13358 POST THIS CARD NEAR FRONT OF BUILDING '
r _ PFRVIT NUMBER
.,CITT. OF CUPERTINO: 13358 .
INSPECTION DIVISION
" + JOB;INSPECTION•RECORD
PERMIT EXPIRATION
JOBADDRESS 20948 .Alves - P1�l %C1': UNIT# - _LOT#
PERMIT EXPIRES'IF WORN
OWNER MARK & ,VICTORIA EVA$UN.Koq IS NOT STARTED'WITHIN
- INSPECTION - DATE INSPECTOR INSPECTION RECORD - 180DAYS OFPERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
- "
LASTCALLED INSPECTION.
UFER
PR EGUNITE
PERMIT VALIDATION
-
OUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ' '
PLUMBING.
' ELECTRICALISSUANCE CE
MECHAN ICAL - - - a ac E E T. PLG. MECH. '
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDINPERMIT ,
. WOOD FLOOR " - INFORMATION
PLUMBING
,VALUATION'
'. � - - � � � '
'MECHANICAL
- - PER To
' I ELECTRICAL � - �^/--/T) MIT
FRAMING ..;.n. - L /•! f/'�' �• „(y
INSULATION .7— STORIES TYPE CONSTR:
' � ' ' ,. - -
• OCC GROUP RES.'UNIT S
PLACE NO SUBFLOOR UNTIL ABOVE HAS'BEEN SIGNED
ROOF ' e ,• SD.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM " r .
BUILDING USE
• "RES IND CON PB O,hei
,. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
'41 �' A SSE550 RS PARCEL N O.
` ROUGH 3- fo,G'
PLUMBING
GAS TEST
TRACT N0, PARCEL NO.
- -
MECHANICAL t
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING infi-[7 SAN # zorvlNc ENG,SITE No.,
INSULATION- - V PLUMBING - - ,�
GAS., -
' MECHANICAL FIRE SPRINK ENERGY T 24"
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING o' "0 "[D
f LOGO ZONE ALU.C.
LATH-INTERIOR ELECTRICAL I
LATH-EXTERIOR - FIRE DEPT. - YE]'•'"[:D °'� "�
SHEETROCK- GRADE FEE SUMMARY
SHEAR INTERIOR - BUILDING -
SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING
FIREWALLS' ELECTRIC PLAN CHECK ,
GAS FEE
'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
1 ,
F�
ARRANGE FOR INSPECTION BY PHONING 252-4505ELECTRIC. ? f-
` ONE WORKING DAY BEFORE REQUIRED INSPECTION " PLUMBING r, Irk
0 PLEASE GIVE JOB ADDRESS'WHEN PHONING
Z — SEE PERMIT FOR.EXPI RATION DATE . . .MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE � �" TOTAL t ��
CALLING'FOR FINAL INSPECTION
OFFICE COPY - -
i
• F. ,
APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES - USE BALL POINT PEN ONLY
f BUI,�.DING PROJECT IDENTIFICATION - PERMIT NUMBER
rUILOINO -APPLICATION & PERMIT
.-� ADRESS '
Iv r ✓ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 13358
OWNS 'S n q a PLAN CHECK VALIDATION
NAME GG
PHDN N OTY. ELECTRIC PERMIT FEE
e
CONTRACTOR
NAME Ka5��15�{9� S- UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00 /-
DNTEACTOR s
ADDRESS APPLIANCES-RESIDENTIAL 4.00
PHONE ' I .PANELS 10.00 DATE OF APPLICATION
ARCHITECT . 'PLAN CHECK FEE P.L.NO.
OR PANELS (OVER 200 AMP) 20,00
ENGINEER
LIC.No' SIGNS TRANS. 3.00
ARCH.OR ENG. q��MIT VALIDATION
ADDRESS r SPECIALCIRCUFF . 5.00 (rip
ZW EMP.METER_OR POLE INS;A 1^ 20.00
APPLICANTS
ADDRESSMOTORS SEE FEE SCH. S�F3
SERVICE CHANGE• 20.00 / rbATE
O O LICENSED CONTRACTORS DECLARATIONCiu' ' Iherebyaffirn Ihat'lanYlicensetlunderprovfsionsofCllepter9 I6dU -
yfcotmnencing with Section 7000)of Division 3 of the Business anJ nr P. '
Q n �••/ -' BLDG. ELECT. PLG. MECH.
