19635 PERMIT NO.
POST THIS CARD NEAR FRONTOF BUILDING 19635
CITY OF CUPERTINO J v J
INSPECTION DIVISION- JOB INSPECTION RECORD
eJOB ADDRESS Imo OV✓V, CeLLTI-V �Vl UNIT# LOT# CATEGORY ! CONTROL I
OWNER J l C �yp/! �L&CLY• -CONTRACTOR 2VlI BUILDING PERMIT INFO
INSPECTION DATE 1INSPEcTOR INSPECTION RECORD,
FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE
UFERGROUNDSHALL BE INSTALLED TO COMPLY WITH f JOBDESCRIPIION ,
PAD/SETBACK-CERT
TI FE APPROVED PLANS AND CITY OF 1
CUI'FR"DNO STANDARDS. j �.}•C_ T`
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 !
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL I
FRAMING VENTS CLEAR
INSULATION - f
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING Orr
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 LATI I
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 '
ELECP.SINAL.TEST
PLUMBING - - -
CAS TEST I '
MECHANICAL
HEATING
ELECTRICAL RELEASE '
FI RE DEPT.-
GRADE
OCCUPANCY _
TEMPORARY APPROVALS
ELECTRIC
CAS
BUILDING .
OCCUPANCY OF BUILDING IS NOT.PERMITTED UNTIL i ISSYDATE .
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR '
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN OE B U 7 !95
12:30 PM AND 430 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT! c.
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEOBY: Vl�t
i
OFFICE COPY
i
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY 44 �L 7
Building Project Identifiction PERNUT NO.
BoldngA
�lJ a1 19635
P^OAe CITYOFCUPERTINOLBUILDINGDIVISION -7
Cantradaa.r�'e N�a�me: Lk.Na: APPLICATION / PERMIT 2-- 1
NGw LC/-'l6mf Z BUILDINGELECTRICAL.PLUMBINGMECHANICAL CATEGORY CONTROL
Amhltect/Engi.rLie.Ncx
Add. QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
PERIATISSUANCE 01 ❑ MI.I ❑ ❑
LICENSED that Is CONTRACTOR'SDECLARATION L�
[hereby ai(Inn tlutlam RcendM under provisions ofChapter9(commmc APPLIANCES-RESIDENTIAL BD RRIIO
ingwlth"-".n7000)of DlWtlon3ofthe Burin mend PmfmloruCode,and
Ilense b N foil forte and dfect.
PANELS
Lke.Cts.0—I9 Lk.# Z �1I S relL CC
ae
Dje: �qr] Conrador
ARCHITECI'S DECLARATION 1.1 AMPS
0Z Iunderstand my plans shall be uned as public records. OVERIODOAM15 SQ.FT.FLOOR AREA f/SQ.FT.
O
Lfoen iProfembrul SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION SPpCIALCRCUIT/M19C L VV
t.., IherebysNrm that l am exempt from the Cornractor's Lkxrm law for the 1 "-
O (o1lmving reason(Seddon 70715,Buanmand Prnfmbru Code:Any city or TEMP.METER OR MICE[NST.
K� oauntywhkA requlresa permit tomra ud,alter,improve,demoilsh,or repair
qqq anyafudure prlorto its issuance,also requires the appllont for such permit to POWER�.yl�q
0.S fiL d signed tlatement that he b Ifeensed pursuant to the provisions of the
0c: Contractor'sLicense Law(Chapter9(commencing with Section 7000)of Diel- gWP1hHUG POOL ELECTRICO sbn3ofthe Buslnmdnd Profn mCode)orthaheisem themfmmand VALUATION
the I»sb for the alleged r.mptlon. My violation of Seettonn 70715 by anyOU71.[i75S1V1'ICIIESFlJ(TURES
O appllont fora perrNt subjecistheapplicant Ina civil pevNy of notmorethan
c. fe
five hundrrdddlarahe pr. NEW RESIDENTIAL ELECT SQ.FT. STORIES TYPE CONSTRICTION
❑I,as iowneron,w of the property,a or my empbyen with wage r there dole
t,2d for
a compesale 5, 70KwRldothe woI'mfesnd theamciumhe ot Contended License
eLaw
O vie(Sec 7(111,Buerenes�and Pmfesdbns Cade:The Cordradors Wense Law
$ does ut apply to an owner of property who builds or improves therean,and OCC-GROUP RFS.UNITS
whodoessuchworkhlmMIf orthrxagh hhownempleym,provided thatsuch
improvemeas art not Intended oroffered for sale.If,however,thebulW ng or TOTAL
improvement is.aod w hM onyearofcomplebntheownerWMerwiU have
t"rden of proving that he did not build or improve for purpose ofsae.). QTY. PLUMBING PERMIT FEE
