B-2017-0010M
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0010
10088 WOLFE RD STE 100 CUPERTINO, CA 95014 (316 20 108)
M R CHRISTENSEN
CONSTRUCTION INC
CONCORD, CA 94520
OWNER'S NAME: CUPERTINO PROPERTY DEVEL I LLC
DATE ISSUED: 06/13/2017
OWNER'S PHONE: 408-343-1088
PHONE NO: (925) 674-0464
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #Z4 262
Contractor M R CHRISTENSEN CONSTRUCTION INC Date 06/30/2019
X BLDG —ELECT _PLUMB
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
STE 100 STOUTS - T.I. - RESTAURANT (3,362 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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
Irfor ce 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
Sq. Ft Floor Area:
Valuation:,$525000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read,this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
31620 108
A (Tenant Improvements)
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
ignature /Z��..Date 8/14/2017
Issued by: AbbyAyende
OWNER DECLARATION
Date: 06/13/2017
-BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
r. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 8/14/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health &Safety Code, Section 25532(a) should I store or handle hazardous
3. 1 certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any'person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become.subject to the Worker's Compensation provisions of the
the Health & Safety Code„ Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
O00
wner or authorized agent:
APPLICANT CERTIFICATION
Date: 8/14/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 811412017
professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
UPE1371iV0 (408) 777-3228 - FAX (408) 777-3333 -- bUildiinntc rc cuperlino.ora 6-2-01 '�—p0/ 0
r l *rr�cr i+nwre rntrna rn�i n nrtt rrnrs ei TrttA7lnAt l P% 1 1 TiTzvICiohy i n-Pri:RRF.r) ownINAL PERMIT iE
PRG1SCrADDKESS 10088 Wolfe Road Suite 100
AIIN$ 1 `_ •- �� ... I
W
OWNERNAME Susan Song
PHONE/
(408)343-1088x110
E-h9All,
ssong@kcrdevelopment-.com
Stevens Creek Blvd,#200 Cn�Y,STATE,z1F Cupertino, CA 95014 PAx (408) 863-7333
CON'I'ACI'NAh1E Sunnie Wu PHONE (510)488-6476 11 -MAIL
sunniew restaurantdesi nconce ts.co
l3TREl?1'All1)RtaSS 1017 22nd Ave Suite 110-b
cITY,srATE 2tr Oakland, CA 94606
Mx(510) 436-7400
13 OWNER ❑ OWNP.R•AUHMER ❑ OWMRAOENT 11 CONIRACI'01t 13 Co1rRACTORAGLNr �' ARCHITECT D ENomser, ❑ DEVELOPOIt LZ TENANT
CONTRACTOR NAME
G_GS
LICENSE DER
o Z
LICrNSE TYPE
AUS. LiC ft
CUV1P YN h1E !F+�
J (moo, '/y( cre
E�h�AIL
AX
rj�f� GUH
SIRL'L•'F AUDRE'S
V(Sd t7� � o
CETY, C, �� C/ ZU
Plt()NE.
ARCIRTECIYGNOINEERNAMR Peter Braun
1,10ENSENu"IDER C-13221
BUS, LIC I
COINVANYNAME Restaurant: Design Concepts
?-MAfI.
11 I.1 O@res tater antdes i.gnconcepts . co
Pax (510)436-7400
STREF.TADORMS 1017 22nd Ave Suite 110-b
G'1TY,STATG,ztP Oakland, CA 94606
PHONE (510)436-93 32
DESCRIPTIO, OF WORK
NON e'4 ment, new hood, new millwork, new Walls, new restrooms, and new
dining room finishes. No patio work w/this permit.
EXISTING USE
N/A
PROI' SW USG WNS7R.TYPr
A-2
1-A
aSTORIP.S
5
USE
TYPE
OCC.
