27942 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO - BUILDING-ELECI'R1C'AL PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 27942
BUILDING DIVISION BUILDING PROJEC'L IDENTIFICATION
BUILDING ADDRESS: `/I�1,a I /,.� a�./.y�J�� SANITARY NO. APPLICAGONSUBMITTALDAlE
31 1/� 1 �'- UNlTg LOT# U T 7 7 C
o,WN�:aS NAME,: PtIONL: CONTRACTOk'S NAME: C NO: l ( ( C
1A-NC>�� COk( �tT$YZF� 213E-3Z3 p Ca►.j R (o?j NIC COST rkoLa
RCHIECTENONCER: ADDRESS: ❑ 76 q
�B slLC
coN9'ncr: PHONE: BUILDING PERMIT INFO
'•I..•..>r.. �j / p�,J G QTY. ELECTRIC PERMIT FEE
d��5�� • 1 ��� f,� �rj � PERMIT ISSUANCE ELECT' PLUMB MECII
LICENSED CONI'RACTOR:S DECLARATION APPLIANCES-RESIDEN'T'IAL JOB DESCRIPTION
mxz I herebyaflirm that l am licensed under provisions of Chapter 9(commerce,with
WOO Scclion]001 Division 3 of me Business and Professions Code.and my license is in PANELS
QUF full force and effect
y<y Dme C ii memrl�3 uPTozdonMrs {VW i
��Ih^I 301-1000 AMPS SO.FT.FLOOR AREA $/SV.IT.
Z OInisZ ARCHITECTS DECLARATION OVER IOW AMPS
O Z-O I understand my Plans shall be uud az public records.
P y i-W SIGNS ELECTRICAL
Licensed Professional
'a aQ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
Ka
OaU 1 hereby iffimh that 1 am exempt from the Canuaeop's License Law for the
L3+-rFit following reason.(Section 7031.5.Business and Profession Code Any citynreounty TEARMETERORPOLEINST.
F O Q which myuires a permit to conswct,alter,improve,demolisM1,or repair any strunum
}� ono its issuance,also requires the applicant for such tto fleasi dstaremeor POWER DEVICES
Pn 4 PP Frani gLa
µajaQp mat be is licensed purmum to the provisions Orme Contractors License Law(Chapter
aXe� 9(rnmmencing with Senion]I](10)ofDivision3nf me Rusines and ProfessionsGde) SWIMMING POOL ELECTRIC VALUATIOty, Q
ty Z, often M17031.5 by any
Permit
subjects
applicant
to civil
of OUTLETS-SWITCHES-FIXTURES
FZQ normSectimthan veanydreddollar, $500).tsubjeebt aPPlicanno acivil Penalty of
not mom than five hundred dollars(5500).
20 NEW RESIDENTIAL F.LIiCIR _S STORIES TVPii CONS'fk UCTION
F� ❑ I,as nwner,fmc Propeny,onny nnployce itbwage anhcicompensation,
y3- will dolhcwork.anJ theswctureianolime unslferedf rsule S(Sac,AtN4,Bminess
and Professions Cade:The Conuactors amuse Low docs not apply loan owner of
prepenywhobuildsorimpruvesthere .andwhodoessish orkhmendfor Woughhis OCC.GROUP RES.UNI'T'S
uwnemployees,providedtbatsuc provemprommuminte dedorofferedforsale.If,
however,the buildingorimpf ment is sold within one year dwmplelion,no owner- TOTAL:
builderwillhavehebnd ofpmvingthnhcdidnotbuild r improvem,mirfomid
sale')' ' QTY. PLUMBING PERMIT FLOOD ZONE APN
❑ Lasow cro the pmpeny,am na
exclusivelycontrectingw licedcanhaetnrsm a
construct in project(Sec.70f4,Business and Professions We:)The Contractor's PERMIT ISSUANCE
License Law o m napply in an ownerofProperty who build.. rimproveslhomomand
whoctnmac f,rsuehprrjec¢wlmaeme cm ) tenseuanttothe Conlmcums EA
License tat. ALTER-DRAIN&VENT-WATER( ) FEE SUMMARY
❑ 1 am a erupt and ec.� u P C for this mason OUTSIDE FEES
SACK FLOW PROTECT.DEVICE
SANITARY Y N
Owner " f Dale RECEIPT#
DRAINS-FLOOR.ROOF,AREA,GOND.
