5861APPLICANTJO FILL IN INFORMATION WITHIN,RED LINES - USE BALL POINT PEN ONLY
BU I LDINGPROJECT I DENTI FICATION
" APPLICATION &PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
^
b
60ILPING
ADDRESS 10600 Ridgeview Ct.
OWNER's
NAME
Intersil ,HONE
CITY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
CONTRACTORS 1O72e1}
NAME OO JJ.J
OUTLETS - SWITCHES -RECEP 5.00/1.00
LIGHTING FIXTURES 5.00/1.00
Viking Fire PTOte Ctionso. C-16
J
DATE OF APPLICATION
CONTRACTOR 'S(I jg
Auoness
3880 Bay Center Place,o,, 785-3571
APPLIANCES- RESIDENTIAL 4.00
PANELS 5.00
AARRCHITECT HaywardSIGNS
ENGINEER
LIC. No.
g.00
PLAN CHECK FEE P.C. N0,
SIGNS TRANS. 3,00
ARCH. ORENG.
ADDRESS
$p EOIAL C.I Rf.(11T 5,00
PERMIT VALIDATION
ITEMP. METER OR POLE INS. 15.00
ZIP
APPLICANT
AP
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
'
pp
` /v Af
LICENSED CONTRACTORS DECLAR ATION
1 hereby ;dtlnn that I and licensed under provisions of Chapter 9
ISSUANCE DATE
(commencing with Section 7000) of Division 3 of the Business and
Professions Code.' l lslglicense is in fall force .'1rg� 7�_ f tt
las _ [.it. Number
Comraaor-Viking-Fire-
OWNER -BUILDER UIaumn RATION PTOte C.
I herebydfirm that I am exem t tium the Convector's Licmvve
: P
Low forUP following reason. (See. 103L5,Business and Professions
CodA permit toconstruct,
e: Any miry or county which structure. ce,aalter,
IInluires for su eIa itsissuance,
smit
BLDG. ELECT. I
❑ El
PLG. MECH.
❑ E]Liccnw
BUILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
VALu ION
%09 0
$/FT.
PERMIT ISSUANCE 6.00
ELEC. CONTR. LIC. NO.
ELTA
that
requires the applicant fur such permit m fill i ,Cont atatmnem that
he applicant h P to signrior ed
nt
l to the provisions of Dm Contractor's inion License
he is licensed 9 (commencing
Law (Chapter
s.,,it9(cmm�inS Cod with Section is 00) ex",fDther,n3ofthe
the Bess for Professions Corel or that he is cxclnpt lhercfrom and
Illi' lit, applicant fm Lafor ad exe m Pobje Any anfifi of nt S. co it ,Rally
oby frumE,rtalorapenneddollars lbc:Ipplicant rnucivilpe"'lltr
of not marc than five Dollars (my
TOTAL
PERMIT -TO
CITY. PLUMBING PERMIT FEE
STORIES
City of CuP d
YPE CONSTR.
IB
ALTER -DRAIN & VENT -WATER (EA.) 4.00
em):
❑ I, as owner of the property, or my employees with wages as
he prop
nch sole Compensation, will the work, and the structure is not
intended or offered for sale (Seca 7044, Rosiness and Professions
BACK FLOW PROTECT. DEVICE 2,00
ace. -GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 4.00
Core: The Contractor's License Law rocs not apply to an owner of
ywho builds or improves does so sell,ibwork
himselfemployees, that suchimPrdvc-
his awn IN,ed Dur
mentsarenotinlenJcdorol'fere) for sale. if, however, the bullring
RRDRS Ire do, inhroughtended
FIXTURES - PER TRAP 4.00
so. FT. FLOOR AREA
TOTAL ACREAGE
GAS - EA. SYSTEM -1INC. 4OUTLETS 4.00
or impowemmnl is sold within one year of Completion, the owner-
builder will have the burden of proving that he did not build or int-
prove for impow ofsule.).
O 1. as owner of Bre properly, am exclusively eontrading with
lieetucd contractors to construct the project (Sea 71344, Business
GAS - EA. SYSTEM - OVER 4 (EA.) 1.00
BUILDING USE
RES IND CON PB Omer
INDUSTRIAL WASTE INTER. 20.00
LAWN SPRINKLERS - 1 INC 5 V.B. 5.00
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 SPR IN KLERS - OV ER 5(EA.) 1.00
contracts for such pmiects with'a contractors) licensed nu ...... t to
Bre Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/5.00
TRACT NO.
PARCEL NO.
WATER HEATER W/V ENT 4.00
❑ I am exempt under Sac. .B.&P.C. fur tllis
anon
Owner Date
WATER SYSTEM 4.00
qCC. DATE
ACC. FILE 1,10.
