19330 PLRNUTNO.
POST THIS CARD NEAR FRONT OF BUILDING 19330
CITY OF CUPERTINO A 3
INSPECTION DNISION- JOB INSPECTION RECORD
• JOB ADDRESS_ UNIT# LOT# CATEGORY' CONTROL#
OWNER CONTRACTOR 601�Wjey BUILDING PERMIT INFO
INSPECTION FOUNDATION/PIERS ATE INSPECTOR NOTE ALL GRAINSPECTID RECORD
AND DRAINAGE O
UFERGROUND SHA LL BE LMUALLED TO COM PLY WITH JOB DESCRII'IIO
.PAD/SETBACK-CERT THE APPROVED PLA NS AND CITY OF
CUI'ERTWO SCANDARDS
GARAGE SLABS PREGUNITE - it
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB INSPECTION "DATE INSPECTOR
.
PLUMBING - 2 _ O - N 'NZ L
ELECTRICAL
MECHANICAL 'O
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _
WOOD FLOOR
PLUMBING Q�([
MECHANICAL
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING -
TUBS&SHOWER PAN
MECFANICAL `
ELECTRICAL ACUZZI BOND
FRAMING STAIRS
INSULATION/VEMI LATION
EMERG.EGRESS'
SSEWER WATER ,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN -
SHEETROCK/SHEETROCK SHEAR
EXTERIOR TI-I/W-SCREEN _
SI W•R 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. IINSPEcToR
SAN.#
ELECT.ENERGY
PLUMBING ENERGY
MECH.ENERGY
BUILDING ENERGY. .
ELECT.FINAL TEST
PLUMBING . .
GAS TEST -
MECHANICAL
HEATING A --
ELECTRICAL RELEASE' 12-19
FIRE DEPT:
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING - ISSUANCE.DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL
BUILDING FINAL 11SIGNEDBY BUILDING INSPECTOR PAID
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
12:30 PM AND 430 PM MONDAY THROUGH FRIDAY,24 HOURS NOV u 9 1981
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING. 011
IMPORTANT! Yfl
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION SSUED BY: J
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
Building AddreB
os2(, IV.-TA&MAU 19330
Uwear.Name one: APPLICATION SUB�[TFAL DAM
NnE" (,sty CITY OF CUPERTINO,BUILDING DIVISION
c Iador.NN. APPLICATION If PERMIT
J E I—I C�1 BUILDINGELECfRICA1,PLUMBINGMECHAMCAL CATEGORY CONTROL I
ArchLlc Na:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Add. /' I. esu ❑ 1:1 ❑
[ELwnssuAN�
LICENSED CONTRACTOR'S DECLARATION
I hereby alrlmm that l am licensed under previsions of Chapor9(comment APPLIANCES-RESIDENTIAL JOB DESCRIPTZN
ingwdhsectbn 70=ot DlvWon3 ofthe Budnessand ProfesdamCode,and my
Ikons b in I.. loons and d(e� C .—gyp PANELS �Z_ �a�
licame Chen L1c/l I(�I 7sI,�/p �z
Date Conuactor UP TO 200AN5
ARCHITECPS DECLARATION 201-IODDAMPS .
NZ I.Mmtard myplamshaBb .0 dupubhcrecrda OVERIODOAMPS SQ.FF.FLOOR AREA $/SQ.FF.
�j Licensed Professional SIGNSFlOCTRR'AL.
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/ML9C
]H3 Iherebys(firmthat lameumpt fr�the Contredor's Lkxvee Lwfathe
pp faleowingreason.(ection 7m15,Business,and Pmfolom Code:Anydtyor
6M I..qqq 1124P. RM
4P.MET OR POLE SF.
county which requires s perms to mmtruc,alter,improve,demoli,th,or repair
ggqyy 6 any structure prior to Its Issuance,also requires the applicant for such permit to POWER DEVICES
K V Bk a dgned statement that he bprovidersBnaed pursuant to the providers of the
Ou, Contractors Lkenae Law(Chepter9(commencing with Section 7ODD)ofDlvl-
4�03 .tion3ofthe Basin.and Prdmbna Code)orthrt he b eampt theafromand '` Me1`G POOL ELECTRIC VALUATION
Sm t the basis for the allaged exemption. Any violation of Section 7MI5 by any
O appliaotfor a perMt subjects the applicant to a dull penalty of nes more than OITILE755WTTCFSSFIXTURES
five hundred dollars MM. NEW RESIDENTIAL E].ECIR Ff.
