15100194CITY OF CUPERTINO BUILDING
PERMIT
BUILDING ADDRESS: 10425 S DE ANZA BLVD
CONTRACTOR
PERMIT NO: 15100194
OWNER'S NAME: BDC HAYWARD LP
DATE ISSUED: 10/23/2015
OWNER'S PHONE: 6506792656
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION:
RESIDENTIAL ❑ COMMERCIAL
s - 1� j
�'
SPIRIT HALLOWEEN
(TEMPORARY HOLIDAY STORE) - ADD 5
License Class . Lic. # /��
(N) CIRCUTTS FIR
VARIOUS PURPOSES (EXIT SIGNS,
Contractor ' icf C �e e$�) 3n/I �KD e
OUTLETS, ETC„)
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 certificate of consent to self -insure for Worker's
Sq. Ft Floor Area:
Valuation: $8000
Compensation, as provided for by Section 3700 of the Labor Code, for the
APN Number: 315917019.10425
Occupancy Type:
performance of the work for which this permit is issued.
�jhave 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..
PERMIT
EXPIRES. IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
WITHIN
180 DAYS OF PERMIT ISSUANCE OR
correct. I agree to comply with all city and county ordinances and state laws relating
180
ED INSPECTION.
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 ---Issued
by:
Date:
costs, and expenses which may accrue against said City in consequence of the
i
granting of this permit. Additionally, the applicant understands and will comply with
all non -point s urce regu tions per the Cupertino Municipal Code, Section 9.18.
Signature Date �d'° �3
All roofs shall bel
RE -ROOFS:
inspected prior to any roofing material being installed. If a roof is
installed without
inspection.
rrst obtaining an inspection, I agree to remove all new materials for
OWNER -BUILDER DECLARATION
Signature of App�icant:
Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALU
ROOF COVERINGS TO BE CLASS "A” OR BETTER
4. I, as owner of the property, or my employees with wagesas 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
2. I, as owner of the property, am exclusively contracting with licensed contractors to
I have read the Hazardous
materials requirements under Chapter 6.95 of the
construct the project (Sec 7044, Business & Professions Code).
California Health
& Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with!
Safety Code, Section
the Cupertino Municipal Code, Chapter 9.12 and the Health &
25532(a) should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations:
i
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Additionally, should
I use equipment or devices which emit hazardous air
Compensation, as provided for by Section 3700 of the Labor Code, for the
contaminants as
(defined by the Bay Area Air Quality Management District I will
performance of the work for which this permit is issued.
maintain compliance
Health & Safety
with the Cupertino Municipal Code, Chapter 9.12 and the
!Code, Sections 25505, 25533, and 25534.
2. 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
permit is issued.
w r r t
iz d agent:
Date: IG e-3 d
s. I 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
( CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I hereby affirm that
there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code, I
for which this permit
is issued (Sec. 3097, Civ C.)
must forthwith comply with such provisions or this permit shall be deemed
Lender's Name—!
I
revoked.
Lender's Address
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
ARCHITECT'S DECLARATION
correct. I agree to comply with all city and county ordinances and state laws relating
I understand my
plans shall be used as public records.
to building_ construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Licensed Professional
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
i
Signature Date
GENERAL PERMIT APPLICATION
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COMMUNITY DEVELOPMENT DEPART10ENT• MEr
t
BUIDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3 55
CUP R "[N0
UPERTIN0 (408) 777-3228 - FAX (408) 777-3333 - buildinoecup rdno.org
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application and the information I have provided is correct I have read the Desmiption of
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CITY OF CUPERTINO
FEE ESTIMATOR — RITII.iIoif' iIIVICI(11V
imADDRESS: 10425 S DE ANZA BLVD
DATE: 1023/2015
REVIEWED BY: MELISSA
APN: 35917019.10425
BP#:
*VALUATION: 1$8,000
*PERMI`I` TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration,/ Addition / Repair
PRIMARY Commercial BuildingPENTAMATION
USE:
PERMIT TYPE: 1 CEAP
WORK
SPIRIT HALLOWEEN TEMPORARY HOLIDAY STORE)'- ADD 5 N CIRCUITS FOR VARIOUS
SCOPE
PURPOSES (EXIT SIGNS, OUTLETS, ETC,.)
