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CUPERTINO •- L
APPLICATION/PERMIT �' PLUMBING.MECHANICALb
O DIVISION Ays- BUILDING PROJECT IDENTIFICATIONDRESS:
PERMn'ND. O
SANITARY ND.
APIX.I(AIIONS(IO)MfI'OAO.DAIT
1... m N�11!� UNII'M LO'1'M
LC.NTACT
^RrqutE:
PIIONE:
1S- —O OO
CONT I' R'g ME: LIC NO:
CONTROLN
NGIN'ER: LI NO:
ADDRESS:_
PHONE:
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lJitle r? XJ— —Q
Q;�I !' 4tf.
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f,s Nr+.: yyq:rr»..be•ri' :e•.: - ax}avv sUr,,,
i'S:-,Y't.`.I,�c`�uitiHUILOWO PERMIT
BL ELECT PLUMB MECII
❑ E3 0
PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I herchy arfiem than I am Iicensd undcrproviriinsaf Chepter9(c.mmencing with
APPLIANCES -RESIDENTIAL
G p
ATI POLO
PANELS
Section 7")of Division] of lbe Business all Professioncen
Professions Code. and my lise is in
full furca tna erfetl.
License Clea LieN
UP TO 2011 AMPS
Data Connector
ARCHITECT'S DECLARATION
I adna nd my plana shall be used u Public retards.
301 - 1000AMPS
SQ, FT. FLUOR AREA S/SQ. IT.
OVER 1000 AM
SE AL
Licend Professional
OWNER BUILDER DECLARATION
I hereby shim that 1 sm exempt from Ilse Convecurta LT.. Law far the
'
OMP, OR POLE INST.
following reason. (Section 7031.5, Burinessand Professions Code: Anycily ormunly
which mquircs a permit to cinsvuct, aha. Improve, demolish, or x1_11 any aw"ub
prior toits luerace:atm".i..Neapplicml fm auch permit t. fil..stgmdeblement
-
POWER DEVICES
that he is licensed Pursuant o the provisions of the Contractor's License Lew (Chapter
9(cmnmencing with Scctiin 70111.4 Division Jof the Business and Profmineu Code)
SWIMMING POOL ELECTRIC
VALUATION
arthat heuexempt
ny.,therefrom mdthe baiafmthe allegdnemlol W Anyviolationpenaon ofSrs
aribjabIhC appliunl bacivil penally of
OUTLETS- SWITCHES - FIXTURES
. motion n, dour,(•permit
rot mom than five hudmd aollm (3500).
five
❑ compnaOon,
wak,a thepropciumrmat
NBW RESOD
STORIESTYPE
CONSIROCI'10
othe
willduthewart, and thenucTuberotinmdde
inhnyeawhhwaae.eatbel(Ses.
dfs ala(Sec. Business
and Praresriina cde: The e.maw.e'. Licence L.w ansa nal .pPlr m a owns nr
Law to
Progeny who builds or lmpruvea therein, and who dons such work hlmselfor through his
ownemployees,pnwidedthst suchimpmvemenb_unmimmn&d ororrer"I fm este. Ir,
OCC. GROUT'
RS.ONI_TS
TOTAL:
however, the buildingnr Improvement lasold within one yearof completion, theowner.
builder will have the burden of proving that he did not build or improve fer purpose of
ale.).
❑ Las Own" uOhe property, amexclusively contracting with licensed canVKIwEI.
ay ri;7rib.:uµ,.. L.. "r,, "toga '�! 'i 1f'
`Loy:'' $tS.lo— - "ib Y, :xn'^�'j:,r {��tFEe�.., .
'
FLOOD ZONE
APN
Darlow the project (See. 7fN4, Business and Productions Code:) The Convector
LlaenulawdmsnwWlymmownerofMn dywho Wlldsorimpmva Ne .end
pC0.MIT ISSUANCE
whocmincbfor such pojeca with ecunvemm(s) licensed pressure .the nlratm'n
License law.
ALTER - DRAIN&VF- WATER(FA)
- FEESUMMARY
C31 am exemptuder Sec. , B & P C fo thisream
BACK FLOW PR OTF VICE.
SANITARY Y N
RECEOPro
Owner Dam
DRAINS -FL F. AREA,
WORKMAN COMPENSATION DF.CI.ARATION
S"OOLTAX Y N
T hereby affirm that l have. cenifinmconsent af conseno self-imure,m. nincemof
mkm'CamPrnmion lnsuremem. ttnifidcopy th"enf (Sec. ]g00.1a C.)which
RF CIPrX
PIXtU TRAP
PARK Y N
covers ell employee's under this permit.YSTIiM-I
Policy N
i IPrN
INCA Rl8
DUILDING >IVISION PIA'
Company
GA - A.S S M VERd(EA)
PLANCIIFGX ITE
❑ CeniOdcupytaherebyrunnhhed.
GR NOU WASTE INTE EPTOR
GRADING FE -assassawas
❑ Ccnifid rogy is Old with thedyimgati.n division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
GREASETRAP
SOOTS
COMPENSATION INSURANCE
SEWER - SANITARY - S RM F.A. 20OF1'.
ENL Y JIM
(This sea,ion need nclbecompletd if thu pemrltHfarop hwdrd dollen) TO)
or lea.)
WATER REATER ENT/ELECTR
I cenify thaOnthe perfonewrce of the wmk dm which NO pemtilHHsud,ls II
rot amid.. any person in any ., m as t. became sobject to ,he Work
A
Comperationlaweof Califmma. Data
WATER SY TAIMEATING
Data Receipt
APplicent
NOTICE TO APPLICANT:[L_kcr At., this Cenille.m.f Eaemptia,mr should
NEW DENTIAL PCMB. SQ, FT.
TOTAL:
become subject to the Workers Comgmatim provision of the labor Code, you must
forthwith comply with such Provisions m this permit still be second revoked.
BUILDING FEC
all
SEISMIC FEE
CONSTRUC11ON LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the gerfnrrtnanm of
the work far which this Pamir Is laud (Sec. 8197, Civ, C.)
I TOTAL:
ELECTRIC FEE
Leader's Nome
s i -'A. r.. — -
Q1'Y.''j,F' a'r MECHANICAL PERMIT°A �: 1*},pj3E':.,';
•10 "� %'e^ _ .Cr';i4,,; QYr(ly" , _
ISSUANCE
PERMIT ISSUANC
PLUMBINGFT:Ii
LendersAddresn
1 cenify that 1 have rad this .ppliaOm ad nate IMI the above information is
cosec! I agree b comply with all city and county arthnancesed state laws to
MECHANICAL fTF,
building construction, rad hebby.ulharim repreunb0vesaf thiscily tocnierupon the
above-mewianed property for inspection purposes.
ALTER OR ADD TO MECU.
CONSTRUCTION TA
(We) agree to save, inJ ify .1rd kecp text the City of Cupertino egeint
liobilida,judgmems,co J prnse hie y in any way attoe again, a id City
AIR HANDLING UNIT pD TO." CFM)
incinsrym ce ofthe of1hl
AIR HANDLING UNIT (OVER 10,1X1 CIM)
Signalcar Apidi UCm m
"DAUST HOOD OVIDUCT)
PAID
HEATING UNIT (TO Im),m1 BTIH
DAZARDOUS MATERIALS DISCLOSURE
Date Receipt al
IItSATINO UNIT (OVER I(b.fgl Rl'UI
TOTAL :
W the applicant or future building moment etre or handle bmrdous materiel
Jell
an ed by the Cupnlm an
Municipal Care, 9.12, d the l lcalth and Safety
VENTILATION FAN SINGLE RESOD)
Code. Sinton 35532(a)7
11 Ycs 13 No
ISSUANCE DAT'8
Will theappdicant mfutumbuildingmeupaal uuequiarem mdtOka,which,ort
BOILER- COMP (TOP OR 111,000 BTU)
BOILER - COMP(OVER I(1,Ot1 BTU)
adoun air cinlammants a defined by the Bay Area Air Quality Management
Pnricl7
Poll;`
❑ Yes ❑ No
/,•,+ ^
- E
�?
NEW RESIDENTIAL MECII, SQ. IT..
1 have rend the haanlous materials requiumems under Chapter 6.95 of the
California Health A Safely Cmk, Sections 25505, 2 5]] and 35534. 1 understand that
AUG E 9 99q
if the building Ams not currently have a tenant, that it is my responsibility m ramify the
Occupant of the requirements which must he met prior to Issuance of a Certificate .f
Occupancy.
/
I l' vf- y
fJ
ISSUED BY:
Own" m nulbvi.gonnl Data
TOTAL:
OFFICE
0
.: ' .r I 1 8 1999
UU
Hardison—
]By
Komatsu
Ivelich
& Tucker-,
October 14, 1999 "
City of Cupertino Building Department
'P1an.Check Division
'
10306 Torre Avenue .
Cupertino, California 95014
Attention:: Mr.` Bruce Donoghue
Reference: Reclassification to Assisted Living
-
ertino` C A
The Forum at•Ranch� San Ant�ni�, 235�� Cr1st� Rey, Cur ,,
-Contiol•No 9548, Permit No. 99070060 .
HKIT 6662.
Dear Mr., Donoghue
:We are in receipt via .the Owner, The Forum at,Rancho San Antonio, of your
.
; follow-up comments dated October, 1,1999. Our resporise to the comments is
as follows:
COMMENT'
1. N1, Please indicaie'at Villa work that no shear wallswill be modified at the new .. ;.
doors.
ARCHITECTURE '
PLANNIN'G'.
t I N T E R.I O R S
,RESPONSE:
No shear W lls , ould be imp cted'when new doors areed.,
' 400''Second Street
Suite '200
COMMENT: , ,
-Sa"n' Francisco'
California 94107 ,
2,. ,NI Also indicate lighting at exterior, smoke detectors odin s�z l
':415-5 41 0 s 1 1
be provided - - -
FAX 4i5 541.0479
'
E=mall
general®hkit.com',
..
RESPONS
Existing exterior lighting exists at.the,Villa units, and currently two
-, existing smoke detectors -(one, at the Living Room and another at one .
- George Ivei¢h AIA
- Architect
Bedroom) exist.,. Also; refer -to Comment.4.`below. Landings exist and are. '
Robert B. Tucker AIA
' Architect`
thus provided outside all, exit paths of travel:
Deruus 1 Okamura AIA `
Architect
COMMENT - - '.' •• •. - '
1[intomD.;Stables In .
3.: N1•The energy code Mandatory Notes and confirmation that no change in
.- •
- compliance occurs.'
EMERITUS
Eronald'C. Hardison FAIA"
S. Richard Komatsu FAIA
' Richard S. Banwell FAIA-