21559 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO,
Building Addres,: �-S _�� /� 21559
nere L I one:( A A
ate. v!P 8V � CITY OF CUPERTINQBUILDING DIVISION
co ra�r'aNai: ti I sect. APPLICATION / PERMIT
BUILDINGELErIRICA4PLUMBINGMECFIAMCAL CATEGORY CONTROL If
Arehit /Engineer. Lie.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: PERM117ISSUANCE ❑ 11 1:1LICENSED CONTRACTOR'S DECLARATION
I hercby affiromection70 that)am Bce3oftheed under provisions Pm ChaptsCW( and my APpLfANCESRE51DEN17AL JOB DESCRIPTION
ingwlth5ection 7000)0(DiWaion3ofthe Budnevand ProfndomCode,and my
Rance b in full nd eif- PANELS • '
Llanse Class L`Y LICN Z � 3 TA� N --s��j
DateContraCHIder
C-4 RTECPS DECLARATION 201-IWO AMPS
q�++Is l,' I understand my plana shall be,used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA 5/SQ.Fr.
jK d(/ Llansed Prole®Zonal SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION $PECIALCD2CUIT/MLSC
7E, 7� Ihembyaffiren that Is.exempt from the Contractor's License Lawforthe
oo following reason.(Section 90315,Business and Professbns Code:An d or
OZF.µ9 y city TEMP.MEIERORPOLEINST.
Fv� a countywhich rcqulresa permlttoconstwq oteq Improve,dem..ch,orrepor
.¢a any atruRure statement
that he is also sed pursuant
t the forwcons,ofpermit e POWER DEVICES
ryG�U like a signed datement that he b licensed pursuant to the proWions of the
3 LLO Contractor',License Law(Chapter 9(commentlng with Section 7000)of Divi- SWIMMING POOL ELECTRIC
El, a slon3ofthe Busincesand Professions Code)orthat hebexempttherefromand VALUAlTON
p yd the basis for the alleged exemption. Any violation of Section 7MI-5 by any
applicant!..:permltsubje ltheapplicanttoativllperultyofoatonrethan OUTLETSSWITCHES-FXT,N2
aEE five hundred da1Ws(SSIX). NEW RFSIDEN77AL EL
0) ❑I,as owner of the property,or my employees with wages as their sole XT. SLOW FS TYPE CONSTRUCTION
compenwtlon,wOldothewwkandthestmmmre nmintendedoroffeexifor
a O sale(Sec.7094,Business and Professions Code:The Contrad.e.License Law
ei S does not apply to an owner of property who builds or improves Ihercon,and
0.0. who does such work himself or through his own employees,provided that such OCC.GROUPRESUNITS
Improvemenbarenwt tendedorofferedforsale.ILhowev r,thebuildingw T L:
improvement bsold withinone yearofcomplefoo,the owner-budderwlll have
then of proving that he did not build or improve for purpose of sale.). QTY, PL GPERMI FLOOD7DNE APN
L1,as owner of the property,am exclusively..trading with licensed PERMIT ISSUAN
contactors to corubuct the project(See.7094,Business and Professions Code:
TM Contractor's License Law does not apply to an owner of property who
W E&or Improves thereon,and who comms fns such p�o)eRs with a ALTER-DRAIN -WATER(FA)
cgtilractor(s)licensed pursuant to the C.nerador's License Law. BACK FLOW PR T.DEVICE FEE SUMMARY
u I am exempt under Sec. B h P C for this mason
Owner Doe DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_
WORKMAN COMPENSATION DECLARATION REGEI'r N
❑I hereby affirm that I have a certificate of consent to seB-inwre,or a FIXTURES PER TRAP SCHOOL TA% Y N
certificate of Workcm'CompeeeaUcn Insurance ora artlfkd copythere.f(Sec. RECEI7 N 17
3800,Lab C.) 4 / GAS FA.SYSTEM-1 INC.9OUTLE7S PARK FEE Y_ N_
Policy#ny 2 h/y p q RECEIPT N
Com aoy_l.(AOI ash 4,.. GAS EA.SYSTEM-0OVER BUILDING DIVISION FEES
rti0edcopy b f ereby I,*wtume cityed. GREASE/INDUSIRLWASTEINTERCEPTOR PLANCHECK FEE
e Bledc b( with the city Wlaettlan division.
