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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