04010107 CITY OF CUPERTINO ^a . s a kr " '� '¢.< °'• "''`�'
BUILDING DIVISION PERMIT p,,�CONTRAC-`TOR INFORMATION4
BUILDING ADDRESS: SASCO ELECTRIC PERMIT NO04010107
NER'S NAME: PERMIT ISSUE DATE
AT & T 1600 MFMORFX DIR /29, 121104
o-SONE: SANITARY N0. CONTROL NO.
(408) 970-8300
ARCHITE
08 7 —
ARCIIITEC/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION ] b Description
u F I hereby affirm that 1 am licensed undn coeSCIIer provisioof Chapter 9(commencing p
z� with5ccti n70{l1J)of Diviskm3ofNcnu.Mutc and Pmfcssiom Code, dmylieenuis
j ? in fullem err9We}. O •/` 58353 ELECTRICAL UPGRADE
License Clens IL Lic.N �'w „
n F Date — i— Comraz orS a4SCA 4].tLllls L
ARCHITECTS DEEC'ARATION Vspe
ltndcrsmnd my plans sM1elI he used as Public records
=ay Licensed Professional FEB 0 3 2004
OWNER BUILDER DECLARATION
.�<p 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
MC following reason.(Section 7031.5,Business and Hofez bat Cole:Any city or county
K m which mqulma a Permit m consulter elmr,imprnw,demolish,or repair any structure
yai priorwits issuance.also requires the applicant for such Permit to rile a signed statement
< Nat he is licensed pursuant mthe provisions ofthe ConuacmriLicencLaw(Chapter 9 Sq. FL Floor Area Valuation
xFe (commencing with Section 70Bo)of Division 3 of the Business and Professions Code)or
y $
that he is acntpt therefrom and the basis for to alleged exemption.Any violation or 'i wn.e.w
Section?031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 ITG,WwUlCarOO Occupancy Type
not more than five hundred dollars u50y.
❑ L ax owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is nut intended or officered for sale see.7W,Business
and Professions Cole:The ConvactuYs License Law docs not apply to an owner of Required Inspections
progeny who builds m improves thereon,and who does such work himself orthmugh his
own employees,provided that uch improvements are not intended or offered formic.If.
however.the building or improvement is old within one Pose of completion.the owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
❑1,as Owner of the progeny,am exclusively contracting with licensed contractors to
construct the pollee,(Sec.7064.Business and Professions Code:)The Contractors U.
cense law does not apply to an owner of property who Wilds or improves themon,and.
who contracts for such prelcets wit a contractor(s)licensed pursuant to the Convector's
Lbenu law.
l am exempt under Sec. ,B&P C for this rtazon _
w Date
WORKER'S COMPENSATION DECLARATION
1 hereby of orn under penalty of perjury one of the following declaration:
1 have and will maintain a Cenifcam of Consent to self-insum fur Worker's Compere
sation,as provided for by Section 3701)of the Labor Code,for to perfmmance of the
work Tor which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700Of the Labor Cod,for the performance of to work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
comhQ:,Ztic[IC bI Policy No.:279&$9'001 -
(A CERTIFICATE OF EXEMPTION FQOMWORKERS'
✓ COMPENSATION INSUR CE
(Thu section need nut becompleteJ if ticpermit is for one hundred dollars($100)
or less.)
1 ccnlry that in dte performance of the work for which this Permit is issued.1 shall not
employ any person in any manner m m in become subject o the Workeri Compensation
Laws of Cal ifurnla.Date
Applicant
NOTICE TO APPLICANT:IL after making this CenifemG of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.J z fonhwi t comply with such provisions or his no it shall he deemed rewuod.
Z O CONSTRUCTION LENDING AGENCY
I-. I hereby affirm that there is a construction lending agency lot the Performance of
a > the work fur which this permit is issued(Sec.3097.Ci,C.)
It7 Q tondos Name
D. Under's Address
,D y
U O 1 moify that 1 haw rail this application and sum that the above information is
L, f"' comma.I agree Io comply with all city and county onlinanees and sum laws reining to
0U building construction,and hereby autOrim representatives of this city to cnmr upon the -
(We)agree to cove,indemnify and keep harmless the City o Cupertino against
UN inconam,wudgments.ceofthe costsandof thiseswhichmayin anyway acme againat mid City a�
U z i P ICAcnec oftegmmingof this Permit.
