Loading...
05050017• Z-1 lo CUPERTINO CITY OF CUPERTI \oq� v.2 `6 6/ PERMIT APPLICATION FORM '% APN # Date: Building Address: ailing Address if different from building address): Owner's Name: �/n M C V % Phone #: Contractor: License #: ._ Contact: 6,yt/Zf-/ r- Phone: 3�r D 3 W 16 r/`;// Fax: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: C h44 /069F ! n d l' 1�v `l Fl -ort ! - S Residential ❑ I -1-10Z- 15s4 -5M F(SZ£ LA>r41§Rmercial Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second -story addition: ❑ Project Size: Standard ❑ Laze ❑ Major ❑ BBOILER5 Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <=100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <-- 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 1 0c, CUPERTINO 9 CITY OF CUPERTIlA PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD. Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Stonn/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL 13REMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 1. CUPERTINO ATY OF CUPERTINO 0 PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS - Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial. BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3 1 J E rMay 06 2005 8:218M HLL FUUD SERVICE DESIGN 5259357860 1� • DESIGN 4 DINING IHI OL'Ael ROAD, P11NtT C\e. UK, GA 14911 015141'44 01"1 aatlA Dt. UDM FROM: DAVID f. WNCLNl TO: CHLEU BIJIMING INSPECTOR PHONE.: 510 410-3453 FAX: 925-935-736,, SUBJECT: • BO.4S.RESTAT;R:ANT_15ri.F.RE-BARIUI R Ii'Pi': 2,00:30 S6.5 DATE: 5,'6/205 l!o May S' I a7r ask to inspxt the installation of 1M ;1 SA) fine buries on the duc •+Work (6 the Bow restaurant located @ 20050 StevenA Creek sitrated in the City of Cupeatino, Upon arming (ate the job site I observed the tnstaUton of he bu-ier wap Rnd sac they were doing it it. full compiianm spelled out by the 1M r. ual fir --nmrailing (l 5A) fue battier Wrap. • The only cornmtnt that 1 had was to only put the strap or so uggly, and no: to right, in cue a fire tvct reused the duct -o cxpxnd and this calartdty thenwould not cause the burner wrap to burar Upon leavtng everything u as done and complete, dte:e Ute I'm int-equitahe passing this Installation with -he rssn"oe, of this dnctnt testifying to rhat fact. Enclosed ate my certificates testifying so my credendal to do the above Sincerely Da,..d J. Man . GC DESIGN 4 DINING P.2 11 0 3m Fire Protection Products May 3, 2005 US Sheetrnetal 1719 Grant Street =i5 Santa On. CA 95050 Dein G)IS. This I•_tta is to eonfunn that your company has been trained an the 3M 1 ire Barrier 15A &: 20A installation method.-. You are trained for Crease ams, Air Ducts and Chemical Exhaast Duets. The trained installer cards for Calvin Inabinen, Andrew Pawlawsky &: • nhue Dang Vo will come from .1M in about 3 weeks. If you have am questions pleas- don't hesitate to call. Rdgai ds, ,Till Mauetas 3M Fire Protection Sb0-933-0732 dMaV 06 2005 Si21HM ALL FOOD SERVICE DESIGN 9259357860 •i E/SP EC 0.i IC -2S IN £PCN: !•e 2M Iltu Prow vtl un '.O, 1 B7E B95-'B8O ?6 FR 001 OF OG 0 0 0 4" ON x d1 t r� ?1. 1J�: 1� i g�'1 �Ny• �u(n '1ifE 1� �� n 1 ' 9 v+ x��� l � 4.1V I$a�a ii p1 J Ai O r a M J �)j[tLy �ij tst (fl hW :l 1' il @ i f Ii il�.ei 3U...ir�i is s,.=e�iha�:nd sir dxrMY&IN.W: 13�"f �1.t[ •S Y4j;il p.3 CTTY OF CUPERTINO BUILDING DIVISIONPERMIT t^'E©NT.i2ACpTp R IN'OItMA'TI®N; »un„•., ...�;^ 2y A1415 ».,.,p, a,IN x: xr^, ..A BUILDING ADDRESS: US SHEET METAL PEa""05050017 0 NER'S NAME: ROAR RRRTARUANT 1'71Q (RANT STREET- #F3 PERMIT ISSUE DATE NE: SANITARY 0. �ftOL NO. "C TEL BUILDING PERMIT INFO ' BLDG ELECT PLUMB MECH l� l� 0 O LICENSED CON7RACiOR'S DECLA0.ATION1 DeSCriptiOn hcmby affirm that I am licensed under provisions of Chapter 9 (commencingJOb SeNon 7M) ol'Division 3 of the Business and Profasstuns Coda. and my licemc is ulltome and ff.Lensee � L[e.g tZ`f%Z REVISION--CHG HOOD DUCT TO 1-HOZ 15A Dam canu NO NEW PERMIT ISSUED/ORIG. #04100166 LARATION Ecir ARCHDEC ITECTS � I ndemta J my plans shall M used u public records �a Licensed Professional 3 OWNER-BUILDER DECLARATION I Manor affirm that I am exempt from the Contractors License Law far the 1 o following mason. (Section 7031.S, Business and Prof"tient Cade: My city at covn0• I which acquires a permit to construct. alms impmw, demolish, or repair any structure < prior to its luuanm. alto requimA tiw applicant for uch remit to Rlc.signed statement Chamber's Uccome Low 9 Sq. Ft. Floor Area Valuation -a(commencing that m is licensed Personal to the provisions of the (Charter $0 i $ with Section 7M)of Division 3 of led Business and Normans Cause) or that he Is exempt therefrom and the basis for the alleged assumption. My vlalatian of APN Number Occupancy Type Section 7031.5 by any applicant two Permit Objects the applicant tor. civil penalty of .at mom than five hundmd dollars (5500). ❑I,not want ofthe property, or my employees with wages u their oak compensation, 36903004.00 - Required Inspections andPrthcsims;CdtheNucwrevnatkwndedmawdow,n,ApplythanButlmss Procode: The License law dm, ret .pray if an owner of q prodna who ves Moment. who htmulredWaugh irk emylone so not intended ve tae not InteMWmoBewd for s. pneortmmevesch improvements ownemployed•providod own owner• however, the or Improvement it veld within mw year of completion• me owner- improvement C milder will haw de burden of proving that on, did not build or improve fa purpose of saw the \ uk.L ❑ 1, as owner of the property, am "elusively contra fang with Bceaed canuamam to [� �y construct the project (Sec. 70,14, Business and Prof asians Code:) The Conteacmes Lt. cense law dean not apply to an owner of property who builds or improves thrown, and who convects fa such projects with aeontraclor(e) limnsed pursuant w Lha Canvxtors Liceae law. ❑lam"empt under Sea. .B&P C for this reason wner Dau WORKER'S COMPENSATION DECLARATION 1 hereby alnrm under peahY of perjury arc of W fallowing declarmons: I hew and will maintain. ConlOcaw of Consent to mlNumbe far womeetCampen- ahen, at provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ... ❑ 1 have and will maintain Wares Compensation Imerame, u required by Secd on 3700,( the labor Cade, for the Fort.... ,tube work for which this permit is issued. My Worker, Cmmpemation Im carrier and Polity number am: esnm 6 Cartier. s�r,#9T? j� Policy No.:��J—_ CERTIFICATE OF EXEMPTION FROM W R ERS' ' COMPENSATION INSURANCE (This secdm need not be completed If the permit is for aro hundred &It=(5IM) or Ices.) 1 unify that In the performance of the work for which this permit is issued. I shall not employ any person in my master an as to became tubjecuo W Wakens' Compenssdan Laws of California. Dam Applicant NOTICE TO APPLICANT: If, after making this Ccnhnam of Demption, you should become subject m the Worker's CamPenulion reviews of the labor Code. you most ' forthwith comply who such provisions or this Permit shall an deemed revoked. Q CONSTRUCTION LENDING AGENCY I Imlay affirm that Nem is a construction [ending agency for the performance of the work for which this permit is voted (Sec. 3097. Ch, C.) Q Lender's Nam. z Lenders Address Q 1 mnify that I haw read Ws application onto sum the W .how information is cartmL I a{me to comply with all city ami county ordimen es and Slow 1. muting in , budding construction, and hereby authorise mpresemsiw, argot city to enter upon W 4T7 above-mendoncd prapery for impaction purpows. IZZ (We) agree to um, indemnify and keep harmless We City of Cupertino against i,i Ilabili0es.judgmcnw. eau and sarcasms which may in ay wry,came against said City Z t—t in costs ovaM of the {ranting of this parol. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature of ApplicuVCamrDOr Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Willy huadrus material m (alum Wilding occupant sem orhandlethe ss defined DY W Cupeniw Municipal Cotle, Chapter 9.13. and W Heslth and Safety t e Cupertino code, Secuan 23533(.)7 All roofs shall be inspected prior to any roofing material being installed. �Ya ❑Nu If a roof is installed without first obtaining an inspection, I agree to remove VAR the applicant or future building occupant m equipment or devices which it haarious air contaminants a denmd by the Bay Area Air Quality Management all new materials for inspection. istricl7 ❑Yea ON. I have mad the huarMws materials requimmcnta under Chapter 6.95 of the Califor. iris Hal Cade, Sessions 25505, 25533 and 25534.1 tuldcmad than ifW Wilding does currently saw a =ML thus II h my mspomibility w nudfy W amupam of W ¢qui ents whit must be met priormiuuaceota ccniit c Oc'curac Signature of Applicant Date All roof coverings to be Class "B" or better owner unmhari ,.gem Da CITY OF CUPERTINO WT +('�a ^ni<» s4"""' a`` T" ` i ButDIVIs1ON PE A!`�l`I°a^ • `^ov I i• o k...r.. . "fe'�iM� W'3rt pr .. L,+RF mei': :7k BUILDING ADDRESS: US SHEET METAL PERMIT NGO5O5OO17 OWNER'S NAME: PERhIT[ BSUE DATE HONE: SANITARY O. OL NO. ARCHITECT/ENGINEER: BOLDING PERMIT INFO BLDG ELECT PLUMB MECHO O O O LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby .m.hat 1 am liad me under provisions of LTapmr 9 (commencing with Secdon]WO)of Division3ofthe BusbcaWNofessiom Code,a mylicc=u imfucense ll Tawe ane rcc� 77(7-1-71-REVISION-=CHG HOOD DUCT TO 1-HOZ 15A LiLicg NO NEW PERMIT ISSUED/ORIG. #04100166 Dam C.rtwwr ARCHI'IECrS DECLARATION 1 ndc,Ga d my prom shall he umarl u pahMc me.& Licensed Professional OWNER-BUILDER ContraON ctors se fmm the Conlrnsl 1 hereby that 11. mempl from d for my UCCA `V^ \/ meraunty Co city a (allowing mason. ](131.6. Business and r inns Code: Any re LOnLNLLalter,Ins pm va. do ay hWclam Permit t me parralall, a sig edny priori its issanpenult such its �ensed e,rsuantous,quires thn,ismdam, applicant for c.mmmrmit micams, CAA, (chapter Li cense Lew(Chade)w Ulehe Sq. Ft. Floor Area\- / Valuation $0 thatheencinnwit pursuentwme provision of Buacwh that he (commencing with Section70W)of DivuionJof me Busineu and Profeaiom Cndc)m mat he ls exempt thcmfmm and the bice for the alleged exemption. Any violadon of SecUon7031.5 by Any Applicant for a permit abjccu the Applicant w A civil pantry of APN Number Occupancy Type not mare than Bw hundred dollars ($500). 36903004,00 01,wowmrofthopmperty.ormyemploycuwimwagwumeinokeompenud0n, Required Inspections 9 P will do Newark and the structure is not intended oroffmad Image (SIC. 7044, Business and Preimts Cade: The Convector's License Law does not Apply to an owner or fea property w ha builds m impraws thereon, and who def such work hi msel (de through his own employees, provided that such improwmemm and not Intended oraRered formats. If, however, the building or Improvement is sold within one year of compkdon. the owner- bolder will have the burden of proving that he did not build or improve fm purpose of Hie.), 1, as Owner of the property, am "elusively Contracting with licensed LanlraCl al to Construct the project (Sec. 7044, Bmineu.nd Prafaaam Cade:) The Commute. Lt. come Law does not apply w an owner or property who builds or improve themon, and. Nno convacm for such projece, with a conumser(s) licensed pursuant to me CarnKmrl License U. ❑ I am exempt under See. , B k P C for this moon Own. Dem WORKER'S COMPENSATION DECLARATION I hereby archm under penalty of perjury ane Of the following dedanUona: ❑ 1 have ark will mein Wn a CerUOamaf Coment w wtr.luum forwmker'a Compen. nUor, as provided for by Section 3700 of the Mbar Code, for the performance of Uc work for which this permit is issued. to 1 have end will maintain Worime. CompensaUom Insunna. a reputed by Scedon 3700.r the Labor Cade, far the performance of the work for which this permit is lamed. My Workees