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12485APPLICANT TO -FILL IN INF BMATION WITHIN RED LINES - USE BALL POINT PFN nNI V M n ,. BU LDI NG PROJECT I DENTIFII06N APPLICATION & P IT j ELECTRICAL- PLUMBING -MECHANICAL QTY. ELECTRIC PERMIT FEE PERMIT NUMBER 12485 PLAN CHECK VALIDATION . DATE OF APPLICATION ADDRESS ss ADDRESS 225:35 SALEM AVE 2431JILDING- NAME NAME flRusT'�-. rue.PHONE969L CONTRgCTOH'S .N�A!ME /HQ4 M i'UG• uc. NO )9))s ao OUTLETS -SWITCHES -RECEP 10.00/1.00 - d(/ LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ''11 q•r 20 LAY iivc. , H,11, PHONE 7'Q ` APPLIANCES -RESIDENTIAL 4.00 (io PANELS 10.00 - OARRCHITECT �roeP ReC►+. ELNGINEER^Ir A 14 Vfl u E46116 LIc, No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS.3.00 ARCH. OR ENG. 'ADDRESS Silk ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION I I)��nn�!! f, 7 LLLEr A.OJ/�7f:_ / ISSUA N1E'p TEMP. METER OR PQ 'INSI ,- 20.00 APPLICANT'S ADDRESS s AV 1),e.M, jA/ S • ¢O $ -VV MOTORS ASEEfFE�L,0.00 SERVICE CHANGE Llty of A. LICENSED CONTRACTORS DECLARATION/�s I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions CodSanq m license ism full for �n,Qeffe License Cl as _ - y Lic. Number 0111b Date �_-_-Contractor �'j'j'(''��1 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License' Law forthe followingmason.(Sec. 7031,5, Business and Professions Code: Any city or county which regoiresa permit to construct,alter, improve, demolish, or repair any structure, prior to its issuance, also regains the applicant for such permit to file a signet) statement that pursuant to the provisions of the ) Of Divisioo License he is (chapter of Division 3 of the Law (Chapter 9 (commencing with Section is exempt Business and Professions empt ort n hi is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5malty by any applicant for ive hemi subjects tireapplicanttoacrvil penalty Of not more than five hundred dollars 155 ❑ I, as owner of the property, or my Comp employees with wageset their sole compensation, will do the work, and the struchtr0 is nal intended or Offered fas or site (Sec. 7044, Business and Professions Code: Tire Contract.,', 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 or improvement is sold within one year of completion, m (Ira owner- builder will have the burden of proving that hu did not build or i - prove 1, aso neeose of sale.). ❑ licensed as owner of the property, am Crojecty Se ro044. a with and Professions Code: The Contrac(Or s License Law dues not apply andPRa wme,Cors dtoconstructthe project Sec. 7044. Business apply to an owner of property who builds or improves thereon, and who contracts ],or such projects' with a conlractom s') licensed pursuant t. the Contractor's License Law. ❑ I um exempt under Sec. ,B.&P.C. for this reason BLDG. ELECT. II ���1'' IT'3 ICJ I"s1, PLG.-rMECH. I� V' 9�� BUILDING PERMIT INFORMATION' MISC. - REFER TO OR PERMIT ISSUANCEVALUATION 10.00 u�.^ 185,000 $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL 7d PERMITTO 5` 1' Dj1t d OTV. PLUMBING PERMIT FEE ALTER-DRAIN-WATER(EA.) 5.00 STORIES 2�2 TYPE CONSTR. BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP R-3 RES. UNITS 1 - DRAINSFLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 d SQ FT, FLOOR AREA 926 TOTALACREAGE GAS -EA. SYSTEM -1 INCA OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 E BUILDING USE �ES IN❑D CON O oOr u INDUSTRIA TER. 30.00 LAWN SPRINKLERS -I INC5 V.B. 6.00 ASSESSORS PARCEL NO. 342-12-061 LAWN E , K ERSa,Ot1( R 5 (EA.) 1.00 ' SEWER-SANITARY-STORMEA.200tt/10.00 d /. TRACT NO, 8016 PARCEL NO. / WATER IATERIW/�V ENT 6.00 6 Owner Date WORK ERS'COMPENSATION DIiCLARAT'ION 1 hereby affirm ([not I have a certificate of consent or self -insure, or a certificate of Workers' Compen�:I n_I nsu�pyge, o ado rtificd COPY Thereof ISec. 3800, LaIrC.). L/�7 L'Yl/NU Policy No. Cmnpany_���-,'L 7 - -5t/- 5tb❑ WATER SYSTEM 5.00 ACC.DATE ACC. FILE N0, WATER TREATING EQUIP, 5.00 ZONING ENG. SITE NO. MISC.