12060093C17Y OF CU PIEIEB')1'l1NO BUILDING ]PIERMff7
BUILDING ADDRESS: 10889 S BLANEY AVE
CONTRACTOR:'=T(5 M
PERMIT NO: 12060093
OWNER'S NAME: PACIFIC RIM PARK LLC
e
DAVE ISSUED: 11/16/2012
OWNER'S PHONE: 4082554163
Q
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El COMMERCIALU
License Class j _ Lic. #
QQ NOODLE - COMM. TJ 2316 SQD]F'T TO CHANGE USE
7
N—
FROM
Contractor Date
]BAKERY TO RESTAURANT
I hereby aff m that 1 am licensed under the provisions of Cha ter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 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
Sq. Ft Floor Area:
Valuation: $100000
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
APN Number: 36934052.10889
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
EICD
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
building construction, 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 ffNSIPIECTIION.
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
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
��^
RE -ROOFS:
Signature / /7 i�-�i Date /
m
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 -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, 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
HAZARDOUS MATERIALS DISCLOSURE
construct the 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. I will
1 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 1 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
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Date:
permit is issued.
Owner or authorized agent: — —p
1 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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
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
A
CONS RUCT N PERMIT APPUCAT110liq
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 %� d
(4 8) 77-3228 - FAX (408) 777-3333 e buildingcu ertino.Or CU PERT11 MO 0
❑ MI
NEW COrCTION/!11 ❑ ADDITION ALTERATION / TI ❑ REVISIDEFERRED ORIGINAL PERMIT #
PROJECT S
APN
OWNER N
PH '
E-MAIL
STREET ADDRESS
rJ
CITY TATE FAX
CONTACT
J
PH E
ne�r
E-
STREET ADDRESSf CITY, STATE ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRA OR ❑ COMRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LTC #
COMPANY NAME
E-MAIL
FAX .
STREET ADDRESS
CITY, STATE, IIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
Co
E-KAIL
FAX
egad 4 Gam,
STREgT ADDREM
d�
CITY, STATE, ZIP p�
P ONE
-2-e% 0
Sof
DESCRIPTION OF RK ^_
o
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQFI'.
VALUATION (S)
EOdSTG 1a
ARFA�q,
NEW FLOOR DEMO
AREA AREA
TOTAL
NET AREA
y���•
,� f /�
,ry//'_
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODELAREA
REMODELAREA
PORCH AREA
'DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA DETACH
❑ ATTACH
# DWELLING U?jFS: _ IS A SECOKD UMT ❑ YES
EIMI ADDED?
SECOND STORY YES
ADDITION' O
sVG1/'" YNO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVE BY:
TOTAL VALUATION:
PLANNING A°PL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
By my signature below, I certify to each of the following: I am the property owner or authorized agent to acct on the pi-pperty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identi5ed property for inspection purposes.
Signature of Applicant/Agent: ( s _ Date:
SUPPLEMENTAL INFORMATION REQUMED
PLAN CHECK TYPE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for❑
existing building(s). Demolition permit is required prior to issuance of building
OVER-THE-COUNTER
/ ' BUILDING PLAN REVIEW
permit for new building.
❑ ExPREss
PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
TANDARD
❑ PUBLIC WORKS
_
form if any Hazardous Materials are being used as part of this project.
tLARGF
FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
SANITARY SEWER
_
submittal of Building Permit application.
MAJOR
DISTRICT
ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06121/11
.rlTr'FnQ�7 d -%Ml .r"Tr T7MTr1Trb rIPTMT/f"K
OCCUPANCY TYPE:
V.11 ll a N.Dg` 14— UR tL` im ti til N �u
FEE ESTIMATOR - BUILDING DI VISIGN
FLR AREA
s.r.
ADDRESS: 10899 S Blaney Ave DATE: 06/15/2012 REVIEWED BY: Sean
PC ]FEE ID
APN:
BP#:
VALUATMN: 1$100,000
*PERMIT TYPE: Building Permit
PLAN CIIECIK TYPE: Tenant Improvement
PRIMARY
Commercial Building
IBTIPLNCK
PENTAMATION
1B TIS
USE:
Elco. Insp. Fere:
PERMIT TYPE:
0 0
hrs
wORK
Tenant Improvement to change use from bakery to restaurant 2316 sq ft).
SCOPE
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.r.
