13080211CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10011 N FOOTHILL BLVD STE 113 CONTRACTOR: ED PERMIT NO: 13080211
OWNER'S NAME: JM4MY LI l l DATE ISSUED: 12103/2013
OWNER'S PHONE: 4086744631 PHONE NO:
LICENSED CONTRACTOR'S DE LARATION r
BUILDING PERMIT INFO: BLDG — ELECT PLUMB
License Class Lic. # �� f4 �fCJ d
MECH -1 RESIDENTIAL COMMERCIAL
Contractor � eiX TII o rcl Date / — 3 — J [---
1 hereby affirm that I arra licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions JOB DESCRIPTION:
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
APPLICANT CERTIFICATION
I certify that 1 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.
❑ OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License L21V for one of
the following two reasons:
1. 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 (See.7044, Business & Professions Code)
Z I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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.
2. 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.
3. 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.
APPLICA 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
LU DENTAL- COMM. T.1 1885 SF TO INCLUDE WAITING
AREA, RECEPTION, EXAM ROOMS, NEW LAB SPACE..
Sq. Ft Floor Area:
APN Number: 34249036.00
Valuation: $125000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN ISO DAYS OF PERMIT ISSUANCE OR
180 DAY)
Issued by:
M LAST CALLED INSPECTION.
Date: % r/n
RE-ROOFS.-
All
E-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. I will maintain compliance with
the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section
25532(a) should I store or handle hazardous material. Additionally, should I 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, Sections 25505, 25533, and
25534.
see
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of work'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 Professional
CUPERTINO
,Z NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(c cupertino.org
❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECTADDRESS ODI, 0141f( gfod Ira
APNN f 2 � ` X90
11 i
OWNERNAME 7�aM_J •r
1 j rl! �i2CS�
PHONE /
��� l���f'qZ31
E-MAiL���_[;/ ,ry
J/MAT CHIC' 61a�tJ G�O4�CF)+
STREET ADDRESS
CRY, STATE, ZIP
FAX
CONTACT NAME / '
Com+
PHONE
} (O E -MAI ^
-7�-fb3 ®Jq
S�TREF.7'ADDRESS 20 7g7 O�KA /L,�
C[TY,STATE, ZIP
�ai- /A 175-07-1175-07-1Tv��sX. )zSs-4szq
Td�❑
1OWNER 13OWNER-BUILDER❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
P�
CONTRACTOR NAME ef+ j`
11 1 �G{"pi
LICENSE NUMBER
TLICENSVTYPE
BUS. LIC A
COMPANY NAME 7(r
i GavL
E-MAI
L CLIHt
J
FAX
U!
STREETADDRESS
CITY,STATE,ZIP
PHONE/,76) 'p
1 `
ARCHTTECTIENGINEER NAME % _ f i a /
LICENSE NUMBER C �O 3z 73-7
BUS. LIC k
COMPANYNAME
E-MAIL I �iQ,tKevl�t,LOr�
FAX
STREET ADDRESS TOG S- fit-Yeei` # Z�Q
CITY, STATE, ZIP
u,L Tie 96113
PHONE
Z17ff7,s/
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR,
TYPE
k STORIES
n
cJen�a 1
USE
TYPE
OCC.
SQ.F1,
VALUATION {$}
AREA
AREA
NEWFLOOR,DEMO
AREA 1p�0
AREA
TOTAL
NET AREA
t �
y}
1
y
GI 1
BATIIROOM
KITCHEN
OTHER
REMODELAREA
REMODELAREA
REMODELAREA
PORCH AREA
DECK AREA TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
I
[]ATTACH
k DWELLING UNITS:
IS A SECOND UNIT YES
SECOND s roRY YES
BEING ADDED? NO
ADDITION? ZNO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS TIIE BLDG AN ❑ YES
RECEI j
TOTAL VALUATION:
PLANNINGAPPLN ❑NO PLANNING APPROVAL LETTER
EICHLERILOh1E? ❑NO
f
/���'�
By my signature below, l certify to each of the following: 1 am the property owner or authorized a nt toacton the property owner's behalf. 1 have read this
application and the information l have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identifiedproperty for inspection purposes.