Compensation Insurance terrier and Policy number Am: Canter. ROi CERTIFICATE EXEMPTIONN FAO W R ERS COMPENSATION INSURANCE ' IThic section need not becamplcmd If the permit bs foram, hundred dollars (5100) or le...) I ser ify that In the performance of the work for which this permit 0 issued. I shall not employ any person In any manner As u at become subject m me Worken'Compenaadon Laws of California. Dem Applicant NOTICE TO APPLICANT: IL after making this CenificAte of Exemplar, you should became subject to the Worker's Compensation provisions of Use Labor Code, you mut forthwith comply with such provisions or this permit shall he doomed cveked. D CONSTRUCTION LENDING AGENCY I hereby Aroma that then is a construction lending agency for the performence of W the work for which this permit Is issued (Sec. 3097, Civ. C.) Undoes Nunc Lender'. Addraas I certify mal i have mad this application And sate mu the Chow information is cancel. l agree or comply with all city and county ordinances and state laws mlaling to open Nc y to wiwsaf this c building co) mom1. rvthadmeep ebovo-menlioned properly fm inspection purismsea fCupertino ova,no against harmless upeteno Aga (We) Agree to save, indemnify and keep harmless me City of Inde t 9 gain A against IlablliUe,judgmcna.cwaand expense which may In Any way sante agilueild City Z in consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Type Roof Signatuse of Applicam/Contrnew, Dataof DISCLOSURE HAZARDOUS MATERIALS Will the applicant or future building Occupant store or handle hava dous maternal , As dented by the Cupertino Municipal Code, Chapter 9.13. and the Health and Safely Cade, Section 35533(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Ye ON. If a roof is installed without first obtaining an inspection, I agree to remove Will thb applicant or ruture building occupant use cyvipment Or devices which emit haurdnm air contaminants As de0ncd by the Bay Arca Air Quality Management all new materials for inspection. District? OYes ON. I haw mad the hazardous materials requirements under Chapter 6.93 of the Celifor. nie Huai Codc .SeNons Z35(IS, 35573 end 255J4.IundcrsmM thmifthc building des curremly watenan4 Net itkmy responsihililywnWfy me occuPutaf the mqui rents whit man be mel pdor lis iuvancc all Ceni0ce¢apOccupuc- Signature of Applicant Date All roof coverings to be Class "B" or better Owner or awhmi dAgcnt Da • • FIR^EPARTMENT 40 SANTA CLARA COUNTY 14700 Winchester Blvd., Los Gatos, CA 95030-1818 (408) 378-4010 (phone) • (408) 378-9342 (fax) PLAN REVIEW COMMENTS c CONTROL NUMBER 05a5c?<9/7 PERMIT NUMBER PLAN CHECK No CODE/SEC. SHEET NO. of a JURIS PLANS SPECS NEW REMODEL AS CONST, DESCRIP. BY cL--'P 10 ❑ ❑ © ❑ vu c SECJFLOOR OCC OCC. LOAD AREA • NAME OFF AGILITY kfA,a � Z © ` Fi,4e H&zt 16-1 /) /1 DATE PAGE U/ 5 ..J�``T F/bor LOCATION //�}9 0 .57 A Colifornid 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 CITY OF CUPERTINO Oem 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN I.......: 36903004.00 DATE ISSUED.......: 05/03/2005 RECEIPT #•........: 29548 REFERENCE ID # ...: 05050017 SITE ADDRESS .....: 20030 STEVENS CREEK BLVD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: BOAS RESTARUANT ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 95015 - RECEIVED FROM ....: US SHEETMETAL & HOOD CONTRACTOR .......: FISHBURN, GUS LIC # 20583 COMPANY ..........: US SHEET METAL ADDRESS ..........: 1719 GRANT STREET #5 CITY/STATE/ZIP ...: SANTA CLARA, CA 95050 TELEPHONE ........: (408)292-1314 • FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ------------------------------------------------------------------------- BPLANCKREP HOURS 1.00 87.14 0.00 87.14 0.00 ---------- ---------- ----------- ---------- TOTAL PERMIT 87.14 0.00 87.14 0.00 METHOD OF PAYMENT 7 ---------------- CHECK TOTAL RECEIPT : AMOUNT ------------ 87.14 87.14 NUMBER ---------- ------- 1399