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13010113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11010 N DE ANZA BLVD CONTRACTOR:WAYNE PERRY INC PERMIT NO:13010113 - OWNER'S NAME: CUPERTINO DE 7R9 CLUB INC 8281 COMMON WEALTH AVE DATE ISSUED:01222013 OWNER'S PHONE: 7148260352 BUENA PARK,CA 90621 PHONE NO:(714)826-0352 JOB DESCRIPTION: RE SIDENTLIL LICENSED CONTRACTOR'S DECLARATION COMMERCIAL (;\p MLio p �D�3Q 5 CHEVRON-VOLUNTARY BARRIER REMOVALS License Class _ Contractor pate 22 I hereby affirm that I am licensed under the provisionsof Chapter 9 (commencing with.Section 7000)of Division3 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 certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the S Ft Floor Area: Valuation:$7500 performance of the work for which this permit is issued. q• I 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 APN Number:30942041.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.d agree to comply with all city and county ordinances and state laws relating W ITMN 180 DAYS OF PERMIT ISSUANCE OR to building concoction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: r/ granting of thi=Mz e itAddluo lythe applicant understands and will comply with allo Manic' al ,Section 9.18. RE-ROOFS: Signature Date Z ` 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. , ❑ OWNER-BUILDERDECLARATION Signature of Applicant: - Date:. I hereby affirm that I am,exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: - 1,as owner of the property,or my.employees with wages n their sole compensation, will do the work,:and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) - - HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to - constrnctihe project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6:95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous strict I Compensation,as providedfor by Section 3700 of the Labor Code,for the will me ntaiair o comp more ce wRh the nts as defined by the aperMDate y Area Air Quality r ,Chapter 9Management .12 and performance of the work for which this permit is issued. the Health&Safety Code, eti a 2550 I have and will maintain Worker's Compensation Insurance,as provided for by Z I� Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ��� • ?/ permit is issued. . - I certifythat 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 CONSTRUCTION LENDING AGENCY Compensation laws of California If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby h ch thithat s permit ere is aceis issuedtru tion(Selending Civ for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work'Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read[his 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit:Additionally,the applicant understands and will comply with all-non point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18`. Signature, Date CONSTRUCTION PERMIT APPLICATION ry COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ((���(��\ J —M 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �/4#/ (408) 777-3228•FAX(408)777-3333•buildincl(apcuoertino ora 9✓✓ CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT N PROJECT ADDRESSAPN t , of o Qo�k "v � �u 3U OWNERNAME G a G PHOM¢. 