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28114 I APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPERTINO Bull,ON,r-hicbUTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLIIMIIING-MECHANICAL. Lyl(J114 BUILDING PRf)JECr I IIF.NTIFICA'i'ION BUILDING ADDRESS; C SANITARY NO. APPLICATION SUBMITTALE: `DAT a�t-J oo V CS UNI'1'N LOTH ISS r•7�' OWNS NAME: PHONE: CONT 'OR'S I.IC No N/C CON'MOI.N �ARCHI .Cr GIN ai LIC NO: ADDRESS: ❑ CONTACT: PHONE: Q'PY. ELECTRIC PF;RMIT PhE HIIILUING PERMI'I'INPO LD F� PLUMB MEC PERMIT ISSUANCE �r LICENSFE)CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION QWZ I hereby affrtm lhat,l um licensed under provisions of Chapter 9(commencing with WOO Suainn]000).1 Division Sot the Business and P..fictitious Cmla,and my license is in PANELS f� full force it effect. <Z License Class 1.iaN UP 10200 AMPS yQy Data Comrmmr 201-1000 AMPS Z0 Z ARCHITECTS DECLARATION OVER 1000 AMPS SQ.Irl'.FLOOR AREA E/SQ.FT. O Z—IO I understand my plans skull be used as public records. F y F W SIGNS ELECTRICAL. r< Licensed Promasiotml OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. KOpW,U 1 hereby affirm that 1 am attempt from the Comrmtors License Law for Lha Iz13my fnllowingreusor.(Section91131.5,Business and Profession,Code:Any city.,rurally 'TEMP.METER OR POLF INST. FLLJ�� which requires a permit to construct,alter,improve,dcmullsh,or repair ons smaure !� �a ''� priortoits iomme,alwinaNhasdaripplicanlfor suchpaminnfile.signed a¢mem H p)C�p that he is licensed pursuant provisions of the Commmols License Law(Chap¢r IJT_NG LELECTRIC 660 ' 9mmurn emg with Section7001 efDivision3of the Business and Professions Code) VALUATION IzK1-oe or that he is exempt herefrom and the basisforthe alleged exemption.Any violation Of LETS-SWITCHES 1-•ZQ nSection 7031.5 by any applicant for a permit subjects the applicantt o a civil penalty of PIX'ITJRES I more than five hundred dollars($500). NEW RESIDENTIAL ELECTR S .Fel'. Q ❑ T,asownerofthepnhpany,ormyemployeeswithwugesustheirsolecompensation, Q STORIES TYPE;CONSTRUCTION will do the work,and the structure isnot intended reoffered for sale(Sec.0094,Business and Professions Code:The Contractor's License Law does nal apply to an owner of pnpvny wh.bullds.rimproves therm.,end whamssuch wn,khlmsei mthmughhis own employees,provided lhatevchlmprovomentsamnn ireended.r.fferedfmsale.if, OCC.GROUP RIS.UNITS however,the building or improvement is sold within one yeurofcompledon,meowner. builderwill havethe burden.fprnving that he did not build or improve forproar moof r� Ie.). ❑ I,asownerafthe property ere exdusivelyconmming wire licensMc.ntacmrstn QTY. PLUMBING PERMIT FEE, FLOOD ZONE APN .nstme,the project(Sec.](D4,Business and Professions Qde:)The Contractor's License Lawdcesnolapply umums.er Ofproperty who builds.,improves Hereon,and PERMIT ISSUANCE whocontmcts forsuch projects with a contractors)licensed pursuant to the Contractor ALTER VI?NT�WATER EA License Law. ( ) FEE SUMMARY ❑ I um exempt under Sec. /7���,B&P C lar this reason _L I BACK MOW PR('1'ECT.DEVICE OUTSIDE FL:. SANITARY Y N Owner - RECEIPT'p -Y DRAINS-FLOOR,ROOP.ARTA,COND. WORKMAN