a- 1OCLMPTI K ES' GREASE TRIM
CERTIFlG OF E)(E ION IN FROM WORKERS• PAID
COMPENSATION INSURANCE
(1'hb setionneed not Wcompleted:(toe permit b(oronehundred dollars SEWER-SANITARY-STORM EA.200F)". Date Recti [#
m00)wfess.) WATER HEATER W/VENT/ELECTR ENERGYFEE Y N
Isnot that in the person Zany of the work
manner Is,as which
penult is bo red,
1 soak(not employ any person In any manner ao a to become subject to the -
O Workers Compensation laws of California.Date WATER SYSTEM/TREATING, PAID
Applicant
Z ZO NOTICE TO APPLICANT:If,offer making this Certlfkate of Exemption,you '�W RESIDENTIAL PLMB.__SQFT. Date Recti t#
Fshould becoe msubject to the WorkersCompensation provisions ofthe Labor TOTAL:
WN Code,you must forthwith comply with such provisions orthb permit shall be
> deemed!revoked. BUILDING FEE
CL (] CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirmthat there b a construdlon lending agency for the perform
O ance ofthe work for which this permit b isued(Sec,3097,Civ.C.) TOTAL: ELECTRIC FEE
uLendee.Name
1L F Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
O w Icertiythatlhave read this
applicetio..odnatethatthsaboveinformation MECHANICAL FEE
Iscormet.(agreetocomplywithalcIty.rulom yoNinanaa and date laws PFRMTTISSUANCE FEES PAID:
} in relating to building mmtwction,and hereby authorize reprexntatives olthb
city to enter upon the above-mentioned property fns Inspection purposes. ALTER OR ADDTO MECH. �s�
(We)agree to save,indemnify an d keep harmless the City of Cupertino Date Reccipt#
against lisbilltieajrdgments,codsand expenseawh(ch mayln anywayamue I AIR HANDLING UNIT ITO lg0Doct M)
zg.iestsaid City in con stnes of the gra ming of this permit. SUBTOTAL:
MR HANDLING UMT'(OVER t0,00pCFM) CONSTRUCTION TAX
mar /i 4,2-96
Slgruture of Applecant/Contractor Date EXHAUST HOOD IW/DUCD CONSTRUCTION TAX PA ID:
HA7AR DOUS MATERIALS DISCLOSURE
Will the applicant or future building occu pant store or hand Is hazardous !RESID:FI�MAL
T!MECH. 9Qt.F7
TT)
material as defined by the Cupertino Municipal Code,Chapter 9.12 and the Date Recei t#
1❑t Yesd Safety Code,SeNioon 75532(a)t IT BTU) TOTAL•
Will the applicant ser❑future building occupant use equipment or devices FRFSID) ISSIJ/q_NGE DATE
which emit hazardous air contaminants as defined by the Bay Arca Air l (Fr' (®
Quality Management District? OU BTU)
Yes II��No
have read the hazars�ous materials requirements under Ch.peer 6.95 of BOILER-COMP(OVERBTU) PEC 11 1990
the Ca lifomla Health k Safety Code,Sedioru 25505,25533 and 2x539.1
undersea nd that if the building does not currently have a tenant,that it is my TTSQ.FT
ropomibildy to notify the occupant of the requirements which must be met
prior to issuance of a CertiOats of Oaupancy. CIO of nl��
Owner or authonud agent Da1e CIO of
TOTAL: SSUED BY:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identlfhatlon \ �1 PERMIT NO. "qq",))ll
Building Address: Z 13�.V
I0Igq
iters afAA A A
hf Z �,I� $S f� CITY OF CUPERTINO-BUILDING DIVISION ' O
Cantrjcftr Na Lk�1Ne: APPLICATION I PERMIT —'j
l I C�� OL��V 4] IJ JD BULDING-aE-CTRICALPLL BING-MECFIAMCAL CATEGORY CONTROLA'l+a'1
Archlte9t/Frgi r. Lk.No: lea G It sC
y Qn ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: QZ— Frg�j�qjSVr1 V4\0.—l PERMIITISSUANCE b ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATI N
I hereby affcen that l am licensed under provision,of Chapter 9(commenc APPLIANCES-RESIDENTIAL JOB DESCRIPTIONIngw'th Setion7000)of DiWkon3ofthe BuslnessandPmfe oneCode,andmy
license is in fail form and effect PANELS
Lt...Cl.. LI.N
Data Contractor 1
ARCHITECTS DECLARATION 201-1000 AMPS
nt07p7OC I understand my plans shall be used as public records. OVER 1000 AMPS 5Q.FI'.FLOOR AREA S/SQ.FT.
X U Licensed Profesabnal SIGNS ELECTRICAL 1 11
z U J J (�,
OWNEReBUILDER DECLARATION SPECIALCIRCUT/MISC
-/owingIlienclrasRrmthetlam ll.5,Bfromthe Contraessionlianx Law fort he
oo following reason.(Section 7 tto Business and Professions Code:Any city it
4,9 TEMP.METER OR POLE INST.
