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15030 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT'IDEN',^IFICA-TION PERMIT NUMBER .� BUILDING APPLICATION & PERMIT °161 EMw,rzE Av� 15030 BUILDING - ELECTRICAL-PLUMBING -MECHANICAL OWNER'S PLAN CHECK VALIDATION NA1ME {� A��1 J 6h�S 'rT, SIr'V_ ZSS'ryb"l5 OTY- ELECTRIC PERMIT FEE PHONE nDmsRACToas '1II L _ UTLETS-SWITCHES-RECEP 10.00/1.00 .OIMMT= •11 SI 5le- LIG.N�bZ.9S5 LIGHTING FIXTURES 10.00/1.00 r-DNTRACTaRs L.,��NIG _.� PPLIANCES-RESIDENTIAL 4.00 1 L.t.l PHONE2SS'�C`1J PANELS 10.00 DATE OF APPLICATION ORRcertscr' PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER uc.ND. SIGNS TRANS. 3.00 ARCH. DD Ees ENa SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP rrEMP.METER OR POLE INS. 20.00 APPLI EMOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 IS = 1985 Foo LICBNSfiD CON'IBACTORS DECLARATION u w I hereby affirm that 1 mo licensed under provisions of Chapter 9 G Z ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and BLD LECT. PLG. MECH. t' " Liccnw.Profess,Q.Code ul m license is in(all I'e�r��m1�f 1 ❑ ❑ ❑ Z o y LiccnscSlass y Lic.Nulyb�{J fJZH��/_ efi o F o Date_;. S fS_Ccnlrayler-r{- LJ < s, BUILDING PERMIT J )/1'CC/ c m w at OWNER-BUILDER I " ARA"PION a o A " INFORMATION X ; LL H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD Law for the following reason.(Sec 7031.5,Businessland Professions j PERMIT ISSUANCE VALUATION $/FT. Code:Any city or county which rehlllres a PClmlt tO CgllstrlCl,alter, 10-00 BE 4 O improve,dem Wish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. u o, requires the applicant for ELEC. pp permit to file a signed statement that TOTAL u w m he is licensed pursuant to the provisions of the Contrail Or's License - PERMIT 70 F Z Q Law(Chapter 9(commencing wi lh Sec[ion 7000)o f D iv inion 3 of the C Q /,a'/S i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE �' �•eVG R F o the basis for the alle'ge'd exemption.Any vlolat Wn oI Section 7031.5 STORIES TYPE CONSTR. au e ;m by any applicant far u Permit Subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,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 RES.UNITS intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AR EA,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 F IXTUR ES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve ®' ..is are not intended or offered for sale,l f,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. 30.00 RE ❑ ❑RES IND N PB ElO❑ ❑ 1,as owner Of the property,and 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 Cade: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 for such projects with a eontrxetorls)licensed pursuant to the Contractors License law. SEWER-SANITARY-STORM EA.200fi/10.00 TRACT NO. PARCEL NO. lam exempt under Sec.-, for this cal WATER HEATER W/VENT 6.00 Owner Duce WATER SYSTEM 5.00 ACO.DATE ACG FILE NO. WORKIiRS'COMPIiNSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of colssent to al&ill.ure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(See 3800.Lab.CI Policy No, Cant PanyL eA6Byd�'� !jtAl O ❑ Certified copy is hereby furnished �Z _ IRE SPRINK ENERGY L 24Z Certified FiitcI it tht f"pec n Avstn. OAppOc MISC.- REFER TO ORD. v [:] N� v C] NC] ir y iRTIFICATI!01s F:XEMPT'ION FROM WORKFRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W COMPENSAT'[ON INSURANCE PLG.CONTR. LICCL 0 .NO" PLG. (This sectio. need nor be completed if the permit is to,ane TOTAL Y NY 11 N� Z hundred dollars IS 100)or less.) U O 1 r,tit, that in the performance of tie..,it for which tllis per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compersxtiorr Laws of California. a Doh. Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } Z NOTICE TO APPLICANTICANT:: If,alter making this Certificate of fx- "y emption,you should hectors subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK U wchtst mx ofothe thLabor Code, you must forthwith comply with FEE pr permit Shull be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONST'RUC'TION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction fending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). FW G UNIT(TO 100,000 B.T.U.) 8.00 Lender's N:urc Lender's Address G UNIT(0VER 100,000B.T.U.)9.50 ELECTRIC I certify that I have real this applirtion anA state that the aboveATION FAN (SINGLE) 4.00inormation is correct. 1 agree to comply with u11 city and county PLUMBING ordinances and slate laws relating to buildingconstruction, andCOMP(3 H.P.or 100,000 B.T.U.) 6.00hereby authorize representatives of this city to enter upon theaboveanentioned property for inspection purposes -COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to saveindemnify and keep harmless te City oREFER TO ORD.upertino against liabilities,Judgments, costs anJexpenses whichmay in any way accrue against said Ci y in consequence of theISSUANCE 10.00 CONST.TAX •raNingtfthis Perm iL LIC.NO. MECH.OTAL TOTAL �ghrarrrc of Applicant/Contractor Dale -� OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING ,.L• .� ] W, PERMIT NUMBER - CITY OF CUPERTINO Lao ' INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS 10131 Empire Avenue UNIT# LOT# PERMIT EXPIRES IF WORK OWNER James Sisk CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATIONV ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. ,. a .�' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ct w UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL Q BLDG. ELECT PLG. MECR El El El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED (�JBUILDING PERMIT WOOD FLOOR MP O INFORMATION PLUMBING VALUATION la slFr. MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR. OCC GROUP RES UNITS. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50 FT,FLOOR AREA TOTALnCHEAGI ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING RES IND uTCON USE O'P" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.N nI""UR5 PARCEL NO - � PLUMBING ELECT,ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE -7-cc.FILE-No FRAMING ELECT.FINAL TEST INSULATION — PLUMBING �ON1"c ENG SITE NO. GAS TEST r GAS MECHANICAL FIRE SPRINK ENERGY 1 74 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ ^'❑ ` ❑ N[] EXTERIOR-SHEAR ELECTRICAL RELEASE FLOODIONE ALUC. INTERIOR SHEAR. - FIRE DEPT. Y ❑ N❑ v ❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR.LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE 1 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALIS SIGN E D 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 i IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL v CALLING FOR FINAL INSPECTION. OFFICE COPY.