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03120107 CITY OF CUPEwrINO '� �` "•*° t PERMIT R " OR` MATz IONt ,rtBVILDING DIVISION F =" BmLDINGADDRESS: ERIC F ANDERSON INC PERMIT NO. OWNER'S NAME: PERMIT ISSUE DATE IE: SANITARY NO. CONTROL N0, ARC1l1TLCf/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH G� (� (� j00 LICENSED COmmed under provisions of CON Job DescriptionL�•p■ !!i ® ��tt.gt U U1 penny affirm IDa I am li d under pmvisions of Chapmr Y(commencing F �0 VV 4`+A LL '13 i with Section lIXkl)of D,' on Sof lhFjSY1i m Pufusions Code,endmylicenscis in rml ran)and erreet. v/ 2_< Q T I j�i Lianu (.a Inc . opo Damcpmnep ire •.& MINOR REMODEL/NEW SHELVING APR 8 2004 w ARCHI S D ATION 1 dmsand or a all M us copra Twp Licensed ,essional .- a n BUILDING OWNER-BUILDER DECLARATION <P 1 hereby affirm that 1 am exempt from dirt Contractor's License Law for the -O O following reason.(Section 703 1.5.Business and Pmfemions Crisis:Any city or county K$ which requires a fit in 0...wi cl.alte,borrow.dcmnlish.or repair any structure prior to its issuance,also mquires the applicant for such Permit to rile a signed statement < that he is licensed pursuant to the provisions Of the Contractors 6lccnce Law(Chapter 9 Sq. Ft. Floor Area Va gI q Y_O (commencing with Section 7000)of Division 3 of the Business and Prorderams Ctvle)or 1�V�� i3$ dial he is exempt therefrom and de basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects lite applicant to a civil penalty of APN Number Occupancy Type not mom than five hundred dollars(2500). ❑1.n owner of the properly,or my employees with wages u 1Mir tole compewtion. 35917019 . 00 will do the work,and Ne strvmura is not iorended or offered forsale(Sec.7 4 ,Business and Proremons Code:The Contractor's License Law does nor apply to an owner or Required Inspections Own enywho s provided that such improvements an ch wmkhimselrorthmugb his Own employehe es provided that such improvements arc not ear o cd or plecrcd for sales If. Wildhowe., illhavediebrimprov cntiamldwithinet year or completion,theowner.of builder will have the Horden of pmvin&Nal he did not build or improve for potpose of tole.). ❑1,as owner of the progeny,me exclusively contracting with licensed conoacmrs to consider Ne project(Sec.70W.Business and Professions Cade:)The Contnnor's Li- nc Law does not apply m in owner of property who builds or improms Neeson,and who contracts for such projects with a contractorre)licensed pursuant to the Contracto's License law. - ❑ m I arm under Sec. .B&P C for Nis mason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury One of the fallowing decorations: bave and will maintain aCenificate of Consent to self-insure for Worker's Com mpcn- tion,m provided for by Section 37M of the labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as,required by Section 3700 of Ne Labor Code,for the performance of the work for which this proton is issued. My Wo isF jr sectio Insure cyand Poy'w Her am: cam . cl t n5� Ft�aopnrggqqqqiii IaE.:R��IGai t 01 CERTIFICATE OF EXEMFROM W ORKERS' COMPENSA 10 SURANCE (This section need not WenmPICLOd if IM permit is for one hundred dollars(S 100) or lcss) I unify that in the perfotmanee of the work for which this Permit is issued.I shall not . employ any goon in any manner m U m become arbject to the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Comr1 ,of Exemption,you should become subject to the Worker's Comgcnaion provisiotn of Nc 1sMm Code.you shu .J O forthwith comply with such provisions or this Permit shall be deemed mvokcd. - 'Z = CONSTRUCTION LENDING AGENCY jaw I hereby 2MOM that there is a consumclon fending agency for Ne Performance of D3 > the work for which this permit is issued(Sec.ID 7,Civ.C.) R] Lenders Name Under's Address � z U Q 1 certify that 1 have read this application and sure that de above information is DS P correct.1 agree to comply with all city and county om inarims and state laws relating to - 0U building construction,and hereby auNorire mpreunutives of this city to enter upon Nc } ahow-rush finned property for inspection purposes. 