1'J �a v Pj�� E-MAIL STREET ADDRESS CITY,STATE,ZIP SW r7 h 1,16 0 CA FAX 6�L�tJ G e1� � U / 1 CONTACT NAME�,/� �J (-�`It(E PHONE�1 ` ��� (Q bI E �i--(�G�Ie � � �CLa� CITY S TE,ZIPA / r,/ FAX STREET ADDRESS y1 �OM�ON ,Ol J�A�Ej Utl.l A`��� }-. �'it gOb2 FNER ❑ OWNER-BUILDER ❑ OWNERA EGENT"T �0 CONTRACTOR OCONTRACT'ORAGENT 0 ARCHITECT DENGINEER DEVELOPER 11 TENANT LICENSENUMBER 7 Ob LICENSETYPE ( BUS.LIC# /� TOR NAM _k6A. ( —�(( 7 � '$Lt('J ri�Z 2,S2 klH�� ` ESL FAX YNAME I '` ^ 1 �K7 �G �P i�G 1e�W �^cc0M�/NCITY,STATE.ZIP ��// PHONE/) 22 SDDRESS 8z8( ttJ'k ltcc cN ' OIQL C JA OLICENSENUMBERBUS.LiC#CT/ENGINEER NAMEFAX -MAILYNAMEADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSEDUSE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑DAETAACH CH n DWELLINGIJMTS: isAECONDVOYES BEING ADDED? 1T ONO ADDITION?ORY ONO COPY OF PRE-APPLICATION DYES ffYES,PROVBJE Is THE BLDG AN ED] "RECE+ B PLANNING ADPL# ONO PLANNING APPROVAL LEITER EICELER HOME? ❑NO 4t By my signature below,I certify to ach of the following:I e property owner or authorized ge act on the property owner's behalf. I have read this application and the information I ha provid is correct. I h v rea a Description ofd f Work and it is accurate. I a ee to Perryomplwith all applicable local ordinances and state laws relating to 'di construction. iz representatives of Cupertino to enter the above-idei ti z Perry with inspection purposes. d Date Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED ` New SFD or Multifamily dwellings: Apply for demolition pennit for existing building(s). Demolition permit is required prior to issuance of buildmg ❑ E ��, � t� � w, permit for new building. _ _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to JOR j t ' 'p',.SXr sswe[e:b, submittal of Building Permit application. ENXI ON' NT '3[E`�A BldgApp_2011.doe revised 06/21/11 I (O P CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 1 S DE ANZA BLVD DATE: 01/22/2013 REVIEWEDBY: MENDEZ APN: - BP#: *VALUATION: 1$7,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION Commercial Building 1GENCOM USE: . PERMIT TYPE: WORK VOLUNTARY BARRIER REMOVALS SCOPE � .. Alech.Plan Chcck - Plumb. Plan Check Elec.Plan Check :l e& Pe nit Fees: Plumb. Permit Fee" Flet. Permit Fee: Other A1ech.Ins71. - Other Plumb Insp. Other 1;lec.Insp. Li I - d3ech.Imp. Fee: - Plumb. Insp. Fee: Elcc.Insp.Tee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School . District etc). These fees are based on the prefindn in ormadon available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eff 711/12) FEE QTY/FEE MISC ITEMS PlanCheck Fee: Hourly Only? ®Yes Q No $0.00 1 hours Plan Check,Hourly Suppl. PC Fee: Q Reg, O:OT 0.0 hrs $0.00 $133.00 ISTPLNCtc PME Plan Check: $0.00 Permit Fee: Hourly Only? ®Yes O No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Feer $0.00 PME Permit Fee: $0.00 Cons Iniction Tnr: Administrative Fee: Work Without Permit? O Yes (j) No $0.00 0 Advanced Planning Fee: $0.00 1 hours Inspections 0 Travel Documentation Fees': $133.00 ISTINSP Inspection,Hourly o Strong Motion Fee: IBSEISMICO $1.58 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 „ „ $2.58 $266.00 NOTAL FEE $268.58 Revised: 10/01/2012 SITE PLAN S E'.1'=304' SITE INFORMATION OWNER:CHEVRON,INC.