S3803 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO.
BUILDING DIVISION APPLICATION/PERD7IT %AM1IBING-MECHANICAL. S 3803
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APLICATION SUBMITTAL DATE
'N R'S NAMOEI PHONE: CONfR/.FI'OR'S NAME. UC NO: -5
��
J NIC CONTROLI
ncAlzTem
R CDING 'E R: LIC NO: ADDRN Q ESS: ❑ ` 07
COMA PHONE: BUILDING PERMIT INTO
^�� D ❑ Consultant Fe®Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSED CONTRACT ORIS DECLARATIONQTY ELECTRIC PERMIT FEE ❑ ❑
1 hmeby affirm Jut 1 am Hottentot provisomox M Chapter 9(cummenciag JOB DESCRIPTION
a�Z wim Seeio 000)aDisision 3oflhe BOOM.,,and Pmfessiom Code,and my lkene i, RESIDENTIAL:
FOOD in full f«a ad cFcct. PERMIT ISSUANCE
KW ❑SEDWL ❑KITCHEN REMODEL
<UR Dalenm Clan C-1 APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBINGRE-PIPE
Q oo Dale—C-1.1-DITlor
AHCIIIll5C1'S DIiCIe1HATION [I MULTI-UNIT ❑STRUCfURAh
Z p n.NZ. I vrMcmand my plan—lb til be usN as public mmrlt PANELS MODIFICATION
C)Z- c UPTO'_ AMPS [I INTERIOR El CHIMNEY REPAIR
G on F!� Lians,d Prof.ineal 201-IBOOAMPS IMPROVEMENT' E)SWIMMING POOLS
Y f, OWNER-BUILDER DFCI.ARATION OVER 1000 AMPS ❑BATH RF1.10DFJlREPA1R ❑DEMOLITION
C < I thereby affirm mm
at I am exempt from the Comraors License Law for me
�ax(06 U foI cir ox measan.(Section]ommuctuimesn and or.Profe,,smea n.-reny canny mor tmty SIGNS ELECTRICAL
Cl OWER
W 43, wbicn mquims v p at.,rx coruoun.,loch imprr,vc,dcmohdh,ry rc)uo any xtrvctnrt
pmol I cc,nm y tha ismir tf hhill i .g cllmamllEm SPECIAL CIRCUI'1'/MISC.
thm he fan dpussu II )of , i of Contractors C xo (Coder or
et. Icon g phSen ]Oflfl) coin 1 nth e ss INP f Any
vi lamon or TEMP.METER OR(`OLE(NST. COMMERCIAL
a e e� mm he r cncmpt therefrom and the bail for the dingel eanmptw.any violvion of ❑NEW BI.DC✓ADDITION ❑DEh101.IT10N
Smion70313 by any applicmt for a perm whjecis the applicant to a civil penally or POWER DEVICES Zv pQaE
, ;Z not more firm five hundred collar,D 10). LMPROVEMFM
2F. NANT El FOODSERVICE
=�< Law'ller of the lanpcnY•Ir my cmpWvecs wim weg¢as Meir sok contpcnsariom SWIMMING POOL ELECTRIC
will do the work.and 11he stricture,is not mended of offered for sale N,,.Sec.IBD,Busin¢a �GTHER
d3 w ail Ihofevsims C,de:The Clmmictrrs License Law docs not apply to an owner of OUT[_=-SWITCHES-FIXTURES e
,,Vny who hou U,tr Impmvcs mare. ,mW wN,dlca ouch work Om.1f or through
his own empinyec,pnrvlded that such improin
mvarnenn me t mndN or ofleml for NEW RESIDEN'I'[A].F:LECIR Sp PI'.
sale.if,however.O a Nilding or improvemcru is-W within one yew of completion,the .FLOOR AREA
av-builder will axe the torten of proving thin he did not build or Improve for For-
p r• MAY 2 6 1 99
as
owneir of the property.aexcluvi dy nmaactng with licensed]contractors to F '
t the project(Sex.7n .Business and Professions Code:)the Corowrra Lo-
rinse u
Law lines not applyio anownef a rr,er,who builds m ortIav¢them,n.and QTY, PLUMBING PERMIT FEE
whomtfact,Eu.wch projccto wilh.convvnortx)licauul prlsuaot m rc bCavtremo?,
Leen t�law. PERMIT ISSUANCE Y
I am eae."mrler 4c. ,B&PC for tho mown
ALTER-DRAIN&VENT-WATER(EA) VALUATION
Date /� !l!� r�
xT WORKERS COMPENSATION DECLARATION BACK FLOWPROTECT.DEVICE 1p t{,yJ O kyJl QOO
I hereby affirm under pewit,of perjury not of Jr,bllwin,declan niorx'.
