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29240
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALLPOINT PEN Y CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. 2 9 2 e 0 BUILDING DIVISION APPLICATIONTERMIT i 'P•UMBING-MECHANICAL 4 HIIILDING PROJECT IDENTIFICATION BUILDING ADDRESS: •, - SANITARY NO. APPLICATION SUBMITTAL DATE oulI Noytffisk 2b rvc. AVE OWNER'S NAME: PHONE: /• COFACTOR'S NAME: _ 1 � LICNO:[i -I ^ CID 1 �? -V imsO,CC 1 K�cclnl�. 707soo N/C CONTROL# ARCHITECT/ENGINEER: LIC NO: ADDRESS: ❑ N n L o .e-tow a K AvUquj C . CONTACT:• PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH LICENSED CO �.i, TOR'S DECLARATION QTY. ELECTRIC PERMIT FEE in I hereby affirm thI am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION p{dfEZ with Scnion TO(IB)af Division3ofne Business and Professions Code,and my license is RESIDENTIAL: FWO in fall force and effectC, 10 l PERMIT ISSUANCE �UF License Cl sa fie` Lic.# CSFDWL El KITCHEN REMODEL Lx; - Contrvdo 'APPLIANCES-RESIDENTIAL CADDITION C PLUMBING RE-PIPE ARCHITECTS DECLA ATION C MULTI-UNIT C STRUCTURAL. PANELS Z O r�j Z, ' I understand my plain shall he used as public rt s � � MODIFICATION OZ.- ' I UP TO 200 AMPS D INTERIOR ❑CHIMNEY REPAIR eF(3 W Licensed Professional - 201-IIXIDAMPS IMPROVEMENT q 4 3 OWNER-BUILDER DECLARATION OVER 1000 AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION O 0 W G 1 hereby affirm Nat I am exempt from the Contractor's License Law for the O g,U following reason.(Section 7031.5,Business and Professions Code:Any city or countySIGNS ELECTRICAL C OTHER LLC F' which requires a pemm in construct,alter,improve,demolish,or repair any structure poor to issuance,also requires Ne applicant for such pcnniuo flea signed statement SPECIAL CIRCUIT/MISC. } that he is licensed pursuant to the provisions of the Comacrors License Law(Chapter 9 W GAOa (commencing with Section 7")of Division 3 of the Business and Professions Code)or TEMP.METER OR POLE INST. COMMERCIAL: 6 c 4 that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION C DEMOLITION Section 711 LS by any applicant for ape,it subjects the applicant to a civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE t more than five hundred dollars($500). _ 1,asowneroftheproperty,orm Ioees with woes as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT, /LL �je lea O C the sYemp Y B pensa I /aT it/ I� 7 Il do Ne work,and th The Contractor not intended]oro w do for ofsale(Sm apply]044,Business DO ER / / L, and Professions Code:The Convactor's License Low does not apply to on owner o UTLETS-SWITCHES-FIXTURES 2 a]� �('/J GS AaQ A 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 NEW RESIDENTIAL ELECT SQ PT. sale.If,however,the building or improvement is sold within ane yearof completion,the SQ.FT.FLOOR AREA $/SQ.PT. nest-builder will have the burden of proving that he did not build or improve for par- poseofsaleJ. C 1,as owner of the property,am exclusively corseting with licensed contractors to construct he project(Sec.70,14,Business and Professions Cale,The