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05080084U CITY OF CUPERTINO ' BUILDING DrvIs1oN PERMIT � CONTRACTOR4NEORMATLOO BUILDINGADDRESS: METROPOLITAN ELECTRICAL C Tr"°05080084 10110 CALIFORNIAA OWNER'S NAME: PERMITISSUE DATE AT & T 2400 THIRD ST 08/11/2005 NE: SANITARY NO. CONTROL NO. (415)642-3000 ARCHITECfYENGINEER: BUILDING PERMIT INFO BLDG E ECT PLUMB MECH l� Q LICENSED CONTRACTOR'S DECLARATION Job Decri tion os p en 1 hereby affirm Nu 1 em licensed under Noniixions of Chapter 9 (ammcing with Suclum 1000) of Division 3 of its. Business and Prol.m. Code. and my he.. c is In fall force ad ofJJA 200AMP METER FOR CELL SITE Liccnac CI is Lic. ia °BIC L'Onlfacbf _ ----� ARCHITECTSEI LARAION�gg PA I understand my plans aba1l be used u public records r 'L-GC�i UNL/ Licensed Professional OW HER -BUILDER DECLARATION , 1 henry affirm 11. exempt num the Contractors License Law for the (Becton 1 onstr Business and Professions Codc: Any city at county fallowing maso on which myuieu a permit us construct, tlmc. improve, sig any swdure vires a 0 Q prior us its issuance. also politics de, h Permit t fie a ate the applicant for such permit mice a signed(Chapter Sq. Ft. Floor Area Valuation to (Chapmr9 that he encingwiit pursuantto provisions; of NC Contractor's p nd Prvctaw (commencingwitamerooland) Jos Business and Professions Cade) or gleed Net he u exempt tbert(rem and Nc btu fm dm alleged exemption. Any violation of th basis f Occupancy Type Section 7031.5 by any applicant for a permit subjects Ne applicant in a civil penalty of not mare tan Bve hundred dollars (tree). 1, u owner of the prepery, or my employca with wages u their sole compensallon, I� �S equire, Innspeetions will do the work, and thesruau a is not intended or offered for aale (See. 10,14, Business and Professions Code: The Character's Liceue Law does net apply to an owner of property who builda mireper.doemon,rand who deeamch work himselfor tluough his It❑IL— (uj II L-, �i O1 own employees, provided Nat such improvements are not intended or offered for site. If. J y ;....L�s himacm. Ne building ar improvement is said within cove year of completion. Ne owner. builder will have Ne W rden of proving that he did not build or improve for purpose of .]a.). v 2z.2QQ5 / 0 I, as owner of the property. em exclusively contracting with licensed contactors to construct the pmjcn (Sec. 70", Business and Profusions Codc:) The Con®cmri Li- " more cow cool apply je an owner of properly who sults or Impmm3 Corton, and mor Landow not so i pmNnywho it p 11 L' ,ta /� pa¢amroNe Gemon,and w contracts f apply wimaeof Inl`�.'fnl flj1� /`,,�/. LKCM1Y mow. 0 I am exempt under Sec. . B k P C for this mission J/{n5 Owner Dat WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury, one of the following declarations: I have and will maintain a Certificates of Consent m ulf-insum for Workers Compcn- on, as provided for by Section 3]00 of the Labor Code. for to Performance of to rkk which Nice permit is loved. 1037,00 l a and will maintain Worker's Compensation Iuurana, u acquired by Section of me Labor Code. for t e performance of Ne work for which Nis permit is issued Workers Compensation Insurance caries and Policy nuumber am;rticr:0�.1 faN ZYiC Policy No.:12�1LL'ifL�_` CE 1C TE EIFDON FROM WORKERS' COMPENSATION INSURANCE " (This section need not W corepleted If the Permit is for ane hundred dollars (SIM) or use) I cemfv that in Ne perfmmencc of the work for which this permit is issued, I shall not employ any person in any map9q so az W heppne subject the Workers' CiouNnsalma haws of caurhmia.Dm Sl rt Appbeant 1la.w t Nal NOTICE TO APPLICANT: IL after making Nu Certificate or Exemption, you should become subject m to Workers Compensation previsions of the ISMr Cade, you mons s fhrNwith comply with such pmvisihu or Nis permit shall be