Signature of Applicant/Agent: Date:il�SlZ'/3
SUPPLEMENTAL INVORMATION REQUIRED
PLAN CHECK TYPE
•ROUTING SLIP
❑ OVER-TIl&COUNTER
PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
�BUWG
permit for new building-
❑ EX s
ING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
nae n
_ Copy of Planning Approval Letter or Meeting With Planning prior to
❑
submittal of Building Permit application.
MAJOR011
SANIT YSEWER DISTRICT
Er-1�1-11RONAIENTAL
BldgApp_2011,doc revised 06/21/11
M
j CITY OF CUPERTINO
Fm -,I FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10011 N Foothill Blvd Ste 113
DATE: 12/03/2013
REVIEWED BY: suew
ON
APN:
BP#: 13080211
"VALUATION: 1$125,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
IBTIPLNCK
PENTAMATION
PERMIT TYPE: 1 B TA
WORK
Tenant improvement of a new Dental Office -1,885 s ft
SCOPE
Suppl. Insp. Feed Reg. O OT
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,I11-B,1V,V-B
1,885
$2,154.16
IBTIPLNCK
$1,679.88
1BTIINSP
Elec. I,tsp. Fee:
$1,679.88
Suppl. Insp. Feed Reg. O OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construclion Tax:
F
Administrative Fee:
O
0
Work Without Permit? O Yes C!) No
$0.00
TOTALS:
1,885
$2,154.16
Travel Uoc•ionetrrrruure Fees:
$1,679.88
Strong Motion Fee: 1BSEISMICO
MECH, HOURLY O Yes O No
PLUMB, HOURLY O Yes G No
ELEC, HOURLY O Yes Q No
Alech. Plan Cluck
Plumb. Plan Check
Elec, Plan Cluck
h&>ch. Petmil Fere:
Plumb, Pennlr Fee:
Elec. Permit Pee:
Other Meeh, /n.sjp•
Ocher phemb 111.sp.ET--I-
Other Elec. hasp. ET
,Meth Iirsp. Fee:
Plumb, 117sP. 1"VE';
Elec. I,tsp. Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planting, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the preliminary information available and are mtly an estimate. Contact the Dept for adds 7 into.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTYIFEE
MISC ITEMS
Plan Check Fee:
$2,154.16
Select a Misc Bldg/Structure
or EIement of a Building
Su 1. PC Fee: • Re OT
pP O g• O
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,679.88
Suppl. Insp. Feed Reg. O OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construclion Tax:
F
Administrative Fee:
O
0
Work Without Permit? O Yes C!) No
$0.00
Advanced Plannipg Pee:
$0.00
Select a Non -Residential 0
Building or Structure O
i
Travel Uoc•ionetrrrruure Fees:
Strong Motion Fee: 1BSEISMICO
$26.25
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$5.00
SUBTOTALS:
$3,865.29
$0.00
TOTAL E7T
$3,865.29
Revised: 1410112013
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 403- 777 -3228
Fax: 408-777-3333
JOB ADDRESS: 100 11 N , ��id►-�( d �# —L (3 PERMIT #t
OWNER'S NAIViE: ,T; rnw.y l-� I �/J en�%y l- '�__........ PRONE #t
GENL•'ly1l, CONTRACTOR: _(&rg f BUSINESS LICENSE #
ADDRESS: ,2j* 9f"wM CITY /7JPCODE:42; V 94& 5 6y_8�
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL Olt FINAL OCCUPANCY i.NSPECTiON(S) WT.T. L BE SCH..EDUT,F.,D UNTTT_, THE
GENERAL CONTRACTOR AND ALT, SUBCONTRACTORS iiAVE OBTAINED A CiTV OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
Please cheek applicable subcontractors and complete the following information:
Date
/ ontractor Signature Date
SUBCONTRACTOR
BUSINESS NAMIE
BUSINESS 1,TCENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
insulation
Landscaping
Lathiii.g
Ma.son..ry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roo-fing
Septic Tank
Mw
SlZeet Metal
Sheet Rock
Tile
/ ontractor Signature Date
CITY OF CUPERTINO BUILDING PERMIT INSPECTION CARD
BUILDING ADDRESS: 10011 N FOOTHILL BLVD STE
113
CONTRACTOR: 4L zv^-13E
DZTSX==ZD
PERMITNO:13080211
OWNER'SNAME:JIMMY LI W tNDy 1 L�
C-
��
1I wv
DATE ISSUED:12/03/2013�
OWNER'S PHONE: 4086744631
PHONE NO:
INSF€CI10NS.',j :, 'r `r "! ` i1aTE?.: ",w. !? .;-, INSPECTOR
BUILDING PERMIT INFO: BLDG r ELECT PLUMB r MEC11
r r
RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
LU DENTAL- COMM. T.I 188S SF TO INCLUDE WAITING
EA, RECEPTION, EXAM ROOMS, NEW LAB SPACE..
