13636 / PERMIT NUMBER
APPLI,CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT 13636
BUILDING BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
ADDNLSS PLAN CHECK VALIDATION
NEW QTY.
ELECTRIC PERMIT FEE
E I
PHONE
UTLETS-SWITCHES-RECEP 10.00/1.00
CONTRACTORS 10.00/1.00
N+.ME LIGHTING FIXTURES
• I o.no. "IDC ACTORS
CONTR
0415 PPLIANCES-RESIDENTIAL 4.00
10.00 DATE OF APPLICAT ION
NO.
P,C.
ADDRESS 7e PANELS 20.00 P�Lyy(t{�CHECK FEF 1
C PANELS (OVER 200 AMP) ( 3 `fJ
ARCHITECT 3.00
ONGIn EER SIGNS TRANS- PERMIT VALIDATION
E
SIC.Nu. 500
ARCH.O
R ENG SPECIAL CIRCUIT P000
ADDRESS EMP.METER OR POLE IN 7
• 21P SEE FEE SCH.
MOTORS
IAPPUCANT'S 20.00
ADDHEs5 SERVICECHANGE /vla. 3/� �II G ¢Z 3 • ISSUANCE DATE
O O LICHNSEU CONI'KACI'ORS DECLARATION BLDG. ELECT. vLG. MECH.
IS w 1 hereby+(lino That 1 un IirenxJ wdcr Pruvisiolu li Cll"a 9 ❑ ❑ ❑ ❑
nam (conuuennng witll Sn uun 70001 of Uiririun 3 01 the If l,.inv and
F O z Pwlessians CuJc.:1nJ my lieens'u m lull lurfl' I� '
Liceme Clay-e9� L,c,l>U,n ^I� BUILDIRMATIO IT
o 0. Doe q)_2 - -Cummrw INFORMATION
1( REFER TO ORD $JFT.
P. VALUATION
2¢a u 0N'NE&tl UILUIiR UF:CLdRATION 5:. MISC.-
w 10.00 ' o-d7-p
x O H I1 r by aft '^ D 11 ''I x' Ipt I tl Cu Iuv for L ^ie PERMIT ISSUANCE
p j L' in'tri "Is mgt wn I$v 70115 11 n1J I d>aral 'i Al",
ELEC.CONTR. LIC.NO. ELEC. PERMIT TO
I- - m Code Ally City o '-only fit I rcquuI s,I W!alt loun au I It r, TOTAL
1 w a 4 i nprov d ..olish or"Pair air and
till wr 1
IS Ds «y rsth 'p'll v,l( r alt Perot loll ITgnJ rt n itthat FEE 4
Wes he Is hvenxJ pursuant to the pro Tston m tri'Cunn for L ^se PLUMBING PERMIT gTOq IES TYPE LONSTR.
r z Q Law(Chaptu 9l'u,nnlenrug xh Ol Seouun 70Wlof Unn on7 of tlII
i O Busnr eys and Proicnions C'odc)or till he is css,n Pl thrrcf«an...l QTY.
the basis tin lir alleged exenrpti°n.An"'I°I+flint-1me endl"0'31.5 ALTER-DRAIN&VENT WATER (EA.) 5.00 qgs.urv❑s
n 3 by any IPPlicnnl fora permit subl<cts the'pp 4.00 OCC.GROUP
CC
not cure than till,hundred dulUra155001.1BACK FLOW PROTECT. DEVICE
❑ I,m owner of the pro Joy�ha my
and....Ih a Italtalth e a Put ROOF,AREA COND. 5.00
their sol'conlpensaliun.w 5.00
to cot uwncrm FIXTURES-PER TRAP SD.FT,FLOOR AREA TOTAL AeRFAce
intended or offered iur sale (Seal 7044, B""°`''> °'d Pndcvwro DRAINS�FL
.
Code.The Coronas or Li:cn>c Law Jul'not nPPb
,copal,' who builds or improve Iharcon.'+'Jed IJ til,,u,i,nnpr.,,-
himsrll or through his own cluployen,P ori. GAS EA.SYSTEM T INCA OUTLETS 6.00 BUILDING USE
menu are not in lc nded ur offered for sal'.IL huwrvar,the building 2.00
GAS-EA.SYSTEM OVER 4 IEA.) RES wo CON
F 13
ur UlPnnemnt is>o IJ x'ilhin one year ui coo Plelmn,the owner 30.00
i builder will have the burden of PFOving tial he did not hnild or 1^r INDUSTRIAL WASTE INTER. AsB ESSORS PARCEL NO.
prokir/ purpose of sale.(.
