13232 (2) POST THIS CARD NEAR FRONT OF BUILDING
^- PERMIT NUMPEH
CITY OF CUPERTINO* 13232
INSPECTION DIVISION ,
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10120 WESTMINSTER CT uN1T4LOT#19
PERMIT EXPIR $ IF WORK
OWNER THRUST' IV corvrRACTOR THRUST IV IS NOT STARED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION -2��( J - - ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUNn /SLAB-_- _ 1 • �e l
PLUMBING
ELECTRICAL - - '"� Jill i C"11SUANCE DATE
MECHANICAL - BLO - •ELEcr. PLc. MEC R.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bu LDING PEaMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING _P7 AO
000
MECHANICAL _ 213�PERMIT TO
ELECTRICAL
FRAMING s1'DWI.
INSULATION - sroFg ES -TYPE CONSTR.
DCC,GROUP RES.UNITS
-" R-3 1
LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED rity nf ropprif"o
( SQ FL FLOOR AREA TOTAL ACRfiAGE
ROOF
DIAPHRAGM "'d""'- .�I9,�
I DING USE
D If HES IND CON PB GO.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 19 El El F-1 1
ASSESSORS PARCEL NO.
ROUGH
PLUMBING -
q•1 y TRACT NO. PARCEL NO,
GAS TEST' 7� �7 Tv CN / 11
MECHANICAL
A
ELECTRICAL '�J- O— � FINALS DATE INSP. AC CC FILE NO.
•
FRAMING !AN SAN # ZONING ENG.SITE NO,
INSULATION I -�,F] ` PLUM
BIN
GAS �� Q
MECHANICAL FIRES.PRwlc ENERGY r.za
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - _ 0 v "o v N[]LATH-INTERIOR gj' ELECTRICAL FLOODZONE A.L.U.C.
LATH-EXTERIOR FIRE DEPT, YC] . N[] Y ❑ N�
SHEETROCK '�. GRADE FEE SUMMARY
SHEAR INTERIOR -97 BUILDING Z
SHEAR. EXTERIOR TEMPQR 'RY, ,11PR'OVALS BUILDING
45.50
FIREWALLS ELECTRIC V- PLAN CHECK
GAS o FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC ,
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ,
O� PLEASE GIVEJOBADDRESS WHEN PHONING.
Z • MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL ~�
CALLING FOR FINAL INSPECTION. �'�• _
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date ...... ................... 192F. Building Permit No.
The Building Located at ...I---0.. ........kj
�
Owned by ......TIA—v-.-acted
r....................... ..............................................
Has Been Com leted or Use As: ...sYJ=.,0...(A/... ................................
Com
..................................................................................................................................................
..............I..................................................................................................................................
........................................................... ........... ....................
PD-7 ..... - BUIL...IN
„ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
N BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ADDRE s APPLICATION & PERMIT 13232
ADDRESS
WESTMINSTER CT Zor /e BUILDING7 - ELECTRICAL-PLUMBING-MECHANICAL
OWNERS C 15\ PLAN CHECK VALIDATION
`T / /���r DTV. ELECTRIC PERMIT FEE
7u PHONE 94 //i
NAME crDR's UTLETS-SWITCHES-RECEP 10.00/1.00 OR
NAME
S g uc.rvo. LIGHTING FIXTURES 10.00/1.00 -�
ADDRESS rolls M,V 9444-3 APPLIANCES-RESIDENTIAL 4.00 -
z6q3 LAAIDAI1125 bQ. PHorvE PANELS lo.og ao DATE OF APPLICATION
ORCHIiECTPANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.N0.
OR
EN 1 EER 1 '
A D61V E LIC.NO. SIGNS TRANS. 3.00
AARCHOR DDRESS ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00il�
APILICAN MOTORS SEE FEE SCH.
ADDRESSDDRESS
2493 ZA SERVICE CHANGE 20.00 / 1,
'02 LICENSED CONTRACTORS D17CLARATION
a v
in I hereby oft,,. that I am licensed under provisions of Chapter 9 OrIsSSLACDAOT
E
Q W
A (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG.of MECH.
