27493ILICANT TO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
fY OF CUPERTINOL
BUILDING DIVISI N APPLICATION/PERMIT PLUMBING - MECHANICAL
BUILDING PROJECT IDENPIFICA
.VINO ADDRESS:
I aiax1 _ f !Q l
PHONE:
LICENSED CONTRACTOR'S DECLARATION
M44Z Iherebyaffimf that l om licensed under pooddonso(Chapter9m
(comencing with
Woo Seclloo 70007 of Division 3 of the Business and Professions Code, and my license is in
C W full force and effect.
Q zu ay Licesse Class Lic. X
Nay Tom Ceramic
Zmr
FO y'� ARCHITECTS DECLARATION
O Z - C I undersand my plans shall No used as public records.
y
at
I"tressed Professional
aK a OWNER -BUILDER DECLARATION
gxxOyu I hereby uffimt that 1 am exempt from the Contractor's License Law for the
tsr30rFii following mown. (Section 1031.5, Business and Professions Code: Any city or county
(= E N which requires a permit fm consumer. alter, improve, demolish. or repair any thrown,7�Y� prior to its issuance, also requires the applicant for such Permit o file a signedsutemrnt
y� C that he is licensed pursuant to the provisions of Ne Contractor's License Law (Chapter
a a e tr. 9 (commencing with Section 7000) of Division 3 of Na Business it Pmmaos os Code)
my or that he is exempt herefrom and the basis for the alleged exemption. Any violation of
Z aa, Section 1011.5 by any applicant for a Permit mbjecn the applicant o a civil porosity of
r2p
not more than fi ve hundred dollars ($5011).
❑
1, six ownerafthe property. or my employees with wages as their sale compemafion,
d will do the work, and rhe structure, is not intended or offered for mile (Sec. 9044, Business
and Profess ns Cede: The Contractor's License Low does not apply to an owner of
propevywhobuildsmimp ose,ibercon,and whodoessuch workhimselforthea li his
own employees, provided that such improvements ve not intended or offered for sale. IL
however, the building or improvement is sold within one year efcompletion, the owner.
builder will have the burden of proving that tactician build or improve for pu Tam of
sale.).
❑ I, as owner of the property, amexclusively contracting with licensed contraction to
consumer the Traject (Sec. 71),14. Businui and Professions CWa:) The Contractor's
License Law does not apply to an owner ofpropeny who builds or improves thereon.and
who connects fo, sue h projects with a conlmctor(s) licensed pursvanuo the Conaecmes
License Law.
❑ 1 oro exempt under Sec. , B & P C for this reason
Owner Data
WORKMAN COMPENSATION DECLARATION
❑ IhembyaRnntl tlbveacediGwmofcons vitas if-insum,orac ricateof
Workers Compensation Insurance or a terrified copy thereof (See. 3800, Lab C.) which
c.sa. all employee. it. this permit.
Policy.
Company
❑ Canifiedcopy is hereby famished.
❑ Cadfied copy is bled with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need notbe compleard ifthe Permit is for one hundred dolla x($100)
or les..)
I certify that in the performance of the work for which this Permit is issued, l shall
not employ any Person any roamer so as to become subject to the Workers
Ctsmptasarionlewsof Califend.. Date
Applicant
z� 0 NOTICE TO APPLICANT: If, far, making this Certificate of Exemption, you should
�;;become subject to the Worker's Compensation Provisions of the labor Cade, you must
0 ; forthwith comply with such provisions or this permit shall W deemed mvoked.
1 (� CONSTRUCTION LENDING AGENCY
0.Z 1 hereby affirm that them is is contraction lending agency for Ne pedrarr iutce of
V O the work for which this period is issued (lice, 1091, Civ. C,I
lenders Name
OUndoes Address
U
W 1 certify that 1 have read flus application and state that the above Information is
vrrcet. I agree to comply with all city and county ordiamen and sate laws relating to
building construction, and hereby authorize mpreunratives of this city to enter upon the
[ ) abovememioned pmpedy tion purposes.
(We) aII//cc m save. dem y and keep harmless the City of Cupertino against
liabilities,jy/gments,cosb Ria which ml%ja my 4y acerae against said City
I, din conseq,,!Veld the gmnt`TotNx permit./, I
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
m defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Cala, Section 25532(a)'!
❑ Yes ❑ No
Will the applicant or future building occupant use equipment ordevices which emit
hazardous air coraminants as defined by the Bay Are Air Quality Management
District?
