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19556 1� POST THIS CARD NEAR FRONT OF BUILDING �' 1,9556��C 1. r CITY OF CUPERTINO A A . v INSPECTION DIVISION- JOB INSPECTION RECORD JOB ADDRESS /DTC,O /I/' / d^ 27r UNIT# LOT# CATEGORY CONTROL x OWNER �G CONTRACTOR74 BUILDING PERMIT INFO INSPECTION INSPECTION RECORD OUNDATION PIERS - DATE INSPECTOR NOTE ALL GRADING AND DRAINAGE UFERGROUND SHALL BE INSTALLED TO COMPLY WITH. JOB DESCWI'I10N PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF - CUPERTINOSfANDARDS. GARAGE SLABS PREGUNITE - - �j C !. 7 .\- I o I 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 SIGNED ROUGH FINALED PLUMBING cOMP TF TUBS&SHOWER PAN rE MECHANICAL g 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/SHEETROCKSHEAR EXTERIOR LATH/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 IINSPECTOR SAN.# ELECT.ENERGY PLUMBING ENERGY _ MECH.ENERGY BUILDING ENERGY ELECT.FINAL TEST PLUMBING - - GAS TEST MECHANICAL - - HEATING ELECTRICAL RELEASE FIRE DEPT. GRADE _ OCCUPANCY TE•MPORARYAPPROVALS ELECTRIC. GAS BUILDING ISSUANCE DATE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR ARRANGE FOR INSPECTION BY PHONING 252.4505 BETWEEN + �j 6.1 12:30 PM AND 4:30 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 ISSUEDBY. OFFICE COPY '� APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY go Idins Pm'ed Identification a-QQ'' lJ,,LL ,�{/// PERMIT 19556 'uildlryAd�rese: �� PWY"Y'r"4 Dk A 44o C'i�P�,eT�o eA net a � . Phone: p p ,eN CITY OF CUPERTINO-BUILDING DIVISION cD Cantactore Lk.No: APPLICATION /PERMIT 7 h BUILDINGELECTRICALPLUMBING-MMIIAMCAL CATEGORY CONTROL ly�jb Architect/ neer. Lk.Na O W BUILDING PERMIT INFO QTY ELECTRICPERMIT FEE Add-t4 O BOX/ PERMIT ISSUANCE ® ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affiron that l am Beemed under provisions o(Chapter9(cemmeme APPLIANCES-RESIDENTIAL JOB DESCRIPTION Ing with Section 7000)of Division 3 ofthe Buanessand ProfesalonsCode,and my Iianse le In full force and effect PONOS 0 � Lkemc Coss effect. Date Contactor I/ v' ARCHITECTS DECLARATION 201-1000 AMPS �pu acZp I understand my plam.hall be used as public records. OVER 1000 AMIaS SQ.FT.FLOOR AREA S/SQ.FT. Licensed Prdemlonal SIGNS ELECTRICAL ! OWNER-BUILDER DECLARATIO fn] N SPECIAL CIRCUIT/MIST 'hereby alOrm Wham exempt from the Contractor's License Law for the O 2 pOi. following reavan.(Section 70315,Business and Professions Code:Any city or TEMP.METER OR POLE INST. Fu) cauntywhkA require its s ismanc,alaorquirestheapmve,dennWh,ormit to H6 anystrocture prbrm ltat uance,aborequlresthe applicant/onuch permit to POWER DEVICES H U file a signed statement that he Is licensed pursuant to the provisions o! the $u, Contractor'.Liceiue Lew(Chg apwr9(wmmmcl. wtth SoBm,7000)of Dlvl- O a1 �' SWIMMING POOL ELECTRIC V O� Mon3of the Businevsand Pro(emm V loCode)orthat he er<mpttherefmVALUATION mand I O the bash for the alleged exemption. Any violation of Section 7031.5 by any. OUTLETSSWIICHESFIXTURES / V rq D O app0ant for a permit the applicant to a civil penalty of not mmethan / V five hundred dollars($500). NEWRESIDENTIALELEC STORIV TYPECONSTRUCTION ❑I,as owner of the property,or my employees with wages as their sole C 6 compensation,will do the work and the structure is not intended or offered for 5 O sale(Sec.7014,Busine.s and Prefesslon,Code:The Contractors License Lw Iii r3$ does not apply toan owneruf propertywho builds orlmproves thereon and Igo OCC.GROUP RES.UNITSEE.. whodoe w6workhtm lfV Waugh Msownempla)ees,provldedthat such Improvement.are not Intended oroffered lorsale.If,however,thebullding or TOTAL: Improvementbsoldwithln oneyearofcompletlon,theowner-bulWerwill heve t e4srden of proving that he did not build or Improve for purpose olsakJ. QTY, PLUMBI