26732 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRI AL PERMIT NO,
BUILDING C DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL 26732_
I O A
BUILDING PROJECT IDENTIFICATION r J G
BUILDING ADDRESS: SANITARYNO. APPLICATIONSUBMITTALDATE
L C6 UNIT# LOT# r . is
OWNS S A PHONE: CONTRACTOR'S NAME: LIC NO: `t' W
a /� N/C CONTROL#
C V
ARC 'rE T GINFER: LICNO: A D SS: ❑
t ��o T e P
CONTACT: PHONE: f9/O• QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
f 9J�1i� BLDG ELECT PLUMB MECH
PERMIT ISSUANCE 11 ❑ ❑
LICENSED CONTRACTOR'S DECLARATION of0a TION AppLIANCEs-RESIDENTIAL tOB DFSCRIP�pN
pyZ, IherebyaRlrtnCEN E licensed uACTOR'SD CLARaTIO (commencing with aj�.,.'i(Vr�JI�J\�0,��.is
POO Section 700(h fDivision 3ofthe Business and Professions Code,and my license is I. PANELS
y�j W full force and eft t. e �1
F,Z License Clase5_p�$,a_-{_rJ LIaN J f`6.)G� UPT02MAMPS
I, Data Comractor 201-I[kq AMPS
Z055— ARCHITECTS DECLARATION OVER AMPS SQ.FT.FLOOR AREA E/SQ.FT.
O Z— 1 understand my plans shell be used as public records.
Q � Licensed Professional SIGNS ELECTRICAL
L�mama OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
y�OyU I hereby affirm that 1 am exempt from the Contractors License Law for the
3 W N fallowing reason.(Seal..7031.5,Business and Professions Code:Any city m county TEMP.METER OR POLE INST.
E4 which requires a permit to consumer,alter,improve,demolish,or repair any structure
N2 prior to its issuance,also requires the applicant for such permitto rile a signed statement POWER DEVICES
ty p 0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter
Wan ' 9(Commencing with Section 7OWymDivision 3ofthe Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION
%XW or that he is exempt therefrom and the basis for the aUagVd exemption.Any violation of OUTLET'S-SWITCHES-FIXTURES 0111;pD- tt
Section 7031.5 by any applicant for a permit subjects the applicano a civil penally of
not more than five hundred it.]].($500). NEW RESIDENTIAL ELLCT'R 5
m ❑ I,asownempfthepmrty,ormyemploymswilhwagesustheirsolecompenaetioa, Q'FT. STORIES TYPECONSTRUCTION
y _ will do the w.,k,a.dthe structure ism.timendedorofferedforsile(Sao J0G4,Business
.it Professions Code:The Contractor's License Law does not apply m an.weer of
property whobuildsorimpmvesthereon,andwhodoes suchw.rk himeelfi n orughhis
own employees,provided thatsuch impruvementsare not intendederoffered forsale.If, OCCGROUP RES.UNITS
however,the h ndingor improvement is sold within one yearofeompletion,theowner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sale.). jag QTY. PLUMBING PERMIT FEE 7LOOD20NE ApN
❑
construct
the project
(See art 4L Business
...sio with de.)n sed conumctom t'
.strum the oesnot(Sec.71004,Business and Professions Code.)The Contractor's
whocontmwdorsuchpplymanowneonvactpeny whnsed pursds uant
nothe Contractors
PERMITISSUANCB �>r
whncseLaw. .rsueh projeus withaconvactor(s)liowsed pursuant mthe Contractor's ALTER (EA
License Law. ) PEE SUMMARY
❑ T em exempt under Sea ,B&P C for this reazon OUTSID FEES
BACK FLOW PROTECT.DEVICE SANITARY YN
Owner Dale DRAINS-FLOOR,ROOF,AREA, OND. RECEIPT
WORKMAN COMPENSATION DECLARATION \ SCHOOL TAX YN
• ❑ Iherebyaffirtnthttlhaveac 1Bcateofconsenttoself-insum,oracertificawof 1 RECEIPT#
Workena'Compensetion lneurance<?a certifiedcopy thernd(See 3800.Lab Cd which FIXTURES PER TRAP PARK FEE Y N
covers all employee' and th'Syc RECEIPT#
Policy wJ g�t0. �% �A GAS-EA.SYSTEM-I INCA OUTLETS - BUILDING DIVISION FEES
Cnmpany�f/f/lfylf JJ Lb l�.n.[U GAS-EA.SYSTEM-OVER4 A) a;! PLANCHECK FEE
❑ Certified copy is hereby farms d.
❑ Certified copy is filed with the city inspection division. GREASEANDUSTRL WASTEI RCEFTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERSGREASE TRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not be completed ifthe permit is for one hundred dollars($100) SEWER-SANOA -9 EA.20OFT. ENERGY FEE
orleee.)
I lenity that in the perrammnce of the work for which this permit is issued,ImallWATE HEA /VENT/6LEC1'R
not employ my person in any m so as to become subject to the Workers PAID
Compensation Laws of Califomia. DateWATERNSSTMITItEATING Date Receipt#
Z Appellant,
z NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESID,NTIAL PLMB. SQ.FP. TOTAL:
,r LLn become subject to the Worker's Compensation Provisions of the Labor Code,you must
�i forthwith comply with such Previsions or this permit shall be deemed revoked. BUILDING FEE
W Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I hereby affirm that there is a construction lending agency for the Performance of T ELECTRIC FEE
0 the work for which this permit is issued(Sec.3097,Civ.CJ
Lenders Name
Q U Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
T certify that I have read this application and suite that the above information is
r�" RWi correct, I agree to comply with all city add county ordinances and state laws relining to PERMIT ISSUANCEMECHANICAL FEE
V) building construction,and hereby authorize repreamonives ofthis city minter upon the
L) z above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX
(We)ogres,I.save,indemnify and keep broadens the City of Cupertino against
lie ' ms,co: ndexcen whichmayinany way becrueaamst.aid City AIR HANDLING UNIT(TO IyOW CFM)
nsequence the ontlnga con1.
ATR HANDLING UNIT(OVER 10,000 CFM)
Sig of Applimm/Contra Dare EXHAUST HOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATMG UNIT(TO 100,000 BTU) Date Receipt#
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(OVER 100,000 BTU) A :
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(a)7 VENTILATION PAN(SINGLE RESID)
11Yes ❑Na
ISSUANCE DATE
Will the a licenrorfuturebuildin pan equip BOILER-COMP(JHP OR IW,IXq BTU)
pp gby t Buse menmuality Management
• haamdous air contaminants az defined by the Bay Area Air Quality Management
District? BOILER-COMP(OVER 100,000 BTU) fi
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FL. r T q t
1 have read,he hamadous materials requirements trader Chapter 6.95 of the /sY
Califomia Health&Safety Code,Sections 25505,25533 and 25534. 1 understand that
ifthebuilding does notamrently have a court,that his my resp.nsibilirytonotify the cupent of APR 16 1995
Omuponey.the requirements which must be met prior t.issuance of a Certificate of
CITY yp
Owner or amhorized agent Date ISSUEDB
OFFICE
W
city of
Cupertino
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Tandem Computers
21543 Terrace Drive
Cupertino, CA 95014
Subject: 21543 Terrace Drive,Permit#26732 -Furnace &Air Conditioning
Dear Resident,
. 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
Pnwea on Recvclea Paper