19510 ll
POST THIS CARD NEAR FRONT OF BUILDING PERMIT
i�� 1951
CITY OF CUPERTINO
INSPECTION DIVISION- J • BINPECTION RECORD 4
J06 ADDRESS \�, -UNIT�q�7y--/ LO'T� ,,"� GA oav � coN'rna1'
OWNER ` -�V � ONTRACTOR_�- l//My�NI.(y"\ BUILDING PERMIT INFO
INSPECTION .DATE JINSPEcTOR INSPECTION RECORD
FOUNDATION PIERS NOTE-ALLGRADINGANDDRAINAGE ❑
UFER GROUND SHALL BEINSTALLED TO COMPLY WITH JOB DEKS11 ON
PAD/SET BACK-CERT THE APPROVED PLAN'S AND CITY OF
CLTERTINO STANDARDS.
GARAGE SLABS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND SLAB INSPECTION DATE INSPECTOR
PLUMBING
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED i
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION Lw
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING
TUBS k SHOWER PAN
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 LATI-I/W-SCREEN
SI IO ER 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 1INSPECTOR, -
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
BUILDING - ISSUANCE DATE J'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
��- ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
1230 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS FEB
ul
BEFORE REQUIRED INSPECTION. JOB-ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING. of } j
IMPORTANT! /\ I " f, +�
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION I
'OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
/Y} Bulldln Pm'ed Idenafie.11. PERh9T NO.
9�Ing Add.
',1'Q -rw>v 6A1rP-. - [AAIV ' - 19 510
1. I tD N '14?RTVtU Phone
9w-$719f •CITY OF CUPERTINO-BUILDING DIVISION
1�5Wctm'a Name: . 1x/.N APPLICATION / PERMIT '
L b HUILDINGF].EC7RICAL-PLUMBINGMFLHAMGL GTEGOR
A tect/Engineer. -Lk.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
naareas: ' ��. ❑ ❑ ❑
PERMITISSUANCE
LICENSEDCONwduRe DECLARATION
I hereby d.700D) fDivi cenuedurderpsss.rd of Qucau Ccamanclo APPLIANCESRFSEDENTUL JOB DESCRIPTION
lien h$ecllon7000)of a affect o/thegumr�esand Pmfesmora Code,and
Manse b N toll( and affect � PANES
Date COmneor UP TD2DOANU
ARCHTTECT9 DECLARATION 701-1000 AMPS
my Pia shall be used as public records. OVER I"AMTS SQ.Fr.F1,00 AREA 5/SQ.Fr.
COSIGNS ELECIWCAL
(a Lkerue Prolesbvl
rLA� OWNER-BNLDER DECLARATION SPEClALCRCUIT/MLSC
IhenbyafBrm that l am exempt from the Comraeore Lieerae Law for the
0() following...(SeW.]0315,Buslnssed Profsbns Code:Anycityor
O<t. 7II.tP.METER OR POLE INST.
F� oounnywMch requtrea issuamomnstuuirest, apmeant foroWh,or repair
< anymnctun primblb Lssuavice,abo requlmthe appBant(m such Permit to POWER DEVICES
O o.U fiir a signed statement that he b lensed pureuunt to the provisions of the
Contractors License Law(Chapter 9(mmmendng with Seedem 7000)of DIW-
3 r{ SWIMMING IVOI,EI.EELECTRICsbn3ofthe BusineaaP
d mfenbns Ccde)orthat he is exempt therefromaM VALUATION
<5 the bases for the alleged exemption. Any violation of S tan 70315 by any 1
appLl ntforaperndtsubjeabtheapplkantoaevllperuhyofnm=mtlun OIIII-EISSLVITCIIESFUCfURFS
five hundred dollars(ESOP.
