00020087 CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
CAL
BUDAING DIVISION APPLICATION/PERMIT
PLUMBING.CTIDENNIFIC
BUanTNG PROBI{CT mRNTRITCATION.. 50001
DDSANITARY NOAPPLICATION SUBMIITAAL DA
BUILDNUAW � Vbo Vv -G. .VV f kV 0 VV
^YO'
O JE SNAME: PHONE: CONTRACTOR'S NAME: ' LIC NO:
JI-,V\ CMN NYC CONTROL#
fAb
CHITECUENGINEER: LaIC NO. ADDRESS:
❑
rLr%r�wlc-
CONTACr: PHONE', ,�-,/ '.,. 'y`�BtN:DiNQ PBRbi1T:INPO +L/iy"'a"x
� .�� �. "R-l�.�i(N (✓ Consultant Fees Pald by Applicant(Initial) � BLD ELi PLUmM,B MMIf
LICENRATION
I hereby affirm that Ism IncCONTRACTOR'S
nsed wa Rr pro is on of Chapter 9(comm nc g ,QTY, • x PJ.P,CfRIC PBR11TP1' " a, m` fFEk& I-> JOB DDESCRI IrIION L7
with Section 7000)ofDivision 3ofrhe Bmumia andPtnfessmons Coll my It,...is RESIDENTIALYI
00 PERMIT ISSUANCE
tin full farce and effect - ❑SFDWL C3 KITCHEN REMODEL
UW Limnsc Class Lu.# APPLIANCES-RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPE
Q 0. Date Concmcmr
Fpy ARCHITECTS DECLARATION PANELS [I MULTI-UNIT ❑STRUCTURAL
Z p y ZV dersund my plans shall bs�/ �I ,usedes public mcmdUPT02W AMPS x MODIFICATION
ozeaLtcen d nT �� �4 4. —�a , REPAIR
TROVERIOR ❑SWIMMING
IMMINGPOOL
- OVER 1000
0 AMPS IMPROVEMENT [IDEMOLINGPOOLS
S OWNER-BUILDER the Cud cu OVER IUUIIAMPS ❑BATH RF.MOUEI/REPAIR [I DEMOLITION
1 hereby arae that I am exempt from the C scions i s License Law for rhe
X p 6 U which
following ream.(Section 7 on sure Easiness and Professions Cade:Any city m roomy SIGNS ELECTRIGAL ❑OTHER
WW 3 W which requires a permit to to conal he alter,improve,demolish.or repair any swcmrc
pat heissceriouce,dmrit1.the theapplieantfe,mchpennlOofife asLw storeman SPECIALCIRCUIT/MIgC.
�} thatheislicenwit pSeen.mthcof5"oosofrheeBwocmra License Law(C ode).,
(ret he is erg with Seen. and
of basis for of the alleged
exempt on,ProAny
Cede)or 'TEMP.METER OR POLE INS T. COMMERCIAL'
that he is exempt therefrom end the basis for the nileged exemption.Any violation of E]NEW BLDG/ADDITION El DEMOLITION
�4e1 {s• Section 7031.5 by any applicant far a permis subject the applicant on.civil penalty of POWER DEVICES 7InTE''
❑
Il; :tvANT FOOD SERVICE
not mart than rive hundred dollars(SSW). V IMPROVEMENT
t5yap ❑1,as owner of Ne property.or my employeexwi@wagesnsNeirsalecompettation, SWIMMING POOL ELECTRIC
will do the work,andthe sweture is notintcndcd or offered forsale(Sec.7044,Business ❑OTHER
and Professions Code:The Contractor's License Law docs not apply to an owner of OUTLETS-SWITCHES-Milli le low
property who builds or improves thereon,and who does such work himself in through
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR
sale.If,however,the building or impervcmenr is sold within one year of completion,the SQ.FT.MOOR AREA $/5Q.Pr.
ownw_huddev will have the.burden of proving that he did not build or improve for pur-
pommfs.1c.)
❑I,as owner of the property,am exclusively conmacdng with licensed conwdnn ro TOTAL:
cmnswc[the pmjem(Sec 7044,Business end Prefessmns Code)The Convactore L s
cense Law dcez not apply ro an owner of property who huilds or wprmves thereo e tl Q'I'y.' is ty NO PERMIT?" et '2 5 -2 s O ✓I a
who contact fin such projects with a emods,or(s)hes.aed pursuant to the Cmaneek es
License Law. 1
❑ I am exempt under Sec. ,B&P C for his mom PERMIT ISSU
Owner
ALTER-DRAIN&VET LENTAT (EA) VALUATION
nam
WORKER'S COMPENSATION DECLARATIONBACK PLOW PROTECT,DE
I hereby effinn under penalty pf perjury one of the following
declarations:
]I haveend will mrintaina Certificate mf Consent tocelf-insure for Worker's Compen. DRAINS-FLOOR,ROOF.AR STORIES TYPE CON.STRUCTI01
sarion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for wW.1i dais Arad,is issued, ( FIXTURES-PER TRAP �T I• ^�
❑1 have and will maintain Wellow.Compensation load......serequired by Section
3700 of Ne Labor Code,for the performance of rhe work far which Chia permit is hued. GAS-FB.SYSTEM-IINCACUTLETS OCC GROUP APN
My Workers Compensation laumnce canter and Policy number are:
Cornier: Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASE/WDUSTRL WASTE INTERCEPTOR
(This,reend need not lb completed ifthe permit is for ono hundred dollan(SI W)
or IessJ GREASE TRAP PLANCHECK FEE
I certify Naas he performance oUm work for vehich[hts pmmh is issued,I shall SEWER-SANITARY-STORM P.A.2W FT.
