13603 POST THIS CARD NEAR FRONT OF BUILDING °I/�
PERMIT NUMBER
CITY OF CUPERTINO, - R 13603
INSPECTION DIVISION
JOB INSPECTION RECORD
- PERMIT EXPIRATION
JOB ADORE BELKNAP DRIVE UNIT# —LOT# ' 6
PERMIT EXPIRES IF WORK
OWNER MASTERS/ZANKICH' CONTRACTOR STEVE ZANKICH IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT IsSu-
FOUNDATION _ ANCE OR 180 DAYS FROM
UFER - LASTCALL EDINSPECTION.
PERMIT VALIDATION
PREGUNITE ,,.ry7rr
'�g 1 - /U/'
POUR O CONCRE E UNTIL ABOVE HAS BE SIGNED !t} ' `
UNDERGROUND'/SLAB J C��C.`J e 4, �.
PLUMBING
ELECTRICAL - - ISSUANCE DATE
'MECHANICAL Bloc ELECT. PLG. MECR.
❑ 1-11❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
_ VALUATION $/FT.
PLUMBING
MECHANICAL
ERMIT TO" '+'
ELECTRICAL J,,,:, • -
FRAMING STORIES r— I TYPE CONSTR.
INSULATION - - --
OCC.GROUP - RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO FT.FLOOR AREA TOTAL ACREAGE
i1
DIAPHRAGM -
RUILOION USE
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Q El El Q
Assess°as PARCEL No.
ROUGH
PLUMBING
TRACT NO. PARCEL NO
GAS TEST
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC,DATE ACC.FILE No.
FRAMING 2• U SAN #
ZONING ENG.SITE NO,
INSULATION PLUMBING
GAS _
MECHANICALFIRE SPRINK ENERGYT24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED iHEATING 1 Y ❑ N❑ Y ❑ N❑
LATH—INTERIOR ELECTRICAL • FLOODZONE A.L.u.c.
LATH—EXTERIOR — FIRE DEPT. Y NE] ° N[]
SHEETROCK — GRADE - FEE SUMMARY
SHEAR INTERIOR - BUILDIN
SHEAR EXTERIOR T E M PO R AWN APPROVALS BUILDING _
FIREWALLS ELECTRIC - PLAN CHECK "
FEE
�G 8 GAS - — 6 - Ar I PWl
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
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
{• PERMIT NUMBER
BUI LDI NG PROJECT I DENTI FICATI ON APPLICATION & PERMIT
B"'LOIN 4° G 13603
ADUREss Q� Ki"I l7l rJ .(/1r BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNERS PLAN CHECK VALIDATION
N•x+E \ `� QTY. ELECTRIC PERMIT FEE
7 Cn ,�4 r lo PHONE Z J
OW c°NTRAc7oRs NAME OUTLETS-SWITCHES-RECEP 10,00/1.00
S e✓-e Z K CLi LIC.No, L Z G LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
IR L PHONE PANELS 10.00 PLAN ATE E OFFEE LICATIOPNC.NO.
ARCHITECT PANELS (OVER 200 AMP)) 20.00
OR
ENGINEER C.NO. SIGNS TRANS. 3.00
ADDR.SS E.G. S.00 ' PERMIT VALIDA31ON
ADDRESS SPECIAL CIRCUIT 0/11,
O/ /g
ZIP EMP.METER OR POLE INS. 20.00 / ` !
aool essTS MOTORS SEE FEE SCH. n ��
SERVICE CHANGE 20.00 IK1
wo o LICENSED CONTRACTORS DECLARATION - ^-),
H �k ' ISSUANCE DATE
a u o I hereby affirm that I am licensed under provisions of Chapter 9
w a" (conunencmg with Section 7000)of Division 3 of the Business and BLDG ELECT.% PLG. MECH.
H o z Professions Code,mt my license is in full force and and o(i I f❑ El ❑
x o - License Class Lic.Number .
O F Date - Contractor
a x pU11.DING PERMIT
m ¢ OWNER-BUIL DER DECLARATION .-INFORMATION
¢ od ° MISC.- REFERTO ORD 1
at ; N 1 hereby affirm that I am exempt from the Contractor's License ZVALUATION $/FT.
law Oa Law for the following reason.(Sec.7031.5,Business and Professions pERMI7 ISSUANCE 10.00
� - Code:Any city or county which requires a permit to construct,alter, 7 .1
ar ¢ Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL P RMIT TO
w$ Ise is licensed pursuant to the provisions of the Contractor's License
"azi Law(Chapter 9(commencing with Section 7000)of Division 3 ort"
e
¢ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 p� �/v/
of not more than five hundred dollars(SSOOM:
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the Structure Is not -.3intended 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.SYSTEM-1 INC. OUTLETS 6.00 3 (�/
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
f 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
❑ 1,as owner of the properly,an,exclusively contracting with
licensed contractors to construct the Project(Sec.7044,BusinessNMWATERITREATINGEQUIP.
KLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and whoKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractogs)licensed pursuant toTARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ lam exempt under Sec. ,B.&NC.for thisER W/VENT 6.00
reason
Owner Date EM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION ATING EQUIP. 5.00
I hereby affirm that I have a certificate co consent t0 ach-Insure, ZGNING ENG.SITE NO.
or a Certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.). `
Policy No. Company
Q ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-74
Z Z ❑ Certifiedc py is filed with the city inspection division. MISC.- REFER TO ORD. yN[] y NE]
Applicant
I- --i PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
IL - CF.ItT114CATF. : I:XI!MPTION FROM WORKERS'
LU COMPENSAtION INSURANCE PLG.CONTR. LIC.NO. PLG,
(LO y� NE] Y � N❑
(This section need not be completed if the permit is for one TOTAL
:) Z hundmd dollars(S 10()or less.)
U O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
I- mit is issued 1 that not employ any person in any manner so as to
O W becooesubjcut to the Workers''Compenmtion Laws of California BUILDING -
Date Applicant ALTER OR ADD TO MECH. 5.0011- Ss
} US NOTICE TO APPLICANT: If,after making this Certificate of ISx-
F.. Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK fly �`�
provisions of the labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,OODG F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE /
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 MICROFILM
the performance of the work for which this permit is issued(Sec.
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OVE R 100,000 B.T.U.)9.50 rELECTRICLender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ING
n iscorrect I agree to comply with all city and countyBOILER-COMPQ H.P.Or 100,000 B.T.U.) 6.00
sd state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Omr 100,000BTU)SEE FEESCH. NICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. .TAX
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.0may in any way accrue against said City in consequence of the
granting oft permit. MECH.CONT. LIC.NO. MECH.TOTAL TAL � y
Signalure of Applin CoNmctor Date (�•�
` OFFICE COPY