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04070168 CITY OF CUPERTINO *- �T��z T' BUILD LNG DIVISION PE C�A\ RbA.CCIR�l�I'OR !O' N '-f Rh, eR,'A ax:✓,ake L�u.3:n?^ BUILDING ADDRESS: a PERMITN(l 070168 0803 ALVES DR V HER'S NAME: PERMIT ISSUE DATE SANTA CLARA VALLEY YMCA PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 � 0 Boa LICENSED CONTRACTOR'S DECLARATION I('� s C 1 hereby affirm Nn 1 am licensed under provisions,of Chapter 9(commencing 1 n ILtg1YYOn b will.5emon]IXkl)aroivisionlarlhe Bu4nrsaandfhoressiarueade.and my Bcenseis « inbut to.and enem, NSTALL DOOR/SIDE LITE License Class Lic.# z Data ContractorlA MAR L1 ARCHITECTMAR S DECLARATION M 1005 r < 1 understand my plans shall Wined as puhlic bi BUIL NG3 so Licensed Pmressiorod OWNER-BUILDER DECLARATION E 3 1 heresy affirm ohm 1 1. exempt from Ne Conuscmo :License Law for the p o following¢axon.(Section]rD construct, Business and ere,dcrioro Code:Any city ns counry K m which requires a perms,m cnnsmn,eller,improve,JcmnlL h,m repair any mmc,um $600; prior m its issuance.also oequiresthe applicant for such permit to rile a signed statement < thethcislimc tip=uammNepmvisionsaftheCon=tor'SUcenmUw(Chapmr9 Sq. FL Floor Area Valuation r m•(commencing with Section]Olq)of Division J of the Buminesmand Professions Code)of i _ that he is exempt therefrom and the bamu far the alleged exemption.Any violation or Section]Ol 1.5 by any applicator for a permit subjceos the applicant m a civil Penalty of -'2)R1INNU�&CPU Occupancy Type nos mom than Bvo,hundred dollars($300k r. 0 1,as owner or the pmpeny,of my cmplbyru with wages as their wlc compensation, willdo Be work and the muuaum is not intended aralbared formal.(Sec.1044,Business and Proressmns Cade:The contractors License law dors oat apply I.as owner or Required Inspections property who builds or improves thereon,and woo docs such wmk himsmf ar through his awn employ..provided that such improvements arc not intended oroRemdl for me IL however,the building or improvement is sold within one year of completion,the owdoe- builder will base the border of proving that he did not build or improve for purpose of sale.). 1,as owner of the property,am eatlaalvely Contracting with litabo ii can raebR to - wm Ne perfect(Sec 7044,Business and Professions Cade:)The,Conuacwrs Li rase Law does not apply to an owner of property who Wilds of impmvc Brentano,and who contracts for such projects with a contremar(s)licensed pursuant to the Comancons License Law. 05 ern.saint funder/SC. B A,P C for his reason rte /R a . V S `' �. —i—"W 0 WORKER'S COMPENSATION DECLARATION it AA Ihereby affirm under penalty of perjury one ofdte folloaat Ciarationc 0 1 has and will maintain a Cenificamof Consent to self-insure forwork.rsCompan- motion,as provided for by Section 3I00 of Ne Labor Code,for the performance of N. work far which this pefmil'u issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code.far dte performance of the work for which this permit is issued. My Workers Compensation Insumrrcs Cartier and Policy number are: Cartier. Policy No.: . CERTIFICATE OF EXEMPIgON FROM WORKERS' COMPENSATION INSURANCE a (The,section need..,becompicted if,he .it if(.,.be huodreddollam(5000) or Items) 1 c yify that in the performance of the work for which this permit is issued,1 shull nut employ any penton in any mannersin as to Wcomc subject a the Workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Canities¢of Exemption,you should Wrnme subject to the workers Compensation provisions of the Labor Codc.you mum 0 O fuMwith comply with such provisions or Nis pmond shail he rimmed revoked. Z y CONSTRUCTION LENDING AGENCY [-. I hereby affirm that there is a consuuctinn lending agency for the performance or (L�: the work for which this permit fs issued.