W'ORKERS'COMPENSAI iON DE CLARATION
WATER TREATING EQUIP. 4.00
1 hereby atf unt Olat I have a cel i(icale of convent to self -insure,
or a certificate of Workers' Compensation Imo ranee, or a certified
ZONING
ENG. SITE NO.
copy 0,erenfl Scc. 3600, LibT'14ational Union Fir
Policy No. Company
❑ Cerliricd copy is hereby furnished. idS- Co
❑ Certified copy is filed with the city inspection division.
Applicant_
A -L Tolbert 1'4S'
CIiRT114CCOMCIF
INS FROM WORKERS'
FIRE SPRINK
Y0 NQ
ENERGY T 24
Y N�
MISC.- REFER TO ORD,
PERMIT ISSUANCE 6.00
OODZONE
A. L.u.c.
PLc, CONTR. LIC. NO.
PLG.
TOTAL
SA1ION
COMI'IiNSA'I'ION INSURANCE
(Ibis wmiu, need nut be completed if the Permit is for one
N❑
CITY. MECHANICAL PERMIT FEE
FEE SUMMARY
It un died dollar, IS 100) of It,, J .
I Certify that in the performance of the work for which Ibis per-
mil is issued, I shall not employ any Person in any manner so as to
become subject to the Workeri Compensulion Laws.of California.
Dam Applicant
NO'f ICE 'f0 APPLICANT: If, after making (Itis Cenil'icute of
-emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must fnrthwith'toloply with
such provisions or this permit shall be deemed revoked.
CONS'TRUCT'ION LENDING AGENCY
BUILDING
006 �b
ALTER OR ADD TO MECH. 4.00
APPLIANCE 4.00
PLAN CHECK
FEE
S/L
AA
AIR HANDLING UNIT (TO 10=C.F.NL) 3.00
AIR HANDLING UNIT (OVER 10,000C.RM) 5.00
SEISMIC FEE
e77
EXHAUST HOOD (WITH DUCT) 2.00
MICROFILM
1 hereby affirm that Detre is a construction lending agency for
Be performance of the work for which this Permit is issued (Sec.
3097, Cis, C.).
HEATING UNIT (TO 100,000 B.T.U.) 4.00
HEATING UNIT (O VER 100,000 B.T.U.)7.50
ELECTRIC
Lender's Name
Lender's Address
I certify that l have read this application andstate that the above
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, am
VENTILATION FAN (SINGLE) 3.00
PLUMBING
BOILER-COMP(3 H.P. or 100,000 B.T.U.) 4.00
BOILER -COMP (Over IGGL000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this City to enter upon the
above-nientioner properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against Said City in consequence of the
gran[ing'isy.uyl(. w.k
A aux/1OiTr711 1-4-85
MISC. - REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE 3.00
MECH. CONT, LIC. NO, MECH.73
TDTAL
TOTAL
1izq
Slglla ufe Of Apphmanl/Contractor Date
A.L. Toll )ert OFFICE COPY
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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LD1 NG PROJECT I DENTI FICATI ON
HUiLDH.G
ADDRESS 10600 Rid eview Ct.
OWNER'S
NAME T
Lnterail PHONE
CC C
NAME CTOH3 187293
NAME
Viking Fire PrOtapt J MNO.
CONTRACTOR'S 415
REss 980 Bay Center Plac&ONE
ARCHITECT Hayward
ENGINEER
I ADDRESS
APPLICANT'S
ADDRESS
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
LICENSED CON'I'RACI'ORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter
(commerem, with Section 7000) of Division 3 of the Business and
Professions Code, rI p license is in fall force and effect.
License laspLie Tactor _1�{.]aSJ2
Date �Y_4L Contractor
ikT.'i .
OWNER -BUILDER DECLARATION Pretee•
1 hereby affirm that I am exempt from Om Contractor's License
Law for the fallowing reason. (Sec 7031.5, Businessand Professions
Code: Any city or county which requires a permit to construct. alter,
tmpTove, demolish, or repair any structure, prior in its Issuance, also ELEC.
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapler 9 (commencing wi0r Section 7000) ar Division 3 of t is
Business and Professions Code) or that he isexcntpt Owrefrom;lnd QTY
the basis for thi alleged exemption. Any violation of Section 7031.5
by any applicant for a Pemtit subjects the applicant Ina civil penalty
ofnot more than five hundred I.Ilars(S500).)*
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
immtided or offered for sale (Sec. '7044, Business and Professions
Codd 'I'1¢ Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who docs such work
himselfor tlrow
tigh his on employees, provided that such improve-
ments are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or im-
prove for Emilio. of sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and 14olc.ssions Code: 'I'lie Contractor's License Law does not apply
to an owner of properly who builds or improves thereon. and who
contracts for such projects with a contractoIls) licensed pursuant to
the Contractors License Law..
. ❑ 1 am exempt under Sec. , BAP.C. for this
reason I
Owner f Date
1
WO�KERS'COMIrENSA 'I' ION DECLARATION
I hereby al on that 1 have a certificate ol'ouasenl or self -insure,
or a certifreat a Irl Workers' Compensation Insurance, or a remitted
policy 14H.
