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13080145 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR:GIDEL AND KOCAL PERMIT NO: 13080145 OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 574 DIVISION ST DATE ISSUED:08/20/2013 OWNER'S PHONE: 4088730121 CAMPBELL,CA 95008 PHONE NO:(408)370-0287 Id LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 11 License Class 1 2 Li/c.# yO jO S O 2ND&3RD FLOOR COMM.T.I OF(2)EXISTING Contractor � Date RESTROOMS,738 SQ FT 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. I 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 ompensation,as provided for by Section 3700 of the Labor Code,for the erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$150000 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:36901027.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 1 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY OM LAST CALLED INSPECTION. 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: 115 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1e i) RE-ROOFS: Signa Date 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) 1,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 I 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 I store or handle hazardous I have and will maintain aCertificate 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 I 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 Sze/ permit is issued. Owner or a=aconstruction Dater 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,l ENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affiding 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 . . .. ..... .. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 5X014,0r 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildingP-cupertino.org CUPERTINO ❑NEW CON��STTRUCTION ❑ ADDITION � �❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PRO.iFr'T gDnnrc oC-v APN# OWNER NAVE �S PHONE5q.l ' E MSjI. - Gld a e�a STREET ADDRESS C �Y, STATE, IP e „ V5-0111 FAX c6 o7,) U S r CONTACT e/ 'Pr ,7�) E vLaIL STRF�p � � CITY(TATE, IP �„tea FAX 1CA ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT 71 CONTRACT R NAME LICENSE NUMBER LICENS TYPE BUS.LIC# CO PA AME E-M GM e1 ✓���/ � �,, &ot A c, ' ab 37c-,-G3 3S ST T DRE CI ,STATE, P P N Pris�G y o �3�0-oa r ARCW�^-""'-­­14AME LICENSE I)iJMBER BUS.LIC# COMP NAME11 F E- L en Ar /CI 1?2qrce e_ 2 STRF,E� RESS '54. Cj�Y STATE, J`Q '9'110 /V� A5L33 - 3 70 � DESCRIPTION OF WORK Y ' 7 EXISTING US PROPOSE USE CONSTR.TYPE #STORIES ;✓ /S USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO �'^✓ TOTAL AREA AREA AREA NET AREA - Ucy J, BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑.ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES.PROVIDE COPY OF IS THE BLDG AN []YES jZE, TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? FIND R By my signature below,I certify to each of the following: I am the property owner or authorized aseit to act on the property 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 authorizatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: �C/ /3 SUPPLEMENT FORMATION REQUIRED �iAN-CIJECKTi�rl ROU�i1Csrlr.,, ._ New SFD or Multif dwellings: Apply for demolition permit for ® OVER THE-CIO.VNTExFr art RCY w existing building(s). olition permit is required prior to issuance of building' permit for new building. © EXPRESS ' 4 ` Q� PLANI TING PT AlY RR'iE _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure © SicANDARv © gCJSLI WORKS 5 t form if any Hazardous Materials are being used as part of this project. RGi , I DEPT” _Copy of Planning Approval Letter or Meeting with Planning prior to Q MAJOR © $ANjTARYSEV4ERDISTRIC7 r submittal of Building Permit application. © �ir�'ROIVME*r"rAI,z 't'It :-v B1dgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20450 Stevens Creek DATE: 0812012013 REVIEWED BY: Sean APN: BP#: 'VALUATION: 1$150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1B TI USE: PERMIT TYPE: WORK Tenant Improvement of 2 existing restrooms 738 sq ft 2nd and 3rd floors SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. (s.f. B (Tenant Improvements) II-B,111-B,IV,V-B 738 $2,061.55 IBTIPLNCK $902.85 IBTIINSP TOTALS: 738 1 $2,061.55 $902.85 MECH,HOURLY (:) Yes E) No PLUMB,HOURLY ® Yes Q No ELEC,HOURLY Q Yes (2)No I-- NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the preliminar information available and are only an estimate. Contact the Dept./or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,061.55 Select a Misc Bldg/Structure Suppl. PC Fee: (F) Reg. 0 OT FO.07 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Pen-nit Fee: $902.85 Suppl. Insp. Fee-0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes (j) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure Strong Motion Fee: 1BSEISMICo $31.