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04020043 CITY OF CUPERTINO BUILDING DIVISION PERMIT a�.�%� 1K.f'lilNFAlI./'l�a J,'Ail BUILDING ADDRESS: RANCHO SAN ANTONIO HOUSING '18 '04020043 r,00 VIA R'S NAME: PERMIT ISSUE DATE NE: SANITARY 0 OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �oo LICENSED CONTRACTOR'S DECLARATION r��FF l hembyaffirse Ws l am licensed underproANnosofCh.pm,9(commencing, e_:_-_, lob Description nm with Section 7000)of0iviuon 3 drive Business and Professions Code,aM my lice. 1a in full forte.nticffett 'az License Class Uc.g REVISION-- HOP EXPANSIONS Dau Contractor X NO NEW PER IT ISSUED/ORIG. #04020019 ARCHITECTS DECLARATION 1 understand my plans shall W used as public retards 6 30 Lmensed Professional \ OWNER-BUILDER DECLARATION F. 0 1 hen's..Item o that 11. exempt from the Contractors e:Any o Law for the F.O o following reason.(Section](131.5,Business and approve. dionnh Cade:Any city structure S $ which mquisa a permit reconstruct,alter,impmw,h permit t ore a sig any ned tommum gin me,heor Incensed e.also Forecast the evisio applicant roe mchpmmiuL rilcense Law(Cha mem licensed pursuant mthc aDisinnaofof cBusiness usi er and Preclsnns Oodmr9 Sq.Ft. Floor Area Yatuation CO $ atheis(commencing with Section IDnd the basis f r of the aged r empt on.Anynn&Co lm or of Y — that Ito u exempt th.refrom and dre basis for Ne alleged cxemptim.Any violation of ' Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy T I not more Nan flue hundred dollars(5500). p y 7(� I,as awnu of the m 34254016 . 00 ❑ p peny,mmy emplaycrs withwagesuthei(Seo 7044,B sstion, will do tint work,and the he Con a tor's Lia d Law itd not a(Sec.]041, cram ss of and eProfessionsrtywhoW llsdc:The ves oacton, ndwhe Law does not apply if an owner of Required Inspections own enywhobutpro iireproves Hereon,andwho doessuch work himceIfedthrough his own.,,th employees,providedthatsuchimprovementsarcMaintained onoffered 1.frocul. worms. however,the building or improvement ishat within one year orimpro a for pur tsm of builder will have Ne When of proving that be did not Wild or improve for pogose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed mnbacmn to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Lt. cense law docs not apply to an owner of property who Wilds or improves thereon,and, who contracts for such pmjecm with a contractor(s)licensed pursuant in the Convector's Lic nse Law. ' I am exempt under Sec. ;BkPCf(It, n " Data WORT R'S COMPENSATIO! CLARATTON (hemby aRiam under penalty of perjury ane of Ne followio declarolou 1 have and will mammin 2CertiOcauof Consent to self-insure for Warker's Compcn- smien,u provided for by Section 3]ql of Ne labor Code,for Ne Performance of Ne workfor which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3]00 of the labor Code,far Ne performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not beeompleted Ifthe permit Is fordo.hundred doll..(SIM) or less.) I certify Net in Me performance of the work for which this permit is issued,.shall not employ any person In any marmstat as w became subject to the Worken'Compensation Lawn or California.Dam Applicant NOTICE TO APPLICANT.IL after making this Gellman,of Exemption.you should become subject to Ne Worker's Compensation prevision&of Ne Iamn Code,you most OQ forthwith comply with such provisions or this permit shall Ise deemed mvnked. Z ^' CONSTRUCTION LENDING AGENCY [ter 4 I hereby affirm that there is a construction lending agency for the pcofurmance of 6i> the work for which this permit is issued(Sec.3099,Civ.C.) QLender.Nam. Ai 0 z Lender's Address V 0 1 unity that 1 have read this application and stale thet the show information is w F cones.L agree to comply with all city and county ordinances and sum laws¢luting In 0V building construction,and hereby auhmins topmecnutives of this city to entenupon the W above-mentioned Property for inspection purposes. gyt (We)agree to save,indemnify and keep harmless the City of Cupertino against Iti yliabilides,judgmanm.coausndexpmmcswhichmayinenywayaccmeagainslsaid City V 7 in consequence of the granting of[his permit. r1• APPLICANT UNDERSTA D AND WILL OM Y WITH AL NON-POINT Issued by: Date SOURCE GUL TI Nays- y Q i Re-roofs nature fApplianYCmmmctor Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hratedous material •defined by tW Cupertino Municipal Code,Chapter 9.12,and the Hutt and Safety e.Stakes 2ss321a>? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ON. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It havardnus air contaminants ns defined by the Bay Arca Air Quality Management all new materials for inspection./ trict?❑Yes ❑No Ihewmadthehvartltmamamrial�uitemcnm underChapkr6.95ofd¢Califor- calthissafetycodesi 25705.$55 and255J4.londcrsundthattfdmWilding not currently le C ant.Nal it i my sponsibility to soul'y dm occupant of theiremen wh h /na etpdork a racemga ra Signatu of Applicant Daie Owner or junhoorind.gen y ])ad All roof coverings to be Class"B"or better CITY OF CUPERTINO BUILDING DIVISION PE RMI �g�'.�'��� "����� '' ^y1a^ w �-�' BUILDING ADDRESS: RANCHO SAN ANTONIO HOUSING '18Y'04020043 PERMIT ISSUE DATE W NER'S NAME: SANITARY 2 O OL NO. NE: BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT� O PLUMB MECH O jo LICENSED CONTRACTOR'S DECLARATION Job Description 1 hemby affirm Net I am limnsad under pmviuons of CNpmr 9(rnmmemning wlN Sectlon 7IXb)-(Division Sof the Buaircuarld Profnduna Code.and mylicensa is mfall frog,coalition. REVISION--SHOP EXPANSIONS a= License Class Lm'gDaW- NO NEW PERMIT ISSUED/ORIG. #04020019 7W As that use DECLARATION < I andCRlBnJ my pION shall hC used Y PYM1IIC reCnfdt LV Licensed Professional OWNER-commit frDECLARATION z 1 Wnby.(firm that 1 1. exempt Imre the Cwbout C e Licence taw far the S O following meson.(Section 703 L5,Bathers and Profeaiom Code:Any city m county $ which requiresu n pendst m enesmel,el¢r.Wprom,demolish,or epaig any auudum iiPrior in is issuance,tlau sequins PrcapPBnnt for such Pmmf Lica ce signed statement S Ft. Floor Area Valuation CO mmho-lslicensadpurtuan7 3.ravisinus(tcConmccssg. Vgw.i.aw(.Codus 9 q Y $ (commencing with Sntion 7000)nf Dlvision3of NC Businnsand Profn¢inns Cotle)m Nm he u exempt tbmfmm and dte baa fa dm alleged a pdI Any violation of Section 7031.5 by any applicant for a pcanft subjects Ne appl'mrt m a civil Penalty of APN Number Occupancy Type Out man than fen huMnd dollars(550)k 34254016 . 00 ❑I;n avmer,of Ne property,or my employcu wit wage.as their sale compensation, windo the anark..rW Be smeatummnatimmnded cropland forsake(Sec.70,14.Business Required Inspections Old Prof ssmn Code:The Conuel License Law does ant apply m an owner of property who Wilds orimprovesNmenn,endwho don.uch worthonelforthrough his awn employees,provided tat such improvemenBan nothdanded uroRend(ml if, however,time building w improvement it sold within oro yam of compledon,the Owner. builder will have the burden of proving that he did am build m improve fm purpom of x1eJ. ❑I.as owner of the pmpeny.am mclwiwly contracting with licensed eonmmors to construct In.projees(Sec.701x,Business and Profs ass Code:)The Combectol Li. come Law don not apply In an owner of property who builds or improve.Nemon,and. who cones for such Jul with a control license pursuant to dm Conroe s U rte law. lam exempt under S. .B&PC far this on i r . Nil �; h Data N WOR R'S COMP ENSAno70 LARATON I hemby a0hm under penally of perjury one of she follow_- decIwa ism: 1 have and will amomn aCemRnm of conent m self-insum for Worker'sCompm- sedan,w provided foe by Section 37W or the labor Code,fm the performance of the work for which this permit is issued. 