COMfific IONDECLARR ION SCtI00L TAX Y N ❑ Ib'Cou,sfirm Natlbrrance nifc rofie c.nsenlm.f(S . m,orerer4ficate.f FIXTURES-PER MAY RECEII'1'p Wmkers'COmpcnsation insurance nru nified copy thereof(Sec. gW,Lab CJ which PARK FfiE Y N covers y ell emplOyce's under this pc GAS-EA.SYSTEM-I INCA OUTLET'S RECETPTp Policy p BUILDING DIVISION FEES Company GAS-EA.SYSTEM-OVER 4 EA) PLANCHECK FEE ❑ Cenifledcopyisherchy citical. ❑ Certified copy is filet ith the city inspection GREASE/INDUSTRL WASH?INTERCEPTOR GRADING IFI? CERTI CA MPE EXIiMPTI 1(]R�' GREASE:TRAP SOILS PI?l? COMPf1JSAT'IONI NCI -/ (Thisseetion adnntbeemopleled if It is for one J.Ilev(SIW) SEWER-SANITARY-STORM F.A.200FT, ENERGY FEE .,lase.) Icertlfythmi din performs,m.f a cok h\ horn this pc Iis issued,10.11 WATER HEATER W/VRNTpiLECfR not employ any pc hany h t. a subj t 1.the W.rken' PAID Z Compensation Laws Celifo_o xO WATER SYS'IHM(IRP.ATING Data ReceiptJa Appl teattt m O NOTICE TO APPLICA T:If,after ma n this Cenifhcmc o' Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. 6 p TOTAL: (q haanu subjcdmthe Wo cm's Cma,mui.npmvidmJa of ¢Comm Cole,youmusl � ; lihrthwllheomplywllhsmir twiWonsnrthispomdtshull •deemed revoked. 0. Q CONSTR TION LENDING ,CNCY V2 1 hereby affirm that the.is. romelion Iendi agency for the performance of O Ilhc work for whicM1 lM1is permit isissu (gu.309], iv.CJ ELECTRICITE Landers Name PLUMBING FEC O F Lender's Address Q'I'Y. MECHANICAL PERMIT FEE V 1 terrify Thal I have read this appiiw on and sinre that the above information is acorrect. I agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE MECHANICAL FEE building construction,and hereby authorize representatives of this city to emerupon lM1e CONST RUCf10N TAX L1 ubovrmeteioned property for inspection purposes. ALTER OR ADD TO MSCI I. (We)agree 1.save,indemnity and keep harmless the City of Cupertino against Iiabililaw,jud a versus spe swhi may in Way way scam against said City AIR HANDLING UNIT(TO 10.000CFM) in consa enc the gran ag f This pert. . Z NR HANDLING UNIT(OVER I0.010 CFM) Si Wtmof pplicanVCa ucror Date EXHAUST HOOD(W/DUC) PAID at HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IN,"B'rU) tip Will the applicant or future building Occupant store Or handle hazardous material HEATING UNIT(OVER 100,000 BTU) TOTAL: its defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cb]a,Sectio 25532(.)4 ❑Yes ❑NO VENTILATION PAN(SINGLE?Il BOILER-COMP(3HP OR I IWD BTU) ISSUANCE DATE Will the epcarmommmwm befitted by the use equipment Quality ch QT A y i) 'Sezand.us dr comaminanB m defined by the Bey A.Air Quelily Management BOILER-COMP(OVIiR IW,000 ETV) Y� gsV -0istricf! . ❑Yes ❑No NEW RESIDENTIAL MF.CH. SQ.FT. JUN O 6 1 have read the hazardous materials requirements under Chapter 6.95 of the ]gg�® California Health&Safety end,haveSections it arn.that it is and 25534. 