14133 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUM1IBER
. BUII.DI,NG PROJECT IDENTIFICATION APPLICATION & PERMIT
RWLDING 0 ill14133
AooREss
BUILDING -ELECTRICAL-PLUMBING - MECHANICAL
OWNERS PLAN CHECK VALIDATION
CITY. ELECTRIC PERMIT FEE
PHONE
iij
�`.; NON EHAaORs UTLETS-SWITCHES-RECEP 10.00/1.00 O
LIGHTING FIXTURES 10.00/1.00
CONTRACTORS 51 APPLIANCES-RESIDENTIAL 4.00
AooREss L'' JT�
8 �� Sly@' DONE � O PANELS 10.00 V DATE OF APPLICATION
ARCHITECT
PANELS (OVER 200 AMP) 2000. PLAN CHECK FEE P.O.NO.
OR
ENGINEER 3.00
I.C.No, SIGNS TRANS.
ARC H.OR ENG. 5.00 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT
IIP EMP. METER OR POLE TINS. 20.00 d
APPLICANTS MOTOR 6 1 (.IIf lag H,3-2 -
A 1DREss I
SERVICE CHANGE 20.00
w 3 K. SFtin2
, 02
O LICENSED CON'I'RACI'OKS DECLARA I'[ON
a u I herr by..then that I an helnxd under previsions of Chapter 9 ISSUANCE DATE
n s, H (commenemb with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH,
F N z Nol',onee,4 Codo ,J my liceis in lull lu / Q rj ❑
z o,n - icensr,(1'11 heeds,Li,.Numb'�Jf�\J(Q��� �r [
Q f.ta Ua1C_aa.VCeutrarler�r✓
Std • .._,.. BUILDING PERMIT
a w OWNER-BUILDI[R DECLARATION INFORMATION
E 3 LL I hereby allinn that I am went t Hun the Ctud,ovtorl Li„n.e. MISC. - REFER TO ORD
p VALUATION $/FT.
F . 0 a Law for the following reason.(Sec.7031.5.Busiressund Profeulunn PERMIT ISSUANCE 10.00
Code:Any city or county which rec uircra twrinit tucorommLalfep
Qimprove,denwlish,or repair any structure,friar to its issuance,also ELEC.CONTH. LIC.NO. ELEC.
0, requires the applicant lar such Permit to❑Ic a signed statement that TOTAL/ PERMIT TO
w 2 he is licensed pursuant to the provisions of the Comrator's License ^ _'T fl` J 6-
LawH z i (Chapte'r9(commencing with Section 7000)of Division 3 ofthe �',•GL/ r"'O
a Business and Prolesslore,Code)or that he is csenpl defefrmn and QTY. PLUMBING PERMIT FEE
r$ the basis for the alleged asamptiun.,%D,vi.alien of Srctien 703IJ $TOMES TYPE CUNST H.
c ; by any applicant for a pemlil subjects Ihr applicant..a ckil Is,mhygLTER-DRAIN&VENT- R A.1 5.00
of nut more than live hundred dollars I S>OOI.I:
❑ I,as owner of the properly,or illy empWyoes with wage' BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP HES.UNITS
their sole compcnsatiun,will Jo the work,and Ih.etrur tae is non
intended or ou`nd fur sale (Sec. 7044, Oosl.... and I'rwb..iun, DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'file Cenlmelal's License Law dee.nut apply to an awocr ul
property who builds or improves lhaeun,and who Joo....It work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AULA TUTAL ACREAGE
h...sell or Ihru qh his own c nipt.......I....idvJ tlial web not rove.
aids a,, let intended I,oil.n.0 ter vlc.Il,however,me ei'hfnp GAS-EA.SYSTEM-1 INC.40UTLETS 6.00
..r imp.......col is.old withlo ouc rear of ea,mpld Wil, He'011111 GAS-EA.SYSTEM-OVEN 4 (EA.) 2.00 BUILDING USE
Builder will hm'v the burden al proving ilia(he did no,build of in RES IND CON PD Ousel
prase fur pur,o.of A,J. INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
D I.as..x ne al III, no"'Hy,a cs<l u.i.'ely can lila Yang whb
licensed runHa,o,, w ......Hurt Ill, p... ,I(Se,. 7044,Bu,iue's, LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSOHS PAIRCEL NU.
and I'H,Vs.ion.Cute:'I'll,(yenned...',Liccuse I.uw d-not apply
to an owner ,I o.......y wino builds or improves Ommo...uaa who LAWN SPH INKLERS-OVER 5 (EA.) 1.00
contracts for such prulecu with a cnntranons)Iiecowd lu L.uant to
We Contractorl License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑ l inn eaengn under Sea .B.dll('.far Hru WATER HEATER W/VENT 6.00
own
Owner at, WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
D
WORKERS COMPENSA'RONUECLA RATION WATER TREATING EQUIP. 5.00 ,5
I hereby affirm that I Have a ecrtilicutc of cummnl to>d6inwr., ZONING ENG.SITE NO.
