25632 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY /
CITY OF CUPERTINO1mILOI '-L,L lRICAPERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 25632 C C n
BUILDING DIVISION BUILDING PROJECTIDEN-r1FIC 11ON' G J U G
I IiU1LDING ADDRESS: SAN TARY NO. AITLICA'IIDN�S�UI{MIITAL DA'lli
<D L.�/ UNIT# IATA 2>
A)
Al
OWNERS NAME: PHONE: CON TR R' 1 NO:
Cad P366--3911 N/C COM RRO'L##
RCII CDEN :ER: LIC NO: ADDR
1 GOI75! 1to El
(J C
'OMACT: PHONE: QTY. ELEM R15 P FEE BUILDING PERMIT INFO
r��' B- OG lil.'C I' PLUMBMI:QF{
`' p � , PERMIT ISSU NC i �f/Kylla
LICENSED CONTRACTORS DECLARATION APPLIp CE. - SIDEMIAL
mmz I herebyaffrn That l am licensW under provinstram'CTapter9(comle
nncing with BOPSCRI ION
4100_ Section 1000)of Division 3 of the Business and Professions Cook,and my license is in
p ry y�
Fyr�1I'� full force an�d effect. `1
Qjty License CIL►0'�1—�////--` Lic.p I 1 0200 AMPS
ti 6 d Uute_..qac,/—Contractor 11l-1000 AMI'.
Fyj V �� ARCHITF.CrS OEChARATION SQ.PT.FLOOR AREA 8/SQ.FT.
Goo, I understand my plans shall be usNaspublo,orriods. OVER IOWA
C)z_Q .1 SIGNSE CAL
Q Y W J Licensed Professional
Eow, OWNER-BUILDER DECLARATION RCUIT/MISC.
KOp�,U I hereby affimn that 1 am exempt from the Contractor's License law for the
W3LLh following reason,(See..7031.5,Business end Prmfeasloos Code:Any city or worry .METER OR POLE INST.
F 0 Q which requires a pemn t m construct,alter,improve,demolish,or¢pair any mmcturc
E�y� prion.its ismalea,Nsn requires nbeapplicam forsuch permilmfileaeigned statement WER DEVICES
fL¢ Iltm he is licensed puouunl In the provisions of the Contractor's License Lew(Chapter
a`ao 9(commencing with Section1000)of Division 3of the Businessend Prefessinns Code) SWIMMING POOL ELECTRIC VALUATION
,n , or that he is exempt therefrom and the basis for the alleged exemption.Any violation of C� �O O�w'd
an
LKQ Section 1031.5 by y applicant for a permit subjects the applicant to a civil penalty of Olpr1.ETS-SWITCHF3 FIXTURES L L,(�
a,mom than five hundred dollars(5500).
E=0 NEW RESIDENTIAL ELECIR _SQ.PIL STORIES TYPCCONSTRUCTION
C F_o ❑ I,asownerofnhepropeny,ormYemPloYeerwilh wagcsastheirsolmompcnsation,
a3°moo will Jo the work.and the structure is not momidedorofferetl for ale(Sa.1044,Business
and Professions Code:The Commctors license Law does not apply to on owner of
pop my who builds or improves themal,and who does such work hinnalfm Throughhis
employees,provldedth:n such improvements are not intendedor-offend forsale.If, OCC GHOUL' Rf:S.UNITS
h wever.the building or improvement is sold within one year ofcomplction,the owner- TOTAL:
builder will have the burden of proving That he did not build or improve for purpose of
role.). QTY. PLUMBING PERMIT FEE RCODZONE APN
❑ l,mr nerofnhe Mopen.anexclusivelYconv tingwithlimnsWcontmmorsno
constrict the project(Sec.7I44,Business and Professions Code:)The Contractors
License Law Jues nor apply luanownttofpropeny whobuilds or improves thereon,and I PERMIT ISSUANCE,
whocnmraels forsuch projects wish u conuaetor(s)licensed poumom to the Gmlmemrs
Liocme Law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ I am exempt under 5cc. .B&P C for This re sun BACK FLOW PROTECT.DEVICE OUT IDE FEES
SANITARY YN
Owner Data DRAINS-FLOOR,ROOF.AREA,COND. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Thereby affirm tbalhaveacenificetc ofemnsent msdf-insurc.on cenificam of FIXTURES-PER TRAP RECEIPfa
PARK FEE Y
orktts Compensation Insurance in acenifxvl copy thereof(Sec.3800,Lab C.)which N
RECEIPTa
Polall employee's miler this permit. GAS-EA.SYSTEM-1 INC.4 OUTLETS
icny# BUILDING DIVISION FEES
any GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEFi
Certified copy is hereby famished.
