06030147 CITY OF CUPERTINOa 'n• ' "' �"� =`�� `
,'IUILDING.DIVISION PERMIT i-CONTRACTQRINFORMATION 1
BUILDING ADDRESS: PERMITN0.
10123 N WOLFE RD # 2074
OWNER'S NAME: PERMIT LSSUBDATE
BENEHANNA OF TOKYO 1607 TICE VALLEY BLV 03/27/2006
PIaONE: SANITARY N0, CONTROL NO.
(925) 934-6133
'RMITECTIENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+Op LICENSED CONTRACTOR'S DECLARATION
tit 1 hereby affirm that 1 am licensed under provisions OfChapwr 9(commencing Job Description
i withSaoneandgpocDivision3OftheBusirtrssandPm(cssimuCode,amlmylicmocix REPAIRING 18 HOOD ) - T��TC RAPPING
in full farce and effect. L
;�? License Class Lk. WITH RI DUCT WRAP
3=q Dow !'-O( Cwtmmar s/
ARCHITECTS DECLARATION
W 1 Motherhood my plans shall W ec
used as public rords
U
C Licensed Professional MAN -2-9
2006
g S OWNER-BUILDER DECLARATION
4 I hereby M.that I am exempt from the Conuachm's License law for the
0 o following reason.(Section 703 IS.Business and Professions Code:Any city or county
$ which requires•permit to ennnruct,alter.improve,demolish,or repair any structure
-act prior to its issuance,also requires the applicant for such remit o file a signed statement iq
££�O Nat he is licensed forlorn to lie provisiotu of the Contractor's Liecmc Law(Chapter 9 Sq.Ft. Floor Area Valu
y t-$ (commencing with Section 7")of Division 3 of Ne Business and Profusions Cow)or
flat he i1cumin therefrom and the basis for the alleged eumption.My violation of
Section 7031.5 by airy applicant for a permit subpect the applicant to a civil penalty of
not mem than fiw hundred dmlars(shooL 31Ag 6104e�0 0 Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compemadon,
will do dte work and nheswmwe isnot intended oroRemd for sale(Sec.7016,Business;
and Professions Code:The Contsacmrs Liam Law does net apply to an owner of Required Inspections
property who In ildsor improves thereon,and who docasuch.,it himself omhrough his
own employees,provided that such improvements se notinmlded oroRered for sale.If,
however,the building or improvement is sold within one year of completion,the Manor,
builder will haw the Wrgen of proving that he did not Wild or improve for purpose of
sale.).
❑1.as Owner of on,property,am uclusiwly contracting with licettud convectors to
conswct Ne project(Sec.7044,Business and Professions CWeO The Contractors Li-
crose Law does not apply m an owner of propony who tiildh of improws thereon.and
who contracts for such pmjecs with a eommuch r(s)licensed pursuant in the Convector's
Lice.law.
❑l am exempt under Sec. ,B&PC for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one,of the following declarations:
llkLha.and will maimain acmifiuu or Cordae,on Mir-insure for wwoorscompcn-
was provided for by Section 37M of the Labor Code,for the petfmmmwe of Ne
far which this permit is issued.
❑1 have and will maintain Worker's Compeftsauon Insurance,as required by Section
3700 of the labor Code,fm the performance of the work for which this permit is issued.
My Warkc,ira's Compem1tion�ngsusp.n�a caress and Policy noumMr art:
Camer.CUAKS! ✓✓a-f Polity N.X-4.4CO IDS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This suction reed not W completed if the Permit is for enc hundred dollar(SIM)
or less.)
1 anify that in the pufomsana of the.,it for which this permit is issued.I shall nm
employ any person in any manner so u m become subject in the WorkersCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenifem,of Eumption,you should
become subject w the Worker's Compensation provisions of Ne labor code,you must
.JO forthwith comply with such pmvisimss or this permit shall W deemed revoked.
z V) CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that dam,is a covwcden lending apmtry for the perform.of
Ot: Ne work fur which this permit is issued(Sec.31197,Civ.C.)
aLenders Name
:D z LeMcrs Address -
fJ 0 1 certify that I haw food this application and mute font dic above information is
ly P coned.1 agree to comply with all tiny and county ordinances and sate laws relating to
OU building constmetion,and hereby aufhorim mfpmunativu of this city to enter upon the
W above-mentioned property for inspection purposcs.
