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19454 •r POST THIS CARD NEAR FRONT OF BUILDING PERMIT No. 19454 CITY OF CUPERTINO A INSPECT�I/ON DIVIISIONp- JOB INSPECTION RECORD • )OB ADDRESS �N �/--E�(M UNIT]#// /LOOT'# CA CONTROL a OWNER_ L CONTRACTOR �7�S �LPa/� BUILDING PERMIT INFO INSPECTION ECORD OUNDATION/PIERS hl,�l M1111 INSPECTION VDATE INSPECTOR NOTE ALL GRADING ARND DRAINAGE PLUP�16 � UFERGROUND SPIAL BE INSTALLED TO COMPLY WITH JOB DESCRIPTION PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF GARAGE SLABS PREGUNITE curERnno STANDARDS. 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 -/C.elaz / S FRAMING/VENTS/CLEAR INSULATION PLACE NO SIIBFLOOR UNTIL ABOVE HAS BEEN 1 ROUGH PLUMBING TUBS&SHOWER PAN MECHANICAL ELECTRICAL ACUZZI 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 LATI-I/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 INSPECTOR SAN.# ELECT.ENERGY PLUMBING ENERGY MECH.ENERGY 13UILDING ENERGY ELECT.FINAL TEST PLUMBING — GAS TEST MECHANICAL HEATING ELECTRICAL RELEASE FIRE DEPT. GRADE OCCUPANCY TEMPORARY APPROVAIS ELECTRIC GAS "�I BUILDING OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL r� ,, ISSUANCE DATE BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN Clly of('Ui?F 1fIBm 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS BEFORE REQUIRED INSPECTION. JOB ADDRESS AND y PERMIT# ARE NEEDED WHEN PHONING. tJ IMPORTANT! r PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEDBY.. `� 1w OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BuI1Cmg Add re�..ildin Pro'ea Identification PERMIT NO. ere ti 19454 rs aare: Phone: A A A ALS�o HyV 35i i CITY OF CUPERTINO-BUILDINGDIVISION • Coetactar'sName: v Lic.No: APPLICATION I PERMIT S I V fhhI BUILDING-ELECTRICAL-PLUMBING-MECHANICAL CATEGORY CONTROL M Architect/Engineer. Lie.N. QTY ELECTRIC PERMIT FEE BUILDING PERMIT IN O Address PERMITISSDANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION Iherebyaffbmthatlam Bcensed under provisions of Chapter 9(mmmenc APPLIANCES RESIDENTIAL •JOB DESCRIPTION ingwlth Section 7000)o(Divislon3 ofthe0uslnessand PrefesslonsCede,and my licenseis In full farm and c" ,�-_ ' PANELS Pe'oIn&�� License Clan f n Co tr s j41.s Data Ja'181 A0. Contractor iflury, UP TO 2W ANTS ARCHITECTS DECLARATION 201-1000AMPS q�v `GG I understand my plans shall be used a public records OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ,FT. ja E Licensed Pmfealoml SIGNSELECTRICAL <� OWNER-BUILDER DECLARATION SPECWLCIRCUIT/MISC t.., I hereby affirenthatI am exempt from the Contractors License Law for the ZOF'� following reason.(Section 7¢)15,Business and Professions Code:Anytlty or pME1T'It ORPOLE)NST. K m countywhlchrequbesapermlttommt d alter,impmve,dem ]B h,orrepalr anystmcture pdarto Rs Wuame,aL requimtheapphcantforsuchpermitto tG file a signed statement that he 0 licensed pursuant to the provbba of the POWER DEVICES Contractor's License Law(Chapter 9(commencing with Section 70M)ofDivi- Pill SWPIMNGPOOLELECTRC O sion3ofthe Businemand Professloa Code)orthathelaemmptthemfmmand VALUATION I y.'S ppli..tf.ra the basis for the alleged exemption. Any violation of Section 7lal5 by any <5 apermitsubjects the applkant tons civil penalty of nam urethan OUILETSSWHCHESFIXIURES _!7/ a^a five hundredsowner its, pro NEW RESIDENTIAL ELECIR SQ,FT. -. ❑1,as owner of the property,ormyemployees with wage as thele sole STOWES TYPE CONSTRUCTION X70 compensation ilq Bilines work,Profte lum Code: rche is Con endedachoe orofferedLaw ' 9a�D sale(Sec.7644,Business and Professlans Code:The Contnctota License Law idsS does not apply to an owner of property who builds or improves thereon,and OC GGROUP RFS.UNI'18 who doessuch work blenself orthrough his own employees,provided that such Impmvements are not intended proffered fore e.If,however,thebuilding or TOTAL: Improvement issold withinoneyearofcompletion,the owner-builderwBl