FOUNDATIONIPIERSIH.D.S.
UFER GROUND
PADISETBACK•CERT
GARAGE SLABS/PREGUNITE
F.Olili'IVD;CQ11tCRE'TEIY.[N7'��,AB()VEE�ii45BEEN,.9SG3!IED:r"s�zv;�, �:�;,:
UNDERGROUND/SLAB
UNDERGROUND PLUMBING
UNDERGROUND ELECTRICAL
DO ]VO,T,PQURTCQOF,,!J )T[I%'AB0-- 1A$',BEEEN'SIGNEDr M
UNDERFLOOR PLUMBING
UNDERFLOOR MECHANICAL
WILDLAND URBAN INTERFACE FIRE AREA r ERH
TO ARRANGE INSPECTION
Call 777-3228 between 7:30 am and 3:30 pm Monday through Friday, at least 24 hours
before required inspection. Job address and Permit Numbers are needed when
requesting an inspection.
CUPERTINO SANITARY DISTRICT
Closed circuit video inspection of property line cleanout, point of connection
and street lateral required prior to passing FINAL CITY PLUMBING
INSPECTION. Call the District (408-253-7071) for an appointment.
NO BUILDING FINALS INSPECTIONS UNTIL ALL REQUIRED
BUSINESS LICENSES ARE OBTAINED
PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT
ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION.
IMPORTANT
When a permit has expired, a charge totaling one-half the fees to obtain anew permit mu
be paid in order to reactivate the permit. If a permit has been expired for more
than one year, a charge totaling the full fees to obtain a new permit must be paid
to reactivate the permit.
NOTES:
SPECIAL INSPECTIONS Inspector: Date:
ROOF INSPECTIONS
PRE -INSPECTION: Inspector: Dale;
TEAR -OFF; inspector: Date:
PLYWOOD: Inspector: Date:
AT7'ENS: Inspector: Date:
IN PROGRESS: Inspector: Date:
FINAL: Inspector: Date:
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION.
OF BUILDING NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BV
UNDERFLOOR ELECTRICAL
UNDERFLOOR FRAMING VENTS
UNDERFLOOR INSULATION
PLACENo 5[1!i> GOORiUNr1L3AaoVua5±EeENSIGNED .' 9'
ROOF SHEATHING
ROUGH PLUMBING , ,Z - l �� f
�7 UBS & SHOWER PAN
ROUGH MECHANICAL
ROUGH ELECTRICALI OOL BOND
RAM[N WSTAIRS/E•. EGRESS f � f �
!
INSULATIONIVENTILATION �{ ,
GO,VER-AbO`I.E"AIKEN IGNED" : ; '":'=.f. i°
EXTERIOR SHEAR/HOLD DOWN
INTERIOR SHEARMOLD DOWN
SHEETROCK/SHEETROCKSHEAR
HI
EXTERIOR LATW-SCREED i
INTERIOR LATH
NO,rAREOR4I14 T, ER=i1NTILiMe�BOVE�ITAS'BEEI!ISIGNEOa-'
SCRATCH COAT
SEWERfWATER
T-BAR/MECH/ELECT ABOVE CELL E I
SvcZ211 a FI: ty ark n
'1 ECTRIC;�-d RELEASE
GAS TESTIMETER RELEASE
GRADE - PUBLIC 4VORKS
FIRE-CALL(408)378.4010 RC1
PLANNING (408) 777-3308
SANITARY (408) 253-7071 �-r � L
1
GLECTTRICAL
MECHANICAL
/
PLUMBiDIG r
HANDICAP
ENERGY
4SPECTOROCCUPANCY
BUILDING1
CERTIFICATE OFOCCUPANCY' ,�
APPLICATION FOR CERTIFICATE OF OCCUPANCY
OR CERTIFICATE OF COMPLETION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUP>;R71N0 ALBERT SALVADOR, P.E., C,B4O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ina(@cupertino.or4
COMPLETE A SEPARATE APPLICATION FOR EACH BUILDING:
PROJECT ADDRESS
APN N
DATE
r
OWNER NANT
,_11M {_ wuNll LLA
PHONE
40V 67Lf-�(-31
E-MAII.