SQ.r•C
VALUATION {S)
ExlsrG
ARrA3362sgfi
NEW FLOOR
..As'+^ n/a
Drwo
AREA n/a
TUML 3362sgft
MARr:A
A-2
1-A
17.3
3362
525,000
BATHROOM 344s ft[e1Tt`HEN
REMODCLAREA
j,
710sgft
,IMMODELAREA
OITIER
[U]NIODELALUM 2308sgft
PORCH AMIA
DECK" R&\
TOTAL )ECIUPOKCH AM
GARAGE AREA:
n/a
n
n/a
8DETACH
n/a ATTACII
I
fl AIVRLI.ING UNITS: ;
IS A SECOND UNrr J1YLS
SECOND STORY f] YES
n/a
BEING ADDED? ONO
ADD111ON? ®NO
PRE :5 LICArI6'q E[YE. IF Yes, PROVIDE COPY OF [STHE DLDG AN [3 YES 'R TOTAL VALUATION:
_
I'LANNINGAPPI.B []NO, PLANNINOAPPROVAL LBITHR EICIiLER11ONR? ®NO 525,000
BY my signature below" 'ccrti ry to cacti of the following: i am the pinperty owner or authorized agont to act on the property owner's behalf.I have read this
application and the inreririlttion {Rave provided 1s correct I have read the Description or Work and verity it is accurate, 1 agree to comply with atl applicable local
ordinances and state laws'iohiting to builldding coltstrtt(;tigalL I authorize representatives of Culwrtino to enter the above•idenliricd property for inspection purposes,
Signature o rAppl icant/Agert,t; Date: 1/3/2017
3UPPLEI-MENTAL, INFORMATION REQUIRPI)
PJ AN C)tECK TYPE
ROUTING SLIP .
0 0V R'rIIE•COUN'rER
❑ BUILDING PLAN REVIEW
—New SFD or Multifirinily, dwellings. Apply Por demolition permit for
existing building(s). Demolition permit is required prior to issuance orbuilding
permit for now building.
❑ EXPRESS
❑ PLANNINO' PLAN RLVIELY
. Commercial Bldgs: 11rovide a completer! Hazardous Materials Disclosure;
1:1STANDARD
0 'PUAt'Ic WORKS
Tor—in if any FIamrdous,Materials are being used its part orthis project.
❑ LARCE
❑ PIRR' DEPT
x Copy of planning AoproJal Letter or Mcoting with. Planning prior to
0 DL\roR
❑ sANrrARYsrwFRwsTRiar
submittal of Building Permit application.
y
1.1 ENVIRONT4ENTALREALTIi
Bldgflpp_201 Ldoc revised 0612!!11
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Attention: [00 O Mh kkh)` I
A vent limiting orifice or device when used with Maxitrol regulators,does not release or relieve fuel gas into the environment during normal operation.
l
' it 1 Maximum Allowable. I"
Vent Limiter ,; Specific Flow Rate,cubic feet v
Gravity1per hour(cm ,
, 3/s) ,
Vent limiter for use only with natural, tt
_ manufactured, mixed gases and LP 0.64 2.5 (19.5) : 9`:
gas-air mixtures. i:''„ .'
Vent limiter for use with liquefied 1.53 1.0 (7.9) 7 EL
r''
petroleum gases. i
—
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,et 12A39 Open/Normal Closed/Limiting
PositionPosition
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12A09 (1/8" NPT) 12A39(3/8" NPT) 12A49 (11J2n NPT)
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.
NOTES: ,
Vent limiters are designed for use indoors and in spaces where limiting the amount of gas escapement due to diaphragm failure Is critical.Vent limiters should not be used
outdoors if they are exposed to the environment.
,. 13A15,13A15-5,and 13A25 Vent Protectors are available for outdoor applications to ensure proper vent protection.
Vent limiters can only be installed in regulators for which they are certified.Vent limtiers must only be installed directly into the vent connection of the regulator without intermediate pipe or
fittings.When using a vent limiting deivice,the regulator must be installed in a horizontial upright position. 4'.
i
NOTE:Maxitrol vent limiters meet ANSI Z21.80/C5A 6.66.The requirement states"Vent limiters shall be of materials having melting points of not less than 800°F(427°C):'
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I! www.mERTIK 1311•XITROL coo
mi, NEPA 54/ANSI Z223.1 NATIONAL FUEL GAS CODE(2012)
5.8.6 Venting. .
5.8.5.1.Line Gas.Pressure'Regulators. 065-5 J_L._.
,
Line gas pressure regulators shall comply with the following I /'~ %,
` ' 1.An independent vent to the exterior of the building,sized in accordance with the regulator manufacturer's instructions,shall be provided
where the location of the regulator is such that a ruptured diaphragm will cause a hazard. 0 ,
a.Where there is more than one regulator at a location;each regulator shall have a separate vent to the outdoors,or if approved by 1
the authority having jurisdiction,the vent lines shall be permitted to be manifolded in accordance with accepted engineering
practices to minimize backpressure in the event of diaphragm failure.(See 5.9.7 for information on properly locating the vent.)
` b.Materials for vent piping shall be in accordance with section 5.6.
Exception:A regulator and vent limiting means combination listed as complying with ANSI 221.80/CSA 6.22,Line Pressure Regulators,shall be 1
permitted to be used without a vent to the outdoors.
2.The vent shall be designed to prevent the entry of water,insects,or other foreign materials that could cause blockage. ''
3.The regulator vent shall terminate at least 3 ft(0.9 m)from a source of ignition.
4.At location where regulators might be submerged during floods,a special antiflood-type breather vent fitting shall be installed,or the ;-
vent line shall be extended above the height of the expected flood waters. i
5.A regulator shall not be vented to the appliance flue or exhaust system.
,
,a
( Codes for Vent Limiters '
l Vent limiters are designed for use indoors and spaces where limiting the amount of gas escapement due to diaphragm failure is critical.Vent limiters
i should not be used outdoors if they are exposed to the environment. ,
Regulators used outdoors must be installed in accordance with one of the following national codes: !,.
1 A.'National Fuel Gas Code; ANSI Z223.1 / NFPA 54 2012 section "9.1.19 Venting of Gas Appliance Pressure
Regulators.
Venting of gas appliance pressure regulators shall comply with the following requirements:(2)Vent limiting means shall be employed on listed appliance
regulators only.(3)In the case of vents leading outdoors,Means shall be employed to prevent water from entering this pipe and also to prevent blockage N
of vents by insects and foreign matter:' n
B.International Fuel Code 2011 section "410.3 Venting of Regulators. i
Pressure regulators that require a vent shall have an independent vent to the outdoors The vent shall be designed to prevent the entry of water or i'
foreign objects.EXCeption:A vent to the outdoors is not required for regulators equipped with and labeled for utilization with approved vent-limiting
devices installed in accordance with the manufacturers instructions." 1
C.,Uniform Plumbing Code IAPMO/ANSI UPCI-2012 section "1209.7.5 Venting. 1209.7.5.1 Line Gas Pressure i''
Regulators. r
Lihe gas pressure regulators shall be installed In accordance with the following requirements: S
=i "
(1)An independent vent to the exterior of the building,sized in accordance with manufacturer's instructions,shall be provided where the location of a 1'4
regulator is such that a ruptured diaphragm will cause a hazard.Where more than one regulator at a location,each regulator shall have a separate vent i
't to the oudoors,or where approved by the.Authority Having Jurisdiction,the vent lines shall be permitted to be manifolded in accordance with accepted
j engineering practices to minimize backpressure in the event of diaphragm failure.[See NFPA 54:5.9.7]for information of properly locating the vent)
Materials for vent pipes shall be in accordance with Section 1209.5.
1 :r gii li Z.agOatorth .n'' btiliordtin.' -at c.m e m; sn its rl, ccordaiir rw xh ANSlf 9 8'O�ICS/t:6shallabet rmitte'd tos ,ose tfao,'
E vein:ze(t ` .o. ..if
' (2)The vent shall be designed to prevent the entry of water,insects,or other foreign materials that could cause blockage'
,, Vent limiters will not prevent water,insects,or other foreign materials from entering the regulator. s'
'1 i :
i'
,'' CAIN CSA B149.1 Natural Gas&Propane Gas Installation Code Canada(2011) ;`
5.2:2 Additional requirements for pressure regulators for propane applications 1,
I ! G<i
5.2.2.4.When used on a system operating at 2 psig(14 kPa)or less,a line pressure regulator equipped with a leak limiting sgstem orificed for 1 ff/h • (r,
4'; (0.0283 m'/h)of having aspecific gravity if 1.53 shall be exempt from the requirement of Clause 5.2.1.5(b).
