133290
POST THIS CARD NEAR FRONT OF 'B UILDING,
I
CITY OF CUPERTIO °.' 13329
rFRMIT NUMRER
INSPECTION DIVISION.
JOBINSPECTION RECORD
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PERMIT EXPIRATION
JOB ADDRESS UNIT# LOT#
_ -1-`'ll�.(.�"r�
PERMIT EXPIRES IF WORK
/_ �'1fU�I�
OWNER I CONTRACTOR
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
INSPECTION DATE INSP CTOR
INSPECTION RECORD'
FOUNDATION
S S 01UCr .. Z(p^>9
LIFER -
r�V
-FIITG 5i0 _ ,$
LASTCALLEDiDATION ION.
PREGUNITE
�. ��^ Q A/l;At I/r
C mk YQ
PERMIT VALIDATION
POU 0 CO RETE UNTIL ABOVE HAS BEE SIGNED
f / J+
6K
UNDERGROUND/SLAB
PLUMBING
.-+�1' ISSUANCE DATE
ELECTRICAL
MECHANICAL
.1 q,
RLDO.' ELECT.
PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
Ci Ol L
` ' - BUILDING PERMIT
- INFORMATION"
' - -
WOOD FLOOR
• VALUATION
$/FT.'
PLUMBING ,
MECHANICAL /0
ELECTRICAL'
--
PERMIT'TO
0 L_
FRAMING O• �g
INSULATION
STORIES
/1
TYPE CONSTR.
OCC. GROUP
F-3
RES. UNITS
1
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
-
50. FI FLOOR AREA
X344 3
TOTAL ACREAGE
DIAPHRAGM 112A
BUILDING USE
R S IND CON PB 00,
❑ 1:1 1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ROUGH-��,
_
ASSESSORS PARCEL NO,
4,; JI'j._
a`
I
PLUMBING
GAS TEST. �/�
'TRACT NfO..p
PARCEL NO.
MECHANICALW; �w ��f.o- 9-
h'
ELECTRICAL � n- �-
FINALS DATE INSP.
ACC. DATE
-
ACC. FILE NO.
FRAMINGSAN
n a
INSULATION I'-2 _
PLUMBING
zoNlNc
ENG. SITE No.
x
GAS -I
'FIRE SPRINK
Y ❑ NCD
ENERGY L]A
Yo NEI
-
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING -.
LATH -INTERIOR �
ELECTRICALQygt
FLOOD ZONE
Y ❑ No
A.LU,C.
.
Y ❑ N❑
LATH -EXTERIOR
FIRE DEPT.
SHEETROCK
GRADE- -
FEE SUMMARY
SHEAR INTERIOR -
BUILDING
BUILDING
SHEAR EXTERIOR 12-10-$7
TEMPORARY APPROVALS .
FIREWALLS I 'ELECTRIC
PLAN CHECK
FEE
•
GAS ^,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
IOCCUPANCY,
SEISMIC FEE
'r ,C
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505,
ELECTRIC
�1 r .-
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN.PHONING.
MECHANICAL
�,
-SEE PERMIT FOR EXPIRATION DATE -
CONST. TAX
-
IMPORTANT!,
TOTAL
I? n -7-a
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
OFFICE COPY
A_PP41CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
13329
BUILDING
ADDRESS
22575 Salem Avenue Q
OWNER'S
NAME
OTY.
ELECTRIC PERMIT
FEE
PLAN CHECK VALIDATION ,
Thrust IV Inc. PHON 415 %9-772
2
CONTRACTOR'S
NOME
/ff OUTLETS -SWITCHES-RECEP 10.00/1.00
37 LIGHTING FIXTURES 10.00/1.00
3
na-Ust IV InC. LIG, NO. 319115
CONTRACTOR'S
ADDRESS
'L APPLIANCES -RESIDENTIAL 4.00
Z
PANELS 10.00
2Q
\� (�[(� �/�/^^
2093 s D . PHONE 969-7722
DATE OF APPLICATION
ARCHITECTPLAN
OR Corp. Arch,
ENGINEER
�2' BI Van De Llc. NO.
PANELS (OVER 200 AMP) 20.00
CHECK FEE P.C. NO.
. r
SIGNS TRANS. 100
ARCH. OREN
ADDRESS �fl=
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
EMP. METER OR POLE INS. 20.00
Ted Dedriksson-Fim. ZIP
p Clklhv
( /
0� -7
d t[/
APPLICANTS
Landings Dr. Mnt. View
Lan
/
MOTORS S�E,FEE`SCH.
SERVICE CHANGE 20.00!
CONI DECLARATION
LICENSED CON
_)
y
\\` 1J
�,pn
1 hereby affirm that I am licensed under provisions of Chapter
(commencing with Section 7000) of Division 3 of the Business and
Professions Cod a'd my license is in full fo feet.
License s Numb
iLL,
ISSUANCE DATE
vfv
(`ltkl C1
BLDG.
ELECT.
UN
PLG. MECN.