PC ]FEES
PC ]FEE ID
BP FEES
BP ]FEE M
B (Tenant Improvements)
II-B,III-B,IV,V-B
2,316
$2,088.62
IBTIPLNCK
$1,942.98
1BTIINSP
Elco. Insp. Fere:
Suppl. Insp. Fee -.(j) Reg. COT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(:onsowction Tax:
Administrative Fee:
0
G
Work Without Permit? Yes No
$0.00
Advanced Plannin Fee:
TOTALS:
2,316
$2,088.62
$1,942.98
$21.00
MECH, HOURLY Q Yes E) No
PLUMB, HOURLY ® Yes (F) No
ELEC, HOURLY Yes Q No
Xtvc/t. Plan Check
Plumb, Plan Cheek
F.lec. Plan Check
. ch. Pertnnii Fee:
Plumb. Permil Fee:
Elec. Permit Fee:
Other Afeeh. Irsp.
Other Plumb Insp.
Other Elec. Insp. C
iaech. Insp. Fee:
Plunnb, Insp. Fee:
Elco. Insp. Fere:
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 nreliminary information available and are only an estimate. Contact the (Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef: 7/1/11)
FEE
QTY/)FLEE
MISC ITEMS
Plan Check Fee:
$2,088.62
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j) Reg. () OT 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,942.98
Suppl. Insp. Fee -.(j) Reg. COT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(:onsowction Tax:
Administrative Fee:
0
G
Work Without Permit? Yes No
$0.00
Advanced Plannin Fee:
$0.00
Select a Non -Residential E)
Building or Structure
G,•
71-ovel Docuenentulion Hees:
Strong Motion Fee: IBSEISMICO
$21.00
Select an Administrative Item
Bldg_Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$4,056.60
$0.00
TOTAL ]FEE:
$4,056.60
Revised: 06/05/2012
04/19/2013 16:57 4OB-244-6690 FEDEX OFFICE 02BB
Z -
OWN
CUPERTINO
CONTRACTOR I SUBCONTRACTOR LIST
PAGE 01
Building Department
city Orcupel,11.11.0
10300 Tom Avenue
Cupertino, (..A 95014..3255
'Telephone. 409-777-32218
T-im 11,08-777-333.1
J () R ADDRESS. i:)gy I�PgRzm.iri- L 2 'go
C)WNi
R'S N.A MT.
GENERAL CONTRACTOR: v 10 NESS LICENSI� 4 ocy)'76
_ A. We - k
-SS: S' I TY/7, jpc opT- 0
PDR I _S�� ;z.
100
*Our municipal code rerlidres all buslne.sies working in the city to linve it City of Cupef 6110 bushle4s license.
NO 111A.I.JANC, FTNAJ, OR FINAL, 0CCUPANCY INSPECTION(S) VVILL Br SCHEDULF.F) I.INTIL THE
GENE,1RAJ., CONTRACTOR AND ALL SU. 8C-WJ1A(:TORS VIAVV ORTAIN171) A CITU OF C'UPERTINO
MJSINESS LICE.NSE.
. . . . . ... ....
.1 am not mingany subcontractors: . . .......
Signature Date
.Please Check Applicable submitractors and compkU ffie following information:
-CJ-,!wg-C—/ i. I tr-a..c ..iwr- Signature 04-
DO tc
SUBCONTRACTOR
C',11MICL6 & M111WOrk
KISMSS NAME
D US 1.N ESS LJCEN.�E 4
----------------- 4
Cemem Finishing
Electrical
Excavation
Fencing
Flooring / 1"ar.poling
Linoleum / Wood
Glass / Glazing
H catt n L,,
(nsulation
..... ........
Lathing
Masonry
Painting / Wallpaper
Paving
plasturing
plumbing
RooFing
.
Septic Tmik
Shect met;11
. . ..........
shcet Rock
..... . .... .........
-CJ-,!wg-C—/ i. I tr-a..c ..iwr- Signature 04-
DO tc
� COO GALLON
00000 HTERCEPTO
MODEL 11PI003EPE-0
USTED BY UPCO
NORTHERN CALIFORNIA
8'-2"
I II I
I II I
I II I
5'-4"
5'-1"
I II I
I II I
I II I
TOP VIEW
(COVERS & RINGS REMOVED)
24" CAST IRON FRAMES AND COVERS
WITH GASKET (GASTIGHT) 2 TOTAL
2'-3"
t
TO 7'-3"
INLET
NYERT
5'- 0"
OPERATING CAPACITY: 1,000 GALLONS,
3", 6" AND 12"
GR2432 GRADE RINGS
AS REQUIRED
AT EXTRA COST
OUTLET
INVERT
3"
SIDE SECTION VIEW
DESIGN LOAD: H-20 TRAFFIC WITH DRY SOIL CONDITIONS
(WATER LEVEL BELOW TANK) AND 1'-6' EARTH COVER.