H y
(We)agree in uses indemnify no hap harmless the City of against idagment
City
Ill in
fth,coarsing of this eswhich may in any way eccmc against said City
t)z in conxqucnce of the Noting Of this permit.APPLICANT
So67
u
L COMPLY WITH ALL NON-POINT Issued by: Date
`' �a� _ 3 a�o6 Re-roofs
mile ofApplic HAZARDOUS MATERIALS DISCLOSURE D� Type of Roof
Will Uric applicant Or future building Occupant Maro orhanuc hasidems material
u defined by the Cupertino Municipal Code.Chapter 9.12,and lie Health and Safely
Code,section 15531(a)?
❑Yea All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use Oquipment or i1mcu which If a roof is installed without first obtaining an inspection,I agree to remove
min h..dous air conmmioam,as defined by the Bay Area Air Quality Management all new materials for inspection.
Ct?
❑ye, 0Nu
I have mad the Wrsrdmss mmcrialsbequiree t n s umkr Chepwr6.95 of the Carrot.
nix Hcaith&Safety Code-,Sections 23N)5.U533 and 25534.1undersund this ifthc Wilding
Jos no clammily haw a tons t,that n is my rcoodualbility w notify the Occupant of Ne
rtyu' ntenKn�Msrxp�enpgoftoissuance0 acerYnaworaeupancy. Signature of Applicant Date
ww G a -d
Owner ofiuthorircd agent Dow All roof coverings to be Class "B"or better
nioot � ]
lam.
Fire Protection Products 7'D 7
Trained
' Installer
Ray O'Dell—CA Mechanical a
has successfully cmnpleted training and is hereby Certlned 3MP-Trained in product e '
application and proper installation procedures for the flowing firectopping systems: d'
U Construction Joints U Penetration Seal
rte Duct and Plenum Wrap U Telecom
10/6/04 U Woodfimun,FljConst/rru\Jcttion
]bi inr^f,dr�nwO dery lArceyean IUl'q M1yU{lt
s',,..nrs..ue/��
3M f
Fire Protection Products
Trained i
installer
Gregorio Hernandez—CA Mechanical
has successfully completed training and is hereby Certi0ed 3\P`-Trained in product
application and proper installation procedures far the fallowing firestopping systems:
U Construction Joints U Penetration Seal
'S Duct and Plenum Wrap U Telecom
10/6/04 U Woodframc Construction
a3M
Fire Protection Products
Trained
Installer'.
John Acosta—CA Mechanical
has successfully completed training and is hereby Certified 3hr'-T alned in product
application and proper installation procedures for the'following firestopping systems:
'Cl Catstmcloa Joints U Penetration Seal
®Duct and Plenum Wrap U Telecom
10/6/04 U Woodframe Construction
)ninin6 nun Dt,me.vd nvrylArceynrs. (t/rjrL
seemmuie.l.i,.;we, dh•m•m.. ,,,,,..,wsa....
v
CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31620037.00
DATE ISSUED. . . . . . . : 03/27/2006
RECEIPT #. . . . . . . . . : 33737
REFERENCE ID # . . . : 06030147
SITE ADDRESS . . . . . : 10123 N WOLFE RD # 2074
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BENEHANNA OF TOKYO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : CURTIS FOSTER
CONTRACTOR . . . . . . . : RONALD L TAYLOR LIC # 21773
COMPANY TERRA NOVA INDUSTRIES
ADDRESS 1607 TICE VALLEY BLV
CITY/STATE/ZIP . . . : WALNUT CREEK, CA 94595
TELEPHONE . . . . . . . . : (925) 934-6133
E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------------- __________ __________ __________ __________ ----------
B FEE VALUATION 15, 000.00 223.56 0.00 223.56 0.00
BENERGY PERMIT FEE 223.56 107.31 0.00 107.31 0.00
BREMREPALT NO UNITS 18.00 257.58 0.00 257.58 0.00
MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
BSEISMICOM VALUATION 15, 000.00 3.15 0.00 3.15 0.00
---------- ________--
TOTAL PERMIT 629.97 0.00 629.97 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ __--___-_____-____ .
OTHER 629.97 VISA
TOTAL RECEIPT 629.97
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
CUPERTINO
•
Building Department
JOB ADDRESS: II (� \ \ PERMIT #
d - L t-g l i-e. kA ��c C r"l�� to 0 6,0 :7 a(Lf
OWNER'S NAME: QK; kQK K� T �" PHONE # ?,Zs - 93V -61-33
GENERAL CONTRACTOR: jerv4 �w Z FAX # 93
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Benihanna of Tokyo
10123 N. Wolfe Rd.
• Cupertino, CA
Description of work to be done:
There are 18 hood exhaust ducts serving the dining area. The above ceiling duct
shafts will be demo-ed enough to facilitate installation and inspection of 3M Duct wrap.
