13590 POST THIS CARD NEAR FRONT'OF BUILDING PBRMIT NUMBER
CITY OF CUPERTINO 1 X590
INSPECTION DIVISION
JOB INSPECTION RECORD ,
• ,PERMIT EXPIRATION
JOB ADDRESS I0570 S. FOOTHILL 'UNIT# LOT# 17
_ PERMIT EXPIRES IF WORK
OWNER JAMES SISK CONTRACTOR JAMES SISK IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECOPID 180 DAYS OF PERMIT ISSU-
FOUNDATION �- s' Gam, ANCE OR 180 DAYS FROM
LIFER 0.4 40LASTCALLED INSPECTION.
�/.4�
PREGUNITE -.;L)47, PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED »-
UNDERGROUND /SLABi, ^ /
PLUMBING
ELECTRICALCiuYlsstua"cE GATE
MECHANICAL OBLDG. ELECT. PLG. MECH.
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION $/FT.,
PLUMBING
MECHANICAL -
ELECTRICAL - PERMIT TO
FRAMING
INSULATION -17- F7 AW - STORIES TYPE co"STR.
OCC.GROUP RES.UNITS
T /
\1 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
/ 1 SO.FT,FLOOR AREA TOTALACREAGE
ROOF A
/ DIAPHRAGM BUILDING USE
HES IND CON PB Olhn
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED `
ASSESSORS PARCEL NO.
ROUGH
PLUMBING _ z
GAS TEST TRACT No. PARCEL No.
MECHANICAL_
ELECTRICAL ; FINALS DATE INSP. ACD.DATE ACC.FILE NO.
FRAMING SAN # I'i
zoNlNc ENG.SITE NO.
INSULATION PLUMBING
GAS ' -�
FIRE SPRINK ENERGY T-].
MECHANICAL -//-�S
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _y/ Y Y NE]
ZONE
0.LU.C.
LATH-INTERIOR I-I- YAr ELECTRICAL, - Y[] IN YC] IN E:]
LATH-EXTERIOR ,9, FIRE DEPT.
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR BUILDING - BUILDING /
SHEAR EXTERIOR TEMPORARY APPROVALS IV '
FIREWALLS ELECTRIC - PLAN CHECK
GAS _ �YIZO 'FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ELECTRIC
\ ARRANGE FOR INSPECTION BY PHONING 252-4505, /
�• \ F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
II� 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 COPV
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI
• � BUILDING PROJECT I DENTIFICATION � PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDREu
S F 0M L •rJ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 13590
`\ OWNER'a PLAN CHECK VALIDATION
//Q 5 OTY. ELECTRIC PERMIT FEES cF
• F--. FHONE25y�O L
NAMERacrons UTLETS-SWITCHES-RECEP 10.00/1.00 Z10
WF-es �. .5151/I Uc.NG.507 J7 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR PPLIANCES-RESIDENTIAL 4.00 �'-
'O(/(' SCaJJJC. pRONFyJS 'fib PANELS 10.00 Q -� DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR aRA` ^ PANELS (OVER 200 AMP) 20.00
ENGINEER a.M71/N
IC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. `,'' SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ADDIRESIt
465 AL Mb YV� �L//prrf Oszl^_T3Z EMP.METER OR POLE INS. 20.00
ADDRES"r$ MOTORS SEE FEE SCH.
1Q CP_.A1 7[. LJPEtr1u SERVICE CHANGE 20.00 ,• •• IV
wO o LICENSED CONTRACTORS DECLARATION L- /!//��
a UI hereby affirm that 1 am licensed under provisions of Chapter 9 �{ Pnno IP195UANDE DATE
G <y' (commencing with Section 7000)of Division 3 of(be Business and yta� 'BLDG. ELECT. I PLG. MECH.
F o i Professions Code d my licenu is in full I e'I f
i o`�' - Licen Class y Lic.Nu
o F Date Contract
m BUILDING PERMIT
a 4 OWNER-BUILDER UEC RATION
a0>ca MISC.- REFER TO ORD INFORMATION
X ; a- h I hereby affirm that I am exempt from the Contractor's License
u_o a Law for the following reason.(Sec.7031,5,Businessand Profevions PERMIT ISSUANCE 10.00 _ VALUATION 3/FT.
Code:Any city Orcounty which requires a permit to construct,alter, G /7c� QLp-O
ELEC.CONTR. LIC.NO. q
tea 4 o improve,demolish,or repair any structure,prior m its issuance,also ELEC /� /
is O re rquires the applicant for such permit to flu a signed statement that TOTAL / 01 PERMIT TO
w 9 he is licensed pursuant to the provisions of the Contractor's License
F z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a$ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
ce = the basis for the alleged exemption.Any violation of Section 7031.5 STORIES, TYPE CONSTR.
u ; _ by any applicant for a permit subjects the applicant toe civil penalty gLTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than five hundred dollars(E500).)
❑ 1,as owner of the property,or my employees with wages as 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 �� 3 /
Cade:The Comraclor's License Law does not apply to an owner of
1 properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 $G,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-1INC.4 OUTLETS 6.00fl-
Owner
02 74_0
\ / or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 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. 30,00RES IND cory PB other
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00ASSESSORS 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 for such projects with a contractoos)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the COntracloi s License Law. TRACT NO. PARCEL N0.
❑ 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W/V ENT 6.00
reason
Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 6.00
I hereby affirm that I have a certificate Ofconseat to self-insure, ZONING ENG.SITE NO.
or a certificam of Workers'Compensation Insurance,or a certified
copy thereof(Sce.MOO,Lab.C.).
Policy No.-Company-
0
o. CompanyO ❑ C:eaWjZd copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ eniGe c p is Olud ith the ity i io
etion divisn.
O \ Appllp� �- MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
CC W RTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00/0 FLOOOZONE A.I.M.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. '1 Y[:] N❑
(JV Y O N❑
EL Z (This section need not b /e completed if the permit is for one TOTAL d oC
hundred dollars(S 100)or less,)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to
0Ubecome subject to the Workem'Conlpensat ion Laws of California.UJ
Date Applicant / r -
a ALTER OR ADD TO MECH. 5.00 BUILDING J
} H NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? cmption,you slmuld become subject to the Workers'Compensation APPLIANCE 6.00 - 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 10MCF.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
erlorma. HEATING UNIT(TO 100000 B.T.U.) 8.00
the perfor of rhe work for which this permit is issued(Sec.3 e .) , MICROFILM
(A 7
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 9d �L
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. I agree to comply with all city and county PLUMBING fti
ordinances and state laws relating to building construction, and BOILER-CONP(3H.P.or100,000B.T.U.) 6.00 UoZ
hereby authorise roperty For
cl this city es enter upon the BOI LER-COMP Wser 100,000 BTU)SEE FEE SCH. MECHANICAL C r
\ above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep hartnlev the City of MISC.- REFER TO ORD. ry
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX 7 p 6 Q
ma in any way accrue against said City in consequen'e of the PERMIT ISSUANCE 10.00
gra ting Gf this permi. MECH.CONT. LIC.NO. MECH.
1 S L TOTAL dee TOTAL 11,1ye,2
Iplaturc of ApplicanllContmctor ate
i
OFFICE COPY