I hove rim will maintvn a Crnificem ofGnsennoself-insort for Witter Compcn- DRAINS-FLOOR.ROOF AR G,COND. STORIES TYPE CONSTRUCTION
wtimn,as Provided rot by Sec51c 3900 of tho labor Cads,for Nc perrommrce of me
%oric for which this crinii is noted. FIX'I'URFS-PER'MAP
❑ 1 have end will mammon on Wor4r's Contpcnwiun homeocc,:u re'LoOd by Section
J]Wufthe Labor Code.for the perfnmumtce of the work for which min permit is isomed. GAS-EA.SYSTEM-I INC.S OUTLETS OCC.GR UP
My Wmwe,Campen tion lnsuraoce carrier and PNart
icv number : 16"36
Carrier: Policy No.: GAS-EA.SYSTEI.EOVER a(EA) ��
CERTIIICATY.OF EXEMPTION FROM WORKERS'
13
COMPENSATION INSURANCE GREASEBNDUSTRL WASTE INTERCEPTOR
BUILDING DIVISION FEES
(This.-tion ru<d nig he rompletN l ane permit o.fwone humLed dollars,IS IM) GRHASCTRAY
or to..) p1ANCHECK FF,I!
Ianify that in l he inmr, rt net ofinewmkmt whichje this th WmIxrs,Com,a11 SEWER-SANITARY-STORM EA.200 IT. -
nia employ any peon in vny runner so as to hecunte wnjat to the H'uMa'Comprn- ENERGY HE as,' O
O Z A,li tot of California,Date WATER HFATI:R W/VEYT/ELECTR GRA 'G FEE
Z Applicant
N NOTICE TObj APPLICANT:If,afteir Comoiling ria ovi,i to of F rnynCod you should WATER SYSTF1.1rLRtaTWG
hmxrte subject to it W..It nv ompcnsmii,provisions of the last Crile,yw muse SOI
Enhwith comply with such prorisions or permit shall he deemed mmkW. WATER SERVICE
Q
.use. 2 CONS .. ON LINOI6GAGENCY NI!W RESIUL'NI'IAI.NLMN, Sp.FT PAID
V Q Thereby affirm that there is..onuwainn knding agency for the perfi,rmnftce of Data RaeiptX
twork far which this permit is issued(See.3000,Civ.C)
F" o
0 Lenders Nome TOTAL:
Irnd¢'s Addn¢s TOTAL
6. I verify tat 1 hove read this opplicuion and sate that the above infonmvim is BUIL 'G FEE 7, nO
rpt corm.I,glee to comply with all city end county ordinvicea end state laws relating to QTY, MECHANICAL PERMIT FEE
C boddingcnrlatroclhm,and heresy nuthoriry rcpre.mnutives ofthis city o,cnmrupantne SEISMIC
uMvenhentiotcJ ptup,ny for...cation pvlusce. PERMIT ISSUANCE
fWc)agmc to xme,inch miry and kecp hennle s the Cry or Cupvr m vgvrmt ELECTRIC FF,B
IiaNllties,judgmrnr.costs cad expenses which may in finny way accrve egainn uaW City AUTERORADDTOMECH.
