19350 POST THIS CARD NEAR FRONT OF BUILDING PERMIT No.
CITY OF CUPERTINO AITUCA IION SUBM19350IE
INSPECTION DIVISION- JOB INSPECTION RECORD ^ l r
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J06 ADDRESS /! UNIT# LOT# CATEGORY CONTROL#�� ,
OWNER V Bty-- 9-,j CONTRACTOR BUILDING PERMIT INFO
INSPECTION I DATE INSPECTOR INSPECTION RECORD
FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE `
UFERGROUND SHALL BE INSTALLED TO COMPLY PATH JOB DESCMTION
PAD/SETBACK-CERT. THE APPROVED PLANS AND CITY OF
GARAGE SLABS/PREGUNITE
CUPEIMNOSIANDARDS. Qr aT
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
FRAMING/VENTS/CLEAR
INSULATION $✓
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNTDI
ROUGH Com!
PLUMBING _ 2 :2 _ G
TUBS&SI-IOWER PAN
MECHANICAL
ELECTRICAL ACUZZI BOND
FRAMING STAIRS 04
INSULATION/VENTILATION
EMERG.EGRESS
SEWER WATER '
' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SI-IEETROCK/SHEETROCKSHEAR >
EXTERIOR LATH/W-SCREEN
SHOWER LATH
SCRATCH COAT,
NO TAPE OR PLASTER UNTIL ABOVE HAS IIEEN SIGNED
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE INSPECTOR
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
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL I uSil=AIN�E DATE
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN C (� 0
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSULD BY: �~ 'I
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMITNO.
Building 9ddnss:
aj�g 5`f ffTFD D .
19350
Ow aces: Phone: p • - A
nL1;2"T J,5u�u 44E6— S1 CITY OF CUPERTINO-BUILDINGDIVISION
' Centracter's Name: Lic.No: APPLICATION I PERMIT Z^ "—
rm. •] L-�BUR.DINGELECTRICALPLUMBiNGMECIiAMCAL CATEGORY CONTROLS&.)
Architect/Engines Lic.N
ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address:
PERMITISSUANCE ❑
LICENSED CONTRACTOR'S DECLARATION
Iherebyafflnm B
ntlutlacensedunderprovision.of Chapter9(commmc-INJI-Illerli
APPLIANCES-RESIDEh1TIAL JOB DFSCRTI
license -HON
ingwlth Semon 7OOO)of Divislon3 ofthe Buslnessand Prof.I...Code,and m
Is in full force and d(ect. PANELS
License lima.
Lk.N
Date Contractor
ARCHITECTS DECLARATION
0l,, I understand my plans.hzll be used a.public records. OVER 1000 AMPS SQ.IT.FLOOR AREA S/SQ.FT.
COC
U Licensed Professional SIGNSELFLTRICAL
�< OWNER-BUILDER DECLARATION sIPGCIALCIRCUTT/MLSC
lhcrcbya(flrtn that l am exempt from the Contractors License Law for the
followingason.(Sedim 7MI,5,Business a ad Professions Code:An d or
r: fe y city TEMP.METER OR POLE INST.
F� c°untywhire requlma bermRrocomtmuirestlicapmve,demoLLah,ormitto
�..: any structure prim tents that he In lborcdetot the
revisionsorsuch of to R J-0
c. floe a signed statement that he t.licensed ening pursuant it the tion 7003 of the ( MOWER DEVICES
�3q Contractor's License
sand Pr(Chapter essio9(commentlng with Section03) Drvb SWIMMING POOL ELECTRIC
O smn3os he he
feed Profevion.Any
rlation f exempt themfromand VALUATION
g the task for the alleged exemption. Any violation of Section not by any
appllantfor a permit.ubjectstheapplicant toativllpemltyofn°tmorethan OUTLEiSSWITCHESFIXT[JRES ry
n, $ five hundred dollars($500). NEWRESIDENTIALELECTR �l V
?�n ❑1,as owner of the property,or my employees with wages as their sale e''QF7. STOW ES TYPE CONSTRUCTION
k ¢ compensation,wllldothe work and thestmcture Isnot intended or offered for ,
y ❑ sale(sec.7054,Business and Professions Contractors The ContraOrs Llceme Law V
�$$ does not apply to an owner of property who builds or improve,thereon,and
who doessuch work himself orthrough his own employees,provided that such OCC GROUT' RFS.AMTS
nmproven,nts are not intended oroffered fcreale,If,however,thebuliding or TOTAL: Z.
