20257 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Fraee/Identification , 1 . rTYMT NO.
ress
Bulldleg Add : (O`l OO TaO.I�ITA V � 20257
ner• ams. one:
"TAr4p� C/'MPR4TERS CITY OF CUPERTINO-BUILDINGDIVISION a�
"L �
Contractor*.Name; Lk.N. r APPrICATION /PERMIT
T1-1Tc2D1 'LZOLn 8 BU7LgNGEDCMCALPLUMCO
BING-MECHANICAL CATEGORY NTROLY
ArchXect/Engineer. Lle N.
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address PERMITISSUANCE ❑ F-1 ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby offlrmtl tfamlkemeduMerpro m.ofChapter9(cvnmen APPLIANCES-RESIDENTIAL JOB DESCiRIPTION
iegw Se i..70W)o/DIVWon3ofthe Businewand Petak.M.Code,and my
limve G In fou tor¢ f4 PANELS
Lkerx Class 7, r. 7_7 a to 4 7Y CHL L_L_E2
Dee'Z- Comnctor TtRG.RssnUP TO 2DO AMPS
ARCHITECTS DECLARATION 701"1000 AMPS
I urdentaM my pl r a,ha0 be used as public teo¢ds- OVER 1000 AMPS SQ.Fr.FLOOR AREA S/SQ.FT.
E 1'j Llamed Pneferbnal SIGNSELFLiRICAL
<< OWNER,
hatlamBUILDER DECLAMTION SPECIALCIRCUIT/MISC
Ih<rcbyafflrmtlutlamvempt fromthe Comractors License Law for the
pp following ream.(Section MIZ,Busbussand Profentiors Code:My city or
O Z F- IIIAP.METER OR POLE INST.
PE county which¢quunapemtltrocoviruq aler,lmpmvp demolIsh,arrepar
< .nye Mmprf¢toi6b me,al.orequlmtheappHantfmwchpe to POWER DEVICES
a V file a signed statement the he,b b
licensed pursuant to the pruvbd ns the
3u, Contrators Lkene,LAW(Chapter9(commencingwllh Section 7000)of Divi- SWIMMING R7IX,
F EO5 ,bn3 ofthe Business and ProtesbnuCode)orthat he 6 eaempt therefroVALUATION
rd maUELECTRIC
M
El« the bash for the alleged aemptlrn. My ddallon d SeGbs 70715 by any . OU"rLEISSWDCHFSFUTUAE9 '�f O at�L
p applicant for.permt subjecatheappHcanttoa dull penatydnot..if.. 0 O O
live hundred ddles($SM. NEW READFNDAL EI.�TR
tf..
F-1 1,as owner of the property,or my employees with wages as their sole SQFT. STORIES TYPE CONSTRUCTION
compensation,will do the work and the structure is not Wended or offered for
Hot vk(SM 7DM,Ruelrcv and PrfeWore Code.The Contractor.Lice.Law I �1L11A$ �T
rjC$ does rest apply to an owner d property who builds or lmprovn thereon and OCG GROUT' ltl5.UNTTS
whodoessuchwurk Mersetf orthmugh h1townemployees,provided that such
bnprovrnmrts re not Intended oroffered forsale.I(,however,thebulldingor TOTAL:
Improvemem Isaddwithinone)earofcomplalorktheow.er-0 Merwilllove
thl�I,Iurden of proving the he did rat build orlmprove for purpose of,ale.). QTY. PLUMBING PERMIT FEE
LI L a,owner of the property,am euu
hWely contracting with licensed FLOODZONE APN
contractor to construct the project(SM 7014,BuelnesaM PrdeWoro Code: PERMIT WIIANCE
The Contractor'.License Law don nut apply to an owner of property who ALTER-DRAIN k VENT-WATER(FA)
builds or Improves thereon, and who contracts for such projem with• FEE SUMMARY
ry➢tledo,(.)licensed purruantrothe Centractar'.Llce.L.w. RACY FLOW PROTECT.DEVICE
u I am e.emp under Sec. e k P C for this reason
FEES
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_
Dam -.• Avner WORKMAN COMPENSATION DECLARATION PLC7lJRFS PER TRAP SCHOOLTAX Y��NY
❑L hereby affirm that I have•cortl/late of...t to wlf-Iraum,m• RECEIPT/
¢rt10¢ted Worken'Compevatlonlnwran¢w•¢nl(6d copythaeof(Sec. GAS F.A.SYSPFAI.I INCAOUILES PARK FFR Y N