Commctors Li- O cense Lawdoes not apply loan ownerof property who builds or improves thereon,and QTY, PLUMBING PERMIT FEE who contours for such projects with a commands)licensed pursuant to the Contmcmi s License Law. PERMIT ISSUA E 1 am exempt under Sea ,B&P C for this reason Owner Date ALTER-DRAIN NT-WATER IEA7 VALUATION _ WORKER'S COMPENSATION DECLARATION BACKFLOWPROTE VICE • I hereby affirm under Penalty of perjury one of the following dodam �0fl®tions: I have and will maintain a Certificate ofConaenitoself-insurefor Worker's Compen. DRAINS-FLOOR,ROOF NO ion,as provided for by Section 3]00 of the Labor Cade.for the perrmanno a of the STORIES TYPE CONSTRUCTION work for which Jus permit is issued. FIXTURES-PER TRAP C I have and will maintain Workers Compensation Insurance,ou require)by Scdion 37W of Ne Labor Code,for toe pamfurmanccof am walk W which this permit is issued. GAS-E,.SYSTEM-1 IN OCC.GROUP APN My Worker%Compensation I_nsyrortce cyner and Policy number ere: Cartier, Policy Na.: GAS-EA.SYSTEM-OVER 4(EA) E%EMP C R C TE OF ION FRO S' COMPENSATION INSURANCE GRFASFIINDUSTRL WASTE INTERCEPTOR BUNU W O I}IHI](ON FEES section road trials,completed if Ne permit is Torun hundred doluda($IIXB GREASE TRAP , -' or leas.) PLANCHECK FEE I certify Nat in Ne performance of the work for which Nmit is peris issued,l shall that employ any person in any manner so az to become subject in the Workers SEWER-SANITARY-STORM EA.200 FT.Campen- ENERGY FEE Oz cation Laws of Califomia.Date, WATER HEATER W/VENT/ELECIR Z (2 Applicant GRADING F&O u 01' EfA NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should WATER SYSTEMy1'REATING 7 become subject to the Workers Compensation provisions of the Labor Code,you must SOILS AM lair UMI-I I INV W4Q fortbwidt comply win such prons visioM this permit shall be deemed revoked. WATER SERVICE � z CONSTRUCTION LENDINGAGENCY NEW RESIDENTIALPLMB. SQ.IT. PAID iP L)- Thar whichmrthatthem inaed(Sm.30lendinagency for the performance of Data Rtteipt# VL the work for which Nis permit is issued(Sm.]09),Co..C.) O Vlenders Name TOTAL: Lenders Addrcu - TOTAL: y1 certify that 1 have read this application and state Nat the above informmion is BUILDING FEE V2 correct,l agree to comply who all city and county omirmnces and state laws misting 10 QTY. MECHANICAL PERMIT FEE UZ building construction.and hereby auNorire reprtscnmtivcs main,city roenter upon the SEISMICFEE ab0vc-mentioned property for inspection purposes. PERMIT ISSUANCE (We)agree to save.indemnify and keep ham0eas the City of Cupertino against ELECTRIC FEE liabilities,judgments,caro andexpenses which may in any wayaccme against said City ALTER OR ADDTO MECH. in consequence of the granting of this peram. PLUMBING FEE APPLICANT UNDERSTANPWAND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM) SOURCE REGULAT MECHANICAL FEE AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCOONTAX SigotislE ofAppl mr - EXHAUST HOOD(W/DUCT) HAZARDOUS MATERIALS DISCLOSU HOUSING MITIGATION FEE Will the applwint infuture building occuphimmirem handle hazardous malaris[ HEATING UNIT CIO 100.000)BTU) as defined by the Cupertino Municipal Cade,Chapter 9.12,and Ne Health and Safety Code,Section 25532md? HEATING UNIT(OVER 100,000 BTU) E]yea No VENTILATION PAN(SINGLE RESID) PAID Will the applicant m future building Date Receipt# pp g occupant use equipmeuality Management BOILER-COMP OR 100,000 BTU) mit harallous air conmminann as ticfinW by the Bay Area Air Quality Management TOTAL Jismct? .