LJ L as owner of the property,am exchulvely contracting wah Licensed FLOOD ZONE APN
contractors to construct the Project(See.7061,Busdnmud Pmfmbru Code: PERMIT ISSUANCE �
The Cordrado/s License Law don not apply to u owner a property who
builds or Improve therm.,and who cor¢racis for such projects with• ALTER-DRAW&VENT-WATER TAU
9111(act.r(O dke'n`d porsuant to the C traduls Limas law. BACK FLOW PAarr�r.DEVICE FEE SUMMARY
LJ I am exempt under Sec B& P C for this reason
QIJTsinFrrrc
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N_
• Owner race DELL RECEII'fg
WORICHAN COMPENSATION DECLARATION FIXTURES PER TRAP SCI{OOLTA% Y_ N
❑I hereby aHbm that I have a orrHliate of rodent to seR-lauum,w a RECER'T
certificate of Workers'Comperamon lw a emitted copytheroof(Sec. GAS EA.SYSTEM-1 WC10UTLEPS PARKFEE Y N
3800,Lab C)
RECFIPI
(2o Y GAIL EA.SISIFM-OVER4(EA)
C. vy BUILDING DIVISION FEES
f LC`"Itl`d coPybn`nby(u"d'1"d' GREASE/DroUSTRL WASTE 1NTERCErfOR PLANCHECK FEE
I7CaJ5 CemNed copy Is Hod with the city Impedbn division,
CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM FA.30041.. Date Races t#
(This neaten need not be completed H the permit is fee one hundred dollars
($10(l)orlm.) - WATER HEATERW/VENT/EIECTR ENERGYFEE Y N
l emay that N the pedomune of the wek(or wMch W s pemdt is WuM,
I shall not employ any person in any runner n as to become subject to the WATER SYSTEM/TREAATINC
Workera'Canpenadov Lawsof GEfornia. Dae PAID
O Z Appllrant NEW RESIDENTIAL PLMB. SQ17. Date Recel t#
Z O NOTICE TO APPLICANT.ILsfln mekdng this CemHlate of Eemptba you
should become subyet to the Workeri Comperuatlen provisbv of the Labor TOTAL:
(n Cade,you must forthwith cornplywith such provlsbns or this permit null be
W j deemed revoked. BUILDING FEC
CONSTRUCTION LENDING AGENCY SEISMIC Il Iheebyaf0rm Unutherels corotrucilon lend log agency for the perform70TAL ELECTRIC FEE
D = ancr.fthrvmkf.,wMchthb pemdt hlwed LSec.309'2,CW.CJ
0 O Lender.Name FEE
IL 1- Lender'sAddnns QTY. MECHANICAL PERMIT. FEE MECHANICAL FEE
O 111
Iertllythatl havereedthisapplletbnand statethattheaboveWorenatlon
IL Lmrred.IagreetocemplywlthandtyandowntyordWnmand aatelER
aws PERMIT ISSUANCE FEES PAID:
r N relating to building covlrunlon,and heraby sutlb representa&ea of this
city to enterupon the shove-mentbrnd for inspection ALTER OR ADD TO MECH.
~ ? (We)agree o nsve,WemNty an d kkeep huMes,the Clry of Cu pertn Date RE ei t#
V agairut bWtin.pdgmentgmasaMexpe.whkh.yinsnywdyamue AIRHANDWNGUNIT(f010,000CFM) SUBTOTAL: _6D
Id consequenceofthegramingofthis pe _ AIR HANDLING UNIT(OVER 10,000CFM CONSTRUCTIONTAX
S o App t/Contractor Date EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID:
A2ARDOUS MATERIALS DISCLOSURE
Ill the app aorfutuebuadbg000cpmtstop or handle hanrdous HEATINGUMT(TO100,00011"E ) Date Recel I#
material as defirad by the Cupertino Murocipal Code,Chapter 9.1 2,and the
I lealth and Safety Code Seddon 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL: .OD
nT�Yes No VENTILATION FAN RESID)
_ -Tvditheapplicantn con bauamg onvpam ode egwPncm«aevim. ISSUnNGERATE
whichcMahuement District?
nb as deHrnd bytM Bay Ame Ab _
O WyblarugcmerrtDistrN. BOILER-COMP DA100,IXDBTU) -EB 071990
Y ❑No
a have read the haaardaus materials requirements under Chapter 6.95 of BOH.E44COMP(OVPRIW,000 BLV)
the c lHe.,a Hnahh&SafetyCade,Sediorn 25505,25533 and 255M.I
urdentard that tithe lou Rdlng does rot currently have atenanL that It is my NEWRMDDMALMECH. SQI-7. fv t.Ts lsnnnl}IBfI
responsibili y to ratify the occupant of the mqubements which rust be met frit
Prior to Issuance d e Certi"te of O.Pmcy. /�n
Owner or authofind agent Date ISSUED BA' 4VTOK Lice—(
TOTAL.: VV""II
OFFICE COPY