✓✓ I.a oxn'r of the Proper,at avdusie Se C 7044. ng with
licensed .,it,In,s m wnstrucl the P'H,,Ct ISeC. 70.ia,Businc>s LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Profo ions Cod':'110 ho build>rur lop IL-111
' s thuc"' mW I'll u
LAWN SPRINKLERS-OVER 5 (EA.) 1.00 TRACT NO. PARCEL NO.
to an owner of propr )'w fp1e uw,n L' EWER -STORM EA.2001t/10.00
,unllaela for soli Pr°l"R with''cunt roma')Ii:anxJ P" 6.00
the C..111`lol's 'icenae Law'. B,bp.c.forthis WATER HEATER W/VENT ACC.FILE NO.
❑ 1 vm r•emPt under Ser. �- 5.00 ACC.DATE
reason Date ZT/r- WATER SYSTEM
0w'ncr_ - 5.00
W'O RKIiKS'COSIPIiNSA'I'ION UEC LA KATION
WATER TREATING EQUIP. ZONING ENG.SITE NO.
hereby
'flirnr trim 1 hale'"Rif i:uc of conxm to scl hi,ume.
uraccr0li:u¢uj\\'orkrr:C°Inprn.tl ion`I,arUe��eb+ ries FIRE SPRINK ENERGY T 24
copy thaenflki 3KIHh -b A =E,
PO NOII= 1unlifll'JC N❑ y IN
0 «sled CupY Is hrreb) ilh tri city' ins 'w" division. MISC. - REFER TO ORD. v❑
Z z p CerliGed copy is file0 10.00 FLOOD ZONE A.LILC.
Applicant PERMIT ISSUANCE YE] 'N❑
~ O YLG.CONTII, LTL'.NO. PLG, yEj N[3
CC - Ch RI'IFICAI'Ii 01'EX"'P1'10N'I°KOM N'ORKIiKS' TOTAL
UJ Z, COMPENSATION INSLIKANCE
CL p FEE FEE SUMMARY
)This sed,dn need enol be complrlyd II the pencil i> wr one MECHANICAL PERMIT
2 hundred dollars In IU01 1,F,
of the work for which This Per- CITY.
O O 1 ecruO t11At in the p' Iwo in any manner us as to BUILDING , ._-
q. mit is mold,1 Shull not employ'an}'pc 5.00
LL U become snbicn w the Workui Cu,npnnaliou Laws of Califoro l:a ALTER OR ADD TO MECH. PLAN CHECK ! i
O w
)a,,_APPllunt .. 5.00
} w NOTICIi TO API'LIG\N1': II,alcor making this CYrtiOmw ul liv FEE ci r :>
F" 2 empliun.You should lanuue wbieet to Inn'\Yorkcri C°,npe nvliHa APPLIANCE C.F.M.) 4.00
lan"H inns of the Labor Cole. You cool for D,with euul Ply with AIR HANDLING UNIT(TO 10p00 SEISMIC FEE
U such provisium or this permit shall br JeemeJ revok'd.
AIR HANDLING UNIT(OVER 10p000F.M.) 5.00
CONSTRUCTION LIiNDING AGENCY MICROFILM
I hereby ail ro trial Wim is a cmisvurdon IvnJing ag°^cY!or HEATING UNEXHAUST DODITOI100 000 B•T.U.) 8.00
Ihr perf°rmans of tlm lurk IDI wild( this permil is iouLvl IScc
. OVER 100,000 B.T.U.19.50 ELECTRIC
7097,Civ.C.lHEATING UNIT I
Lender's Nene4,00
Lender's Address VENTILATION FAN (SINGLE) PLUMBING
I certify that I have read This ipplinlid,and>Pelo that the'bull
infonnalluo is correct. I agree w comply with all Cnyr and C°unl}' BOILER-COMP(3 H.P.0 100.00".T.U.) 6.00 MECHANICAL
°IJinanc's and state laws «(slog lu buiWwg rorol.. Hun' vire BOILER-COMP IOwr IOOpDO BTU)SEE FEE SCH.
hereby an huriee rePresema¢n or this city w inter u on the REFER TO ORD.
