13216 (2) POST THIS CARD.NEAR FRONT OF BUILDING .
' PERMIT NUMBER
\ CITY OF CUPERTINO13216
INSPECTION DIVJOB INSPECTION RI SION CORD
IDI Ib PERMIT EXPIRATION
JOBADDRESS WESTMINSTER -COURT UNI T# LOT# 18/19
PERMIT EXPIRES IF WORK
OWNER THRUST IV, INC. CONTRACTOR THRUST IV, INC. IS NOT STARTED WITHIN
INSPECTION DATE I INSP CTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION1-4 70
_-2y-.&7 (ZP oW ANCE OR 180 DAYS FROM
F-
UFER LAST CALLED INSPECTION.
� '�
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I'®
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL J J ISSUANCE DATE
MECHANIeyg� T. PLG, MSCH,
CAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED euaowc PERMIT
INFORMATION
WOOD+F LOOK VALUATION s/FT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL '
FRAMING +'��'� r � �4"
STORIES TYPE CONSTR.
INSULATION
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
tlUILU USE
RES IND CON
PH Orocr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ El 11
ROUGH ASSESSORS PARCEL NO.
PLUMBING
iHACT NO PARCEL NO.
GAS TEST '
MECHANICAL
ELECTRICAL; FINALS DATE INSP. ACC.DATE ACC.FILE NO,
FRAMING SAN 0
INSULATION PLUMBING- 7 ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
ELECTRICAL FLOODZONE A.L,U,C.
rH—INTERIOR �
H-EXTERIOR FIRE DEPT, Y[] NYO NEI
TROCK GRADE FEE SUMMARY
I INTERIOR BUILDING7-.2--7-a'-
EXTERIOR
TEMPORARY APPROVALS BUILDING j C�
LLS ELECTRIC PLAN CHECK
I
GAS FEE
E OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE r.w�
CYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
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.
OFFICE COPY
4PPI-'CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT 13216
ADDU"LRE East
�7M N5121
AppnSss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
Eoua-r aT �s
OWNER'S PLAN CHECK VALIDATION
NAME (J/C¢IS) OTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTORSRAVE UTLETS-SWITCHES-RECEP 10.00/1.00
Q C. LIC.xD LIGHTING FIXTURES 10.00/1.00
r-Dxrn4cTORs
APPLIANCES-RESIDENTIAL 4.00
AOORf55
PHONE PANELS 10.00 DATE OF APPLICATION
OR
•./� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINE Aa /�
LIc.No. SIGNS TRANS. 3.00
ARCH,OR - PERMIT VALIDATION
ENG.ADDRESS SPECIALCIRCUIT 5.00
ZIP ITEMP.METER OR POLE INS. 20.00 00,
APPUCANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
a is u I hereby affirm that I am licensed under provisions of Chapter 9 of CVY ISSUANCE GATE
(commencing with Section 7000 of Division 3 of the Business and
a vawi ( S ) BLDG. ELECT. PLG. MECH.
M Professions Co an m license is in full for��sa d IT ct.
a0 W Liwnse Class ± Y Lic.Number_p. </.S - ❑ ❑
2 m r J Datc Contractor
BUILDING PERMIT
tc M a OWNER-BUILDER DECLARATION
c d U MISC.- REFER TO ORD INFORMATION
w ; LL N I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
F u m a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to constmet.alier,
uEa a p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
al C u requires file applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w m m he is licensed pursuant to the provisions of the Contractor's License
H z r
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 o Business and Professions Code)or that he is exempt therefrom and OTT. PLUMBING PERMIT FEE w A
f$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than ftve hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractors license Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 50,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 8.00
m .enare not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of Sala). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PR oma,
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such proicets with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO, PARCEL NO.
❑ lam exempt under See..,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKERS'COMPE-NSA'fION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or e{jl�d ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab,C
NI -
Policy No. ComPunyY11r�1-52�/__--% r�llll�_
O ❑ Certified copy ishareby furnished FIRE SPRINK ENERGY T-24
ZZ ID Certified copy is fled with the city inspection division.
p: -
O Applicunt '�aigMISC.- REFER TO ORD. Y [:JN❑ Y [:] N❑
rn PERMIT ISSUANCE 10.00
LU - CERTIFICATE EXEMPTION FROM WORKERS' PERMIT ZONE A.L.U.C.
W > COMPEE NSATION INSURANCE vLG.CONTR. LIC.No. vLG.
0. Z( This section need not be completed if the permit is for one TOTAL Y El NEI Y 11N0
hundred doll..($100)or I...)
) O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
Dace Applicant BUILDING Epp?
a ALTER OR ADD TO MECH. 5.00
} ti NOTICE TO APPLICANT: IL after making this rs'Certificate sa lix-
F 2
provisions
you should become subject m the Workers'CComply With APPLIANCE 5.00 PLAN CHECK
provisions io the Lobar Cade, you must forthwith comply with FEE
CJ such provisions or This permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000OF.M.) 4.00 r
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE s9 a
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 .�
the performance of the work for which this permit is issued(Sec. - HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.CJ.
Lender's Name HEATING UNIT(OVER 100,000 B,T.U.)9.50
Lender's Address ELECTRIC
I Carlify that I have read his upphcallOn and State Thal the above VENTILATION FAN (SINGLE) 4.00
l information is correct. I agree to Comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the 801 LER-COMP 10ver 100,000 BTU)SEE FEE$CH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, 'indemnify and.keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against mid City in consequence of the PERMIT ISSUANCE 10.00
IRS ling of this permit. A MECH.CONT. LIC.NO. TOTAL / &0t]t pe A456'-2(d$y TOTAL fQ
Signature of Applicant/Contractor Data
OFFICE COPY