H w i Professions Code,and my license is in full force and effect. - - 11 E: 1:1E, O m - License Class Lin.Number-
E,
m - � Dote Contractor - -
Q Y f
.¢ ¢ w OWNIi R-BUILDER DIiCLARATION BUILDING PERMIT
MISC.- REFER TO ORD INFORMATION
w ;LL H - I hereby affirm that I an exempt from thv Contractor's Lice Se ,
u'Oj Law for the following reason.(Sec.7031.5,Beinessand Professions - VALUATION $/FT. s
N w - PERMIT ISSUANCE 10.00 �
Code:Any mulish county which Structure permit prior
t o is issuance,
alter, /� "-D
¢ ¢ p improve,demolish,or repair tiny stnclure,prior 10 its issuance,also ELEC:CONTE. .LIC.NO.1 ELEC. /
'O LL requires the applicant for such permit to file a signed statement that TOTAL a, PERMIT TO
u w S he is licensed pursuant to the provisions of the Contractor's License -
HiQ Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe A"d0/7G-d
EEO Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT � FEE
• ¢ H the basis for the alleged exemption.Any violation Df Section 7031.5 ' STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to acivil penalty
of not more than five hundred dollars($500j)
I ALTER-DRAIN -WATER (EA.) 6.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE ,4.00 - .
their sole compensation,will do the work,and the structure is not OCC.GROUP BEs.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 O o
Code:The Contractor's License Law does not apply to an owner of - O
property who builds or improves thercoo;and who does Soch work 'FIXTURES-PER TRAP 5.00 sO.FT.FLOORAREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
meatsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 RES 'IND CON PB Other
❑ I,as owner of th .
e property,am exclusively contracting with ❑ [:] E) EJ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-. -INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions Code:The C.m renor's License Law docs not apply ^
to an owner of property who builds or improves thereon.and who LAWN SPR INKLERS-OVER 6d EA.) 1.00
contracts for such projects with a cantractor(s)licensed pursuant to - SEWER-SANITAflV-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam xempt under Se . ,B.&P.C.for this WATER HEATER-W/VENT 6.00
reason I�( Owner _ a _
WATER SYSTEM .5.00 ACC.DATE ACC,FILE NO, .
WORKERS'COMPENSATION DECLARATION WATER TREATINGLEQUlIapperono 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or xreerlified ZONING - ENG.SITE NO.
copy thereof(Sec.3800,Lab C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished - - FIRE SPRINK ENERGY T44
Z Z ❑ Certified copy is filed with the city inspection division.
FO Applicant MISC.- REFER TO ORD. Y❑ N❑ 'v'❑ NO
cc W CER'I'IFICA'1'17 OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 10.00 � FLOOD ZONE A.L.0 C,
W > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
jZ ('This section need nOl he completed if the permit is for one TOTAL Y E] NE] Y❑ N❑
hundred dollars(5100)or less.)
) 0 1 certify that in lite performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to
O U become subject to the Workers'Compensation Laws of California.
y NOT Applicant ALTER OR ADD TO MECH. , 5.00 BUILDING_
W NOTCertificate
C lo,
} ICE TO APPLICANT: If,after making This Cerl ificale of Ex.
Z emption,you should become subject to the Workers'Compensation APPLIANCE ' 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10)00DCF.M.) 4:00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) ._5.00
the performance of the work for which this'permil is issued IS c. MICROFILM '
3097,Ce.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT 100,000 B.T.U.)9.50
,r Lender's Address ELECTRIC
Icertify that lhave read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING 10
• ordinances and stale laws relating to building construction, and .BOILER•COMP(3 H.P.OF 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. 801 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
rtf
Copen against liabilities, dgm- s, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may - By we accrue a id fly in consequence c the
gm n of LTi etmi6, /C/ MECH.CONT. - LIC.NO. MECH.
SAS OTAL TOTAL /y��
sy. S azure of Applicant/Contractor Datc
OFFICE COPY -