19453�I
P T Tfk CARD NEAR FRONT OF BUILDING
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CITY OF CUPERTINO
INSPECTION DIVISION - JOB INSPECTION RECORD
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J06 ADDRESS CD• zf 6 � �SA_ UNIT#. - LOT #
OWNERCONTRACTOR
PERMIT NO.
1. 9453
A A
; C
CATEGbRY
CONTROLx
BUILDING PERMIT INFO
`INSPECTION 'DATE IINSPECTOR
INSPECTION RECORD
NOTE ALL GRADING AND DRAINAGE
SI IALL BE INSTALLED TO COMPLY WITH
THE APPROVED PLANS AND CITY OF
CUPERTINOSTANDARDS,
-
INSPECTION
mu H
. 0
FOUNDATION/PIERS
UFERGROUND -
30 DESCRIPTION
'
DATE FiNSPtcfbR
PAD/SETBACK-CERT -
GARAGE SLABS/PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
'
ELECTRICAL
MECHANICAL -
-
-
DO NOT POUR 'FLOOR UNTIL ABOVE HAS BEEN SIGNED
-
WOOD FLOOR
PLUMBING f
"
'
MECHANICAL
ELECTRICAL Lldf
FRAMING VENTS CLEAR
-
INSULATIONAli,
(' !
13
'
PLACE NO SIIBFLOOR UNTIL ABOVE HASBEEN SIGNED
-
ROUGH
PLUMBING
- -
"VI
-
TUI3S & SHOWER PAN
MECHANICAL
I
ELECTRICAL/JACUZZI BOND
FRAMING/STAIRS,
INSULATION/ VENTILATION
EMERG. EGRESS
-
SEWER WATER
COVER NO'.WORK UNTIUABOVE HAS BEEN�SIGNED'ii�"`
EXTERIOR SHEAR HOLD DOWN
-
INTERIORSHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREEN
SHOWER LATH
SCRATCH COAT
WO,TA'PE:ORtPLASTERIHNTIL ABOVE HAS'BEEMSIGNED
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 APPROVALS
ELECTRIC
GAS
BUILDING ISSUANCE DATE ,
OCCUPANCY OF BUILDING 1S NOT PERMITTED UNTIL n
BUILDING FINAL IS SIGNED BY BUI MING INSPECTOR 9,S �,�•�, t
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. '}Ir 3Tf Pnn�IJst
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION I ISSUED BY.
OFFICE COPY v
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APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE SALL POINT PEN ONLY
Bulldlne Proird Idc`uficalap;�.
' Bu0ding Rddreau y . -
ID`j-6Z SC.eNIC �I✓ Ccn lr N
PERMIT NO.
19 4 5 3
Dere �a5ces: T L / Phare:
YT F—t e� S7F^II Ft 4,4.6 3?04
CITY OF CUPERTINO6BUILDING DIVISION
APPLICATION / PERMIT
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Contractors Name: Lle. No:
'
BUILDING-ELECTRICAI.PLUMBINGMECHANICAL
CATEGORY
'
rONTROL#
' Architect/Englneer. Lie N.
QTY ELECTRFCPERMIT FEE
BUILDtIsNrGPERMITINFO-
Addrcs.:
PERMIT ISSUANCE
❑ ❑
LICENSED CONTR RATION
under provisions
I heh SrctI i70 Hutlam.iaM3 licensed ftheBupmmand?r(ChapleCodeamrnc-
ingwil 1. In full farm fDivikon 3ofthe Buslnaseand Proles.loneCade,and my
license le In (u0 force and affect.
License Claes n
Date Coontrtractor
APPLIANCES -RESIDENTIAL
J08 DESCRR'ITON
PANELS
201-1000 AMTS
ARCHITECTS DECLARATION
I understand my plansshall be used u public records.
OVER 1000 AMPS
SQ, OOR EA
$/SQ. FF.
SIGNS ELECTRICAL
Licensed PmfmJoml
SPWIALCIRCUIT/MLSC
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
'[EMP. MEHRORPOLEINSF.
following mason.t5ect10n 70415, Business and Pro(eslons Code: Any city or
cmntywhich mqulms a permit to mmtmd, altep Impmve, demolbh,orrepair
anystruRure pdorto its bmmer,also requirmtheapplicant fee such permit to
file a signed statement that he is licensed pursuant to the provfkons of the
POWER DEVICES
SWIMMING POOL ELECTIiiC
OUTLETS—SWITCHES-FIXTURES
Cmrnteor'e License Law(Chapmr 9(com ucacing with Section 7000) of Divi-
sion 3ofthe Buknessand Pmfeasioru Code)orthat he la exempt therefromand
the basis for the alleged exemption. Any violation of Section 7031.5 by any snore
applicant fora peradt subjects the applicant to a civil penalty of not re than
VALUATIODL
�D%\ Or-��
VV
NEW RESIDENTIAL ELECTR SQ.FT.
flue 1, as o nerdolof he pr .
ro 1pe as owner of the property, or he employees with wages thele sale
l do he workand d for
UR ES
TYPE CONSTRUCTION
tSm 7 K B..ine ssima ode: heIs et Contractor or License
vie (Sec, 7046, Buelnsm and Profeseloru Code: The Contractors Llceve Law
Law
does not apply to an owner of property who builds or Improves thereon, and
who doessuch workhlmeell orthrough hisown emplayees, provided thats ch
OCC.GROUP -
RIS. UNITS
Improvements are not intended oroftemd for sale. If, however, thebullding or
Improvement issold wllhinoneyearofcomplelloMtheowner-builderwlll have
TOTAL:
t Iden of proving that he did not Wild or Improve for purpose ofuleJ.
