25485 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE B.LA L POINT PEN ONLY
CITY OF CUPERTINO .. PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT 'BUILDING
PROGCT IDENNICAL
FICA
�(jJ� NUIIAING PRl3dRCT'IDBNTIFICA'f1UN
25485
BUILDING AD/c;? S0�� aN��A) ZA UNIT# /DO LOT# SANITARY NO. APPLICATION SUBMITTALDATE
OWNf:R/5`lVl'M�O-(Dy��+ �/ /R//\ P NE. ��� ONTRACTOR'S NAME: LIC NO:
'AY/ NIC COI M�ROJ
ARCHITECT/ENGINEER: LIC ADDRESS:
. _ ❑ 2`l
Co PHONE: �' �'' - "' BUILDING PERMIT INFO
/�le� ps6�•K q p L p QTY. ;. 19,CTRIC PERMIT FEE
gl�ll 3b_100 . 11Mf`l•k,y.._ E M MECH
UIVJ((JJ PERMIT ISSUANCE 3 Lr
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL1pgDESCRIPI'ION
QWz I hereby effort that l am licensed under provisionsol'Chaplm9(cnmmmaingwidt �s -,r�r\fl►
1900 Section]000)of Division 3 of the Business and Professions Cale.and my license is in PANELS V
yU� full force and effect.
FW License Class Lic.# UPT0200AMPS
L
Data Crammer 201-1000 AMPS
ZOy� ARCHITECTS DECLARATION OVER 1000 AMPS I ,FLOQB AR $/ .
cz—
® I understand my plans about heated as publi<raoNa. \`v ry�V/�
E y t, SIGNS ELECTRICAL
CCQLicensed Prafnsimul
H< OWNER-BUILDER DECLARATION PECIAL CIRCUIT/MISC.
yW4X ,
u 1 heathy affirm that I am exempt from the Consaemrs License Law for the W 3 h following reason.(Section 7031.5,Business said Professions Code:My city or county TEMP.METER OR POLE INST.
which requires a permit to construct.alter,improve,demolish,or repair any structures
P� prior to itsismsence,als,ow iondo,.ppllcmtfe,suchpemd,tofileassuredstatement POWER DEVICES
GO that he is licensed pursuant to the provisions of the Committees Lissome Law(Chapter SWIMMING POOL ELECTRIC
Ly ez 9(mtmnencing with Section 90M7of Division 3oFlhe Ratsbane and Prolusions Cade) • LUATION
W_N or 114,heisexempt therefrom and Ne basis the alleged exemption.Any molmion of LITIE'S-SWITCHES-FIXTURF_S `�
I_Z Q Section 7031.5 by any applicant fora permit mbjeca the applicant m a civil penalty of V V
CO trees than five hundred dollars NEW RESIDENTIALELECIR _SQ.FT. STORI L�ECONSTRUCTION
mwill Jo thework,and the swcture isnotimendsdoroffered fa sale(See 9044.Busimis
and Prolamines Cade:The Contractor's Licenselaw does not apply to an owner of
property whobuilds or improves thereon,andwhodoes such work bimmlfomhmughbis
otendeEmoffered fords.If. I S
however,lbebuilding or Improvement is sold within one yew ofeumpletion,tbeownwr builder will have the burden of proving that he did not build m improve for purpose of _ •
n
.Is 1.as mmowdthe pmperty,amenhwivelycontracting with licensed eantraerorsm QTY , ' PLUMBING PERMIT FEE I
cons ct the project(Sec.9044,Business and Professions Code:)The Ccm ucer'e
License wdoes not applymanownerofpri,mywhobuildrorimprovesNereem,and PERMIT ISSUANCE DATE A0
who contracts forsuch projects with a conractorad licensed pursuannothe Contractors
License Law. ALTER (FA) - FF,E
❑ 1 nm escmpt onJcr Sm. B&PC for this reason rFEES
BACK Il0 W PROTECT.DEVICE D
SANITARY YN
Owner Data DRAINS-MOOR,ROOF,AREA,COND. RECEIPT#
• WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑❑ Thereby affirm that l have a cerificme ofcowwal to self-inmme,ore ccrOfcateaf FlXTIIRE9-PER TRAP RECEIPT#
l�mken'Compensation Insurance or acetified copy themof(Sce.3800,Lab C.)which PARK FEE Y N
coven all employee's under this permit. GAS-FA.SYSTEM-1 INC.4 OUTLETS / RDIVISI p
Policy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM OV ER 4(EA) PLANCIIECK ME O
❑ Cmifedcapy isherebyfumishad.
