13360 POST THIS CARD NEAR FRONT OF BUILDING
HF,IT NUMB[R
CITY OF CUPERTINO
13360
INSPECTION DIVISION
JOB INSPECTION RECORD
10861 MAXINE PERMIT EXPIRATION
JOB ADDRESS UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER FRANK VAVAK CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATEINSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LASTCALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED k-• V
UNDERGROUND /.SLAB
r
PLUMBING
ELECTRICAL ISSUANCE DATE
BLDG. EIECT. PLG. MECH.
MECHANICAL 0 ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR ) VALUATION $IFT.
PLUMBING
MECHANICAL
J'- PERMIT TO
ELECTRICAL
FRAMING J
N RIES TYPE CONSTR.
INSULATION C\�y
OCC.GROUP RES.UNITS
PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED
SU.IT.FLUOR AHL'A TOTAL ACREAGE
ROOF
DIAPHRAGM BU I L 0 1 NG USE
AES IND CON PB 011,1,
APPLY NO ROOFING UNTIL ABO VE HAS BEEN SIGNED
ASSESSORSPARCEL NO.
ROUGH
PLUMBING TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
ACC.'DATE ACC.FILE NO,
ELECTRICAL FINALS DATE INSP. 1
FRAMING SAN _ ZONING ENG.SITE NO.
INSULATION PLUMBING a)
GAS /, �-/
F IRE SPRINK ENERGY T.24
MECHANICAL v [jN� v ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EL000 zoNE A.L.u.a
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. v N❑
N� v �]
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
IL ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
wt PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATI ON APPLICATION & PERMIT PERMIT NUMBER
BUILDING
Aoon
as
BUILDING-ELECTRICAL-PLUMBING -MECHANICAL 13360
OWNER'S b PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
j PHONE a
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.oR ENG. SPECIAL CIRCUIT 5.06PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICAN MOTORS SEE FEE SCH.
AOOREss
SERVICE CHANGE 20.00 /
woo LICENSED CONTRACTORS DECLARATION
a .U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w< u'A� (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H y z Professions Code,and my license is in full force and effect. ❑ ❑ E]z D m - License Class Lic.Number
-
9 2 D Dule Contractor
`" - BUILDING PERMIT
¢w o OWNER-BUILDER DECLARATION INFORMATION
w LL
as 1 hereby affirm that I ran exempt from the Contractor License MISC.- REFER TO ORD
u0j Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
� - 0 Code:Anycity orcoun(y which requires a permit locons(Tuct.alter,
6QQ0 improve,demolish,or repair any structure,prior to its lSSpJIIC[,also ELEC.CONTR. LIC.NO. ELEC.
ar
O u requires the applicant for such permit to file a signed statement(hat TOTAL PERMIT TO
u wes he is licensed pursuant to the provisions of the Contractor's License / D
t,zus Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe Business and Professions Code)or that he isexempt therefrom and OTV. PLUMBING PERMIT FEE
fr
3 S O
¢ H e the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
aim by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S5000:
❑ L as owner of the property,or my employees with wages as IBACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLET$ 6.00
ments are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
L3 1,as owner of the property,am exclusively Contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code The Contractor's License Law docs not upply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sec. .B.&P.C.forthis WATER HEATER W/VENT 6.00 --
reason
Owner Uate WATER SYSTEM 5.00 PCC.DATE ACC.FILE N0.
WORKERS'COAIPENSATION DECLARATION WATER TREATINGEQUIPI. ( I„ / 5.00
I hereby affirm that I have a Certificate of Consent to self-insure, TONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified p
Copy thereof(Sec.3800,L.A.C.). city a Lttine (OD
Policy No. Company
Q ❑ Certified Copy is hereby I'umished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. Y N❑ Y N❑
O Applicant
FyPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
0: > AT
CERTIFICATE 01'EXEMPTION FROM WORKERS'
Lu COMPENSION INSURANCE PLG.CONTR. LIC.NO. PLG. /G ^ y❑ NE] Y❑ NE]o (This section need not be completed if the permit is for one TOTAL
0 Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
Ow become subject to Dm Workers'Compensation Laws of California. BUILDING
Date Applicant ALTER OR ADD TO MECH. 5.00
} tail NOTICE TO APPLICANT: If,after making this Certificate of
Ex-emption,you should become subject to the Workers'Contpensutlon APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply will, FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.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 lot which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 po-b
Kpf unalion is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
dnourmees and slate laws refuting to building construction, and
hereby authorize representatives of this city to enter Inion the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
above mentioned property I'or inspection purposes,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
grant i goflhispermiL MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of Appl cant/Contractor Uate
OFFICE COPY