPTION
ingwhh Seaion7000)of Division3°fthe Buslnessand ProfeciorsGode,and my
license Is in full force and ef@ct. PANELS
Llmnse Clam LIc.M �Zt
Date �ah�all
S DECLARATION 701-1WO AMPS _
7. I understand msed as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA E/SQ.FT.
Licensed Professional SIGNSELECTRICAL
Q IOWNER-BUILDER DECLARATION n Fa SPECIAL CIRCUIT/M1SC '
E, Ilaeremission.(Secton7MI H.tureaxptfmmthContractorslicense Lawforthe
following reason.(Section 7031.5,Buelnev and Professions Code:Any city or
O Z i-. TEMP METER OR POLE INST.
Fg mystm Mhreortoiape ancsitoamregt,alter,Impmvntfor Wh, er ttr
Q .c ale.sigturceatereathat he is
plito
the
provisions
of to POWER DEVICES
K�e file a actor's statement that he is licensed pursuant to the Pon 7000) of the
L�O� Contractor's License law(Chapter9(commenciatheisSection7000)ernan-
!�n SWIMMING POOL ELECTRIC
O�p elon3of the Business and Prolessioru Code)orthat he la exempttherc(romand '1 (� VALUATION
GGG555p777 PO S the basis for the alleged exemption. Any violation of Seaton 70315 by anyOU7LETSF_SFT
SWITCHXCURFS
appilcant for a permit subjects the applicant to a civil penalty of not more than V
five hundred dollars(3500).
j ❑I as owner of the property, NEW RESIDENTIAL ELECTRSQFE STORIES TYPECONSTRUCTION
, p perry,or my employees with wages r their sok
rom C3ce.7 Kwill Bothe work and ionstructure Code:
C intended or offered Law
$ O sale pec.7044,Business and Professions Code:The Contractors License law
j$$ does not apply to an owner of property who builds or improves thereon,and OCC.GROUP RES.UNITS
whodoessuchwork himself orthrough hisownemployees,provided thatsuch
Improvements are not intended orofferedforsale.If,however,thebuliding or TOTAL:
Improvementisaoldwithlnoneyearofcomplett theowner-budderwgllove
thelisirdesofproatngthatM did not build orunprove forpurpose ofsaled. QTY. PLUMBING PERMIT FEE FLOODZONE APN
as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
tractors to construct the pro)eat(Sec.7014,Business and Professions Code: s
e Contractor's License law does not apply to an owner of property who
Wilda or improve thereon, and who contracts for such pVoALTER-DRAIN&VENT-WATER improve
with a 1 - FEE SUMMARY -
con4actor(.)licensed pursuant to the Contractors License Law. BACK FLOW PROTECT.DEVICE
o
L,J I am exempt under Sec. B &P C for this reasn
DRAINS FLOOR,ROOF,AREA,COND. SANITARY Y N
Owner Date RECEI'[=.
WORK MAN COMPENSATION DECLARATION .NPER , SCHOOLTAX Y N
❑I hereby affirm that I have a certificate of consent to pythemo ora ' RECEIPT N
3800,Lab
ofWorkers'Comperwtlonlnsuranceorarertifled ropy Nemo((See GAS EA.SYSTEM-]WC40UTLE1'S PARK FEE Y N
Policy ab CJ —
RECIDrf M
Polity x GAS
F.A.SYSTEM-OVER 4(EA)
Com any BUILDING DIVISION PEES
Cerilfled copy is hereby furnished. CREASE/[NDUSIRL WASTE INTERCEPTOR .-� PLANCHECIC FEE
❑Certified copy is filed with the city inspection division. �pI 1
CERTIFICATE OF EXEMPTION FROM WORKERS' � II. , u
COMPENSATION INSURANCE . _ PAID
(Thissectlon need nut becompleted ifthcpermit isfx-one hundred dollars --SANIT'�Y STORM EA'I "` Date Recei t# '3A�k
0100)or Isco') WAT HEATER W/VENT/ ENERGY FEE Y N
I cemfythat in the performance of the work for which this permit is cawed, II —
I shall not employ any person in any manner so as to became subject to the ATTR SYSTEM/TREATING
Workers Compensation lawsof California.Date .PAID
OZ Applicant RESDLNTALPLMB. SQ.FT. Date Revel t#
Z O NOTICETOAPPLICANT:I,after reakingthis CertBlcateof Exemption,you
should become subject to the Workers'Compensation provlac°ns of the Labor TOTAL:
F N Code, must forthwith comply with such provisions orthiii permit shall be,
j deemed reenked. PY P P BUILDING 'E
W CONSTRUCTION LENDING AGENCY SEISMIC FEE 5.
CL z Ihereby affirm that there b a construction lendingagency for the perform- TOTAL: ELECTRIC FEE t
Z anteofthe work for which this permit u issued(Sec.3097,Civ.C.) —
U O Lender's Name PLUMBING FEE
Lenders Addma. QTY. .MECHANICAL PERMIT FEE
I cedifylhatl have ad thisappiication and statethatthe above lnformatl
O on
Y MECHANICAL FEE
Wnectreuro .Iagreetocomply with all city and county ordinances and slate laws PERMIT ISSUANCE �gs0Z FEES PAID:
1 „
} relating to building construction,and hereby authorize representatives of this
n to entero the above-mentioned for inspection ses. ALTFRORADDTOMECH.
F— Z city port property heron purpo I Date Recei t#
(We)agreeagree to save,Indemnify an d krep harmleas which the City y ay actinocrue P
O
against liabilities,it; judgmen ,� sand xpenseswNch may in any way accrue AIR HANDLING IIMT(TO 10,000 CFM) SUBTOTAL:
agaivtsal stye con tee' of( gin rating ofthis permit.
mgY AIR LdnNDunc uNTr(DYER Ia,000cFM) CONSTRUCTION TAX
r p /comranor Date DCHAUSTHOOD M/DUCT CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Willt pplicant or future building occupant store or handle hazardous HEATING UMT(TO 100,000 BTU) Date ReceI t#
material as defined by the Cupertino Municipal Code,Chapter 9.17,and the
Health and Salary Code Section 25532(s)? HEATING UNIT(OVER 100,000 BTU) TOTAL: O J?
❑Yea r]No nr
Will the applicant or future building occupant use equipment or devices Z VENTILATION PAN(SINGLE.RESIQ) coy ISSU�A�CE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management District? BOILER-COMP OEm OR IOO,OM BTU)
Yea QF�No
J4havcreadtheh a ousmaterialsmgWrcmentsunderdapter6.95of DOMER-COMP(OVER10gW0BTU) MAY
the California Health&Safety Code,Sections 75505,75533 and 2534. I
understand that ifthe building does not currently have a tenant,that it is my NEWRESIDENTALMECH. SQ-Fr aa„
responsibility to notify the occupant of the mquimments which must be mat �pry�//��;
prior to Issuance of a Certificate of Occupancy. �N40 0
Owner or authorized agent Date ISSUEDBY•-
TOTAL:
OFFICE COPY