4 (We)agree m save,indemnify and keep harmless the City of Cupertino against H N habilities.judgmcnu.Costs and experam which may in any way&cxmc against mid City U Z in consequence of Ne granting of this permit. .- APPLICANT UNDER D WILL COMPL7 WITH ALL NON-POINT Issued by: Date / SOURCE REG ONS /lkC—I G0-63 Re-roofs IRI, mApplica OConoactor Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will he applicant or rotor.building occupant•tort min mllc hvadous material as deGncd by the Cupenino Municipal Code.Chapter 9.12.and the Hcaldt and Safety Cole.Section 25532(a)p All roofs shall be inspected prior to any roofing material being installed. ❑Yu �t+o Will the applicant or future building occupant use equipment or devices whim If a roof is installed without firs[obtaining an inspection,I agree to remove ha/ardous air contaminants as defined by the Bay Ana Air Quality Management111,112 all new materials for inspection. 0 yes Ihave MA Nehma nmN .11. lsrequitemenuunder Chap¢r6.95o(1eCalifor ' nix Health&Safety Coda Section 255115.25533 and 25534.1 understand Naif de building does not cumently haw a¢nano that it a my responsibility,to notify the occupant or Ne nggimments wnien mgst tir.Met minorte isre2 apanry. Signature of Applicant Date oauthorlaeda cat / "onto All roof coverings to be Class"B" or better CITY OF CUPEaTIN° CONTRACIOR;INPORMA N Via. BUILDING DIVISION PER BUILDING ADDRESS: ERIC F ANDERSON INC PERMITNO.O'3120107 OW NER'S NAME: PERMIT ISSUE DATE LONGS DRUG STORES IhIC InCC RP.P. 1471? ST NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH j� 0 inLICENSED GONnRACIOR$DECLARATION Job DESCllplµ)Il '��[I U C I hereby a1Erm that 1 am licensedunderprovisions of Chapter Y(Commencing {,®p L <U wilM1 Scclion]IXllp of Di onJ of mfa� Ines Polc senile.ane my Aanm is mfull fo�rta({,and cfrecL �/ u s2SY'� TI = ED LICCnSe P'� Lk.X T i—o DaR��1g� a Contract r'c -. a A MINOR REMODEL/NEW SHELVING ~ ARS CIII S D RATION # u 1 dcrs'.a `all W us crud. gpq�a'� AFt� 9-- pQQ LiCcnxd a cssional B��I p NG ON OWNER BUILDE0.DECLARATION L 1 hereby affrm Ihm 1 sip cmmpt Gum the Convanar's Liecnac Law fur rite p O following rc a(Sectlun]113 L3.Business and PmfC.xions Codc:Any city or rnunly K m which rcquim.a p_it to can.wct,eller,imprnuc.Jcmalizh.nr Rpair any AlrucluR .—va which the app ICNIfof SaCh pefmll to fl CaSlgn[J SlalCment a that hcixliccnscJ pursuanuo'bepmvisionsnf the Contractor's Licencelzw(ChaPRr9 Sq. Ft. Floor Area Vat+l 1L�a OOO (commencing with Senion)IyIU)nl Divisiunl of the❑usincsx mJ Prafcsxions CnJc)m y� y Nat he i5 ucmpl Therefrom and Ne basis for the alleged exemption.Any violation of Sevion]oJ1.5hyany.pprea ff cora retail Subjects the applicant to a Civil penally of - APN Number Occupancy Type nm more Nan Dva Warm,dollars(5500). ❑Laxowner Cirtheproperly:ormyemploycm with wagesas Theirstilt Compenatiaq 35917019 . 00 wad Prefeswons and thesuuaureis Contractor's cnerve,Law it f not apply to in Owner of Required Inspections and property who Code.impTherroves Co thereon, rad who Law es such not apply lf in owner is q P own enywyees,dsorimpmvesch improvements ootid intended himwlfodNrough his own employees,provided that such rat iss sold wit arenot uncoiledmoffered for sale.if. however.the building or den of proving is Bald within one year of completion.the use of buiddq will have the burden of proving Nal he did not Wild or improve for Pumam of sale.). 