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08120091CITY OF CUPERTINO ayP stn-;�'!*�-.tea �g''>' ��,g-� BUILDING nIVISISINa PERMIT �r'rg�'" tart ..�::Q.I TRACT�R�Itf1<D�A °IDi� ?°a`'Ph:&ra;.rTe6, :-t,%` ads hsa� BUILDING ADDRESS: PERMR NO. 10881 S BLANEY AVE TBD - TO BE D ' OWNER'S NAME: PERMIT i55t1E DATE ONE: A CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CON'MACIOWS DECLARATION Job Description I bercby affirm that I am licensed under provisions of Chapter 9 (commencing of rvreionlof Business eusin,and Profcssiam Code, and mylicense is in fail fortea�ffcn. REPLC EXTER ROOF MNTD LIGHTS W/TITLE 24 COMPLINT, License ClassLk.Is Dam Cantracher WALL MNTD LIGHTS W/CUTOFF SHIELD ARCHITECTS DECLARATION 1 understand my Plana shall he used as public records Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt them to Commetort License Law for the fallowing mason. (Section 703 1.5, Business and Profestioa Code: Any city or county which ¢quires a permit to convect. altar, impmw, demolia , or repair any swcture pnof 11) its issuance. also mgaiRa the applicant for such permit to rile a algncd slltamanl Sq. Ft. Floor Area Valuation Thar be is licensed smsumlto the provisions of the Contractor's License Law (Chaper9 (commencing with Section ]00)) of Division 3 of the Basin= and Professions Code) or 4 O O (] exnpt therefrom and the basis for the alleged exemption. Any violation of Nat M uct APN Number Occupancy Type Section 703M by airy applicant for a peit subjects the applicant to a civil penalty of permit nam tame tluv ftw hundred dollars (SM 36934052.0 (] ❑l,uawrcr of tk prvparty.mmY wploymca with wagesv their sok compenhaden, Required Inspections will do the wort and theaaacam, I$ mKialmdad aroffemd fortale (Sec. 7054. B ssircss and Pmfasdares Code: The Canmct s License Law does oat apply to an Owner of property who builds or improves thereon, and who does such wort himself or Nmugh his own employees, provided Nal such improvements are notinlended ar Olrea d for We. If. howews the building or improvement is sold within atm year of rompicni n, Ne owncr- builder will haw the burden of proving that he did Out build or improve for purpose of sale.). owner of the propa ty. am atlutiwly co meting with licensed conttxmrs to muwct to project (Sec. 7014. Business and Prelcuuma Cade:) The Conaacmrs U. cense Law does not apply to an owner of property who builds or improves thereon. and who contracts for Bach projects with a eonlriemr(s) licensed pursuant to the Conasences License Law. ❑ I "ft See. . B & P C for Nis rsmon Owner/ ��y '�� 1--�--Dau I t' WORKER'S O�MPENSATION DECLARATION 1 hereby alfum under Penally of ped., one of the following dedartt am e - hsw and will maintain a Certiriea a of Consent to self-imuum for WorluYsCompen- on, u provided for by Section 3700 of the Labor Code. far the performance of the wart for which d u p met u issuad. 0 I haw and will maintain Workers Compemadon hrsmmce, as ¢tapered by Section 37W of Ne labor Code. for the perrmmane,of the work for which Nis Permit is issued. ' My Workers Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE rl3mlaaccton head mil acemnpleheJ if to permit is foram, hundred deflart (SIW) or kss) I comfv that in du perfmmuue Of the work for which this permit u caused, 1 shall net employ trey person in any manner so as mlkcomesubject to the Workers' Compmwtan Laws of Califami�^Z Y tA� iI �.Y Applicant /� �' NOTICE TO APPLICANT: If, after rallang this certificate of Exemption, you should became subject m the Wodmrs COmpevadon provisions Of the labor Code% you Most forthwith comply with such NNYVIROM or Nu permit shall be dem ad reveled. I CONSTRUCTION LENDING AGENCY ' I hereby affirm the ft. is a construction lending agcmy far Nc performanceOf the week for which this permit is issued (Sc. 3097. Civ. C.) Lenders Name , Leaders Address I certify Nat 1 haw read this application and suis that the abuw information is ' correct I agree in comply with all city and county ordinances and suis laws relating in building construction. and Womy amhodan mp arentaives of this city to enter upon the l above-mentioned pmpaly for inspection purposes (We) agree to have. indemnify and lamp Imarmleas the City Of Cupertino against i liabilities judgments, costs and expenses which may in any way accnhe against red City in consequence or the g.drg of this pemmt ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date SOURFEGULATIOONN , Re-roofs Type of Roof / Sigwum of Applicants nuactor Dam HAZARDOUS MATERIALS DISCLOSURE Will the applicant Or future building uccupenlsmre or handle hmsrdow malarial as deffm d by the Cupertino Municipal Codc. Chapter 9.13, and the Health and Safety Code. Section M32(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑yes 'WNC If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which I has mmus air cocurriwtu as derittd by to Bay Area Air Quality Msnagcmcm all new materials for inspection. ct7 ❑yes �]No 1 have mat! the ham dour materials requirements under Cha ner6.95 of the Califor. nia Health& Safety Cade, Sections 25505.25533 and 2553d. l undeumand thmifNe Wilding does not currently haw a means that it u my mapmuibility to notify the hcaupant Of the rcquircm tawhich MUUA mel poor to issuance of a Certificate of Oc7scary Signature of Applicant Date BYO All roof coverings to be Class 'W' or better Data 0wner or