99080081 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL P
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL.
RIIILDNC PROIECP IDENTIFICATION _ r
BUIIy1NC.ADDRESS: � L,` SANITARY NO, APPIJCA ONS PMfITAL DATE
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G EER LI N S,' ❑
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C ALT U!91fl�li': BUILDING PERMIT INFO
/ ❑ Consulutnt Fm Paid by Applicant(Initial) BLDO E� PLUMB MOCH
LICENSED CONTRACTORS D :LARATION ^ QTY ELECTRIC PERMIT - FEE •f`�" ❑
I herthy affix 11rvt l am IicernN under pmvi inns d Chapter9(c mme riving JOB DESCRIPTION
O�Z wiJ Seaim N00)nf Division3of 11e Uusireas aM feasiml Code.emmylkenseis RESIDENTIAL
:
W OO PERMIT ISSUANCE
F [ in fu 11 force rest eRcct. ❑SFDWL ❑KITCHEN REMODEL
FZ� 1Q �a C..,— APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
F=vai CTS DECLARATION PANELS El MULTI []STRUCTURAL
sa-Z r h used es Public record, MODIFICATION
OZ-a IIP TO 200 AMPS El INTERIOR ❑CHIMNEY REPAIR
F�E'u] Li n uiu 201-PX0AMP5 IMPROVEMENT 0SWIMMING TOOLS
OW 9UILDER DFCIARA'LON
W
p4 C Q M1 HImI that 1 xempl front Ilse:Cnnlreelor'x Licenw Law for the OVER 100 AMPS E)BATH RI?MODEIIREPAIR ❑DEMOLITION
x O d U fallowing V,..,ISwtlm 90313,Bit,,,and Pmfenllms Code:Any city u
to county SIGNS ELECTRICAL ❑OI'FiER
u7 3 4.-5 which rcyuirtn a panto,m[onarae, alta,improv0.dcxmit t,or repair eti Vrvdurc
C)-5 primx,it)L,Beuren sew rtquithe th.,ism[anl firBe such lermiDofile ifern,g w(Chcmcnl SPECIAL CIRCUR/MISC.
f lyy Thu he u'lianwidpursuant lu tlt)offEitom d thee,Busim,, Liccnsc lsw(CTtapI)m
1r=�C0 Iestmmeeeine wish Sectio]Oro)ofDivisimJoflhc Pusircv aryl Pmfc+simsCMe)m TEMP.METER OR PULE ENST COMMFR IA
a a e Net he is exempt drertfrom rest the basis for dle r ic'eal exemption.Any vioWion of ❑ EW M DDITION ❑DFMOLRION
_
} ^ POWER DEVICES
NT ❑FOODSERVICE
°OI'"m Bear fve hunched dollars 13500y
I'
I OVFMFN
< ❑ I.ssswrcrdlhe pmpeery.mmy cmpbya.s wish»agessdeu tole mtlpcnavuen. SWIMMING P(JOL ELECTRIC
F O wM11
still woxk.a1cgmCNrei,.inlerMled uroRertJ fvr a (See.]0s4,Business ❑0 't
a�j m and Pmfcaime s Code:The Coo rcI«s L,re .a Isw dotau apply In N owner of OUTLETS-SWITCHES-FIXTURES
63- P^ rwhV M1uilds N improve,,ttcxVV,and who date nsuch work himself er Ihrmgh
bi.e mvn arf h,ve,pmv:IM Nal such itrtpmvensntn are not iNendM u offered for NIEW RESIDENTIAL ELECI'R SQ FT.
wlc.IL however,fie binding oclmymvcment in told within orc year ofcontpletion,the SQ.FT FLOOR AREA LSQ.ET
enbuiLIr will have Rbc Wrticn of pining Thal he did not huid or improve fix Wr-
lew(It le.)
❑ I,ss comer of the Prof,am eaduelvely can oxcling with Iicenud an.1—m OrAL.
mNWawca cares not (Se<.]Onoomeucuaml Pm ressitms Cove:) C.es thereof.V-
ern law fi,s ath Pato anowrrer of pmlteny w,"waldseeinyrto the Comem.aml Ql'Y. PLUM G R FEE (-•111 !'`011/,,
wllocmtrnlfu sleh lvojccts wiN ecaurecla(s)laen.ipurwanOottr Conlmcl«s
Liame law. PERMIT ISSUANCE
❑1 am exemry Lader Sec. .B&P C for Nis
At -DRAIN&VENT-WATER VALUATE
0»ver, Dart,
WORKER'S COMPENSATION DECLA"TION BACK ROW PROT'EC`T.DEVICE
I herchy affirm miler Pero ty of perjury sere d the fclmving Ilalentinns:
I have"w1H rieuVun a Cenificneof Cor[senl In self-inwre for Wotkcr's Compen- )XII]NS-FLOOR,ROOF,AR� COND. STORIES TYPE CONSIR UCION
tion,u provided for by Sxliun 3]01 of tle LM1IIr CMI,for the perf.ntt of iM 1 -,
wlsrk tie which Jia Pemtil is i.auM. FI%I i5-PER TRAP N
I] 1 have am will mainmin Worucrx Cmnpcn�nim nemana,an t V0( ahl by Snli'm
3700ofdte laNK QJe,for the lerf.,eofthe work for which thiepermh it LasuM. GAS-BA VSTEM-I INCA OUTLEIF (XC.ORO P APN
My Work«,Cn.,Vs.a ian Inwtaree currier and Poli[,number u.
Cefricr: Pniky No.: GAS-EA.SY -OVER4 1 ��J/roI•
CERTIFICATE OF EXEMITION FROM WORKERS' �(•'fr
COMPENSATION INSURANCE GRFASFIINDUST TIE INTERCEPTOR BUILDING DIVISION FEES
(Thu stttim real not be compkBd fide lmtil u home hundrM dollar(3100) GREASETR
m tev) PIANCIIF.CK FTP
I eerifylha in Chep afomance4h, vsk for w1hi[h dos Permit is issued,IrTWI SEN' -SANITARY-STO EA.200 FT,
not employ toy pawn in my ruorcr n v to hcavne sinjecl to the Worker*Cmnpen- ENERGY FEE
0 ralim lawlofCdifomia.Date ATTR HEAtTEl WNENT/ELEL GR IG FEE
Z APPlicant t 0
y NOTCI?TO APPLICA ,If,efts making mis Ceaifate d Evcmryiorl,yon steed WAIT:R SYSTEM/TREATING SO E
becnmth
c Whjw Pat e Workds Compemadmm ptvl
unlms of the Laba
Labor Code.Ym mo
fnnM1u'ith....Vply win such pmvisium or Nin Pcmti(slall be kro 1 rt1.1,4 WAD:R SERVICE SQ. PAID, 1999
WIy AAUG 10
CONSBUCTION LENDING AGFCY NEW RESIDENTIAL PLMB.
u z DNe Reaipt M
V O Ihrrchyi,h his slmmc ice[ongm[liottkrtgurtcy for the perfnntlancc of
Pthe work far whish his permit u ivuM(.Sw.3119].Co,Civ.CJ TOTAL
F' Ietster's Name
V 1<rnler'I Address TOTAL: .
I anify 11Nt I have rod flus rpplAa1W11 and qve not Be above iNumnim is BU DING FEE
t0( I.t.I qmc to[anply Ovid,all city and murvy adi—nst state laws rvlerilto QTY. MECHANICAL PERMIT FEE
UZ buidingcorNfmlion,mdhaebY awhmire rclnesentntisr,oflhiscity locrufuxbndl SEISMIC ME
rDnve-mentioned prlrlmY for impectioe purgrse 14ERNIIT ISSUANCE
(We)agme 10 save,indemNfy arld kap harrnkas the City of Cu,eramo agunq ELECTRIC FIS
I;qlq,mcha.,f
nni,ludgmrnmo,al■1tst expenseswhich rayon any way e¢me egainnsaid City ACHE OR ADD TO MICH.