FEE II L as owner of the property,am exclusively contracting with licensed FLOOD ZONE APN PERMIT ISSUANCE contractor.to construct the project 7014,Business and Professions Code: coe The Contmctars License Law does nor apply to an owner of property who ALTER-DRAIN 4 VENTWATER(JEW or Improves thereon,and who contracts for such p(ojecb - -with a FEE SUMMARY Cgg1(actor(s)licensed pursuant to the Contractors License Law. BACK FLOW PRO I_l l am exempt under Sec. - B&P C for this reason 1 01 ITS I OF FITS DRAINS FLODR,R F,A S A Y Y_ N_ Owner Dae RFGE9'TN WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAI i TAX Y_ N_ QI hereby affirm that I have•arti(late of consent to vel(-insure,or• RECOI'T Y 3600,labb ceal(IaCJ S of Workers Compenutlonlraurance an artllled cepythereof lSec, GAEA.SYSTEM-1 INCAOUTLEPA TS RK FEE Y N Policy J TM Cam S any GAEA. � OVER —BUILDING DING DIVISION FEES ffCertBled copy is hereby furnished. CREABE/INDUSTRL WASTE INTFRCO'TOR PLANCHECK FEE 2-c;OCehiied copy is filed with the city Inspection divlMon. L 7 CERTIFICATE OF EXITIPTION FROM WORKERS' CREASETRAP PAID COMPENSATION INSURANCE SOWER-SANITARY-STORM EA 200FT Date Recei tR ('Ihbvneed not be completed If the permit VGators hundred dollars ($I I0)orloses.)ess.) WATER FffATERW/VENT/ELECTR ENERGY FEE Y N ]stilly that In theperformancei aof thaworkfo as to b co permit Ito the label]not employ any person In any mannerso as to become subject to the WATER SYSTEM/TREATING Workeae'Compensation Laws o(GIIlomla. Date PAID Z Z Applicant NEW RESIDENTIAL PLMB. SOFT. Date RCCCI tic Z 0 NOTICETO APPLICANT:If,after making this Certificate of E.emptlan,you should become subject to the Workers'Compematlon proisloru of the Labor TOTAL: N Code,you must forthwith comply with such provisions or this permit shall be BUILDING (� Wj deemed revoked. a CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby afRrmthat there is.conetructlon lending agency for the perform- ELECTRIC FEE M Z ance ofthe workforwhkh this permit b baced(Sec.3097,Civ.C.) TOTAL: 0 O Landers Name PLUMBING FEE IL F Le dceaAddmse QTY. MECHANICAL PER JrEMECHANICAL FEE OO I Certlfythat l have read this appliatlonand statethat theabove Information W Lscorrect.Iagree to complywlth all city and county ordinances and Mate laws PERMIT ISSUANCE FEES PAID: relatingtobuildingarutrunion,andhembyauthorizemprcsentativaofthts N city to enter upon the above-mentioned property for inspection purposes. ALTER OR ADD 7O MECH.(We)agree to save,Indemnify an d keep harmEess the City of Cupertino Date ReceiptMAIR HANDLING UNIT GO 10,000 CFM) SUBTOTAL' against said City In consequence of the granting of this permit. AIR HANDLE NG UNIT(OVER 10,"C)M) CONSTRUCTION TAX Signature of Applicant/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will theapplicanl or future building occupant stare or handle hazardous HEAITNG UNIT(TO 100,ODO BTU) Date RDeei tq material as defined by the Cupertino Municipal Code,Chapter 9.1Z,and the I kalth and Safety Cade Section 25532(a)2 HEATING UNIT(OVER 100,DDO BTI) TOTAL' ❑ Yes. N Na Will the applicant or future Wilding occupant use equipment or devices V EMDLATION FAN(SINGLE RESID) ISSUANCE DATE which endt hazardous air centa hens..av deRned by the Bay Area Air Quality Management District? BOILER-COMP(3FR'OR 100,000 BTU) ❑Yes ❑No Q Ihave read the haaarclous materials requlremems under Chapter 6.95 of HOMER-COMP(OVER 100,000 BTU) the California Health&Safety Code,Sections 25509,25533and 75534.1 g l understand that if the building does not currently have a tenant,that it b my NEWRESIDEFITIALMECH. SQ.FT. roponslblity to eddy the occupant of the requirements which must be met pMorte' uanceola Ceni6cateofOc panty. o Q� cl�92 Owner or authwtud agent T TOTAL: ISSUEDBY: OFFICE COPY