�X. BOILER-COME(OVER 100,000 BTU) ❑Yes '1Sr\R - 1 Ibaveread Johazatdousmaterialsrtquire omundaMpor6.95of Ne Cali- AIR CONDITIONER ISSUANCE /^TSE forma Health&Safety Code,Sections 25585,25517 and 25534.I understood that if Ne NEW RESIDENTIAL MECH. SQ.PT. Wilding does nmaarenC Sections 53 and !M.1 maetifyodthan afar pdormissuantt ofaC ' eaten Own thorized agent Date TOTAL: ISSUED BY: OFFICE 01/16/96 10:16 FAX 1 818 442 7342 AHTECH LIGHTING f�J003 PROJECT NAME DATE Southland Restore Project 7-11 # Z l / �•PROJEC ADDRESS BLAw VE UIQ' . . 1 PRINCIPAL DESIGNER-LIGHTING TELEPHONE Building Permit _ Jack Melnyk (800) 800-2668 i DOCUMENTATION AUTHOR TELEPHONEPager # Checked bWDate John List (800) 800-2668 (800) 670-4471 : EnfMoment Agency Use. GENERAL,11NIFORMATION DATE OF PLAN BUILDING CONDITIONED FLOOR AREA ' 21 BUILDING TYPE X❑ NONRESIDENTIAL HIGH RISE RESIDENTIAL HOTEUMOTEL GUEST ROOM PHASE OF CONSTRUCTION NEW CONSTRUCTION ADDITION ALTERATION UNCONDITIONED(File Affidavit) METHOD OF LIGHTING COMPLETE BUILDING COMPLIANCE © AREA CATEGORY TAILORED PERFORMANCE This Certificate of Compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations.This certificate applies only to building lighting requirements. The Principal Lighting Designer hereby certifies that the proposed building design repreresented in this set of construction documents is consistent with the other compliance forms and worksheets,with the specifications, and with any other calculations submitted with this permit application. The proposed building has been d si o meet the lighting requirements contained in sections 110, 119, 130 through 132, and 146 or 149. L NED 'lease check one: JAN 16 1995 I hereby affirm that I am eligible under the provisions of Division 3 of thi0&t id f�e ssions Code to sign this document as the person responsible for Its preparation; and that I am a civil elegy M �ifL�'gror architect. � �'(nQ 9 PERTINO ® I affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code by Section 5537.2 of the Business and Professions Code to sign this document as the person responsible for its preparation; and that I am a licensed contractor preparing documents for work that I have contracted to perform. I affirm that.1 am eligible under the exemption to Division 3 of the Business and Professions Code by Section r of the Code to sign this document as the person responsible for Its preparation; and forthe following reason: PRINCIPAL LIGHTING DESIGNER-NAMESIGNATURE LIC.N0. DAT Jack Melnyk C10) 464280 'LIGHTING MANOATORY MEASURES Indicate location on plans of Note Block for Mandatory Measures GA:5 sheet unless otherwise INSTRUCTIIONSTO APPLICANT For detailed Instructions on the use of this and all Energy Efficiency Standards compliance forms, please refer to the Nonresidential Manual published by the California Energy Commission. 