13592 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING L APPLICATION & PERMIT
ADDRLls BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13592
O LL L
OMNER'S PLAN CHECK VALIDATION
NAME '1 c A'
x JAMEi Lfe 71$ 1 , r�SDNE�5.44 5 CITY] ELECTRIC PERMIT FEE a Og
NANTRAciaR's
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
/
JArkS S671< acrd _507-Cl LIGHTING FIXTURES 10.00/1.00
DDRESS Rs
A 1 APPLIANCES-RESIDENTIAL 4.00
a0 S� 11� PHONE2rZS'J%JS PANELS 10.00 Q DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEE
A604 U56A LIC,NO, SIGNS TRANS. 3.00
ARCH,O ENG, 1 _- SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
s L
Qn ze-C45 TEMP. METER OR POLE INS. 20.00 -
ADDRESSrs MOTORS SEE FEE SCH.
APPLCA
G SERVICE CHANGE 20.00
p
woo S LLICENSED CONTRACTORS D17CLARATION
<v w I hereby affirm that I am licensed under provisions of Chapter 9 ,•'.Lt 1 ISSUANCE DATE
(commermat,with Section 7000)of Division 3 of the Business and BLDG. E#ECT. PLC. MECH.
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Professions Co and my licenss is in full fs fmv.�. l n®
z 0 Lice lav Lic.N p1
O Z F D Uate Contr to V
m s ) BUILDING PERMIT
ar a OWNER-BUILDER :C ATION
a w sa INFORMATION
w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
VALUATION S/FT.
caLLO Law for the followingreason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 Z( -
Code:Any city orcounty which requiresapermit tocomtract,after.
ae < 0 improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTE. LIC.NO, ELEC. Q _
requires the applicant for such permit to file a signed statement that TOTAL / PERMIT TO
X $ he is licensed pursuant to the provisions of the Contractor's License ''/
F z a Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe J-Fv W/_
Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE
H 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; _ by any applicant for a permit wbjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.15.00
of not more than five hundred dollars($500).):
❑ I,as owner of the properly,or my employees with wages es BACK 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
(a property who builds or improves thereon,and who doss such work FIXTURES-PER TRAP 5.00 -' M FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 IN C.4 OUTLETS 6.00 - X76 0
or Improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or loI-
'+ p' ' prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND ON P8 00 ,
( ❑I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPR IN KLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and ProfesUons Code:The Contract.,',License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3S_7-0S_-1r
contracts for such projects with a contractons)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00
the Contractor's License Law. Q TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 8.00
reason
Oars! Date WATER SYSTEM 5.00 ACC,DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a Certificate of consent t.YIf-Nwtt, - $ONING ENG.SITE NO.
or a certificate of Workers'Compenation Insurance,or a certified
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company
O ❑ Certified copy is hereby famished.
FIRE SPRINK ENERGY T-ZO
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
Q Applicant Y � N� Y � N�
CC N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 Q _FLOOD ZONE A.LU.C.
LLQ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, / � 01+ Y� N� Y �
� Z (This section need not be completed if the permit is for one TOTAL N
hundred dollars(5100)or less.)
0 O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
IL I- mh is issued,1 shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
LU
Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,efts,making this Csrifucate of Ex-
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 - PLAN CHECK
provisions of the Latour Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING LINT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby of inn that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 S
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). Z HEATING UNIT(TO 100,000 B.T.U.) 8.00 (o q
Lender's Name HEATI NG UN IT ER t OO,ODO B.T.U.)9.50 / c- �
Lender's Address ELECTRIC ECTR I C
I certify that l have read this application and slate that the above 2, VENTILATION FAN (SINGLE) 4.00
01 information is correct. I agree W comply with all city and county BOILER-CCMai H.P.or 100,000 B.T.U.) 6.00 PLUMBING Q�
ordinances and state laws relating to building construction, and
W hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposs.
(We) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD.
Cupertino against liabilities,judgments, costa and expenses which CONST.TAX p 6�
may in any way accrue against said City in consequmc of the PERMIT ISSUANCE 10.00 CJ I
g of this permit. MECH.CONT. LIC.NO. MECH.
TOTAL w - TOTAL /'yc/ .L
ature of Applicant/Contractor ate / ��
OFFICE COPY
POST THIS CARD NEAR . OF BUILDING '
PERMIT NDMEE
CITY OF CUPERTINO R
INSPECTION DIVISION 13592
JOB INSPECTION RECORD"
1
PERMIT EXPIRATION,
JOB ADDRESS 10550 S. FOOTHILL BLVD UNIT# LOT# 19
PERMIT EXPIRES IF WORK
OWNER JAMES SISK CONTRACTOR JAMES SISK IS NOT STARTED WITHIN
INSPECTION DATE IN TOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION J - ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
UFER
PREGUNITE PERMIrvµlDnrloN
1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL _ ll�-' ' ISSUANCE DATE
BLDG. ELECT. PLG. MECH,
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED CC��OIBiri
FORMATION RMIT
WOOD FLOOR CAN •vnwnuoN $/FT.
PLUMBING
MECHANICAL " 7
PERMIT TO
ELECTRICAL
FRAMING / —9-0/ STORIES TYPE CONSTR.
IN ULATION
(T-
S OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF SO.FT.FLOOR AREA TOTALACREAGE
7 DIAPHRAGM
41Exl
9UIL CON USE
r/ ,Z RES IND CON PO OIn.'
APPLY NO ROOLFIN UNTIL ABOVE HAS B SIGNED ❑ 11
ASSESSORS PARCEL NO.
ROUGH IF
PLUMBING
,� • . TRACT NO PARCEL No.
GAS TEST
MECHANICAL
ACG DATE ACC.FILE NO,
ELECTRICAL FINALS DATE INSP.
FRAMINGSAN #
ZONING ENG SITE NO.
.
INSULATION Y LCY/e pa I — 8:8 C PLUMBING
f GAS.
FIRE SPRINK I ENERGY T.]<
' MECHANICAL Y [] N❑ Y ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
a000 ZONE A.L.u.c.
LATH—INTERIOR — ELECTRICAL
LATH—EXTERIOR 3, _ FIRE DEPT. ZPSIg YE] N[] Y0 N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDIN
SHEAR EXTERIOR TLMPOR'ARYrAPPkOVALSr
BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
1
1 w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
1 o� PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL �
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. r
OFFICE COPY