1undemand thm /x11 f, •� ocetipllon militia,the ossnmareal,llyha omen be me,Alis my rumonsibilitymnmify ma V I �ff tfI o�capon of Tho rcqulremmns which must be met prior to iasuunce of a Certificate of �UrkH fl1 y, anpanay. Owner or authorized agent Data ISSUED BY OFFICE POSTTHIS CARD NEAR FRONT OF BUILDING Lnow CITY OF.CUPERTINOZ r PERMITNO. IM BUILDING DIVSEIONjk BUdDiNG PROJBCI'IDENT67CAT10N BUDDING ADDRESS: SANITARY, APPUCATTON SUBMITTAL DAT Zo3oo S s c iz �G WD FLOOR ER' NA PHONE: C_QNTRACTOR'S N14, UC NO: . tiVCC� N/C CONTROL• CHITS /ENGINEER: LIC NO: ADDRESS f ❑ BUD-DING PERMIT INFO INSPECTIONS DATE INSPEC. ❑ Consultant Fees Paid by Applicant(Initial) _e G E¢Cr PL fa FOUNDATION/PIERS/H.D.S. INSPECTION RECORD 7 1..•/�Jy JOB DESCRIPTION UFER GROUND NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL PAD/SETBACK-CERT SHALL BE INSTALLED TO COMPLY WITH ❑sFDwL ❑KITCHEN REMoDEL THE APPROVED PLANS AND CITY OF ❑ADDMON ❑PLUMBING RE-PIPE GARAGE SLABS/PREGUNITE ❑MuLTI.uNrr 0STRUCURAL POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED MODIFICATION O INTERIOR ❑CHNLNEY REPAIR UNDERGROUND/SLAB IMPROVEMENT PLUMBING O BATH REMODEUREPAIR ❑DEMOLITION ❑OTHER ELECTRICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED COMMERCIAT- PLUMBING t7P NEIJ BLDGIADDRION ❑DEMOLITION MECHANICAL NO PERSON(S)SHALL PERFORM WORKO ANT ❑FOOD SERVICE THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMENT ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION OOTM FRAMING VENTS INSURANCE REQUIREMENTS. INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SHEATH/DIAPHRAM PLUMBING TUBS&SHOWER PAN ECHANICAL CTRICAUPOOL BOND AMINO/STAIRS/E.EGRESS INSULATIONMENTILATION COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIAL SHEARMOLD DOWN INTERIOR SHEARMOLD DOWN SHEEIVIROCK/SHEETROCK SHEAR EXTERIOR LATW W-SCREED SHOWER LATH NO TAPE OR PLASTER UNTILABOVEHAS BEEN SIGNED SCRATCH COAT SEWER/WATER' TEMPORARY APPROVALS .. ., OCCUPANCY ELECTRICAL GAS FINALS:: fo.L Ac.,T�^n.:?4 i p d GAS TEST 14 GRADE O FIRE A O HANDICAP NOV O ELECTRICAL IMBING CHANICAL _ r'-t CIT( OF CUPERTINQ LCY i - - r VISUAL FINAL ONLY - RTIFICATE OF OCCUPANCY ❑ BUILDING -r---or IMPORTANT: ISSUANCE D OCCUPANCY'OF,BLJILDINGISNOT:PF.RMITTED gty PLEASE READ REVERSE SIDE BEFORE TIL� UNBUIL.L)ING FINAL IS SIGNED BXBUILDING.. CALLING FOR FINAL INSPECTION!! 'INSPECT0PQ%�,,,'.,'`,. ?[�r:: ...�s;t."21?r•`.ua' 'k,.'."`"• ISSUED BY: Ocitv 10300 Torre Avenue of Cupertino,CA 95014 Cupertino Building Division (408)777-3228 (408)777-3333 (fax) September 23, 1996 Symantec 20300 Stevens Creek Blvd, 2nd Fl. Phase 2 Cupertino, California 95014 SUBJECT Tenant Improvement: Permit#28129 To Whom it may Concern: We have been cleaning out our files in the Building Department, and contacting those people with permits which have remained "open". • According to our inspection records, the subject permit has never been finaled. Many times an inspector will sign the permit in the field, but neglect to report all of the information to the clerical staff for input into the computer. If your records show the subject permit as finaled, would you please contact us so we may complete our records? If the permit is not signed off your permit can be reactivated and an inspection could be scheduled for final closure of the permit If we do not hear from you within ten (10) working days, we will dispose of the file and remove the records from our computer. Thank you for your assistance. Sincerely, CITY OF CUPERTINO Christy Akatiff, Administrative Clerk Printed on Recycled Paper APPLICANT TO FILL IN INFORMATION WITHIN RED LINES^USE BALL POINT PEN ONLY ' CITYOF CUPERTINO ... 