19528 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NO.
. . . '. , : � ; ." . - 19528°
CITY OF CLJPERTINO A
m.,
INSPECTION
/DIVISION JOB INSPECTION RECORD.
�3 JOB ADDRESS _4 � UNI # - LOT # CONTROL
cAreco v. . . CONTROL x -
- OWNER - CONTRACTOR +,z�I:.IBUILDING,4 , , IT�WFO
:INSPECTION. . ".J'� ! :; .DATE I INSPECTOR INSPECTION RECORDNDD
FOUNDATION/PIERS. ' BIINOTE:
LBL ALL iRAbIN6 A;AI.LED TO COMPLYAN7TH JOB DESCRIPTION
-Ur GROUND - r' IIIE APPROVED PLANS AND CITY OF '
PAD/SETBACK-CERT s i CUPERTINO STANDARDS. -
GARAGE SLABS PREGUNITE
,POUR,NO,CONCRETE'UNTILABOVE HAS BEEN SIGNED`.
UNDERGROUND/SLAB 'INSPECTION DATE .INSPECTOR
'PLUMBING , _
' ELECTRICAL . '
MECHANICAL. '
ADO NOT,POLIR.'FLOOR.UNTIL'ABOVE'HAS'BEEN SIGNED ••
WOOD FLOOR -
PLUMBING . .-
- MECHANICAL w.• - A I "
. ELECTRICAL i -
FRAMING VENTS CLEAR'- i:!
r INSULATION +, - - .
''PL'ACE NO,SUBFLOORWNTILL"ABOVE HAS,BEEWSIGNED
ROUGH= - - -
-PLUMBING
TUBS&SHOWERPAN `01- - Y`
MECHANICAL r - -
ELECTRICAL JACUZZI 13ONDII ' - •�
FRAMING STAIRS
INSULATION/VENTILATION
V
-
EMERG.EGRESS S � '_{
SEWER WATER ABOVE:U .
'WORK:UNTIL HAS BEEN SIGNED ' !.
y.3 H
EXTERIOR SHEAR OLD DOWN
'tiiisr� INTERIOR SHEAR/HOLD DOWN -
SHEETROCK/SHEETROCKSHEAR - -
EXTERIORLATI-I/W-SCREEN'" - -
SHOWER LATH
SCRATCH COAT - +1.
' ANO.TAPE OR'PLASTER UNTIL ABOVE'.HAS BEEN SIGNED - -
NOTE:NO FINAL INSPECTION SHALL,BE MADE BEFORE 7 ,k n
THE CONSTRUCTION TAX IS PAID' -
FINALS - + - 'I DATE INSPECTOR - -
SAN.#
ELECT.ENERGYPLUMBING ENERGY "
'MECH.ENERGY '. 1
BUILDING ENERGY -
ELECT.-FINAL'TEST It '
PLUMBINGGAS TEST �I -
MECHANICAL'
HEATING
ELECTRICAL RELEASE -
FIRE DEPT_ .
GRADE -
OCCUPANCY'
TEMPORARY APPROVALS`Ill
ELECTRIC'
GAS:. . - .43
BUILDING ! "" - - ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL -
fi BUILD/NG FINAL IS SIGNED BY BUILDING.INSPECTOR •j Io =
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
IMPORTANTI
t` + tiF�.H.I�
PLEASE READ.REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION; �nBY 1.J1 C 1 ' +4
OFFICE COPY
„,, ...
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY7p
building PrWed Identification PliT NO.
'Bul'am Address: '•' a� n f1(�
.'S' CI9G)U G�/G. T�vsY.�i�D a,n!� R• . _ I VM G t,8
Phone: A, q
�', .7rr rill pikz;FeCITY OF'CUPERTINO-BUILDING DIVISION
Contractor's his. Lic.No!
f.� APPLICATION l PERMIT
'
-�t-CC Z O 07 ' BUILDING-ELECTRICALPLUMBING-MrCHAMCAL CATEGORY CONTROLX
AmhltM/Engineer. Lk.No: '
.• -') '1 i.. BUILDINGPERMIT,INFOI .
