25153 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO MBI .-MEC
ANIC . PEamrr NG. 2 5 1 5 3
APPLICATION/PERMIT PLUM111NG-,1, ", ex,ICAI.
BUILDING DIVISION BUILDING PROJECT IDRN'rIF'ICATION
BIjI1,11ING ADDDRESSSS:/l��.� SANITARYNO. APPRACA'DONSUBMHTALDKIE
420
/
Y, L0)-to J �xl l,a�� Nelr� ` UNrrx LCR
OWp{[iRS NAMF'y PHONIi: CONTRACT LIC NO:
V\ A 1�1T N)C CONTROhp
RCHITE 714JGINEER: LIC
�INO:
� ADDRESS ❑ /C V
Ate'
10%
;. et
I }.` y 1 QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
" �•J�(y� `�,e"l�l Nr BLDG I U
PERMIT.ISSUANCE
LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPJ]QN
❑wz Iherebywrion But l em licenedunder provisions of Chapter9(commencingwith Ow �N 1f7`
�00 Section 700Division
0)nf 3 of he Btuiness and Pmf<wsione Cade,and my license is in PANELS G ` x. , Pei
y,lF-. full deffect,
Fye Licensense ClaClnss Lic.p UP T0200 AMPS
m 6 a DContractor 201-IOW AMPS
H ate SQ.FT.FLUOR AREA $ISQ.FT.
SOt° ARCHITECTS DECLARATION OVER 1000 AMPS
O"L ❑ 1 uMcrsteM my plans shall h used aw public recoNs. ,lot
O
n�.4l SIGNS ELECTRICAL,
to
KK6 Licensed Professional
N OWNER-BUILDER DECLARATION SPECIAL CHRCUFIMISC.
xdOwU 1 hereby affirm that 1 am exempt two the Convectors License Lew for the
F40o~n fullti.all own.(Solmo l(1715,Business end Pntfessions Code:Any city mcomay TEMP.METER OR POLE LOST,
_ which requires a permit to commuct,alter,improve,demolish,or repay any swcwte
prifirm as issuance,unto requires theapplicant l'eawch penniuo fileasiloed swtemem POWER DEVICES
Ad 6�<0 that he is licensed pursuant the provisions of the Contactors License Lew(Chapter VALUATION
aa❑ 9 with Section 7000 of Division 7 ofthe Business and Professions Code) SWIMMING POOL ELECTRIC �j
xo� (commencing ori ) �y.a Cr
or Nat heisexcmpnhwermm end the basis finite alleged exemption.Art Iation of
F-,ZY f1'1'LETS-SWRCHES-RXTU
Seaton?071.5byanyapplicantfarapc.I,subjecuNcnpplicamm.civilpenaltyof RES J fN L
not more than five hundred dollars(SSW).
�S❑ NEW RESIDENTIAL ELEC R SQ,FT. STORIES TYPECONSTRUCHON
e[zC3I.mownerofthepmp Tty,ormy<mplo mswithwagesmtheirsolecompensation,
y3°. will do the work.and thesvucture is not intendedoroffcred forsalo Sec.701 Business
cod Professions Code:The Contractor's License Law does not apply to an owner of
eropcny who builds m improves Ncmon,vnd who docs mcM1 work M1imul(or though his
own
cmploytts.provided that such improvementsurenol lntendonoroffered fortune.If. OCC.GROUP RES.UNI'15
however,the building or improvement is sold within one yew of completion,the Owner.
builder will have the burden of proving that he did not build or improve for purpose of
sole.). QTY. PLUMBING PERMIT FEE
❑ Law awneroftbeproperty.an cndusively convecting wiN licensed mnwnors to FLOOD ZONE APN
instruct the pnniect(Sec.7044,Business and Professions Cade:)The Contrector't
License Lawdo<anot apply to an ownerofpmpeny who builds or improves thereon,and 11
PERMIT ISSUANCE
whocmnrncu for wish projects with a em armclunt)licensed pursuant m N<Conwnors
License law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ 1 am exempt under Sec. ,R&P C for this masonEES
BACK FLOW PROTECT,DEVICE SIDE
SANITARY Y N
Owner Date DRAINS-FLOOR,ROOF,AREA,COND. RECEIPI'p
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Iherchy affnn lM1utlM1avc acertificva of consentmsdf-insure,oracenificam of FIXTURES-PER TRAP RECEIITp
t
Workers'Compensation Insurance ora ccnifiedcopy Nereuf(S.,3800,UIECJ which G PARK REE Y N
U o covers all employee's under this permit. GAS-EA.SYSTEM-1 INCA OUTLETS RECEIFTp
Policy N BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE 2
❑ Certified copy is hereby famished.
