28129 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOI ILDI f4- lih'A RICA I PERM IT NO,
APPLICATION/PERMIT I'IAMIIINO-MECHANI28129
BUILDING DIVISION BUILIJIrvO I'RO.II!CI'111NNTIFN'ICIL'AT'I(JN
BUILDING ADDRESS: /� ^ SANT TART NO. APPLICATION SUBMITTACDDAAIT:
2 Q S /�rs UNiTp I.OT4
OW SNAME; PiloNE: CONTE IO ' N LIC NO:
N/C /CIONTROLp
%RCHITE G E- : LIC NO; ADDRESS: ❑ � /
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. IiLECTRIC PERMIT' FEE
tlLoc1 r.rcrPLUMO MI?
PERMIT ISSUANCE T�S-C` El
LICENSED CONTRACTOR'S DECLARATION APPI.IANCES-RFSIDENTIAI. JOB DESCRIPTION
m C 4 1 hereby affimuhat I am licensed underprovisions ofC'hupmr9(commencingwith
POO Section]IXXpafDr,,,mhJul the Business and Positivism,Codetind in,license is in PANHILS
F&'C fall force and affect.
F6ZW License Class Lia.p UPTO 200 AMPS
m¢y DateContractor 201-10110 AMPS
—ARCHITECTS DECLARATION OVER 1000 AMPS SQ.n.FLOOR AREA $/SQ.IzI'.
ZONZ,
F y 5 Q 1 understand my plana shall be used as public s. :,�.
SIGNS ELECTRICAL1 4 17J—{,,•
ELECTRICAL tI
Li<enseJ l'ndessinnnl
,OWU
I+13OWNER-BUILDIiR DECLARATION SPECIAL CIRCUIT/MISC.
��44 : 1 hereby affirm that 1 aw m exempt from the Contractor's License lafor the
rr LLm following reason. 7031.5,Business and professions Code:Any city or county TE MP.MET ER OR MIX INST.
F-He�g' which requires u permit to cmeame,eller,improve,demolish,ar repair any smahms
f WTpriormits issuance,also requires the applicrat forsuchpermiuofileasignedstemmrnt POWER DEVICES
,7
�G OO that he is breathed pursuant o the provisions of the Contractor's License Law(Chapter
9mommcncing wilb 5ection]WO)of Dlvlsion3nl the pusinees end Professions Cade) SWIMMING POOL ELECTRIC VAIAA'I'ION
onhal he is exempnhcre(romund the basis for the alleged exemption.Any vmlalinnof LEI'S-SWITCHES-FIXTURES
❑Z¢ Seaton 7031.5 by my applicant for a permit subjects the applicanuo a civil penalty of l D
t€ act me than fisc hundred Jollurs($5W). NCWRE.SIDEM'IALEI.EC'IR _SQ.Ff.
tea, ❑ 1,asowneroftheproperty,ormyemployeeswith wages m lhelrsolecompenxution, SIORIESt TYPE CONS'IRUNION
y3°= will do the work,and the structure is not intended or offered for vale(Sm.7044.Business
and Professions Code:The Contractors I.icense law does not apply to an owner of
IFroperty who hui Ids far imprnvw Ihercnn,and who dons such work M1imsel for Ihrougb his
own employees,providelial such improvements are natintenduloreffered forsale.If, OCC.GROUP RES.UNITS
however,the building arimptovemetn is sold within oneyearo(completion.the owner- .(
builder will have the burden of proving that he did not build or improve for purpose of
suleJ.
❑ I,usownerofthepropeny,amexclusivelycontrectingwithlicansedcontacsorxtn QTY. / P MBI r ER IT FEB FI-00D ZONE AI'N
on"mct the project(Sec.](Nq Business and Professions Code:)The Contractors
License Lawdoes not apply to an menernfproperty whohuildsorimprovesthereon,and PERMIT SS
who contracts for such projects with o contractors)Iiecnsed pursuant to the Contractor's pLTItR-DRAIN& WATER rA
Urdeae"ve. (' J FEE SUMM CRY
❑ 1 um exempt under Sec. ,B&P C for This rewsm BACK FIL I'ROfEC'. 1 ! UTSIDF.FF.H.
