12020070CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10118 BANDLEY DR CONTRACTOR: MARINA PLAZA LLC PERMIT NO: 12020070
OWNER'S NAME: MARINA PLAZA LLC 4546 EL CAMINO REAL STE CDATE ISSUED: {I8/13/2012
OWNER'S PHONE: 4088137691 LOS ALTOS, CA 94022 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT QNF®: BLDG I- )ELECT r- PLUIYi[l6 �
License Class Lic. #
Contractor Date
1 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.
hereby affirm under penalty of perjury one of the following two declarations:
1 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.
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.
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
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.
Signature
Date
LTJ OWNER-BIJILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.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.
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.
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
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
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
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the pertino Municipal Code, Section
9.18.
L
Signature Date
MECH r— RESIDENTIAL F COMMERCIAL 7
JOB DESCRIPTION: TI-STE G,TAPIOCA EXPRESS CREATE NEW RESTROOM,
INSTALL NEW WALK-IN COOLER -TOTAL 230 SQ FT.
Sq. Ft Floor Area: 11 Valuation: $8000
APN Number: 32634066.00 11 Occupancy Type:
PERMIT ]EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT MIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date:
RE -ROOFS:
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 "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 &c
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, ections 5505, 25533, and 25534.
O er thor ed e �9
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Nwrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professiona
CUPERTINO
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 . building(aa)cupertino.org
el
n9aml,176 11_'ZV
3F
❑ NEW CONSTRUCTION ❑ ADDITION K ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS�'
o
_
AIN # r a _� 0�
OWNERNAMEPH
NE
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E-MAIL _ p �1
STREET ADDRESSQ e
IyAW/�`t
CirY, STATE, ZIP Q
14
FAX
f
CONTACT NAME_
� ��
E-MAIL
Aa-paPHONE _
STREECADDRESS
CTIY,STATE, ZIP
FAX
hmd
CA 01
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME - !
+ U
LICENSE NUMBER ��'S L)
S❑
LICENSE TYPE „ ` D
0 ��
BUS. LIC #
) d:2
COMP E-MAIL
FAX
STREE CITY. STA
PHONE
ARCHITECTIENGINEER NAME/C Au
LICENSE NUMBER ^ (j �';113
Bus -u"
t'
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
SQ
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
''...
� /
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
�
v
EXISTG
AREA 6D
NEW FLOOR
AREA 60
DEMO
AREA
TOTAL
NETAREA ys�
y
B n
�gB
p^`
c�
w
xIs% %a�1
BATHROOM
KITCHEN
OTHER
REMODEL AREA % d
REMODEL AREA ( 70
REMODEL AREA
''.............
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA:El DETACH
,
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UA'IT ❑ YES
SECOND STORY YES
BEING ADDED' ❑NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECE Y:
TOTAL VALUATION:
PLANNING APPL # []NO PI-ANNING APPROVAL LETTER
MCBLER HOME? ❑ NO
By my signature below, I certify to each of the following: I am the Drot7ertV owner or authorized agent to ac on the prrr;perty owner's behalf. I have read this
application and the information I have provided is correct. ')`have read -the Description'of Wyork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to builkipg con truction. I autho ' e r " nta 'Nes of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicandAgent: Date: 1—
SUPPLEMENTAL INFORMATI Q==D -
PLAN CIiECK TYPE
ROiJTTNG SLIP
❑ OVER -TM -COUNTER
BUELDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
PLANNING PLAIN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
PUBLIC WOM
_
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIliOtNMENTAL HEALTH
BldgApp_2011.doc revised 06/21111
tC TY OF tC1.UP EI[ TEN®
W_M'Iff F EIE IESTEMATOR — BUI LMNG IIDffVffSff®N
OCCUPANCY TYPE:
ADDRESS: 10118 Bandley dr
DATE: 02/1512012
REVIEWED BY: larry s
PC FEE I®
APN: '
BP#: -W Z007e
-VALUATION: 1$8,000
IPERMIT TYPE: Building Permit
PIAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
[ISE;
IBTIPLNCK
PENTAMATION 1B TI
PERMIT TYPE:
WORK
create new restroom install new walk-in cooler- total 230 sq. ft
SCOPE
Q.Q hrs
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE I®
BP FEES
BP FEE IID
B (Tenant Improvements)
II-B,111-B,IV,V-B
230
$1,912.00
IBTIPLNCK
$536.00
IBTIINSP
$536.00
SuppL Insp. Fee @ Reg. Q OT
Q.Q hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_.
0
G
Work Without Pennit? Q Yes D No
$0.00
;ldrancedPlannine]ace_
$0.00
TOTALS:
230
$1,912.00
Strong .Motion. Fee: IBSEISMICO
$536.00
Select an Administrative Item
MEC191, DOURLY 0 Yes Q No
PLUMB, HOURLY Q Yes Q No
EILEC, HOURLY Q Yes Q No
MISC ITEMS
Plan Check Fee:
$1,912.00
Lj I
Suppl. PC Fee: 0 Reg. (DOT
Q,Q hrs
$0.00
j -
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ ete. ). These fees are hated on the nrelindnary information available and are only an estimate. Contact the Dent for addn'I info.
FEE ITEMS jFee Resolution .'1-053 9 . ,1.%'11
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,912.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. (DOT
Q,Q hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$536.00
SuppL Insp. Fee @ Reg. Q OT
Q.Q hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_.
0
G
Work Without Pennit? Q Yes D No
$0.00
;ldrancedPlannine]ace_
$0.00
Selectallon-Residential G
Building or Structure 0
,. '_.,.
Strong .Motion. Fee: IBSEISMICO
$1.68
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2,450.68
$0.00
TOTAL FLEE:
$2,450.68
Revised: 1/1912012
03/29/2013 16:16 0 PAGE 01/02
J
Bufkliazg 1LDepaa-tment
City Of Cupertino
1.0300 Torre Avenue
i Cupertino, CA 95014-3255
Telq bone: 408-777-3228
CUPERTi ® ' =ax, 408-777-3333
CONTRACTOR
3TOR I SUBCONTRACTOR MSL
�
JOB ADDRESS: 10 11 B Ink
�._ . PERMIT # Q W 200 70 -
OWNER'S NAME: 1&-L40 ( ,ff"5� PHONE # etoo,•
GENERAL CONTRACTOR: LR ��rdftL ^ BUSINESS LICENSE
��u.r enaan�ctpnn cofle reclni.res :�ba lDus6t.�eases vrorM:iatg to tlloe city to b:�ve a �;ity �Ia atpemtino R►aDsiates, 11cenSe,
NO IBITYI.:DING FINAL OR FINAL OCCUPANCY 'ENSPECTION'(8) 'WILL HE V3N'IfTL 'U'E-IfIE
GENERAL CONTRACTOR AND ALL S'U BCONTRAC' 'ORS HAVE OBTAINED A MY Y QD1I+ C U PERT)I.NO
BUSINESS L ICENTSE.
1 am not using any subcoo-actors:
Signature Date
Please elieck applicable subcontractors and. complete the follo fling l.nt'orwallaM
V
SUBCONTRACTOR.
l%US1111a'SS NAME
BQlRNTESS .LICEINSE �
Cabinets & Millwork
Cement Finishing
1✓lectxica1
6
Excavat.io►1
Fencing
:Flooring / C'ul?etinb�—
Linoleum / Wood
Glass / Glazing
Heating
ZA
r
Insulation
S o
Landscaping
Lathing
Masonry ^ _
N /fel
.
Painting /Wallpaptn'
LL .._C.._..
Paving
PlasteringaLOFM5
g §
q
Phwibirlg
Roofing
_
Septic TankSheet
,Metal
Sheet Rock
�� ,
-
QWneP; 4;aali, actoa Signatu»e Date
CUPERTSHO
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 ^ buildinaacupertino.oro
Effective January, 1, 2009, Assembly Bill 2335 amends California Health and Safety Code,
Section 19825, regarding disclosures and verifications required for all applicants seeking Owner -
Builder construction pen -nits. These new application requirements provide an enhanced level of
consumer awareness and protection for property owners accepting the risks associated with
Owner -Builder construction permits.
