02040006 c> BUILDING DPasoNO
tiNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21855 HOMESTEAD RD 02040006
OWNER'S NAME: APPLICATION SUB DATE
•BP OIL COMPANY 04/02/2002
TONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
iz In Ihereby Affirm that l am licensed under provisions of Chapter 9(commencing Job Description s
'nCu withS.,i.7") fDivisi.3ofth,BusinessendProfessionsCode, dmyiicense ELECT SERVICE . '
cornu mrz de _/
':�{5'a wernaeclaJ� ue.T 7811 a( (ORIGINAL #99110030)
ir u. Date/ Cnntmctor
Xi ITECuse DEC ATION
1 understand my plans shall he used as public records
i >•
1 p O Licensed Profcssionol
OWNER-BUILDER DECLARATION
E'4_' 1 hereby M.Nat 1 1. exempt from the C Professions
Co License Law co the
M whichfidluaingmmsa permit
]O7LS,Business and Profession..Code:Any city or county
S va which requires n permit reconstruct,oder,improve,demol t file
repass any structure
63Cm ..pnortonnssnsed umbersalso the applicant for Cormumuttofilea Law sramrtrrno- - _ _ _
(corn nlcensdpunuennarnepm ratonsafdteContractoYSLrttnselaw(Chaptu9 �.,.,yp S Ft.,FloorArea t }!� 1 Valuation
(com g th Sec(on 170110)ofD stun 3 or the Buyrpeu and Professions Code) j, ;�,sy A Z,'>a9'3\)!4 l; } {I[p,
or that hi rd eaempf therzfrdm Anti the haus for Ne allegcd.eiempbnd.Any vroleoon y
-of Section]031.5 by any Applicant for a permd subjcats the applicant to a civil Malty
:urnot mmethan five hundred dollars(5500). A NNumber ,:..r. OCCupancy'n'pe
01,As owner of the property,or my employees with wages as their sole compensation,
-will do(he work;and-the'nrpmure'is not intended"orbrared'for InIC(SecT](x4;'
Business'And Professions Code:The Contractor's License Law does not apply to an 501 - FINAL ER8(tiiPRMGkji&tiNNERGY,
owner of property Who builds or improves daemon.and who docs such work himself 505 - FINAL ELECTRICAL
or th gh h'x own employee provided Nat coed improvements em not mend J r
;9((e'pr AAie If.Fi the cots Idtng r mpro m n cold wnh n one-yearo(' _.,_ .. ...._. ._ _...._ .,... ..._ ..._.,. _.._. ._. ......_ ...... .._ _...__ __...
completion,the owner-budder will have the burden ofbuild
p proving that he did not or 7'
improve for puryose or sale.).
01,as owner of the pmpeny,nm exclusively contracting with licensed contractors t
consuoct the proles(Sec 7044,Business and Professions Carlo)The Comnc(o s 1
rt I
License Law does not apply to an owner of property who builds or improvo thereon.
..and who contracts for such pro3ccts.wM a contractor(s)Lccnsd pancom at to Ne. _.__ _... _.. _.._._.. .._.__. .... _ ._ .. .1 .. ____. _ .. ....
C..'recl.e.Lice..u L
❑I raptndeSSec "` B&P C f thu reason
Ow c r, Eare
NS
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pe,oaty of kri4y''neofthe following declarations:- '
0 1 have.nil will..main 2a Cenificete'of Consent to'self-insure for Worker.
Compensation, as provided for by Section 37W of ,he Labor Code, for the
padmorancam ffie work(or which this permit is issued..,
01 have acid will'mdiniun Worker i Ctimpenioiion Insurance,M requirad by,Section
' ensued ft Wnabo a c e,ens t o Incur c' f the work'fo which thisPerron s
7100 of the Lobo'Code f r Ne pedw un a ;1 d Podcy nbmbe arc
. .+.PoR x f•I, -
;s!1'."'
it )!A !� s`.'h
,r // 44 }f, 41
r 5- I , 3
b T ,4 CERTfFICATION OF E%EMPTION PROM wQRKERS 1 'i. v;.� c �� .'S Q!l . , 1, ':..
... "" COMPLNSATION�INSURANCE" _ t' '_ t
(Tho unionnecd not Ee'campleted if the pemdt is for one hundred do s.. .- '_-_-__ ---__-� -� -- _-� _. ._... ..._.
.' A1C
(5100)or less) ,.