3800,Lb C.) RECEBT/
PokyY -7(r, SSI 0x,'5091 GAS F.A.SYSTGI-0VER4(EA)
CertN py lr�O�byh/urN,hM!KS BUILDING DIVISION FEES
ed on"lit filed with the city lmpe ion dhdsion. GREASE/INDUSTRL WASTE INTFRCFPTOR PLANCHECK FEE
CERTIFICATE OF INAtFTION FROM WORKERS' GREASE TRAP PAID
COMPENSA NINSUR H gyrpyS,hM.f.ARY STORM EA NI(Ff Date ROcef IM
00)or
need rad trcompld theore hundneddollm ENERGY FEE Y N
(ST I07¢lean.) WATER HIATFR W/VENT/M ECTR
l artlfytha lothe perfo /o tins pemuX6 Wiled,
I shall not employ any pe I iv=. to bemma subject to the WATER SYSTEM/'IREATING
Workers Compensation V Gllforn6 PAID
ZZ Applicant NEW RESIDENTIAL PLMB. SQ.FT. Date Remi t#
O NOTICE TO I aft tins Certificate of Ficmmppbn,you
should become the we C mpewtimr provisions ofthe Libor TOTAL:
T Crdgyou at h comply with such provbloro orthb permit shall be_ BUILDING FEE
LU ] deemed revoked.
11 o CO RUCTION LENDING AGENCY SEISMIC FE'
Iherebyaffirmthat thertbacomtructlon lending agency for the perform TOTAL ELECTRIC FEE
Z ance of the work for which this permit b Issued(Sec 3097,CW.C.)
(,) O Lender.Name PLUMBING FEE _
LL ~ LeMcrs Address QTY. MECHANICAL PERMIT FEE MECHANICALFEE
O W I¢dlfythatlhavemad thleappuatboand mtethathe above 6formmlon
1 bcorrcG.Iagreetocomplyw haUdtyandcountyordWnmandtl telaws PFRMITISSUANCE FEES PAID:
} N relating tobulkling construction,and hereby authorlre rcpmaortatNes ofth6
F- U) cry to enter upon the.hove-r¢mbrcd property for inspection purposes. ALTERORADDT0MFCH. Date Recei t#
(We)agree to save,indemnify an d keep been.the City of Cupertlrm
agabst llabWties,Judgment,co.aaM eaperses which may ina.ywayaccrue AIR HANDLING UNIT(TO 10,(D0 CFM) SUBTOTAL:
against said City In coosryuerce of the gram Ing of this Permit.
AIRIIANDENG UNIT(OVER l0,000CFM) CONSTRUCTION TAX
Signature of Appuant/Contractor Dae EXHAU57 HOOD CW/DUCE? - CONSTRUCTION TAX P
HAZARDOUS MATERIALS DISCLOSURE %
Will the applIanl or future building occupant Mom or haM6 hazardous HFATING UNIT(TO 100,0001iTV) Date RCtCI III
material as deHred by the Cupertino MuNdpal Code,Chapter 9.17,and the
Health and Safety Code Section 75537(x)? 1 rFATING UNIT(OVER 100,000 BTI!) TOTAL:
❑ye, M No
WHltheappllomr NWu bullding.pantu,eequlpm.nt ordev4m VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air contamW ma..deflned by the Bay Area Air
• Quality Management District? BOILER-COMP OHPOR 100,000 BTU) an�
4Yes ❑❑No P
huveread the ha mous materials requirements under Chapter 6.95of BOn it-COMP(OVEt10D,D00R71ti A l U
the California Hahh h Safety Code,Sectlors 255G5,25533 and 25531. 1 FEB
urdmtaMtMtlfthebu0dingdonnwl mntlyh.veatenant,thatlt6my NEW RESIDENTIAL MECE SQ-17 e,8
respomlbelty to ndltythuleatc.Occuparequbement,which nwet be rrcr •DD FI 199
a cenlrkamrro.,�panry. 1 GI-11L�E2— otPt,a ,S
1 11"r � �
2-27-9� Pv� Vf t.,. ,r i.%
Owner or aulhoNeda rat Date - ISSUED
L —
OFFICE COPY
01tv
OI
Cupertiuio
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
December 4, 1995
Tandem Computers
10400 Tantau
Cupertino, CA 95014
Subject: 10400 Tantau, Permit#20257 - Replace Chiller
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
r 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 r �
• — J
F- ca PPcYc tla P;we/