. abuse In"lured proH) lir,inspoCllull n1urp^.cs. MISC.- CONST.TAX
n,
(Wel a' to mvc, indcninniy and keep hl"ni", (Ill Clp' ill10.00
Cu a again 1 lubilitirs,iudgnunts, cull' and eat"O whidl PERMIT ISSUANCE MECH.
D in any w' ateme 'gel 1 sale etly in eunsuqu.mre of Ihr LIQ N0. TOTAL TOTAL 7r
JJJ��� //}/I l tri, M6CH.CONI.
ailing of thi nu �1?1'-r
ICmliCunlrarmr Uu1.
Sigtrvmr APP' CiF'rlCECOQY
l
-APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BILD1 NG PfiOJECT I DENTI FICATI ON PERMIT NUMBER
S1
YDILDING APPLICATION & PERMIT ����
'AGDOREas BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S I PLAN CHECK VALIDATION
.• NAME DTV. ELECTRIC PERMIT FEE
PHONE 4I
cONTRAcrorsUTLETS-SWITCFHES-RECEP 10.00/1.00
NAME
F L
R NDIGHTING IXTURES 10.00/1.00
. Na4
1 GONTPACTORS �L+I S' PPL IANCES-RESIDENTIAL 4.00
/f ADDRE S
22Z-'/� PANELS 10.00 DATE OF APPLICATION
PtLCHECK FE .C.NO.
ogcHlTEcr PANELS (OVER 200 AMP) 20.00 ( W 3 •f`$�
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH,OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP TEMP,METER OR POLE INS. 20.00
APP UCANTS MOTORS SEE FEE SCH.
ADDRESS
e
3 aA SERVICE CHANGE 20.00
iso LICENSED CONTRACTORS DECLARATION ( O/a 3�a 7
a U w I hereby affirm that I em licensed under provisions of Chapter 9 ISSUANCE DATE
a a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
Professions Code, d my license. in full fur��sy�e t ❑
I m License ale Lia Number ❑ ❑ ❑
Q I H�- Lle y/Z Con[mctoT
P m BUILDING PERMIT
E a w OWNER-BUILDER DECLARATION SF ILLS INFORMATION
w0
LL H I hereby affirm that I Am exempt from the Contractor's License MISC.— REFER TO ORD
a-'0 Low for the following reawn.(Sec.7031.5,.Business and ProfessionsPERMIT ISSUANCE 1000 VALUATION f/FT.
r — � Code:Any city or county whlchonciresa permit to construct,alter, W� /iz e-1"
Ic ¢ oimprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
al
0 a, requires the applicant for such permit to Idle a signed statement that TOTAL PERMIT TO
e w m he is licensed pursuant to the provisions of the Contractor's License
r I i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
1 i o Business and Professions Code)or that he Is exempt therefrom and QTY. PLUMBING PERMIT FEE
m H $ the bass for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. /I
n ; _ by any applicant for a permit subjects lheapplicam to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 l/
of not more than five hundred dollars(5500).):
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
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 on owner of '
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 yo.FT.FLooR AREA TOTALACREAGE
. himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
mems are not intended or offered for sale.If,howcveq the building
or improvement is sold within one year of completion,the owner. GAS
S.
EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or ins" RES IND CON PB Orbe,
Prov Ar purpose of sada). INDUSTRIAL WASTE INTER. 30.00
11�� I,as owner of the properly,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 Low does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a conlmclorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
O Inns exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner i Date J—P7 WATER SYSTEM 5.001 ACC.DATE ACC.FILE NO.
WORKF.RS'COMPENSATION DECIARA'rION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate ofecosent toself-insure. ZONING ENG.SITE NO.
or a certificate of Workets Compenytio `nsur ncei or a mortified
copy thereo,.LL(S 38 a f.,.l /bCsT 1 �nse♦ FF.f�
PnlicY NoM6i¢ '+ngurnfle'�p,_
O �rlered copy rs hereby furnished. FIRE SPRINK ENERGY T Z4
Z Z ❑ Centered copy n filed with the city inspemion division. MISC.- REFER TO ORD.