(, c. 3800, pian 8tional Union Fir
i'o• Na. Co ereb
❑ Ce Nificd4opy is hereby furnished. Ins • Co
❑ Cert ificJi copy is BI.d with the city inspection division.
,E COMPENSATION INSURANCE
iThis sectiolg need not be completed if the permit is for one
hundred dollar] IS 100) or less.)
I certify Ili.5t in the performance of the work for which this per
mil is issued. L shall not emP1oY any pcnon in any manner so as to
becxnnc subje(i w the Worker' Compensation Laws of Celifomia.
Date 1 Applicant
N01'ICIi '10' 1'PLICAN'I': IL after making ""' Certificate of
Cmptimr, you 1 could became subject to the Workers' Compensation
pr0vizI'm, f h. Labor CDJc, you must for0awith comply witla
such provisionor this permit shall be deemed revoked.
ONSTRUCI'ION LENDING AGENCY
hcrcby af�'rm that there is u construction lending agency for
the pcdorman'fc of the work for which this permit is issued (Sec.
Lenders Addr,�s
I certify Elm I have read this application and state that the above
information is correct. 1 agree to comply with all city and county
onlinanees wW1 state laws relating to building construction. and
herchy all tlmrisc representatives of this city to enter upon the
above-mentione)I property f or inspection purposes.
(We) agree �s save, indemnify and keep harmless the City of
Cupertino agairit liabilities, judgments, costs and expenses which
may in any way accrue against Said City in consequence of the
ELECTRIC PERMIT I FEE
JTLETS-SWITCHES-RECEP 5.00/1.00
GHTING FIXTURES 5.00/1.00
'PLIANCES- RESIDENTIAL 4.00
_S
5.00
2.00
6.00
TRANS.
3.00
ALCIRCUIT
5.00
METER OR POLE INS.
15.00
IRS
SEE FEE SCH.
ICE CHANGE
10.00
LAWN SPRINKLERS -OVER 5(EA.)
1.00
M ISC. -
PERMIT
PLUMBING PERMIT
ALTER -DRAIN BE VENT -WATER (EA.) 4.00
BACK FLOW PROTECT. DEVICE
2.00
DRAINS -FLOOR, ROOF, AREA,COND.
4.00
FIXTURES -PER TRAP
4.00
GAS - EA. SYSTEM - I INC. 4 OUTLETS 4.00
GAS - EA. SYSTEM - OVER 4 (EA.)
1.00
INDUSTRIAL WASTE INTER.
20.00
LAWN SPRINKLERS- 1 INC 5 V.B.
5.00
LAWN SPRINKLERS -OVER 5(EA.)
1.00
SEWER -SANITARY -STORM EA. 200ft/8.00
WATER HEATER W/VENT
4.00
WATER SYSTEM
4.00
WATER TREATING EQUIP.
4.00
t
5861
V
/,
ISSUANCE DATE
BLDG. I ELECT, I PLG. MECI
EJ ❑ ❑ ❑
BUILDING PERMIT
INFORMATION
VALUATION S/FT.
Q�
7-
PERMIT TO
FEE 7'/•CE' Jji2iN�IlQ
STORIES TYPE CONSTR.
GROUP RES. UNITS
J�O'CC
T. FLOOR AREA TOTAL ACREAGE
RES
11 I1-1
❑N 1:1PEI O❑r
ENG. SITE NO.
FIRE SPRINK ENERGYT.24
MISC.- I REFERTOORD. _ y❑ N❑ Y❑ N❑
PERMIT ISSUANCE 1 ,6.00 F1nnn InNF I A_L.I)C.
PLG.
TOTAL
MECHANICAL PERMIT FEE
ALTER OR ADD TO(MECH. 4.00
APPLIANCE ' 4.00
AIR HANDLING UNIT (TO 10,000C.F.M.) 3.00
AIR HANDLING UNIT (OVER 10=C.F.M.) 5.00
EXHAUST HOOD (WITH DUCT) 2.00
HEATING UNIT (TO 100,000 B.T.U.) 4.00
HEATING UNIT (OVER 100,000 B.T.U.MSO
VENTILATION FAN (SINGLE) 3.00
BOILER-COMP(3 H.P. or 100,000B.T.U.) 4.00
BOI LER-COMP Over 100,000 BTU) SEE FEE SCH.
MISC. - REFER TO ORD.
PERMIT ISSUANCE 3.00
.ONT. LIC. NO, MECH.
TOTAL
• • ToWert 1MCDCr•T(1R COPV
Y❑ N01 Y❑ N❑ I
FEE SUMMARY
BUILDING
O
PLAN CHECK
FEE
/-
Sof
SEISMIC FEE
Ory 7
MICROFILM
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
TOTAL I Y'ff I