❑ Cenil3.d copy is filed with Neclty inspection division. GREASRgNDUSTRI VA E R GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREAS TRA SOILS FEE
COMPENSATION INSURANCE
(This section need Oot be completed if Nc permit is forma,hundred dollars($100) SEWER- r1 - R -JWrr.2NERGY FEE
or less)
I certify Nat in the performnnceof Ne work for which this pemtit is waOd.I shall WATER HK TERW/VF.NT/F.1
not employ any Persian to any manner so as to became subject to the Workers' �/� Pp ID 1
Comprnatimnlawsof California. Date WATER SYST yea Dwe Rcc,ip
O Applicant
z 0 NOT ICE TO APPLICANT:If.after making this Cenificate of Exemption,you should NE ESIDENTIAL PLMB. SQ.FT. TOTAL:
VI becmnesubjecuo the Worker's Compensation provisions ofthe Labor Cede,you must
aforNwiN comply with such provisions or Nis permit shall be deemed revoked. BUILDING FEE
0. Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
`7
I hereby affirm that them is a concoction lending agency for the performance of z ELECTRIC FEE
the work far which Nmi
is pert is issued(See.3097,Civ.CJ T `
lenders Num. PLUMBING FEE
I—' Icnder's Address QTY. MECHANICAL PERMIT FEE
U 1 cenify that 1 have read this application and store Nat N<above informedon is MECI IANICAL FEE
�-' correct.l some mentality with all city and county ofdinancesand state lawsrelmingm PERMIT ISSUANCE
F-' building construction and hereby awhorize represcnatives of this city to enter upon the CONSTRUCfIONTAX
U above-mentioned property for inspection purposes. ALTER OR ADD TO MIECII.
(We)a cc to save,amemnif and k handles'
Ne City of Cupertino against
liabilitio,j gmengcosssande nses c mayinenywayamrueagv....said City AIR HANDLING UNIT(TO ILAWCFM)
,a coule c of the grant C?
AIR HANDLING UNIT(OVER IU,LOL CFM)
Sig Of Appf a VC nsr Date EXHAUST HOOD(W/OUCD PAID
]AZARDDUSM RI 1 DISCLOSURE HEATING UNIT(1'0100,M)BTU)
Dv¢ ReceiptM
Willth app emomfumrebuil ngoc pant store or handle hazardous material HEATING UNIT(OVER IOIl,WO BTU)
as defined Is Ih upenin.Manicies .Chapter 9.12,end Ne Health and Safety
Code,Sectio .532nd? VENTILATION FAN(SINGLE R1iSID)
❑Yes ❑No
Will Iheapplicammrfuwrt builJingmcupam uucgoipmem ordevices whichemit
BOILER-COMP(314P OR 100,01W BTU) ISSUA 1: A E
�hsoardom air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER I00.00a,BTU) d
' 1UIJ 24 1993
District
❑Yes ❑No NEW RIESIDIEMI'IAL MSCI I. SQ.FT.
1 have read the harandous materials requirements under Chapter 6.95 Of the f.liy OF kJ Ur CI11IlvV
CaliforniafteulHealthdo&Safety Cody Sections ant.du 25577 and 255�1responsibility
l undersand that V
ifthebuilding does not currently have ast Is, et it myssuance oily mnotify Nc
wapam of the requirements which must be met prior t0 issuance of a Certificate of
Occupancy.
Owner or authorized agent Done ISSUED BY'
CUPERTINO SANITARY DISTRICT
SANTA CLARA COUNTY
DISTRICT MA NAGER•ENGI NEER 20065 STEVENS CREEK BOULEVARD.BLDG.0 BOARD OF DIRECTORS
MARK THOMAS • CO. INC. CUPERTINO.CA 95014-2396 ROY M.RUSHTON,n
PHONE(408)253-7071 • FAX(409)253-5173 WENDELL H.KERR,JR.,cern.
DISTRICT COUNSEL CURTIS B.HARRISON
PHILIP D. ASSAF OF DR.JOSEPH F.BROWN
STURGIS, NESS. BRUNSELL d RICHARD A.FELLOWS
SPERRY
June 29, 1993
File: CuSD - MOP
Building Department
(Cupertino)
Mr. Jerry Brager
Building Department
City of Cupertino -# a,6r 53
10300 Torre Ave
Cupertino, CA 95014-3202
Re. Tenant Improvements, Corridors
Syva/Cupertino
RECEIVED. 20400 Mariam Ave
Cupertino
JUL Control 97308
'y17y, OE CUPERTINO (APN 316-22-018)
0-VILDING BfL
. Dear Mr, Brager:
Based on the proposed improvements as shown on the plan submitted
to this office on June 25, 1993, no additional fees or permits are required
by the Cupertino Sanitary District. 1
The condensate from any HVAC equipment shall not be discharged to the
sanitary sewer.
Very truly yours,
MARK WOMAS & CO. INC.
Dista [/I(,la a r er /
y arl H. Beckhap
CHB: Ih
cc: Minert Architects
SUPPLYING SANITARY SEWERAGE SERVICES FOR:
CITY OF CUPERTINO, PORTIONS OF THE CITIES OF SARATOGA. SUNNYVALE AND L05 ALTOS
AND SURROUNDING UNINCORPORATED AREAS