have t relenofproving that he did not build or improve for purpose ofsale.). QTY, PLUMBING PERMIT FEE FLOODwNE APN Lj L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to construct the project(Sec.7044,Business and Professions Code: 1. The Contractors License Law does not apply to an owner of property who ALTER-DRAIN kVENT-WATER builds or Impmva thereon, and who contracts fee such pfojeab with a (EN cgD1(ader(.)licensed pursuant w the Contractor'.License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec. B k P C for this mason OUTSIDE Owner DRAINS FLOOR ROOF,AREA,CONT, SANITARY Y_ N_ • Date RFCEI'T R WORKMAN COMPENSATION DECLARATION FDOURFS PER TRAP 5QiOOLTAX Y N 1 hereby affirm that I have o mrti0cate of consent d sey the r of(Sa RECEIPT X mfkateof Workeae'Comperaatlonlaurance cars<ertifkd copy thereof(Sec. GAS EA SYSTEM-1 INCA OUTLETS PolicyMW, ab CJ PARK FEE Y N Policy p OY' r��•—�i`j — RECEIPT M Co�any -IY Fan Wm GAS-EA.SYSTEM-0VER4(EA) BUILDING DIVISION FEES certified copy 6 hercbyth the ed.city GREASE/INDUSTRL WASTE INTERCEPTOR PLANC14ECK FEE 119 Certified copy is(fled with the city inspection division. Y' CERTIFICATE OF EXEMFFION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE (Thissection need not becompleted tithe permit la foronehundred dollars SEWER-SANITABY-'STORM EA.ppFT. Date RCCCI til ($100)otifythTo WATER HEATER W/VENT/ELECTR ENERGYFEE Y N I ll not that employ any person i any work foras tube mmh this esubjrmit is Ltsued, _ I shall not employ any person in any manner so u to become subject to the Workeai Compensation laws of California.Date WATCR SYSTEM/TREATING 00 PAID 0 Z Applicant Z O NOTICETOAPPLICANT:If after nuking thla Certl(Icate o(Exemption,you NEW RESIDENTIAL PLMB. SQb7, Date Rel%iI t# F N Ch cyou=stfbjcctto the Workers'compensation provisions of the Labor TOTAL: Code you must forthwith comply with such provisioex orthis permit shall he LU > doemed evoked. BUILDING FEE CL F3 CONSTRUCTION LENDING AGENCY SEISMIC FEE = Z Hicerbyaffirenthattlum bamatnecurs,lending agency for the perform TOTAL: / ELECTRIC FEE ance of the work for which this permit b Issued(Sec.3097,Civ.C.) (� O I�neer'.Name PLUMBING FEE / 0 LU Lndar§Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O JmrtlythatlhavemacithlsappBcannnand rtatethattheabove ln(ormatlon 1 eco,rc .I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES AID. } relating to building construction,and hereby authorize representatives ofthls J .a Z city to enter upon the above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. �l7 — (We)agree to save,indemnify and keep harmless the City of Cupertino ate Receiptlt against liabilities,judgments,crehand expenses which may in anywayaccmue AIR HANDLING UNIT(To lo,WOCFM) agslatsid Cityinconsequen f the granting of this permit. SUBTOTAL: p��///M�„ �� .�1,� AIRHANDLWG UNIT(OVER 10,000CFM) CONSTRUCTION TAX sl a (Applicant/'Contractor ^-" Date ' EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant orfuture building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) mmerlal as defined by the Cupertino Municipal Code,Chaptcr9.1Z and the _ Date RCCCI t# Health and Safety Code Section 25532(a)? HEATING UNIT(OVER 10,000 BTU) ❑ Yea []Na 'a- ..TOTAL: Will thexpplicant orfuturc building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit ha ardour air contamiante as defined by the Bay Area Air Quality Management District? BOILER-COMP OTI'OR 100,000 BTU) ' Yes ❑❑No have read the haza usmateriab requirements under Chapter 095 of BOILER-COMP(OVER 100,000 BTU) the Callferrua Health k Safety Code,Sections 25505,25533 and 25534. 1 ,,{ understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECL SQ.FT. City of ('tIDPIfIRo repo ibil'yto naify the occupant of the requircmenb which most be met P, ior nccofaCertIf" of Occupancy. ��,,� - tea Ownerw authonud agent pate TOTAL, ISSUED BY: OFFICE COPY