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15549APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - BU I LDING PROJECT IDENTIFICATION =' - APPLICATION & PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER " - 15549 DRE G �% ADDRESS I+ M PI V L Q U � 0131 C OWNER'S N�"pWtGS af I/ TC • JIB PHONE��J-/����� OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION _ DATE OF APPLICATION CONTRACTOR ' N ME ' C -S SIS V__ uc. NO OUTLETS -SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S �C Io�WL PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER Ll C. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 moo 'Ess ENG. ZIP SPECIAL CIRCUIT 5,00 PERMIT VALIDATION �+ ISSUANCE DATE - L LECT. PLG. MECH. ❑ ❑ ❑ EMP. METER OR POLE INS. 2800 O - APPLICANTS- LICENSED CON"FRACT'ORS DECLARATION 1 hereby allirm that 1 am licensed under provisions of Chapter 9 (commencing with Suction 7000) of Division 3.1 the Business and Professions Co d my liven Li is in full f - a I LiccnsS C���y'�.��1yy�_.� Lia Num 1) v Conrcuct ��..��11�Q / OWNER-BUI LUER DECL AT10N `rte_ I hereby affirm that I am exempt from Um Contractor's License Law for the following reaSon. (Sec. 7031.5. Business and Professions Code: Any city or County which requires u permit to construct, alter, improve, deprolish, or repair any structure prior m issuance, also TNulres the applicant for such permit IO file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation ufseclion 7031.5 by any applicant for a permit subjects the applicant to r civil penalty of not more than five hundreddollars(S500).)' ❑ L as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenot intended or offered for sale. If. however, the building 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- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, BusinessLAWN and Professions Code: The Contractor's License Law does mol apply to an owner of property who builds or improves' thereon. and who contracts for such projects with a contractor(,) licensed pursuant to the Contactor', License Law. ❑ l am exempt under Sec ,B.&P.C. for this reason MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 iu CI`7 LDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE AE.9 VALUATION S/FT. ELEC. CONTR. LIC. NO. ELEC.its �A- ELEC. �`�� yy TOTAL PERMIT TO T v4r. CITY. PLUMBING PERMIT ALTER-DRAIN&VENT-WATER (EA.) 5.00 STOHIES TYPE CONSTR, . BACK FLOW PROTECTDEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM - i INC.4 OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 so. Er. FLOOR AREA TOTAL ACREAGE BUILDING USE RES IND CON PB Omer INDUSTRIAL WASTE INTER. 30.00 SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1,00 SEWER -SANITARY -STORM EA. 200ft/10.00 WATER HEATER W/VENT 6.00 TRACT NO. PARCEL NO. Owner Date WATER SYSTEM 5.00 WORKn that I have a certificate e ofco RATION I hereby affirm that I have a certificate of consent illor wifeinsure, or a certificate of Workers' Compensation Insurance, or a certified coli thereofyN.'(Scc.380QLab.G1.eEKA� - 1N pry Policy No. Company hh I ACC. DATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. -' REFER TV5.008UILDING ❑ Certified copy te'Icrcby [amished. C d cony is file4 wish L ci inspection division. Applica/I FIRE SPRINK Y ❑ NE] ENERGY T"24 Y [3 N[] _l LSLBINOCA'FE OF EXEMPTION FROM WORKERS' COMPI-NSATION INSURANCE section need not be completed if the permit is for one dollars IS 100) ar IessJI certify that in Ute performance of the work for which this per- is issued, I shall not em lo an y manner. as m Y y per,on inanbecome suhject to the workers'Compensation Laws of Culilornia. Nate Applicant NOTICIi TO APPLICANT: If, eller making this Certificate of 1>x- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith cornply with such provisions or this permit shall be deemed revoked. CONS'FRUCI'ION LENDING AGENCY I h Emby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, CR.C.L Lender's Name Lenders Add.... I certify that I have read this application and state that the above information is correct. I agree to comply with all city and couy informnt ordinances and state laws relating to building construction, and hereby authorise representative, of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save, indemnify and keep h.morss the City of Cupertino against liabilities, judgments, costs and expenses which oma in any way accrue against Said ity in causer, nee of the (� /3 g ISSUANCE FLOOD ZONE NEI A.L.U.C. Y ❑ Nhundred ZPLG.CONTR. LIC. NO. P(Ihis TY❑ MECHANICAL PERMITmit FEESUMMARYP OR ADD TO MECH. APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10=C.F.M.)6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM ELECTRIC HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 VENTILATION FAN (SINGLE) 4.00 BOILER-COMPor 100,000 B.T.U.) 6.00 PLUMBING 100,000 BTU) SEE FEE SCH. MECHANICAL REFER TO ORD. 10.00MECH. CONST. TAX CONT. . NO. MECH. TOTAL TOTAL igna re of Applicant/Contractor Due OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING .1` PE R MIT NUMBER *CITY 01"CUPERTINO ~''`{' 15549 INSPECTION DIVISION JOB INSPECTION RECORD _ JOB ADDRESS 10131 Empire Av_anue UNIT# OWNER James Sisk CONTRACTOR INSPECTION DATE I INSPECTOR 1 FOUNDATION NOTE: UFER ALL GRADING TO COMPLY WI PREGUNITE --I .....,_.._...___. PLUMBING ELECTRICAL MECHANICAL (CRETE UNTIL ABOVE HAS UNDERGROUND/SLAB )R UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR MECHANICAL' ELECTRICAL FRAMING INSULATION PLACE NO SUBFLOOR DIAPHRAGM ROOFSHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED PLUMBING TUBS 8 SHOWER PAN MECHANICAL ELECTRICAL FRAMING INSULATION GAS TEST COVER NO WORK UNTIL ABOVE HAS BEEN EXTERIOR SHEAR INTERIOR SHEAR SHEETROCK INTERIOR LATH PERMIT EXPIRATION LOT,4 NSPECTION WIT ' PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN RECORD 180 DAYS OF PERMIT ISSU- TEASE ANCE OR 180 DAYS FROM AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. THE APPROVED PLANS AND CIN OF PERMIT vAI.IUAiION NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID PLUMBING ENERGY MECH.ENERGY BUILDING ENERGY ELECT. FINAL TEST PLUMBING GAS MECHANICAL HEATING ELECTRICAL FIRE DEPT. BUILDING ELECTRIC PLASTER UNTIL ABOVE HAS BEEN SIGNED lOCCuPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL I. LU ARRANGE FOR INSPECTION BY -PHONING 252 . ONE WORKING DAY BEFORE REQUIRED INSP o� PLEASE GIVE JOB ADDRESS WHEN PHONING. z - SEE PERMIT FOR EXPIRATION DATE IRAPORTAKITI ❑ ❑ ❑ ❑ BUILDING PERMIT INFORMATWN � �o to o" o o' � PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY TOTAL ENG SITE NO. FIRE SPRINK Y N❑ ENERGY T-29 Y❑ N❑. TEASE FLOOD ZONE v0 N 7LUC. L No FEE SUMMARY BUILDING IRARY APPROVALS PLAN CHECK' FEE SEISMIC FEE GNED BY BUILDING INSPECTOR. 4505, ECTION. MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY TOTAL