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7040 Business and Professions Code:
QTY, PLUMBING PERMIT FEE'
-
- PERMIT ISSUANCE
E.00DZONE
APN
The Contractor. License Law does net apply to an owner of property who
or Improves thereon, and who contracts for such ptojecas with a
cgp((actor(s) licensed pursuant to the Contractor's License Law.
LI I am exempt under Sec. 0 & P C for this reason
ALTER -DRAIN k VENT -WATER (EA)Wilds
BAIX FLOW PROTECT. DEVICE
FEE SUMMARY
OUTSIDE FEES—
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y N
RECE rT M
WORIOAANOwner Date
C PENSATIONDECLARATI N
Of hereby affirm that I have a certificate of consent to self -Insure, ora
ccAifiateofWorkers'Comper tlonlruuranceoracertified copythereof(Sec.
3800, Lab C.)
Policy p
FUTURES. PER TRAP
SCHOOL TAX Y N
RECEIVE p
CAS LA.SYS�FAI- AO`171Lr1'St F
q�g`K
"
Y_ N_
RECENT p
GAS G. SYSTCM- VE24 (EA) c —, „O
Com any
N UILDING DIVISION FEES
Certified mpy 6 hereby furnished.
F1 Certified copy is filed with the city impecilan division.
GREASE/INDU WASTE WTERCE'TOH i� u "PF
- w
CHECK FEE
GREASE TRAP
CERTIRCATEOFIXEMPFION FROM WORKERS'
COMPENSATION INSURANCE
(Thisam ion need not becompleted lithe permit Isforone hundred dollars
22 ate Remi [#
SEWE&SAM AAV -STORM EA.
WATER HFATERW/VENT/ELECTR
ENERGY FEE Y N
(f100)or less.)
rtifythatit Is Issued,
IUnwemplo tanyhe
mbiedtothe
pemninaofthewoerwo tichtml
I shall not employ any person in any manner so se to become mb)ect to the
Workers'Compsnsation Laws of CaliforniaATER
llfornla. Date
SYSTEM/TREATING
PAID
Applicant
NOTICETO APPLICANT: If, after making this Certificate of Esemptwa, you
should become subject to the Workers' Compensation provis one of the Labor
Date Recei t#
NEW RESIDENTIAL PENIS. SQ.FF.
TOTAL:
Code, you most forthwith comply with such provisions orthis permit shall be
deemed revoked.
IN G ME
SEISMIC FEE
CONSTRUCEION LENDING AGENCY
Ihereby affirmthat there is a construction lending agency forthe perform -TOTAL:
ance of the work for which this permit Is Issued (Sec. 3097, Civ. C.)
ELECTRIC FEE
Lender. Name
Lender'. Address
I mAifythat I have mad thlsepplicatumand kamthm theabove information
Ismrreci. I agree to complywlth all etyand county ordinances and state laws
relating to building construction, and hereby authocus representatives ofthis
-
QTY. MECHANICAL PERMIT' " FEE
PLUMBING FEE
MECHANICAL FEE
PIRMITISSUANCE
-
FEES PAID'
rhzl!' 5339
city to enter upon the abevcmantioned property for inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
against liabilities, jrdgmens, mks and expenses which may In any wayamme
aga Wt said City in consequence of the granting of this permit.
ALTERORADDTOMECH.
AIR HANDLING UNIT (To io,000CFM)
r
Date Receipt#
SUBTOTAL:
AIR ILANDLING UNIT(OVER 10,000 CFM)
CONSTRUCTION TAX
Signature of Applicant/Contractor Data
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT 00 I DBODO BTU)
-
Will the applicant or future building occupant store or handle hirardous
material as defined by the Cu petino MunicipaI Code, Chapter 9.12, and the
Ilea llhandSafety C "Section 25532(a)I
❑ Yrs No
Dale RCCeI t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VENTILATION FAN (SINGLE RFSID)
ISSUANCE DATE a
` (V .&)
G.� aLLI
Will the applicant Ature building occupant use equipment or devices
which emit havrdous air mntaodnentsns defined by the Bay Area Air
Quality Management Dlsl ci7
yen No
BOILER-COMP(3HPOR 100,000 BTU)
4 have read the hexa ous materials requirements underCh. pier 6.95 of
BOILER -COMP (OVER 100,000 BTU)
n
P„�D
the California Health h Safety Code, Sections 25505, 25533 and 25534. I
NEW RESIDENTIAL MECH. SQ.FF.
understand that if the Wilding does not currently have a tenant, that it is my
responsibility to ratify the ompant o(Ihe iequlrements which most W met
ic s
prior It Issuance of a Ccrtifof Ocmpanry.
I Z
ISSUEDB y B sell B
Own authorI to
TOTAL:
OFFICE COPY �e