Curtis Foster
Superintendent
Terra Nova Industries
925-260-3149 C�'C
F
mm
AY
•
OFFICE
•
y4
C
O
YCQ
l
V
O
Y
O
i f
a
�po
E ® ® ® W Z
Q
L
g Or
S 3.
i U
N
70
o F
z 5
® ® ® ® M
N
0 b
d
c
C
C3
S
s �
Pq
•
Community Development
tp+ 10300 Tone Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
CPEkTINO
Building Department
All Cupertino building permits must meet certain conditions related to maintaining
environmental quality and public peace and safety. The two most common
conditions are described below.
STORMWATER POLLUTION CONTROL
State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Valley Water District control stormwater pollution. Educating local
residents and businesses and enforcing stormwater pollution control laws are key parts
of the City's compliance efforts.
Stormwater pollution prevention: It's up to us
In northern Santa Clara Valley, storm drains flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife
dependent on our waterways, for people living near streams and baylands, and for the
local water supply. Common sources of stormwater pollution include:
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
• Landscaping runoff containing pesticides or weed killers; and
• Any material dumped or spilled into streets or storm drains
• The property owner and the contractor share ultimate responsibility for activities
occurring at a construction site and will be held responsible for any environmental
damage caused by subcontractors or employees. .
For more information on construction-related stormwater requirements, see the
Stormwater Quality Regulations section of the City of Cupertino web site at:
htti)://www.cur)ertino.org/city government/departments and offices/
environmental services
COMMUNITY NOISE CONTROL
The basic noise control requirements for construction sites are as follows:
• Typical construction work hours are:
- Weekdays - 7 a.m. to 8 p.m.
- Weekends - 9 a.m. to 6 p.m.
• Construction other than street construction is prohibited on holidays.
• Residential daytime noise levels from complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
For more information on noise control, please see Chapter 10.48 of the Cupertino
Municipal Code, which can be accessed at httD•//www amlegal com/cupertino ca/
• Greg Casteel
Building Official
CITY OF CUPERTINO
CUPEkZTINO PERMIT APPLICATION FORM �(�o�D�y�
APN# ,S J 6 2 o D 3 7 Date:3
X ilding Address: D R3 c e .'�fA Mailing Address (if different from building address):
�( D
Owner's Name: Phone#:
e�tv�n.ccvi o� �o ` - RS3-
CPtractor: II C3tvLicense 4:
erra Nauc Tw."14'' lwLL+ ere�k Obi 9'Me p
nt t: Phone: gx5 Noo-3r51y Cupertino Business License#:
v r -5 �as ri Fax: .2J 77
Building Permit Info: R2 % ^i i �' hoed exGnks� dwc�s > GvroP/r ^g �� 3 /t1
Bldg Elect D Plumb ❑ Meche",
Job Description:
Residential ❑ Commercial Jed
Sq.Ft. Floor Area: q.Ft.:
Cost of Proiect: Occupancy Group:
o,D G
Type of Construction: Please check this boa if the project is a
w ra second-storyaddition: ❑
Project Size: Standard PO Large ❑ Major ❑
'WQuantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BB01LER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu NECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS Boiler> 1.75MBtu MECHANICAL
BCONSTAX Construction Tac BUILDING
BCONSTAX Ind/Off/Com a/ uasi BUILDING
BCONSTAXBQ Con. Tax for EQ 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
• 1 of3 C.4 �b0 �QScj3 O r
PF
CITE' OF CUPERTINO
CUPEfZTINO PERMIT APPLICATI®N FORM `.
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMTTIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMIvIE New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOI\D,AP New Comm Plumb PLUMBING
BOVERTDvE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees . BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUI RING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCH$ Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Re eat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUREBING
BPSEWAGE. Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK La«v S rinklerBackflo PLUI\4:BING
BPSTORM Storm/Rain Water PLUMBING
BPTR P Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Instaltiter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Rein mtion Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAII2HAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY .. Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREM1q)RN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREllIINHOOD Installation of Hood 111ECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRp,PP Rem Non-Res Appliance
ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BgEMYO«'ER Power Device/Apparatus ELECTRICAL
BRE11Il2ECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
g BREMRgPALT Repair/Alter Heating MECHANICAL
BRBMRESAPP Remodel Res Appliance ELECTRICAL
2of3 •
CITY OF CITPERTINO
CUPEI�°T`INo PFIZNUT APPLICATION FORM
Quantity Fee ID Fee Descri tion 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 BUII DING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEAILPPERM 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
AIPERMITFEE Mech Permit Issuance MECHANICAL
PPERMTTFEE Plambing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUE DDING
•
3of3