I t
Icattily[butm,he perf ce of th wokfo-which this pe ,t l' audl
shall t mol y Any.IMom n any,mann (tryecome��cy h Work n 7 1 -fi
Comprn uon la�•c Cahfp�� One `T / � _
PP
:NOTIC ev'Oh2ANP,1( re/Camixeaking th Cn,Bcat ofEe pt nyou should ,.. -I,; ,, ,
Obecom Subject to the Worker's Compensat un provisions Aide labor Code,you must
forthwith comply with such provisions or Nis permit shall IN daemon revoked.
z _ _ . .. .. ___ ..___ _ ___ _____ _ -- I. .. .. _
F Vh+1 its,"' I CONSTRUCTION LENDING AGENCY i'I';' ..
a y Iherchy fflim tddnhe e, econswnlo drag gig cyf rthe perfd.A ca •t ( s 'Ire;.
d,a work Por
A1<nd .Name •,�.` ._..u' .... .0 c_,. �...-,. .e. _ r_ _.... __.___._... __..__ .. . ...____.. _ .. ___ ___....
Zr
•.f __ _... .__... ._.._ _-- ._.. _.....
LeNA' Addrtss-
I• I certify that 1 have rznd this Application entl nate that the above mfomlm ins is
eorrtetgrte to comply.wiN dl city end mumy ordinances and stnm laws relating
On(J to build;ngconnrvcdon:and hertby emhodss rzprcshnudves of this city to.mer upon
a'k7 the above-memionon property for mspcnion puquses.
�}�..tt Pi
(We)
agrte to save,mdcmnify on}i keep hermlees the Ciiy of Cripenino againn
.FI fA liabilities,judgments.case end expenses which may in any way emrve against said
V City in consequrnce of the grmung of this pelma '• ' { Q
APPLICANT UNDERSTANDS AND WILL COMPLY'N'FTH ACLNbIN:Po1NT'r"
souR'c +cul:. s, Issued by: Date
- iarq o s ppiican ontrenor .Date',. .('. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
. j; Will the upplicammfuture W;1 ing occ pant store or handlehazmd66 moterml _Type.of Roof,,... :,As defined by(he C penins Mu p I Cde GLIA let 9.12.and theHealth and Safety _ -
Cade Scot n 255R(als s 'i 6 A ` s - t ; i 4 i s r 5 t } (t
°Ye °N ill, ,' d ' _All roofs shall be inspected poor to any roofing matenal being installed.,.
_ ...r , - _, .. ....
w u th cool cam f rc to Id ng occupant use egmpment o devices which If a roof is installed'�without first obtaining an�ins eetion;'I agree to`remove
I � v Y Qa y g mens g p _ g
,it haurdo comm t o def d b the Be Arts A r ai t Marta'e
sa ll all new materials for inspection Applicant understands and will comply with
6 ,13
Y a ❑ i all non-point source regulations ... 1
ill. a OadNe.hazaMnonmaterial,regaimmunts'under Chapter b 95 of the
C.1domra LealN&Safely Cade,Sauom 25505 25533 and 23574 1 uMcrstnrM that
(the boddmgdocs mi.currtndy have.sonans did it n my Atamnbtluyt comfy he
'Occcupa^t o,the eq itm nta winch must.be met priorto issuance of a C r!ficmc of
a y t; r 'rr;'•,. Signature of Applicant _.... ._ . . - _ _ . Date
can Tera th nze
lit, All roof covering s to be Class "B"or better
J '� • �; _.n _ ._ _. ..OFFICE' -
.> ?
CITY OF CUPERTINO - ' +� :. " -a • '
BUILDING DIVISIONpERMI CONTRACTOR`IN,FORMAT ,
BUILDING ADDRESS:
PERMIT N0.
21855 HOMESTEAD RD 02040006
OWNER'S NAME APPLICATION SUB DATE
BP OIL COMPANY 04/02/2002
f HONE: SAN TARY NO. CONTROL NO.
q 0Oz ARCHITECT/ENGINEER: BUILDING PERMIT INFO
6L" BLDG ELECT PLUMB MECH
s` v u
�
z LICENSED CONTRACTOR'S DECLARATION Job Description
Z_qq I hereby a0iN1 emlicensedthBusiness
under provisions of Gpru escrP
a 9(commencing
�S7 wiih Section 7000)of of n Division3 oof the usinessand Prafeui�sCode.aod my licenu ELECT SERVICE.
