6949 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT 6949
ADDREsa 10600 Ridgeview Court BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
- NAME Intersil PHONE 996-0600 OTY. ELECTRIC PERMIT FEE
roR-s
NAME UTLETS-SWITCHES-RECEP 5.00/1.00
• NAME
Valley Electric LIC.NO. 155128 LIGHTING FIXTURES 5.00/1.00
CONTRACTOR APPLIANCES-RESIDENTIAL 4.00
IMj Leghorn, Mt.VieXONE967-5728 PANELS 6.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 VLAN CHECK FEE P.C.NO,
OR
ENGINEER
K8Ut uc.No, SIGNS TRANS. 3.00
ADR, ENG. 500 PERMIT VALIDATION
ADDRESS ss SPECIAL CIRCUIT .
ZIP EMP.METER OR POLE INS. 15.00
�APPUCANT'B - MOTJ
ORS SEE FEE SCH. �
ADDRESS .
2 h M SERVICE CHANGE 10.00 / (/ l
w o o 6CENSED CONTRACTORS DECLARATION //(/// iV
2 I herby ifforc thea I am licensed under provisions of Chapter 9 ISSUANCE DATE
n 4 h Icontmcncing with Scclimh]000)of Division 3 of the Busincxs uml BLDG. ELECT. PLG. MECH.
F m z Professions Cecil yyµyI license is in full for c' a 'L ❑ ❑ ❑ ❑
z o L - Licenuj'J;/sy�..,5aby=Lie.Number- -E�
Ism Date-1G/1}/�4 Conl tactor s}/_
er y BUILDING PERMIT
c a re < OWNIi R-BUILDER DECLARATION INFORMATION
E: 3 A I- 1 hereby infirm thus 1 um exempt from the Contractor's License MISC.- REFER TO ORD
Get Law for the followingroason.(Sec.9031.5.BuslncssmdP,ofcssion° PERMIT ISSUANCE 6.00 VALUATION 6/FT.
� - 0 Code:Any city orcounty which requires a permit to construct.alter,
Qa Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
- ¢ requires the applicant lir such permit to file a signed statement that TOTAL PERMIT TO
a w m'L he is licensed Imrsounl to lire provisions of the Contractor's License r
rzi
Law(Chapter 9(commencing with Section"7000)oflAvision 3ofthe �r G�G
- 4 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
a, r rs the basis for lire alleged exemption.Any violation of Section]031.$ STORIES TYPE CONSTR.
d ; by any applicant for u permit subjects the upplicum macivil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
,of not more than five hundred dollars(SS00).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
role need or offered for sale(Sec. 7044, Business end Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Cade:The Commetor,S License Law does riot apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SD.FT.FLOOR AREA TOTAL ACREAGE
hinnself or through his own employees,provided flat such imm
pve-
utemsamnotintendedornlfcredfursale.l f,howeveCille building GAS-EA.SYSTEM-I1NC.4OUTLETS 4.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did nor build or im. RES IND - CON PB Other
prove for no,ow of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ 1,as owner of the property,am exclusively contracting with
licensed Contractors to construct the project(See 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an..net of property who builds or iaprons thereon,acid who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contrac Wtls)licensed pursuant to
the Cuntmaur's License Law: SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ tem exempt under sec. ,B.&P.C.lo;this WATER HEATER W/VENT 4.00
reason
Owncr Date WATER SYSTEM 4.00 ACC.OATE ACC.FILE NO.
WORK RS'COMPI:NSA'IION DECLARATION WATER TREATING EQUIP. 4.00
I lerelly alfirm that I have a certificate of consent to self-imum, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy themof(Sce.3X00,Lab.C.L
Policy Nn. Company
O' ] Certified copy is hereby l urnished. FIRE SPRINK ENERGY T-24
z Z ]aJ Certified o y is Glad with aha eery nspection division. MISC- REFER TO ORD. Y NO Y N0
o ApPheant_ �y-'leetrie--6ompnsy--
= y CERI'IPICAI'Ii OF I?XIzMPIION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LJ > C0M1`I7NSA'1'ION INSURANCE PLG.CONTR. LIC.NO. PLG. Y� N� v � N❑
O 11 his section need not be completed if the permit ix for enc TOTAL
Z hundred dollars(SIO0)or less.)
U O 1 certify that in the performance of the work for which this per QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I shall not employ any person in any menncr so as to
O w bceomC subject to the Wnder Compensation Laws of Cxlilornia' BUILDING
Date Appheanl - ALTER OR ADD TO MECH. 4.00
} Go NOTICE'TU APPLICANT:U.alter making this Certificate o1'Ex
F 2 cotillion,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
movisione cit the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 3.00
CONS'fRUCr1ON LENDING AGENCY AIR HANDLING UNIT(OVER I0OOOC.F.M.) 5.00 SEISMIC FEE
I hereby uflion that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work fir which this permit is issued(Sec. HEATING UNIT ITO 100,000 B.T.U.) 4.00 MICROFILM
3097,CD.C.).
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.P.50 ELECTRIC rQ, �t
Lender's Address
1 Certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree m'comply with all city.,,it county BOILER-CON??H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city W enter upon the BOILER-COMP (oY,IOW000BTU)SEEFEESCH. MECHANICAL
above-montimcd properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs andexpenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against Said City in consequence of rhe
gra g I is it MECH.CONT. LIC.NO. MECH.
3 1 K
TOTAL TOTAL
Signa re odApplicaullConINI Dale
OFFICECOPY