- REFER TO ORD. •Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPRINK' Y[] NEI ENERGY T2A YE) NE] CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need or be completed if the permit is for one hundred dollars(8100) .r 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 manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant PERMIT ISSUANCE 10.00yd FLOOD ZONE Y 0 NO A.L. U.C. Y E] No PLG.CONTR. LIC. NO. PLG. TOTAL /07- DTV MECHANICAL PERMIT FEE FEE SUMMARY BUILDING 545,.:50 ALTER OR ADD TO MECH. 5,00 NOTICE TO APPLICANT': If, after making this Certificate of lix- enption, you should becorne subject to (he Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I 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.), B Lender's Name APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10,000GF.NL) 4.00 ( V R OMC.F.M.) 6.00 AIR HANDLINGOOD SEISMIC FEE 12,95 EXHAUST HUCT) 5.00 (WI H D MICROFILM H EATING UNIT'ITO 700,0008.7. U.) 8.00 Lender's Address,,X' / 1 certify that I have read this application and state that file 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 this city in Comer upon the above-mentioned property for inspection purposes. (We)- agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against mid City in consequence of the grouting ofthis ffspermit . ��s��Qj-o� /�- MECH. HEATI NG UN IT(OVEA166,000 B.T.U.)9.50 ELECTRIC �-�-p VENTIL N ($I GLE) 4.00 PLUMBING /d BOILER-COMP(3 .ort OO B.T.U.) 6.0 BOILER -COMP Over 100,000 BTU) SEE FEE SCH. MECHANICAL yNO MISC. - REFER TO ORD. PERMIT ISSUANCE 1().0016 `--- TAX 280.00 CONT. LIC. NO, MECH. TOTAL r ✓ TOTAL Signature I Appimant/Contractor pate Q ^O- of URIC[ GUYY I 'l' 1 - 144 1,49 'a POST THI RD NEAR FRONT OF BUILDING • 'Cl OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ' 9I 22535 SALEM AVENUE JOB ADDRESS' ` • UNIT# _LOT# OWNER THRUST IV INC CONTRACTOR THRUST IV INC PERMIT NUMBER 1245 PERMIT EXPIRATION ��j,��yIr • PERMIT EXPIRESIF'wOCIC IS NOT STAqf D WITHIN 180AVS OF PERMIT .. I AN�PE OR 180 DAYS FROM' I LAST CAL LE0jI NSPEOuION., INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - - �oYC[.q �`CL OI< 10 6 . UFER �— �7 PREGUNITE � -- � � , PEHMIT VALIDATION g� 'I A ISSUANCE DATE S %-27 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDf UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL BLDG. ❑ ELECL I ❑ •PLG. I ❑' MECH. ❑� DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOP VALUATION $/FT. 18$.000 PLUMBING S MECHANICAL - .ELECTRICAL - PERMIT TO SFDOL FRAMING low ALP INSULATION STORIES 21 TYPE CONSTR. • 9 �0 7Vvup 911.E}ACE NO SU'BFLOOR UNTIL ABOVE HAS BEEN SIGNED OCC, OUP Jf R-3 RES. UNITS 1 ROOF d "t J y 1 u $SO FT. FLOOR AREA 2926 TOTAL ACREAGE DIAPHRAGM ••-( 1/ . DpD Ino BUILDING USE R INCON PEI JIFrl E 11 E =El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH F' ASSESSORS PARCEL NO. 1. 341--ffil PLUMBING pC 0 - GAS TEST -9-el veo - TRACT NO. 801 PARCEL NO. MECHANICAL /0, 7- 87 00 ELECTRICAL �.�^�FINALS'� ,,. DATE ' �INSP. - ACC, DATE ACC, FILE ND FRAMING ' INSULATION PLUMBING zoNlNc ENG. SITE NO. GAS _ - �-31 MECHANICAL FIRE SPRINK Y ❑ N❑ ENEHGV LZA Y ❑ N� CWn NO WORK UNTIL ABOVE HAS BEEUOCCUPANCYSEISMIC ING LATH—INTERIOR - I .'Z _RICAL ,7, ..7/_� FLOOD ZONE Y ❑ N A.L U.C. Y I] N❑ LATH—EXTERIOR -EPT. SHEETROCK' IE) g']E - FEE SUMMARY SHEAR INTERIOR I NG BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS RIC Il it ; 007 PLAN CHECK�'� FEENO _ _ TAPE OR PLASTER UNTIL ABOVE HAS BANCYcifit SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, II-. DAY BEFORE REQUIRED INSPECTION.' z. PLEASE GIVE JOB ADDRESS WHEN PHONING. Z' - SEE PERMIT FOR EXPIRATION DATE - . ELECTRIC / PLUMBING % MECHANICAL CONST. TAX 280.00 IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY