10080188I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20010 STEVENS CREEK BLVD
OWNER'S NAME: HEINZ JONG
OWNER'S PHONE: 8009350560
❑ LICENSED CONTRACTOR'S DECLARATION
License Class„// X -��,R�%�(��' -,)L Lic. N /q1
Contractor /A�r- t-J9FJ*+[7//t/(l Date�es7�j
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a ceni ficate of consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the tabor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives enter of this city to
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 exp which may accme against said City in consequence of the
granting of is pe it. Additionally the applicant understands and will comply
with all nob -point s ree regular s per the Cupertino Municipal Code, Section
9.18.
Date °8 - 20(D
❑ OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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 (Sm.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the pmjmt (Sm.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 Worker's
Compensation laws of Cali forma. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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 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 accrue against said City in consequence of the
grunting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
CONTRACTOR: MG/SOMA CONSULTING PERMIT NO: 10080188
INC
2535 W WINTON AVE STE 4G DATE ISSUED: 08/30/2010
HAYWARD, CA 94545 1 PHONE NO: (510) 781-0500
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: REMOVING 3 NON-STRUCTURAL WALLS
Sq. Ft Floor Area: I Valuation: 51500
APN Number: 36903005.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bv: Date
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspeolion, 1 agree to remove all new materials for
inspection.
Signature of
Date:
ALL ROOF COVERINGS TO BE CLASS "A” OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
conga Lempliance
defined by the Bay Area Air Quality Management District 1 will
mal aiwith the Cupertino Municipal Code, Chapter 9.12 and the
H Ith Code, Se ons 25505, 25533, and 25534.
wren ed ant:
Dale: a3/r3�/v/,
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
I understand my plans shall be aced as public records.
Licensed
am- CITY OF CUPERTINO
OF
CUPERJ1INO GENERAL BUILDING
PERNHT APPLICATION FORM
APN # j 0'3 0 t'
Date:
l6 .
Building Address: %ln S9�✓e.,3 Cf &_4
/•fib/.
'�--e C,?
Mailing Address (if different from building address):
/
Are Hazardous Materials being used as part of this project? Yes
No
HOA:(Exterior work only) Yes ❑ No Z If yes,
provide letter from HOA
Owner's Name: y_
. �T�M� c/�+s✓L
Phone
#:
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Contractor:Phone:
/�/%�% �•�//� Com+�7in/G—
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Fax:
3—lo- W. o Loo
Contractor License #:
Cupertino Business License #:
Contact: /
V
Phone:
Zu. j90
Fax:
�76/ o Ls
Residential Commercial
Job Description: 62e. -,OL/
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑
Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B E� II/UI/V-A ❑ IVM B, IV -HT, V -B ❑
Valuation: q '
Square Footage:
Project Size: Express Standard ❑ Large ❑
Major ❑
Green Building: Please complete relevant portion of the Green B ' ding/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.builditgreen.org
Revised 07/14/09
IN A(
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CODESEC. I SHEET I NO.
FIRE DEPARTMENT
SANTA CLARA COUNTY
14700 Winchester Blvd., Los Gatos, CA 95030-1818
(408) 378-4010 (phone) • (408) 378-9342 (fax)
CONTROL NUMBER
PERMIT NUMBER U CV:J�
PLAN CHECK No,
Existing fire sprinkled& fire alarm systems shall be modified as necessary. Submit 3 sets of drawings,
completed permit application & fees to the Santa Clara County Fire Dept. for approval prior to altering
system. CFC 901.4
All portions of the building shall be within 75 feet of a fire extinguisher having a minimum rating of 2-
A:10 -BC. CFC 906
Commercial cooking equipment shall be provided with a Class K portable fire extinguisher located within
30 feet of the equipment and in the path of exit travel. CFC 904
Egress doors shall be readily operable from the egress side without special knowledge or effort & shall not
require tight grasping, tight pinching or twisting of the wrist to operate. Key operated locking devices are
permitted when readily distinguishable as locked and signed THIS DOOR TO REMAIN UNLOCKED
WHEN BUILDING IS OCCUPIED. CBC 1008. 1.8
Means of egress shall be illuminated at all times with 90 minute back up where 2 or more exits are
required. CBC 1006.3
Exits shall be marked by illuminated exit signs. Signs shall be illuminated at all times and have 90 minutes
of emergency backup power. CBC 1011
6 Contractor shall field verify the integrity of existing rated construction/assemblies and restore or repair as
necessary. Penetrations in rated walls/ceilings shall be protected by listed fire rated assemblies (dampers,
doors, caulking, fire stopping, etc.) CFC 703
Tenant shall provide a labeled emergency access key for placement in the building emergency access key
box. CFC 506
This plan check does not perm it the use, storage or dispensing of hazardous materials; operations or waste.
Tenant shall provide a completed HMIS to the fire department's hazardous �++atcrials specialist folr review
and comment. A CLOSURE PERMIT is required prior to termiiiating the` Qrriagof hazardous materials
c
at a permitted storage facility. Demolition of any facilityistorage area that previously tsly orerl'hazacd.ou�s
materials shall not be approved prior to obtaining a CLOSURE PERMIT.
APPROVED: OKAY to issue building permit subject to compliance ��rith above items.
JURIS PLANS SPECS NEW REMODEL ASCONST DESCRIP SV DATE 'PAGE
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