x 3 1610(YII(Ort`gnd ert�u` _/ -� 1
raa LicenuCl Jct L ue.rr` (ORIGINAL 499110030)
Ole D e _ Comnaar
Be o L; ITECT'S DEC ATION
,g I understand my phos,shall be used u public records
r
p o L¢enud Prafeuionel
OWNER-BUILDER DECLARATION
I hereby arthro on 11. exempt from the Contras o e:An u Law for the
tS Z< following reason.(Section 7031.5.eusinm and Profession Cade:Any city or county
structure 2 F G which requires a permit a mnswn•alter,improve.demolish,fi repair sanynal ,acture
�3- _pnaraJOictted pinsorequids thnyislosofthewchpemr mccass,aw(Chament .. _
thPt heiilicecoed pursPidugthe proyislom of the Contractor,l7ttnu low(Chaqcr9 S ,F[.Floor Area, Valuation
(eammeaing with Sauon]000)of Division 7 of the Biyipeu yW Profeuiom Cade) 9 . ;{ t ,'y'
or Net he is uempi therdfibm end the basis for the allegod.ciempriod.Any violation - '
-of Seodm703l.5by anyapplicemfmapentduubjautheepplicanttoadvilpe ty
ofAPN Number Occupancy e
. notmaethanfivehunduddollsra(5500). P yTyp
°1•m ownerof the property,or my employees with wages u their sale compensation,
'-will do'the work end the structure is not intended or offered for sale(Sec.7044,'
RiumcSs'aoil Proriuim,Code:The Contmcu."a Licen,e law does not apply to an 501 - FINAL E&8fi1iP8217Ifi ti�TERGY'
owner of property Who Wild,or improves thereon,and who uses such work himself
or throes h his own employ.,.provided that such improvemems ere not imendd or _ 505 - FINAL ELE CTR I CAL
- _... . __._. _ .-.__...._ ... .". . ... . ...._ .
.offered or ole:If,however.the building or improvement is sold within yen o(� --
dompletian,the owner-builder will have the burden of proving that he did not build or
improve for purpose of We.),
°I;a,Owmr of the P gaunt'am exclusivdy contracting with licensed contncuu to
consuun the projem(Sec.7044,Business end Professions Code:)The Contractor's
i or int roves thereon, `
°I em esempt under Law.
Wol ProPe Y B lord nuant a,the ..:.- .. . .. ... .. _
n D 1 an sara License Law . . ...�j� ~`. ..__... ... _ . . .. . ....
Lice Law alas not apply to an owner of n who bre Ids p
.end who contrau fa such ecu.wnh•co mcmr(q lice pre
&PCfor this reason
Owner' rDau
"WORKER'S COMPENSATION DECLARATION
�1 hereby affirm under penalty of perjury one of the following declarations:
flA"'tin ❑ 1 have end will'membrin''A Certificate Of COmem m self-inure for Worker's
Competisption, m providd for by Section 3700 of the labor Code, for the
performonce athe work far which this permit is iuud.
O I have and will mainiam Worker S Compehsai�an Inabrance,as required by Section
3700 0(the Liflar Code,for Ne perfonneme of the work far
which Nis pereut is
cued My Work rs Com notion Insuring,twirler eM POL number em ' ' '
' !' t'etii A ., :Y':l.v..tt ` I
'jMTTnCATI OP EXEMITIONFROM,WQRKERS'.'. . . .� .. r. 5 . .. .. .
•'...' COMPENSATION INS URANCB' �__..,.
. 6 ... ................._"""____......_.___.._.__.__-.__._"_-.._.._..._._.... ... ._.. .___.._ ."........__... _._._
actions mond riot be'cainpleied if the parent it for one hundred dollars • - •1�
(5100)or leu.),.
.1 comfy Nn m the perfamiana ofd wook for which W,pereut is inud I
:hill d employ any.Peron i any mann r o sib Warken
Comphuuonlo�s p(Cel ala `'"T r-•° �"` h - ...
APPhrantl "411i1Llik_�.
NOTI[f/FOJ,PP� meWng this —0,74te of Exemption.you should -- - - - --
ll P
z becmn tubjai to the Workiei Compamation provisions of Ne Labor Code.you must
0 Q farihwiaicomplY with tach Provision,or lis permit uhan btdonmd my kd.
A ._..._ ... _. _ . .. .. _._ .
•";'"..•.-:.-:r'`:CONSTRUL"130N LENDING AGENCY - .. ...
ax 1 hereby Affirm that dere is a Iconsounion lending agency fa the perfdmuna
of de wank for which this'permit is brad(Ser.3097,Civ.C.) '-"
y:Q '6mel"'s Nurse,-.r"u__.. v. a.: -_,:c....:....: .._ ._._.. - _ _. _. ... ._ .. . .. _
�50 , ...a I ccnify dot 1 have red rens application and sone thatdeabove information is - ,t
tae: eoi(ecii agree 10 comply with W city end county ordinances ad state laws misting
C;,. j to Wilding construction,and hereby authorize representatives of this city to enter upon '
_y W the above-mmdond property far inspection purposes.
k,: Gx s (We)agree to sive,indemnify aid!Incept haredea,Ne City of Capitation sitarist
Fw ' liabilities.jud4menu,eau and upemes which may in any way accroe agumt mid
V'Gi Ciry in comequmce of de{noting of this periNc'-- " '.• '• a
APPA UNDERSTANDS AND WILL'COMPLY Wmi ALL ribWPOINT"
SOUR,
c S: Issued by: Date
atwa' pull_ ahvactm .. , .oa . Re-roofs
HAZARDOUS MATERIALS 61SCLOSUBE
�',. PAII'Ih::ppruens lir funve yJldivg acupeht atoeaEumle haialloes mpcid -Type.of Roof., .
y prem Municipal Code.Chapter 9.12.ad theHealth and Safety
es defind h the 3 no
Codd,[I Its 25572(e - -.- - -r, c
°Ye °N° ' ' `p
All ioofs shall be inspected pgor to any roofing material being installed.