�I-
1 /y -
Co rt
Date Contracmr
Y--'
BUILDING PERMIT
INFORMATION
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law for the ity orcountywhihng mason. e, 703 requires a permit tocodProfessions
Code: Any mulish county any structur e permit o its issuance,
improve, , alsoalter,
improve, demolish, or torah any structure, prior to its issuance, also
the d applicant forsuch
requires ilicensed revispermion ftile aSContactor's statement nse
he is licensed pursuant to the provisions of the Contractor's License
Law (Chaplet 9 (commencing with of Division 3 of the
- D
MISC.REFER TO OR
PERMIT ISSUANCE 10.00 140 -
VALUATION
z 5 M-Tt l
oL
5/FT.
ELEC. CONTE. LIC. N0.
ELEC. /pnl,1D
TOTAL /<
PERMIT TO
S ri'j7 W
Business and than ie is exempt
or that he is exempt therefrom and
DTV.
PLUMBING PERMIT
FEE
vv
STORIES
O�
T CqN
N
he anlagen eCode)
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant fore permit subjects $500o.licam tnucivil penalty
malty
of not more than five hundred dollars (8500).):
ALTER -DRAIN VENT -WATER (EA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will Jo the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractors 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.
ments are not intended or offered for sale. If, however, the building
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
�.� 3
RES. UNITS
l
DRAINS -FLOOR, ROOF, AR EA,COND. 5.00
FIXTURES - PER TRAP 5.00 90-
S0, FT, FLOOR AREA
�� rs
TOTAL ACREAGE
GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00 6-
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 ofsale.).
Cl I, as owner of lite property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 IEA.) 2.00
BUILDING USE
RES IND CON PB Omer
' 13
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
's License Law docs not apply
and Professions Code: The who
to owner of property who builds improves and who
LAWN SPRINKLERS - 1 INC 5 V.B. 6,00
LAWN SPRINKLERS -OVER 5 (EA.) 1.00
A55E550RSPARCEl NO.
3 ��-I
tr ensedthercon.
contracts for such projects with a contractor(s) licensed pummnt in
tr licensed
the Contractor5t License Law.
❑ lam exemppu
t under Sec.-. B &P.C. for this
SEWER -SANITARY -STORM EA. 20t/0.0
/ 0f1 0 /Q `-
TRACT NO.
�OI
PARCEL NO.
/ WATER HEATER W/VENT 6.00 6-
reason
Owner Dine
WATER SYSTEM 5.00
5'-
ACC. DATE
ACC. FILE NO.
WORK ERS'COMPRNSA'I'ION DECLARATION
WATER TREATING EQUIX .'° 5.00
I hereby affirm that I have a certificate of consent to self-inuve.
or a certificate of Workers' Cnmpe n1q11tra�Ht,�q or a cetlil icd
copy thereof (Sec. 3800, Lab.C.1. �2/��+
Policy No.-Cmpany
e„
ZONING
ENG. SITE N0.
pA -
O Certified copy it hereby furnished.
Cl Certified copy is filed with the city inspection division.
Applicant
1 p h1
I'- 0
FI RE SPR INK
N
EN ERGY T 24
V N
MISC.- HFTFERITO ORD.
,s.V
CI: RTI FICA' TE 017 EXEMPTION PROM WORKERS•
PERMIT ISSUANCE u..
10.00
/
/Q -
FLOOD20NE
A.L.U.C.
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
Y[] NE3
Y ❑ NO
PLG. CONTE. LIC. NO.
PLO
TOT.AL 127^
hundred dollars ($ 100) or IersJ
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in tiny manner so as to
become subject to.the Workers' Compensation Laws of California.
Date Applicant
NO'T'ICE 'FO AI'PLICAN'F: If, after making this Certificate of Ex"
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith coroply with
such provisions or this permit shall be deemed revoked.
DTV.
MECHANICAL PERMIT
�. ,
-
FEE
FEE SUMMARY
BUILDING
G
1
ALTER OR ADD TO MECN. \: 0 5.00
APPLIANCE \ kJ 5.00
PLAN CHECK
FEE
_
AIR HANDLING U IT (TO 10,000E .M) 4.00
AIR HANDLING UNITIOVER 10=1C.F.M.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
f
the performance of the work for which this permit is issued (Sec.
3097, Cie.C.).p
Lender's NameF+I.13----'- _
Lender's AddrS713 V 12W Sail 951
MICROFILM
Q HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
I certify that I have read this application and state that the above
.information is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and
�•
VENTILATION FAN (SINGLE) 4.00
/(� •-
ra�
BOILER-COMP13 H. P, or 100,000 B.T.U.) 6.001PLUMBING
hereabove-mentionedyuauthorize
hereby authorize representatives of this city to elver upon the
property forinsp ofth i purposes.
BOILER -COMP (0,ar 100,000 BTU) SEE FEE SCH.
MECHANICAL
0,0
/�'
(We) agree io save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
cru
may in any way ace against said City in consequence of the
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
Q--
CONST. TAX
O✓
��a, ✓
gra Iing of [his pepniL
Signature of Applicant/Contractor Uate
MECH. CONT. LIC. NO. MEC".
OTAL ¢7S-'
TOTAL
OFFICE COPY