Ar
nor employ any'now in any mr s
anneo as m former suct N
bjem e Workers'Compen- ENERGY FEE '
OZ. ac tion Laws of CaEfomia.Dem WATER HEATER WNENT/ELECfR
Z 0 Applicant t - GRADING FEE
y NOTICE 10 APPLICANT.If,after making this Cenif¢ste of Exemption,you should WATER SYS"fEMRREAi1NG
E+ become subject m
the Worker's Compensation pmvi.siuns cruse Labor Code,you most SOILS FEE
{ar forthwith comply with such previsions or this permit shall be deemed resulted. WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PCMB. SQ,FT. PAID
f,{Is QH I here bam mo thnhem isalen dinaencfor the ertormence of Dole Receipt#
the work for which this pentyl isssuont(Sce..3097,
Civ.CJ
O Lenders Name . TOTAL:
LendefAddress TOTAL
I came)that 1 have mad this application and sum Net the above information is x < BUILDING FEE
U N correct I agree to comply with all city and county ordinances end nam laws feeling g to FMBCIiANICAL PERMI4'. s) pFEE ad a
V� budding oonstrvcmon,mrd hereby authorize mprosenumvea of Nt mty mentor,open the L ,a � rase w. (:',6i ,s`=G'i gHISMiC FEE
above-mentioned property,for inspection puspous. PERMIT ISSUANCE
(We)agree to s.cc.indemnify and keep harmless the City of Cupertino against ELECTRIC FEE
liebilides,judgments,cosu and expenses which may in any way acerae against said City ALTER OR ADD TO MECH.
in consequence of the granting of dmfs permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)
SOURCE REGULATIONS. MECHANICAL FEB
AIR HANDLING UNIT(OVER IO,WO CFM) CONSTRUCTION TAX
Signature of Applicnnt/Conuecmr Dam EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building uccupont store or handle haurdous material HEATING UNIT(TO 100.000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health end Safety
Code,Section 25532(x)7sHEATING UNIT(OVER 100,000 BTU)
sssss�wwww[��(('''�''
❑Yes U(1#Ao VENTILATION FAN(SINGLE RESID) PAID
Will the applicant or future building arrogant use equipment or devices which Data Receipt
int
haurdous air contaminants as defined by rhe Buy Area Air Quality Management BOILER-COMP(3HP OR 1 WWI.BTU)
'TOTAL',
....n0
❑Yes )(No BOILER-COMP(OVER IW,W)BTU)
I have mad the Inventory;materials requirement under Chapter 6.95 of the Cali- AIRCONDITIONER ISSUANCE DATE
train Haddo&Safety Cnde,Seetiona 25505.25533 and 25534,1 md.ound Net if the NEW RF_SIDF.NTIAL MECH. SQ.Fr.
buil grices not currently have a screw,that it is my popogsibduyeanotitytheoccupant
h adamants welch m Won, 'n e�ssvance M arm f, of ttupancy
wn or autl ar ze gut ale TOTAL'. ISSUED BY:
OFFICE
FIRE DEPARTMENT
a.
CONTROL NUMBER
SANTA CLARA COUNTY o0 o y
14700 Winchester Blvd.,Lo Gatos,CA 95030.1818 A
(408)378-0010(phone)•(408)378-9342(fax) PERMIT NUMBER p
PLAN CHECK Na
r,.
t998 GonE PLAN REVIEW COMMENTS
CODFJSEC, SHEET NO. OLJE,eS GILE�
7\6—t Io�EZ FOR /.1L=u1 S!/ $ fLs i}Tiosl /ZooN
i 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
Z Tenant shall have access to a minimum of 2A1013C minimum rated fire extinguisher(s),
located within 75 feet travel distance. UFC 1002
• Tenant shall have access to one Class"K"type fire extinguisher,within 30 feel of commercial
cooking equipment. Post sign near"IC'extinguisher noting commercial fire protection system
should be activated prior to using the portable fire extinguisher. UFC 11102
Exit doors shall be operable 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
This plan check does not permit the use,storage or dispensing of hazardous materials,operations
or waste The tenant shall provide a completed HIvIIS to the fire department's hazardous
materials specialist for review and comment. _
PROVED FOR BUILDING PERMIT ISSUANCE subject to compliance
with the above checked comments prior to final inspection.
JURIs PLANS SPECS NEW REMODEL AS CONST.OESCRIP. BY PAGE
e� P ❑
1JE5 Lity 6.5 7 a ,JOFJ_
AMWJFLOOROCC OCG LOAD AREA - ARCWENCYCONTRACTOWOWNER
-B IZSO bA) FIA)i-t Azc-
NAME OF FACILITY LOCATION
A California Are Protection District serving Santa Clara County and the mmmunitles of
Campbell,Cupertino,Los Altos,Las Altos Fills,Los Gatos,Monte Sereno,Morgan hill,and Saratoga