in consequence of to granting of Nmi
Nis pert. PLUMBING FTE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-FOL AIR HANDLING UNIT(TO 10,800 CFM) MECHANICAL FEE
SOURCE REGU
5. AIR HANDLING UNIT(OVER 10.000 CFM)) CONSTRUCTION TAX
nor (Ate EXHAUST HOOD WIDUCT)
HOUSING MITIGA'110N FEE
IA]A lulu S ilding cup thgC SURE
NJlmevpCu,,ertrs,MurcbuadCorie, upant9omar and(bh eadws mmerial HEATING UNIT fill]I(NI,(g10RN)
ns JeBnM by the Cupcnilra Municipal Code,Chapter 9.12,and to IIcaIN ofd Safety
Co4.5mioo 23332(a)'! HEATING UNIT(OVI!R 100.000 BTU(
❑Yes I�JQ/\, VENTILATION PAN(SINGLE RESED) PAID
It
Mio applicant or(rime lending u<u t or devices which Date ReReceiptll t
pant use cquipmcn BOILER-COMP OHP OR I00,Om1 BTU)
mil lb—f, .tar nmtamirwnIs rs&-fined by the Buy Area At,Quality hlenageme t
UlahinR BOILER-COMP(OVER 100,000 BTU)
E]Vest _0yo
lave and tach vdror%materials ,undo Clxtt rM195 of me Cali- AIR COVDmOUER ISSUANCE DATE
nq im rn
fomin Hralth&Safery Cote,Smiths 255(15.2551]and:5N.1 unler>tar l tan if ttr NEW RESIDENTIAL MECH. Sp.EL �f 9
bwhgrlg docs rot is mYneynrssibimYlr unify Jc oaupana �— 2 ( �_ l
nr tin rwn' Ir to iasuarce rracamreme Tracor
o lo,itc TOTAL; ISSUED BY'. l
OFFICE
' ' °06 FIRE DEPARTMENT
CONTROL NUMBER
FIRE �` SANTA CLARA COUNTY
14700 Winchester Blvd., Los Gatos, CA 95030-1818 V 3l9d 3
(408) 378-4010 (phone) e (408) 378-9342 (fax) PERMIT NUMBER
PLAN CHECK No.
PLAN REVIEW COMMENTS
COCEISEC. SHEET NO. Review of plans for a minor tenant improvement/construction project which
meets the guidelines for over-the-counter plan checks for the City of Cupertino.
_Lz �I.DEMO[7AJ TA-.E3L¢' j?fF`LT/Ci�'2)
The following CHECKED items apply to this project:
( Existing fire sprinkler system shall be modified as necessary. A licensed C-16 fire protection
contractor shall submit to the fire department, three sets of shop drawings, a completed permit
application and applicable fees for review and approval, prior to performing work. UFC 1003
Existing fire alarm system shall be modified as necessary to accommodate new construction. A
licensed fire alarm contractor shall submit to the fire department,3 sets of shop drawings, a
completed permit application, and applicable fees, prior to performing their work. UFC 1007
Tenant shall have access to a minimum of_ 2A10BC minimum rated fire extinguisher(s),
located wctRf- 75 feet travel distance. UFC 1002
Tenant shall have access to one 40BC minimum rated fire extinguisher, proximal to the kitchen
cooking area. UFC 1002
Exit doors shall be openable from the inside without the use of any special knowledge or effort.
Thumb-turn dead bolts that require more than 1/4 tum to operate are not acceptable.UFC 1207
Exit Illumination: Provide illuminated exit signs. UFC 1212
Contractor shall field verify the integrity of existing rated construction/assemblies and upgrade
or repair as necessary as part of this work Penetrations in rated walls/ceilings shall be
protected by listed fire rated assemblies (dampers, doors, caulking, fire stopping material etc.).
UFC 1112
At time of final inspection, the tenant shall provide to the fire department a labeled emergency
access key for placement in the building fire department key box. UFC 902.4
This plan check does not permit the use, storage or dispensing of hazardous materials,operations
or waste. The tenant shall provide a completed H IIS to the fire department's hazardous
materials specialist for review and comment.
o !k� APPROVED FOR BUILDING PERMIT ISSUANCE subject to compliance
2 2 l with the above checked comments prior to final inspection.
JURIS PLANS SPECS NEW REMODEL AS CONST.DESCRIP BY DATE O PAGE
Ct�P ® ❑ ❑ Q1 ❑ �eS[E'7 !/✓f1U D51X�LL7' 7�f f of
JFLOOR OCC OCC.LOAD AREA ARCH/ENG/CONTRACTOR/OWNER
JJ 1�.
NAME OF FACILITY LOCATION
A California 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