19392 POST THIS CARD NEAR FRONT OF BUILDING PE MITNO.1 9392
CITY OF CUPERTINO - LUN hUbMl
C INSPECTION DIVISION'- JOB INSPECTION RECORD
• JOB ADDRESS�ObU(/ N• 7D1� JIJ. UNIT# LOT# CATEGORY COMB
OWNER W` —CONTRACTOR BUILDING PERMIT INFO
i
INSPECTION DATE tNSPECTO INSPECTION RECORD bukli
El
PIERS NOTE ALL GRADING ANO DRAINAGE
UFER GROUND SHALL BE INSTALLED TO COMPLY WITH JOB DESCRIPTION
PAD/SET BACK-CFRT - THE APPROVED PLANS AND CRY OF ter, ,
CIIPTIGINO STANDARDS
GARAGE SLABS PREGUNITE T
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND SLAB INSPECTION DATE INSPECTOR
PLUMBING
1�
ELECTRICAL I2 � o' / L'�Lr�i.
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
TU13S&SHOWER PAN
MECHANICAL - .
ELECTRICAL JACUZZI BOND -
FRAMING STAIRS
INSULATION/VENTILATION
EM ERG.EGRESS -
SEWER WATER .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN -
SHEETROCK/SHEETROCK SHEAR
EXTERIOR L.A li/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 IINSPECTOR '
SAN.#
ELECT.ENERGY Y -
PLUMBING ENERGY
MECH.ENERGY -
BUILDINGENERGY
ELECT.FINAL TEST -
PLUMBING -
.. GASTEST
MECHANICAL - ,
HEATING' - -ELECTRICAL RELEASE - d
H RE DEPT.
_GRADE.
OCCUPANCY '
TEMPORARY APPROVALS ,
ELECTRIC
GAS
BUILDING ISSUANCE DATE -
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR , (Q�,$
. ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING. C"It' "^^tfinD
IMPORTANT! '.
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION suEDBv:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Build] Prd et Id.Wifkadm PERMIT NO.
;B.Ud g Add 00
AZZ
19392
Phone: "PL[CATION SUBMITTAL DATE
G� E CITY OF CUPERTINO-BUILDING DIVISION
Con
• ' G_/b Lk.No: APPLICATION / PERMIT
. Ar Ret/En BURDINGELECIRKALPLUMBING HAMCAL , CATEGORY CONTROL Y•
Llc No
QTY .ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Add.-?- �j/f/ PERMITISSUANCE �� ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
Iheeby affirm that l am beamed order prmlatees.f Chapter 9(mmmenc - APPLIANCESRE ENTIAL JOB DESCRIPTION �
ing Mth Se on7D00)of Divlelon3ofthe Buslneaeand Profeta Code,
11¢nMC� co
PANELS
Lf¢Dat ,or EC7`SD ONS N11 TO200MI'SObeu pub record OVER 1!2510 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
ww O SIGNS ELECTRICAL
Fi UZ(Oj nscd boa -. � �. -
<�Q61 OWNER-BUILDER CIARATION SPECIAL CIRCUIT/M15C
i., Ihereby.(Irm that[am ezrmp[t the Contrator'a LI¢rorLaw fee the
70 !.lowing ream..(Setion 70715,B..lnem and Profession,Code:Any city or IFAII'.METER OR POLE INST.
mury
^ whieh reqube co
a permit to essumct,alter,improve,demolbh,or iepalr
any etruture prior to itsbuan<e,abn require the applicant for such permit to .
i. Ile.signed a.temeLa that he L B¢nmd pursuant it the donprovisiom of the
IK%4FR DEVICES
f„F Contrator'e Lkerue Law(Clupter9(mmmpndng with Setlon 7!100).!Met. SWID7MING POOL ELEGIRIC VALUATION
BOJ then3orthe the al e M exemption.
