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13330.9',- a POST THIS CARD NEAR FRONT OF BUILDING y( CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION. RECORD �-5�fs 5�1ern /-1-V� JOB ADDRESS # UNITLOT# I�T�/�� < I-1/ '' OWNEfl�, lr U-J� CONTRACTOR'-rh U5f J -Y_ PFRMIT NUMBER 13330 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN .1BODAYSOFPERMITISSU- ANC E_'p 180 DAYS FROM LAST CALLED INSPECTION. ^^ I INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION �L i •��8 ox UFER PREGUNITE /` yt� I+PERWU VALIDATION V CUDCf1\00 C} CS �• r� ISSUANCE DATE POUOO CO CRETE UNTIL ABOVE HAS BE S GNED UNDERGROUND/ -SLAB PLUMBING - - ELECTRICAL -. .MECHANICAL BLDG, ELECT. E� PLG. MECH� rq �• 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUIILDDINGPLEERMIT INFORMATION ` • WOOD FLOOR VALUATION / i) $/FT. PLUMBING, _ MECHANICAL ELECTRICAL PERMIT TO :5 �! FRAMING INSULATION - STORIES /1 TYPE CONSTR. s - OCt-C^�GHODP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF1_� SD. IT. FIOOR "EA IG TOTAL ACREAGE DIAPHRAGM 4` tau rKhY 5 `Nw — d^ LLOING u5E RES IND CON PB 00,ni o o o APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED A55ESSO`R-5^PARCELNO. J �_;�—r3 -6>&, ROUGH . ' PLUMBING GAS TEST TRACT NO. C//y !J PARCEL NO. MECHANICAL - ELECTRICAL ^�'r FINALS, 'DATE INSP. ACC.DATE ACC, FILE No. FRAMING ^-are_ SAN # ZONING ENG. SITE NO. INSULATION PLUMBING ' - GAS EIRE SPRINK,, Y NE ENERGYT.za YL. NC] MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN S G ED HEATING '�� Econo ZONE Y C] NEl a.l.u.c YO NEI LATH -INTERIOR ELECTRICAL LATH -EXTERIOR FIRE DEPT. .SHEETROCK 2 GRADE - FEE SUMMARY SHEAR INTERIOR BUILDINGI_ BUILDING SHEAR EXTERIOR \'2-.\p>$ "TEMPORA APP OVALS FIREWALLS ELECTRIC PLAN CHECK FEE SEISMIC FEE .117 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCVOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBV BUILDING INSPECTOR. uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE'WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - —SEE PERMIT' FOR EXPIRATION DATE — MICROFILM ELECTRIC LT• ir' - PLUMBING MECHANICAL � CONST. TAX �j�(�•' IMPORTANT! PLEASE READ REVERSE SIDE BEFORETOTAL' CALLING FOR FINAL INSPECTION. 11 f47f� I OFFICE COPY ' ' 'APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 13330 BUILDING ADDRESS 22585 Salem Avenue Q7' OWNER'S NAME DTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION Thrust IV Inc. PHON 415 969-772 's NAMECONTRACTOR- NAME OUTLETS -SWITCHES -RECEP 10.00/1.00 99•' Q LIGHTING FIXTURES - 10.00/1.00 20 -- Thrust IV Inc. I Lm.No.319115 CONTRACTOR'S ADDRESS APPLIANCES - RESIDENTIAL. 4.00. $_ 2 PANELS 10.00 20- y 2093 LwAings Dr. PHONE 969-7722 DATE OF APPLICATION ORCNrtEcrCorp Arco OR ENGINEER VanDe LIC, NO PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG. per_ ADDRESS XXLL�ItlC SP ECIAL CIRCUIT 5,00 PER T ALIDATION •'s�l✓i rrEMP. METER OR POLE INS. 20.00 Ted DedriksSOn Enp. ZIP n r AS ADDRESS MOTORS SEE FEE SCH. 5 ^` 5- SERVICE CHANGE '20.'00 2093 ' ��G City ;1/da67 Ghry �� LICIiNSED CONTRACTORS DECLARATION slfx n 1"�-I 1 hereby affirm that I am licensed under provisionsof Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Co, qmd my license is in full foryy'''��yyggaf(fed. Licens s-Cic.Numbe- hr, 47 Date Contractor L�1' dr ' -� I J ISSUANCE DATE n.x. _ �„ BLDG'. ELECT. PLG. MECH. ' OWNER.BUILDER DECLARATION Contractor's License I hereby affirm that I am exempt (m.5 the Contractor following whichequire .a perminess t 10Cnd Professions Law: Any city Code: Any city or county which requirtsa permit to consrucL edeq 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 BUILDING PERMIT INFORMATION MISC.