authomcd age¢ 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN .1......: 36934052.00 DATE ISSUED.......: 12/12/2008 RECEIPT #.........: BS000006813 REFERENCE ID # ...: 08120091 SITE ADDRESS .....: 10881 S BLANEY AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER PACIFIC RIM PARK, LLC ADDRESS ..........: 5057 FOREST GLEN DR CITY/STATE/ZIP ...: SAN JOSE, CA 95159 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: STEVEN F CASERZA CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBD - TO BE DETERMINED ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: OFEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL 1BREMFIXT NO. FIXTURES 1.00 61.19 0.00 61.19 0.00 1BSEISMICO VALUATION 4,000.00 0.84 0.00 0.84 0.00 1EPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT - --------- 143.61 0.00 ---- ---------- 143.61 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------------ CREDIT CARD ------ 143.61 --- VISA ------ --------------- TOTAL RECEIPT 143.61 • Y CITY OF *UPERTINO L Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408)777-3333 Building Department JOB ADDRESS: n /� ,, C W SU✓%% ,S cti i L PERMIT # 2- 0U1e/f OWNER'S NAME: c t kc Lrr-/Gt z -Lc PHONE # Zs -s- Y16 GENERAL CONTRACTOR FAX # V `J& z S37 y,,6 I am not using any subcontractors: � `- ved Signatur Date Please check applicable subcontractors and complete the following information: Owner/ ntractor ignature ate 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/ ntractor ignature ate a• Assessors Parcel Number: 369-34-052-00 Name of business. Pacific Rim Park, LLC Project address. Contact person. 10881 South Blaney Ave. Steven F. Caserza Current use of space. Tin Tin Market Proposed use. same Building construction type. concrete Occupancy Group(s) Occupancy Load. •Square footage of remodeled area. Is the building equipped with: Fire sprinkles? Number of floors in the building? 1 V IN Phone. 408-255-4163 V U Fax. 408-255-4163 q� ,ME Plerly and 1 on the i h , "Poo ificaQn„ nh B W L411YCir n¢e rs B8 S the 6ubwL_ _ ou, w Or au. _.. Utt Or W' of "' up � aa * 1 tTie��StsY0 On what floor(s) is work being done? 1 (exterior) Brief description of work. replace exterior roof .mounted lights with Title 24 compliant, wall mounted liqhts with cutoff shield. Code editions: 2008 CBC (Y - N)2008 CFC (Y - N)2008 CMC (Y- N) 2008 CPC (Y - N)2008 NEC (Y - N) Effective 1/1/08 Are there any chemicals/hazardous materials to be stored at site? Y If above answer is yes, provide a list of materials and quantities. If job is involves food service, provide 3 extra plan sets for Health D 8002 I Z X30 • CI�1�Y���g $Y:/�� Commercial Plan Review Process Work BookPage -10- revised 1/1/08 R w� 11 0 • 11/04108 Applications — Security, pathway and perimeter lighting; ideal for entry ways, walkways and parking facilities, especially where glare can be an issue. Typical Mounting Height: 8 to 18 feet Typical Spacing: 2 to 3 times the mounting height JiiA' >_ w of .• .• %a .i7 rem` _4 ,moi+ 8-3/8"H x 8-3/8"W x 17-7/8"D One medium base lamp included Sturdy die-cast aluminum housing and lens frame, with dark -bronze polyester powder -coat finish Adjustable cutoff glare shield One piece anodized aluminum reflector • 1/2 -inch NPT tapped back and two sides for conduit entrances • Optional photocell available • UL Listed for wet locations • 1 -year warranty Photocell, field installed CAT.#: E-ACpi (120 volts) CAT.#: 11 (208/240/277 volts) 1501 9V Street Sturtevant, Wisconsin 53177 1 (888)243.9445 1 Fax (262)504-5409 1 www.e-conolight.com Lamp . •• D- • • • •-: Weight amp I Color Outputase Rendition 70 -watt High 120 -volt Reactor Clear, E-WPAH071Z Pressure Sodium ballast NPF E26 medium base 9 Pounds 6000 lumens 22 CRI (HPS) Wail Pack (-HP070M) E-WPAM071Z 70 -watt Metal Halide (MH) Wall Pack 120 -volt HX ballast NPF Clear, E26 medium base 10 Pounds 5500 lumens 70 CRI (-MH070ME) E-WPAM10DZ 100 -watt Metal Halide (MH) Wall Pack 120/277 -volt HX ballast NPF Clear, E26 medium base 10 Pounds 8500 lumens 70 CRI (-MH100ME) x Sturdy die-cast aluminum housing and lens frame, with dark -bronze polyester powder -coat finish Adjustable cutoff glare shield One piece anodized aluminum reflector • 1/2 -inch NPT tapped back and two sides for conduit entrances • Optional photocell available • UL Listed for wet locations • 1 -year warranty Photocell, field installed CAT.#: E-ACpi (120 volts) CAT.#: 11 (208/240/277 volts) 1501 9V Street Sturtevant, Wisconsin 53177 1 (888)243.9445 1 Fax (262)504-5409 1 www.e-conolight.com �J • ITY Of CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM 0h),0091 APN# Date: 369-34-052400 12 December 2008 Building Address: 10881 South Blaney Ave. Mailing Address (if different from building address): 5057 Forest Glen Drive, San Jose, CA 95129 Owner's Name: Phone #: Pacific Rim Park, LLC 408-255-4163 Contractor: V)Phone: Fax: Contractor License #: Cupertino Business License #: Contact: Phone: 408-255-4163 StevennF. Caserza Fax: 408-255-4163 Residential El Commercial Job Description: replace exterior roof mounted lights with Title 24 compliant, wall mounted lights with cutoff shield. Building Permit Info: Bldg ❑ Elect © Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, N -HT, V -B 1 Valuation: �A &C, Square Footage: vv - Project Size: Ex rens 99'� Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.buildit reen.or . Revised 10/20/08