13230 (2) le
POST THIS CARD NEAR FRONT OF BUILDING -N PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION 13230
JOB INSPECTION RECORD ppqq�
10110 WESTMINSTER CT 18 PERMIYEAf TION
JOB'ADDRESS - UNIT# LOT# '}pERMITI.EXdIRESdf�WORK
OWNER THRUST IV INC CONTRACTORTHRUST IV INC ISNOT STARTED WITHIN
TION 180 DAYS OF,PERMIT ISSU-
TION DATE INSPECTOR INSPECTION RECORD ANCE OR1180:D'AYSJFROM `
FOUNDATION —LZ LASTCALLED INSPECTION.
LIFER
PREGUNITE . . - -PERMR.VALIDATION
s IL �27
POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED J
UNDERGROUND /SLAB
PLUMBING �• 1 �'i' 7
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT. PLG. MECH.
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUII.DING PERMIT
- WOOD FL OR INFORMATION
PLUMBING-
MECHANICAL ./O-BJ 4.1)00
- PERMIr To
ELECTRICAL
pw
FRAMING Q A7
^ STOR ES TYPE CONSTR.
INS CATION Y
VJ ��o DCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED �7 7 f —
SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF city of Cupertino
DIAPHRAGM
11,46 BUILDING USE
D
RES IND CON PB Other
❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE H
AS BEEN SIGNED gSSESSORS PARCEL NO.
ROUGH
PLUMBING _ 3x TRACT NO. PARCEL NO.
GAS TEST (�MECHANICAL .1 .: / ACC.DATE ACC.FILE N0 40 ROIA
ELECTRICAL FINALS DATE INSP. , .
FRAMING --I SAN # TONING ENG.SITE NO.
INSULATION I PLUMBING
GAS
MECHANICAL FIRE SPRINK ENERGY tza
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ "❑
LATH–INTERIOR C I-13- �} ELECTRICAL - FLOOD ZONE A.L.u.c.
LATH–EXTERIOR FIRE DEPT. Y❑ N❑ v❑ N❑
SHEETROCK IZ- – GRADE FEE SUMMARY
SHEAR INTERIOR Q' BUILDING " Z BUILDING
SHEAR EXTERIOR D� TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK '
00
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCv 'CI" SEISMIC FEE
14.28
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BVBUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ' /
0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! , CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
TOTAL
CALLING FOR FINAL INSPECTION. 3 =
OFFICECOPY
CITY OF CU1'JERTIN0
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
-? � a — /
Dat ------�7............... Building PermitNo. ....................F I
No. ....................
The Building Located at .... ...cT
Owned by .....�ri-tr77,-7ZZ....tv-,c....................................... ... ..........
Has (Completed) )
or Use
Bec;�,etD
....................... .........................................................................................................................
...............................................................................................................................................
................................................................... ........ .... ...........
PD-7 ..........
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
ICATION PERMIT NUMBER
I. BUI LD1 NG PROJECT I DENTI F
BUILDING APPLI£ATIOrN & PERMIT 13230
ADORE
10110 WESTMINSTER CT A6 BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S fA/ PTYELECTRIC PERMIT FEE - PLAN CHECK VALIDATION
NAME CI'
I. .
PNONE -`�/72 2
croRs
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
SA ETic.NO.3111 S LIGHTING FIXTURES 10.00/1.00
ADDRESsrons Ms Vr 9 43 oZ APPLIANCES-RESIDENTIAL 4.00 - N.
20 3 PHONE PANELS 10.0Q20 DATE OF APPLICATION
RcnlrecT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
O
OR
ENGINEER1,y�
GJiM U WB 6
LIC.No. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
P
EMP.METER OR POLE INS. 20.00 A 1
APPucnrvr's
ADDRESS MOTORS €E SCH.
a9 L M 9 0 3 SERVICE CHANGE -( 20.00 -�f f'19y
' 02 LICENSED CONTRACTORS DECLARATION L, /^s y p 7
< L,UI hereby affirm that 1 am licensed under provisions of Chapter 9 I` - f 4.I§SUA E DATE
a (commencing with Section 7000)of Division 3 of the Business and .1 / BLOG. ELECT!' PLG, MECH.