�l�e,�:s4� r;6 yal,�o,
STREET ADDRESS
CITY, STATE, ZD'
FAX
CONTRACTOR NAME
(; �CJ•
PHONE
j(C 5-0706346
E-MAQ.
�.
STREET ADDRESS
CITY, STATE, ZIP
FAX
MAIL CERTIFICATE TO: (Please allow up to 10 business days for delivery):
CONTACTNAME JiM�y 7 ; 7PHONE4-467q-4631 E -MA u.�iM�
STREET ADDRESSj� CITY, STATE, ZIP FAX
za --7 2f,/LKI'+ � .S4-.fr y (/A i5"a7�
T.TST AT.I, RTTTI.T)TN(-T PFRMT'T'S TRRTTF.T) FOR PROT .rT-
PERNUT SIBbIIT
NUMBER DATE
ISSUE
DATE
DATE [i 1SPECTOR SCOPE
MALED
Ti loqf-211 8 /z.,6
121 k3
s/rqt-tp«
2
3
OCCUPANCY DATA:
USE OCCUPANCY TYPE FLOOR AREA OCCUPANT LOAD
I
2
3
4
BUILDING DATA -
,--,hN
Leri
0 STORIES
13ELOW GRADE
# STORIES
ABOVE GRADE
OVERALL
FLOOR AREA
LNLAX OCCUPANT FIRE SPRLNIMERS FIRE SPRINKLERS
LOAD REQUIRED YES OR NO PROVIDED YES OR NO)
9 PARKING
RE UWD
# STANDARDICONIPACI'
PARKLNGPROVIDED
N ACCESSIBLE
PARI:INGPROVIDED
- OFFICE USE ONLY (To be completed by inspector of record) -
SPECIAL STIPULATIONS OR CONDITIONS:
Cof0 Applicalion.doc revised 6104111
is Building Code certifying that
the portion�:of'tilisrstruetu`re _'d 'spdjdted for compliance with the
at the time of issuance,
requirements of this code and with the
various _,ordinances of th&City
pgu a J.ng� wilding=construction for the occupancy
and division ofr,7&66panty and the use'WiO-ichthe dd11�-"aribv is classified.
�'p9qy'p
Building Permit Number(s): 13680211 Applicatr Nate(".'6)" Issuance Date(s): 12-03-2013
Address of Building: 10011 P6, Ij i I I" B lid. S u i Ite # i i 3�"V
Tenant rl�a` n '54--
Portion of Building: provement (1885 sq.ft.
66 n ta I,--
�c
Use: Dental Office Qcdbp�tbldy C 16zsification: B 0,cup6nt Load: 26 occ.
.'Z11
Floor Area: 1885 sq.ft. Type,of,, Q-on'st( V-13,
System:. Throughout
'.
Current Property Owner: Jimmy Li
" 6 -
Current Owner Address: 20282 Zbrkb' Ave S A f i f 687 0'�
T
Final Inspection By: Larry.Se i;Bu'i ing,,-,'psp, rk�,,h-_.,
, S,
q 6 b]rc i �t, Idi-r-1 "i;- t'Of"I"
2'
Final Inspection Date 05-t-9- "O'llk-"'
�540 A�t �V
*SPECIAL STIPULATIONS OR OONDYTIOKS.:��'
W
Albert Salvador, P.E.,C.B.O., Building Official Date Issued
NOTICE/POSTING: No-changessha. beina'dein,the' �charqqer. of b�%u ncy. -7his ceilificdte -thaftin-4i conspicuous place on
e p6ited "
--'.0e ppremises, and shiiIG& be re -Moved except the authority of (Ike 6&kn
9tfficiak
M;P"
ot%W
This Certificate is issued pursuan"t 31r,
is Building Code certifying that
the portion�:of'tilisrstruetu`re _'d 'spdjdted for compliance with the
at the time of issuance,
requirements of this code and with the
various _,ordinances of th&City
pgu a J.ng� wilding=construction for the occupancy
and division ofr,7&66panty and the use'WiO-ichthe dd11�-"aribv is classified.