^ AyyyPLICA UNDERST9M SAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
!PL"RE ULATI�NS
Itl_t, ^-fl'22-0`I Re-roots
Sign a ApplicanVConlncmr Dalc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or future building Occupant store or handle hararduus material
u defined by the Cupertino Municipal Code.Chapter 9.12,and the Fears and Safety
Code,Schen 21132(a)?
Yes tr All roofs shall be inspected prior to any roofing material being installed.
Will to epmiea ,pr mtom building«capon,mi,equipment Or devi winch If a roof is installed without first obtaining an inspection,I agree to remove
emit horardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
[3 Yes
1A, recalm e haraNe smamrialsmquimmenuundcr Chapterb.95ofthc Califon
n' HS5aai etyC d,Sccuou2lY)5,25533.d25534.l.nWrs.dJ .iftha Wilding
docs(rot cu y haw a that it is my responihibuy to notify the occupant or the
menlsw ieh I prior to issuance of.Cerdncate pf eltpaney. Signature of Applicant . Date
owner9 tpriredagen, o m All roof coverings to be Class "B" or better
CITY OP CUPER'I'INO
�CONTR`�CTI�R INI ORM
DIVISION PERO "
BUII,DINC D4 ,
BUILDING ADDRESS: SASCO ELECTRIC PERMI"r NO04010107
OWNER'S NAME: PERMIT L6UE DATE
AT &
NE: SANITARYNO. CONTROL NO.
(408) 970-8300
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECIi
0 0 0 0
moo LICENSED CONTRACTOR'S DECLARATION
w❑ 1 hereby aMrm shat 1 am licensed under provisions of CW,uar 9(commencing Job Description
iWwiNScaLOA71I of Division 3 of the Bus .Odl Professions Code.and my lice.is
(oil rt dervr,[,t o 5"83S3y ELECTRICAL UPGRADE
n�i License Clas r--t Lic.p
�Fm Dam — i— Cuntnc orek4Scc, I;LkLtk4cl
1�yW ARCHITECTS DECLARATION
Ya3 undcrslnnJ my plansshallMuuJ as public rccnNs
JiU
;p�', Licensed Pmfcssional
i�iog OWNER-BUILDER DECLARATION
S 1 hereby affirm that I am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5.Business and Prufcssinns Code:Any city or county
K m which milm es a permit to construct,alter,improve,demolish,Or repair any structure
priorlo itsissuance,also requires theapplicant for such permit to file a signed statement
=Y<
that he is licensed purstrantio the provisiam or the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
^io
yl- (dst he
ingwith Section7000)And df,Division of the Business and
lmi.a.cuinnaCode)latima I
i�$ Nat he is ncmpt therefrom and tic buts for Ne alleged camption.Any vitiation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penahy of 3 20gl4,4j'Mgr0 0 Occupancy Type
not more Nan five hundred dollars(SSW).
1,AS owner of she property,or my employees with wages AS their sole compensation.
will do the work,and the suumum is not intended oroffead for sale(Sec.7 W4,Business
And Professions Code:The Contactors Liao•<Law dans not apply m an owner of - Required Inspections
property who builds or improves Hereon,and who do rssuch work himself orNmugh his
own employees,provided that such impmvem.nm are not intended or offered for sale.If.
howevcq the building or improwment is sold within one year ofenmpletion,Ne owner
builder will have the burden of proving Nat he did not build or improve for puryos of
Ask.).
❑1,as owner of the property,am uclusively contracting wit licensed contractors to
conswn the project(Sec.7844.Business and Profasions Code:)The Contrast Li" l
theme law docs not apply to an owner of propcny who builds orOptions themon.and
lir/
who commcu for such projeces with a contractors)licensed pursuant to the Contractor's
License law,
❑
I Law.
under S¢. ,B&PCfor Nixrtuon 3 J
Owner Dale /+v
WORK ERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 ban And will maintain a Cenificare of Consent to self-insert for Worker's Compcm
cation,as provided for by Section 37M of the labor Code,for Ne po form once of the
work for which this permit is issued.
