00010009 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY Ail001DO061
CITY OFCUPERTINO I I BUILDING-ELECTRICAL PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING MECHANICAL ppm
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
O
OW 4:5 NAME: PHONE: CONT A 'S NAME: r L NO:
L�r NIC CONTROL k
CHITECflE L1 EER:'A LIC NO��O RESS: /,94 4C=, W--`
CONTACT PHONE: DUILDING PERMIT INFO
�/•. ' i/a� a El Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
I hereby affirm that I am licensed under provisions of Chapter 9(commencing _ JOB DESCRIPTION
0WZ with Section WXYd)nf Division 3 ofthe Business and Professions Code,aadmy licenseis
, 00^ mfall force and eBeclPERMIT ISSUANCE RESIDENTIAL•
� .
U V License Class Ed.k ❑SFDWL El KITCHEN REMODEL
Fzw Date Contracmr _ APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
ARCHITECT'S DECLA ATION PANELS
p.7sgn ❑MULTI-UNIT L1 STRUCTURAL
Z O y,Z„ I understand my plans shall be used as pahlic records MODIFICATION
OZ^0 UPT0200AMPS - ❑INTHRIOR El CHIMNEY REPAIR
W Licensed Professional 2014"AMPS IMPROVEMENT
S„H OWNER-BUILDER DECLARATION El SWIMMING POOLS
a 6 I hereby affirm that I am exempt from the Cmanictor's License Law for the OVER I000AMPS ❑BATH REMODELMEPAIR ❑DEMOLITION
ip5s O 6 U following reason.(Section 7031.5,Business aad Prof e vain,Cude:Any city or county SIGNS ELECTRICAL - ❑OTHER
u+3 LL y which requires a permit to construct,alter,improve,demolish,or repair any structure
�•u.rrOrr��� prior to arc issuance,also requires lhcilimicam forsveb perm,[to file asignedrmemenl SPECIAL CIRCUDMISC.
that he is licensed pa mans to the provisions ofthe Contractor's License Law(Chapter 9
{Sayapo (commencing with Section 7")ofDivision3 come Business and Professions Code)or TEMP MFIkRd&P4 COMMERCIAL:
G y e' that he is exempt therefrom aad the basis for[he alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
tisCl W Section](I3L5 by any applicant fora permit soldras the'uppliwm to a civil pen of C ,may
F not more than five hundred dollars($500). / TENANT ❑FOOD SERVICE
560 0-Las owner ofthe Drapery,or my employees with wages as their sole con G OLELECT V I ROVEMENT
g. will do work,and Ne,wcmre is net mounted. oQctedlbrsile(Sec.7= ❑OTHER
3 and Profess;.'Code:The Commerce,License Law does am apply mea of oU - u
f1i property he builds or improves thereon,and who does such work himulf or throe
his own employees,provided[hat such impmvemenls are not amended ar offered f RE& TR
sale.If.however,the building or improvement is sold within one year ofcompletiou,[h SQ.FT.FLOOR AREA $ISQ.FF.
ownerficilder will have the burden of proving that he did not build or improve for Dur .:
ip
pose of sale.).
❑L as owner of the property,an exclusively commiling with licensed contract T L:tFEE
erstract the project(Sed]1144,Business and who
had
Codr aTne Centrad
.w Law does not apply manowner
....cany wvemodds cram;the out
"III
MB[NG PERMIT
whonse Lack for such projects with a convaemr(s)Ilem,ed prsuent to Ne Qml
License lues. s - PERMIT ISS DANCE
- ❑ lam exempt undo Sec. ,B&PCfor this reason '
wrier
ALTER-DRAIN 8.VENT-WATER(EA)
Date VALUATION
as
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE-
I by affirm under penally of pery rjoone of Ne following declarations V`�s•-i
❑I have and will maintain a Certificate of Consenun.self-Insure for Workens Camara- DRAINS-FLOOR,ROOF,AREA,CONU. DRIES TYPE CONSTRUCTION
sa[ion as Provided far by Seclion 3]00 of the Labor Cade,fur the permmo ice of the
work far which this permit i......d. FIXTURES-PER'I'RAP
and will maintain Worker's Compensation Insurance,as required by Section _
]X of the Labo,C 1e.for lheperformanccofthc weak for whichthispermtt is issued. GAS-EA.SYSTEM-1 INC.4 OUTLEMy TS OCC GROUP �7APZ.