- - - QTr b. �a ',ELE-CTRIC PERMIT .1! FEE rr" „
Add.: PLUMB hll�lfi
PFRMITISSUANCE - ❑. . ❑ ❑
" LICENSED CONTRACT'OR'S DECLARATION A
I heh Swill 70 thatf iv BceneM under ineis on sof Cssions9de,and c MPUANCFSRESIDENTUL 708 DESCRII'I'ION
'iicares Senlon7000)of i efilaon3o(1he Buefnesaand Professions Code,and my "\,
Blease Is In full fosse and erre#[. PANELS
License Cbmee-//7 LieX 2 06e/!
Date-/_ZF�p_ContraR UP TO 200 AMPS
r ARCH s public
re rd OVER I AMPS
ceO Zp (understand my glare eha used as publlcrecords. OVERIWOAMIsS. SQ.FT.ILl70A AREA $/SQ.FT.
.td Licensed Professional r SIGNS ELECTRICAL '
6 OWNER-BUILDER DECLARATION
Hn Un SPECIAL CIRCUIT/MIS -
ZoH � herebyaffimthatlamexemptfromtheC.M.d.e.Licenserawforthe ;
OZ rs following reason.(Sed[on 7(13 1,5,Business and Professions Code:Any city or gyp,g� OR POLE INSf. .
county which requires a permit to construct,alter,improve,demolish,orpair '
ggqmm .a anystructure paorta Its bsuance,abo requires lheappBcent forsuch permit Ie
ppWpg DEVICES
r4 file a signed statement that he Is licensed pursuant to the provisions of the -
3u, Cord.cfirb Liceme law(Chapten9(cemnrncingwith Section 700())of Divi.
,��OS slon3aflhe Business end Pro(essiov Code)orthat helsexempttherefromand SWIMMING POOL ELECTRIC r VALUATION
Gp51 ¢ the hasb for the alleged exemption. Any violation of Senior,7031.5 by any OUTLE7SSWITCHE&FIXTURFS S ��
applicant fora permit subjects the applicant to a civil penalty of not more than
w five hundred doll..($500).
❑I,as owner of the property, NEW RESIDENTIAL ELECTR SQ.FT, STORIES- TYPECONSTRUCTION
p pray,or my employees with wages r thele dale
mmpeneat0K Business
work and thesimnurc b not Intended or offered for _
�a O due nor apply Bu sin e,andf property who
Wild.or impers.ntractor's Llcerse Law
3$ docs noes suchpply tarn owner ofpropertyhis onemoymprwvided ron,and _ OCC.GROUP RES.UND'S,
whodoem nts amendwork Inter, edoorthroffemd ow le.If employees,provided that such
• Improvement issold ithmoneyearoeremplatile.th howeve milder Bdl have TOTAL.
Improvement esold withlnoneynarofcomplctlorythe owner-budderwlll have - -
tt�n unien of proving that he did nut build or Improve(or purpose of sale.). QTY, _PLUMBING PERMIT „��•, "FEE FLOOD ZONE- APN
U L ai owner of the property,am exclusively contracting with licensed
contractors totheproject(Sec.7014,Business and Professions Code: PFRMRISSUANCE
destruct
'The Contractors License Law does nor apply to an owner of property who ALM-DRAW&VENT-WATER(EN
Wilds or Improves thereon, and who contracts for such Isp)ects with a .. .
cLJI
gIlf dor(s)licensed punuant to the Contractor's License Law., - n. 'JEE SUMMARY ,
am exempt under Sec. B k PC for this Lesson BACK FLOW PROT[CT.DEVICE
` OUTSIDI FEES
Owner - Date DRAINS FLOOR ROOF,AREA,CONT. SANITARY N
RECEIPT
WORKMAN COMPENSATION DEC W RATION
" MTURE4 PER TRAP SCHOOLTAX Y N
UrY, ❑I hereby affirm that 1 have a certificate of consent to ae8-Insure,ora RECD,h
certificate ofWorks lnisura4na ora certRledcopythereof(Sec. '. GAS EA.SYSTEM-i INC OUTLETS PARR FEE Y N
3800,Tab C.) Z1d U.-)f ��',
Policy If - -- RECEIPT X
CAS FA.SYSTEM-OVFR 4(FA)
Com anY '� BUILDING DIVISION FEES
reified copy b hereby furnished, CREASE/INDUSTRL WASTE IbMCFPTOR PLANCHECK FEE
Certified copy b filed with the city lvpectlon division.
•CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE TAM r PAID
COMPENSATION INSURANCE SEWER SANITARY STOIIM EA 2pOFT Date L RCC21 t#
Rhlssectlonnecdna Mcomplat ifthepermitbforomhundmddollars P
($1I0)certifying
^ '
orI .
I in the performance of the work for which su
hthle permit is issued, WATER HEATER W/VENT/ELECTR ENERGY FEE Y N'—
I shall not employ any persom In any manner eo v to become subject to the - WATERSYSTQa/TREATING
Workere Compensation Laws of California. Date - PAID '
ra -
'Z Z
Applicant
NOOAPPLICANT.It,atter makingthis Certlfkate of Exemption,you NEW RFSIDENTUL PLMB. SQ,FT, Date Recei t#
Fshould become subject to the Workers'Compersatlon provisions orthe Labor - TOTAL:
W Code,you mu at forthwith comply withsuch provisions orthls pemdtshall be
W > deemed rovoked. B 1 DING FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE
'd Iherebyaffirenthat there iso conetmnlon lending agency for the perform ELECTRICFEE
M Z anceoftheworkforwhichthbperretlslasued(Sre.3097,Clv.C.) TOTAL: a
U O ae.aName PLUMBING FEE
-a I- I.erWer'a Address ' QTY: : ',' M_ ECHANICAL PERMIT 'FEE MECIiANICAL FBG
O 111
Icenl(y that l have read this application and statethat theabove information -
f11 IBcormn.Iagnee to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
relat Ing to build Ing construction,a cad hereby amhodae representatives of this - -
F.'Z city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH.
_ (We)agree to save,indemnify a d keep harmless the City of Cupertino Date Receipt#
against liabilities,judgments,costs and expenses which may In anywayaceruu AIR HANDLING UNIT(TO iQ uld) SUBTOTAL: -
agalmtsaidCityincoosequenceof the granting of this permit.
- AIR HANDLING IEVIT(OVER 10,W0 CFM) CONSTRUCTION TAX
Signature of Applicant/Contractor Data EXHAUST HOOD(NI DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the a ppBo nt or future building occupant store or hand In hazardous' HEATING UNIT(TO 100,00 BTU) .:Date - RCCCi f#
material as defined by the Cupertino Mu olnpal Code,Chapter 9.12,and the
health and S(ety Code Sedh,n 25S32(a)7 HEATING UNIT(OVER IN,"BTU) TOTAL:
RYes ,I+�-,y�r,�6
illthe epphcSnt orfuture building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) , ISSUANCE DA -•
Tr J,ti which emit ha>ardous air contaminants.,defined by the Bay Arca Air pp +
Quality Management District? BOILER-GDMP(3tIPDR l00,0008TU) JAN 18 199(0
q Y s 0q /f '/�1
have read thehaza us materials requirements under Chapter 6.95 of BORMR qN
ER-COMP 100,000 BTU)' .��j.
Thee California Health A Safety Code,Sections 75505,25533 and 2SS34.I , 0 4s.of�
;Ly'•,L... understand that if the building does not currently have a tenant,that It is my NEW RES]DENTIAL MECH. SQ.FT. 1 tlDQl'�Im�
r resporeihility to nullify the oceuptcat of theosuimerents which must be met Clly
rto nco ofa Csrtl(icate ofOmFancy.
Owns rauthorived agent One ISSUE.DBy_\\�
TOTAL: V�-
OFFICE COPY