The URL can be used to link to this page

12497 (2)Y tl U^ . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY G ,4 ' -011-DING PROJECT IDENTIFICATION 20 APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 12497 BUILDING aoDRESS 10130 WESTMINSTER OWNER'S NAME CITY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION y_M,.XJlJC, PHONE 967- 2 NAMERacrces p OUTLETS-SWITCHES-RECEP 10.00/1.00-rNO IGHTI NG FIXTURES 10.00/1.00 (dU5 LIC.ND. /JS - DATE OF APPLICATION DR's CONTRACTOR OND Cnq �x 40 3 LAM DIMbs DR, My PHONE 94 -7722 y PPLIANCES-RESIDENTIAL 4.00 ii PANELS 10.0 p ORRCHITECT�rORP 2mN. %ir5 & LIC. NO. ENEWEER PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS ee, ZIP SPECIAL CIRCUIT 5,00 PERMIT VALIDATION TEMP. METER OR POLE INS, 20.00 APPLICANT'SADDRESS '21 fi3 Llai/ 1/,/(.a,5 W /r.�. .3 MOTORS SEE FEE SCH.A SERVICE CHANGE 20.00LICENSED CONTRACTORS DECLARATIONI /) II T hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Co n my license is in full force an a feed. License Class Lie. Number 1 Date Contractor-11-� ts� OWNF-R.BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for nye following reason. (Sec. 703 L5, Business and Professions improAny city or coumy which structure permit locpnsuanc ,flat' improve, demolish, or repair any rm it structure, prior W its issuance, also ser isles the applicant for such permit to file a signed actor lei That he is licensed pursuant to the provisions of the ) offamor's License of Division 3 of the Busi (Chapter r (commencing with Section is exempt Business and Professions thus he is exempt therefrom and i,% !'�r-... ISSUANCE DATE ., ` G I.. BLDG.- ❑ ELECT. ❑ PLG. MECH, ❑ ❑ /e pl(v of ,s /I.�"ll:) BUILDING PERMIT INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 O - VALUATION 181 000 s SIFT. ELEC. CONTR. LIC. NO. ELEC. / 7 7 TOTAL T PERMIT TO SFDWL DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. emptor the basis for Lhe alleged exemption. Any ululation of Section 7031.5 by any applicant for a permit subjects the applicant tea civil penalty of not more than five hundred dollars (5500).): 5 N1;. HR'. ALTER -DRAIN & VENT -WATER (EA.) 5.002 ❑ I, as owner (if tile property, or my employees with wages as Ibeir Sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 71144, 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- meetsarenotintendedorofferedforsale.If, however, file building BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP R-3 _ SO. FT. FLOOR AREA 2$54 RES. UNITS 1' TOTAL ACREAGE DRAINS -FLOOR, ROOF, AREA,COND. 5.00 F IXTUR ES - PER TRAP 5.00 Q GAS-EA.SYSTEM-11NC.40UTLETS 6.00 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 in,- prove for purpose of sale.). - ❑ I, as owuer of the property, am exclusively contracting with licensed contractors m construct the project (Sec. 7044, Business and Professions Code: Thi, 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 RES IND CON PB Cl 91 ❑ ❑ Cl ❑ INDUSTRIAL WAS TE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B.' 6.00 " -- LAWN SPR INKLERS - OVER 6'(EMI 1.00 ASSESSORS PARCEL NO. .342412=061- ' contracts for such projects with a controetons) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORMS 20 ft/1000 p P•. Q TRACT NO, PARCEL NO. ❑ lam exempt under Sec. , BA P.C. for this rcas'on 8016 WATER HEATER W/V NT J 14'd.00 .Owner Date WATER SYSTEM.5. 0 -' ACC. DATE ACC. FILE NO. WATER TREATING EOUI I v'- `5'i 0 WORKERS'COMPIiNSA110N DECLARATION I hereby affirm that I have a certificate of consent to se(&insure, or a certificate of Workers' Compensalhggn Inst{{r��nc�a, or a certil led Copy thereof(Sec. 3000, Lab.C.).3TAY& YVAID Policy No. Company_,"'1-27-lab ZONING ENG. SITE NO. a j - FIRE SPRINK ❑ N❑ ENERGY T-24 Y ❑ N❑ O Certified copy is hereby fuRaDhed. ❑ Certified copy is filed with the city inspection division. ApplicantV MISC.