1,as owner of Ne property,am exclusively contracting with licensed contractors to construct the pmjen(Sec.7044,Business and Profession.Code:)The Convanor's Li- Ise Law does not apply in an owner of property who Wilds or improves thcrton,and who contracts for such pmjects with a eontnmm(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec. .B&P C far this reason Owner Date _ WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following de in ndOms: 1 have and will maintain ICenifcme of Concent to self-hou a for Workers Compen- cation,as provided for by Section 3700 of the Labor Code.for the performance of the work fol which this Permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of Ne I,ZeWr Code,for the Performance {of Ne work for which this pemnil is issued. coma cllt aP1,3.:RS7rtU4i DI . CERTIFICATE OF EXEMITI FROM WORKERS' COMPENSA 10 SURANCE (Thu section need not W completed if lite pewi,is farone hundred dollars(glm7 or less.) 1 certify Na in the performance of the work for which this permit is issued.1 shall Out employ any pew any manner m as In bacteria,subject 10 me Woken Compensation Laws of Californ a!Dae A,ham NOTICETO APPLICANT:If,at let making this CC nlOcmc of Extra prion,you Should become subject to the worker's Compensmion provisions of the Labor CMC,you most .J,'Z forthwith comply with Such provisions or this permit shall be deemed Rvoked. Z O CONSTRUCTION LENDING AGENCY PI threby affirm Na there is a mnstractinn lending agency for the Performance of a > the work(a,which This permit is issued(S.C.3097.Civ.C.) .W Q I2ndce.Name a z Lcndcr'a Addrats U Q 1 cenify that l have read this application and sum that the above information is BL f" coned.I agree to comply with all city and county ordinances and sum laws relating to r 1 0U building construction.and hereby aumofim rcpresamalives of this city to enter upon the U] ahovemcmioned property for inspection proposes. gy (We)agree to save,indemnify and keep harmless the City of Cupertino against % HN lisbililies.judgmens.costs and expenses which may in any way scene against saidCity U Z. in consequence of NC Brunn.,alums permit. APPLICANT UNDER O$AND WILL COMPLY WITH ALL NON.POINT Issued by: Date SOURCE REG OtlS CJ Re-roofs Ac� sl ancol'ApplicaliVCommottor Date fiAZARDOARDOUS MATERIALS erpa DISCLOSURE Type of Roof Will one applicant or future buildings Chanuuuc2.had orh t.1th ad C define)im the Cupertino MunicipalCode.Chapter 9.12.enc rite f{caBh and Safely Care.seams aslz(a)? All roofs shall be inspected prior to an roofing material being Installed. ❑rax _FL o P P Y i g Will the applicant or from building occupant um equipment or atykes which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air conlaminanb as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Ycs I have Rad the ar nusmatcriulsrcquircmcme under Chapter 6.95 of the Califor ma Health&Safay Code,Sections 2x505,35533 and 25534.1 understand thus if the Wilding does not c Umcmly have a teram,Nat it is my mspmsibilily m and fy the oicupanl of the RquiRmentawhich mu.l re�aNnm,ex Signature of Applicant Date OwOV aathorimd a enl D„e All roof coverings to be Class "B” or better x i nxa ooL� FIRE DEPARTMENT CONTROL NUMBER aD FIRE SANTA CLAM COUNTY ZQ! 14700 Winchester Blvd., Los Gatos, CA 95030-1818 (408) 378-4010(phone) • (408) 378-9342 (fax) PERMIT NUMBE C IRE9Y F PLAN CHECK No. PLAN REVIEW COMMENTS CODE/SEC. SHEET NO. 1he following CHECKED items apply to this project: Existing fire sprinkler system shall be modified as necessary. A licensed C-16 fire protection ontractor 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 