"The Legislature hereby finds and declares that there is an urgent and statewide public interest in
assuring that building contractors comply with the Contractors License Law ... and provisions of
law relating to Workers' Compensation Insurance for building construction, that property owners
are informed about, and protected from, fraudulent representations, liability for worker's injuries,
liability for material and labor costs unpaid by contractors, licensing requirements, and
employer's tax liabilities when improving their property as owner -builders"
Important information you need to know BEFORE pulling your permit!
The term "Owner -Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each has benefits or Risk, and it is possible to combine thein?
Hiring a California ]Licensed Contractor means you do not personally perform any of the construction work, the
permit is not taken out in your name, you are not personally responsible for the construction and you are not an
Owner -Builder. Instead, you become a "Customer" and California law provides you the benefit of protection from
poor workmanship, failure to finish the job and financial risk due to worker injury.
Benefit/Risk: Highest Benefits and the Least amount of Risk
Owner -as -Worker is a type of Owner -Builder where you personally perforns the construction work, the permit is
taken out in your name and you are personally responsible for the construction management, knowledge,
workmanship, and completion of the job. You benefit by not paying others to perform this work for you and your
risk depends on your own ability to complete the job successfully.
Benefit/Risk: ' '_;.;:c; : with LoNs Financial Risk
Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contractor, the
permit is taken out in your name and you hire California licensed sub -contractors to perform portions of the
construction work. WARNING: The benefit of protection provided by law when you hire only California licensed
sub -contractors can tum to serious financial risk if you hire unlicensed contractors to perform any of the work.
Benefit/Risk: ,, ,, t :. L�, r:..iL and Significant Financial Risk
Owner -as -Employer is a type of Owner -Builder where you pay any individual to perform any construction work
valued at more than $500.00, the permit is taken out in your name and you are personally responsible for their
employment requirements, supervision, performance, safety and welfare while on your property. WARNING: Cost
savings benefit can tum to serious financial risk if you fail to deduct payroll taxes or provide workers compensation
insurance for each worker.
Benefit/Risk: i ;:: 1; .: ; with Sianificant Financial Risk
Over 20,000 consumer complaints are filed each year. Many complaints relate to
owner/builder projects and include workmanship and workers' compensation issues
Homeowners suffer financial harm due to defective workmanship and injured employees.
OwnerBuilder 2010.doc revised 06/08/10
Following are alarming examples of ghat has occurred with Owner -Builder permits:
Example 9: Homeowner received insurance money to rebuild burned -down home.
Owner/Builder permit pulled to rebuild structure.
13 Unlicensed contractor built substandard structure — must be torn down and replaced.
Estimated financial injury is $225,000.
13 Additional financial injury - IRS threatened to tax insurance payout if house not
completed by the end of the year.
Example 2: Brother-in-law had active license but filed an exemption from Workers Comp.
13 Owner -Builder hires brother-in-law to install a new roof.
13 Employee falls and sustains multiple spinal and extremity fractures as well as a head
injury and remains in a coma to this day.
The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for
reimbursement for benefits paid to the injured worker.
Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to
install septic system and suffers injury that results in permanent disability.
• The Owner -Builder did not have a homeowner's insurance policy on the house against
which to submit a claim.
• The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to
the injured worker.
®id you know/ — unlicensed persons frequently have the property owner obtain an "Owner -
Builder' building permit which erroneously implies that the property owner is providing his or
her own labor and material personally?
®id you know/ — your homeowner's insurance may not provide coverage for injuries
sustained on your property by an unlicensed contractor and his/her employees?
®id you know/ — if you are considered an "employer" under state and federal law, you must
register with the state and federal government, withhold payroll taxes, provide workers
compensation and disability insurance and contribute to unemployment compensation for
each "employee"?
®id you know/ — that if you fail to abide by these laws you may be subjected to serious
financial risk?
OWNERS BEWARE AND CONSIDER THE RISK REBORE ACCEPTMG FULL
RESPONSIBILITY FOR YOUR CONSTRUCTION PERV1fiIT
OwnerBLilder 2010. doe revised 04/12/10
CUPERTONO
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 ^ buildingacupertino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
ENT M.
�i11� ' �'vr:.l hs nJ �.L�iL/'�. ,%�� 1«�� v�/�11I,�l : •�.�.'�'N4�=
i
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT ARID VERIFICATION OF INFORMATION
(DIRE TIONS: Please read and initial each statement below to signify you understand or verify this information.)
