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13520 i POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO LFRMITNUMBER INSPECTION DIVISION 13520 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 21432 ELM COURT UNIT# Lor# PERMIT EXPIRES IF WORK OWNER STEVE WAGNER . CONTRACTOR I IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION ANCE OR 180 DAYS FROM UFER ' LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG. MECH. E) E] ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION- MECHANICAL ELECTRICAL PERMIT TO FRAMING — +' INSULATION STORIES TYPE CONSTR. OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SFT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM Q BUILDING USE RES IND ON PB Olein APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E] ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING if GAS TEST 1 RACE NO. PARCEL NO. MECHANICAL ELECTRICAL _ FINALS DATE INSP. ACC.DATE ACC FILE NO. FRAMING SAN * INSULATION PLUMBING 9, ��7 zoNlNc ENG.SITE No. GAS MECHANICAL FIRE SPRINK ENERGY T.za COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ Y ❑ N❑ LATH—INTERIOR ELECTRICAL FLooD zoNE A.L.u.c. LATH—EXTERIOR FIRE DEPT. Y❑ "❑ Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! !COHNST-TAXPLEASE READ REVERSE SIDE BEFORE / CALLING FOR FINAL INSPECTION. OFFICECOPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING. /j APPLICATION & PERMIT 2 4s �� BUILDING — ELECTRICAL—PLUMBING—MECHANICAL 13520 O R'S Vi PLAN CHECK VALIDATION fe "M �I'p /y �jpe �/� QT ELECTRIC PERMIT FEE CNV V ,Ie PHONE "� CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 NAME LIC,No, LIGHTING FIXTURES 10.00/1.00 _ CONTRACTOR DDR E55 PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ORCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No. SIGNS TRANS. 3.00 ARCH,OR ENG. SPECIAL CIRCUIT S.DD PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. n ' ADDRESS SERVICE CHANGE 20.00 ,P p w ¢Oo LICENSED CON'I'RACTORS DECLARATION ��j 7 a v U 1 hereby affirm that 1 am licensed under provisions of Chapter 9 IS DANCE DATE Hay' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H H z Professions Code,and my license is in lull fart"and effect ❑ ❑ Z i m W License Class Lic.Number Date Contractor a y E BUILDING PERMIT ¢ ¢ w ¢ OWNER-BUILDER DECLARATION 0 A U REFER TO ORD INFORMATION w3 LL H I hereby affirm that I am exempt from the Contractor's License MISC.— uoa Law for the following reason(Sec.7031.5,Business ad Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. L- - 0 Code:Any City or county which requires a permit to construct,alter, KQ 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 PERMITTO a w mhe is licensed pursuant to the provisions of the Contractor's License H z i Law(Chapter 9(commencing with Section 7000)of Division 3 oftle �/��/_ — ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 4/ ¢ F D the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit Subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 — of not more than five hundred dollars(S500)J: ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for rade(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 TOTALACREAGE • himself or through his Icon employees.Provide)that such improve- merits me not intended or offered for Sade.ll',however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 orimprovement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other ❑ 1,as owner of the property,am exclusively contrasting with El 11 ❑ El F-1licensed 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 does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts f such projects with a contreclor(S)licensed pursuant to the C. is Lice Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT rvo. PARCEL No. ❑ I x•mpt­A111 n Se ,B.f�P .fortlii yyATER HEATER W/VEN2REFERTOORD. caro wrier Da — _ WATER SYSTEMACC.DATE ACC.FILE NO. WORKERS'COMPENS '1 NDECLARATION WATER TREATING EQU 1 hereby affirm that I have a c r ica,of consent to self-insure, or a certificate of Workers'Comp cation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T Z4 Z Z ❑ Certified copy is filed with the city inspection division. MISC-Q ApplicantY❑ N❑ Y ❑ N❑CC y PERMIT ISSUANCE17C — CCRTIPICATEPEIATIOTINS PROMW'ORKIiR1' FLOOD ZONE A.L.U.C. W � COMPENSATION INSURANCE PLG.CONTR. uC.No.CL0 (This section need not he completed if the permit is for one Y❑ N❑ Y ❑ No hundred dollars(S 10(Tor less.) U O I certify,that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY IL I— mit is issued,I shall not employ any person in any manner so as to U W become subject to the Workers'Compensation Laws of California. y Date—Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex- F_ z emplion,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 be deemed revoked. AIR HANDLING UNIT(TO 10=1C.F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(See. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 dT+ Lender's Address ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.1 agree to comply with all city and county PLUMBING ordinances sad state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives forms of this city es enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property forinsp of purposes. (We) agree to save, indem ify and keep harmless the City of MISC.- REFER TO ORD. Cope i o against 'hies,j tents, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX �r�a way ac ag n aid City in co qucnc of[hc MECH.CONT. LIC.NO, MECH. P162n� __4TOTAL TOTAL use of pean t/Conlraclor Ealto OFF ICE COPY