or a cvNifinlr el W'orkcri CemmosaRiun hot be,,or a«nifcJ
cupy'there
oythC
Polley No.. i f (11`
Q ❑ Certil icJ rap)'a here,y'fumub,d, FIRE SPRINK ENERGY T]a
Z z niOrJ copy is filed lith the it, IOSp.i lien division. MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ No
O Pli.am__
10.00
~ in PERMIT ISSUANCE
� - Rl'IPI .OP IiSI:AIPPION I'ROht 11'U R) U LOOD ZONE A.L.U.C.
F
L,I > COMPENSATION INSURANCE PLG.CONTR. LIG.NO. PLG. v❑ N❑ Y ❑ NE](This w,lidn Iced nut He .empl"sd if the pernit is ter ane TOTAL
z hundred dollars($100)or less.I
U Q I cenity that in the PeH.rnrm,rc..i file wok fur'shin this"" QTY. MECHANICAL PERMIT FEE FEE SUMMARY
l.L 1- mit is issued. 1 shall not employ any Person in an, manor.w m to
UW bc.om,s.bj,,t1.file N'or4ui Cunymnvliun Laws of Calilonda' BUILDING
Date Appllcanl ALTER OR ADD TO MECH. 5.00
} t6i) N'OT'ICE TO API'1-ICAN'D If,after making this Certificate of I:,-
Fz en,pt ion,you iln...w beeonne s.b,,,,to the\Yorker:('oro p.n.:'fiw, APPLIANCE 5.00 PLAN CHECK
p..visiuna el Ihr 1-aber Calc, You most lonhwith mNIDIy with FEE
U such provision.er osis permit.hall he deemed revoked AIR HANDLING UNIT(TO 10)="C.F.NL) 4.00
CONS[RUCTION LIi NDwG AOEN'CY AIR HANDLING UNIT(OVER 10=C.F.NL) 6.00 SEISMIC FEE
1 hereby all inu flim there is n nm9ructian lending agency Ihr EXHAUST HOOD (WITH DUCT) 5.00
Ihrrnluncc ui rile work for which thuspcnnil is iaurJ IScc. HEATING UNIT (TO 10Q000 B.T.U.) 8.00 MICROFILM
309],,CiCiv.C.l.
Lenders Name HEAT]NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC of
Lend,, Add,,,-
I certify that I have read this ipptiaallmt and state that Ill,above VENTILATION FAN (SINGLE) 4.00
infonnatiun is care,,. 1 agree to comply with all city and county. PLUMBING S-
oNinade" and state Haws rrlaing m building cans0uctum.. and BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00
hereby aatbariac r,Incs,mtatises of this sit, m ewer upon til, BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
abased entiunN prup,ri) lot inspection Pullin-
(We)
ullin s(We) agree to +am. R&I'do a nod kee'P han.d", the City of MISC.- REFER TO ORD.
COPerll . nst I"t iliti,s,p mnO, costs and .cpnsxs'hi'll CONST.TAX
mSd'o
any u.c -p n J Cit in .onxyucn.e of til, PERMIT ISSUANCE 10.00
+ gror 'is 'NOD M[CH,CONT. IIQ NO. A1ECH.
TOTAL TOTAL a oI Applicanl)ConHcele. I . 1
Q-FF-tCE COPY
POST THIS CAR D'NEAR FRONT OFBUILDING
PERMIT NUMBER
CITY OF: CUPERTINO 1 X133
INSPECTION DIVISION
JOB INSPECTION RECORD
4
PERMIT EXPIRATION.- '
JOB ADDRESS 10900 N TANTAU AVE - UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER INTERSIL CONTRACTOR RIEDEL ENVIRONMENTAL -IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- '
FOUNDATION
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED "•� '
UNDERGROUND /SLAB
PLUMBING 1 No
ELECTRICAL IN JC�, ISSUANCE DATE
. MECH.
MECHANICAL - U�`j y. BLDG. ELECT. PLG
El El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PE IT
WOOD FLOOR INFORMATION
.VALUATION E/FT.
PLUMBING :
MECHANICAL
ELECTRICAL PERMITIO
Fl c r.f �4-;:;
�. .
FRAMING
STORIES TYPE CONSTR.
INSULATION -
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
S ROOF sD.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
- BUILDING USE
RES INCON PBrrOme,
APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
_ ASSESSORS PARCEL NO.
ROUGH ?`
PLUMBING -
GAS TEST - TRACT NO. PARCEL No.
MECHANICAL '
ACC.DATE, ACC.FILE NO,
ELECTRICAL FINALS 2DATEINSP.
