00110043 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILI.INGA11T&gs;i�7 N WOLFE RD511464Ty— PERMrf Na00j. 1.0047
INER*6N`I"hNDEM COMPUTERS INC /V �>- APPuCAlIOJIPodlpo00
]ONE; ^� .�/J, .,,a /h VII^ l _ SANI'IARYNO. CONTROL NO.
`J' ✓{�O�`(a(L VJI+ x(VII/�t�J BUILDING PERMIT INFO
O z¢ ARCHITECT/ENGINEER:
6 (� 131. ELECT PLUMB MECH
lit 06 o 1=1
yid
LIN)CON'I'RAC9Yl12'S DECLARATION '
z��= 1 hereby mrnnarm mmeant 1 ntn hcen,ed ander pnw�.n,n>laf ebarrer 9 aammenci„s � Job Description
`.'1=°
s mz E a is to fall lfionrnccomdefffeuni,.+�nn?�n me BnL.icin.ep.
,and nnrea.i„n.e,.lc,:,nd,ny seen>e
CHANNEL LETTER WALL SIGN
LiceneCla..
a. Dam m�
uac
liAHCIII1LCT'S JDaEv CLpuAbl
RicArcfw10,rNOta rum.0 d
s
t I'n+tcssianal
OWNER-exempt R DECLARATION
e vl=vi I heaby.sec tnm 11. exempt fmtn the Conlrso Ct Any c Lew hurdle
following remora Iconan to
71DLS.Bualter, rap lac,dedoro Crile:Any city structure`y..p
which 4 e. 11 t t r J I:h p :I mere
Prat t Irequires.. applicantir, me aft .g l.tmr„em
(coin t.with n II 1' ' Inc I t 1 ve fennRr9 Sq. Ft Floor Area Va�uyt�o 4
emhathe rtevrmsal an 700iurns tfhieanonirt eahe Ifo:meanr.:i ni adal
or Shat he is exempt Shercfmm and the boars it the alleged exemption.plucito Any l violation
of talion 7031.5 by any applicant for a permit whjaac the applicam to a civil renally
of not mote than rise hundred Julian ISSWI. APNr 1
f
�tQIP
Occupancy Type
❑ as owner Ill properly,rr lily employees with vOrac as memarm em70-14. �G. 00
wh Jo tire ink,and 1111 IminnIlm in mol mmndeJ Or nfcmJ fur vu,(Sec
]Iw.
Bneiness and Vofla,um,Code: live Contractor's License law Ane.not apply to on Re spections
of pr,peny Who looddo mpm es thercrn.and who does such work himxelf 101 — �FourdD��g
Lir through his ossa employees,Or
that such impmvcmems are not intended or I IFER
Offered far sale.If,however,the building Or improvement is sold within one year of 103 —
iampletien.the owner-bander will have the burden of proving that be did not build err
mprove flat un,p'aoc al sale.). 104 — REBRR
❑La,rwnerof the property.nme xclnnivoly cla.nrucdns with Ram
Ranee e„ mnlar.m 105 — ANCL-If1R nnI.TS
Limnatmct me pope,)see.mas w.Bndneand Pr,nssimns Code:)rhe Contmalar's 304 — ROUGH ELECTRICAL
cense Taw doco not appy to an owner elf prmpeny who builds or intpmves therson.
and he comencla for such prnjoin,with a camincorrO)heenaed pursuam la he 505 — FINAL ELECTRICAL
Connote o' Lia La
❑I air,exempt der.;,K .B a P C formas reason 514 — FINAL PUBLIC WORKS .
G
wner_
WORKER'S COMPENSATION IIECLARA'1'ION.
1 hereby aRrm under penalty of perjury one of the fallowing dmlmatione:
I have and will maintain a Certificate of Consent to self-insure for Worker's
umN ,mioun, is pmviJCA tour by Section 191x1 rr She labo ,r Cite (,a, the -
perfnnuunae el IN work for which in,Inrmit is ,.OJ.
