05070091 (4) CITY OF CUPERTINOa
BUILDING DIVISION PE �CdNT1tACf.QR TN�'� �, QN
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BUILDING ADDRESS: PERMRN005070091
R'S NAME: PERMIT ISSUE DATE
PHONE: SANITARY N0. CONTROL NO.
ARCHITEC IENGINEEW BUILDING PERMIT INFO
BIRO ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION Job Description
I Mosby%!firm that I am licensed under provision of Chapter 9(commencing
with Section 7W)afDhIskm 3 of the,Bud.and Professions Code,and my license is
Lrenra ertal BUILD SOLID WALL (NON-LOAD BEARING)
License a.. IJc.a
Dam Conuaamr MOVE LIGHTS/RELOCATE HEAT/AC DUCTS
ARCHITECTS DECLARATION
1 uMenund my phos shall he need u public rectrds
�a Licensed Pmfeulonal qty, 9977 rte,
F atIamsector,OWNER-BUILDER DECLARATION AEI :
g: I hereby.Inns thin 1(13 1 .umpt from Betins Conmaewo License law for Illy FIN �rYrR
0 O
following reasua.(Section cavaam Business and Proimprove.
de oli Cady:My city or coume,
$ which leguilcaaFarrahe.sho reteaes ft Wu.ht far sudpanall,Il.a sig anyatsuwm
iy
prior so heticensed prsart to the provision of fa sonmmactut mfties,La (Clepu Col
€o thathelsliCowithSnuanrmtheprovisioion3.f BuinssandPlsclaw(Clmpu9 Sq.Ft.Floor Area 57 . uat 1000
® (commas exempt
pt Section7000)and
balsian3 nfthe Business and Prolcu violaamr,of
.. Nu he V excmpt there(raa and the bels for the alleged caemptian,Any vlplsJan of
Section 7031.5 by any applicant for a permit ubjects the applicant to a Civil pcnity Of APN Number e
nee more dun five huadmd dollars(SSW).E3 5 92 0 0 2 9 . 0 0
I,u ac w
veor thin reepany,or my ployen with wages u lhebmic compewlion,
d do the work.and me atruc cam is not Intended uraayeed lboule(Sc.70/1,Business
and Profession Coda.The Contractor,I.kcue law(aes as appy to an ante,or Required Inspections
propenywsaWildaorimprove,thereon,andwhodaea aachwork himsalforduougb his
awn employee,,provided that such improvements art not Intended aranered for,ale H.
however,me building or Improvement Is veld within one year of Completion,the owner-
bcvlder .will have the hordes of proving mat he did am build or improve fm purpose of
sale.).
❑h u owner of the property am exclusively contracting with licensed Conuaewm to
construct the project(Sec.7044.Business and Prolessioos Cadem
)The Ccome 's U.
tersn e law dosol apply man owner of property who Wilds or improve%thereon,send,
whocearacu for such projeela with a conannuoh)licensed pursuant to the Canuaclues
License i
❑14mmtm0$S� �? ,B&P fa Ws '
/1/
Dam S L
WORKER's COMPENSATION DECLARATION
I hereby ahem under penalty of perjury an of the following declaruloa: .--
❑I have and wBl mainuin a CeNOnm ofColuent w mif-luum fm Workth Compere -When.u provided for by Section 3700 of the LAW Cade.for the performance of the
weak for which this Pennell is usual
❑1 have and will maintain Worker's Compensation Insurance.u required by Section'
3700 of the LaWr Codd,for the performanco or the work fon which this permit 1.Wood. -
' My Worker',Compensation Insurance carrier and Policy number am: - -
Carrkr. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Into action sed not W compklad if the permit tsfa onchunmed dallars(SIM)
erkaa)
1 cenify the,in the perfnrman[ of the work for which this penult is housed.I shall not
cmploymy person in myon fI, a •[came s�i bre[!to Ip Warkcn'Compcnadon
Law,of C7a'o 666ia.D Y / !r
Applicant Pf t J
NOTICE subject
0 the If.alar making this Ccnins of of L&W Exemption.you uhmust
barome anomp m tins Warkul Compensation provisions o!the lata Code,you mesa
Qforthwith Comply with such provision a lid,permit shill W deemed nevaked.
ry.. CONSTRUCTION LENDING AGENCY
1 hereby aMno that mem Is a Consuaction leading agency for the perlonnanm of
the work for which this permit Is issued(Sac.3097,Civ.C.)
zUndo is Name
Landeh Addram,
Q 1 certify mu 1 have read Ws application and cute thea the show infomution is
cmlen 1 agree as Comply with all dry and mthly oNinaaz,and saw Ins rtlNns to
4V: Wilding eauuuation.and hereby mmarim nprcenudws of this city to enter upon the
D.1 aWw-meadoned property for hupeeelicen purposes.
G (We)agree to save,indemnify and keep henmless use City of Cupertino against
.,cn nabillikajudgmenu,Costs and expense,which may in any my secure apinuaid City
7 in eonsoqumtt of thegmating of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
s�uI��RVjy t �)• r� 7Ij �lo� Re-roofs
g ort ofANN"'IrKK 12ontmtlea
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupantmnm or handle huudous malarial
1 d by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Seems,25532h)? All roofs shall be inspected prior to any roofing material being installed.
[3 yes ❑No
1 o
Will the applicant or future Wilding oeeupam nee equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmandnns air cmuminanu as defined by me Bay Arca Air Quality Management all new materials for inspection.