F 7 z Professions Code dd and my license ism full fore and Effect.
i O 0 License Class_p=1_Lic.Number)
L - -/t.S I
O D Date Contractor
y,M W
� E� BUILDING PERMIT
¢ 0 w u OWNER-BUILDER DECLARATION INFORMATION
w ; n� I hereby affirm that I am exempt from the Contractor's License MISC.- REPERFF(Q ORD
a PERMIT ISSUANCE 10.00 �(Ji VALUATION $/FT.
u0 ¢ Law(ortheity or c reason. Professions
� W N � Code: e,tem y or county whiny requ hum,permit to construct,issuance,
hq 213,000
rte ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEL,CONTR. LIL.NO. ELEC. G i
al
O 0 requires the applicant for such permit to file a signed statement that TOTAL/ PERMIT TO
a. w m he is licensed pursuant to the provisions of the Contractor's License •A
Hz >
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe SF,DA
i 4 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hunlired dollars(8500)): 2 5N. HR
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 cc GROUP RES:UNITS
their sole compensation,will do the work,and the structure is not _ 1
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code:The Contractor's License Law does not apply to an owner of
-� property who build,nrImprove,thereon,and who does Such work FIXTURES-PER TRAP 5.00 O^- ,D.FT.FLOOR AREA TOTAL ACREAGE
himselforno(hrough
de ownemployees,for
le.If,however,
r,the
improve- GAS-EA.SYSTEM-1 6.00
menta are not intended or offered for sale.If,however,the building 3385
or improvement is Sold within one year of completion,the owner. GAS EASYSTEM OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im. - . - REB IND CON PB Omar
prove for 1,as owner
the
INDUSTRIAL WASTE INTER. 30.00 IYT El ❑ O ❑
❑ d as owner of the properly,he exclusively contracting with lJ
licensed contractors to construct the project(Sec.7049,Business LAWN SPRINKL INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to contracts
owner of property who builds tr improves thereon,and who LAWN SPRINKL R 5(EA.) 1,00 342-12-0
theCtmet.r'chcene ts Lwitha contractor(s)licensed pursuant to SEWER-SAN Y T, EA.200ft/10.00
the COnhaCtors License Law. 9 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. - ,B.&P.C.for this WATER HEATER r gr)Li 6.00
reason 8O 16
Owner DateWATER SY T M 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREA I ,4-10 5.00
I hereby affirm that 1 have a certificate of co sent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,owAtii reed
copy thereof(See.3600,Lab.C.L� p-Al
Policy No. Company.&& 5Z7�gb rlls� -_D
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z Z ❑ Certified copy is filed with the city inspection division.
0 Applicant TAIR i*T- A MISC.- REFER TO ORD. Y[] IN Y❑ N[]
~ w
CERTIFICATE EXEMPTION FROM WORKERS' 00 FLOOD ZONE A.L.U.C.PERMIT ISSUANCE 10.
� � i
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, -t
CL Z( This section need not be completed if the permit is for one TOTAL�r>2 Y N� Y N
hundred dollars IS 100)or less,)
U 0 I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
u. U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California. 1
i Date ApplicantALTER OR ADD TO H. 5.00 BUILDING 715.50
} W 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
U such provisions Or this permit shall be deemed revoked AIR HANDLING UNITI I'0 10=11F,M.) 4.00
CONSTRUCTION LANDING AGENCY AIRHANDLINGUNFf IOVER 10,000 C.RM,I 6.00 SEISMIC FEE 14.91
I hereby affirmthat there is a construction lending agency for EXHAUST HOOD dTh 5.00 S the performance of file work for which this penult is issued(Sec. � MICROFILM
3097,Civ.C.). Fr =. B ` HEATING UNIT(T 1"TCl0 S.T.U.) 9,00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.19.50
Lender's Addre $ ELECTRIC
I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building ConSITUCtion,and BOILER-CON?(3 H.P.or 100,000 B.T.U.) 6.00 4?
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,0008TUl SEE FEE SCH, MECHANICAL 3 '-
(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 280.00
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
granting of this permit. nn � MECH.CONT. LIC.NO. MECH. - '-.
,TXc, !D_ � 7•/, 87 TOTAL �f TOTAL - u
Signature of Applican[/Con tractor Date /
�� OFFICE COPY