C Any
viothatheb eirempt therefrom end
the Wst,for the alleged ezemptbn. Any violation of SMbn 7m15 by an UTLE'ISSWITCHESFD(TURFS
O app0¢ntf.r.p,r tsubrtheappkanttoadviperuhy4nmmmthig
q five hundrnl doBan($5M, -
6 I,as owner of the Property,or cony employees with wages ae[heir mit NEW RFSIDFN33AL ELECTR STORIES TYPE CONSTRUCTION
GC7 a compensation,will do the work and the etrurtem Is not Intended or offend for 77Ljh �Q /
5 O ale(cc.70M Bualnea and Pmfembns Code:The Cootradoes LI¢nu Law
doe not apply to an owner of property who builds or improves thereon,and4
^ who does such work himselfenthrough Na own employees,provided thalsuch Z- - - OCC.GROUP. RES.UNITS
improvement,are not Intended oroHemd forsole.If,However,thebulNing or ZOTAL
improvement beold withno^cyearofcomplelb the.wner-b MerwiB have -
tlA.jIurdenof powing that he did not buBd or improve for purpose orale.). QTY. PLUMBING PERMIT PEE
u L a,owner of the property,,m eshcontracting
alvely wBh er
Ibued FLOOD ZONE APN
PFRRkf1S ISSUANCE
comsat..to mratrut the project(Sec 70444 Business and Presentations Code:
The Contractor's Llrerae Taw doe not apply to sin owner d property who
bu0d,or Improves;UuHson,and who commues fee each p<o)Ms with a ALTER-DRAIN&VENT-WATER(EA)
�7TTor(e)B¢naed pursuant to the Contractd,License Law. BACK FLOW RtOITZT.DEVICE " FEE SUMMARY
LI I am exempt under Sec B k P C for thio mason
• Qvrier Dale DRAINSFI.00KROOF,AREA,COND. SANITARY' Y_ N_
RECEIPT Y
�y,poI�� WORKMANI DNI_Phave
SATION of
ATION FDCrURES PER TRAP SCI{OOL TAX Y_ N_
Alfl hereby or tr n that I have i¢trB of a maffi to self-hur .p FFIFT Y
¢ ate o(Worken'Compewdmlrounn¢or.¢rtltled mpythereof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N
3800,Tab .
Polky Y RECEIlIT Y
•� GAS EA.SYSTEM-OVER 4(EA)
BUILDING DIVISION FEES '
L_jCertiffied copy b hereby f theGREASE/INDIISTRL WASTE INTERCEPTOR PLANCHECK FEE
°l`�irtuled copy b rhea with the city IropebH
tn dbion.
CERTIFICATE OF E(EMPION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCESEWER-SANITARY STORM EA 200F7 Date RCCCI tp
(This vection need not be completed ti the pemet b for hundred dollars
($10D)
IWATER HEATER W/VENT/ELECTR ENERGY FEE Y N
¢rtifythattithe perfomun¢o(the work forwNch thio pemWbblued,
1 shallnot employ any person N any manner n s to become aub)e t to the WATERSYSIEM/YRPATING
Workers'Compenstbn Lw,of California.Date PAID -
PF Rcrel tp
BOnt
Z 0 A NOTICE TO APPLICANT:If,ager making the Certll¢te o(Exemptbn,you - NEW RESIDFNIIALAMB. SQ.FT. Date
e cold becmme subjet to the Worken'Com peraeton pmvLsbru of the Labor - TOTAL
Code,you at forthwith amply with such provLsbroor thio pemdt shall be
W j deemed rewked: .
OUILDING W - CONSTRUCTION LENDING AGENCY EISMIC FEE
d G Iherebysf0nnthatthema, mrutrutienlendbgagemyfortheperminm_ TOTAL, ELECTRIC FEE
M Z anof the work for which thio prrm rt b blued(Sec 3097,Clv.Q
00 Lender'.Name - PLUMBING FEE
IL F Iender.Addrese QTY. MECHANICAL PERMIT FEE MECHANICAL FEE .
IcerHfythatl read thb.p caton,rdatateth,ttbeahovei
O W
a bmrmG.is to comply wf altlyand Darn rdln.... eat ws PERMITLSSUANCE FEES PAID:
>_ N relatlrigt IMingmnstry on, hembya rep t:It fhb
1- Z nyt. teruponthe e-m,ennoP or pPu ALTERORADDTOMBCFL
Me ae, derrwry ane m BY of pertw Date Recti tp
V
against flab gments,met,rd see wh yin an ,y,mve AIRRANDLINGUNTTRO10,000CFW SUBTOTAL:
against dC erne oft ,ming pemdt.
AIR HANDLNG UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
_ Z' CONSTRUCTION TAX PAID:
gruturoo cant/Con Date FIUUUS'T I100D(W/OLl'D
HAZARDOUS MA RIALS LOSURE
WOltheapplkantorfuture Bain pant store or handbha:ardou. [-IFATINC UMT(IO 1fU,N0 BTU) Date Recti tN
materi.lsde0rdbythe Cu U urudpaICode,Chap(,,9.IZ.dth,
1'leaitharid Safety cm p)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
Ye
Will the appBrant o ildingar pant use equipment or dev VENTILATION FAN(SINGLE RFSID) 1$ ANGE DATE .
which rout ham bmnt nt,as defi^N by the mBay A..A \ r
QualXy Ma eent rkt7 BOILER-QTMP pHP OR 100,IXD BTU) _21s f VvZDU U &L
4 Y No
ve red the r trials reyu me underC pl 6.95. 3011,MCOMP(OVER 100,0(11 BTU) ,
th Ilf.mla eaBh ST C.dq SeRl ,25533 34.1
u an tifthe dding down me yhaveate ,that It Y, NEW RESIDEMIAL MECH. SQFr.
respons, to not the omrpant the Irements meat met
PH imua aCertlRcaw.f p ry. !Tys
nen ora agent ISSUED BY:
ems- TOTAL:
OFFICE COPY