31403 (2) APPLICANT TO-FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITY OE CUPERTINO BUILDING-1?LECTkICA1, PERMIT NO. l 0
w BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL - .1
IIUII.DTN11 PROJE(TI'IDEN'rIFICATION
BUILDINGADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DATE
,Su3 SLA; C� Vt ' �Q, tSoiL X0.3
OW`tX9SNAME: \ I` PH NH: O T(�i31JAMIi: LICNO: NIC CONTROLN
'DW C ❑
CHITEC GINEER: _ LIC NO: ADDRESS: .
F UN
CONTACT. PHONH. - - BUILDING PERMIT INFO
P,
,.. ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT, PI MH MECH
LICENSED CONTRACTOR S DECLARATION QTY ELECTRIC PERMIT FEE
Ih by 11 that licensed ud provisions f Clclptcr 9(chrmosome, JOB DESCRIPTION'
P4 with S i 7000) EDivision3 of theBusiness dlroressanC I, dmylcen is - RESIDENTIAL:
00 PERMIT ISSUANCO
in fullerc an Icffed.
y I+I� � � ❑RIT]WI. ❑KITCI{EN REMODEL
F4.V V License Class Lic.M
to Q4 Dam Contractor APPLIANCES-RE.SIDENI'IAL ❑ADDITION, ❑PLUMBING RE-PIPE
ARCFIITGCTS DECLAHA'fION - • O MUI.TI-UNIT O STRUCTURAL.
Z0,�7a I undenivnl my plans shall he used as public rcculds .'{'- PANELS ,1
MODIFICATION
OZ - - t UPT0260AMPS '
C1 INTERIOR ❑CHIMNEY REPAIR
Q��� Licensed Professional - - 201-1000AMPS IMPROVEMENT
....l1 dim I at BU ur,l I.DEthe Com sto OVER ONIIIAMPS O BATH REMODEUREPAIR O DEMOLITION
0,U Q '1 hereby ulflmm dwl I um exanpl Coni the Contivmor's h cause La w I'nr Ube
, following re...a.(Section ID315,Business and Professions Coca:Any city or roumd, SIGNS ELECTRICAL ❑OTHGR'
ii+LL LLO 1-' which restirm,a minut to construct,other.improve. l 1 h pa y immune,
prion s also 1 IM1applicant f h permit file signed se t mem
ry - SI'ECIAI.CIRCIII'f/MISC..
imtl licensedcommon t II p (t C I' I L L ICh pier9 _
13. a2 (n m e is itigexempt
pt treSection,lgnd oe mars or the ne all
ged exx unit oil.Anions Cndc)or TEMP METER OR POLE(NST. -n COMMERCIAL:
.a a e Natio is exempt therefrom land Inc bnsix far to alleged exemption.Anyit per ion of ONEWTHN BLDG/ADDITION O DEMOLITION
•ad Section 1011,1 by any applicant fora permit subjttts the appliconnoecivil pcnahy of POWER DEVICES
Ids} ❑TIENANT ❑FOOD SERVICE
yyyy mol ntoro than e Evc hundred dollars tum y empl 4 -
Q ❑ Lo the weroflhepmpeny,nr myemployeesi caryeee with wag was lalei(Ser, 0,14.8 siren. SWIMMING POOL GLECB'RIC IMPROVEMENT
Ise will dmf scions Coce:tursdafthe cium Comforters
Livenstuded or of s not apply to an Business COMER
IL3 m and Professions Code:The Contractors License Law rices not apply dm if owner of OUTLETS-SWITCHES-FI%TURFS '
property whooyce,or improve thereon,and who does such work himself ortrough
nl,a own empleyec,,pmildia tl Nnl sura improv old w ora nm i ear.f or nlTerW for NEW RI:SIDP.NTIAh P.LF.CTft• SQ FT.
soletLhoweveallthave the human
ofprovid Mold he lid.noneildoriprovetionlhe _ SQ. 1. 0H[?A S/SQ.PT. '
swnertvi]der will haveN hN fp i gtmh did.not build nnmprose for our- - 'w—�
pnsof sale)
1 - mcontinuation,
- - - OC
31
- ❑ I,ox owner of the ppcny m exn ly c t -g th I tensed contnuors la ._ TOTAL: 1 1.
construct the juicier,(Sec 9(b4 Business d Professions Cade)The Contractors Lt - •' yVK
cense law doe,not apply) an owner of nooproy who builds or Improves thereon aad TY PLUMBING PERMIT FEE �r
who contract for such projects wit a communist licensed pursuant to the Contractors Q Yur uLr
License Law. ' PERMIT ISSUANCE. CrIJJJVU
Ll I um exempt under Sec B K I'C fm th"emon
11
owneIDoa ' (E
ALTER-DRAIN AF VENT-WATER A) VALUATION
r _ _ fl
WORKERS COMq(.NSATTOND i!:LARLARATION BACK FLOW PHOI'[CT.DEVICE
have
ai antler penaltyof perjurypnctfthe lnstareor WorkersCo:
❑These anJ will maimainuCenificamnf Cdnsennsi self-insure for Worker's Cooper- DRAINS-FLOOH.RDOF,ARI?A,COND. ! STORIES TYI'H CUNSTRUC'OON
when,as provided for by Section 3'/W of the Unfair CMe,for the p ifterr ace of Ne '
work for which this permit is issued. FIXTURES-PERTRAP
❑'I have and will maintain Worker,Compensation Insurance,as required by Section
3700.1 to WMn Code.trnn.performance oftha work In, I Lit this permit is is sued GAS-IiA:SVSTI?M-I INOaOUTLETS %); OCC.CROUP APN
fy Workers Compensation lncu shom carver and Policy pointer am: -
Camcr. Policy N.,� GAS-EA.SYSTEMOVER a(EA) t
CERTIFICATGOF EXEMPTION(BOM WORKERS' y GREASININDUS'TIiL WASTi:INTERCEYfOR -
COMPENSADONINSURANCE BUILDING DIVISION Is1iGS
Mi,xeration readran permit isforone hundretl dnllanlSlWl OR'A""
I'
orleas.) -
PLAN CHECK FEE
I cenifythat inthe Perfommntent the work forwhichthis penmdis isxued,lsnall SEWER-S 1TARY-STORMEA2g1 FT.
col employ any ninon in any cormicr so as to bosun subject m the Workers'Compen- - ENERGY FEE
Z cation lawsuf Califamia.Dine
z� Applicant . :R HEATER WNENT/ELECTR GRADING ME
sy lA NOTICE TO APPLICANT:IL after making this Certificate of Exemption;you should WATER SYSTENITREATING
L~ "� became suhjwt m the Worker',Compensation provisions of the Labor Code,you must SOILS FBF
fnnhwith comply with suet provisions or this permit shall be darty revoked WAT13R SERVICI! ,i ...
..CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,PC PATO
a •
Ihorl achirm i permit
ee30 len ding agency forthe performance of Dam Receipt
� F the wisrk'fnr which this permit is ixsucJ[Sw.300],Co,CJ -
U Landers Name TOTAL:
1 nder'Add B
E„ y 1 <nify that 1 ha rc d Ih u p,licat I tate that th h int ation x BUILDING FEF: s
ma I far t only 'd II 'thy W: ry I' test I:rl : •(ming to QTY. MECHANICAL PERMIT FEE
V
huldingemistrarlion,and h by Ih ne p : I s,ofthis cityt t unto the SEISMIC FEE
aMwe-menlamed pmpcny for inspection purposes.
