13327POST THIS CARD NEAR FRONT OF BUIL;DING. "
CITY OF CUPERTINO
INSPECTION DIVISION
2 ^�jJOB INSPECTION RECORD
JOB ADDRESS ��' ``�"'-'�e_'' UNIT# LOT#
OWNER � ��51 � CONTRACTOR {�(,C�' .i�
PERMIT NUMBER
13327
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION - DATE INSP CTOR,
` - INSPECTION RECORD.
FOUNDATION -j- ?
-�-� p,�s—
-4 Qd / oK if
N �Q(fL(,F NRS
UFER - -2
PREGUNITEPERMIT.VALDATION
"
1
ISSUANCE DATE
P R NO ONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
t 0
Ci Y
- c, C.
�Ly7
`ELECT/
c�
PEO MEi
�ry Its
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
VALUATION $/FT.
WOOD FLOOR
PLUMBING
MECHANICAL -d•
ELECTRICAynL� -
PERMIT TO
a�C1-�t�L _
FRAMING - @�. Q
Y
INSULATION.
STORIES
TYPE CONSTR.
OCC. GRouup
�^
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO FT 33L�R/q�IIA
1
TOTALACREAGE
DIAPHRAGM
1'
eto C� 15
I ` b 8
BUILDINGUSE
R NO CON P9 Orrrer
❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS, BEEN SIGNED
ROUGH
ASSESSORS PARCEL NO.
3N2-'►-otG(
'f
PLUMBING 4,j- -
GAS TEST 3-/_
TRACT NO,
PARCEL NO.
MECHANICAL
ELECTRICAL �� -
FINALS '�' DATE INSP.
ACC.UATE
, '
ACCFILE NO.
FRAMING -
SAN #
INSULATION - .�.
;AN
ZONING
ENG. SITE NO.
GAS
FIRE SPRINK
Y ❑ N❑
ENERGY T34
Y ❑ N❑
MECHANICAL i i
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING 3
LATH -INTERIOR
ELECTRICAL
FLOOD ZONE
Y E. No,
A. L.U.C.
Y'❑. No
LATH -EXTERIOR - 1
FIRE DEPT.,
SHEETROCK _;LQ-
GRADE
FEESUMMARY
SHEAR INTERIOR
BUILDING g
BUILDING
y
(15
SHEAR EXTERIOR
TEMPORARY APPROVALS
FIREWALLS
ELECTRIC -
PLAN CHECK
FEE
-5c Ecd I. [-
GAS
NO TAPE OR PLASTER UNTIE ABOVE HAS BEEN SIGNED
JOCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
'ARRANGE FOR INSPECTION BY PHONING 252-4505,
Z ONE WORKING DAY BEFORE REQUIRED INSPECTION.
o� PLEASE GIVE JOB ADDRESS -WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL
IMPORTANT!
READ REVERSE SIDE BEFORECALLING.FOR FINAL INSPECTION.AL
FCO:NTAXPLEASE
OFFICE COPY - V
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT_PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
PERMITNUMBER ,
BUILDING
ADDRESS 22555 Salem Avenue tor413327
OWNER'.
NAME
TY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
Thrust IV Inc. PHONE(415 �4�
DATE OF APPLICATION
croRs
NAME
NAME
Thrust, IV, Inc. LIC. NO.319115
OUTLETS -SWITCHES -RECEP 10.00/1.00
26 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
CO
ADDRESS
2093 Landings DnHONE969-7722
2 PPLIANCES- RESIDENTIAL 4.00 �}
^1 PANELS 10.00 20
ARCHITECT Corp. Arch.
OR
O
ENGINEE
am Van De We Ih I®.
PANELS(OVER 200 AMP) 20,00
PLAN CHECK FEE P,0. N0.
SIGNS TRANS. 3.00
ARCH. OR ENDS
ADDRESSame
SPECIALCIRCUIT j, 00
PER ION
EMP. METER OR POLE INS. 20.00
Ted Dedriksson En .:IP
41G 198-1,
s 77T000'l//1
ADDRESS
ADDRESS
6 MOTORS E SCH. 6 ^
SERVICE CHANGE 20.00
2093 Landings Dr. Mnt. Viet,
pC�p�DD
LICENSED CONTRACTORS DECLARATION
r P 1013-7
1 hereby affirm that I am licensed under provisions of Chapter 9
'ISSUANCE DATE
(commencing with Section 7000) of Division 3 of the Business and
Professions C aaPpd my license is in full form gf1'ep.
Licensse� CS�I s 1 Lic. Number 111 ..JJ
I
no
BLDG.
ELECT.
JJ�jJf
PLO MECH.