.....-
Will dewcont menta Wilding by
occupant use irQ)ado i a ejon If a roof is idstalled without first obtaining an inspection,,I agree to"remove
't haWdoue au cicator nu u defined by de Bey Ares ip Quaint'evic.which
g P g
all new materials for inspection Applicant understands and will comply with
°Yrs ON. .. -. ..
11 1o t ( .1 : all non-point source regulations ,.
ad the haaerdo s materials requirement,Enda Chapmr 6.95 of the
Cdifomia Heald&Safety Code,Sectiotn 25505;25533 and 25534.1 underatand that
"ifthe building does notmnently have a tenant,that it is my respoasibiliry,to notify the -
'docupkgt f N'rtquiremenuhlch roup be met pre no lssuence of a Certificate'of
onup.n Signature" of Applicant. Date
woe p and rize gem' I�. - .. ... . .
ere All roof coverings to be Class "B" or better
C «
OFFI .
.:. . . CE_.
x . ....... . .. a_ _. .
:_
'A CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub : Blk: Lot :
APN . . . . . . . . . 32014002 . 00
DATE ISSUED. . . . . . . : 04/02/2002
RECEIPT 4 . . . . . . . . . : 17893
REFERENCE ID # . . . : 02040006
SITE ADDRESS . . . . . : 21855 HOMESTEAD RD
SUBDIVISION . . . . . ..:
CITY SU
IMPACT AREA . . . . . .
OWNER BP OIL COMPANY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CLEVELAND OH, 44101-
RECEIVED FROM . . . . : DLC COMMUNICATIONS
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- - - - - -- -- -------- - - --- ---- - ----- ----- ----- - - -------- - - ----- - - - ------ - ---
BENERGY PERMIT FEE 157 . 00 47 . 10 0 . 00 47 . 10 0 . 00
BELEC1000 METERS 1 . 00 44 . 40 0 . 00 44 . 40 0 . 00
BPERMFEE VALUATION 10 , 000 . 00 157 . 00 0 . 00 157 . 00 0 . 00
EPERMItFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
BSEISMICOM VALUATION 10, 000 . 00 2 . 10 0 . 00 2 . 10 0 . 00
BUSLIC FLAT RATE 1 . 00 98 . 00 0 . 00 98 . 00 0 . 00
---------- ----- - ---- --- - ------ - - --------
TOTAL PERMIT 384 . 12 0 . 00 384 . 12 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 384 . 12 1076
"TOTAL RECEIPT 384 . 12
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL• ELECTRICAL
' - P,001�001
CAPEX EN'GINEERdNG INC_
PO WX 14198,MAW['.['.CA94$39
'I'el:(S1U)(dr6-ITIS N�t:(SIU)18U.94NU
Mr.RAI BATNS Project No. 1278
BAINS DEVELOPMENT February 14,2002
3164 Middlefield Avenue
Fremont,CA 94539
Subject: Proposed Building Remodeling and
Carwash Add(tion at
21855 Homestead Road
Cupertino,CA
SPECL4L INSPECTION SERVICES FINAL AFFIDAVI
FOR STRUCTURAL.STEZL FRAME WELDING
Dear Mr.Baine:
At your request CAPER ENGINEERING INC., has provided. testing and spocial
inspection services at the subjeul site in accordance with suction 1701 of the Uniform ,
Building Code as listed below:
(1) Review mill certification(tact reports)bt Check welder's certification.
. (2) Inspection of welding prooadam(FCAW)specifications qualiti6ation and equipment.
(3) Check structural members for thickness adiamnt to welds,
(4) tnspoction of completed fillet welds on connection of TS 3 x 3 steel roof Bunn steel roof
frena to TS 3 x 3 column and IS 3 x 3 brace to gusset plate,(Per drawing S-1,2/S-5)
Personnel under the general supervision of a registered Civil Engineer performed these
inspections.Based on the inspections performed and upon our substantiating reports that
the inspected work was performed,to the best of our knowledge,in conformance with the
approved plans and specifications and the applicable workmanship provisions of the
Uniform Building Code.
ftecrcly,
CAPEX ENGINEERTNC, INC., F
Ii 1 Pnnct�al
FEB 19 .2002 Ll r h *
ju C IVj✓D
FE9 1 0oFc�
t'v.Z.:_: 2002