71
Certified copy is filed with the city inspection division. GREASEBNDUSTRL WASTE INTERCEPT DING FEE
CERTIFICATE OF IIXEMPTION FROM WORKERS' GREASETRAP ILS FEE
COMPENSATION INSURANCE
(This section need not be completed ifthe permit is(crone hundido11ars(8100) EWER SANITARY-STORM EA.2WIT. Ii .RGY FEE
or les.#.)
I cenily0rl in the Pe,knorarceofuhawork for which this permit is issued,l a hall RHEATER W/VENTXLECfR
not employ any person in any mnnncrs o as to become subject to the Workers' fs�I
Compereationlawsof Califomia. DateWATER SYSTEMOIRRATING Dune Receipt# 0-)
ZZ Applicant
NOTICETOAPPLICAM':TLaflermaking This Certificate of Exemption.you should NEW RESIDENTIAL I'LMB. SQ. QT
F' (A become subject to the Workers Compensation Provisions of the Labor Code,you must
� ? forthwith comply with such provisions or this perd in
mit shall be deemevoked. IILDING FE
Q CONSTRUCTION LENDING AGENCY SEI E
n 7-
7 Z I hereby aflimnhat there is a consrunion lending agency for the Performance of
U O the work for which this permit is issued(Sec.YAP,Civ.C.) 'I' I' ELECTRICF
Landers Name PLUMBING FEE
0
0 F Leaters Address QTY. MECHANICALPERMIT FEE
U I certify Jun I have read this application and some that the above information is MECHANICAL FEF.
>" correct.I agree to comply with all city and county ordinances and state laws mining to PERMIT ISSUANCL•
F-' buildingeonamOinv,and hereby mahorre rpmsenunives of this city to enter upon the CONSTRUCTION TAX
(, 'z above-mentioned property for inspection purposes. ALTERORADDTOMECH.
[We)agree m save,mdnmnify end k,r,hamless the City of Cupenin,against
liabilities,judgmcm. Vstsn expe,eswhiehmuyin any wayaceroe againummid City AIR HANDLING UNIT(TO 10,000 CFM)
in commit nee of of. permit.
'1 AIR HANDLING UNIT(OVER 10.000 CFM)
Si sure of pp uanVCon for Dae EXHAUST HOOD(W/DUCry
PAID
HAZARDOUS MATERIALS DISCLOSURE HCATING UNIT(TO 100k000 BTU) Data Receipt#
W. applieam ,,home bulldingracupam store or handle hazardous ma¢rild I RATING UNIT(OVER 100.000 BTU) O
as defined by We Cupertino Municipal Code,Chapter 9.12,and the Ileahh and Safety
Code,Section 25532(a)'!
Cl Yes ❑No VENTILATION PAN(SINGLE RESID)
Will Jct opplicanmrfmurebuilding«cupentuxcgoipmcm ordeviceswhich emit
BOILER-COMP DHP OR 100.000 BTM P�ISSUANCE DATE
sxmdous air conuuninants as defined by the Bay Area Air Quality Management BOILERCOMP(OVER 100,000 BTU)
11 1996
❑Vcs ❑No NEW RESIDENI'IAI.MECH. SQ.IT. 'JAN
p N
1 have read the hmnrdous materials requirements order Chapter 6.95 of the 0'1`V
California Health&Safety Code,Sections 25505.25533 and 25534. l understand that /r /lh CUFEHTIN
if the buildingdors not currently have a tenant,that it is my responsibility to notify the VIT'y t v
occuExist of the"Wivorents which must be mel poor to Issuance of a Ceruficane of
Occupancy.
Owner m authorised agcnl Dale ISSUED BY
OFFICE
CiC\' OI
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333 -
September 20, 1995
Syva Company
20400 Mariani Boulevard
Cupertino, CA 95014
Subject 20400 Mariani Boulevard, Permit# 25632
• Dear Sirs,
• According to our records the above mentioned permit has never been finaled by a -
City Building Inspector. A permit is considered to be valid only six months from its
last inspection date. If your permit shows that the final inspection has been completed
please send a copy of the permit, along with this letter to 10300 Torre Avenue,
Cupertino, CA., 95014, Attention Building Department.
If your permit has not been finaled, please contact the Building Department by
calling (408) 777-3228, so that we may arrange to extend your permit, and schedule a
final inspection.
In an effort to control the number of expired permits, the City of Cupertino
requires a response in ten working days from your day of receipt of this letter. If we do
not hear from you, the City of Cupertino's Building Department will have no
alternative but to resolve your permit as expired and discard the records.
Thank you for your assistance.
Sincerely,
City of Cupertino
Primed on Reryrlod Paper