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06080165CITY OF CUPEkTINO _'ITY OF CUPERTINOM PERMIT APPLICATION FORM APN # b Fee ID Date: P/-- 41 Building Address: L,3 0/, Mailing Address (if different from building address): Owner's N e:. MECHANICAL Phort� #: Contractor: f rew� J�� License #: 6 �C Contact: Phone: '_ +t-01sIZI ICupertino Busi ess License#: i, Fax: c, >'t�- Building Permit Info: Boiler > 500K to 1M Btu I'ii-�► O'' Dn BBOILER4 Boiler > 1 M to 1.75 M Btu Bld `Z Elect Q Plumb E4 Mech [j Job Description: MECHANICAL Residential ❑ Construction Tax Commercial Sq.Ft. Floor Area: BCONSTAX Sq.f 96-43 Cost of Project: 0 Occupancy Group: t4 3 Type of Construction: V -a BUILDING Please check this box if the project is a BCONSTAXH Hotel and Motel second -story addition: ❑ Project Size: Standard X Large ❑ Major ❑ Constax - Resi/Mobile anti 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 > 1 M 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 1 of 3 aall,11ITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEK rINO Quantity 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 Sprinkler/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 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 BREMFIXT Lighting Fixtures ELECTRICAL BREMFLT N Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 1 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 OF „Rr� cl OFA CUPEkTINO JTY OF CUPERTINO 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 BTEIVIPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL 6 Y MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING `T PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 CITY OF CUPERTINO 'ks ib"I ., r �I Y2w -ITY OF CUPERTINO PERMIT APPLICATION FORINT APN-# Fee Description Fee Group Date: 3G `� �-c� > -- oo MECHANICAL BBOILERI Boiler <= 100,000 Btu Building Addres : BBOILER2 Mailing Address (if different from building address): MECHANICAL BBOILER3 c �o/vz- Ownler�'s. N me: BBOILER4 Boiler > 1M to 1.75 M Btu Phone #: Contractor: Boiler > 1.75M Btu MECHANICAL License #: T BUILDING BCONSTAX Ind/Off/Comm/Quasi Contact: �-n Faone., ��-��-k .Cu ert-7i nnow Business License#: BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Building PeiTnit Info: _ U Bl g ❑ lect ❑ Plumb ❑ Mech ❑ Job Description: BELEC1001 Elec 600V> 1000A Residential ❑ BELEC200 Commercial Sq.Ft. Floor Area: BENERGY Sq.Ft.: Cost of Project: BENERGYADD Occupancy Group: BUILDING BINVESTIGA Investigation fee Type of Construction: C— -- Please check this box if the project is a second-storyaddition: ❑ Project Size: Standard ❑. Large ❑ Major ❑ 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 — ResWobile 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 of 3 J IT 1 _ ITY OF CUPERTINO CITY OF PERMIT APPLICATION FORD CUPfk lNO Quantity 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 Lection Overtime i BPBAC'KFLOW Atmospheric Vac_ uum BPCESSPOOL Cesspool BUILDING PLUMBING 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 BPSPRM Lawn Sprinkler/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 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 BREMFIXT 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO �TY OF CUPERT'INO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNTS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD BSEISMIC'()M - BSEISMICRE Scb Specific Plan Seismic Commercial. _ _ Seismic Fee Res BUILDING BUILDING -- _. 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 Electnical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech 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 Change BUILDING 3 of 3 CITY OF CUPERTINO BUILDING DIVISION PERMIT�TQ�RMTI� auING ADDRESS: MICHAEL CHEN PERMIT N°' 06080165 0030 STEVENS CREEK BLVD NER'S NAME: PERMIT ISSUE DATE MICHAEL CHEN PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing P with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. DEMO/TI RESTAURANT -INTERIOR ONLY MECHANICAL License Class Lic• # r Date Contractor ELECTRICAL, PLUMBING-STEVENS CREEK BUFFET ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance. also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter' (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). [11, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. I am exempt under Secy , B & P C for this reason r'WOVKER'S COMPENSATION DECLARATION I hereby affim`f under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (chis section need not be completed if the permit is for one hundred dollars ($ 100) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Cal' tc Applicat}t NOTICE TO APPLICA : If, after making the C rifrcatc of Exemption, you should become subject to the orkees Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOUR GULATIONS. j /i—7/_Y.Le moi, `�. / o --C/ ._tom e HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety .tde, Section 25532(a)? ❑ Yes i No Will the applicant or fu urc building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District. ❑ Yes Adous o I have read the hazarterials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requs which must befit let prior to issuance of a Certificate of Occupancy. Owner or ZZ Date Sq. Ft. Floor AreaI Valuation $92500 APN Required Inspections Issued by: Re -roofs Type of Roof Date r Type All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better rN BUILDING DIVISION PERMIT BUILDING ADDRESS: MICHAEL CHEN 20030 STEVENS CREEK BLVD_ OWNER'S NAME: MICHAEL CHEN _ PHONE: ' ARCHITECT/ENGINEER: 00 LICENSED CONTRACTOR'S DECLARATION U F I hereby affirm that I am licensed under provisions of Chapter 9 (commencing i Z i with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. i ? License Class Lic. p F, p Date Contractor ARCHITECTS DECLARATION wa I understand my plans shall be used as public records :yu O N Licensed Professional t 0 S OWNER -BUILDER DECLARATION j>_ 1 hereby affirm that I am exempt from the Contractor's License Law for the 0following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure I o prior toils issuance, also requires the applicant for such permit to file a signed statement ?< that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 t=— (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (3500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon, and . who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. ❑ I am exempt under See , B & P C for this reason Date '140 KER'S COMPENSATION DECLARATION I hereby alr under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: PERMIT NO. 06080165 PERMIT LSSUE DATE SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description DEMO/TI RESTAURANT -INTERIOR ONLY,MECHANICAL ELECTRICAL,PLUMBING-STEVENS CREEK BUFFET Sq. Ft. Floor Area APN Number Required Inspections Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (3100) or less.) 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Califo i, . ate Applicant --'11, NOTICE TOA PLICA : If, after making this Certificate of Exemption, you should become subject to the'Worker's Compensation provisions of the Labor Code, you must ,Z forthwith comply with such provisions or this permit shall be deemed revoked. zO CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the perfurmance of (�' the work fur which this permit is issued (Sec. 3097, Civ. C.) W 0 Lender's Name Z:) Z Lender's Address U Q I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to U building construction. and hereby authorise representatives of this city to enter upon the >-4 W above-menduned property for inspection purposes. (]. (We) agree to save, indemnify and keep harmless the City of Cupertino against Hto Iiabilitics,judgmenls, costs and expenses which may in any way accrue against said City U 2 in consequence of the granting of this permit. ►- APPLICANTUNDERSTANDSAND WILL COMPLY WITH ALL NON -POINT Issued by: //; . .C(_ / O -,/- . L` c Signature ofplicant/ontractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstore or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? Cl Yes No Will the applicant or fu ore building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? ❑Ycs AN"o Ihave dthchazartcrialsrequirementsunderChapter6.95oftheCalifor- nia Health & Safety Cede, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my responsibility to notary the occupant of the rcqui s which must be met prior to issuance of a Certificate of Occupancy. Owner or aS6orizcd agent Date Re -roofs Type of Roof Valuation $92500 Occupancy Type Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: '% c o ��,' e%^ �� �� g PERMIT #0 '50 OWNER'S NAME: PHONE # GENERAL CONTRACTOR: - yaV\ FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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