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12090129CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10120 N DE ANZA BLVD CONTRACTOR: CELTIC CONSTRUCTION PFRMIT NO: 12090129 OWNER'S NAME: ROMAN CATHOLIC WELFARE CORP OF SAN 1094 HUNTERSTON PL DATE ISSUED: 09/142012 OWNER'S PHONE: 4082526441 CUPERTINO, CA 95014 PIIONENO:(408)973-1224 ❑ LICENSED CONTRACT'OR'S DECLARATION JOB DESCRIPTION: RESIDF,KIIAL COMMFRCIAL 11 License Class Lic.H INSTALLATION OF A DIESEL GENERATOR FOR SCHOOL CARNIVAL OCTOBER 12-I4 2012 Contractor Date- 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. hereby affirm under penalty of perjury one of the following two declarations: I have mid 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 Sq. Ft Floor Area: Valuation: $3000 performance of the work for which this permit is issued 1 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 ,UW \umber. 31626097.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with ail city and county ordinances and state laws relating;+ITHIN 180 D ERMIT 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 DAYS OM LAST CA+ LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgmems, costs, and expenses which may accrue against said City in consequence of the �[ grunting of this permit. Additionally, the applicant understands mid will comply Issued by: Dn[e: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. RF-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining ah inspection, 1 agree to remove all new materials for inspection. ❑' OWNER-BUILDER DECLARATION Signature of Appli©nC Date: hereby' affirm that I um exemptfrom the Contractor's License Law for our of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A" OR BETI'ER I, as owner of the property, or my employees with wages as their sole comfunsation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, ran exclusively contracting with licensed contractors to IIA%ARDOUS NIATERIAI S DISCLOSURE construct the project (See.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth & Safety Code, Sections 25505, 25533, and 25534. I will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the declarations: Ilealth & Safely Coda Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate 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 Bac Area Air Quality Management District I performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I has•e mid will maintain Worker's Compensation Insurance, as provided for by the Ilealth & Safey Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for die performance of the work for which this Owner or authorized agent: Dale: permit is issued e , I certify that in the performance of the work for which this permit is issued, I shall not employ any person in My manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I '- RUCODICONSTT'NG AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm (hal there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w'ork's for which this permit is issued (Sec. 3097, Civ C.) .Lenden;'s Name APPLICANT CERTIFICATION' Leader's Address I certify that I have read this application and state that the above information is r 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 ,1RCIII'1'FCI"S DECLARATION and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may aceme against said City in consequence of the 1 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=J� CITY OF CUPERTINO lye(/I FEE ESTIMATOR - BUILDING DIVISION WFADDRESS: 10120 N De Anza Blvd DATE: 09/14/2012 REVIEWED BY: Sean UNITS APN: BP#: 'VALUATION: $3,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: $167 PENTANIATION 1REAP8 PERMIT TYPE: WORK Installation of a Diesel Generator for school carnival Oct. 12 - 14 2012 SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check QTY UNITS BP FEES Elec. Permit Fee: IEPERM/T Generators 1BREMPOWER Other Elec. Insp. 0.0 hrs $45.00 1 # $167 Permit Fee: Suppl. Insp Fee PME Unit Fee: $167.00 PME Permit Fee: $45.00 Construction Tut: Administrative Fee: IADMIV $42.00 Work Without Permit? O Yes Q No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $167.