❑ Certified copy is filed with the city inspection division GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF FMMPFON FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(lasso onna nMhc mplmMifNepnr tiaforonehundrddolhn(SIWI SEWER SANITARY-STORM EA.200FT. ENERGY HE
or
I cenify the,inthepcoftenmace of the work for which this Permit is based.I"I WATER HEATER W/VENT/ELECTR
an employ any penin in my rammer sm in to become subject to,he Workers' PAID
Coarpenamion Lawsof Califomia. Date WATER SYSTEMfMEATING Date Receipt#
O z Applicant
z 0 NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEWRESIDENTIALPLMB. SQ.FT.. TOTAL:
ctr to become subject to the Workers Compensation previsions oftM Labor Code.you most
foMwith comply with such Provisions or this pemtit shall be domed revokM. BUILDING FEE
0.Wi A CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm thauhere is a construction lending agency for Ne performance id
U O the work for which this Permit is issued(Sec.21(yG,Civ.C.) ELECTRIC FEE
larders Name a "s "� PLUMBING FEE
O F Under's Address QTY. ME_C_HANICAL PERMIT FEE \
C) I amity dust 1 have trod this aWlicm on and state that due above information is a MECHANICAL FEE
novel.l agree m comply withal city and nearly ordinances and mate laws relating to PERMIT ISSUANCE
a' brildingconswNan,mdhembysutho6zempr mdvaof Nisciry townwit on the CONSTRUCTION TAX
V Gj7 above.mrndoned property for inspection purposes. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep hmnless the City of Cupertino against
liabilities,judgmmtx,costs ands wNchmay in my., ema'airal. City AIR HANDLING UNIT(TO 10,000 CFM)
in consequence ebbe it.
AIR HANDLING UNIT(OVER IQON1 CFM)
Signor p amVrte [DUAUSTHOOD(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt#
Will the splattered arfuture building oceupon store or handle Mzardons material HEATING UNIT(OVER 100,000 BTU) TOTAL:
as defined by the Captains,Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532007 VENTILATION FAN(SINGLE RESID)
❑Yes ❑No
BOILER-COMP(3HP OR UK,WO BTU) #ISSUANCE DATE
Will theapplicmmrfmure buildings:cupanmxequipmrnmrdevicea whichemit "-410
bez4 ma mr emenit brio m defined by the Bay Arca Air Quality Management BOILER-COMP(OVER IM."BTU) n/�
Dimrit" S p .9z
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT.
LcadomiaHealh
ead,he haaerdom materials requirements ander Chimer 6.95 of the L,/l) Ur
th&Safety Code,Sections 25505,8533 and 25534. 1 understand that Lauf;,
does not curen0y hevt etenant,that it is my responsibilirymna,ify,hee mquirements which must be met prior be issuance of a Certiftae oforiredagent Date L ISSUED BY:
a
County of Santa Clara COUVT}
Health Department
2220 Moorpark Avenue �4'�.q Cy,P'�
San Jose.California 95128
September 8 1993
Andrew Klein
1040 Grant Road RECEIVeo;
Mt. View, CA 94040
PROJECT NUMBER: 3753 SEP 1 u foo.;
.CITY OF, CUPERTINO
PROJECT NAME-, POLLO°S BULLRING ^:r.
PROJECT ADDRESS: 10525 SO. DEANZA BLVD. , CUPERTINO CA 95014
Plans for the above project have been reviewed by this department and
have been stamped approved, subject to the conditions listed:
1 . Corrections noted on plans .
Please present one (1 ) copy of the plans to your local building
official for the required permit application and approval. Please
retain the second copy on the job site. A FOOD FACILITY CONSTRUCTION
CARD will be attached to the job copy and must be posted with the other
building permits .
Please be advised that you are responsible to contact this office to
arrange a construction inspection prior to installation of equipment
and again upon. completion of the project.
Absolutely no food storage or food preparation will be allowed on-site
until this department issues you your Permit to Operate. This permit
will be issued upon the successful conclusion to our final construction
inspection . You will also be asked to submit verification of garbage
collection...prior to the issuance of the Permit to Operate .
If you have any further questions or would like to call for an
inspection appointment please contact the undersigned at (408)
299-6060 between 8: 00 a .m. and 9: 30 a .m. Monday through Friday.
RONALD E. SHARP, R. E.H.S .
SENIOR ENVIRONMENTAL HEALTH SPECIALIST
PLAN REVIEW AND CONSTRUCTION UNIT
DEPARTMENT OF ENVIRONMENTAL HEALTH
RES :er
CC: City of Cupertino Building Department
Board of Supervisors:Michael M. Honda. Zoe Lofgren, Ron Gonzales. Rod Diridon. Dianne McKenna
County EXCCuflVei Sally R. Reed