SUITABLE SUB -BASE BEDDED WITH GRANULAR MATERIAL SHALL BE
PREPARED TO HANDLE ANTICIPATED LOADS.
FOR COMPLETE DESIGN AND PRODUCT INFORMATION
CONTACT JENSEN PRECAST.
9/19/07 ,Jensen Precast reserves the right to make changes to product design
JPi000G_EPE_N0CAL B.dwg and/or dimensions without notice. Please contact Jensen Precast
@ 2007 Jensen Precast whenever necessary !or confirmation or advice on product design.
MINIMUM EXCAVATION
6'-4" x 9'-2"
x REQ'D DEPTH
IYIGy LL IL V.7.V4P VVIUCII 10dLU I\tlJI C14. LLv
1212 -41st
1212 -41st Ave.
®end, CA 94601 .
J I V L V IV Wu FA. r-
M
Tel : (510) 261-0737
Fax- (510) 261-0738
0 14 -gauge stainless steel stove top.
o Choice of back off front drainage t=el.
Choice of back or front drain basket -
o Choice of 'Water -Cooled, Top" or "Water ]Fall Backsplash" system.
o 2 -piece Pipe Rack.
o Manually controlled swing &wet between wok chaur> bm.
o Independent galvamed drnp bray under each burner for grease mid auris collection
o "U'shape gas shut/on valve handle provides easy access for knee.lewed and bands fime gas adjustment
during cooking.
o 5tmdard wok chamber available sizes: 13,16", 18", 20", 22° undies in
o Custom models available with yup to 9 bumers.
o Seven types of Guinn available.
191 -Tip Duck Burner: 120,000 BTU/!h>r.SS�ecffiy wk,-@ gzdw
26 --hp jet Burner: 120,000 BTU/hi. Gas,
23 -Tip let Bu>rneg: 130,000 ]BTU/hr. � Liquid tae Cas
Iff elevr ijom above 2000 fL, Specify_____X
32 -'Tip Jet burner: 140,19Q013TUlflar. Mam ff—bid A-�pea
Two -Ring 1�umer 30,000 BTU/hr. Nig Gas - s.® W.C.
Three -Ring Burner: 100,000i, BMAM Liquid Pte» Cs -14.0 W.C.
20 -Tip Jet Spm Bumer:130,000 B TUAm
0 comblE ibis: Sidle: 6 inches R9- 3 inches
Ividy LL IL VS.J,)y VUIUCII Vt2LU IIC.JI Cly. LLIi
U 1 ULU I U! JU Fi. I
SOMOM (Tags
0
fl2fl2-4Ilst Ave. MaggagabPo�f� HT0�,mom 0o
�akfle,�d, CA 9401 , o I� �� '769: (510) 261-0737
F=(510)26i-0739
1-11
-------------------
1
u�
Nuumbeur off
E) To get the minimum required Power bating for the water heater, multiply (D) by:
660 (gas) 95040 BTU (required)
our
0.15 (electric) IOW (required)
F) Water Heater Power Rating Given 120,000 BTU (given)
IOW (given)
N:\Plan Check Group
Compartments
P1Ian➢h�y:
A)
Utensil Sink (for dishes & pots) 3 x
25 =
75
Handwash Sink (including restroom) 5 x
5 =
25
Bar Sink x
10 =
Food Prep Sink 2 x
10 =
20
Mop Sink 1 x
10 =
10
Pre -rinse Sprayer 1 x
45 =
45
=175
GPH
(Gallons Per Hour)
B)
Hot water consumption for other fixtures (eg: dishwasher,
clothes washer)
from cut sheet
65 GPH
C)
Add (A) & (B)
240 GPH
D)
Multiply (C) by: 0.6 (busy full service restaurant)
or
0.4 (lower usage situation, eg: deli)
or
0.2 (market)
144 GPH
E) To get the minimum required Power bating for the water heater, multiply (D) by:
660 (gas) 95040 BTU (required)
our
0.15 (electric) IOW (required)
F) Water Heater Power Rating Given 120,000 BTU (given)
IOW (given)
N:\Plan Check Group