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