- REFER TO ORD. CFR'I'IFICA1I:OFEXFMP'I'ION FROMWORKERS, PERMIT ISSUANCE 10.00 LO FLOOD ZONE A. L.U.C. PLG.CONTR. LIC. NO. PLG, / TOTAL ! ZM C04ENSWION INSURANCE (This section need not be complete'] if file PCRnit is for one Y ❑ N ❑ Y ❑ N ❑ hundred dollars (S 100) or less.) 1 certify that in the performance of the work for which this per. mit is issued, I shall not employ any person in any manner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING 635.50 become subject to the Workers' Compensxf ion Laws of California. Data ApplicantALTER NOTICE TO APPLICANT: If, after making this Certificate of Ex- . . OR ADD TO MECH. 500 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10p00C.F.M.) 4.00 PLAN CHECK FEE enhption, you should become subject to the Workers Conhpensation provisions of theLabor Code, you most forthwith comply with such provisions Or this permit shall he deemed revoked AIR HANDLINGUNI, VERIO,000C.EM.) 6.00 SEISMIC FEE 12.67 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOO (� H4 UCT) 5.00 S the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ. Fi T.�. MICROFILM HEATING UHI,T, IT t00,000.B.T.U.) 8.00 (p HEATING UNT-OV ER 100;000 B.T.U.) 9.50 ELECTRIC �'7 (N Leader's Name - - Lender's Addre RAY 1 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 3 VENTILATI F SIN LE)' 4.00 �- PLUMBING ! / V -7 (%71 BOILER- B.T.U.) 6.00 BOILER -COMP (Duo10, BTU) see Fee scH s ,, MECHANICAL i- ' hereby authorize representatives of this city IG enter upon the above-mentioned properly for inspection purposes. MISC. - REFER TO ORD. CONST. TAX 280.00 (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, casts and expenses which may in any way accrue ago nst said City in consequence of the g ting of this permit. .00 PERMIT ISSUANCE - 10.00 MECH. CONT. LIC. NO. MECH. rorAL �� p3 TOTAL - Signal" Applicant/Contractor Date 5. OFFICE COPY CERTIFICATE OF'-�OMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO r DATE w 19BLDG. PEF•;a11T NO. r �' THE BLDG. LOCATED AT / U ` l 3 U OWNED BY e HAS BEEN /Pvs% -7V— 71"G O PLETED) FOR USE AS (ALTERED) I* OFFICECOPY POST THIS CARD MEAR,,PRONT OF BUILDING .' CITY- OF CUPERTINO � PERMIT N %UMI'E INSPECTION DIVISION "�"q JOB INSPECTION RECORD ' PERMIT EXPIRATION JOB ADDRESS 10130 WESTMINSTER CT UNIT# LOT# gn - PERMIT EXPIRES IF WORK OWNER THRUST IV INC CONTRACTDR THRUST IV INC IS NOT STARTED WITHIN 180 DAYS of PERMIT ISSU- ANCEFOUNDATION OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD -.ZZ LIFER PREGUNITE PERMIT VALIDATION —2 POUR NO CONCRETE UNTIL ABOVE HAS BEEN -SIGNED UNDERGROUND/SLAB ' B 7�,. a' ' ISSUANCE DATE PLUMBING I ELECTRICAL - MECHANICAL -. ' HE q LJ I ELECr. ❑ PLG. MECH. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLO R VALUATION $/FT. PLUMBING 101.000 MECHANICAL ' ELECTRICAL �Iy1 4',�-E;�_71) SPDHL PERMIT TO FRAMING T INS LATION - STOHIEs TYPE CONSTR, Jul I 1 2 s N. HR. OCC. GROUP, HES UNITS PLACE NO SUBFLOOp UNTIL ABOVE HAS BEEN SIGNED CIfY Of C I rtinn R-3 1 ROOF SO. FT FLOOR AREA TOTAL ACREAGE 2654 DIAPHRAGM • BUILDING USE I{E$ INDC❑ON P❑B OQ, pL�J 0 F-1 UNTIL ABOVE HAS BEEN SIGNED ASSESSORS ASSESSORS PARCEL NO, ROUGH 342-12-061 PLUMBING - 0 ^k4z GAS TEST - _Aj^ TRACT-Np PARCEL NO MECHANICAL ELECTRICAL p. s^—j'7 FINALS DATE INSP. DA ACC. TE ACC. FILE NO, FRAMING �Z, ?' SAN # 3 INSULATION' PLUMBING ZONING ENG. SITE NO. A_� d GAS $�� MECHANICAL, - -L �' FIRE SPRINK v ❑ N❑ ENERGY T 24 v [:] N[]C R NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING iV ATH -INTERIOR - ELECTRICAL a^ GLOODZONE A,L.U.C. �.�f'^ Y❑ IN [:j Y❑ N❑ LATH -EXTERIOR FIRE DEPT. SHEETROCK AM GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING 635.50 SHEAR EXTERIOR •TEM;51�,' 'RY APPROVAL FIREWALLS - - ELECTRIC PLAN CHECK FEE Gns i 1a l?7 FNO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BV•8}JILDINGINSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC r� U.1 F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' r PLEASE GIVE JOB ADDRESS WHEN PHONING. Z PLUMBING =SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 'CONST. TAX 260.00 - ! IMPORTANT! TOTAL PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICECOPY