27520 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOBUIII. 1.4-ELF•fRl AL PERMIT NO.
BUILDING DIVISION
APPLICATION/PERMIT PLUMBING-MECHANICAL 27520
NUIhDING PROJECT IDEN-I'IF'ICN'DON
H1111.UING ADDR[SS: SANITARY NO. APPUCA'1lONSUBBMFI'ITALUA'fE
UNIT# LOT# L � l M C
OWNF SNAME: PHONE: CONTRACTOR'S NAME: LICING:
NIC COM ROLIt
ARCHITEC'DNGINEER: LIC NO: ADD FSSI'l5 [:]�L
ONTnCI': T 1
PHONE: _ GLBUILDING PERMIT INPU
�OQTY. EC'fRIC PERMIT FEE
C B EL PJ IIFFB MECH
PERMIT ISSUANCE L��`•
s LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
OKZ Ifiereby.fGnn Wm l am livemeolunderpruvixionsof Chapmr9(c.mmcncingwith
Pu00 Scclian70"nof Division Jof the Business and Professions Code,and my license is in PANELS
yF UWt full force and effect.
Fye [J♦ \—�'
License Claes Lich UP TO 200 AMPS
,<e-e1 Dae Contractor 201-IOW AMPS
y SQ.FT.FLOOR AREA $/SQ.FT.
)ONy ARCHITECTS DECLARATION OVER IOW AMPS
O'L-0 I unde,land my plam,hall he used us public rccnrds.
F,yFul SIGNS ELECT [CAL
Q Licensed Professional �•/�/
� C6 OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC.
KOyU I hereby affirm m that I aexempt from the Contractor's License law for the
m3ay following reason,(Section 703I.S,Business and Professions Cade:Any city or county TEMP.METER OR POLE INST.
F I_0Q which requires a permit to commact,.lair,improve.demolish.or repair.,sWcmrc
5ud}5 prior o its issuance,also expire,the applicant for such Permit to lite a signed statement POWER DEVICES
Ka that he is licensed pursuant m the provisions of the Contractors License Law(Chapter TI
ido� 9(c.mmetring with Section]000)of Division 3.f the Business and Professions Code) SWIMMING POOL ELECTRIC VALUAON
Wim or that he is exempt therefrom Ne basis for the alleged exemption.Anycivil Penalty
of OUTLETS-SWITCHES- Y� I
tZYQ Se<tinn 703 LS by any a farm for 1permtl objects the applicanno ecivil pcnahY of FIXTURES
not more Than five hu d tars 'K
SSG NEWRESIDENTIALELECTR _SQ.FT. STORIES 'I'YPECONS'PRUCIION
C F_o ❑ Lusowncndlb P ithwagesas (Sac.
cW.Buaion,
to =L will Jo the work,an snotimcadcdwoffercd fm sale(Sec.]0a4,Business
and Professions Code T e Contmclors Livens.Law)nes not.pply ro an owner of
propcny who M1uilJso, vex thereon,and who doessuch work himself.,through his
own employees,provided Wal such improvements are not intended or offered for sale.IL As O(ZC.GROUP RIS.UNITS
however.the building or intprovnneat is sold within one yearideompletiorythcowner. J G
builder will have the burden of proving that he did not build or improve for purpose of
sale.). QTY. N PERMIT FEE FLOOD ZONE APN
❑ I,nx ownernDM1c property,vm exdusivdy convecting wiW licensed contraetomo
.name,the tontject(See.70,41,Boniness and Professions C.de:)The Coaaactor,
License Law dues nm apply to anownerof propcny who huilds or improves thereog.nd PERMIT ISSUANCE
who contracts forsuch projects with a contracmr(s)licensed pursuant male Conttacror's
License Law. gLIT:R-DRAIN&VENT-WAT EA) FEE SUMMARY
❑ Lm exempt under Sec. ,B S P C for this.. HESHACK Fl.OW PR .DEVICE OUTSIDE P _
\ SANITARY Y N
Owner Dae DRAINS-FLOOR. O EA,COND. RECEIPT#
WORKMAN70MPENSATION DECLARATION SCHOOL'I'AX Y N
❑ Thereby.(firm shall haveaccnificum of consemmself-in sur0.nracenifcateofIAXTURES-PFR'1'RAI' RECEIITp
Workeri Cmnpensaino tnaurunee oracenifieJ copy Wereof(Sec.JSW.fabCJ which PARK FEE Y
covers all em to cc's dA.,Wis t. RECEIPT p
P Y .0 Pcv^' GAS- .SYSTEM-1 INC.6O tTS BUILDING DIVISION/rli
Policy p
Company GA -FA.SYS -OVFR6([A) PIANCHIiCK FF.F.
❑ Cenificd copy is hereby famished.
Ccnified copy is fled with the city inspection division. GREANDL STE INTERCEPTOR GRADING FE-E
CURTIFICATE OP EXEMPTION FROM WORKERS' GREAS.TRAP SOILS FEE
COMPENSATION INSURANCE
(This sealonneed not tecompldeddrie permit is fur one hundred d.11.($100) SEWER-SANITARY-STORx WA.2WFT. ENERGY FEE N1 J
or less.)
I redly shat in the performanccofthe work for which met .it is issued.I shadi WATER HEATER WIVENTELECIR
not employ any person in any manner so as m Income subject I.the Workers' PAID
Z Compcnsatinnhuwsof California. Date WATER SYSTEMOREATING\ Receipt#
Applicant
Z NOTICE TO APPLICANT:It.after making this Certificate of Exemption,you should NEW RESIDIiRfIAL PLMH. SQ.FT. TO'T'AL:
r q become subjen m We Workers Compensation provisions of We tater Code,you must
F4 7 fonhwithconadywiW such provisi.ns or this pennitshall be Jccmedrevoked. BUILDING FEE �y
r� CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I hereby affirm that there is a construction lending agency for the performance of
U O the work for which this permit is issued(Seca 307,Civ.C.) ELECTRIC FEE
Leader's Name PLUMBING F
Lender's Address QTY. MECIIANICALPERMIT FEE
V I certify that 1 have most this application and state that the above information is MECHANICAL\F
>' F11 come(.I agree m comply with all city and county comosecesand suite ltw,mlming to PERMIT ISSUANCE �
I^ huildingcunsvuction.and out 'mrepreacntativesof Wn inymemerupon We CONSTRUCTION X
U z abovemindeneJ propcn fnrimpecti.n urpoxs. '1'ERORADDTOMECH.
e m save,indemnify andnp harmless the City of Cupertino against
liabi ties,judg cameos sand—Pense Inch may in any wayacerueagaim,said City AIR HANDLING ON]'1'(1010,000 CFM)
c of the gm 'ng of thi. it.
AIR HANDLING UNIT(OVER 10.0m CFM)
Signa re App munV am 'Dam EXHAUST HOOD(W/DUCD
PAID
HA% US MATERIALS DISCLOSURE HEATING UNIT(TO IW,000 BTU) Dam Rett I#
Willthe applicamnr ore building occupantsmm or handle havvdous material HEATING UNIT(OVER IW,000 BTU) 'I 'AL:
as dchne0 by the Cupertino Municipal Code,Chepmr 9.12,and the Health and Safety
Code.Section 25532(a)'f VENTILATION FAN(SINGLE RPSID)
EE
❑Yes ❑No
ISSUANCE DAT
Will thea Ileont or future tuildin cu anus a tordevices whichemit BOILER-COMP(3HP OR 100,"BTU)
finco 'co gbc p 9ua Air pp A '
District? air commitments m defined by the Bay Area Air Quality Management BOIL[iR-COMP(OVER IW.(100 BTU) Y'
District?
❑Yes ❑No NEW RESIDENTIAL MECIT SQ.IT.
1 Wive read the haaardous material.,requirements under Chapter 6.95 of the FEB 271995
California Health s Safety Codecurrently
have
toant.that
is y responsend 25534. 1 responsibility
,,mend Wel
if the building does not cumen0y hove a mnanl,that h is my respnnsibilty m notify the Cil y(Jr
occupant of the requirements which must M met prior to issuance of a Certificate of 47 L"Urth I Iry
Occupancy.
Owner or amm iacd agent DateISSUED BY:
OFFICE /
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Tandem
10080 North Wolfe Road
Cupertino, Ca 95014
Subject: 10080 Wolfe Road, Permit# 27520 - Tenant Improvement
Dear Resident,
• According to our records the above mentioned permit has never been fmaled 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 fmaled, 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
Z
South any
South Bay Construction
January 16, 1996
City of Cupertino
Building Division
10300 Torre Avenue
Cupertino, California 95014
Reference: Permit#27520
To Whom It May Concern:
• We are in receipt of your letter dated, December 4, 1995, regarding Building final for 10080
North Wolf Road, permit#27520.
We meet with the Building Department on December 28, 1995 and at that time they indicated
that the building was final on February 22, 1995.
All work has been completed so please call if this information is not correct. Otherwise we will
consider the job has been finalized and closed out.
Sincerely,
Larry Paterson,
Project Manager
408/379-5500 Ext. 248
Ip/cw
cc0116
511 Division Street Campbell, California 95008 408/379-5500 Fax 408/379-3256 Lic. B336974