Chalet?
C]Y. C3 No
1 haw and the Mrardas materials requirements under Chapter 6.95 of the Califor.
nia Health d:Safety Code,Secdons 35505,25533 am125534,1 undcnund that if thc Wilding
Jan sol curtently low a lanes!,Nat h is my responihility,to notify de occupant of thc
irtmhnss c r prig[w 1 vane of a
Ccrofc f Oe'/-ry-
Signature of Applicant Date
Data All roof coverings to be Class "B" or better
er a authomad%gem
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JUL 1 5 2005
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SACS.XRA to
Gy FIRE APARTMENT • CONTROL NUMBER
SANTA CLARA COUNTY
14700 Winchester Blvd., Los Gatos, CA 95030-1818 PERMIT NUMBER
(408)378-4010 (phone) •(408) 378.9342 (fax)
PLAN CHECK No.
PLAN REVIEW COMMENTS
CODE/SEC. SHEET No. i^1io5[�rDtsc�tP%�/n7til 1. -� �Qp ; w�Q,Q LM-
V
The following CHECKED items apply to this project:,
1 Existing fire sprinkler system shall be modified as necessary. A licensed C-16 fire protection
contractor shall submit to the fire department, three sets of shop drawings, a completed permit
application and applicable fees for review and approval,prior to performing work. UFC 1001
Z Existing fire alarm system shall be modified as necessary to accommodate new construction.A
licensed fire alarm contractor shall submit to the fire department, 3 sets of shop drawings, a
completed permit application, and applicable fees, prior to performing their work. UFC 1001
Tenant shall have access to a minimum of2AlOB ated fire extinguisher(s).
Travel distance to nearest extinguisher shall n exceed 75 feet. C 1002
Tenant shall have access to one Class "K" type fire extinguisher, within 30 feet of commercial
cooking equipment. Post sign near"K"extinguisher noting commercial fire protection system
should be activated prior to using the portable fire extinguisher. UFC 1005
• Exit doors shall be openable from the inside without the use of any special knowledge or effort.
Thumb-tum dead bolts that require more than 1/4 tum to operate are not acceptable.UFC 1207
Exit Illumination: Provide illuminated exit signs. UFC 1212
Contractor shall field verify the integrity of existing rated construction/assemblies and restore or
repair as necessary as part of this work. Penetrations in rated walls/ceilings shall be protected.
by listed fire rated assemblies (dampers, doors, caulking, fire stopping material etc.). UFC 1111
now
At time of final inspection, the tenant shall provide to the fire department a labeled emergency
CLW access key for placement in the building fire department key box. UFC 902.4
cn
This plan check does not permit the use,storage or dispensing of hazardous materials, operations
or waste. The tenant shall provide a completed HMIS to the fire department's hazardous
materials specialist for review and comment. Furthermore,a CLOSURE PERMIT is required prior
to terminating the storage of hazardous materials at a permitted storage facility. Demolition of
any facility/storage area that previously stored hazardous materials shall not be approved
prior to obtaining a CLOSURE PERMIT.
APPROVED FOR BUILDING PERMIT ISSUANCE subject to compliance
with the above checked comments prior to final inspection.
JURIS PLANS SPECS NEW REMODEL AS CONST.DESCRIP. BY r'� r^I DATE r- PAGE
eU� ❑ ❑ ❑ V ��Ix�C:�J �OF I
SEC./F/1LOOR OCC OCC.LOAD AREA ARCH/E /CONTRACTOR/OWNER
• r
NAME OF FACILITY LOCATION
tJ�,v L l W4t,. °mac,
A California Fire Protection District serving Santa Clara County and the communities of
Campbell, Cupertino, Los Altos, Los Altos Hills, Los Gatos,Monte Sereno, Morgan Hill, and Saratoga
lacl
*CITY OF CUPERTIN*
CUERTINO PERMIT APPLICATION FORM
(jS07o0
APN# _ Date:
35q- ao - oa q
Building Address: Mailing Address (if different from building address):
2ba b Rd ,
Own is Name: Phone#:
'E•1 C,t�'� �• off] `N0-Z4,Kc aS7�3OGb
Contractor: n License#: g.? aI a7 D
a144-o (�
CJS - , rSLnj_gV! r pC_ Phone: 3D-a Z3�f Cupertino Business License#:
IEG �I ("
Fax: 3 /D7
Building P mit Info: g m jU&V I U % 4z✓i3 D ` CL l V("D � D r yc S
75
. Bldg [� J Elect I� o Plumb ❑ �G�6� 15 fIICM h,o; h �O
Job Description: SL) ; I Sb ulA2( nvn-lD .v ; movt�% fS r�� 4X--e, 44,11
Residential ElCohimercial CAs
' Sq.Ft. Floor Area: $/Sq.Ft.: Ow3
Cost of Project: vdb Occupan y Group:
�' 0,14.t�
ype of Construction: Cun5 wrw h��f—wazc Please check this box if the project is a
second-story addition: ❑
Project Size: Standard Er Large ❑ Major ❑ -
Quantity Fee ID Fee Description Fee Grou
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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*CITY OF CUPERTINO
CUPEf1iTIN0 PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOM M New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTDAF, Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Stomi/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfrn MECHANICAL
BREMAPPLI Appliance Instal] MECHANICAL
BREM 3USWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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&ITY OF CUPERTINO*
�ITM0 PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE -Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Faro PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
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