❑ Yes ❑ No
1 have mad fif hazardous materials requirements under Chapter 6.95 of the
California Hcalth & Safety Code. Sections 25505, 25533 and 25534. 1 undersand that
if the building does not currently have a moan, that if is my responsibility m party flue
occupeal of the requirements which must be mel prior to issuance of o Certificate of
Occupancy.
Owner or authorized .gent Date
1 11 ELECTRIC PERMIT
PERMIT ISSUANCE
APPLIANCES -RESIDENTIAL
PANELS
UPT0200AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC.
TEMP, METER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
9UTLETS- SWITCHES -FIXTURES
NEW RESIDENTIAL ELECTR _SQ. FT.
PLUMBING PERMIT
PERMIT ISSUANCE
ALTER - DRAIN & VENT - WA M
BACK FLOW PROTECT. DEVIC
DRAINS- FLOOR, ROOF, AREA, COND.
FIXTURES - PER TRAP Al
GAS - EA. SYSTEM -1 INC. 4 OUTLETS
GAS - EA. SYSTEM -OVER 4 (EA)
GREASEgNDUSTRL WASTE INTERCEPTOR
GREASETRAP
SEWER - SANITARY - STORM EA. 200FT.
WATER HEATER W/VENTIELECIR
WATER SYSTEM MrTING
NEW RESIDENTIAL PLMB. SQ. PT.
TOTAL:
MECHANICAL PERMIT
PERMIT ISSUANCE
ALTER OR ADD TO MECH.
AIR HANDLING UNIT (TO 10,000 CFM)
AIR HANDLING UNIT (OVER to." CFM)
EXHAUSTHOOD(WIDUCI)
HEATING UNIT (TO 100.000 BTU)
HEATING UNIT (OVER 100,0001111D
VENTILATION FAN (SINGLE RISID)
BOILER -COMP THP OR 100,008 BTU)
BOILER - COMP (OVER I0i" BTU)
NEW RESIDENTIAL MECH. SQ. FT.
\ �—,.a
VALUATION ^2r,
t
SI oQe
FEE
1-le,1.V 27493
IDX
SANITARY NO.
I APPLICATION SUUBMII'ITAL DATE
—a "�
LIC NO:
NIC
CONTROL is
FEE SUMMARY
FEE
BUILDING PERMIT INFO
BLQG ELECT PLUMB C
L�1 St'
SANITARY
JOB DESCRIPTION
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC.
TEMP, METER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
9UTLETS- SWITCHES -FIXTURES
NEW RESIDENTIAL ELECTR _SQ. FT.
PLUMBING PERMIT
PERMIT ISSUANCE
ALTER - DRAIN & VENT - WA M
BACK FLOW PROTECT. DEVIC
DRAINS- FLOOR, ROOF, AREA, COND.
FIXTURES - PER TRAP Al
GAS - EA. SYSTEM -1 INC. 4 OUTLETS
GAS - EA. SYSTEM -OVER 4 (EA)
GREASEgNDUSTRL WASTE INTERCEPTOR
GREASETRAP
SEWER - SANITARY - STORM EA. 200FT.
WATER HEATER W/VENTIELECIR
WATER SYSTEM MrTING
NEW RESIDENTIAL PLMB. SQ. PT.
TOTAL:
MECHANICAL PERMIT
PERMIT ISSUANCE
ALTER OR ADD TO MECH.
AIR HANDLING UNIT (TO 10,000 CFM)
AIR HANDLING UNIT (OVER to." CFM)
EXHAUSTHOOD(WIDUCI)
HEATING UNIT (TO 100.000 BTU)
HEATING UNIT (OVER 100,0001111D
VENTILATION FAN (SINGLE RISID)
BOILER -COMP THP OR 100,008 BTU)
BOILER - COMP (OVER I0i" BTU)
NEW RESIDENTIAL MECH. SQ. FT.
\ �—,.a
VALUATION ^2r,
t
SI oQe
FEE
FLOOD ZONE"
FEE SUMMARY
S E
SANITARY
Y N
RECEIPTg
SCI LTAX
Y
RECEIPT
ARK EEE
Y
RECEI 0 '
BUILDING DIVISION ELI
PLANCHECK WE
2.
RE
SOILS I EE
ENERGYF
PAI
me
Receiptp
TOTAL.:
BUILDING FEE
SEISMIC FEE
ELECTRIC M -
FEE
PLUMBINGFI .
MECHANICAL RE
CONSIRUCTIOI TAX
PAID
U— 0
/AIV 26\1995
CITY Ut. LourClillN
ISSUED BY: !
0
of,
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Symantic
10201 Torre Avenue
Cupertino, CA 95014
Subject: 10201 Torre Avenue, Permit # 27493 - Tenant Improvement
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
•
Panted on Pecvclea P:mcr