�n ❑I,as owner of the property,or my employee with wages set their soleal RL9DEJTIAL EI-CC7R - �'FI'' S[O IS TYPE CONSIRIICTION
h
C rompansetlm,wW Bothe wora,and lheatructurebwtlnterMed or offered for
y ❑ sale(Sec 70K Baines and professions Code;The CoMraem's License Law
5� doe notspply to a owner dproperty who builds or improves thereon,and -OCG GROUT' RES.UNITSP. who doessuchworkm
hUeUorthwgh Mw
san employee,provided that such
Impmverrems are not Intended proffered forsa e.IL however,thebuikling or TOTAL:
Imprommembsod within aneyurofcmnpledlan,the wvner-bullderwW have
t rden of proving that he did no,build or treprerve for purpose of sale.). QFY. PLUMBING PERMIT FEE
Lj L a owner of the property,am exclusively santrwIng with Ikened FLOODZONE APN
oontraders to mmtrua the projeet(See 7044,Busins and Pm(esbro Code: PERMIT ISEMANCE
The Conine ar's Lke e e law dm out apply to a owner of property who ALTER-DRAIN 4 VFM'-WATER ffN
builds or improves tbueon, and who contnm for such M"wkh • FEE SUMMARY
rya[(+dor(U I mos d pursuant to the Comraem's Lleerae Law. IN«FLOW I'ROT'uCi.DEVICE
LJ I am exempt under Sec B 4 P C for this reason
DRAINSLO
OUTSI DE FEES
FOR ROOF,AREA;COND. SANITARY Y N_
• Owner Date RFLEBar/
WORKMAN COMPENSATION DECLARATION
❑I hereby affirm that I have a artifiote of consent to saff4rum,or a FIXTURES PER TRAP SCHOOL TAX Y N_
ael(la(evf Workeri Cmnperwnimt Inauraa a•sniffed copy thereof L"ae
RECEIPT/
MO0,Iab C.) __ / GAS EA SYST134.1 ING4 OUTLET PARK FEE Y_ N_
I'atieyI Q'7 -/-moi/_A �^UA°I�MT� RECEIPTN
Com ny -- GAS EA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEES
[]C<niBed copy b hereby fumbled. CREASEANDIISI'RL WASTE INTERCEPTOR LANCHECK FL•E
�ertl(led copy b filed with the ehy Inspection division. I� �7��
CERTIFICATE OF EXEMPTION FROM WORKERS CREASE TRAP PAID 1-100 Jam' /O
COMPENSATION INSURANCE SEVER-SANITARY-STORM EA 700FI' Date Remi I "��lllJ EE
(TMs aectbn need not be completed lithe pemJt b far onehundred dollars
a1 m)a Ism) ENERGY FCE
I mmlythat in the pedonsanmofthewak forwhichthb permB is issued, WATERHEATER W/VETT/EdECTR a
1 shell not employ any person In any manner so a to become subject to the WATER SYSIFM/TRFATIrJG
Workers'Compenardanlawsof GBfomla.Due PAID:1=�' V
01
O Z AppBont NEWRESIDEJTIALPLMB. SQFL Date a
Z O NOTICETO APPLICANT-.If,after maldngthb Certiflateof Exempion,you
ahold become subject to Ua Worlearst Compevatbn provisions of the Labor TAIL
N Code,you emert forthwith comply withsuch provisions orthb permit shallbe BU
ILDING FEE
LU ] deemed rewkad.
CONSrRU IONLENDINGAGENCY SEISMIC as
CL C Iherebyaffirm that there ba construmm lending agency for the perform ELECTRIC FEE
Z anmoflheworkforwhkhthb per cot is Wued(Sec 309],CW.C.) TOTAL t�
(.) 2 lender's Name PLUMBING FEE
LL H i<ndere Addna QTY. MECHANICAL PERMIT FEE
O W I artily that l have mad this appBatbnand matethst theabove information
MECHANICAL FCE
0. bmnngt.building co ructioh allcity and Mmby aunryordinam at state lam PERMIT ISSUANCE
} N ldlatbgtobup.gmnstrueattiond apetthariue mpeeteeenp.rpoives ofthio
H etybenter upon the above-mentbrcd prs.perty for Wpeebn purposes. ALTER ORADD 70 MECH.
? (We)a no ave,Indemnify an d keep harredes the City of Cupertino ate Race1
aga Wtlla B ,judgments,mmsaMexperaewhkhmeybaywayac AER HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
against vl ity sego enne of the granting of this prm .
AIR HANDLING UNIT(OVER Io,000cFM) CONSTRUCTION TAX
Signora
reo t/ ontraetm Date EXFIAUSr IIO0D(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the apphom orfutum building ocoapenn start or harAk haaardos 11EATING UNIT(TO 100,000 BTU)
material as defined by the Cupertino Municipal Code,Chapter 9.17,and the Dale Recef t#
Eleahh ami SafetyCode Section 25537 W7 HEATING UNIT(OVER 100,D00 BTI) TOTAL:
❑ Ye ,1T No
Willtheappliandur naeWlldingoccupantuseequiprrcntmdevkes VENTILATION FAN(SINGLE RFSID) 5UA,�JCE DATE
which emit hanrdous air contamoums a defined by the Ray Area Air
Q�i. Management District? BOMER-COMP OHPOR 100,000 RTU)
Ye 1 No
have rudthe ha meus materials requlremenb underChapter 6.95 of BOILER-COMP(OVER 100,0D)BTI) FEB �,L i ��^JO
the California Health 4 Safety Code,Sections 75505,25533 and 75534. I
uMmWMtl tlftheb Udingdoe mnnUyhaveatenantthatitbmy NEW RESIDENTIAL MECH. SQ.Fr.
responsibility to rally the occupant of the rryubeme,ts whkh at be mart
prior to taname ora�rurkab oroa-aparKy. Q!0/eU P. I�
Owner or suthcrlrad agent Date ISSUED BY:
TOTAL:
OFFICE COPY