SANII'ARV YN
Owner ATIDate DRAINS-FL ,ARBA,COND. RIiCI?II
WORKMAN COMPENSATION DECLARATION . SCHOOL TAX Y e N
❑ Iherchy a0irm thmih:rva ucenilicute of consent to self-insure,ora cenilicme of 1'IX'rURES-PER TRAP RECE p
Wmken'Compensutianlnsumnceorace"ifiedcopylhereof(Sec.380RLab C.),anch PARK FFH ' N
coven all employee's under this Permit. GAS-EA.SYSTEM-1 INE 4 O S
Policy p BUII. V 'ION FRES
Company GAS-P.A.SYSTEM-OVI3R 4 BEA) PlLANCIIECK FEE
❑ Certified copy is herehy Pomished.
❑ Comfit copy is filed with the city inspection division. GREASFJINDUSTRL WASTE INTERCEPTOR GRADING FF..
CER'I'IFICAI R OF EXEMPTION FROM WORKERS' GRBASRTRAP SOILS FE
COMPENSATION INSURANCE
(tfiissection need not be completed ifthe permit is for one hundred dollars l$100) SEWER-SANITARY-STORM EA,200FT. IiNCRGV I'EE r1M
or Ies.vg 4 GLA
�V
I certify that in the performance of the work for which this permit I&Road,l shall WATER HEATER W/VIJPp/EI=R
not employ any person in any manner so as to become subject In the Workers' PAID
Compensation lawsof Culifernia. Date WATER SYSI'EMaREATINO Date p It
0 Z Applicant
Z O NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should NEW RESIDENTIAL PI.MB. SQ.FT. TOTAL:
Ern become subject to the Worker's Compensation provisions of the Labor Cade,you must
5: lorthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEC O �y
6i Q CONSTRUCTION LENDING AGENCY7:72SEISMIC FEEel a
'J zI hereby affirm that them is a construction lending agency for the performance of r L
V Q the work for which tlis permit is issued(Sm.9097,Civ.C.) T AL. CLI?LTRIC IlC
Lenders Name
OF Lenders Address QTY. MIZCHANICALP17RMIT FEE PLUMBING FCC
V I certify that 1 have ..it this opplioation trod"are that Ibo above information is
r7" a
correct.Iegreemromply with oil city and county ordinances and stem laws relining toI PERMITISSUANCE MECIIANICALFF.E
1-' y building comwminn,and hereby anthems,rtprtsenmp tivofthis city ote
to tr upon the CONSTRUCTIONTAX
U Z above-mentioned property for a�nx
purposes AER OR ADD TO MHCH.
(We)agree In save,'ndeke rmless the City of Cupertino against
liabililies,judgmems. osand oyina^Y way accmeagain aid City AIR HANDLING UNI'1'(TO10,(X10CFT1)
ogseyue ce ofth aming ///��I
co I / HANDLING UNII'(OVER 10,000 CPM)
1 v
(.dd,
ureof Applin Contmcmr Date EXHAUST HOOD(W/DUCT)
PAID
HAZARDOUS MA'MR1Al,S DISCLOSURE HEATING UNIT(TO I((IpW BTU) Dam Rec<iptp
Will the applicant or future building occupant store or handle havardous material _
ned by the Cupertino Municipal Ceske,Chapter 9.12,and the Health and Safety HFdDNG UNI'T(OVER I 00.00(t)BTU) TOTAL:
Srcti 55 0 25532(n)? IJ No
❑ VENTILATION FAN(SINGLE RRSID)
2
Will hhe air im icamorfuwrs building by the Bay equipment Quality
Managhemit
BOILER-COMP CHP OR 100,00)(I BTU)) ISSUAN
aamic'?s trim cnnmminanls as delincd by the Bey Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) {xp�Y%22
� 9
ismicB ry
❑Yes ❑No NEW RESIDENTIAL MECH.—SQ.Rf. P
1935
1 have read the mountains materials requirements ander,Chapter 6.95of the JUN 22 ur cUh'tHl INO
&
California Health Safety Code,Sections 25505,25533 and 34
255 . 1 understood that VV R 1.if the building does not currently have a tenant,that it is my responsibility to notify the
occupant of the requirements which must he met prior to issuance of a Cenificam of yll Y
Oceupuncy. lNI rr
Owner nr mmhnrieaJ ugenl Dom ISSUEDD .
NO
OFFICE
W--- c.1tv
10300 Torre Avenue
Cupertino,CA 95014
of'.
cupe1"th10 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 928129
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
Pnl:e.'.or Recycled Pape.: