23361 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification 7 PERNUTNO.
Building Address: 23361
10600 RIDGEVIEW COURT BLDG. 229
WMr9 illle: one. A
TANDEM COMPUTERS CITY OF CUPERTINO-BUILDING DIVISION
• Centraner'sName: Lie.No: APPLICATION /PERMIT
SASCO VALLEY ELECTRIC 583536 BUILDING-ELECTRICALPLUMBING-MFC IIAMCAL CATEGORY CONTROL a
Amhlten/Eay4Re^r Lie.No:
TWIN LINK QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: P.O. BOX 2406 MENLO PARK CA 1 PERMITISSUANCE BLUKU at=--PLUN[B MEL
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(comme APPUANCESRESIDENTIAL JOB DESCRIPTION
ingwithSMion 7000)ol Divislon3oftheBusivssand PrilecaP m PANELS LACEW COMPUTER RM. PNI
license is In full force and effect.
lij ttn=Cum Lica JD 1
—PDU ADD 1—HVAC UNIT
ate Contractor UPIQ2MAHAnshall a used as
OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FP.
I understand my plain shall be used v public records.
U6O
U SIGNS ELECTRICAL
�j Licensed Profevlavl
Q¢w OWNER-BUILDER DECLARATION
Iherebyaffirm that l am exempt from the Contractor's License Law for the SPFLLILCTRCUIT/MLSC
07.O^ following reason.(Section 7031.5,Business and Professions Code:Any city or TEMP.MEHIR OR POLE INSf. ""
Fp county which requ3ma permit to construct,alter,improve,denobsh,or repair
4 anystmnum prior to its issuance,alsorequlrestheappllcent for such permit to OWER DEVICES t
CEO file a signed statement that he Is licensed pursuant to the provlslov of the I j ) 1 r IIS
wO Coenanars Lice.Law(Chapter 9(commencing with Section 7000)of Divi. SWIMMING POOL ELECTRIC � .� e
30G yon3ofihe Businessand Pr eviomCode)orthat helsexem therefromantl �'yS O N
^I the basis for the alleged exemption. Any violation of Section 70US by any SGV
m5, O oUTLETSSWTTCHES-FIXTURES ---
ER
applicant for a perMtsubjensthe applicant too dull penalty of not more than
QQ five hundred dollars($500), NEW RESIDENTIAL ELECTR
M I,as owner of the property,or my employees with wages as their sole �' STOW ES TYPE CONSTRUCTION
VX compensation,will do the work andthestrumaretsnotintendedorofferedfor 1 125 RVA PDU
O sale(Sec.7044,Business and Pmfessiav Code:The Contractors License Law
I"I,IS� does not apply to an owner of property who builds or imprwes thereon,and 1 LIEBERT UNIT GCC.GROUP RIS.UNITS
who donsuch work himself ormmugh hlsoweemployne,provided thatsrcn
Improvements am not Intended oroffered for sale.If,however,thebulldingor 1 CONDENSI T�
Improvement bwld withinoneyearofcompleion,the owner-W Bderwillhave
t1ILIlieden of proving that he did not build or Improve for purpose of sale.). QTY, PLUMBING PERMIT h E FLOOD LANE APN
LJ L as owner of the property,am exclusively contracting with licensed PERMITISSUANCE
contractor to construct the project(See.70K Business and Professions Code:
The Contractor's License Law don not apply to an owner of property who ALTER-DRAIN&VFM-WATER(Els)
Wilds or Improves thereon, and who contracts for such projects with a FEE SUMMARY
��11TTec
actor(s)Ilcensed pursuant to the Contractor's License Law.
c L51 am exempt under SB Is P C for this mason BACK FLOW PROTECT.DEVICE
OUTSIDE FEES
DRAINS FLOOR ROOF,AREA,CONE SANITARY Y_ N_
Owner Date RECEIPT a
WORK MAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOL TAX Y_ N_
❑I hereby affirm that I have a certificate of consent to selGinsarc,ora RECE117 M
certificate ofWorkeri Compevatlonlruurance ora certified copythereof(Sec. GAS EA.SYSTEM-1 INC.4OUTLETS PARKFEE Y N
3800,lab CJ — RECEIPT#
Policy Y GAS EA.SYSTEMAVER 4(EA)
Com ny BUILDING DIVISION FEES
erti0ed ropy is hereby fumished. GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
IF
edified!ropy Is filed with the city inspection division.
CERTIFICATE OF E)(EMPTION FROM WORKERS' GREASE TRM PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Date Reoci t#
(This section need not be completed If the permit b forces hundred dollars
($10M or less.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y_ N—
I ceNfy that be the performance of the work forwhich thin permit is issued,
I.lull not employ any person in any manner w v to become subject to the WATER SYSTEM/TREATING
worker:Compensation Laws of California.Dale PAID
OZ Applicant NEW RFSIDENIIAL PI-MB. SQ.FT.
PDate Recel t#
A
Z U NOTICETOMICANT:ILaftermakingthb Certificateof Exemption,you
should become subject to the Workers'Compensation provisions of the Labor TOTAL:
N Code,you at forthwith comply with such pmvisions or this permit shall be BUILDI
NG FEE
W > deenad revolted. SEISMIC LENDING AGENCY SEISMIC FEE
Q. I hereby affirm that there Is a construction londing agency for the perform- ELECTRIC FEE
TOTAL:
0 essee
anca of Lenders Name
for which thb permit e;Issued(Sec.3097,CIv.C.) PLUMBING FEE
U U Lerder'.Namc
LL L) Landc/.Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W bcoingtobgrceto comply with allcityand rxbyaunty ordinances and state
esoftlaw. PERMITISSUANCE EELS PAID:
} Ia.W relacity to enter
rupont construction,aMdproprtyotl in representatives olthls
eft We)agree
ru tve,indemnify aned for
ess inspection u ALTER OR ADD70 MECH. Date ReCeiPt#
~ ? y(We)agrc upon
save,Indemnify an d property
harMev ma City purposes.
p come
V agaWtlUbllitles,judgments,cosnand npcnses which may In anywayattrue AIR HANDLING UhlTf(TD 10,000 CFM) SUBTOTAL:
against said City in come ` mof the(Ragt thi "'.
� ► �/�y AIR I-wNDunG UNIT(OVER II,BaoCFM) CONSTRUCTION TAX
s' nature car pplinnt/Com n Date EXHAUSTHOOD(W/DUC'D CONSTRUCTION TAX PAID:
HAZARD US ATERIA DISCLOSURE
Will the applicant or future bullding oc pant score or handle havrdous HEATING UMT(TO l00,W0 BTU) Date Recei t#
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
I and Safety Code Section 25532(a)2 HEATING UNIT(OVER 100,"BTU) TOTAL:
Yee I—I No
Will the applicant or'P NO
Wilding occaapant use equipment or devices VEMILATIONFAN(SINGLERFSIU) ISSUANCE DATE.
which emit havardous air contaminants as defined by the Bay Area Air
Quality Management District? BOILER-COMP DHP OR 100,0M BTU) O
Yes nn No
Thsvemad the hanmousmaterials requirements under Chapter 6.95of BOILER-COMP(OVER 100,000 BTU)
the California Health k Safety Code,Sections 25505,255533 and 25534.I
understand that if building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT 111 7 Q ���/�aB
responsibility to notify the occupant of the requirements which must be met Nov
18 `.�J�.\/e—/1)
prior to issuance of a Certificate of Occupancy. TC
�a
Owner or authorimd agent - Date TOTAL: ISSUED BY: �V��i r•' +
OFFICE COPY