- REFER TO ORD /-O- PERMIT ISSUANCE 10.00 ' VALUATION Ny ' �0 /100 D l/l/� $/FT. ELEC. CONTR. LIC. N0. ELEC. I/ �T TOTAL l6 PERMIT TO �� DW OTY. PLUMBING PERMIT " FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation o(Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5000.): 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 sl option, is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP P,Code: RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 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. mems are not intended or offered for sale. If, however, the building - J �y )Q- F IXTUR ES - PER TRAP 5,00 IVO- SD. FT. FLOOR AREA ^ TOTAL ACREAGE GAS - EA. SYSTEM -1INC. 4 OUTLETS 6.00 �.- 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.), ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RE Into CON PB Omar ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business Contractor's License Law does not apply, and Professions Code: The who to ofproperty who buildstr improves LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5(EA.) 1.00' ggqSSESSORS PARCEL NO. rased Uandwho frowner contracts for such projects with a contrectogs) licensed pursuant to the Contractor's License Law. El am exempt under Sec. ,B.&P.C. for this mason SEWER -SAN ITARV-STORM EA. 200ft/10.00 /O -' TRACT NO. ( - XVy' AC�'1Y/^ PARCEL N0. - WATER HEATER W/VENT•', 6.00 6'- Owner Dale WATER SYSTEM 5.00 5 ACC. DATE ACC, FILE NO, WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION, 1 hereby affirm that I have a certificate ofconsent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy Noeof(Sec. 3800, Lab.CJ. ,S'Yrt npf]G Policy ere Company_ �?(j__ ZONING ENG. SITE NO. t•r r rinnrllnn , FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ '❑ Certified copy is hereby furnhs Cd. ❑ Certified copy is filed with the city inspection division. Applicant MISC.- REFER TO ORD. CERTIFICATEOF EXEMPTION I7ROM WORKERS' PERMIT ISSUANCE 10.00 �Q� FLOOD ZONE A.L.U.C. . COMPENSATION INSURANCE ('I his section need not be completed if the permit is for one Y ❑ N [:JY ❑ N❑ PLG. CONTR. LIC. NO. - PLG. TOTAL .SIO%'� hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I stmt! not employ any person in any manner so as m becomesubject to the Workers''Compensation Laws of California. Date - Applicant DTV. MECHANICAL PERMIT FEE r,. n ,_..;.. FEE SUMMARY BUILDING L/ 3 ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of F, eruption, 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 r APPLIANCE I I (� C �� 5.00 PLAN CHECK FEE AIR HANDLIN UNIT (TO W,000 .M.) 4.00 , AIR HANDLINGUNIT(?VER ig000C_RM.) 6.00 SEISMIC FEE lir CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for I` EXHAUST HOO D'IW ITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). I BIII Lender's Name Lender's Addre951003 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 $- HEATING UNIT (OVER 100,000 B.T.U.) ELECTRIC tv I certify that l have read this application and state the the above information is Correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, and z VENTILATION FAN (SINGLE) 4.00 g• PLUMBING D�, BOILER-COMP(3 H.P. Or, 100,000 B.T.U.) 6.00 BOILER-COMP(Ovs,100,000BTU1SEEFEESCH. MECHANICAL 3 , hereby authorize representatives of this city m enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX O V - (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 said City in consequence of the - PERMIT ISSUANCE 10.00 �D-- granting of this permit 8 3 87 MECH. CONT. LIC. NO. MECH. TOTAL 3� TOTAL Signature of Applicant/Contractor Dace OFFICE COPY