'A. rhRnurrvD. ' BUILDING DIVISION^ APPLICATION/PERMIT 1'INGPROJECTIDENT-MECHANIFIC 28129 .BUILDING PROJECT IDENTIFICATION +- BUILDINGADIlRE55: //.a'�'a' ^ SAN]]AR) NO, APPIACAI'ION SUBMITTAL DA IF 2 O VVrrissel S ONtf# LOT# 60 • OM" SNAME: PHONE: CONTR TO ' N ptt LIC NO; NIC-1 /CONTROL# ''. ARCHITE- GNU- : LIC NO: ADDRESS: ❑ / COINTACT: PHONE: E-.Ec- ICP""BRMIT'" FEE. - eta BUILDING PERMIT INFO "'.+`� N CT PLUMB M[pil PERMIT ISSUANCE ❑ LICENSED CONTRACfOR'S DECLARATION APPLIANCES-RESIDENTIAL ]CZ Ihe,ebvafmmmm Lou licensed under provisionsofariper9(commencing with JOB DESCRIPTION ?00 Section 7100).!Division 3 ft he Businessand Professions Code,end my license ism PANELS full forte and effst. t 1 �Z License Class Lie# UPTO HI(i -<y Date Contractor 201-Ipast AMPS 'r z ARCHITECTS DECLARATIONSQ.FT.FLOOR AREA $/SQ.M. ;hI erstand raYPlano,ml ba sad.,publicrecrde. OVER IIXX)AMI'S , und — ^ sat SIGNS ELECTRICAL Licensed Net usional 2-8 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. %iF 1 hereby a!!flat I am exempt from Ne Contractors;License Law for the m fallowing..n.fSutim I031.5,Business and Professions Care:Any city or county TEMP.METER OR POLE INST. -y; which retains,a Permit to concoct,alter,impose.demolish.in repair any structureUhf pnmm its issuance.also requires the applicant for such permit in rile a signed statement POWER DEVICES i-0 than he is licensed pur..mno the provisions of The Contractors License Law(Chapter SWIMMING POOL ELECTRIC VALUATION 9(commencing with Section 70M)of Division 3 of the Business and Professions Code) -_,�, or that he is exempt therefrom and the basis forte alleged exemption.Any amumion of LLTS-SWITCHES-FlXTURES -Z< Section 7031.5 by any applicant for a permit subjects the applicmuo a civil mnZ.f I. 8 _--O 0-- I., me do[[.(SIM),❑ l.aownerofemoprty.aYePloyaswithwa esmfheirwiccom.nation, NEW RESIDENTIAL ELECIR _SQ.PT. SrFORIH TYPNSTRUCTION 3= will aathew...Cm:the Mrs,Cmiacours kende offend for sale fSec.]Dsa,Business ma Rvfessions Cale:The improves tsaon,License Isco a«s'o r apply lf rt owner of popmywxces,pdsm improv es memprove who areniudtwodhroffered for gbhin OCC.GROUP RES.UNITS ownemployees,providedtlwtsuchimprovementsin notintendedmofferorforsale.If, bowder r.m ill have ori en ovemem is that he within ens yam of a prove for thrower- 1 builder will have the burden of proving that he did not build m improve for purpose of ,Well. - .- ❑ I,mawnerofine progeny,ameaclusively contracting with fanned contractors to QTY' ', PLUMBING PERMIT i- ' + . 'vY,. FEE FLOODZONE APN outrun the projst(Sec.70,14,Business and Professions Code)The Co mumrx IJcen wdmsmupplytomownerofpropenywhobuildsmimpmvumea.n.and PERMITISSUANCE { whomntrmafmsuch WojecuwiN.c.n c'.gs)licen.Wpunumumhe Contractor's License Law. ALTER A ) :')`�'.