tamed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm Net mere is a nn lending agency Icor the Performance of ed Sec. ' work fur which tis permit is issued Sec. J041, Co. CJ ' Lffice lenders Name - Leaders Address j I cenify that 1 Mve rad this application and sane Nat the above information is ' correct- I agree to comply with all city and county oNimnces and stain laws relating to building construction, and hereby authorim mpreurinancs of this city to enmr upon the above-mentioned property for inspection purposes. (Wc) agree m save, indemnify and keep harmless the City of Cupertino against j IiaEilita,judgmenLs, costs and expenses which may in any way acerae against endCity in consequence of the granting of this permil. ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date 0. SOURCE REGULATIONS. Re -roofs Type of Roof Signature of ApplicaRData HAZARDOUS US MATERIALS DISCLOSURE Will the applicant future building occupant.Copt store or handle M1ssalth Capaitar and u defined by the Cupenlno Muni ' al Code. Chapter 9. 12. and she Health anJ Sa(cly ale, Sccuon 25532(0)? All roofs shall be inspected prior to any roofing material being installed. ❑Yrs Nu If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or,kvices which nit hazardous air conuminanor aydefred by the Bay Area Air Quality Management all new materials for inspection. trict?❑Yes IDi. 1 have mail Ne h madmis materials requirements underChap erb.95 hfthe Califor. ce HaIN& SafmyCodc, Sectiar 25505.25533 and 25534.1un larsmn l thslifNc building u notifyoccupant of the quire tswn hmuvbcm pda arta raw amorocaley.l J Signature of Applicant Date �� All roof coverings to be Class "B" or better ` Muct Owncr or authorized agcm "e �Cm OF UPEkTINO t Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: (0(to c,,s,AY PERMIT # 0-1-64-aooB-"1 OWNER'S NAME: PHONE # GENERAL CONTRACTOR:(W �pw LgK%fAL FAX # I am not using any subcontractors: Signature Date Please check aonlicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date s D I I - LJ CITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEkTINO N # Z Lf Z 6 3 0-(q Fee Description Date: — BAPPLOTHER Other Appliances n .— Q Building Address: Mailing Address (if different from building address): MECHANICAL BBOILER2 Boiler > 100K to 500K Btu Owner's Name: 77 W (0 BBOILER3 Phone #: MECHANICAL BBOILER4 Yl —q 7 3 — 3"T,3 Contractor: BBOILER5 License #: MECHANICAL BCONSTAX Construction Tax Contact: Phone: 'its-- 99'( X635 Cupertino Business License#: &LXf-M Fax: yts•G9 299 .Z 2 Building Permit Info: BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile Bldg ❑ Elect 111� Plumb ❑ Mech ❑ Job Description: Residential ❑ .2®0 A htv k ►M0,0V "Fott CF(-L-Sl'rLmmercial C� Sq.Ft. Floor Area: ELECTRICAL $/Sq.Ft.: Cost of Project ELECTRICAL Occupancy Group: /20(qC)— BUILDING BENERGYADD Type of Construction: BUILDING Please check this box if the project is a Investigation fee BUILDING second -story addition: ❑ roject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu _ MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL / BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 °7^ w1y" � yF. 3 1 d� CITY OF CUPERTINO Cl OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME _New-Comm_Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING 1 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMA.IRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFD{T Lighting Fixtures ELECTRICAL BREMFURN Relocation ofFumace MECHANICAL BREMFURNOV Relo Fumace > 1 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL. BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY of CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 Insection BUILDING BSWIM 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—"--" --Plumbiu—PermifIssue---PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3of3