of2A10BC minimum rated fire extinguisher(s). Travel distance to nearest extinguisher sh 11 not exceed 75 feet. UFC 1002 Tenant shall have access to one Class "K" type fire 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-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 HMIS 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. JURIS PLANS SPECS NEW REMODEL AS CONN'SI D�ES/CRIP. BY ///� DATE PAGE ❑ El C1 ❑ V J— 001zo/� I Z�Ic�'C� —[OF� SEC/FLOOR OCC OCG LOAD AREA ARCH/ENG/CONTRACTOR/OW N NAME OF FACILITY LOCATION r Q (� '• ` L^Uc C 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 i BELDEN Consulting Engineers oject Name Project Number Name LA;� (!�75�� Description: Route Action Req'd by Date -Z O ❑ Meeting Notes Name Initialed ❑ Please Reply Telephone No. ❑ Phone Memo ❑ For comments Company ❑ Field Reports Cl Info only Meeting Location ❑ Other ❑ Note Er return Attendees ❑ Approve Er return ❑ File ❑ Other Additional Information �.. 70fh 3P0 t. 5e7_v-AIflo,cy U ere: � — o 21IG P�FESSIONgr O�,pS Y.4 FF�2c2.- • pA 12- T 9 Scrf-� M�7rG �P SrgTE OCCP�oQ2 6670 Amador Plaza Road • Suite 200 Dublin, California 94568 (925) 829.0772 Fax (925) 829.0682 • belden@beldeninc.com t _ BSI( 1181 Quarry Lane, Building 300 Pleasanton, CA 94566 (925) 462-4000 • FAX (925) 462-6283 15 January 2004 13SK Job No. C04-023-60P Permit No. BEP03120107 Mr. Donald Anderson R'IF;C:FJ'VFD Eric F. Anderson Construction 1066 Beecher Street FEB 2 3 2004 San Leandro, CA 94577-0207 BY: Subject: Structural Steel Welding Observation Services Longs Drug Store#260 10455 S. De Anza Boulevard . Cupertino, California (Period Covered: 01115104) Progress Report No. 1 Dear Mr. Anderson: At your request and authorization, we have performed structural steel welding observation services for the subject project. Enclosed is a summary of our Field activities. We appreciate the opportunity to be of service to you. If you have further questions or comments, please contact the undersigned. Respectfully submitted, 13SK Associates ?h2abA Q . Elizabeth A. Levi Construction Services Division EAL:trl (G:\W P60\DOCSICONSnDATA\REPORTS\C0402360P.PR I) Enclosure: Summary of Field Activities Distribution: City of Cupertino Plan Check Division Attn(BuilditigOfficial Geotechnical Engineering • Engineering Geology • Environmental Services • Construction Inspection &Testing • Analytical Testing e Structural Steel Welding Observation Services BSK Job No.C04-023-60P Longs Drug Store#260 Permit No. BEP03120107 10455 S.Do Anza Boulevard 15 January 2004 Cupertino,California Enclosure &eriod ress Report Covered:01/15/04) ogNo.1 STRUCTURAL STEEL WELDING REPORT Item Inspected YES NO Item Inspected YES NO Plans/Specs Checked X Grades Comply X Electrode Storage Comply X Size Comply X Material Identifiable X Fit-up Comply X N.D.T. Required X Drawings Approved 01/13/04 Welders Certified X Shop/Field FIELD Procedure Identification AWS D1.1 /Pre-Qualified Areas/Items Inspected: Completed: TS Brun-to=TS Column colmections, per attached Detail. PROCESS: FCAW ® FILLER: E71T-8 WELDER: Jason Unck Weld Type(s): FP Remarks: Reference attached S.E. approved Detail. The work described DOES conform to the Project Documents. Inspector: John Dodt,ion ICBO#: 5104735-85 Date Work Performed: 'Thursday. 01/15/04 Time: 5 Flours ` BSK H D `iib SHB JOB CALL ® STRUCTURALlEN91NEER DATE 20 �o C,.y!; L J G r1 Ptd 2 n N V 2-l00 QAOFESFl S/ON QQOFESS/pyq Quo p, No. S 1790 y^ a No.S 1790 Exp. 30/05 3i Exp-9/30/05 �q TRUCNQP �POFC A�� SOF CA��` dS�crr•Erwr�reE cENwAEc.n� a� �,�2 TY vi-At'-�'4tfLAr � Ile/I 360 CIVIC DRIVE, SUITE F, PLEASANT HILL, CA 94523 • TEL 925-825-9540 FAX 925-825.9561 E-MAIL STAFF®HDRSE.COM