in 1g 7IfJlepermil. PLUMBING FEH
SAND WILL COMPLY WITH LL ON-POINT FAIR IIANDLING UNIT(ID IQBMIChM)C I 10 - MFCHANICAI.REE
` � r AIR HANDLING UNITIOVER 00oi CFM) CONSTRUCTION TAX
Signa a APp wVCon �/ Doe EXHAUSTHOOD(WMULT) HOUSING MITIGATION FEE
HAZAVOUS MATERIALS DISCLOSURE
Will the applic to.luiding¢cupant was o fatten,h Arduss material HIEATI NO UNIT TO 100.000 BTU)
n defrcd by be C Municipal Crile,Chspter,9.12 and be Health red Safety
r Code,Setbp 2533(.)^ HEATING UNIT(OVER 100500 BTU)
0Ie No VENN.ATION FAN(SINGLE RFSID) PAN Dae Rectiryl --
Will tk eippliew flmlre WiWin�uxupnN use equiPnlem m Minn whi[h
it anorlktm est comms Its IkfmJ by de Bry Arca Air Wrlip Mmisgement BOILEi-COMP DHP OR 110,000 BTU) TOTAL
nm0? BOILER-COMP(OVER 10(),001 BTU)
❑Ya
I have fwd the4 mNaialx t Vocnenme untie ChuMc (.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
forma Ilwtllh&Sa y CI Slzlkx:n^3015,25537 utd 255. .1 u that It Ile NEW RF_SNENTIAL MIECIL SQ.Fr.
nnpdin [m amnmtt.mal it ix my rtNand dy In aify de mealntn
IR Thr t n>ti Prirxmictuarce� uryrcy.
agrnt - TOTAL: ISSUED BY:
OFFICE
OLARA °�o FIRE DEPARTMENT
CONTROL NUMBER
a< IR.E a� SANTA CLARA COUNTY
14700 Winchester Blvd., Los Gatos, CA 95030-1818 PERMIT NUMBER
(408) 378-4010 (phone) • (408) 378-9342 (fax)
PLAN CHECK No.
PLAN REVIEW COMMENTS
COD&SEC. SHEET NO.
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 1001
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 1001
Tenant shall have access to a minimum of J. 2A10BC minimum rated fire extinguisher(s),
located within 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-tum dead bolts that require more than 1/4 turn 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 restore 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 1111
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 9024
This plan check does not permit the use,storage or dispensing of hazardous materials, operations
or waste. The tenant shall provide a completed HUS to the fire department's hazardous
materials specialist for review and comment.
APPROVED FOR BUILDING PERMIT ISSUANCE subject to compliance
with the above checked comments prior to final inspection.
JURIS PLANS SPECS NEW REMODEL AS CONST.DESCRIP. By �p DATE PAGES
El ❑ C-1 �` l OF(
ECJFLOOR OCC OCC.LOAD AREA ARCKEN&CONTRACTORtOWNER
NAME OF FAC LITV LOCATION
6 e-est.
A California Fire protection District seruing Santa Clara County and the communities o
Campbell, Cupertino, Los Altos,Los Altos Hills, Los Gatos, Monte Sereno, Morgan Hill,and Saratoga
�PCyARq coG FIRE DEPARTMENT
SANTA
CLADA COUNTY
+ CONTROL NUMBER
14700 Winchester Blvd.,
Los Gatos, CA 95030-.1518 PERMIT NUMBER
(408) 378-4010 (phone) • (408) 378-9342 (fax)
PLAN CHECK No.
PLAN REVIEW COMMENTS
CODE/SEC. SHEET NO.
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 1001
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 1001
Tenant shall have access to a minimum of�L 2AlOBC minimum rated fire extinguisher(s),
located within 75 feet travel distance. UFC 1002 r.
Tenant shall have access to one 4OBC 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-tum 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 restore 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 1111
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 11MIS to the fire department's hazardous
materials specialist for review and comment.
APPROVED FOR BUILDING PERMIT ISSUANCE subject to compliance
with the above checked comments prior to final inspection.
JURIS PLANS SPECS NEW REMODEL ASCONST.OESCRIP. BY ,p DATE PAGES
�//A I ( OF
SECJFLOOR OCC OCC.LOAD AREA ARCWENGICONTRACTOR/OWNER
%�� 8 � H2, v
NAME OF FAC ITY . . LOCATION
A California Fre Protection District serving Santa Clara County and the communities o
Campbell, Cupertino, Los Altos, Los Altos Hills, Los Gatos, Monte Serono, Morgan Hill,and Saratoga '