�rLY4VI( lD�-C�/.�h
Date1(% Conhacmr Ih,``]]77
BUILDING PERMIT
OWNER -BUILDER DECLARATION
I hereby collo that 1 am exempt from the Contractor's License
Law for the following reason, chemuinsa,ermBusiness t tocand Professions
Code: Any city or county which structure permit to construct,alter,, also
improve, demolish, or repair any structure, prior n 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 ofthe
Business and Professions Code) or that he is exempt therefrom and
INFORMATION
MISC.- REFER TO ORD
vALUATIOg
�x/�r'DD\
O`/ t/Js l//1
S/FT.
PERMIT ISSUANCE 10.00 /Q ^�
ELEC. CONTR. LIC. N0.
/,I����
TOTAL
TOTAL /"'7"
PERMIT TO
45P Aj
s/
OTY. PLUMBING PERMIT FEE
STORIES
TYPE CONST
the basis for Ole alleged exemption. Any violation of Section 7031.5
by any applicantfor a permit subjects the applicant toa civil penalty
of not more than five hundred dollars (55000.):
ALTER -DRAIN -WATER IEA.) 5.00
❑ I, 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 Contractor's 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
R�--
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
/ FIXTURES - PER TRAP 5,00 90"
SQ FT. FLOOR AREA
b
TOTAL ACREAGE
GAS-EA.SYSTEM-11NC.40UTLETS 6,00 4
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that h e did not build or im-
prove for purpose of sale.).
❑ I, as owner of the property, an, exclusively contracting with
licensed contractors to construct the project (Sec. 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
GAS - EASYSTEM -OVER 4 (EA) 200
. ..
BUILDING USE
RE IND CON PB Omer
❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
I LAWN SPRINKLERSCr V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
IAL4
11 ��ee
contracts for such prajems will, u con raetorfs) licensed pursuant to
the Contractor's License law.
SEWER-SANITA YrSTORMEA?200tt110.00 /0-
TRACT NO.
PARCEL NO.
❑ lam exempt under Sec.-,B.&P.C. for this
reason
gv'�
WATER HEATE `W/ E T 6.00 6-
Owner Date
WATER SYSTEM 5.00
p ftIDO 5'
ACC. DATE
ACC. FILE NO.
WATER TREATI QUIP. 5.00
WORKERS'COMPIiNSATION DECLARATION
I hereby affirm that I have a certificate ol'Cousenl to self -insure'
or a certificate of Workers' Compe I su�r gr certif,,d
copy themor(See. 3800, Lab.C.1. � 8� 27 �b�
Policy No. Company
ZONING
ENG. SITE N0.
_1 O
FIRE SPRINK
Y ❑ N ❑
ENERGY T-24
I Y ❑ N❑
❑ Certified Copy is hereby furnished
❑ Certified copy is filed with the city inspection division.
Applicant
MISC.- REFER TO ORD.
CERTIFICATE OF EXEMPT ON FROM WORKERS'
PERMIT ISSUANCE 10.00 140
FLOOD ZONE
A.L.U.C.
PLG.CONTR. LIC, NO.
PLG. /2��
TOTAL L
COMI'ENSA'I'ION INSURANCE
(This section need not be completed if (lie permit is for one
Y N
❑ ❑
Y N
❑ ❑
CITY. , MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars IS 100) or less.)
I certify that in the performance of the work for which this per.
mil is issued, I shall not employ any person in any manner so as to
become subject to the Workers' ComP ensation Laws of California.
Date Applicant
BUILDING
�l
15 i
ALTER OR ADD TO MECH. 5.00
NOT CE TO APPLICANT: If, after making this Certificate Ex-
APPLIANCE 5.00
PLAN CHECK
rs' sa
emption, you should become subject to the Workers' Compensation
you must drevoke comply with
provisions io for Labor Cit shall
such provisions or this permit shall be deemed revoked
FEE
AIR HANDLING I I• � � O,000OF.M.) 4.00
AIR HANDLING UNIT(OVEF.(110,OOb C.F.M.)6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
EXHAUST O'CjbJ(WITH bUGT)
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.). F . I . B
Lender's Name -5-1.08._
Lender's Address
MICROFILM
HEATING UNIT (TO 100,00 .U.1 8.00
Q /�.
HEATING UNI 1(9V'ER• ,000B.T.U.19.50
ELECTRIC
/vf 4.
I 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
VENTILATION FAN (SINGLE) 4.00 /Q -
PLUMBING
BOILER- CUMP(3 H.P. or 100,000 B.T.U.) 6,00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
1
�3•
hereby authorize representatives of this city to enter upon the
above mentioned property for inspection purposes.
MISC. - REFER TO ORD.
CONST. TAX
UX
(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 suit) City in consequence of the
PERMIT ISSUANCE 10.00 /O-
granting of this Permit.
8/3/87
MECH. CONT, LIC. NO. MECH.
TOTAL +ria`=
TOTAL
/zq,
Signature of Appicant/Contractor Date
OFFICE COPY
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