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07030293r00 7UU :Z .a Baa >yU U y .oa ,}-a �p0 i L 3 F BUILDING DIVISIO'1 PERMIT BUILQI68,HRE S DE ANZA BLVD OWNER'S NAME: SYMANTEC CORPORATION ,NE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and m license is in full force and cfE 3 rJs License Class Date Contractor a ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following mason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). [11. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and . who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. Q 1 am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION .7 0 Z R .� Cn w rr aQ aZ UO OU Uz I hereby affirm under penalty of perjury one of the following declarations: ] 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compens 'on Insurance carrier and Policy number am: Carrier W,9 Policy No.1279=t—L3 d. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constroctinn lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that 1 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 building construction, and hereby authorize representatives of this city to enter upon the ahovc-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLIC UN ERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOU REGU A�T�ONS. d2 '^ Signature ofApplicanU ntractor Date HA7ARDOUS ALS DISCLOSURE Will the applicant or future but ding occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? Yes to Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as dcftncd by the Bay Area Air Quality Management District? 0 Yes ❑ No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safetycodc, Sections 25505, 25533 and 25534.1 understand thatif the building does not curre ly have a ant, that it is my responsibility to notify the occupant of the requirer h' et prior to issuance of a Certificple of Oczcupancy. Owner or authorized agent U \ / e ' Date PERMIT NO. MEADE CONSTRUCTION GROUP INC 07030293 645 RIVER OAKS PKWY INSTALL: A/C FOR FITNESS ROOM 7. - Issued by Re -roofs Type of F.00f q. Ft. Floor Area Z PERMIT ISSUE DATE 03/27/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description "Required Inspections atlon Occupancy All roofs shall be inspected prior to any roofing material being installed. If a roof : s installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO 7 ITEMS OF 14 PERMIT RECEIPT OPERATOR: bethe COPY # : 1 Sec: Twp: Rng: Sub: B11: Lot: APN ........: 36901035.00 DATE ISSUED.......: 03/27/2007 RECEIPT 4.........: BS000000803 REFERENCE ID # ...: 07030293 SITE ADDRESS .....: 10200 S DE ANZA BLVD f�m3ld-'' SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ...... OWNER SYP'IANTEC CORPORATION ADDRESS 10200 S DE ANZA BLV 4TH FLOOR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: RECEIPT INTERFACE CONTRACTOR .......: TIP? TEMPEL LIC # 27856 COMPANY MEADE CONSTRUCTION GROUP INC ADDRESS 645 RIVER OAKS PKWY CITY/STATE/ZIP ...: SAN JOSE, CA 95134 TELEPHONE (408)321-6450 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- BENERGY PERMIT FEE ---------- 1.00 --------------------- 34.86 0.00 34.86 0.00 BPERMFEE VALUATION 15,000.00 223.56 0.00 223.56 0.00 BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0.00 BSEISMICOM VALUATION 15,000.00 3.15 0.00 3.15 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 PPERMITFEE FLAT RATE 1.00 38.37 ---------- 0.00 38.37 ---------- 0.00 ---------- TOTAL PERMIT ---------- 386.94 0.00 386.94 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- --------------- CREDIT CARD 740.85 VISA --------------- TOTAL RECEIPT 740.85 a,%L I CITY OF CUPEkTINO CITY OF C'UPERTINO PERMIT APPLICATION FORM G 703 0,/? APN # / 30 - Date - Building Ad r ss- Ma' ' g ddress (if di erent from building address): Owner' me: C. Phone #: Contractor: �j License #: � Contact: Phone: i��/, Fax:VA, 1 Cupertino Business License#: ' Building Permit Info: -� C6 " k" .'re- CA s. Bldg ❑ Elect Plumb Mech E l Job Description: Residential ❑ %ZQ /1 Commercial Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: V �" Occupancy Group: Type of Construction: ! /� Please check this box if the project is a ❑ / 1 second -story addition: P t S' e• Standard Large El Major ElJ BCONSTAX rojec iz . Qua_ntity Fee ID BAPPLOTHER Fee Description Other Appliances Fee Group MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 E oiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Inci/OffJComm/Quasi BUILDING BCONSTAXBQ Cc n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 EJ ec 600V <= 1 OOOA ELECTRICAL BELEC1001 F lec 600V > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD H_nergy Add Multi BUILDING Rr\TVFCTMA Investigation fee BUILDING of 3 CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantit Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Conan. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Ir spection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Ga; Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Phn 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 SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Inst ill/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT [reinspection Fee BUILDING BREMACOVER A/C' Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rela Furnace > IOK btu MECHANICAL BREMHEAT Neater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pc le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R,-pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 = CITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rrr dl Signs Add Branch ELECTRICAL BREMSIGNS Reriodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Wnt Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Scismic 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 El -c Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Pl imbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3