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03080164CITY OF CUPERTINO CONTRACTOR INTORMATION BUILDING DIVISIONPIrRMIT s BUILDING ADDRESS: SYL—MAR CONSTRUCTION PE"""03080164 fR'S NAME: 1310 TULLY RD. 4 114 PERMITISSUEDATE PHONE: (408)293-7969 SANITARY 0. CONTROL N0. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH CJ 0 t� L NSEDCON'IRACTOR'SDECLARATION Job DescritIDD P I hereb ren Nm 1 am licensed under provisions of CWPmr 9 (Commencing with Seci )of Division Sof NC Buainea and Professions Cafe.and my license is _ in funx Claandcgect Lica 2 TENANT IMPROVEMENT FINALED Cuntrenor hinder and mye alllbcusedaspublie¢cords n p OCgr11 2 T 8 2003 plans Lkmnsed Professional OWNER—BUILDER DECLARATION License Law for the 1 hereby .(Sero that 11. exempt from she Cessions BUILDING o fallowing roman. ]1131.; airs and Professions Cale: Any city m manly which a permit m poroma, al¢q improve. hCerrott ri anygned twaum permit t r. earepair its circa priors itsiensedr alsoimports;to the the applicant for such Permits Ties Law(mmmmem is wit pursuant m Nm of Ne Comm�essa LlmnxlswsCods)r9 Sq. FL Floor Area Valu tion (that commO(Disio. (commencing with Section7000) of Division 3 of the exempt and latx47 or ncing on. Any that he u exempt therefrom and On baa for Ne alleged compiler. Any violnlon or ro aged 1161gori nn APN NumberOccupancy '- -- Type . - "— - Section 7031.5 by any applicant for a permit objects Oc applicant to a civil lcnslty of —— -- not mom Nan rhundred dollars (5500).-- ue p I, as owner of the property, or my employees with wages u their mole compensation, ' 101 - FOUNDAWO�R;kdInspections will do the work and the twelum is not intended or aRemd Waste (Sm. 70", Business and Professio. Code: The Canlsactors Limine Law it= not apply or in owner of property who builds or impro mthereon, and who does such work himselfor through his 102 - PIERS own employees, provided Nat such improvements are not imnded orogemd for a le. If, 103 — UFER however, the building or improvement is sold within an year ofes mPledion, On owner builder will ban the burden of proving Nat he did not Wild or improve for purpose of 104 - REBAR sale') 105 - ANCHOR BOLTS ❑ I, as owner of the property, am exclusively contracting with licensed conuacmm to mostma the project (Sm.71Ma,Basin. and Prefessitans Cod.:) The Comrxmr'&Lb 106 — SEWER & WATER most, Law does not apply in an he, of property who Wilda or improves Romenand, 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s) licensed pursuant m the Contractors License Law. 203 - UNDERFLOOR MECHANICAL ❑ 1 em exempt under gee. . B & P C for this mason 204 -.UNDERFLOOR FRAME r 205 — UNDERFLOOR INSULATION ... .. WORKER 'SCOMPENSATIONDECLARATION Ihereby alrranunder Penalty ofpaduryone ofthe following declarations: 301 - ROUGH PLUMBING ❑ I bane and will maintain a Ccnifate of Consent o self -Insure for Worker's CumpW- 302 — TUB & OR SHOWER sation,. provided for by Section 3700 of dm i Code, for On pedromanm or the 303 - ROUGH MECHANICAL work for which NIb permit is issued. 3 04 , ROUGH ELECTRICAL ❑ f have and wit .maintain Worker's Compensation Insurance, ss required by Section 3700 ofthm l nee, for the NOOOmanbd of Ne work for which this permit is issued. 305 — FRAME M war /�c�ga�m_ype�.mala�m or Policy number Y 306 - HOLDOWNS Cy r. 7/ g1/3 r1/1J Policy No. CERTIFICATE OF EXEMPTION FROM oRK 307 — INSULATION COMPENSATION INSURANCE 308 - , SHEETROCK (TTlsaccdon need notacompletedifshe permhisforonc hundmCdollarb($100) 309 - EXTERIOR LATH err lCbb.) I certify that in the perrormance of Or, work for which this Permit is issued. I shall not 3 10 — INTERIOR LATH employ any porton in any manner ser an to become subject o the Workeri Compensation 311 — SCRATCH COAT Laws or carfomin Dam Applicant 313 - 501 - ROOF NAIL FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: If. arldr making this Certificate or Exemption, you thou W become subject to the Worker's Compensation provisions of the iCode, you must forthwith comply with such provisions or Nis Permit&hall W deemed revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that there is a construction lending agency for performanm of 504 - FINAL BUILDING ENERGY the work for which this permit is issued (Sec. 3197. Civ. C.) Lenders Name 505 - 506 - FINAL ELECTRICAL GAS TEST Ian6rs