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07030290Sao U U i :2 .a UJ ra< >aU U. H .oQ �00 �cFc0 FY OF CUPERYIjvU BUILDING DIVISION PERMIT )ING ADDRESS: 1.0200 S DE ANZA BLVD OWNER'S NAME: SYMANTEC CORPORATION ,NE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prof os Code, and my license is in full force and e(fe 835 License CI Lm• 1► Dam Contractor RCHnEC ! DECLAR 10 I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5• Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior m its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (SSW). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conuactor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ] 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Wor s Compensa ' n Insurance carrier and Policy number am: Cartier.UEQ Polity No. CERTIFICATEOF EXEMPTION FROM W RKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the ahove-mentioned property for inspection purposes. (We) agree to save• indemnify and keep harmless the City of Cupertino against liabilities, judgments, coslpod expenses which may in any way accrue against said City in conseque of the ng of this permit. APPLIC UND ANDS AND WILL COMPLY WITH ALL NON -POINT SOUR GUL l ' 5 Si ore of Applicant/ ontractor 5-re Date ARDOU ATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes C�F?No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as deli d by the Bay Area Air Quality Management District? Q Yes Nu 1 have read the It 7 rd aterials requirements under Chapter 6.95 of the Califor- nia Health &Safety Code, Scc ' 25505, 25533 and 25534.1 understand that if the building does not currently have a t, that it is my responsibility m notify the occupant of the rennimmentc-which mu 40 issuance of a Certificate 09accup;t6sy, authorized agent �� I z / Date MEADE CONSTRUCTION GROUP 645 RIOTER OAK INSTAL], A/C UNIT HALO ROOM Issued by Re -roofs iq. Ft. Floor Area Num PERMIT NO. 07030290 PERMIT i55UE DATE 03/27/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description "Required Inspections Valuation Occupancy Type of F.00f All roofs shall be inspected prior to any roofing material being installed. If a roof :s installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class "B" or better Date CITY OF CUPERTINO 7 ITEMS OF 14 PERMIT RECEIPT OPERATOR: bethe COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36901035.00 DATE ISSUED.......: 03/27/2007 RECEIPT #......... : BS000000803 REFERENCE ID # ...: 07030290 SITE ADDRESS .....: 10200 S DE ANZA BLVD SUBDIVISION ��VYl CITY CUPERTINO IMPACT AREA ...... OWNER SYNANTEC CORPORATION ADDRESS 10200 S DE ANZA BLV 4TH FLOOR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: REC'EIPT INTERFACE CONTRACTOR .......: TIM TEMPEL LIC # 27856 COMPANY ..........: ME.7.DE CONSTRUCTION GROUP INC ADDRESS ..........: 64E RIVER OAKS PKWY CITY/STATE/ZIP ...: SAY JOSE, CA 95134 TELEPHONE ........: (4(8)321-6450 FEE ID UNIT QUANTITY 1,MOUNT PD -TO -DT ---------- THIS REC ---------- NEW BAL ---------- ---------- BENERGY ------------- PERMIT FEE ---------- 1.00 ---------- 34.86 0.00 34.86 0.00 BPERMFEE VALUATION 12,000.00 191.16 0.00 191.16 0.00 BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00 BSEISMICOM VALUATION 12,000.00 2.52 0.00 2.52 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 ---------- 38.37 ---------- 0.00 ---------- TOTAL PERMIT ---------- 353.91 0.00 353.91 0.00 SR. CITY OF CUPEkTINO CITY OF C'UPERTINO PERMIT APPLICATION FORM 0r76 -o,290 APN # � / to Fee Group MECHANICAL MDate- Building Address: MECHANICAL Mailing Address if diffe a from ildin address): Boilc r > 100K to 500K Btu MECHANICAL BBOILER3 10- L®� Owner's Name: BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL Phone #: Contractor: MECHANICAL BCONSTAX Construction Tax License #: Contact: - Phone2/I BUILDING BCONSTAXBQ ertino Business �ense#: BUILDING Fax: �•;J BUILDING BCONSTAXR Building ermit nfo: -TLC�w &A. . f Bldg ❑ Elect ® Plumb ❑" Mech Job Description: Residential El,� n , / r � �' (O%� Commercial Sq.Ft. Floor Area: Energy BUILDING BENERGYADD Sq.Ft.: Cost of Project: RnrvFCTTra Investigation fee BUILDING Occupancy Grp: j Type of Construction: Please check this box if the project is a F— second -story addition: El Project Size: Standard Large ❑ Major ❑ Le) cv Quantity Fee ID BAPPLOTHER Fee —Description Dther Appliances Fee Group MECHANICAL BBOILERI BcHer <= 100,000 Btu MECHANICAL BBOILER2 Boilc r > 100K to 500K Btu MECHANICAL BBOILER3 Boi: er > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Ccn. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Ccnstax – Resi/Mobile BUILDING BELEC 1000 E= ec 600V <= 1000A ELECTRICAL BELEC1001 E,lec 600V > 1000A ELECTRICAL BELEC200 Elec. Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING RnrvFCTTra Investigation fee BUILDING of 3 ,a CITY OF CUPER,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantit Fee ID BMISCELL Fee Description Miscellaneous Fee Fee Group BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N,,w Comm Plumb PLUMBING BOVERTIME In,,pection Overtime BUILDING BPBACKFLOW Atriospheric Vacuum_ — PLUMBING �_— --- BPCESSPOOL Cesspool PLUMBING / BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK flan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rf i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT A]t of Drain & Vent PLUMBING BPWATER Inst0l/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT f[eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rent Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA R elocation of Hood MECHANICAL BREMREPALT R,-.pair/Alter Heating MECHANICAL uv1M%4u -PQ nPP Rer,odel Res Annliance ELECTRICAL 2 of 3 CST of CUPEkTINO CITY OF C'UPERTINO PERMIT APPL)[CATION FORM Quantity Fee ID i ee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS VE ntilation Systems MECHANICAL BSCBLVD 'Scb Specific Plan BUILDING BSEISMICOM Commercial BUILDING ----Seismic BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T .-m orary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elf c Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Meoh Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3