O 1 have and will maintain Workers Compensation Insurance,u recruited by Section
37W of Ne Labor Code,for N.performance of the work for which this permit is issued.
My Worker's Cnmpeastiion Insurance carrier and Policy number am:
Cartier.a—Z'L(! f�' Paltry NO:
z7 95S
{aJ CERTIFIUTE OF EXEMPTION FFRROM��WORKERS'
COMPENSATION INSUROkIE .
(TMs section need not the complomd if the Permit is for one hundred dollars(SIBIc)
in,less.) -
1 eessify Nal in the performance of Ne work for which Nis permit is issued.I shall not
employ any Panama in any manncr ire an become subject to the workers Compensation
Laws of California.Dam
NOTICE
NOTICE TO APPLICANT:If,after C.Oomaking this Cisions or of Exemption,you sham,
become subject to it Workers Comas or this provisions of the L.hdeemed
evokeCode you must
.J z. forthwith comply with such provisions lir this permit shall be ticemcJ revoked.
Z O CONSTRUCTION LENDING AGENCY
Ihereby affmm that there is a construction lending agency for the Performance of
ry'
the work for which this permit is issued(Sce.3097,Civ.C.) '
W Q Leader's Name
Lender's Address
oz
U O 1 certify that 1 have rad this appuenlnn and sum that dm show inrwmetion is .
If, E-' correct.I agree to comply with all city and county ordinances and sum laws«Iming to
Obuilding construction.and hemby authorise representatives of this city to enter upon the
LS7 shove-mentioned property for inspection purposes
(WE)agree to save,indcmntfy and keep harmless the City of Cupertino against
F't liabilities.judgments,costs and expenses which may in any way acme against said City s1
U z in eansegwnee of the granting of this ne,mi,.
Ay PLICA UNDERSTB.H S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
.. SIu BEE RE ULAT,I NS �_0�
1 n Re-roofs
sign tLr Avnlicanncantr.aor 1� Date
IM HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will tic applicant or(.tore building occupant lime.m handl.haardous material
faz
_dic,
r.
by the Colo .Municipal Code,Chapter 9.12.and she H.aIN and Safety
cadd.,SectionIss3z(B)7
yt, m All roofs shall be inspected prior to any roofing material being installed.
Ycs
Am Will me applicant lir tome.nmiming occupant mac egminntent or devices which If a roof is installed without first obtaining an inspection,I agree to remove
nit hazardous airconmminanu as dcfncd by(be Bay Arca Air Quality Managcmcnt all new materials for inspection.
twee,
❑Yes
1> sad Neho.W"sm."ialsmquiscmcnuundcr Chapmr6.95ofdc Califon
rnHya ING cry Code,See tions 25505.25533 Bad 25534.1 undersand hard Ne building
does or,
cameo yh.wthe a tNut it is my cespmsio14y m null l y the occupant of Ne
r , mm.now ich IPour t.issuance OfACcnlrcareof�paneyy. Signature of Applicant Date
owner mhori_/agcm o e All roof coverings to be Class"B"or better
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Y
OCITY OF CUPERTIN*
CITY OF PERMIT APPLICATION FORM ( ° v
CUPEkTINO
Ill APN # 3(� o / Date:
Building Address:
10101 K� - Dc Lz C3: ✓b .
Owner's Name:� Phone#:
Ameeq- RztI wG AiFtr '-to g- CI-70- 3 JD
Contractor: License #:
6SCO �U-rT IL
Contact: Cupertino Business License#:
,13 PIrmit Info:
B Ele Plumb ❑ Meq ❑
Job Description:
Residential ❑ ommerci I.
Sq.Ft. Floor Area: $/Sq.Ft.:
I
Cost of Project: Occupancy Group:
Type of Construction:
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 1 M Btu MECHANICAL
B130ILER4 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
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELE 200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
/ BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
I of
CC - +CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER WaterHeater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMA.IRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Furnace > l 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
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� e OITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Grou
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 Insection 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
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot I PLUMBING
ZADDCHG Address Change BUILDING
BMISCELL Building Misc Fees BUILDING
•
3 of 3