(We)ugmc 1. .,,:indemnify and keep hamdeas the City of Copenino against PERMIT ISSUANCE ELECTRIC
liuhilitie,judgmm�¢,costs nnJ expensax which may In any wayaccrueasl avid City Add ER OR ADD'1'O MECH.
is mnsequ secof the granting of this peril.• gvinPLUMBENCKEEN C.,PS - .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH'ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM)
SOURCE REGULATIONS. _ MUCHANi .F i
AIR HANDLING UNIT(OVER 111,0011 CPM) CONSTRUCTION TjX '
Signature of AppiicantlCommctor s Dam EXHAUST HOOD(W/DUCT) HOUSING MITIC ION FEE
'
HAZARDOUS MATERIALS DISCLOSURE
Will the upp]icaut or future building eacupam.store or handle hamrdous material HEAT]NO UNIT(10 100,000 BTU)
it,dclined by(be Cupertino Municipal Civic,Chapter 9.12,and the Health nodi Safety
Coda Section 25532m)'!' •, HEATING UNIT(OVER 100,000 BTU)- ,
❑Yes 0N yENTILATION FAN(SINGLE k[31D) • PAID
0 a Receipt Y
Will the air l ichnior future fundi ng by the:i use equipment or Ma ae which '
' .mil hnzordou,oar commminiints as dellned by dine BuY Arw Air Quality Management a BOILER-COM('f3HP Olt IlN1.OW H'I'll)
Dismrin^. TOTAL:
❑Yes ON. III-COMP(OVER 100,000 BTU)
s -
I have read the h:uallou,materials requiremenu under Chapter 6,95 of^ AIRCONDITIONGR the Culi- - ISSUA CE DATH
forms Health is,Safety Clsde.Sections 25505,25533 and 2551x.1 undmmnd that dike NEW RESIDENTIAL MECEL SQ.Fr.
building does nod currently have a tenant,that it is my responsibility to modify the lecupant ,
of the reyuireno:nts which now M mel prior to issuance of a Coni Ocvte of Occupancy.
Owner or auihmizeJ agent -
Data s TOTAL: ISSUED I3Y:
. OFFICE.. -
„ k1��
_ r
CUPERTINO SANITARY DISTRICT
20085 Stevens Creek Blvd., Bldg. C PRS:
Cupertino, California 95014 CHB: —
t (408) 235-7071AEF: =
5- R
File:
"OVER THE COUNTER REVIEW rr
Date: (9c�T
File: CuSD- MOP
Building Dept-Cupertino
Community Development Department- Building
City of Cupertino
10300 Torre Ave.
l Cupertino, CA 95014-3202 I I l /
1 Re: Subject: Fe-5 I Q�•—Tr�� A d d � �-r�-rt � � vi.raQeJ
r Name: 7CJ +-2 c t.J e
Address: 5 7 03 .Sum 7 /���'
APN: – Das
Control/Plan Ck No:
Permit No:
Gentlemen:
The Cupertino Sanitary District has reviewed the plans for the subject project:
❑ No additional conditions/requirements by the District.
•” Sanitary sewer is available and the existing building is connected to sanitary sewer, see
conditions/requirements listed below.
❑ Sanitary sewer is (not) available, see conditions/requirements listed below. (Refer plans
to County Health Department.)
The following Conditions/Requirements are made:
❑ Cupertino Sanitary District Fees or Permits are required for the subject
improvements please do not issue any building/grading permits
❑ Plans and enclosed Restaurant Wastewater Discharge Questionnaire shall be reviewed
by the Industrial Waste Division of the San Jose/Santa Clara Water Pollution Control
Plant, Phone 945-3028 for an appointment. Please Do Not Issue permits until
pretreatment recommendations have been forwarded to you by the District.
Locate and raise to grade a property line cleanout.
❑ Install a backflow,protective device (verify serviceability if existing.)
❑ Break areas authorized minor electrical appliances only.
❑ No disposal or commercial dishwasher installations.
❑ No addedclab/office equipment which results in additional waste water discharge.
Lam /1 e Ut9 i Kk 4�� Y'�- U reute,-k-4 /�_- b
• l� Other. ..........('.............................................. ............................. ....... .........
A dol UX)
The condensate from any HVAC equi ment, surface water or irrigation water shall not be discharged to
the sanitary sewer.