19377 POST THIS CARD NEAR FRONT OF BUILDING ; PERMIT NO. Q q
CITY OF CUPERTINO F a31 IAL r
DA Ili
,INSPECTION DIVISION- JOB INSPECTION RECORD
JOB ADDRESS. / D 6 D N t-sUNIT# LOT# CATEGORY CONTROL N
OWNER 'CONTRACTOR _ `Co yt BUILDING PERMIT INFO
INSPECTION DA INSPECTO ' INSPECTI RECORD
FOUNDATION PIERS NOTE:ALL GRADING AND DRAINAGE Ll
UFERGROUND - SHALL BE INSTALLED TO COMPLY WITH JOB DESCRIPTION'
PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS
GARAGE SLABS PREGUNITE
r.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB INSPECTION - .DATE ` NSPECTOR
•'
PLUMBING
ELECTRICAL -
MECHANICAL -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING -
MECHANICAL -
ELECTRICAL
FRAMING VENTS CLEAR ,
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROUGH
PLUMBING ,
TUBS&SHOWERPAN '
MECHANICAL
ELECTRICAL/JACUZZI BOND
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/SHEETROCKSHEAR - -
• EXTERIOR LATH/W-SCREEN -
SHOWER LAT
SCRATCH COAT.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED -
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX 1S PAID '
FINALS DATE INSPECTOR
SAN.#
ELECT.ENERGY °
PLUMBING ENERGY
MECH.ENERGY -
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING -
GAS TEST
MECHANICAL
HEATING
EbECTRICAL RELEASE
T IRE•DEPT.
GRADE'
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL - '
• BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR PAID
ARRANGE FOR INSPECTION-BY PHONING 2524,505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS D, I?bJ
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE'SIDE BEFORE CALLING FOR FINAL INSPECTION Iss"T"BY: 0
OFFICE COPY J
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
-Building Pro en Identification - PERMIT NO.
Bui[ding Add.,: . 19377
o&o ANT a-
Phone:
CITY OF CUPERTINO-BUILDING DIVISION
Cm «a N• APPLICATION / PERMIT L - �(G •� Q Sa CAT a BUILDING-ELE{7RICALf4.DMBINGMOCHAMCAL
CATEGORY CO,
7fROL M
Archltect/En rear: re
Cry ELECFRICPERMIT FEE BUILDING PERMIT INFO
Add. '
LICENSED
IC ENS EDCONTR r�nDeEC
ARATION
oPERhffT
ISSUANCE ❑ 1:1
R ❑
I hereby that lamlicensed
under
pmvWau of Chapter API1IANC6RE5IDFNTIAL JOB DFSC
InthSrxilm70ofahx,3x(heB.,d nd Cde,and
licecase is In WB force and effect, C PANELS
LkxnseCEss Lk.I 9V
Date Contractor U N10
ARCHITECTS DECLARATION -1 AMPSr�U
q�+QZwg bvoted
¢ I underrd my plans shad] ie puWe records OVER 1000 AMPS SQ.FT.FLOOR AREA f/SQ.FT.
6i d�j Llrenscd Professional SIGNS ELECTRICAL
GG 6 yW�rquq OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MLSC
Z � Iherebyaffirr,that l am exempt from the Contractor's Licave Law for the ,
p following ream.(.SeNm 7(31,5,Basi ®nand P.6.1em,Cade:Any city or
Pmrntywhichrequl apermlttomnkmv alter,Unpm ,demolbhorrepalr TEMP.METER OR OLE INST.
�y� anyet mprbrtolb Lvuance,aborequ4 theapph=tfmachpe to
NPOWER DEVICES
5 e a signed statement that he la Licensed pumuant to the provisions of the
Contractors Lkave Law(Chapter9(commencing with Section 7000)of Dld- SWIMMING POOL ELECTRIC
f� O Mona of the Bualncaa and Pro(®bv Code)or that he is exempt therefrom and VALUATION
R1 the bole for the alleged exemption. Any violation of Section 70315 by any
applicant for.permit subjects the applicant to a cMI penalty of nor more than OIITLETSSN77CFQSFlXfURIS
- five undredddlan(5508).