](m
F-1 1,as owner of the property,or my employees with wages as their sola STORIES TYPE CONSTRUCHDN
Y� mmpenaadon,willdo the work and Nestructure la not intended or offered for
5 O .—k(see 7(A4,Bualroe and Profesbna Code:The Contractors LI¢me Law
don rout apply to an owner of property who builds or improwva there n,and
�^ who don such work himself or through his own employees,provided that such OCCGROUP RES UNITS
Improvements are not Intended oroffered for sell If,however,the building or TOTAL:
Improve..Ltadd withlnorcyearofcampldbRtheowrrtr-W llderw111 have
t4Lkudenofpmvingthat Fedldm UdoriffTw forpurpomo(eak.). QTY. PLUMBING PERMIT FEE
U I,as owner of the property,am ex<WaWely ntncting with licensed FLOOD]DNE AIN
contad¢e to mrWruct the project(Sm 701/,Business and Profesbna Code: PFRSITTISSUANCE
The Contractor's Lbenae Law does net apply to an owner of property who ��-DRAIN&VENT-WATER(FA)
WW.or Improves thereon,and who contracts for such ptaa with• FEE SUMMARY '
c�[actm(al licensed pursuant to the Contactors License Law. BACK FLOW PROTECT DEVICE
LSI am exempt under Sec B& P C for this mason
Avner Date DRAINS-F7.00R ROOF,AREA,COND. SANITARY Y_ N_
SWOR"ANCOMPENSATIONDECLARATTON RECEBTa
,QI hereby affirm that 1 have s¢rtlOate of tomcat to self-bwre,or PD('NRES-PER TRAP S4TOOLTAX Y_ N
certRECE]P #
3800LleCof�W�orken'CornpCematlon lmupvn¢¢a¢rtllled mpythereof LSec. GAS EA.SYSTEM-I MG4OUTIEM PARK FIE Y N
3P8ol00�0bWPIniBS7'$ 1 -0q AFI:EIIT�
GAS EA.SYSTEMOVER 4(FA)
Co rt . t BUILDING DIVISION FEES
I eertNedmpy LrhertbyfurNshed. GREASE/INDUSRI,WASTE INTERCEPTOR PLANCHECK FEE
Certified copy is filed with the city Im)xctbn divWon.
CERTIFICATE OF EXEbEPI10N FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWFRSANIfARY-STORM EA 20ArT. Date Reoel tin
(IldeeMbn need nctbecomplee ifthepe b(¢oreshundr doBan
(S1fIcotifyth WATER HEATER W/VENT/MFCTR - ENERGYFEE Y N
I certify thaththe pedonnance ofthework for which this pemdthlasued,
I shall nest employ any person in any manner so as to become subject to the WATER SYSTEM/TREATINGWorkers'Ccmpcna n1on liwa of California.Date PAID
C• = Applicant NEWRIS DEN E,LMB. SQFT. Date Recei tin
Z O NOTICE TO APPLICANT:If slier making thla Certificate ofEumptbn,you
should become sub}M to the Workers'Compensation provlaiam of the Labor TOTAL
~ N Code,you mind forthwith comply with such provisions orthb permit shall be 13UILDING FEE
> dnrrcd revoked.
CL o CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there b•construction landing agency for the perform. ELECTRIC FEE
Z anceof the work for which this permit b issuedc 309]
(Se ,CIV.C3 TOTAL
u O lender's Name PLUMBING FEE
IL I— Tendrrs Address QTY. MECHANICAL PERMIT FEE MECHANICALFEE
O W I orrtlfy,that l have mad this application and state that the above Information
(1 Isco ett.lagrectocomplywhhaudtyandmunty.rdWn.ands telD:
aws PERMIT ISSUANCE FEF$PAI
>. N nelaling to Willing construction,and hereby authorlu repersenhthes o(thls
F Z dty to enter upon the aboscmentbrud property for Wpedbn purposes. ALTTRORADDTOMECH. -
_ (We to ore' IvdenWfy an d keep harmless the City of CupertinoDate R elptk
a lab tics,judgmew=and npenses which may In anywayacaue, AIR HANDLING UNIT(TO 10,000 CF'hD Ain I I SUBTOTAU
4,.JaatVAAfty Uonuqua ofhegravtine of this prmnl
./ AIR HANDLING UNIT(OVER 10,000 CFM) CONS'CRUC17[01V-'FAX6y
Signature.!Applicant/Co arta Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
llaHA]ARDOUS MATERIALS DISC RE LII'! rl (,"I"rt1DlF
WBltheappntorfumu b,uildingonvpantsto rlbandirli.rdou, EIEATTNGUNTT(TO100,0)0BTIn Date Recel tic
molethlore deletedbyted Cason 255 Murdtlpal Code,Chapter 9.12 and flat .
Healthes safety code Scalon]5532(.)7 HEATING UNIT(OVER 1fA,00D BTU) .TOTAL:
1(�""II Yn No
whichj theemit brardntor�wre building as delioccupant by the BayequipmentArea dcvlm VINDLATIONPAN(SINGLE RFSID) r� 1g LS$UANGGG•EEE DATE
whkheManavrdow dreovtandnanteas deRncd by the Bay Arca Air —��+?J�/� Iia I'�I 'I� II I'll
S
Quality Management D-]No BOILPR-0DMP OFB'DA lOO,IXD BTU) t I1F�a IYI�n/ 'LFI-Da TUI 1(IIrJJJI D
4 Yn No '�L lll\tl'I D
have read the here esus materlab requbemcnte under Chapter 6.95 of BOILER-COMP(OVER 100,OOD BM
theerstannh Heaith&SafetyCods otcum Ti505,ve a tend,that I NOV 291989
understand that if the Wlldingdcetnot arrently haveatenanL that ltbrtry NEW RESIDENTIAL MECH. Ff.
responsibility to rally the occupant of the rcqulmmenn which..be met ,
prior to Issuance of a Certlflate of Occupancy. "
UG. I(V�PEC71 tJ DEPARTMENT,
Pvnerwauthorirad agent Data ISSIIEU�Yt" HOr/fTlhsn
TOTAL a?T"C.TTTI'PLT—
OFFICE COPY