Addma this application and Bute that cid .1W. inrorelating it I certify Nu 1 nave With building 1 agree m comply with ell city and county and cute laws relating 507 - FINAL PLUMBING unfim of e building construction, and hereby authoria rePresenutivcs of this city mcnter .,on theFIN MECWNCAL abovooncrawndd propdny for inspection purposes. (We) agree to ave. indemnify and lump harmless the City of Cupertino against 09 F I N / — liabilifies,judgments, costa and expenses which may in any way accrue agalmt said City consequence of do, granting of this permit( 5 Gin APPLICA UND STANDS AND WILL COMPLY WITH ALL ON -POINT Issued by:5 — 2 WORKS Date 6 [[ SOURCE TIONS Re -roofs Hfk4ure of ApplicanUCoamselfir IDate HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding Occupant stare or handle husi dour material fined by the Capordo. Municipal Code. Chapter 9.13, and the Health and Safety 25532(&)? All roofs shall be inspected prior to any roofing material being installed. 0Yei ON. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future Wilding occupant use equipment or devices which emit Wnri nus air contaminants m defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ❑Na- Ihavemadthe rtlousmaWhalsmquimmenuundef Chepmr6.95ofthe Califon nu Health&Safe a6, Sx6.25505,25533 uu125534.I untkrWM thatifNe Wilding does not cu y hnyE� renant, Net it u my res .ihiI ty to nudity the necupans of the rewhich bebrwiuuanc ofa Ccnir Tab pansy. Signature Of Applicant Date All roof coverings to be Class "B" or better Ownero authorianages Dmc tF .N1 CITY OF CUPERTINO ' ,PONT.RA CT ::. IN ' BUILDING DIVISION PERMIT PERMIT BUILDING ADDRESS: 10100 & 10200 TANTATI AVE SYL - MAR CONSTRUCTION PERMIT NO0 3 0 8 016 4 OWNER'S NAME: 1310 TULLY RD. ## 114 PERMIT ISSUE DATE PHONE: (408)293-7969 SANITARY O. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a a 0 0 L ENSED CONTRACTOR'S DECLARATION Job Description 1 hemb tem that 1 am licensed under provisions of Chapter 9 (commencing with Set: 0(I(I) of Division 3 of the Business and Professions Codc, and my license is in mnsc Clas aeffect. Lic p Z TENANT IMPROVEMENT F "'D r Cunlractor ouown �Wwm w- CHITECTS DEC A N I undo and my plans shall be used as public records } g$i , G' 8 2003 Licensed PnNessional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the following mason. (Section 703 1.5, Business and Profcssiuns Code: Any city or county SUILDINU which requires a permit m construct, alter, improve, demolish, or repair any structure prior to its issuance. also requires the applicant for such permit to file a signed statement Sq. Ft. Floor Area Valu that he is licensed pursuant to the provisions n(the Contractor's License Law (Chapter 9 t) on (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt ftmrrom and the basis for the alleged exemption. Any violauon of 3 1619061 -00 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjecu the applicant io a civil penalty of not more than five hundred dollars (5500), ❑ 1, as owner or the property, or my employees with wages as their sole compensation, 101 — FOUNDAWE;4QRd will do thework,and the structure is not intended oroffered rorsalc(Sec. 7044, Business and Proressiorts Code: The Contractor's License Law does not apply to an owner or Inspections property who builds or improves thereon, and who does such work himself or through his 10 2 - PIERS own employees, provided that such improvements are not intended orofrered forsale. fr. 103 — UFER however, the building or improvement is sold within one year ofcompledon, the owner - builder will have the burden of proving that he did not build or improve for purpose or 104 - REBAR sale.). 105 - ANCHOR BOLTS [:11. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- 106 — SEWER & WATER cense Law docs not apply to an owner of property who builds or improves thereon, and 2 0 2 - UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's LicenseLaw. 203 - UNDERFLOOR MECHANICAL F1 am exempt under Sec. , B & P C for this mason 204 - UNDERFLOOR FRAME Owner ate WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION 1 hereby affirm under penalty or perjury one of the following declarations: 301 — ROUGH PLUMBING F1 I have and will maintain a Certificate of Consent to sclr-irvsum for Worker's Compcn- 302 — TUB & OR SHOWER cation, as provided for by Section 3700 of the labor Code, for the performance or the 303 - ROUGH MECHANICAL work for which this permit is issued. 