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12495„APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION APPLICATION &PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 2495 BUILDING ADDRESS /y. y SALEM __ OWNER'a NAME Til I/S NC• PHONE QTY.'. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION NAME CONTRACTORS NAME �� OUTLETS -SWITCHES -RECEP 10.00/1.00 / LIGHTING FIXTURES 10,00/1.00 uC. NO. 9//j` r gACTo 's AooREss M.V 41C APPLIANCES 4.00 PANELS 10.00 '- zQ PHONE 969- M2 DATE OF APPLICATION ARCHITECTC%I)AEON, k OR E. F1 ENGINE 6AK 4.1 DoW&WE LIC. NO. -' VER 200 AMP) 20.00 PANELS(O FLANCHELK FEE P.C. NO. -' a. SIGNS TRANS. 3,00 ADDRESS ENG' - _ SAms ZIP SPECIALCIRCUIT 5.00 )// PERMIT VALIDATION er/ / '�/3(,J ISSUANCE DATE TEMP. METER OR POLE INS. 20.00 APPLICANT'S AD DRESS 2O LAMB g N 3 -MOTORS PlAgo SEE FEE SCH. SERVICE CH NGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cad µn my, license ism full fore License Class- sec. Number ��11.. 3 Dale Ta' Contractor J'--:_ 1�t A._ r J / ijf .IIB,..... BLDG. ELECT. �r C� PLG. MECH. rtI _ LC. .-ter tqf BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License La w for the following mason. (See. 7031.5, Businessand Professions Code: Anycity orcounty which requires a permit reconstruct, 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 a License Law (Chapter 9 (commencing with Section 7000) ofDivision 3 of the Business and Professions Code) or that he is exempt therefrom and MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION 215 OQO • $/FT. ELEC. CONTE. LIC. NO. ELEC, _l TOTAL 9~ PERMIT TO SFDW1, QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars (S500).): 2 ALTER -DRAIN -WATER IEA.) 5.00 O 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 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP R-3 RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who docs such workFIXTURES himself or through his own employees, provided that such improve- HIC!HS are not intended or at't'end for sale. ll', however, file 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 int- prove of sale.). 1, aso Las ownernee of the property, am exclusively contracting with licensed contractors to construct the project (See. 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 - PER TRAP 5.00 52d so. FT. FLOOR AREA 34,31 I TOTAL ACREAGE GAS-EA.SYSTEM-1.INC.40UTLETS 6.00 GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 'BUILDING USE R IND CON PB Other -1❑ INDUSTRIA WASTE INTER. 30.00 LAWN SPRI SIS' 1 INC 5 V.B. 6.00 ' LAWN SPRINK ERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. 34-12-061 contracts for such projects with a cuntraetons) licensed pursuant to the Contractor's License Law. SEWERSANITARY-STORM EA. 200ft/10.00 Q"'- TRACT NO, PARCEL NO. ❑ tum exempt under Sec. ,B.&I'.C. for this rea- $016 WATER HEATER W/VENT 6.00 .Ownerson Date WATERSYSTEMu9e 100 5.00 '- ACC.DATE ACC. FILE NO, WORK I:RS'COMPIiNSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofcoment to self-insum. or a certificate of Workers' Cumpens fipn Insurance, or n ceti f,.1 copy thereof (Sea 3500, LAIC.). TS IrOND ZONING ENG. SITE NO, l Policy No. Company --A 0 -j --27--B6' - FIRE SPRINK ❑ N[:] ENERGYT Z< Y [] NG' ❑ Ceitfied copy is hereby furnished. ❑ Certified copy is filed with rhe city inspection division. Applicant -Y MISC.