Car War m�YJsation �yc joldy Noy nu •r : GASB-EA.SYSTEM-OVER 4(CA) G.o
CE ( CATS OF _ EMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASMNDUSTRL WASTE INTERCEPTOR
(This section need not be completed if Ne permit is forone hundred dollars($100) BUILDING DIVISION FEES
or less.) GREASE TRAP
PLANCHECK FEB
(certify that in the perforemer s.ftbe beconsrwhiohato the Wclslss'Corihml SEWER-SANITARY-STORM EA.2X FT.
not employ any person iia any manner so as to become subject m the Workers'Compen- ENERGY FEE
Z Armon Laws of California,Dale
zOA licant t WA'1'ERHEATER WNENT/ELECTR
pP GRADING FEF,
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
WATER SYS'IEMITREATING SUMER—
WATER
become xab]ecl m Ne Workers Compensation provisions of the labor Code,you most
fonhwlN comply wish each provisions or[his puml[fiall be deemed evoked. • WATER SERVICE,
I 1
U Z CONSTRUCTION LENDING le AGENCY NEW RESIDENTIAL PUMP. SQ.F"f. PA
"a Ihereby mfi mob per.,,
i issued(Ser.30lending agency for Nc performance of I Rnrciptk
LTs (-' the work for which this permit is issued(Sec.309],Civ.CJ
Lendee,NameVj L:
GU Lendds Address TOTAL:
1 certify that 1 have read this application and to.thea the above information is B LDING FEE
correct.l agree to comply with all city and county ordinances and Stam laws relating to QTY. MECHANICAL PERMIT PEE t..
V Z building construction,and hereby authorize representatives of this city to enter upen the S'S IQ EGL
above-memimmil property for inspection purposes.
(We)agree lo,ave,indemnify and keep hrmlav the City of Cupertino against PERMIT ISSUANCE ELECTRIC FEE
liabilities,judgments,Was and expenses which may in any way accrue against said City ALTER OR ADD TO MECH.
quence Imagramingo
spermit. PLUMBING FEE
APFLICAN n�1N STA AND WIL OMPLY WITH ALL NON-POINT AIR HANDLING UNI'I'(TO ID,000CPM)
SOURCE/n�GU AT NS MECHANICAL FEE
1, AIR HANDLING UNIT(OVER 10,00t)CFM) CONSTRUCTION TAX
Si namreofAppli..VCon,.,or - - Date EXHAUST HOOD(WIDUCI) HOUSING MITIGATION FEE
_ HAZARDOUS MATERIALS DISCLOSURE
Will the nppliWax or future building occupant store or handle hazardous material HEATING UNIT(TO 100,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)'I HEATING UNIT(OVER I(SE000 BTU)
❑Yes ❑No
VENTILATION FAN(SINGLE RESID) PAID --
IF—pt M
Will the applicant orlLm banding occupant ysd Dale
mil hbzMoux air cmrnvns as defined by the Bay Area AirQuality Managenant BOILER-COMP(3HP OR X,003 BTU)
TAU
Dixv en
E-1 Yes LjNo BOILER-COMP(OVER 100,000 BTU)
AIR CONDITIONER 0
1 have the hemand os mu X115
s unretch npmr G.95 of the Cali- ISSUANCE DATE
forma Health Safe axle,Sect . d25534.1understand Nat if Ne NBW RESIDENTIAL MECH. SQ FT.gd note yhave wponsibility to notify Ne occupant / L me sw ch mo metofa Cwfdiente fps nay. o O 0
Ow r raplhmized genes—// C,{',Dale TOTAL: ISSUED BY: ', L
OFFICE
CLARA � \
�� °oy FIRE DE)PA,RTME7 ra
m� F �� SAl\ lA CLAM COUN 1 i � CONTROL NUMBER ,
14700 Winchester Blvd., Los Gatos, CA 95030-1818
I (408)378-4010 (phone) • (408) 378-9342 (fax) PERMIT NUMBER
PLAN CHECK No.
�19� /yi8 PLAN REVIEW COMMENTS
CODE/SEC. SHEET NO. ` all-D N&113 FVR LA6 J 5-0/2L i2De r!
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 as necessary to accommodate new construction.A
licensed fire alarm contractor shall submit to the fire department,3 sets of shop drawings,a
completed permit application, and applicable fees, prior to performing their work. UFC 1001
Tenant shall have access to a minimum of___,2AIOBC minimum rated fire extinguisher(s),
located within 75 feet travel distance. UFC 1002
Tenant shall have access to one 40BC minimum rated fire extinguisher, proximal to the kitchen
cooking area. UFC 1002
Exit doors shall be openable from the inside without the use of any special knowledge or effort.
Thumb-tum dead bolts that require more than 1/4 tum'to operate are not acceptable.UFC 1207 .
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
2 This plan check does not permit the use,storage or dispensing of hazardous materials,operations
or waste. The tenant shall provide a completed EMS to the fire department's hazardous
materials specialist for review and comment.
APPROVED FOR BUILDING'PERMIT ISSUANCE subject to compliance
with the above checked comments prior to final inspection.
AURIS PLANS SPECS NEW REMODEL AS CONST.DESCRIP. BY
e )r ❑ ❑ k 13 LJESL bDDATE0 PAGE
/
OF
SECJFLOOR OCC OCC,LOAD AREA ARCH/ENG/CONTRACTOR/OWNER ,
L00 HIDGLEpi STN� Io
*;E OF FACILITY LOCATION
h qk c- e- L a X62 y0 I3u3a Rl>
A California fire protection District serving Santa Clara County and the communities o/
Campbell,Cupertino,Los Altos,Los Altos Hills, Los Gatos,Monte Sereno, Morgan Hill,and Saratoga