0 1 have and will maintain Warker's Compensation Insurance,as required by Section 3700 of the Labor Code.for tire performance of the wed,far which this permit is wood My Worket's Compensation rnsmann cmrim and Policy number am: Cartier. Policy No.: CEMM:ATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need act W comnplemd Ute permil is(mane hundred dollan($100) or less.) 1 cenify Nal in to ptrfnmuanec of the work for which this permit is Issued.I short not employ any Person in any manner an n to become subject an the Workers'Comp u sadon Law.of California.Data Applicant NOTICE TO APPLICANT.Jr.after making this Certificate of Exemption,you should socome subject to the Worker Compensation provision.of the labor Crede,you most Z foMwilh comply with such provision m this Permit shall W deemed revoked. O CONSTRUCTIONLENDINGAGENCY Ihemby arl.shat Nen is a c-manucdnn lending agency for Ne pe'r-mance of y'> th work for which Udo permit a issued(Sec 3099,Civ.C.) C) Q Lend.e.Name Y Z Under'.Add., � 1 nNfy that 1 have end this city and county ty Ordinances sum Net the above wmmation u L F coadin I ague c comply wW all city antl county Of and sum laws relating m 7 V building construction.and herby authond mpmamalmsofCity otymcntl uponino ago Nc above-mentioned property fm inspection purposes. (WO)agree m aero,indcmnifY and kegp hamless Ne City of Cupertino against yIiabilitia,judgmenu,costs and expensal which may in anyway accrue against laid City JZ is consequence offtreating n(fhispermiL Date rr APPLICANT UNDER! AMD WILL OM Y WITH ALP NON-POINT Issued by: SOURCE. UL TI Re-roofs nature fApplieenJConrramor ✓ DataType of Roof HAZARDOUS MATERIALS DISCLOSURE Will to applicanl Or future Wilding xcupmtuom or handle hal material as defined by Ute Cupertino Municipal Cade.Chapmr 9.11,and the Health and Safety C.&,Section 23532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yrs ONO If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future Wilding occupant use equipment or devices which emit hmardmus air conummana as claimed by the Bay Ana Air Quality Management all new materials for inspection. District? ea ON. ❑Y 6 qqq % 1 IhavcroN Ina harardnusmateriWsn uinmcnu ondcrCestool.95ofll Wilding nuxniN&salt In e.5ec us05,n5 .ndsss3 I,,Intler, thacc.p Worm CXCx. vY.nt Jon not curcntly ha L Net It it my apomihility m nodl'y Nq mcupant of Nc ray iromcn wh)ch et pre i>�u gaafa Cenifica f�Occ j Signatu of Applicant Date ' 7U � All roof coverings to be Class"B"or better Owner or a lmneOd agent ✓ Da Adult �1t/ALL —REM7"-7 FGR GIM1�oSCrr� 1?G�T2_ — GU7�z'� SET 91 ------ �c coNc72FTE -P TIO rll3dV Tag ri? o Z FE8 0 2ErniroRc cavcxFT�r���trt �� f 'DEF' , g - 41 a CUN79i� eonrcr > 7E ( ii'/yxz'IaY O.I CJLOui , 1 I Y-V"5045 14 �+� 11W N%WfT t E�fTY -ofi j g r�/�- " - ; i W/.?TfIGCf� � i ( "iLT 7n ot1T5iPE t2�f. �E .ED ,. r. spe,iflcallons z � 1 fi i aat at FT� o E I 1 I on th ho at all tktizs and it n '-' J i h j y tul�to mak ny chang�s; or, site ns f f same wiL.. . writt.n Ip rmission n IpJegt„ City ofCupertino, building i h stamping or plan ani specifi i �u NOT b held to Permit or,m ae 1. iIetion of to P It!aoy City Odd ami o[ Sata - - 41 W h N i 1 _ c ofi c�c ET �T�Loew I Tz /n($U[ -� � FYT'ICAL: YZ RFfd+FGs�Ct.u'fs- �rJ3l:f.1+t �`r / ,�:•� Tr55 ' $ iAtFarercV 79/48 j5i>o)&ZFPi•vJvFzr�t' /+F BLOGKbe/AtL : L l6" 7Zr`PE7iTi,�,c/ ^� 3 `R£7E7iiiod W�srucco v °a mCs FLO oil_ :" a Q CITY OF CUPERTINO Prem 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 34254016 . 00 DATE ISSUED. . . . . . . : 02/05/2004 RECEIPT # . . . . . . . . . : 24429 REFERENCE ID # . . . : 04020043 SITE ADDRESS . . . . . : 23600 VIA ESPLENDOR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RANCHO SAN ANTONIO HOUSING COR ADDRESS . . . . . . . . . . : THE FORUM CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RAYMOND FENN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : RANCHO SAN ANTONIO HOUSING COR ADDRESS . . . . . . . . . . : THE FORUM CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 • TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- - ------- ------------- ------ ---- ---------- ---------- ---------- - --------- BPLANCKREP HOURS 2 . 00 111 . 00 0 . 00 111 . 00 0 . 00 ---------- --- - ------ ---------- ---------- TOTAL PERMIT 111 . 00 0 . 00 111 . 00 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - ------ -- -------- ------------ ------------------ CHECK 111 . 00 7264 TOTAL RECEIPT 111 . 00 WITY OF CUPERTINO CUPEkTTYOF O PERMIT APPLICATION FORM Q� o 2- o - �3 APN# � 7YI i Date: Building Addres : X100 VIA Owner's Name: Phone#: Contractor: License #: • pC Ol.v.t(�� Contact: Y / Cupertino Business License#: nermit Info: Elect ❑ Plumb ❑ Mech ❑ scription: ^ � � Residential El C e c 1 Sq.Ft. Floor Area: $/S4tFtv Cost of Project: Occupancy Group: _ Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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> 1.75MBtu 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 BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 *CITY OF CUPERTINO* CITY OF' PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE 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 Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation ofFumace MECHANICAL BREMFURNOV Relo Fumace> l OK 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 2of3 *CITY OF CUPERTINCS CITY of PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 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 Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbin Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BMISCELL Building Misc Fees BUILDING • 3 of 3 OWER-BUILDER VERIFICAT*IV r 1. (Check one) I or my immediate family (parent,spouse or child)will perform A. All the work authorized by this permit B. 4A portion of the work C. _ None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work . B. -j2$; A portion of the work (complete section C r„-.. Contractor Address/City. Phone # tats epse # 'Type of work to U 8 7004 be erformed 3. I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed I declare under penalty of perjury that the above is true and coT- cL have read and understand the Owner-Builder Information(reverse side). Property Owner'sSignator . �` Date: a� Job AddreNr/ 4 3,40 Vte ''c // Perndt# - OO/ Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. t� City of Cupertino Building Department CITY OF 10300 Torre Avenue �' C O P E kT I NO Phone: (408)777-3228 Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally.performing their own work. If your work is being performed by someone other than yourself,you may protect yourself from.possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family,and the work (including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as contractors or subcontractors,then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation contributions. There may be financial risks for you if you do not cavy out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S. Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor,only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper ago OCITY OF CUPERTINdb CUPERMIT PERMIT APPLICATION FORM l Date: 3 ,ZOO Y Building Address: .ve;,q �sp�7�ctil>GP ;23600 I , o CA . 9Y-0/ Owner's Name: %Ncs F°'Rurt LO- Phone#: 'RA-NCl(O J1+JV 4- ,V-CONI 0 0/00 Contractor: License #: CSU/IVF P11,5- Contact: FC Al Cupertino Business License#: . 71dg 'ng it Info:d©� Elect D Plumb ❑ ech )) J cription: Residential ❑ Commercial ❑ Sq.Ft. Floor Area- d CEIL�Nc� /Sq.Ft.: ilyd+/�l L L ©JZ C stofProject: Occupancy roup: T of Co structio Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 i � *CITY OF CUPERTINO* cuPEr�F PERMIT APPLICATION FORM • Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTBIE 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 rinklerBackflo PLUMBING BPSTORM Storm/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 BREMBUSWAY Remodel Busways ELECTRICAL BREMFLYT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK 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 2 of 3 I aWITY OF CUPERTINOO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Grou • BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heatin MECHANICAL BREMRESAPP Remodel Res Appliance - ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL 1 F cAY 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 ELECTRIfl Electricals foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BMISCELL Building Mise Fees BUILDING 3 of 3 ,f &OU FIREAEPARTMEWCONTROLNUMBER SANTA CLAM COUNTY (FJ�14700 Winchester Blvd., Los Gatos, CA 95030-1818 PERMIT NUMBER(408)378-4010(phone) • (408) 378-9342(fax) PLAN CHECK No. PLAN RE>>VIEW CO E, yv CODE/SEC. SHEET