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $6.00 SUBTOTALS: $3,001.90 $0.001 TOTAL FEE: 1 $3,001.90 Revised: 07/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 eCUPERTINO Fax:408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS - ', r.t• �,, %;: PERMIT# OWNER'S NAME:. PHONE # GENERAL CONTRACTOR #��._�> � p _ti, -' BUSINESS LICENSE# ADDRESS: `' __?'.°raj r;d ;. ps �/' r",- CITY/ZIPCODE: JR *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. :e NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date;; ::_ Please check applicable subcontractors and complete the following information: , . SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical . Exgavation Fencing Flooring/ Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing ;Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank . Sheet Metal Sheet Rock Tile Ow-her�-Contractor Signature Hate STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-LTG-2A(Revised 08/09) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE LTG-2A Lighting Control Acceptance Document Pae 1 of 4 Project Name/Address: I, IA A"V,&r-? MOB 63$ STE') ; f CQFt1K(3 �JTJ�ZC irJ ED�CAT�o1� �'� SQA a 'LZo L.>,P(A 9501 System Name or Identification/Tag: System Location or Area Served: Enforcement Agency: Permit Number: 0060 1 yS Note: Submit one Certificate of Acceptance for each system that Enforcement Agency Use: Checked by/Date must demonstrate compliance. FIELD TECHNICIAN'S DECLARATION STATEMENT W -7 • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is t ue and co lt • I am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance(Field Technician). • I certify that the construction/installation identified on this form complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency,and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NAT • 1 have confirmed that the Installation Certificate(s)for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s)issued for the building. Company Name: 31VL t3A V-E IL Field Technician's Name: L01R,..G.� Field Technician's Signatur � � w t�t�tI Date Signed: Position With Company(Title): RESPONSIBLE PERSON'S DECLARATION STATEMENT • 1 certify under penalty of perjury,under the laws of the State of California,that I am the Field Technician,or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this form. • 1 am a licensed contractor,architect,or engineer,who is eligible under Division 3 of the Business and Professions Code,in the applicable classification,to take responsibility for the scope of work specified on this document and attest to the declarations in this statement (responsible person). • 1 certify that the information provided on this form substantiates that the construction/installation identified on this form complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency,and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NAT • I have confirmed that the Installation Certificate(s)for the construction/instaIlation identified on this form has been completed and is posted or made available with the building permit(s)issued for the building. • I will ensure that a completed,signed copy ofthis Certificate of Acceptance shall be posted,or made available with the building permit(s) issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: Phone: J—),-,- Iuv—*4L (4oW jT(LJ L 7*10A �8�8aZ- 191 Responsible Person's Name: Responsible Person's Signature: `t>VA fix 1LIe License: Date Signed: Position With Company(Title): 10 /-7 / ( dnj,- t. Occupant Sensor,Manual Daylighting Control,and Automatic Time Switch Control Intent: I Lights are turned off when not needed per Section 1 I9(d)& 131(d). Construction Inspection 1 Instrumentation to perform test includes,but not limited to: a. Hand-held amperage and voltage meter 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-LTG-2A(Revised 08/09) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE LTG-2A Lighting Control Acceptance Document (Page 2 of 4 Project Name/Address: 1g4se STc"as cd�t�a�-a sr z3n System Name or Identification/Tag: System Location or Area Served: b. Power meter continued on next page 2 Occupancy Sensor Construction Inspection D4 Occupancy sensor has been located to minimize false signals ❑ Light meter ❑ Ultrasonic occupancy sensors do not emit audible sound(119a)5 feet from source 3 Manual Daylighting Controls Construction Inspection If dimming ballasts are specified for light fixtures within the daylit area,make sure they meet all the Standards ❑ requirements,including "reduced flicker operation"for manual dimming controls stems 4 Automatic Time Switch Controls Construction Inspection a. Automatic time switch control is programmed for(check all): Weekdays 16 Weekend - -- ❑ - Holidays --- ---- ------ b. Document for the owner automatic time switch programming(check all): Q� Weekdays settings Weekend settings ❑ Holidays settings ❑ Set-up settings ❑ Preference program setting ❑ Verify the correct time and date is properly set in the time switch ❑ Verify the battery is installed and energized Override time limit is no more than 2 hours Occupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in accordance with the applicable provision in Section 119 of the Standards,and model numbers for all such controls are listed on the Commission database as Certified Appliance and Control Devices A. Select Acceptance Test(Indicate lighting control systems Names/Designations by the applicable tests below) Jr 1 Occupancy Sensor ❑ 2 Manual Daylighting Controls J9 3 Automatic Time Switch Controls B. Equipment Testing Requirements Applicable Lighting Check and verify those items applicable to selected system: Control Systems Occupancy Sensor-Step l: Simulate an unoccupied condition 1 2 3 Ic. Lights controlled by occupancy sensors turn off within a maximum of 30 minutes from ©/N Y/N Y/N start of an unoccu ied condition er Standard Section 1 I9(d) The occupant sensor does not trigger a false "on"from movement in an area adjacent Y N Y/N Y/N to the controlled s ace or from HVAC o eration Signal sensitivity is adequate to achieve desired control (Y)/N Y/N Y/N Occupant Sensor-Step 2: Simulate an occupied condition 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-LTG-2A(Revised 08/09) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE LTG-2A Lighting Control Acceptance Document (Page 3 of 4 Project Name/Address: Hiols-ru-- LA Lt vs c+1.c�El`��.bo �,,Peta•,�,o• 950 !y System Name or Identification/Tag: System Location or Area Served: a. Status indicator or annunciator operates correctly Y/N Y/N Y/N b Lights controlled by occupancy sensors turn on when Immediately upon an occupied y N Y/N Y/N condition OR this requirement is mutual) exclusive with Ste 2.c.) C. Sensor indicates space is 'occupied"and lights turn on manually Y/N Y/N Y/N continued on next page Occupant Sensor-Step 3: System returned to initial operating conditionsY N Y/N Y/N Occupant Sensor-Step 4-Sensor is also a multi-Level Occupant Sensor used to qualify for a Power Adjustment Factor in Section 146(a)2D of the Standards. If yes,then `a,' `b,' Y/N Y/N Y/N and `c' must also be es. a The first stage activates between 30 to 70%of the lighting either manually or Y/N Y/N Y/N automatically. A reasonably uniform level of illuminance is achieved by dimming of all lamps or b. luminaires; or by switching alternate lamps in luminaires,alternate luminaires,or Y/N Y/N Y/N alternate rows of luminaires. After the first stage occurs, manual switches have been provided to activate the C. alternate set of lights,activate 100%of the lighting power,and manually deactivate all Y/N Y/N Y/N ofthe lijzhts. Manual Daylighting Controls-Step 1: Manual switching control Fb. At least 50%of lighting power in daylit areas is separately controlled from other lights Y/N Y/N Y/N The amount of light delivered to the space is uniformly reduced Y/N Y/N Y/N Manual Daylighting Controls-Step 2: System returned to initial operating conditions Y/N Y/N Y/N Automatic Time Switch Controls-Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch Y N Y/N Y/N b Verify the switch only operates lighting in the ceiling-height partitioned area in which N Y/N Y/N the switch is located 0 Automatic Time Switch Controls-Step 2: Simulate unoccupied condition qk a. All non-exempt lighting turn off per Section 131(d)1 Y/N Y/N Y/N Manual override switch allows only the lights in the selected ceiling height partitioned b. space where the override switch is located,to turn on or remain on until the next OY N Y/N Y/N scheduled shut off occurs C. All non-exempt lighting turns off /N Y/N Y/N Automatic Time Switch Controls-Step 3: System returned to initial operating conditions Y N Y/N Y/N Note:Shaded areas do not apply for particular test procedure C. PASS/FAIL Evaluation(check one): PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Re uirements responses are positive Y- es) FAIL: Any applicable Construction Inspection responses are incomplete OR there is one or more negative(N-no) ❑ responses in any applicable Equipment Testing Requirements section.Provide explanation below. Use and attach additional pages ifnecessary. 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-LTG-2A(Revised 08/09) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE LTG-2A Lighting Control Acceptance Document (Page 4 of 4) Project Name/Address: '_t^1X/►„yv\A.44,m j jJs�`0. �O lL System Name or Identification/Tag: System Location or Area Served: 2008 Nonresidential Acceptance Forms August 2009