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Bui er" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
in urance coverage for injuries to workers on my property.
f2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
onstruction and are not hiring a licensed Contractor to assume this responsibility.
iect3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
P
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
na a instead of my own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
bers on permits and contracts.
' 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
I value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
sidered an "employer" under state and federal law.
. I understand if I am considered an "employer" under state and federal law, I must register with the state and
I government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
floyment compensation for each "employee." I also understand my failure to abide by these laws may subject
serious financial risk.
7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
lice ed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
Janfinancial
ormed under contract with a licensed general building Contractor.
. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
or personal injuries sustained by any subsequent owner(s) that result from any latent construction
s in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04/14/10
-I understand I may obtain more information regarding my obligations as an "employer" from the Internal
+anthe
ue Service, the United States Small Business Administration, the California Department of Benefit Payments,
California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed
contractors.
10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that
a he party legally and financially responsible for proposed construction activity at the site address listed above.
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
b II applicable laws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
inf mation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
yo contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. te: A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city mabe required to be presented when the permit is issued
to verify the property owner's si natu
Property Owner's Signature: Date:
---------------------------------------------------f�J(
------- --- --- ----------------------------------------------------------------------
(NOTE: The following Authorization Form iuired to b ompleted by the property owner only when designating an
agent of the property owner to apply for a cruction permit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project. I p 1� a,
Scope of Construction Project (or Description of Work): A10N N -164 S°�
Project Location or Address: UIai t►vfol royName of .. w
AuthorizedAgent:* � i ,� i ' r►' � `� o i �'�. j% i1 � • �I �' fir'
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, fonn notarization, or other
verification acceptable to the city m be requ' d t� be presented when the pen -nit is issued to verify the property owner's
signature.
iL_Property Owner's Signature: Date:®�� .
N,nerBuilderForm 2010.doc revised 04114110
M
ZLARA
SSAN7AA CLA RA (C®Ul\i7V
14700 Winchester Blvd., Los Gatos, CA 95032-1818
fESY65EFVICE (408) 378-4010 -(408) 378-9342 (fax) o www.sccfd.org
February 2, 2012
Mr. Lawrence Wang, Owner
Tapioca Express
10118 Bandley Dr. Suite G
Cupertino, CA 95014
Subject: Recent remodel work at restaurant without building permit
Dear Mr. Wang,
On 1 / 31 / 12, I was at the restaurant to observe fire sprinkler work performed
under an installation permit issued by this department. While at the site, I
observed other building improvement work performed within the restaurant
that did not appear consistent with the most recent plans on file at our office.
The work in question include:
a) It appears that a previously installed ADA -compliant restroom has been
replaced with a walk-in cooler/ freezer and that a new, possibly non-
compliant restroom has been created in a small space.
b) The kitchen cook line appears to be different than what we had on file
from 2002/ 2003 where a kitchen upgrade occurred. The fire protection
system protecting the hood & duct exhaust system appeared to have been
broken down (perhaps for the new water heater installation) and re
installed. The work performed on the fire suppression system requires a
permit from this office.
As the new restroom has created an un-sprinklered space within the building, I
have instructed the fire sprinkler contractor to install coverage within the room.
We have contacted the fire suppression contractor who most recently serviced
your system and advised him to obtain a system modification permit from this
office. A re -inspection of both the fire sprinkler addition and the hood and duct
extinguishing system is required. Both contractors must contact us for those
inspections.
As the business owner, you are also instructed to consult with the City of
Cupertino Building Department to ensure compliance with the adopted Building
and Fire Codes for the other work performed.
Organized as the Santa Clara County Central Fire Protection District
Serving Santa Clara County and the communities of Campbell, Cupertino, Los Altos,
Los Altos Hills, Los Gatos, Monte Sereno, Morgan Hill, and Saratoga
10
Mr. Lawrence Wang
Page 2
Should you have any questions, feel free to contact myself.
Sincerely,
Wayne Hokanson, Deputy Fire Marshal
Santa Clara County Fire Department
CC: City of Cupertino Building Department
Marina Plaza LLC -Property Owner, 4546 El Camino Real #C, Los Altos, CA
94022-1069