Improvement 6s idwithlnomyearofcompleti theowner-budderwlll have
X.:Xt ben of proving that he did not build or Improve for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOOD 7ODIE APN
S a.owner of the property,am exclusively mntractlng with licensed
ntradom to construct the project(See,7044,Business and Professions CodPERMIT ISSUANCEe:
The Contractor's License la,w does net apply to an owner of property who ALTER DRAIN&VENT-WATER(EA)
solids or Imp.thereon,and who contract, for such projects with a
cgp!(ador(411camsed nuant tothe Contrador'e Lt...Law. gACg F(,pIN PROTECT.DEVICE FEE SUMMARY
Ll I a B &P C for this reason
Date DRAINS FLOOR ROOF,AREA.COND. SANITARY Y_ N_
OUTSIDF
Owner RECEIPT N
WORKMAN COMPENSATION DECLARATION
❑1 hereby affirm that I have acertificatelrarof consent to pytheure,ora FIXTURES PER TRAP _DD SC1dOOL TAX Y N
UM,abofWorkers'CompensatlonImunnce ora cenifled copythennf(sec, RECEIPT_ NN
3800,lab CJ GAS Iik.SYSIRM-1 INC.40I17LETS PARK FEE V N
CaPolm any GAS FA.SYSTEM-OVER 4(EA) RECIf
BUILDING DIVISION FEES
rICertlhed copy bi hereby fural.hed.
❑C,hifled copy Is filed with the city Inspection division. GREASE/INDOSTRL WASTE INTERCEPTOR PLANC14ECK FEE
6 r 7f-
CERTIFICATE
MPE SATION NS FROM WORKERS' CREASE TAM PAID �-^ "l
COMPENSATION INSURANCE
(Ihlssection need nes be completed if the pemdt leforone hundred dollars SEWERSAMTARY-STORM EA.2WFT. Date Recei t#
(5100)rtifyt.) ' WATER HEATER W/VENT/R TR ENERGYFEE Y N
Icenot mplo anypersoni any e ofthe
nnerswork or s t.1mhich hls permit Lt.thu c Q O
I mk not employ any person In any manner sa az to be me b�'ed to the WATER SYSTEM/,TREATING
Workers'Co rt i N9( B(omhi Date_f-ZI�I/125
0 Z Applicant a'AQ f---'N' PAID
2 O NOTTCE TOAPPLICANT:I,oftip/rvkingthi.�Aticateof Exemption,you NEW RESIDENTIAL PLMB._SQ.FT. Date Recei t#
Fshwldbecomesubjec[tothe Warkeca'Compe,wtlon pmvbiomofthe Labor TOTAL:
V9 Code,you rtwat facthwith mm ply with.uch provaimamthlt NrrNt shallbe
W > def"'°d revoked. BUILDING FEE IOD
(L o CONSTRUCTION LENDING AGENCY SEISMIC FEE
= Z I hereby affirm that there is a construdlon lending agency for the perform TOTAL: ELECTRIC FEE
O once of the work for which this permit 6 Lmued(Sec.3097,CIv.C.)
(,) Lender.Name PLUMBING FEE
IL F I.Ondae.Add. QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W lrcditythatItZ madthbappliatlon dgdrtatethattheaboveieformatlon
(1 umrm[.Iagreeto comply all city county ordinances state laws PERMIT FEES PAID:
} N relating to building comtrudion,and hereby authorize representative of this
F Z city to enter upon the above-mentioned property for inspection Purposes. ALTERORADDTOMECH.
— (We)agree to save,indemnify an d keep harmless the City of Cupertino Date Receipt#
against hiflilitles,jadgments,mn.and expenses which may in anywayaccme AIR HANDLING UNIT(I'010,000 CFM) SUBTOTAL:
against sold Cit In con quenre fthe granting Mthla permit.
((f -rL7Uf z// AIR HANDWNG UNIT(OVER 10,000CFM) CONSTRUCTION TAX
signature of ppBc t/Cena r M& EXHAUSP HOOD(W/DUCT) CONSTRUCTION TAX PA ID:
HAZARDOUS MATERIALS DISCLOSURE
Will the appliantorfuture building occupant store or handle hazardous HEATTNCUMT(TO100,000B7V)
nuterialasde0nedbythe Cupertino Municnp.ICode,Chapter9.12,andthe Date Rmei t#
Ileolth and Safety Code Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
.�
❑Yes �No -
Will the applicant or future building occupant use equipment or devices VFNIILATION FAN(SINGLE RFSID) ISS[JANCEbATE
which emm
it haeardous air na.tium dented by the Bay Area Air _e
Qualify Management District?
Yet, NoBOILER-COMP OH POR 100,000 BTI))
❑
4h,mce.dth h do us matenalsrequlrementaunderChapter6.95of BDILER-COMP(OVER lalBTU) DEC U, 1961
00 the California Health&Saloy Code,Sections 25505,25533 and 25534.I
understand that if the building does not currently have a tenant,that It is my NEWRFSIDENTIALI.fECH. S,71
responsibility to notify the occupant Of the requirements which must be met n,. pF rISPa�Ir4�
Priort°Issuanceofa Canifiateof Occupancy. I., It
Owner or authorlmd agent Date
TOTAL: ISSUEDBY.'1 V�
OFFICE COPY