-CHEVRON FACILITY NUMBER M700 OCCUPANCY:M,CSTORE,MINIMART CODE REFERENCE DATA:2010 CALIFORNIA BUILDING CODE CONSTRUCTION TYPE:V-B SCOPE OF WORK o ppp_ s aootlw' luxe VOLUNTARY BARRIER REMOVAUMAINTENANCE PROJECT: Nw.r TSN— wn wT Ju O1 INSTALLATION ON 60 SO FT CONCRETE WALKWAY AND REMOVAUREPLACEMENT OF APPROXIMATELY 260 SO FT OF FLAT CONCRETE r O PROVIDE "HONK FOR ASSISTANCE"AND CREDIT CARD DECALS AT FUELING ISLANDS. � O INSTALL O SO FT OF TRUNCATED DOMES AT PATH OF TRAVEL AND BUILDING ENTRANCE � �J o Q CONSTRUCTION NOTES PATH OF TRAVEL SHALL MEET CURRENT 2010 CALIFORNIA BUILD !J5 REMOVE AND REPLACE ® AN 2 2 r.c.� •, I APPROXIMATELY 260 So ® FT OF FLAT CONCRETE I INDEX OF DRAWINGS Q \ \ O O SITE PLAN.........................................................................................................................................._...... .. .. SHEET U 4av,1 emeaw ., C CONSTRUCTION DETAILS.................................................................................................................................SHEET2 G O LEGEND �I O O O ©6 • CONCRETE REPLACEMENT O O INSTALL CHEVRON PROVIDED"HONK FOR O O O INSTALL 4 'MIN.WALKWAY THROUGH ASSISTANCE"DECAL AT FUELING ISLAND aeEXISTING PLANTER WITH MAX.5% A SLOPE AND 2%CROSS SLOPE "•e• INSTALL TRUNCATED DOMES t COMMUNITYDEVELOPMENTUPERTINO N N BUILDING DIVISION-CUPERTINO ❑ INSTALL(4) KI APA..RU JE® DIFURNISHDIRECTIONAL ANDINSTALL ACCESSIBLE ROUTE e TRUNCATED DOMES AT }, r�-+ VV CC DIRECTIONAL SIGNAGE 4 p�T BUILDING ENTRANCEIK 9��� INSTALL(6)HONK DECALS This set of plans and specifications MUST to k, �.1_u�0 WTH NEW CREDIT CARO DECALS AT EACH DISPENSER job site during Construction. it is unlawful to make any t.;ge3'.; i . C)"dment changes or alterations on same,or to deviate }:; u%►dlf3 therefrom,without approval from the Building Officl 1. a ■ ■ a The stamping of this plan and specifications oh �_�; 2 2 203 a be held to permit or to be an approval of th 11 F'EVIE'i4E�J;`OR 0 Oi1�L{A�lOE ,y of any provisions of any City Or;finance a N mow= um �—wao. <,�„ .. RCVi�:v6'.'.F�gy: TBY A INSTALL DIRECTIONAL SIGNAOBATE r.m. e TO ACCESSIBLE ROUTE PERMIT NO. Carc DE ANZA BOULEVARD F � � � w Dw`'T'NSHEET TIRE AC 01/05/2015 WFIGURE No. Z w WAC SITE PLAN �. 3 . gLypq OWNERSITE LOCATION ® CHEVRON FACILITY NO.9-5700 REV m 11010 NORTH DE ANZA BOULEVARD PROJECT NO. 0 15 30 CUPERTIN0,CALIFORNIA 12.487 x\ENG-B..\a�«AN.nA\..srt«aaa.a m Tml\�7o0_11010 N„n,o.Anm er+e.aFw�e\�7au�ro PmNy.xw.ey ACCESSIBLE PARKING SIGN R99C(CA) TOW WARNING SON 31006(CA) REFIECTORIZED SIGN CONSTRUCTED OF SIGNAGE AND IDENTIFICATION OF SPACES- APPROPRIATE ADDRESS AND PORCELAIN STEEL WITH BEADED TEXT 1. EACH ACCESSIBLE PARKING SPACE TO CONTACT INFCLMATCN MUST BE OR EQUIVALENT INCLUDED ON SIGN(MIN. CHARACTER HAVE PERMANENT (70 SO. IN.) OF 1 INCH HEIGHT) REFLECTORIZED PORCELAIN ENAMELED STEEL SIGN, FREE STANDING SIGNS S LOCATED IN A PATH OF TRAVEL SHALL N®d. BE MOUNTED A MIN. OF 80" ABOVE