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not includejecs due to other Deparnnenes (i.e. Planning, Public if orks, Fire, Sanitary Sewer District, School District. etc.). These lees are ha.ced on the nreliminary information available and are onh, at estimate. Contact the Dent for audit 'I into. FEE ITEMS (Fee Resolution 11-053 EIC 711111) Much. Plan Check Plumb. Plan Check Elec. Plan Check 0.0 1 hrs $0.00 Afech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERM/T Other,lfech. Insp. Other Plumb Insp. Other Elec. Insp. 0.0 hrs $45.00 Mech. Insp. Fee: Plumb. htcp. Fee: Elce. Insp. Fee: NOTE: This estimate does not includejecs due to other Deparnnenes (i.e. Planning, Public if orks, Fire, Sanitary Sewer District, School District. etc.). These lees are ha.ced on the nreliminary information available and are onh, at estimate. Contact the Dent for audit 'I into. FEE ITEMS (Fee Resolution 11-053 EIC 711111) FEE QTY/FEE MISC ITEMS Plan Check !'ee: .Sapp/. PC Pee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $167.00 PME Permit Fee: $45.00 Construction Tut: Administrative Fee: IADMIV $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Planning F'ecxs: Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Sids Commission Fee: IRCBSC $1.00 SUBTOTALS: $300.501 $0.001 TOTAL FEE: $300.50 Revised: 07/01/2012 GENERAL PERMIT APPLICATION \a,� M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION vlo 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \�0 M I /� CUPERTIN Hol 0 (408)777-3228• FAX (408) 777-3333•buiil-dinoCrDwoertino.ora ■V_ nerurnlr. M r7riIYf .Mir.1 14 P11'RICAI. nMISCFLLANE0DS PJtOIECT ADO ESS C e n C APN Y I , ^ I ^ ` —f 1V��4 f i OW ERNAML' P Q n PIIOI`ltl - �� ✓' U STREETADDRESS Mar L ay' S PrincSpQL CITYSTATE, ZIP FAX r KzM NAME! - mlva M QnQ PHONI; - N All. E - O ` n 'ETADDRESS C' In ro r've cln'. sr ZIP 9 61 23 1 ,Aa - ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONIAACTOR. M1E ICP' G;. I.NUMBER !CENSE TYPE r BU LACY I'n E-MAIL cLw G1 f Q� FAX SIAP.PT ADDRESS e 5�"on 01Q. -e V r K• CI� ATILZIP` i ''I 'J .L!1 PNONE _R /Y�- I ZZI ARCII1=1ENGINEER NAMI! LICENSE NUMBER BUS, LICK COMPANY NAME E-MAIL FAX STREIFr ADDRESS CITY-STATE ZIP PHONE USE OF ❑SFDa.DUPLE\ ❑ MULTIFAMILY BUILDING: COMMERCIAL PROTECT IN WILDIAND ❑ YFS URBANIND!RFACEAREA NO PROJECT IN YES FLOOD ZONE NO IS THE BIDE AN ❑YFS ECNLER IfOS1LT O DESCRIPIONIT WORR m v,-\ e r c a Gener 13Pnwer.1aA r .-,br- 3-OCA.C F o + 2-n I TOTAL VALUATION: U OO V RECEIVED BY: By my signature below, I cenify to each of the following: I am the propery owner or authorized agent to act on the property owner's behalf. I have read this application and the informatian 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 rclaling to building construction, I authorize mpresenlntivcs ofCupenino m enter the abovye-identified property for inspection purposes. Signature of Applicam/Agent: S-J�-..`. n.t(w�-- Date: 1r CSupppurtviFWTAL INFORMATION REQUIRED o n 1 Q Info o ' ri n d2rn - Per rn i i Co -o rJL T lafo r St. SosePh Of Cupe('�. 0 t)cKoo L Wa y0q-252--6gL41 C(?,LI, - G)D( '13a-2-053 A w OFFICEUSEONE.Y ❑ oY1: R+n H:.couYrEx f 0 EXPRESS ❑ sr.,Na.,RD 3 ❑ I.,R,, 6 ❑ MAJOR AIEI'A4iscApp_201 /aloe revised 06121/11 ,mo North _mBlvd m* m& m= 0 ( ( 0 ` }\ \ { ( 71 LTTL HHHHHHHH 7 } IIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIII __ Public Access q eek / Fp£ �{ \/ I( \U) / ) � �� _ !} « �� +9 � 1'0 SW. � {r \\ !} \ QgAa} \ / ! !� ( !I \ � ( q / �{ I( \ / ) !} +9 � to | \ � . ! ( !I / �{ / ) `t, IWxWl I OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION II%7_rJ�\I� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUIPERTIN0 (408) 777-3228 " FAX (408) 777-3333" buildinga( )cuoertino.ora Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: ITEADDRESSgn7Z /'n APN BP# 4 OWNERNAME OWNER ADDRESS DESCRIPTION OF WORK: Q 3 _ - - n__u O- 213.1 We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. read and initial each statement below to signify you understand or verify this information.) 9h 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 194 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. %-3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �A 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license ,�nu/mbers on permits and contracts. "/N' 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 011 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. %_7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 9L 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction rlafantc in tha wnr4monchin nr matarinlc 07/12/2012 17:08 4086774963 SHAWN a:; .tr [ui[ Lo: �e 4UGG0[7r is SI Jv-L.H G--P&:T11a:1 4 OFFICE OF THE SIdERIFF SANTA CL{RA.COUNTY SOW"LAURIN R. SAIM LAW ENFORCEMENT RELEASE One D4y Liquor Permit Nam of Organization: M"'.10: ir Fol -ra-0-0 1' 0 M' 4 V, q MM � . --- M PAGE 02 P11GE 02 n .y Tier+e: From 10 1 L 6ptn ' To������yy �nn^_�,, r•� Matte of Event: y�+. t�..�� 1.�----- - m NmulTier of yeero event hats bean held: _ __ Approx, att"dwacc expected: -r =-Vo. x1 Atseradeaos Last ,rrsr: -3 Q,�-�qpao 2 Yrs. Raw '- •— Typs d swarity yygt �irlv0ts Pi! VotttBtabk LkNO aset PQ17Dn rfapoaeiMe for the Organkatioa and Opd+BNOM Of I" Ovem' p A the ;'Tdid'prteon trust be present at el1 tfinea that alcohol willbe IMYed. Thil PeMog has at�the�ticeossm for "Mmoaty of alcohol laws provided by the Shatft s doyart""t and understands that they the sale/dispeuoing of alcoholic bevem9ea at this event, Licensee Nfvae: �� Phi �a Drivef's Licrnse or DOB: l l i'Lq ^�. _� Andre: -y7 5 C Q_ Qi.