0 LTG-1: Required on plans for all submittals. Part 2 may be incorporated in schedules on plans. LTG-2:,Required for all submittals. LTG-3: Optional"OFOR Use onlIf lihtincontrol credits are taken. LTG-4: Optiothod Is used. Parts 2 and 3 used only if applicable. Nonr•sidendal Co - January 1995 r 01/16/06 10:10 FAX 1 818 442 7342 AIITECH LIGHTING Z005 • /1 i PSPOWER toreROJECT NAME D # arE �O 9 CTUALLIGHTING /' LUMINAIRE NUMBER OF WATTSPERLUMINAIRE CECDEFAULT TOTAL/. NAME DESCRIPTION LUMINAIRES (Including Ballast) Y M WATTS ain Sale5 ❑ 0 D 16 ' 4-Lamp T8/EB Strip 99 ❑ ® I-gg I C 12 ' 3-Lamp T8/EB Strip 78 ❑ �] Z B 8 ' 2-Lamp T8/EB Strip 52 ❑ A 4 ' 1-Lamp T8/EB Strip 33 ❑ ❑ ackroom //////////////////////// ////// //////////// ❑ ❑ D 16 ' 4-Lamp T8/EB STrip 99 ❑ C 12 ' 3-Lam T8/EB Strip 7 ❑ B 8 ' 2-Lamp T8/EB Strip 52 ❑ A J141 1-Lam TS/EB -Strip 33 ❑ ❑ EB - Electronic Ballast SUBTOTAL FROM THIS PAGE PLUS SUBTOTAL FROM CONTINUATION PAGE L^^� LESS CONTROL CREDIT WATTS L—J (FROM LTG-3) 'If not using the CEC Default value,Dlease provide aupporOng doeumenta8on. ADJUSTED ACTUAL WATTS 225 ALLOWED LIIGHTIING�POVVER (Choose One Method) COMPCEI E¢BUILDING`METFtl3CYix r:y?ar,s' :.';>3aa','. BUILDING CATEGORY(From Table 1-" PER SF BLDG.AREA WATTSD , ARE4CATEGQRYMEfHQD. ;ax; 4>.€. € x.€ .,p a , s � s;I,F€t u _a=u. .., r.: AREA CATEGORY(Fmm Table t-N) WATTSALLOWED PER SF (SF)AREA WATTS Grocery 2 .0 (p 'Zg7 Z Corridors,Restrooms,Support 0 .8 22 3 g5 21 TOTALS AREA warns TAILOREDWETHOWn g ;x = TOTAL ALLOWED WATTS (From LTG-4 or from computer run.) Nonrasid•no'al Compliance Form January 199: 01/18/98 10:18 FAX 1 818 442 7342 A51TECII„LICNTINC 2004 . • . PROJECT NAME , Store # I�'2l GATE irolgr,� LAMPS BALLASTS ' LUMINAIRE NAME TYPE NO.OF TYPE NOTETO (eg.TYWI.Type-2.etc.) I F X LAMPS WATTS/LAMP S E' O' NO./LUMINAIRE FIELD Main Sales ❑ F-1 El ❑ ❑ ❑ D IE 11 760 24 .75 ❑ x❑ ❑ 1 ❑'Q ❑ Z 26 .00 ❑ x❑ ❑ 1 13 L) [Z O 26 .00 ❑ El El 1 A ❑ ❑ Z 33 .00 ❑ Ej ❑ 1 Backroom ❑ ❑ ❑ //////// ///////// ❑ ❑ ❑ D ❑'Q,❑ 24 .75 ❑ x❑ ❑ 1 c ❑ ❑a ❑ 26 . 00 ❑ x❑ ❑ 1 B ❑ Q ❑ 26 . 00 ❑ El 1:1 1 A ❑ IE ❑ 33 .00 ❑ HI ❑ 1 DO 11 ❑ ❑ ❑ 'Protide Supporting Documentation CONTROL LOCATION CONTROL CONTROLTYPE NOTETO' (Roams!) IDENTIFICATION (Autc Time Switch,Extedor,etc.) SPACE CONTROLLED FIELD: • • • • , DONTROLLOCATION CONTROL CONTROLTYPE LUMINAIRES CONTROLLED �IVOTETt]` (Room•or Dwg.•) IDENTIFICATION (Occupant,Daylight,Dimming,etc.) TYPE •OF LUMIN. r%FIELD a s,» •a iV E � s a i iNcnnsldentlal Campeenae Fomr January 1995 NVId 38g1SM 9NUH9111 ` a ..ww er1 Bwc oe/o <m L� .i an aame'�m °.�i ae�um.er NOUVWwoo CINV1HIlIOS �Hl 0 .n O0m CD U 00 W W O ? W O N Z X z J i 'W—� in lu ' w � J�l 1 • � { K O6 far a gaa � o ' O J� v j oscz ;. �AN1 VSD : c e40G. G 1895 4 A17Np MFhp of y zoo in HOmKv HOVt '0059V V ILIVI MI BLZ BI90 TONT 9B/9T/10 Z00 ' 9NLLHDI7 H031XV ZV£L ZVV 9T9 T XVH VI:OT 96/9T/TO