�� 3, anystmhmpM arltot p ance,a oregt,altheapmvntforilsh, er ttr
g a any structure tatements that
he Is lice sed Pursuant to the revisions of t e POWER DEVICES
file a signed statement that he t licensed pursuant to the provisions of the '
u, Contractors License Law(Chapter 9(mmmenang with Section 700D)o!Div'- SWB.SMIINGPOOLELECTRIC
akm3ofthe Business and ProfesdoruCode)orthat he u exempt therefromand / - VALUATION
G5 the basis for the alleged exemption. Any violation of Section 70.115 by any OOTLEISSWITC 19KTUR
applicant n
ntfora permit subjectstheapplicanttoa civil penalty of not mcethan ` 1 1
c five hundred dollars(S500. NEWRESIOENTIA LECTR .FT.
Q•-(^n I,as owner of the property,or my employees with wages as their sole STORIES TYPE CONSIRUCIION
< compensation,will d o the work and the ftm=m b not intended or offered for
❑ .1.(5oc.7044,B puce.and Professions Code:The Contractors License Law
�j does not apply to an owner of property who builds or improves thercory and OCC.GROUP AES.UNITS
whodoessuch workhimself orthr-ugh hisownemplcyees,provided thatsach
Improvement are not Intended oroffemd formle.IL however,thebulldleg or TOTAL:
improvement tsold within--eyecarofcompletiogtheowner-bu8derwill Tuve
t rden of proving that he dmn-t bund or Improve for purpose ofale.). QTY. PL ING IT FEE ---TIpp ZONNE APN
Ll L as owner of the property,am exclusively contracting with licensed P IT L55 A E \
contractors to construct the project(Sec.7044,Business and Prolemion,Code:
The Contractor's License Law does not apply to an owner of property who
Wilds or improves thereon,and who contracts for such pipjects with a AL A & - A (EA)
,1 LI(actor(s)licensed pursuant to the Contractor's License Law. BAIX PR EC EV10E FEE SUMMARY
LJ f am exempt under Sec. B &P C for thin reason
F�cs
Owner Data DRAIN FLOOR OO ,A]l CO SANITARY Y_ N
WORKMAN COMPENSATION DECLARATION RECEIPT p
pI hereby affirm that 1 have a certiRote of consent to self-le,,or a M TRAP SCHOOLTA% Y N
ceni0at of Workers'Compe®ationlraurance or a certified mpythemof(Sec. RECEIPT
S M
3800,Lab C.) GAEA.SYSTEM-1 INCA OUTLETS PARKFEE Y N
Policy 8 RECEE'T a
Com any GAB-EA.SYSITAf-0VFR4(EA) BUILDINGDIVISION F[ES
[�Candiied copy is heed with to ed.city GRFASE/INDUSIRL WASTE INTEW,,Mg PLANCHECKFEE
Candied copy t(fled with the city Inspection division.
CERTIFIGTE OF IX EMPTION FROM WORK ERS' GREASETRAP PAID Ib`31"Y6
COMPENSATION INSURANCE
(fhissectionneed not becmmpleted lfthe permit tfwomhundmd dollars SEWER-SAMTARY-STORM FA.20(17. Date Remi t#
(y100)oarless.)
lartify that In the penormanceefehe work farwhich this permit is l rao,d, WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_
1 shag not o
employ an/person in any manner so as to become subjet to the
WorkersCompensation laws of California. Date WATER SYSTEM/TREATING
O PAID
Z Applicant ate
_Z O NOTICE TO APPLICANT:If,after making t his Certificate of Exemption,you r'fEWRESIDENTIALPLMB.
~ �
should become subject to the Workers'Compensation pcovtiora of the Labor __SQ,1[, DRI2 RC'CCI t# �1(
TOTAL:
UI Codeure
,you=atforthwith comply wilhach provieloorthis penNt shall be
W > deemed revoked. BUILDING •E co
9L p CONSTRUCTION LENDING AGENCY SEISMIC FEE Q
I hereby affirm that there B.construction lending agency for the perform,
M O ante of the work for which this permit Is Issued(Sm.3097,Civ.C.) TOTAL: ELECTRIC FEE
V _ Lenders Name PLUMBING FEE
LL t- Lenders Adams QTY. MECHANICAL PERMIT FEE
O w 1 eenlfythatl have read thtappucation and statethattheabove inforrstion MECHANICALFEE
isromed l agree to comply with all city and county ordinances and Rate laws PERMIT ISSUANCE FEESPAID:
} N relating to building mrotruction,and hereby authonre mponsentatives of this
F Z city to enter upon the above-mentioned property for Inspection purposes. ALTERORADDTOMECH.
