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04100105Z)z Z0 N z> d .. Z) U _ OU U r� F� U CITY OF CUPERTtNO Q ,Z Q 'Z a ;ray „,'. w .u. "'' 2 � -'.''r_4" — BUILDING DIVISION PERMIT CONTRACT?OR INFORMATION': BUILDING ADDRESS PRESTON PIPELINES INC PERMITN®4100105 8920 FORGE DR OWNER'S NAME: PERMIT ISSUE DATE RAZA MICROELECTRONICS 133_ BOTHELO AVE 10/14/2004 PHONE: SANITARY NO. CONTROL NO. (408)262-1418 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED COhTRACtORan DECLARATION 1 hereby firm that I am licensed under p ns of Chapter 9 (commencing is art sCndc, and my license is with Sectio ]( )tfDivisiun lof the Busincsa an m con rnfce �,/A `3n !�D C/O FOR SANITARY S �S fili Liccns yLz/t'741 _c Da¢ Contractor IITFA APN I understa mY plans shall I he used public records nr.T LI 2004 Licensed Professional OWNER BUILDER DECLARATION - e ret I hereby affirm that 1 am exempt from the Contractors License Ir' w for the following (Section ] Business and ons Codes: Any eily o, county IIIVIII ®� micron ve do which a e, alms impfnve, requires a pertnB ri mash any structureNG GInpI 84200 h remit t requites the applicant for such permit m files signed statement its i ro umcs t thith er s Sq. FL Floor Area Valuation that l ensed pursuant the Law licensed pSection 70th)) to Divisionftcnmmnss and Professions or me with a of 3 of the Business Code) or (commencing Sec is asmFth bastisaf aged on. Any Nat he is exempt themrrom and the baso far the alleged cmmption. Any violation of focon d Occupancy Type Section 7831.5 by any applicant for a permit subjects the applicant a civil penalty of not more than five hundred dollars(S500). 1, as owner of the pmpcny, of my employees with wages ss their sole compensation, Required Inspections will do the work, and the structure is nut intended or offered for sale (See. 7 4 , Business and Professions Code: The Convactor's Li«nae 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 improvements arc not intended or offered for sale. If, however, the building or improvement is sold within one year or completion. the owner- huilder will have too burden of proving that he did not mild or improve for purpose of salt.). ❑ 1. as owner of the property,)) exclusively contracting with licensed contractors to construct the project (Sec. 70s4. Business and profcesiow Code:)The Conuanor's Li law docs not apply to an owner of property who builds or improves themon, and wuse no contracts for such projects with a contractor(s) licensed purses nuo the Contractor's Licea¢ hw. O l am exempt code, Sea .B& PC for this mason Owner Dat WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury one Of the following declarations: I have and will maintain a Certificate of Consent to self-insum for Worker s Compcn- cation, as provided for by section 37M or the labor Code. for the perfnroonce of the work for which this Permit is issued. I haus and will maintain Worker's Compensation Insurance, as required by Section 3]00 of the Labor Coda for the performance of the work for which this wr ou is issued. My Wake Cnmpertsatien lnsurancu carticr and Policy num he cam��AMr I tryNn(lL3e399 00-U CERTIFICATE OF EXEMPTION FROM2 OVERS' COMPENSATION INSURANCE OTis.scaion need not be completed if the Permit irfor one hundred dollars(Sifq) ,r le..) 1 ccnify that in the petro marc of the work for which this Permit is owned. l shall not employ any person in any manner so As In become subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Cenlficate of Exemption, you should become subjuct m the Worker's Compensation provisions of the Labor Coile, yno most forthwith comply with such provisions or this Permit shall he deemed revolo d. CONSTRUCTION LENDING AGENCY I hereby orfirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 309]. Civ. C) Lender's Name Lender 's Address . I ccnify that 1 nave read this application and stare that the above information is couco. I agree to comply with all city and County ordinances and state laws clad ug to building construction, and hereby authodae representatives of Nis city to enter upon the above-mentioned property for inepcnion purposes. (We) agree to save, iodumni fy and keep harmless the City of Cupertino against liabilities. judgments, costs and ex crow; which may in any way secret against said City p ispermit. in OMY4, APPLI ND WILL COMPLY WITH ALL ON -POINT Issued by: Dale SOUR U -'' IX Re -roofs Type of Roof Of App Cant/pas Date HA].ARDOU RIALS DISCLOSURE Will the applicant or future building Occupant store or handle hanrduus material as defined bythe Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Code. Section255.u(an All roofs shall be inspected prior to any roofing material being installed. ❑ Yea a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or nttrre building d==apart use equipment or devices which mit baeallous all emoaminants defined by the Bay Area Air Quality Management all new materials for inspection. District? J}.� C] Yes `lyl no I have mall the havardtwus materials requirements under Chapter 6.95 oldie Califon ON Hca W & Safny Code, Sectors 25585.25533 and 25534.1 understand that if t e building JtWrant, tha 1 is my rex nsibility w nmily the rceupant of the `r m me p rt,!,I u ora-Edawof QySignature of Applicant Date %�. All roof coverings to be Class "B" or better gent Date CITY OF �UPEkTINO 4 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 artment I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date a7z>A5�y— l yPoe/ ate SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing A) ?, We- Roofing Septic Tank Sheet Metal Sheet Rock e a7z>A5�y— l yPoe/ ate CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31609030.00 DATE ISSUED.......: 10/14/2004 RECEIPT #.........: 27439 REFERENCE ID # ...: 04100105 SITE ADDRESS ..... SUBDIVISION ...... CITY .............: IMPACT AREA ...... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... RECEIVED FROM .... CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ... TFT.PT)T-T(1TTP 4REE ID UNIT ---------- ------------- BPFIXTURE UNITS BPERMFEE VALUATION BPSEWAGE UNITS PPERMITFEE FLAT RATE BPSEWER SEWER SYSTEM TOTAL PERMIT : 18922 FORGE DR CUPERTINO RAZA MICROELECTRONICS CUPERTINO CA, 95014-3548 PRESTON PIPELINES PRESTON, MICHAEL LIC # 10661 PRESTON PIPELINES INC 133 BOTHELO AVE MILPITAS, CA 95035 (408)262-1418 QUANTITY AMOUNT AMOUNT PD -TO -DT THIS REC NEW BAL 1.00 9.00 ------------------ 10446 0.00 9.00 0.00 4,200.00 115.56 DESCRIPTION 0.00 115.56 SEWER 0.00 1.00 67.14 ROUGH 0.00 67.14 302 TUB & OR SHOWER 0.00 FINAL 1.00 38.37 506 GAS TEST 0.00 38.37 PLUMBING 0.00 1.00 21.58 0.00 21.58 0.00 251.65 0.00 251.65 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- CHECK ------------ 251.65 ------------------ 10446 TOTAL RECEIPT 251.65 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 1[1 r I S CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check'Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 CITY or CUPERJINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appfiance7 ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSW1M Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BMISCELL Building Misc Fees BUILDING • 3 of 3