$-q,s+`L. FEB SUMM Kl"r I ❑ 1 sum exempt under Sec. ,B A P C for this reason BACK FLOW PROTECT.DEVICE 0 S D.FEE' SANITARY Y_N Owner Dam DRAINS-FLOOR.ROOF,AREA,CONE. RECEII'1'N WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN # ❑ Thereby Wfum mmihevicecenirism of consenno selLinsurt,oreanificam of FlXTURES-PER TRAP RECE12 _� N'ohen'Compensation lnurancearacmified copy Ncrmf(Sec.]800,Lah C)whicb PARK FEE N caters all employs s under this Permit. R '.I p Policy* GAS-GA.SYSTEM-I INC.4 OUTLETS HUH-AjV4NTVAION FEES Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE ❑ CeriRW copy is hereby formatted. ❑ Certified copy is filed with rotary inspstion division. "^'urF.PfOR GRADING FE CERTIFlC COMPENSATION INN FROM WORKERS' .. COMPENSATION INSURANCE SOILS FE (Thisssfion mM not hc�mple�ed if dm permit is(Drone hundred dollen(E100; ENERGY IEE n M .r less.) LV 1 cmify that in the performance of Ne work for which this Permit is issued.I shat not employ my Person in my manner to as to become subject to the WorkerPAIU Z Compensntionlawsof Califomia. Dale Data p t APplmcant j NOTICE TO APPLICANT:If.after making this Cafificme of Exemption,you shot J.PT. TOTAL: W) became subject m me Workres Compensation provisions of the IsLvr Code,you in larm.Ih comply with such provisions.,.his permit shall he restated revoked. BUILDING FEE O CONSTRUCTION LENDING AGENCY SEISMIC ME Z Ih...I,affirmthat there is.construction lcnding.gency for the perfmmmce of TCI AL.� ELECTRIC FEE O the wmk far which this Part is i...ad(See 307.Civ.CJ Lenders Name_._ U Lender s Address QTY. . MECHANICAL PERMIT "' FEE PLUMBING FEE 1 certify that T have paad,his application and sum that Are above imd..am is Zcomet.l agree m comply withall city and county mcli...ces militate laws relating 1. PERMIT ISSUANCE MECHANICAL FEE y building concoction.and herebyamhmae repsexemmivasof,hisciryo emeruponthe CONSTRUCTION TAX t Z aMre-meminned prnpem for 31ya pu0ro.cs. TER OR AOD TO MECH. (W'e)alma m sal make less the City of Cmamin.againstiabilities,judgments o sandw ¢ ay in ur4waynccmengain aid City AIR HANDLING UNITfT010.1X)UCFMI in Co. ce ofth ming HANDLING UNIT(OVER I;.(X)CFMI a ("ill urt or Applic .VCmwnor Date IiXHAUST HOOD(W/DUCT) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT'(TO 100.000 BTU) Data Receipt 9 the applicant or future building cmurym store or hamlle he>mdous material ned bythe Cupertino Municipal Code,Chasm,9,13,and the Health and Safety I MATING UNIT(OVER H0,000 BTU) TOTAL: Section 25532(a@ ❑Yes ❑No VENTILATION FAN(SINGLE RESID) ISSUANCE DATE' N IINeoppiicanmrfuwrc buildingmcupam useeyuipmcn,ordeviceawhi[h emit tlO1LF:R-COA1P(]I{POR I(q,fKKI RTU) rt Dionemardt os air conuminmts m defined by the Bay Area Air Quality ManagementBOILER-COMP(OVER 1(0.0X10 BTU) rt /,J�/ f 2� 1995 ❑Yes ❑No NEN'RESIDENTIAL MECI I. SQ.rill s -� f 1 have tend,he hazard...mmmuls ortmocmems under Chapter 6.95 of the J(J ' Ur California Health&Safety Coil,Sections 25505,]5533 and 25534, l understand that J if the building does not currently have a umm,.that it is my responsibility to notifythe ar s[.pm,of the reyuir Trema which malt he met pa.,t.issuance.f.Cmm[ate of Occupancy. I Ouncrorambomea agent Dwe V4— ISSUED; . r I/pIC) 0 F F I CE APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY CGfYOFCIJPERTINO BUILII]tl- sLEC'I'Bills, I'IiKMII'NO. ^ �,a BUILDING DIVIsioN' APPLICATION/PERMIT rl,umntNc-.MBcnnNlc"1" L l8 L 8 BUILDING PROJECT IDENTIFICATION - BUILDING ADDRESS �y ,,ms�ss SANII'ARl'NO. APPLICATIIONNSUIMUTALDAIIi V Wa✓ UND is I.OI', OWNfB%NAME: ( �� PHONE: CONTRACT(tB:ti NAME: LIC NO. OW v 5VN/C CUN9ROLN ARCHITECT/ENGINEER: 1.ICN0: ADDRESS: rWAADO D►JE375tZ G 0 CONTACT.th WALTZ 9D8°ga5-3ygl QTY. �_:ELECIRICPERMIT FEE BUILDING PERMIT INFO #kms BLDG ELECT PLUMB MECII PERMIT ISSUANCE. LICENSED CONTRACTOR'S DECLARATION APPLIANCES -RESIDENTIAL 1 DESCRIPTION y 7 1 hereby affidn 0a 1 am licensed under provisions of Chaprec9(commencing with �DO SenimnT000).Mivimon Jofdh,B ,mp,,and Professions Code,and my licem.oad PANELS T? fun force and effect. ! C/�,, L License Coss Licp UPTO200AMPS Data Cammnor 201-IUM AMPS v Z ARCHRECPS DECLARATION OVER IUM AMPS SQ.1-1.FLOOR AREA S/SQ.FT. I to dcntand my plans shall be used as public me.o s. SIGNS ELECTRICAL .i, Liccmed Professional �< OWNER-BUILDIiR DECLARA'DON SPECIAL CIRCUIT/MISC. U I hereby sfr,.Our I am exempt from the Contram ors License Law for the awe following re.mm(Section 7031.5.Business and Professions Code:Any city mooumy TEMP.METER OR POLE INST. which requims a perrnil m composer.alter,improve,demolish,tor repair any s.c,urc or prior prior to its issuance.also requires the appheah for such permit to rile asigned statement POWER DEVICES p that he is licensed punuannothe provisions of the Contractor's License Law(Chapter ;Tx 9 lcormncncing with Section7"t.fDivision 3afdm Business and PmPossionsCode) SWIMMING POOL ELECTRIC VALUATION -m or that he is exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-Fl%TURES _Z� Section 70313 b)'any applicant for a perm mitsubjects the epplicato a civil penalty of __, net mon than fivehundmi dollars(3300(. NEW RESIDENTIALELECiR _SQ.FT. ❑ I.asnwnerofthepropedy.ormyemployeeawithwagesanheirsolecompensation, STORIES TYPE CONSTRUCTION -3= win dorhe work,sod Ne structure is not lmendedoroffeted mrsole(See:90,14.Business and Professions Cade:The Contract License law does not apply to an owner of property whobuild,mmprnves dhercmn.and whodoessuch work himselfmrthm.,di his OCC.GROUT' RES.UNITS own employees,provided that such improverma sort not intendedmofferM forsale.IL however.the building or improvement is sold within ane year of completion,the owner- TOTAL: builder will have the burden of proving that he did not build or improve for purPose or sale.). ❑ L asowner ofthepmperp.amexelusively contracting with licensed contractersm �' p'•;1 L GPERM]T'.'- .;a�'FFEE' * FLOOD ZONE APN common the proper(Sec 700.1.Business and Professions Code:)The Conn..,', License Esw does not apply m an owner of property who but Ids or i m proses do..and whoconnacmforsuchpmjecuwiNacon=tods)limnsedpursuanuntbe Comta1.11 ygNT-WATER EA) Liamclay. ( FEE SUMMARY ❑ 1 am exempt under Sec. ,B A,P C for this re FL W PROTECT.DEVICE 41f OUTSIDE - SANITARY Y N Ouncr Data RECEIPT# WORKMAN COMPENSATION DECLARATION INO I RAINS-FLOOR.ROOF.AREA,CON'D, SCHOOL TAX Y—N [DI herehyaffirm door l have.cenifineofconsent mmlf-insae,mo aertificateof FIXTURES PER TRAP RECEIPfp ' Workers Compchasmmm Insurance me codified copy thereof(SecJeM,Lab C.)v I PARK FEE Y_N coven all employee s order this permit. GAS-E.SYSTEM. INC.4 OUTLETS RECEIPT policy# BUILDING DIVISION FEES Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE ❑ Coifed copy is hereby famished. ❑ C<niBM copy is filed uiN me city inspection division. GREASFF4N GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE COMPENSATION INSURANCE p n (this section need not br completed Hour permit is forma,hundred dollars(SIM) SEWER-S S �0�an ee Co ooG orles+ I cenify that in the of the work for which this Permit is issued.I shall WATERH90b=rEafiG11 of 0Wher acc bapmp g not employ any Pearson in any manner so as 10 become subject 10 the Workers Z Compcnsvior Umsor California. Dam WATERS i or eorreebn a Dam Receipt# Applicantafter pons on O NOTICETOAP,the Walker Conspersuouhis vifieneteaf Exemption,ioayouushould Most NEW RES TOTAL: In fecameh compo rot i.,hpre,omn,mild,provnsh.1ofthe Tabor Cude,you runcOMOWN ..a.{{#a.. forthwith comply with such pmvisimns or chis permit shall be deemed revoked, #e 11{i# �SER" UILDING FF,E CONSTRUCTION LENDING AGENCYPmgawyg th IC FEE Z I hereby affirm that them is a construction lending agency for she Performance of TA LECTRIC FEE .7 the user,for which this permit is issued(Sec.3199,Civ.C.) (antler's Name Lender's Address QTY,, 'r , A PLUMBING FEE ' V I eenHy dust I have read this applicmlon end state that the above infomwdion is [i] chncct, lagrec ro comply with all ester mind county ordinnn<es and smwluws rduhngm PERMIT ANCAL FEE building construction.and hemby auNodae reprembutivesof this city to enter upon the AX Z aMvc-memimned property for inspection purposes. ALTER OR ADD TO MECH. (We)agree to sane,indemnify and keep harmless the City of Cupertino against liabilaks.jodgmcnu.costs and expcmes which may in anyway accrue against said Cay ATR HA IT(TO 10.f%NI CF 'n<nnxyucncen the gramipg of this //✓i AIR HANDLING UNIT(OVER IIkIgO CPM( SilrAttat of Apprcarvenmmno: ^l ^'T Ilse EXI IAUST I IOOD MMUC) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.0(1(1 BTL) Date Receipt a Will the applicant or future building occupant store or handle hamrdous mmeriul as defined by the Cupertino Municipal Coda Chapter 9.12.and the Bruhn and Safety HEATING UNIT(OVER IM M%1 BTU) TOTAL: Cade.Section 253321e1". El Yes 11 No VENTILATION FAN(SINGLE RESID) t ISSUANCE DATE Will thea licam orlmum buildin pan yuipmenmr BOILER-COMPOfiPOR IM.(I(IU BTU( pp Fbyt Us), devicesanagemmir ��„ m:Vdfdt? air comvninuna as defined by the Bay Arta Air Quality Management BOILER-GDn1P(OVER I00.f%)O RTU( ,(1(1[' UrstdcC .x77..77.1 - 11 yes 11 N" NEWRESIDFNTIAL MECH. SQ.IT. I have seta the hty Corte. mations 5505.25533 under Chapter understand of the r• '..'J�Cr(I�f(a) CaliforniaebulHealth do S Safety Code.a%etiam 25505.t it is and 25534. 1 dy or road thin ifrbcantl oftdoesnot cunemlyhaveastnines,thatnis myrsuance ofa enotify the ec alert of the rcyviremenrs which must he met prior m issuance of n Certificate of Occupancy. Orcncna nmhorved ugem Da¢ TOTAL: ISSUED By. OFFICE