F n i Professions Code,and my license is in full fore and efffec1. C r rn 710 ❑ ❑ ❑ ❑
Z 0 A- License Class_) / Lic.Number 19.11il ••mss
Q r w Date Contractor
a Y s BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION INFORMATION
-a 0t MISC.- REFER TO ORD
X ;LL w I hereby affirm that 1 am exempt from the Contractor's License
w VALUATION $/FT.
LLOg Law for a,ermit to construct,
Professions PERMIT ISSUANCE 10.00 Q
ENw Code:Any city or county which requiresapermit toconstruc,,,at,, - 204,000 e
Q Q ¢Q Improve,demolish,or repair any structure,prior to 13 issllanCe,aI50 ELEC.CONTR. LIC.NO. ELEC. (G�J QV a A'
In y 0¢ requires the applicant for such permit to file a signed statement that TOTAL /OLJ PERMIT TO
a,es se he is licensed pursuant to the provisions of the Contractor's License v s
= za
Law(Chapter 9(commencing with Section 7000)of Division 3 of the SFDWL h
4 0 Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ Hp the basis for the alleged exemption.Anyviolation orSection7031.5 STORIES TYPE CONSTR.
i ;- by any applicant for a permit subjects the applicanto a civil penalty ALTER -WATER (EA.) 5.00 2't
of not more than five hundred dollars(S500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP .RES.UNITS
their sole Compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R-3 1
Code:The Contractors License Lew does not apply to an owner Of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 x( SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such Improve. GAS-EA.SYSTEM-11NC.40UTLETS 8.00 236
meats are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-E V T M•OVER 4 IEA.1 2.00 BUILDING USE
builder will have the burden of proving that he did not build or in,• R1;5 I❑ ❑ ❑ D❑r
prove for purpose of sale.). INDUSTR STE INTER. 30.00 rL3FJs
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAfWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Profession,Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINK'I:E -OVER 6(EA.) 1.0 347-12-069
contracts for such projects with a contractorts)licensed pursuant to SEWER•SANITARY•STORM EA.200ft/10.00
the Contractors License Law. U TRACT NO. PARCEL NO.
❑ lam exempt under See.-,B.&P.C.for this WATER HEA ER!W/VENT 6.00 8016
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate Of consent to self-insure' ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,oroAp Sed
copy thereof(Sec.3800,Lab.C.)�B0-527-Ilii D�UA//1 '�"O
Policy No. Company F
O ❑ Certified copy is hereby furnished. e, FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division, MISC.• REFER TO ORD.
Q Applicant "I'_'r•Q••-��.� Y [D N❑ v ❑ N❑
CC tn CERTIFICATE OF EXEMPTION FROMWORKERS' PERMIT ISSUANCE 10.00 U- FLOOO ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTH. LIC.No. PLG, ?? I
1 0 (This section need not be completed if the permit is for one TOTAL /J� v❑ N❑ Y❑ N❑
:3 Z hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which this per. PTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers Compensation Laws of California.
LU Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 693.00
} 0 NOTICE.TO APPLICANT: If,after making this Certificate of Ex
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT IT 0 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HAND LING UNIT(O Rt 0 C.F.M.) 6.00 SEISMIC FEE 14.28
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD IW,ITH. UCT1. 5.00 S
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). .r ' HEATING UNIT IT 100,000 .7:U;) 8.00 jo
Lender's Name HEATING UNITI _ ER 00,000 B.T.U.19.50 �
Lender's Address�..S� 1 ELECTRIC -�
I certify that I have read this application and state that the above VENTILATION F (SIN {• Iq0 4.00
information is correct. I agree to comply with all city and county PLUMBING0s-J
ordinances and State laws relating t0 building construction, and BOILER-COMP(3 H.P.of 100,000 B.T.U.) 6.00 3rJ
hereby authorize representatives of this city to enter upon the J 'b
above-mentioned property for inspection purposes. BOI LER-COMP (Over 100,000 EITUI SEE FEE SCH. MECHANICAL J-
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino
against aaccrue audg ants, costs and expenses which PERMIT ISSUANCE 10.00 Q i CONST.TAX 280.00
Y Y Y 6 y in consequence of the
granting of this permit. �J MECH.CONT. LIC.NO. MECH. N- - -
)t e- Ne- 7/•87 TOTAL �/� TOTAL
Signature of Applicant/Contractor Dale ?'
OFFICE COPY