:WOR COMPENSATION LAR_in re SCHOOI.'1'AX Y N
❑ There yaffirmtFl asette le of co emmself-insure.'No,
of RXTURE3 PER TRAP RECEIPTX
Work..G pensation ler. Casette
opy themaf(S..3800,1ab C.).hi,h PARK FEE Y N
Halle ployees under spermil. GAS-EA.SYSTEM-1 INCA OI1TLF1'S RECEIPT#
polis,is BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
Ce -•F��a
❑ 0 d copy i.s hereby fu - W. �J�
fVCenifi icoMisfiledw' the city inspection division. GREASEgNDUSTRL WASTE INTERCEPTOR GRADING FEE
Imo•
BR III ATE OP EXEMPTION FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section neW not be completW ifmc pcnnit is foronc hundred dollars($100) SEWER SANITARY-STORM EA.200 p. IrERGY ME
or less.)
I anify that in the performance of the work for which this Permit is issued,)shall WATER HEATER W/VF.NT/ELECTR
not employ any person in any manner s,as to become .bje.to the Workers' PAID ,L
Compere.ion Lawsof Colifomm. Date WATER SYSTHM/TREA'I INC, Dvm Recti
Q Z Applicant
Z 0 NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should NEW RES]DENTIAL PLMB. SQ.FT. TOT
l--' become subject mthe Workers Compensation provisions fthe labor CWe,you must
forthwith comply with such provisions or this permit shall be deemed revoked, BUILDING FEE14T1 V1 RK,-10
fi7 2_�mn
CONSTRUCTION LENDING AGENCY SEISMIC PBF Ll/
1 hereby affirm that hem is a construction lending agency for the performance of
U0 me work for which his Permit is issued(Six.3097.Civ.C.) TOTAL: ELECTRIC( "
Lender's Name
0 Lender.Address QTY. MECHANICAL PERMIT FEE PLUMBING F
U 1 certify that I have road his application and slate that me above information is MECHANICAL I'
correct.l agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE
haildingmnswetion,and hereby nufloriee representalivesofinis dtytoemeruporthe CONSTRUCTION TAX
U Z above-mentioned property for inspersion purposes. - ALTER OR ADD TO MECII.
(We)agree to sive,Indemnify and keep harmless the City or Caperton,against
Iiabilities,judgmenot.costs andexpenses which may in any way accrue against said City AIR HANDLING UNIT ITO 10,000 CFM)
in consequence of the granting of this permit.
AIR HANDLING UNIT(OVER 10,000 CFM)
Signature of Applieanl/Contractor Dale EXHAUST IIOODOV/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IOO,11W BTU) Dale Nivira#
Will he applicant or future building occupant store or handle midd ous aramom HEATING UNIT(OVEN 100,000 BTU)
es dcfnaf by the Cupenino Mi nici salCole,Chapter 9.12,and the Health Lind Safety
Code.Section 255320)+ VENTILATION PAN(SINGLE RESID)
❑Yes, No ISSUANCE DATE
Willmeapplicantnr Tutebuildingoccupamt useequipmentordevices whichemit BOILER-COMP OHP OR IO ,M BTU) pp
docs air imm— mus as defined by the Bay Area Air Quality Management BOILER�COMP(OVER 11)0,000 BTU) P M D
kiisrictl ur _
❑Yes >(No NEW RESIDENTIAL MECH.—SQ.FT.
I have mad the havardoas materials requirements under Chapter 6.95 of the "JUN 29 1995
California Health tit Suley CWe,Sections 25505,255J3 and 25534. 1 understand hat
iflhe th ]ion dins not cum d ha tenant,that it is my responsibility m notify theIr-
«eapatn,r mai wine m at rte met prior to ixs,anee_,rp emir,tt�,r 011-Y Ur GUrCH I I
1
Owner ata Boom,agent Dam 'TOTAL: ISSUED
OFFICE
&--.— Citv
10300 Torre Avenue
Cupertino,CA 95014
of,
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
May 8, 1996
Tandem Computers
19131 Vallco Parkway
Cupertino, CA 95014
Re: Expired permit, (copy attached)
Dear Owner:
According to our records, the referenced permit has not 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 (408) 777-
1228, so we may arrange to extend your permit and schedule a final inspection.
The City of Cupertino requires a response within ten (10) working days from the date of
receipt of this letter. If we do not hear from you within this time, the building department
will have no other recourse but to resolve your permit as expired and discard the records.
Thank you for your cooperation,
Building Department Staff, City of Cupertino
•
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