I,u owner of the property,or my empbyeea with wages u their sob NEW RESIDENTIAL ELECTR SQFf. STORIES TYPE CONSTRUCTION
compersatlon,will do the work and thestmmrro is not Intended or offered for
nrole X 70K Busirca and Prok.J es Code:The Contractors Llceroe law
0$2 don not apply to an owner of property who builds or imp.thereon,and OCC GROUP RIS.UNITS
whodoessuchworkhirvelforthrough hEidar
ownemployces,proved that ch
lmpmv mew are rn,Intended oroffered foreale.If,however,thebulWing or TOTAL
Impmve.nd 6wld whhinorcyarofcunplctbn,theawner-W Bderwi0 have
t rdenof proving that he did not baud or improve for purposeof k.). QTY. PLUMBING PERMIT FEE
L u owner of the property,am exclusively mntracting with Ifanaed FLOOD TONE APN
PERMIT ISSUANCE
contractus to construct the Inviter(Sac.70K Bu.1o.and Prdeabv Code:
The Contractors Licences Law don nor apply to an owner of property who ALTER-DRAIN 6 VENT-WATER(EA)
Wor improver thereon,and who contracts such pkokM with a
cptpxtor()Bceved pursuant to the Contractor:License Law. BACK PLOW PROTECT.DEVICE FEE SUMMARY
U 1 am exempt under Sec B(r P C for this mavenOLrTSIDE FEES
eyDRN F,AREA,COND. UD SANITARY Y N
Date
. Owner RECF]I'I'0
WOfmrnth.tI . PEN5AT10NDECLARATION �.N�$�IRM,
❑I hereby affirm that I have• Imurane of consent to o y thereof
m a SaR3DL TAX Y N
It
3800,L certificateo(Worker Cunpevatim Insurance oracertil4d copy thereof LSec. RECEIIN
3800,1r,b .) GAS FA.SYSTEM-1 INCL OU'E.EI5 PARK FEE Y_ N_ -
P.1k,Y♦ 2.O C�I RECEIPT It
Ce ny GAS EA.SYSITM-OVERI(EA) BUILDING DIVISION FEES
TLCertilldd copy h hereby funs CREASE/1NDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
Certlfledcopy b filed with the city inspection dl lion.
CERTIFICATE OF FSEMPTION FROM WORKERS GREASE TRAP - PAID
COMPENSATION INSURANCE SEWER-SANITARYSNRM FA 7f1($$T Date Revel IN
(This lection need era be completed tithe permitb/uorc hundred dollars
($100)°f1Gth WATER HEATER W/VENT/E.ECTR ,�O ENERGY FEE Y N
I certify thatbUre peAomwceofthatwait for tobtldspembID stared, —
1 WhaB net employ any PersonLaws b any mariner at u to bcwme sub)ea to the WATER S-YSDM/TREATING
Wuk<n'Compewtbn l�ays ofGWuw.Dae PAID
O Z Applicant NEW RIS[DENIIAL PLMB. SQFT. Date Remi t71
Z Q NOTICE TO APPLICANT:If,after nuWng this Certifiale of Pxemptbn,yru t
should ecome subject W the Workers'Compensation pmviebro ofthe Labor TOTAL:
N Cade,you nota forthwith comply with such provbbru or thio permit shall be BUILDING
W > deemed revoked.
4 C cothat Uvre ba oN LENDING AGENCY ESEISMICFE
Z Iherebya k forwhieertba mmitr blmlending 097,0(.C.) perform TOTAL D ELECTRIC FEE
7 ansa erthe work(or which thio permit V kwN bee 309'/,CN.C.) J y.D
02 lender:Name - - PLUMBING FEE ,C17
LL F Ieraer.Aaan9s QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW 1 cenilythat l havereedthls applirauonard Mateth t theabove information
D_ Iscomeer.Iagrtc Wcomply with aBcityaM muntyordln.ncaand Mate laws PERMIT ISSUANCE FEES PAID:
>_ IL to building mrwructim,and hereby awharlre representatives of this
N city to enterupon the abovcmentbrcd property(or Wpectbn purposes. ALTER OR ADD TO MELH.
_ (We).gree to lava Indemnify an d keep harmivs the cfty of pro Date Recciptp
V a gaimthabfhtles,Idgmew,coat d erases which maylnmyway.mue AIR HANDUNO UNIT(TO 10,ODO CFM) SUBTOTAL' _D
egairs dCl incovegaeue (the rating 1 Is permit.
.LlL�j i l Z -0'7 _ AIR 1uNlxiNc arm rovFn 1D,oao ctlN) CONSTRUCTION TAX
Slgnshlre of Appllcamt/Ccmtrf�abr Dae DHIAUST HOOD(W/DUCD CONSTRUCTION TAX PAID:
H RDO SMATERIALSDISCLOSURE
Will the a ppBcant or WWre building occupant store or hard ie havrdms I MATING UNIT(TO 100,000 BTU) Date Revel tit
materiel ate defined by the Cupertlm Municipal Code,Chapter 9.1 7,and the
IiealthaMSafety Code Sectior75532(a)r HEATINGUNIT(OVER100,OODBTUi TOTAL: oD
❑Yea No
WWthc�ppBant ar Wre Wilding aavpant use equlpmerrc uaov4n VF11I7IATIONFAN(SINGLERESID) ISSUANCE DATE
which emit harardeus air canUmW rata as defined by the Bay Area Air A
. Qu IBy Mmagement DLaact7 BOILER NMP OHP OR 100,O(D BTU) PAID
Yn No
I havc read the harm meterlaL+mqubemenis under Chaplcr Q95 of BOILFRNkf1r(OVER l00,0008M
the Califomia I leahh k Safety Code,Sextbro 75505,rR33 and 75536..I DEC
uMerst.dthalfthebulldingdonm,artentlyhaveatenant.thatitbmy NEWRISIDENTIALMECH. SQ.FT.
re,povBtBity to notify the amvpard of the requirements which must h met
prbrto La..cf.CertiflateofO.Pmey.
1 �If10
Owner or.utherired agent Data ISSUED BY:
TOTAL:
OFFICE COPY