O Applicant V❑ N❑ V ❑ No
Fy PERMIT ISSUANCE 10.00 LDDD ZONE A.L.U.C.
cc CIiRTI FICATE OF EXEMPTION'I'ROM WORKERS' F
W 1 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ V ❑ Na
O. ❑ (This section need not be completed if the permit is for one TOTAL
Z hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is ivued,I shell not employ any perumn in any manner so as to
become subject to the Workers'Compenmtion Laws of California. BUILDING
O a Date Applicant ALTER OR ADD TO MECH. 5.00 /3U
} 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex-
f— Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECKI / z
provisions of the labor Code, you must'forthwith comply with FEE U'
U such provisions or this permit shall be Jcemed revoked. AIR HANDLING UNIT(TO 10jMC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE P
I hereby affirm that there is a construction finding agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.G). ) s HEATING UNIT(TO 100,000 B.T.U.) 8.DO
Lender's Name
Lender's NameAddress HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
k) information is correct.1 agree to comply with all city and county PLUMBING
ordinances send slate laws relating to building comtwction, and BOILER-COW Q H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cup o agai t liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 . CONST.TAX
in any w accrue agai t said City in consequence of the
ruing of th p i MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 7 J
SignattlApplicant/Contractor Dat
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING •
" •..,G[RMR NUMBEN
CITY OF CUPERTINO 1 3636
INSPECTION DIVISION /
JOB INSPECTION RECORD
PERMLT'EXPIRATION
JOB ADDRESS 10900 N TANTAU UNIT# LOT# '—
I PERMIT EXPIRES IF WORK
OWNER 'INTERSIL CONTRACTOR REIDEL ENVIRONMENTAI IS NOT STARTED WITHIN
I
INSPECTION DATE NSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR,180DAYS FROM
FOUNDATION, LAST CALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB 14 r
PLUMBING re4geaA t /
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG, ELECT.' PLG. MEC .
/ xG H❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATIONT '$/FT.
PLUMBING
MECHANICAL
' PERnuT To
ELECTRICAL
FRAMING o.
- STORIES j TYPE CONSTR.'
INSULATION -
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
50.FT.FLOOR AREA TOTAL ACR EAGE
ROOF .
DIAPHRAGM - -
BUILDING USE
" / -.3- `J•. ANTf/ /s/ANP C/b nes IND CON PB ONe,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED S4eoei F,4 6 NPAII 7W. - ❑ ❑ ❑ ❑ E
ASSESSORS PARCEL NO.
ROUGH
PLUMBING _ '
TRACT NO, 'PARCEL NO.
GAS TEST
MECHANICAL '
' ACC.GATE ACC.-FILENO'
ELECTRICAL' �_ _ 1f FINALS DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
.INSULATION � PLUMBING �
GAS, FIRE SPRINK. ENERGY T 2
MECHANICAL v N� Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,
FLOOD ZONE A.LU.L.
LATH–INTERIOR ELECTRICAL' i
_ LATH–EXTERIOR FI RE-DE PT. v� ,N� YI] N❑
SHEETROCK GRADE - - FEE SUMMARY
SHEAR INTERIOR BUILDING – 'BUILDING
SHEAR EXTERIOR - TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS "
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
- OCCUPANCY OF BUILDING IS NOT PERMITTED U NTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Il' ONE•WORKING DAY BEFORE REQUIRED INSPECTION., PLUMBING
0� PLE.ASE'GIVE JOB ADDRESS WHEN PHONING.
Z : - MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL �{
CALLING FOR FINAL INSPECTION.
OFFICE COPY _
OFFICE COPY
ELECTRIC SERVICE NOTICE
BUILDING INSPECTOR'S NOTICE '
CITY OF CUPERTIN' ^� tt ?
19
To
' c You are hereby authorized to Connect electrical swice for
f Owner or Tenant
At—
Size of Wires Size of Switch �-
No.of Wires J
T
Phase
Motor Load �— Voltage
K.W. Voltage
Heating Load
/ Light 110�Ne• Service Reco.,nea
No.of Meters Heal 120_Three Wire More Service
Power —
Three Phase Move_Meter
No,04 Acid.Meters
r Oj ELECTRICAL INSPECTOR