APPLIANCE / EQUIP TYPE FEE ID 9TY UNITS BP FEES
Special Circuits 1BREMMISC 5 # $715
l-- _ - TOTALS: I I $715.00 1
-Wch. flan Check I'Itr,rtL3. I'=ctn t'itt:'c% Elec. Plan Check 0.0 hrs $0.00
bfech Pesti Fee: p'a to%. per , Fee: Elec. Permit Fee: IEPERMIT
Oiher Rtech. Inv). (Ther 11urrab l ,n Other Elec. Insp. El, hrs $48.00
.A,Jech. 113sp. Fee: fllu h. -h isj). Fee: -1 . tec.. Imp Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
�ictrin4 ofn 1 Tkoen ina o I.ncaA nos fln na•vlJrr.is.n.•�r ica fnr nAinw mrnilnl�7o ns�ilhra nmh� nsa octis»nto. i'n»tnrtt$fo I)nnt fnY 2/.�dH'/%Kfn.
FEE ITEMS (Fee Resolution 11-053 E ..' 711/13)
FEE
QTY/FE
MISC ITEMS
Plan Check Fee:
fiuppl. PC" Fee
PME Plan Check:
$0.00
suppl, Insp Fee
PME Unit Fee:
$715.00
PME Permit Fee:
$48..00
Construction Tax:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes No
$0.00
,4dv in(:ed Planning Fees:
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Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICO
$2.24
Select an Administrative Item
Bld Stds Commission Fee: 1BCBSC
$1.00
IJBTO'TAI;S::.'.
$859.24
$O.QOTOTAE EE:
$1359.24
Revised: 10/01/2015
FITTING ROOMS
H.G. FITTING
DX -I
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DX -7
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5ALE5 AREA
tlTl� t��
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ADA GASH ""I
0
EXISTING EXIT
SIGN AA AF.
DX -5
r GP
GASH REG 18" AFF 4 54" AFF
15" AFF
ELECTRICAL PLAN
1 SC&S 3/3r - r -W
11 99
PANELBOARD DESIGNATION QX NEW INSTALL ___ EXIST LOCATION X_ RELOCATED EXIST
_I20-Z2Xg_VOLTS _3-PHASE 4WIRE, SOLID NEUTRAL -200-AMPERE BUS -200-AMPERE MAIN ___ MCB____
CKT
#
DESCRIPTION
WATTS
LOADWRE
TYPE
SIZE
BRKR
SIZE
a
A B C
15
180
500
360
360
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
a
BRKR
SIZE
WIRE
SIZE
LOAD
TYPE
WATTS
DESCRIPTION
'f5KVA
1
EXIT SIGNS
15
_
12
20
1
1
20
-
-
--
SPARE
2
3
GP RECEPT - FRONT
180
R
12
20
1
1
20
-
-
--
SPARE
4
5
CASH REGISTER
500
R
12
20
1
1
20
1 -
-
--
SPARE
6
7
GP RECEPT - REAR
360
R
12
20
1
1
20
-
-
--
SPARE
8
9
RESTROOM RECEPT
360
R
12
20
1
1
20
-
-
--
SPARE
10
'1
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
12
13
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
14
15
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
16
17
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
18
19
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
20
21
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
22
23
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
24
25
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
26
27
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
28
29
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
30
31
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
32
33
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
34
35
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
37
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
38
39
SPARE
--
-
-
20
1
1
20
-
-
--
SPARE
40
41
SPARE
--
-
-
20
1
1
20
-
-
--
S. ?ARE
42
375 540 500 SUB TOTALS L = LTG OR SIGNAGE
R = RFVCEPTACLE
1415 M = ASCELLANEOUS
CONNECTED LOAD ____ H = HuV,A.C.
K = KITCHEN
Lc -(21 D
ALL NARE - #12 THHN COPPER
20A DUPLEX
® EXIT 516N
NO CHANGES TO TH15
EQUIPMENT
EXISTING
EXI5TIN5
450V
PANEL
PANEL
'DX'
'H'
REFER TO
PANEL
SCHEDULE
'f5KVA
TRANSFORMER
ELECTRICAL ONE -LINE DIAGRAM
RECEIVED
OCT 2 3 2015
BY
CUPERTINO
Huilding Department
1 I
I OCT 2 3 2015
REVIEWED FUR CODE COMPLIANCE
Reviewed By h4rN%
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The Stamping of this plan and specifications SHALL NOT
be held to permit proval of the violation
of an ons o rdinance or State Law.
PERMIT#
OFFICE COPY
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