WALKING SURFACE. WALL MOUNTED JBE PARKING SIGNS LOCATED AT INTERIOR END OF ONLY �" PARKING SPACE SHALL BE MOUNTED A LETTERING ON SIGN MUST __ MIN. OF 36" ABOVE FINISH GRADE. ON WIE)A COLOR(Bu2. OFF—STREET PARKING FACILITIES 70 ON WHITE) G 1 INCL HEIGw u §250 HAVE SIGN AT EACH ENTRANCE OR IMMEDIATELY ADJACENT TO E VISIBLE FROM EACH STALL OR SPACE NOT 1.TM1A�S901E LESS THAN 17"x22" IN SIZE. SIGN TEXT vuwa m a o xelc rveluAnr ` + SI BE BEADED (OR EQUAL). DIRECTIONAL ROUTE slaHs x1nH To wx1 L %I,I 3. SIGN TEXT TO STATE THE FOLLOWING: ISA ID AT EVERY PRIMARY ENTRANCE vowel AND MAJOR JUNCTION IN THE vpaA sImyP ;yg, "UNAUTHORIZED VEHICLES PARKED IN AccESSBLE ROUTE DlRwnxc TDwARDs z1` DESIGNATED ACCESSIBLE SPACES NOT THE ACCESSBLE ENTRANCE Z sol T°eE � a I Twm aAlpTn DISPLAYING DISTINGUISHING PLACARDS OR SPECIAL LICENSE PLATES ISSUED xipxngWFm " 1 FOR PERSONS WITH DISABIUTIES WILL vel,axasRWr BE TOWED AWAY AT THE OWNER'S m "F""PPgppNA1E - EXPENSE. TOWED VEHICLES MAY BE RECLAIMED AT CUPERTINO POLICE DEPT. OR BY TELEPHONING 408-868-6600." ESE FILL IN BLANK SPACES WITH o APPROPRIATE INFORMATION AS A PERMANENT PART OF THE SIGN. n CONTACT LOCAL JURISDICTION FOR APPROPRIATE INFORMATION. FINISH RWR 4. SIGNS SHALL BE LOCATED CURB SIDE SO THAT A 24" OVERHANG OF A PARKED VEHICLE SHALL NOT DAMAGE IT. ACCESSIBLE PAFKM SIGNS 7 NTS TRUNCATED DOMES mum 1/4-HOLE F 1-1/Y TOOL SMOOTH TILE EDGE O MATCH TOMEALu nax WALKWAY 3r� O ADJACEP SURFACE HWT (ONJOR MATCH DOM) O pig O 0 O sa IOOOO�OOOOI ° Ni IOD 0 �I CURE NO g 1 0 0 1 0 O I >' . 8didira Do artment PR IN�lE3�N%r� DBS,RDCiLCN b _ G O_O - MR �� PoETEAND THRdR1CaHTERT ^A OF TILE EACH WAY *RESISNT �1l/ �WALL( AND SIDEWALK NOTES: pt?er�,, EVI,�fEWEGE GROOVED BORDER 1. WALKS AND SIDEWALKS SHALL HAVE A CONTINUOUS COMMON SURFliCE xWH�H1TtABRUPT CHANCES IN LEVEL EXCEEDING 1/4 INCH (CBC 11338.7.4) AND SHALL BE2. SURFACES WITH SLOPE OF LESS THAN 6PERCENT GRADIENT SHALL BE AT LEAST I :'1 THAT DESCRIBED AS A MEDIUM SALTED FINISH. 77� 3. SURFACES WITH SLOPE GREATER THAN 6 PERCENT GRADIENT SHALL BE SUP RESISTANT. 4. SURFACE CROSS SLOPES SHALL NOT EXCEED 2% ( 1/4 INCH PER FOOT) AND 5% SLOPE IN THE DIRECTION OF TRAVEL 5. WALKS, SIDEWALKS AND PEDESTRIAN WAYS SHALL BE FREE OF GRATING WHENEVER POSSIBLE. FOR GRATINGS LOCATED IN THE SURFACE OF ANY OF THESE AREAS, GRID OPENINGS IN GRATING SHALL LIMITED TO 1/4 INCH IN THE DIRECTION OF TRAFFIC FLOW. 6. WHEN THE SLOPE IN THE DIRECTION OF TRAVEL OF ANY WALK EXCEEDS 1 VERTICAL TO 20 HORIZO UNITS (5%) IT SHALL COMPLY WITH THE PROVISIONS FOR PEDESTRIAN RAMPS AND RAIUN S. 7. WALKS AND SIDEWALKS SHALL HAVE CONTINUOUS COMMON SURFACE, N07 IN RUPTED Y STE ABRUPT VERTICAL CHANGES IN LEVEL EXCEEDING 1/4 INCH. LEVEL CHANGES B 4 IN D B IXfiPA7F10F TiAYH. INCH ARE BEVELED A MINIMUM OF 1:2. CHANGES GREATER THAN 1/2 INCH SHA BE AC SHED BY 1 Nis MEANS OF A RAMP.. DR1WN SHEET TIRE FIGURENO. WAG 01105/2013 CONSTRUCTION DETAILS RE OI 2 A L � REyp1 OWNER/SITE LOLhTION CHEVRON FACILITY NO.9-5700 REvpp 11010 NORTH DE ANZA BOULEVARD PROJECT NO. CUPERTINO,CALIFORNIA 12.487 \ENO-Bm\f,M1^R<^AA1\...Stp baNE b WR\0100_11010 NOM Ds M.&M.ap�rino\ssT00_Dp Pacb�WRJJq