�'p9qy'p
Building Permit Number(s): 13680211 Applicatr Nate(".'6)" Issuance Date(s): 12-03-2013
Address of Building: 10011 P6, Ij i I I" B lid. S u i Ite # i i 3�"V
Tenant rl�a` n '54--
Portion of Building: provement (1885 sq.ft.
66 n ta I,--
�c
Use: Dental Office Qcdbp�tbldy C 16zsification: B 0,cup6nt Load: 26 occ.
.'Z11
Floor Area: 1885 sq.ft. Type,of,, Q-on'st( V-13,
System:. Throughout
'.
Current Property Owner: Jimmy Li
" 6 -
Current Owner Address: 20282 Zbrkb' Ave S A f i f 687 0'�
T
Final Inspection By: Larry.Se i;Bu'i ing,,-,'psp, rk�,,h-_.,
, S,
q 6 b]rc i �t, Idi-r-1 "i;- t'Of"I"
2'
Final Inspection Date 05-t-9- "O'llk-"'
�540 A�t �V
*SPECIAL STIPULATIONS OR OONDYTIOKS.:��'
W
Albert Salvador, P.E.,C.B.O., Building Official Date Issued
NOTICE/POSTING: No-changessha. beina'dein,the' �charqqer. of b�%u ncy. -7his ceilificdte -thaftin-4i conspicuous place on
e p6ited "
--'.0e ppremises, and shiiIG& be re -Moved except the authority of (Ike 6&kn
9tfficiak
M;P"
San Jose
Sm Water
Company
110 W. Taylor Street
San Jose, CA 95110-2131
San Jose Water Company
1319
Water Services Administration
1265 S. Bascom Ave., San Jose, CA 95128
Facsimile: 1 408 279-7889
Writer's Direct Dial: 1408 279-7879
January 17, 2014
RECEIVED
Leonard Ataide - r1772_ JAN `� 3 2014
Jones & Forrest, Inc.
3851 Charter Park Drive, Suite U ` BY
San Jose, CA 95136
Reference: 10011 Foothill Boulevard, Cupertino
Dear Mr. Ataide:
The purpose of this letter is to inform you of the procedures you need to follow to shorten
and adjust the 6" hydrant connection and to raise any meter boxes to grade if necessary.
Basically, you will need to hire a contractor to perform the work to our standards and under our
inspection. It is suggested, but not required, that you contact one of our general contractors to
have the work performed. They are West Valley Construction at 408-371-5510, and Lewis &
Tibbitts at 408-925-0220. In any case, your contractor must possess a valid license for this type
of work, and must obtain a permit from the City of Cupertino to do the job.
San Jose Water Company standards must be followed for the hydrant relocation and any
service lateral adjustments; enclosed are our Standard Drawings that detail approved installations.
After you have responded to this letter, please contact our Construction supervisor, Kevin
Dickens, at 1 408-279-7890 to coordinate your construction details (i.e. fittings, materials, etc.).
You also need to schedule your installation with Mr. Dickens.
Also, please submit one copy of the APPROVED OFF-SITE IMPROVEMENT PLAN.
Your j ob will not be released for scheduling without this plan. Furthermore, since this proposal is
based on an unapproved plan, any changes made due to approval requirements may result in the
need to reconsider our installation_ You will be responsible for the cost of additional engineering
and water facilities, if needed, and associated time delays.
If you would like to proceed with the work, please sign, date, and return this letter with a
construction deposit in the amount of $1,560 to cover the cost of our reviews and inspection.
Please make your check payable to San Jose Water Company.
Leonard Ataide
January 17, 2014
Page Two
If you have any questions or require further information, please contact me at 1-408-279-
7879.
Sincerely,
ORIGINAL SIGNED BY
Wanda E. Folk
Water Services Representative
WEF:bct
Enclosures
foothil110011.doc
cc: Building Department, City of Cupertino
Mark Knudsen, Kier & Wright Civil Engineers & Surveyors, Inc.
ACKNOWLEDGED AND AGREED
Signature
Print Name
Date