(Sec.3W7.Civ.C.) W QLattice,Name 04 z Lcndcr's Address' U C) I candy that 1 have read this applbedion and sate that the above information as Uy r- conca 1 agree in Comply with all city and county o dinaaaes and sure laws relating to 0U building Conswction,and hereby suthonat representatives or this city to enter upon the Y'W above-mentioned propcny for inspection puria mes (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgmenls,costs and expenses which may in any way accrue against said Clry t Use in consequence of Ne granting of this permit. ^� AP LICANT UNDERSTANDS AND WIL LY WITH ALL NON-POINT Issued by: Dater XO ERE TIO�)S. COMPLY l`—� Re-roofs gnazure of ApPiic HAZARDOUS MATERIALS DISCLOSURE m Type of Roof Will the applicant or future building Occupant tore or handle havaadaus material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety ee tion 2ss32(>? 0Ye014. All roofs shall be inspected prior to any roofing material being installed. Will the appiie.no.1 future building o.eapanl..:r equipmem.1devicex which If a roof is installed without first obtaining an inspection,I agree to remove emit hisallous it contaminants as derided by Be Bay Area Air Qualify Management all new materials for inspection. District? ❑Yam © �! 1 have mad the haaaNmnx materials requimmens,under Chapter 6.95 of the Califon ria Health&Safely Code,Sections 25505,2553]and 25534,1 undersand thalif th.building i ,curtently M1aw a anane Nm lq' my resp.nsibJi,y of notify the arupenl of the q. kwn ma Certificate of Olcupon Signature of Applicant Date • All roof coverings to be Class "B" or better Owner or au,horiecd agent are _ .. -. '. t � 2.K neL-:" i#ice ."'�� -`-' Y`•`Rr F 'z "trt�.F 1 ice` - _ '; •._-'E "nri"".#C '"X.� �-,� v `* -.P.•E+�w�rariir.✓'lvas.sArirF ' �' a .a iliR '-i/ODR/«lFYla�fi - i .y R tx Y q. wNur nil iwrims F ly lO f0 _0 C�w4f 9611 r fe**�e,,W __ -- - :+:i '� is•N S _ si ,`�."` � s: : " y �1 � t hO4 _—.—_—____---__-- &Z!—O" - - - _.� j s F _' `* *IQ 171_04 !! r-Op ISe 10,-9)" te " . . ,_.F ya"'• ` �i..'�A1AWi -`_ e , �+t�+.x�4 3�_ ♦ Y1.1 .. -k _. -_ S PIT r� ry f � ,per . _ f • . _ _ oo —s - - - -- T UT zZ fi00 J WL TOMLET; ( r i T T - — F Wellness Resource Center Door& Side-Lite _ Demo of sheetrock& framing as required. /f I 1= a ¢ Frame new opening in existing wall for one 3070, 90 minute fire rated, P F �5S Hollow metal door, with 2870 fire rated hollow metal side-lite frame & glass. I�A�a!RY +�L�►-L.-rYPV+i Door will have a 21" X 30" vision lite. f i 1 � ------ f *r - — 1011 TLftVNtj�s�( �� _ r14 I WOME MEWS LOMER R09 Et # i - - - _ _ - _ - - - - - �-�.K•�t� Pte, T�f►'. -�'� ` � � � � � - -�- 1 .g" e.ra't 4�a� 0t�oa 5�4n 12:0 - 1 —_ I3 1 N( _ � _ _ � ` � � g �. ��JF'I'�.�✓t1��1_�t� V`--tet. �,�{�`}�4i� ._ � ' Yi 1 Jy? 17 WeA OAA .4 IT HAUUW Wellness Resource C Center YO�r wwrh /cuSPtt t=A1+ 72btt� !. tt �..:; UO11 oar =tRE MlrLt. Vri'F 1G L�P — la x 12 I G �c r2 l APPROVED s • _ � . z . T�1 .� IN ACCORD CE WITH THE CfTY OF �" ; - - O COPE ES AND INANCE Gi EPT i µ- .� 27'yc1Gg SIGNEfi "� -This set of and �catwns MUST be l - QeAT1at,4kept a all Umar and a kis unlawful;, FIT�JE$ GENT k changes or aU�atans on sameI&AAi14 1 . i p 5�t• { ut written pertnissbn from d* Building T�r 44.A j h�D* 4A of Cupertino. , The stamping of this plan and specifications S4ALL NOT be held to permit or to be an < r Ai r a,3roval of the violation of any proviswns of - <_- any City Ordinance or Stare Law. .. _ N{�GtiA[�{CAL Ta ��'+t�'TH f NCS _ � , _' �'�B ��@�. �. a t� � [( '-j •+'' ~ � SQ.Fr D Pt$ �o�r� Sf w/Tim- Pei 76 . f. a y/[ %� ; " MNL 1,111 --- -- i - —- -- / 1 Tyr' 'r r vro To .J,.,_,./ - � � ,-• --tea C tN c D iL; #A471R - _ r�� � , r � (� ft 4e, let fj -- '- - - - ----- --- ----- - — - - ` - i 16fat' 1?`- to & at iL , lora` -o" r \; -- - — — --- —----- - - — -- - - _ - - FLOOR PLAN H y ' r NOR , �P GI,ARA CCG FIRE DEPARTMENT Y FIRE4 SANTA CLARA COUNTY CONTOROL NUMBER 14700 Winchester Blvd., Los Gatos, CA 95030-1818 U cou I s 1 (408) 378-4010 (phone) • (408) 378-9342 (fax) xPERMIT NUMB i^ /.,]��� PLAN CHECK No.rL 11 PLAN REVIEW COMMENff CODESEC. SHEET N0. �/ ry-� �^"�"."" '(:B, 1� ✓�ne�c,. crco qm m..YX �U.ce•�e _ The following CHECKED items apply to this project: Existing fire sprinkler system shall be modified as necessary. A licensed C-16 fire protection contractor shall submit to the fire department, three sets of shop drawings, a completed permit application-and.applicable-fees for review and approval, prior to performing work. UFC 1001 Existing fire alarm system,shall be modified c completed permit apAl}catio�T, essary to accommodate new construction. A licensed fire alarm c`ontra`ctor shall submit-to the fire department, 3 sets of shop drawings, a applicable fees,prior to performing their work. UFC 1001 Tenant shall have access to a minimum of 2AIOBC minimum rated fire extinguisher(s). Travel distariceStoYneaaze'St(e>c}ir&MN1t_aQl not exceed 75 feet. UFC 1002 Tenant shallh�a have aacc�c �es�on7rCC-laPTWTJ�typeTfire extinguisher, within 30 feet of commercial cooking equipment..Post sign near"K"extinguisher noting commercial fire protection system should be activated prior to using the portable fire extinguisher. UFC 1005 • Exit doors shall be openable from the inside without the use of any special knowledge or effort. Thumb-turn dead bolts at req}�ire more than 1/41 tum to operate are not acceptable. UFC 1207 e !y� haunt. ati c�x Exit Illumination: Provide illuminated exit signs. UFC 1212 Contractor shall field verify the integrity of existing rated construction/assemblies and restore or repair as necessary as part of this work. Penetrations in rated walls/ceilings shall be protected by listed fire rated assemblies (dampers, doors, caulking, fire stopping material etc.). UFC 1111 At time of final inspection, the tenant shall provide to the fire department a labeled emergency access key for placement in the building fire department key box. UFC 902.4 This plan check does not permit the use,storage or dispensing of hazardous materials, operations or waste. The tenant shall provide a completed HM1S to the fire department's hazardous materials specialist for review and comment. Furthermore, a CLOSURE PERMIT is required prior to terminating the storage of hazardous materials at a permitted storage facility. Demolition of any facility/storage area that previously stored hazardous materials shall not be approved prior to obtaining a CLOSURE PERMIT. APPROVED FOR BUILDING PERMIT ISSUANCE subject to compliance with the above checked comments prior to final inspection. JURIST 7 PLEA INS SPECS NEW REMODEL AS CON T.DESCRIP. BY D.