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13217POST THIS CARD NEAR FRONT OF BUILDING CITYIOF CUPERTINO. INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS SALEM AVENUE UNIT# LOT# 20 OWNER THRUST IV, INC CONTRACTOR THRUST IV, INC PF R MI(NLOH ER 13217 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED-INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION :�, S - LIFER PREGUNITE PERMIT VALIDATION t, cx O JA R .1. C, G O ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Pp UNDERGROUND/SLAB PLUMBING11 - - - u`V J ELECTRICAL MECHANICAL, City of BLDG. C�F!� ECT. o PLG. MECR. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED, BUILDING PERNLT INFORMATION WOOD FLOOR VALUATION $/FT. 4 � PLUMBING .,y MECHANICAL ELECTRICAL � � - PERMIT TO FRAMING�tv,;4j- INSULATION STORIES TYPE CONSTR. OCC, GROUP. RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF so. Fr FLOOR AREA TOTAL ACREAGE DIAPHRAGM - RUIL USE NES IND CON CON P9 Olney El ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH . ASSESSORS PARCEL NO. PLUMBING GAS TEST � � - TRACT NO. PARCEL NO.. ' MECHANICAL ELECTRICALFINALS . DATE INSP. ACC.DATE ACC. FILE NO. FRAMING SAN # INSULATION IPLUMBING ZONING ENG. SITE NO. GAS MECHANICAL FINE SPHINK Y ❑ N ❑ ENERGY L24 . Y ❑ NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL _' FLOOD ZONE Y0 NE:j A.LU. C. y N❑ LATH—EXTERIOR-FIRE-DEPT." SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING- BUILDING 4u d SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS _ ELECTRIC - - PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE /j OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC - PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. ', TOTAL I. ( 0 OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY •- IfUI LDI NG PROJECT I DENTI FICATION APPLICATION &PERMIT BUILDINGELECTRICAL-G PERMIT NUMBER i� I BUILDING ADDRESS SA(,41 Ave 2O OWNER's - /�yf� "AME ll TT++ � r � vHDNE 96 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION NAM¢RacroR /.4• LIC. NO, /.S OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRA - - ADDRESS ZL4i1101AICS Ae PHONE APPLIANCES APPLIANCES- RESIDENTIAL -4.00 PANELS 10.00 ARCHITECT ENGINE T .; AS [} LIE NO PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. . SIGNS TRANS.- 3.00 1 ADONEss ENG - ZIP' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION PAID Jull F�"'� JW 'YI,.J Q /D� �/ /O e S BL L MECH. rV2 ,r21 El F1 F EMP. METER OR POLE INS. 20.00 11 ADDRESS A DRESS is ESS ' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class _Q -_L Con Number '�.�(i.�� __ Dale �•' f Contractor OWNER -BUILDER DECLARATION' I hereby affirm that I am exempt from the Contractor's License Law forthe following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for Such permit to 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 of Section 7031.5 by any applicant fora permit subjects $500D.applicant toacivil penalty of not more than flue hundred dollars (SS00)J: ❑- 1, 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 Contractors License Law does not apply to on owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvr - Rents are not 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 am- prove L as o neeose of sale.). ❑ L as owner of the properly, he exclusively , 7044,[Bu withIicenseJ contractors to construct the project (Sec. 7044, Business Professions Code: The Contractor's License Law does not applyto an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant toSEWER-SANITARY-STOflM Contractor's License Law. ❑ lam exempt under Sec. B.&P.C. I'or this reasonOwnerDate BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCEVALUATION 10.00 La �7 $/FT. - ELEC. CONTR • LIC. NO, ELEC. TOTAL PERMIT TO tl�, - ` /V /�e�, - - CITY'. - , ! PLUMBING PERMIT- - FEE - STORIES TYPE CONSTR. ALTER -DRAIN BACK F LOW PROTECT. DEVICE 4.00 ocC. GROUP AES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 6.06 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 50. FT. FLOOR AREA , TOTAL ACREAGE " GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 ING USE ❑N , PB❑ 0❑' INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5V.B. 6.00S FESI PARCELNO.and LAWN SPRINKLERS - OVER 5 (EA.) 1.00 EA. 200ft/10.00,the PARCEL NO. WATER HEATER W/VENT 6.00 WORKF-RS'COMPENSATION DECLARA'T'ION 1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or u c•r ted copy thereof(Sac. 3800, Lab.C.,j. Policy No. CompanyEY.21J'�j'1_r p�F•Gluh ❑ Certified copy is hereby furnished. _ ❑ Certif• opy is Bled with, the city Inspection division. Applicant_ I J0O CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($ 100) or less.) I certify that in the performance of the work for which this per- mit Is issued, I shall not employ any person in any m manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- emptimt, you should become subject to the Workers' Compensation .provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTIONLENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.).y� Lender's Name • �� 8• Lender's Address _ lrr'o. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of"tnnpurposes. s city to enter -upon, the above-mentioned property for ins inspection (We) agree tosave, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the 'Ming of this permit' vO' s 6 WATER SYSTEM 5.00 ACC FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. - _ MISC.- REFER TO ORD. FIRESPRINK Y[] No, "ENERGVT24 V❑ N[] PERMIT ISSUANCE 10.00 FLOOD ZONE V 0 N A.L.U.C. V 0 NC] PLG. CONTR. LIC. NO. - PLG. TOTAL . DTVMECHANICAL PERMIT FEE - - FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10,O60C.F.M.) 4.00 - AIR HANDLING UNIT (OVER 10=C.RM.) 6.00 SEISMIC FEE 76 EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM _ HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATI NG UN IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 - BOILER-OOMP(3 H.P.Or100,0008.T.U.) 6.00 ' PLUMBING BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIGNO. MECH. TOTAL TOTAL Slgnaturect ppll�t/Contra�� Dat OFFICE COPY