Z (We)agree to ave,Indemnify an d keep harmless the City of Cu Faction Date Receipt#
against lbbietim,judgments,costa and expenses which may in any way accrue AIR HANDLING UNIT(To 10,000 CFM)
againstsaid City ronstyuena of the granting of this permit. SUBTOTAL:
III,— ,>.{,l I MR HANDUNG UNIT(OVER 10,000 CFM) CONSTRUCTIONTAX
olgraMMM Applicant/Contractor /Spate
HAZARDOUS MATERIALS DISCLOSURE UTDAUSTHOOD(W/DUCT) CONSTRUCTION.TAX PAID:
Will the applicant or luture building occupant store or handle hazardous HEATING UNIT(TO 100,0008
materials,defined by the Cupertino Municipal Code,Chapter 91Z and the _ Date Recei t# r
Iiealthand Safety Cod,Settle.2M32(a)i HEATING UNIT(OVER 100,0(10 BTU I Js
❑Yes . N No TOTAL: J
Will the applicant orfuture building occupant use equipment or devices VEMTILATION FAN(SINGLE RESID) ISSUANCE DATE
which eMahgement airrict? Maas defined by the Bay Area Am
Quality Management DkMct7 BOILER-COMP OFN OR 100,000 BTU) '
Ya-m.El ❑No
haved the ha&Safety Code,Sect 25505, ,enter Cha peer 6.95 o! BOILER-COMP(OVER 100,000 BTU) A��
the Calflomisliealth&Salety Code,Sections 75505,75533 and 25534.1 /.l ]
understand that if the building does net currently have a tenant,that it Ismy NEW RESIDENTIAL MECH. SQ.FT, d O11
O(jO
responsibility to notify the occupant of the requirement which must be martY>51f0
Prior to issuance of a Certificate of Occupancy. V+1
Owner or awhorixed agent Data
TOTAL: ISSUED BY: V U
OFFICE COPY
County of Santa Clara REC6ry�® C'ou:"v-
Environmental Resources AgencyOC f..
Deprirtmenl of Environmencd Healtli - 1994
CCnRal Oflicc-2220 MOOrlDark:\\'enUC. Lasl Win};. RUunIIW &M. OE GDpER(MU
ULM P.O. LION 26070 am
r
San.IUSG CalikJmia 95159-6070 � �A C-
(408)
(408)399-60(30 FAX 298-6261
September 28, 1994 RECEIVED,'
Mont Williams Lo.: 1' 06 1994
1550 Las Plumas Avenue
San Jose, CA 95133 CITY OE CUPERTINO
BUILDING DEFT.
PROJECT NUMBER: 4321
PROJECT NAME: PORTOFINO CAFE
PROJECT ADDRESS: 19998 HOMESTEAD RD. , $C, CUPERTINO, CA 95012
Plans for the above project have been reviewed by this department and
have been stamped approved, subject to the following condition:
Water heater must recover 94 gph to 1200F.
This approval shall expire by limitation and will become null and void
if the construction, reconstruction, alteration, or other work
authorized by this approval is not commenced within 180 days from the
date of approval .
• Please present one ( 1 ) copy of the plans to your local building
official for the required permit application and approval . Please
retain the second copy on the job site. A FOOD FACILITY CONSTRUCTION
CARD will be attached to the job copy and must be posted with the other
building permits .
Please be advised that you are responsible to contact this office to
arrange a construction inspection prior to rough plumbing signoff,
installation of equipment and again upon completion of the project.
Absolutely no food storage or food preparation will be allowed onsite
until this department issues you your Permit to Operate. This permit
will be issued upon the successful conclusion to our final construction
inspection. You will also be asked to submit verification of garbage
collection prior to the issuance of the Permit to Operate.
If you have any further questions or would like to call for an
inspection appointment please contact the undersigned at (408)
299-6060 between 8:00 a .m. and 9: 30 a.m. Monday through Friday.
PAYMON6 GUNDERSEN, R.E.H. S .
SENIOR ENVIRONMENTAL HEALTH SPECIALIST
PLAN REVIEW AND CONSTRUCTION UNIT
DEPARTMENT OF ENVIRONMENTAL HEALTH
• RG: er "
cc: City of Cupertino Building Department
Jahangir Jamshidi, 19998 Homestead Rd. , Cupertino, CA 95012
13oard of Supervisors: michael m, Honrh. Zoe I_olgren. Ron Gonzales. Rod I)MClon. Dianne McKenna
e wi