-ArTE�/ LJ PAGE El El 0 • SECeLOOR OCC OCC.LOAD AREA ARCH G/CONTRACTOR/OWNER VM CA NAME OF FACILITY LOCATION VCA 20 o3 A L UP=S A California Fire Protection District serving Santa Clara County and the communities of Campbell, Cupertino, Los Altos,Los Altos Hills, Los Gatos, Monte Sereno, Morgan Hill, and Saratoga FYN iu7rt ku�ec�r' 'is .,-w COMMERCIAL/INDUSTRIAL INTERIOR AA d l ryt cCITY Of . , IMPROVEMENTS COVER SHEET '-UPERTINO I Assessors Parcel Number: Name of business`-A oz6 wQ o� 1 I 1 Cl IN Project address. Q09033 FaQAn,—p> Zi . Q is Qpn v�k� CA , QSU°F� Contact person. Phone. DO aj 5 I -a 44 r} Fax. C u4o8� �5T - 1o44f3 Current use of space. RKI n n owd_7 Proposeduse. b._ Building construction type. Occupancy&oup(s) B Occupancy Load. p \1s1Y! l� Square footage of remodeled area. 100 Rd Is the building equipped with: Fire sprinkles? (D N; Fire alarm system? I N Number of floors in the building? On what floor(s) is work being done? Brief description of work. O C}/ bJov9i� q ��¢ C)&, . Code editions: 2001 CBC (Y -N)2001 CFC (Y-N)2001 CMC (Y-N) 2001 CPC (Y.-N)2001 NEC (Y-N) Effective 11/1/02 Are there any chemicals/hazardous materials to be stored at site? 'Y - NO If above answer is yes, provide a list of materials and quantities. If job is involves food service, provide 3 extra plan sets for Health Department review. • IJ Commercial Plan Review Process Work BookPage-11-revised 4/28/04 CITY OF CUPERTINO Idem 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng : Sub : Blk: Lot :. APN . . . . . . . . : 32632039 . 00 DATE ISSUED. . . . . . . : 07/27/2004 RECEIPT 4 . . . . . . . . . : 26458 REFERENCE ID # . . . : 04070168 SITE ADDRESS . . . . . : 20803 ALVES DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SANTA CLARA VALLEY YMCA ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : PAUL VLACH CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . .. FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- - - ------ --- - - -------- ---- - - ---- -- -------- ---------- - - ------- - ------ ---- BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00 BENERGY PERMIT FEE 126 . 36 60 . 65 0 . 00 60 . 65 0 . 00 BPLANCHK PERMIT FEE 126 . 36 168 . 63 0 . 00 168 . 63 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICOM VALUATION 6 , 000 . 00 1 . 26 0 . 00 1 . 26 0 . 00 ---------- - --------- - - -------- ---------- TOTAL PERMIT 395 . 27 0 . 00 395 . 27 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - --------- - - - ---- --- - -------- ----- - ---------- -- OTHER 395 . 27 VISA TOTAL RECEIPT 395 . 27 s kITY OF CUPERTINOO . CUPC1 aYOF:EIOTINO PERMIT APPLICATION FORM v 7 d APN# 3261' „ / 3 Z 63 Date: Building Ad ss: Mailing Address (if di Brent fro uilding ddress): 0 03 oat-) Q° ciSoI Owner's Name: Phpne#- hie 1� 1� 8 Contractor: License #: 9S-789S- Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: BA Elect ❑ Plumb ❑ Mech ❑ Job Descriptio Residential 1 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Proje Occupancy Group: 000 Type of Cons ction: c t� Project is a nd-sto d tion: Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> IM 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 1 of 3 # 3 �Y /7 (DnL WITY OF CUPERTINO• CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTEVIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 rirMer/Backflo PLUMBING BPSTORM Stonn/Ram Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/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 BREMAIl2HAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace> 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 s - kITY OF CUPERTINC CITY.OF PERMIT APPLICATION FORM CUPEIITINO Quantity Fee ID Fee Description Fee Group 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 BTENMSVCS 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3of3