FRAMING ` SAN * SITE NO.
ZONING ENG.INSULATION PLUMBING �GAS
MECHANICALFIRE SPRINK ENERGY L2<sCOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ v C� N[]LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.uc.• YY `
LATH-EXTERIOR FIRE DEPT. ❑ NEI Ll 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
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICo
/
` � ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Fu _
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
_ IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 1'
CALLING FOR FINAL INSPECTION.
OFFICE COPY
1,5iPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU It PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT
BUILDING 14133
ADDRESS
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME '--- GTY. ELECTRIC PERMIT FEE
•, LIk-, PHONE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 0 �
Ic.No LIGHTING FIXTURES 10.00/1.00
r,ONTanc.oas PPLIANCES-RESIDENTIAL 4.00
V `, LS�Q� GONE p PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20. PLAN CHECK FEE P.O.NO.
OR
ENGINEER
' LIC.No. ISIGNS TRANS. 3.00
ADDRESS sNa SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 d
a APPLICANTS MOTOR .0- -
A DRE55 QA
xfA]- ,\
,•\ SERVICE C6HAN E 20.00
wo o LICENSED CONTRACTORS DECLARATION SFI►n2 7
r z w I hereby affirm that 1 an licensed under provisions of Chapter 9 T" w ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Basin ss and - BLDG. ELECT. PLG. MECH.
H w i Professions Code nd my license is in full f�R�
r, ❑ ❑
z 0 w - iter. Lic.Num 7 t'
0 H• Date ,f1' Contractor -
a m x " . ! . ...... ..S f`n11R�100 BUILDING PERMIT
It a w a OWNER-BUILDER DECLARATION _ INFORMATION
oA " MISC.. �{ CUr1CM11V WfREFER TO ORD
X ; N I hereby affirm that 1 em exempt from the Contractor's List ..
u0a Lawfor the following mason.(Sec.7031.5,Businrssand ProfessionsPERMIT+ISSUANCE 10.00 VALUATION S/FT.
- Code:Any city or county which rector.a permit to construct,site,
of ¢Q FO improve,demolish,or repair any vn¢ture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. _
0 u requires the applicant for such permit t0 file a signed statement that TOTAL/„ .z PERMIT TO
w$ he is licensed pursuant to the provisions of the Conlmctor's Eocene ��
ri10 Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe p
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
to d3 by any applicant fora permit subjects the apppliantioacivil Penalty ALTER-DRAIN - R A.) $.00
of not more than five hundred dollars(S5001):
❑ I,as owner of the property,or my empluyees with wages- 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,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 5a FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00
ments are not intended or offered for sale.If,however,the building
or improvement Is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA) 21,70 BUILDING USE
builder will have the burden of proving that he did not build or ire- . . .
RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the propeny,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 Codr:The Comorctor's License Law 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 contractons)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,BAP.C.for this , WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.,
WORK ERS'COMPENSATION DECLARATION WATER TREATING EOUIP. 5.00 S- -
I hereby afOrm that 1 have a certificate of consent to wirinsure, f. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE N0.
copy the.
(- syy.S rj80Q,Jan c t _�h
Policy No.
O ❑ Cenifxd copynhere yfu tshed. ) I J• FIRESPRINK ENERGYT24
Z Z 0�15rtifmd copy is fled with the city inspection division. MISC.- REFER TO ORD.
O Plicanl _ V[:] N❑ Y F] No
~ rn �" - PERMIT ISSUANCE 10.00
- TIFI 01'EXEMPTION FROM WO R O FLOOD ZONE A.LUA.
W > COMPENSATION INSURANCE PLG,CONTR. LIC.NO, PLG.
1 O (This section need not he completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
Z) Z hundred dollars IS 100)or less)
L) O 1 certify that in the performance of the work for which this per- GTY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued.I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of Culitomia. -
a Date APPlicuntBUILDING
ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? empt
ion,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 perout shall be deemed revoked. AIR HANDLING UNIT(TO 109MC.F.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE
I hereby affirm that there is o construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sea MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Add, HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC a
ess
I certify that I have read this application and state 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 construction, and BOILER-COMP(3H.P.or1OO,000B.T.U.) 6.00
hem by authorize representatives of this city to enter upon the BOILER-COMP (fiver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree tosave, indemnif and keep Im.11. the City of MISC.- REFER TO ORD.
Cuperf and t abiliti s,j encs, costs and expenses which CONST.TAX
ma n any accruA;idCaoq ucnce of the PERMIT ISSUANCE 10.00
g nlingof lis •Rail. MECH.CONT. LIC.NO. MECH.
, /�� TOTAL TOTAL
Sign reof Applicant Conlmclor fi'm/
. OFFICE COPY