- - REFER TO ORD. CERTIFICATE OF E:XBMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 d-- FLOOD ZONE A.L.U.C. PLG. CONTR, LIC. NO. PLG. b TOTAL �� COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N Y [:] NE] hundred dollars IS 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 Say manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ]20.50 become subject to the Worker' Compensalion Laws of California. Date ApplicantALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex APPLIANCE 5.00 PLAN CHECK emption, 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. AIR HANDLING UN I' C.F.M.) 4.00 FEE ' AIR HANDLING UN ( QOWC.RM.I 6.00 SEISMIC FEE 15.05 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST H 0 (W TH UC1T) 5.00 S the performance of the work for which this permit is issued (Sec. 3097, 0,C.), yP �-� Lender's Name) MICROFILM HEATING UNIT(T01C10 00'B.T.U.) 6.00 HEATINGUNTIOV� 100 0 .T.U.1 B.50 ELECTRIC ro Lender's Address k {� 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 relatingto building construction, and VENTI LATIO A ( 4.00 !4a' PLUMBING BOILER-OOMP(3 H.P. or 100,000 B.T.U.) 6.00 801 LER-COMP Over 100,000 BTU) SEE FEE SCH. MECHANICAL l hereby authorize representatives for ins of this city to enter upon the above hereby authorize property for inspection purposes. MISC. - REFER TO ORD. 'pERM1T ISSUANCE 10.00 UL 6 CONST. TAX 2$0, 00 (We) agree to save, indemnify and keep harmless the City' of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue,againstsaid City in consequence of the grantigng of this permiLy/sJ yX].Gi �, A_ RYQCt �'• /�/A� MECH. CONT. - LIC. NO. MECH, TOTAL i /� 021 TOTAL -.--(i - SignatureofApplicant/Contractor r Date 6'8'87 OFFICE COPY ' POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO > ti9 INSPECTION DIVISION JOB INSPECTION RECORD ' JOWADDRESS 22525, SALEM AVENUE UNIT# _LOT#1 THRUST IV INC "" THRUST IV INC OWNER CONTRACTOR �' '.PER MIT NUMBER 124 PERMIT EXPIRATION - PERK T UPIRES IF WORK S GIO ARTED WITHIN +Bo VS OF PERMIT'ISSU-, ANC -�OR X180 DAYS FROM L""AST ClilL E D INSPECTION. INSPECTION DATE INSPECTOR - INSPECTION RECORD FOUNDATION - �g Gv'ee� bon OK 0.1! $7 L, UFER PR EGUNITE r LV OPEniik.Tvt;ED,pnoN �V4 , J ISSUANCE DATE S- -%i"g7 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED "•. UNDERGROUND'/SLAB PLUMBING - ELECTRICAL MECHANICAL BLD . ELECT. oI PLG. �, MECEJ ox DO NOT POUR FLOOR UNTIL ABOVE -HAS BEEN SIGNED BUILDING PERMIT INFORMATIONS WOOD FLOOR - VALUATION E/FT. 215*000 PLUMBING _ - " MECHANICAL ELECTRICAL - - ryr f " �t i tJ PERMIT TO SPDWL FRAMING �', INSULATIONZ" STORIES TYPE CONSTR. 0 / „ OCC.GROUP &'3 RES. UNITS is 1 PLACE NO SUBFLOOR UNTIL ABOVE HAS.BEEN SIGNED �I 'ROOF _ SO. FT. FLOOR AREA 3431 TOTAL ACREAGE: ' DIAPHRAGM —/ — i BUILDING USE RES INDPB Orner ID 0 0 11 AP.PLY,NO ROOFING UNTILABOVEHAS BEEN SIGNED ROUGH ' ASSESSORS PARCEL NO. " PLUMBING _ -17 TESTTRACT _9- N0. PARCEL NO, MECHANICAL - ELECTRICAL p- % FINALS DATE (NSP. ACC.DATE ACC. FILE NO. FRAMING .-Z SAN # r�o2 INSULATIO _ ' PLUMBING ZONING ENG, SITE NO. GAS /_ g' MECHANICAL - FIRE SPRINK � ENERGY T}0 V L. NE] COV ORK UNTIL ABOVE HASBEEN SIGNED HEATING ... *7 - ,Pe LATH -INTERIOR 111-2 C: _ ZONE "� A. L.U.C. "� _44ELECTRICAL LATH -EXTERIOR - FIRE DEPT. SHEETROCK I GRADE "FEE SUMMARY SHEAR INTERIOR ,"' - BUI LDING -4%- "APPROVALS 290 50 SHEAR EXTERIOR^� lo/BUILDING .TEMPORA FIREWALLS ELECTRIC 'PLAN CHECK FEE " - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 15.05 OCCUPANCY, OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ID BY BUILDING INSPECTOR. MICROFILM w ARRANGE FOR INSPECTION BY PHONING ?52-5,05,,_ O~� ONE WORKING DAY BEFORE REQUIRED FIN$P CT10N7 Z PLEASE GIVE JOB ADDRESS WHEN. PHONIIt{fJ7ITyG�.I -SEE PERMIT FOR EXPIRATION On 1 Ef CDp$rtIDD ELECTRIC Pv\ PLUMBwG - f MECHANICAL CONST. TAX 280.00 - IMPORTANTI PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION,' TOTAL:-,�-7771 OFFICE COPY I