NO. ` OBJ The following CHECKED items apply to this—p ct:' 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 Tenant shall have access to a minimum of J. 2AlOBC minimum rated fire extinguisher(s). Travel distance to nearest extinguisher shall 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 A-Ishould 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 taw This plan check does not permit the use,storage or dispensing of hazardous materials, operations uric or waste. The tenant shall provide a completed HMIS to the fire department's hazardous Jtacft 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. PPROVED FOR BUILDING PERMIT ISSUANCE subject to compliance . 71 with the above checked comments prior to final inspection. JURIS PLANS SPECS NEW REMODEL AS C�O-rNSST.DESCRIP. B/V-l , DATE PAGE Cv a El El 5$ ❑ L ) Vl it 44� Z"3-0q ( OF ( SEC./FLOOR OCC OCC.LOAD AREA ARCH/ /CONTRACTOR/OWNER L&-� -1�, w 4:424� NAME OF FACILITY ©� � Nab' LOCATION Z 3 6o© . 1 A-C-S/'LC DO R- 4-Lo {-0 21-1 �I `J 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 THE FORUM AT RANCHO SAN ANTONIO 23600 C i//i¢ Sp��n/f MOVE STOREROOM & EXPAND : HOBBY SHOP Personal Care Facility • Cupertino, Ca. 7 SCOPE OF WORK F BCT.b Basic Changes Remove existing sto ro and w`al „ built in Feb. 2000, wn with cross- HOBBY SHOP - ? hatching and build a new storeroom as �z shown with solid black lines. Remove NEti/ /iREA = Ce t2 SQ_FT, existing 12ft. garage door and replace with a stud wall with a stucco exterior and gypsum interior. r Walls at� Remove 37 linl.d, �o'fRYt Wills and S construct 38Uyr tvDE";4tNneQc�s�t dawalls 23 which will incl a ..a.f of i the Hobby SJA. and i �f • REMOVE '-- area of the b sq.ft. _—_ -- - - D SIGNED STOREROOM ihls' Equipment beE set of pla - ,nd specifi a6ons is, ..Pt an th6'l MUST. lob at all Hn REMOVE WALLS k Move the exitstUrgte.vr ndo�ws 1r-conditioner 7sra ADD �'� and instal in 'Wt]se gwal oe 'i3clirs replac �� ing the g ahgelniohsr. Move thea£hVrmostat �r STOREROOM 0T.y a1 u ically co p olrPedofex-liaus�sefa-ai from the j 1 Provide full height wall. _I_=hr_rated existing Doval nmtejto� 410jall Ott�fsfmreroom. b . the viol�tiomof ` NEW WALLS construction to be 2x4" studs 16" O.C. Electrical any MY Ord ine any p Qna w 5/8" type "X" Gyp. Bd. ea. side. �'oG ( Caulk fire-safe all penetrations r fire caulk. Add one Remove (6) duplex wall outlets and install } w/min 1-ht! 0 sprinkler head as rqd to provide ( 7) new duplex outlets. Relocate ( 2 ) 220V coverage per NEPA 13 . outlets. Move (4) existing fluorescent lights and install ( 2) new ceiling lights , Remove 12 ft. Garage Door and replace with LOADING DOCK 2"x6" stud wall with: R-30 Insulation Gypsum Interior Stucco Exterior it l -PY< .R.W. FC Nril� TR. •' �l r j sHe:F_T"` ! of r' SC AL. E I _ Z�A-rF_ d104/ rrVi.sED' 2 2 0'f THE FORUM AT RANCHO SAN ANTONIO ELECTRICAL LIGHTING & POWER OUTLETS 23600 - VcR Personal Care Facility v Cupertino, Ca. (tel 0 6(r) QD(E) _ c�C ) d (G� NOTES: FFCi 1 FF(e) F�( F^ F(c�FF(s) pre- C ) FF(E) Delete (6) 110V duplex .outlets - Install (7) 110V duplex outlets (�) HOBBY SHOP Delete (4) wall switches Install (6) wall switches _ FF CEi _ FF(�} PcF(F-) _ FrCE� FF(e) pr-(E) Move (2) 220V power outlets — Move Room Exhaust Fan. r-FC,�) -F�CN) ��) Move Window Air. Conditioner r II CN) CN) L l r (E) LEGEND 3 (E) = Existing FF(sRF-Ery CCll (N) = New L/vrfTJ�y (M) = Moved / FF = 4 ft. Fluorescent Light #M� = 110V Duplex Outlet CN) I_ = 220V Power Outlet u^( _ C#1 = Circuit #1 LOADING DOCK Air =Cond. =Circuit #2 NEW Air Cond. = Window Air Conditioner (M� �CN) (N�� STOREROOM Fan = Thermostatically controlled Wall Fan AM {E} FF CE c n ( r. • h .7 77 j&AR.AGE_. s 2- nn, Jr. 11eet# .Z oof 3 zOOR (E) \ Scale: ;^ = 1 ft. \ Date: 1/30/2004 Rev„sD Z/2/2my RIVEWAY. --- - srDr✓giK DELETE. G i i-o 1' 1 V4- p �0 0 IYz. ��l,L Lam. �lv�w �XlSrtnl�r `EXISTING N ? , NEW 212• UPRIGHT HEADS i iv o- i I _ yL 10-0 i 3, — G N NEW WALL 13VI Yui :. __N� (! �Z CT✓L. � Ley • NEW NEW STOREROOM SPRINHERHEAD - RQD Fr: M-o z1 P SPRINKLER LAYOUT SECTION OF DRAWING #8586 3/10/2000 rQ -T # �r I