1 A regulator with vent limiting means shall be installed in a ventilated space only. (
•
dditional requirements for pressure regulators for natural gas applications
.1.When used on a system operating at 2 psig(14 kPa)or less,a line pressure regulator equipped with a leak limiting system orificed for 2.5 ft'/h
( 6 m'/h)of a specific gravity of 0.6 shall be exempt from the requirement of Clause 5.2.1.5(b).
A i ulator with vent limiting means shall be Installed in a ventilated space only.
5.2.3.2.For systems with inlet pressures above 2 psig(14 kPa)a pressure regulator shall be exempt from compliance with Clause 5.2.1.5(b)of this
j Code,provided that it is equipped to limit the escape of gas from the vent openings,even in the event of a main diaphragm failure,to less than 2.5 ft'/h
J (0.0706 m'/h),that it has having an overpressure protection device(OPD)set to a pressure either below 2 psig(14 kPa)or 2 times the delivery pressure
1 on the system and certified,to ANSI Z21.80/CSA 6.22.
I '
I • i'
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®2017 Maxitrol Company,All Rights Reserved
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Since 1970
Certifies that:
, Adrian E® .ovoa
Completed a Training Course in the Theory and Practice of. Applying Subsurface
Interface Radar in Engineering and Geophysical Investigations.
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StructureScan Mini- .
November 13, 2013
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Geophysical Survey Systems Inc.
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Service Agreement No.:21400
Date: 09/29/2017
3801 Charter Park Court,Ste.M,San Jose,CA
95136 Tel:(408)266-7000 Fax:(408)266-7050 p Reg ❑ Night ❑ Sat ❑Sun ❑ PW
Contactus@safe2core.com
Contractor License No.:940453
CUSTOMER'INFORMATION: JOBSITE INFORMATION:
Company: MR Christensen Project Name: Stout Burgers
Requestor: Matt Christensen Job/Project#:
Cell II: P.O.#:
925.766,3713
' Tel#: Addre 10088 Wolfe Rd,Cupertino ,
Address: •
Contact: Ranolfo
Remarks: Tel#: 209.409.1630
DESCRIPTION'OF SERVICES: I CONCRETE SCANNING 0 CONCRETE CUTTING `: 0 UTILITY LOCATING 0 OTHER,
Instructions&Special Equipment:
Scan 4-6 areas 1'x 2'on 12"thick slab and(3)8'x 16'ceiling.Lift on site.
Completion Notes:
-Scanned3areas on slab
Marked all rebar and conduits found in slab
Grit open areas only
All •
Work completed,will comeback next week for overhead scanning
Operator: Adrian Start Time: 01:30 PM(' Lunch Break: End lime: 02:15 PM(• Total Hours: 0.75
Oper/Helper: Start Time: Lunch Break: End Time: Total Hours:
Disclaimer:Ground Penetrating Radar(GPR)is a non-destructive method used to locate embedded materials in concrete and soil such as plastic,metal,steel,voids etc.Safe2core,
Inc.will not be liable for any damages to rebar,post-tension cables,conduits,or any other embedded targets that arise as a result of Ground Penetrating Radar inspections performed
by our technicians. GPR has accuracy limitations that could result in human error. Safe2core,Inc.will not be liable for any damages to nonconductive lines(Nonmetallic,PVC,Water,
Etc.)and for any conductive lines(Electrical,Gas,Etc.)with no accessible connection point or those that do not appear on blueprints,maps,or as-builts provided by customer prior to
locating.Safe2core will not accept back charges under any circumstances for the repair of any damaged embedded target.Safe2core reserves the right to,choose the repairing
company if we believe Safe2core.is responsible for it.Safe2core,Inc.will not be responsible for any loss or damage arising out of the use of,or reliance on the data collected,or the
report presented. Customer further agrees that he/she has carefully read the forgoing release agreement,knows and understands the contents of the same,and signs this release
agreement as his/her own free act.Customer shall indemnify and hold Safe2core,Inc.and its directors,officers,employees,and agents harmless from and against any liability and all
claims,actions,proceedings,damages,losses and expenses(including attorneys'fees)arising from any personal injury or death,and for injury or destruction of property of a person'
or organization,including any loss that arise from the performance of the work under this agreement.
Ranolfo a
Accepted By(Print Name) (Signature)