304 - ROUGH ELECTRICAL ❑ I have and wit maintain Worker's Compensation Insurance, as required by Section 7700 of the r Codc, for the performance or the work for which this permit is issued. 3 05 — FRAME My Wor ;Compensatiop Incupnce r:anjpr and Policy number m: 1 ��//'"`II//77��//��yy��l�++ 306 — HOLDOWNS rVi'i./L.1YJ/ Polity No., C er. CERTIFICATE OF EXEMPTION FROM OR 307 — INSULATION COMPENSATION INSURANCE 308 — SHEETROCK (1 -his section need not be completed irthe permit is foronc hundred dollars(SIOlt) 309 — EXTERIOR LATH or less.) I certify that in the performance of the work for which this permit is issued. I shall no[ 310 - INTERIOR LATH employ any person in any manner so as to become subject to the Workers' Compensation 311 - SCRATCH COAT Laws Applicant or California. Date 313 501 - ROOF NAIL — FINAL ELECTRICAL ENERGY NOT CE TO APPLICANT: If, after making this Certificate or 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. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY 1 hereby affirm that there is a construction lending agency for the performance of 504 - F I NAL BUILDING ENERGY the work for which this permit is issued (Sec. 7097, Civ. C.) Lender's Name 505 506 - FINAL ELECTRICAL - GAS TEST Lender's Address 1 cenify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to 507 - FINAL PLUMBING, building construction. and hereby authorize representatives of this city to enter upon the FIN MECHAN CAL shove -mentioned property for emnif an keep hs (We) agree to save, indemnify and keep harmless the City of Cupertino against O 9 F I N liabilities, judgments, costs and expenses which may in any way accrue against said City in 5 NG consequence of the granting of this permit ICANT UND STANDS AND WILL COMPLY WI H ALL ON -POI NT Issued by:5 C WORKS Date " 2.7 CE TIONS. Re -roofs Type of Roof A 000i �aturc of ApplicamAtdntractdir Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle haiallous material as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code. Section 25572(a)? All roofs shall be inspected to any roofing material being installed. M Yes r-1 No prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? r1Yes ❑ No Ihave read the -aid nus materials requirements under Chapter 6.95ofthe Califor- nia Health & Safe odc, Sections 25505, 25577 and 25534.1 understand that if the building docs not cu y ha a Ienant, that it , my res nsibiliiy to notify the occupant of the 'orwissuanc require whichm�beIn draCeniO re foee panty. 103 Signature of Applicant Date All roof coverings to be Class "B" or better Owner or authorixcd agent I Date CITY OF CUPEkTINO TY OF CUPERTINO .m PERMIT APPLICATION FORM 6 .1 APN # 1-11 16 -11 0 6/ 7 Fee Group Date: Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot Building Add BBOILERI Mailing Address (if different from building address): ts-�cmoo -oo 'T s Boiler > 100K to 500K Btu Owner's Name: BBOILER3 Boiler> 500K to 1M Btu Phone #: Contractor: Boiler > 1M to 1.75 M Btu MECHANICAL License #: 'j MECHANICAL BCONSTAX Construction Tax Contact:. `' ( Phone: Ind/Off/Comm./Quasi Cupertino Business License#: D"- - b 'l Fax: - 2 Bu* ding Pe it Info: BUILDING BCONSTAXR 71 BUILDING BELEC 1000 d ELECTRICAL Plumb ❑ Mech ❑ J b e ription: ELECTRICAL BELEC200 Residential ❑ ELECTRICAL BENERGY Sq.Ft. Floor Area: BUILDING BENERGYADD $/Sq.Ft.: Cost of Project:] BINVESTIGA Investigation fee Occupancy roup: BMITIGATC Comm. Housing Mit. Fee BUILDING Type of Construct on: Please check this box if the project is a sPi��y to addition: ❑ r Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 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 Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 , ( FY OF CUPERTINO CM OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWM-ULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEVW it TI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric 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 Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 CITY OF CUPERTIN CnoF CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPER.NMEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fees foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3