❑I haveand will msinmin Worker,Compenwlirn Imumnce.as"Wisest by Section
3701)of the IaMm Code,for the performance of the work for which this permit is
sued.bly wort: Compenar i Insurance carrier and Policy rumbler am:
Policy No.:
CE I IIICAI ION Or EXEMPT ION FROM WORKERS'
COMPENSATION INSURANCE
mot,sooma need mol he completed if he pcmmi,is for one hundred dollars
(5101)Or level -
I certify Shat In the I,erhammllce of the w uA for which this permit is issued.I
.hall out employ any I...nn in Indy manner.o naw become mnjv,r to the Wn kno, '
COn,pmuation Laws Of California.Data
Applicant
NrTIICE Tf l APPLICANT':IL after making this Certificate of Exemption,you should
become subject So the Worker's Compencamion rrovisim%of the Labor Cade,you all
Q Q forthwith comply with such provisions or this permit shall he demned revoked.
Ft CONS'I'RGCfION LENDING.AGENCY +
C1 hereby alfmm lht ':Re m Si... Irneing agonay fur the performance
W of mho wnrA tear whicht J S•c.31X97.Civ.CJ
0. C .enIcr's Name
Z hemlar'a AJJre,
V Q [certify that l have read Shi.capplicatWnund statemal lheeM,ve information is
f+ t..t curtest.I naive m comply with all city and county Ordinances and state laws totaling
Q V I buldingnn"naotion,1 1barony unthmire mprescmmlvm Of Ii,ray ,,cuter upon - -
�„ the an'
.ve,memlonm prrpeny b,r inspeniam Perplaaea.
E„ a IWQ agree to gam,indemnify ane Alp hm may
in be wa OI Cupertino against
rn liabilities,judgment,roma and expenses which may in any wry acerae against said
l City in”' yuynce of the 6mming of this perm. �J , v
APPI.If I'UNDE Sf'N AND wII.I.COMPLY wRH ALL NON-POINT Issued by. �/V/('�/�•w�,(• ate
Or
r larM,pdemoClammmlar hale Re-roofs
HA'AR00 so MATERIALS UISChOSURIi
wa1 nue appreant to'mwm nedamg rccalum arca no nanme nmw„e,material Type of Roof
s delard by She Cupeninn Municiral Ede.Chapter 9.13,auf the Hvalmh and Safely
Cr.lc.Scctinn 255?21a)'!
❑w, CI''fc All roofs shall be inspected prior to any roofing material being installed.
Will the appncmn'or nnmebailiinglaaepualaseegnipicmlardevice^which If a roof is installed without first obtaining an inspection, 1 agree to remove
nnh hamoluus air annnnminxnn as Jdir by the tiny Arca Air Quality Management
nuanvn all new materials for inspection. Applicant understands and will comply with
0 Ye. all non-point source regulations.
1 have read the ha.arinua railroads requirements under Cramer 6.95 of the
Calitnnln Health k Safety Code,section,255115.25533 and 25514.I understand that
If the hudding docs mol anncialy have a"nam,that it is my re.pun.dully m rorty me
occupant of the earl ment,which must be met odor to Ismanee of a Certilimtte of
°Cepa., Signature of Applicant Date
Kn nemodaceagem, Dale All roof coverings to be Class •'B” or better
OFFICE
CITY OF CUPERTINO
• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY 4 4
Sec: Twp: Rng: Sub: Blk: Lot:31605052.00
DATE ISSUED. ......: 11/08/2000
RECEIPT q. ........: 13976
REFERENCE ID 4 . ..: 00110043
SITE ADDRESS .. . . . : 10827 N WOLFE RD
SUBDIVISION ... ... .
CITY . . . ..........: CUPERTINO
IMPACT AREA .......
OWNER . . . .........: TANDEM COMPUTERS INC
ADDRESS .. . . . .....:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3548
RECEIVED FROM ....: JERRY B
CONTRACTOR .......: LIC 9
COMPANY . . . . ......:
ADDRESS . . ....... .:
CITY/STATE/ZIP .. . . ,
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ------------- ---------- --------' ----------
BREMSIGNS NO SIGNS/MARQ 1.00 22.20 0.00 22.20 0.00
BUSLIC FLAT RATE 1.00 90.00 0.00 90.00 0.00
EPF.RMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
'i• PERMIT 147.72 0.00 147.72 0.00
METHOD OF PAYMENT AMOUNT NUMBER
__ ------------ ------
CHECK 147.72 12748
.
TOTAL RECEIPT 147.72
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
..e..... ............................ ........ ........................._..
101 FOUNDATION 103 LIFER
104 REBAR 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
514 FINAL PUBLIC WORKS
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