��l�--9 orgaairstivn Title: e—ro �czllS _ 111 f Day Phcwe: Phone Number during eveltt hours: 'LQ5=5Z2 It is underctood that the Lioertsee will conduct the safe of slcohotic bevorrges in,strict.�t:cordallce_with the of Atcuholic A,"94e Conttv'Piiijlhia provisiana of the application r tt C ppermit issu the Deparrttumt 165'? permit nay be susponded or revoke CASH 2�.fuj P:2012 09:37 Signature of l.iceostx: We have n,a objeefion tv firs Issuance 4f the One Day Idpawr Permit s�I��rF� ��+,�air,��Nr AnAfnv'tsp•�rtor+ prtial+ad: ' XW. of Alocdwlic de'amse CnnLrol _1I . too PAM ds Sol,AWalopilS belt sow, CA 99113 OV= Phan: 177-1200 T2" Cur: pamlulopuecioca Chy NkAw PERMIT 12 2548 Granted to: EIRE DEPARTMENT SANTA CLARA COUNTY 14700 Winchester Blvd., Los Gatos, CA 95032-1818 (408) 378-4010 • (408) 378-9342 (fax) • www.sccfd.org PER(\91T EXPIRES: 14 October 2012 St. Joseph of Cupertino School the provisions of the Fire Prevention Code of The City Of Cupertino to Conduct a special event: 2012 St. Joseph's School Carnival Location: 10120 N. DE ANZA BI, City: Cupertino Premises known as: ST. JOSEPH OF CUPERTINO CARNIVAL Issued this date 13 August 2012 Subject to the following conditions: who has applied under NOTICE rhn, Ipmjrgw:,rot 14, pte, ppre v(arrylirmr .,y�mrJ In, lam and n IT n: oti; e. Any:%+ng, In itv . avupinry of f^rudui .Jve;l' . t9:. npsi; prrm;e Comply with all provisions of the attached plan review comments and schedule a pre -event inspection by this office. TESTING: ❑ Welded pipe inspection E] Hydrostatic test at 200 psi for 2 hours / Flush Test ❑ 24 hour stand-by battery test ❑ Leak test required at 50 psi above static pressure ❑ 60 hour stand-by battery test ❑ Concentration / Pressurization test ❑ Functional test for Hood & Duct Appointment scheduling (24 hour advance notice): (408) 378-4010 This permit does not take the place of any license required by law and is not transferable. Any change in use or occupancy of premises shall require a new permit. This permit is issued on condition that there shall be compliance with all provisions of the Fire Prevention Code. Any violations of these provisions may be grounds for revocation of permit. POST ON Hokanson, Wayne PREMISES Fire Pmvenrion Division 5 nature as the Santa Clara County Central 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 FIRE DEPARTMENT SANTA CLARA COUNTY 14700 Winchester Blvd., Los Gatos. CA 95032-1818 (408) 378-4010 • (408) 378-9342 (fax) • www.sccfd.org PLAN REVIEW No. BLDG PLAN REVIEW COMMENTS PERMIT No. 12 2548 'Review of plans and application for a special event (St. Joseph School Carnival) to be held on October 12th, 13th & 14th 2012 on the Parish/School property. Comment #1: Comply with all appropriate conditions as noted in Standard, Detail and Specifications SI -2 (attached) and conditions within this plan review and permit. Comment #2: .Comply with any written or verbal instruction issued by members of this department during the run of the fair. Comment #3: 'Comply with all conditions of approval and direction of the Santa Clara County Sheriff's Department jand Santa Clara County Environmental Health Departments. Comment #4: All remote power distribution units located within the carnival shall be isolated from public contact ,by hard -barriers by the carnival operator. Comment #5: ,Portable fire extinguishers shall be distributed throughout the carnival so that travel distance to an extinguisher does not exceed 75'. Minimum rating of portable fire extinguishers shall be 2A:10BC and must be inspected within the last 12 months. Comment #6: Any food preparation unit provided by the carnival wherein a fixed fire extinguishing system is :installed shall be UL 300 certified and serviced within the past 6 months. Specialized, " K" class 1portable fire extinguishers for such unit shall also be currently serviced or inspected. 'Comment #7: 'Hay combustible materials used for props and decoration within auditorium/rummage sale area shall be flame retardant treated prior to placement within the buildings. CRY PLANS SPECS NEW RMOL AS CUP ❑ ❑ ❑ ❑ ❑ OCCUPANCY CONST.TYPE AppllcanlNpme St. Joseph Of Cupertino School DATE 8/13/2012 PAGE 1 OF 2 SECFLOOR AREA LOAD PROJECT DESCRIPTION Special Event PROJECT TYPE OR SYSTEM Festival NAME OF PROJECT SI'. JOSEPH OF CUPERI'INO CARNIVAL LOCATION 10120 N. De Anza BI Cupertino TABULAR FIRE FLOW REDUCTION FOR FIRE SPRINKLERS REQUIRED FIRE FLOW ® 30 PSI BY llokanson, Wayne as the Santa Clara County Central Fire Protection District Serving Santa Clam County and the communities of Campbell, Cupertino. Los Altos. Los Altos Hills. Los Gatos, Monte Sereno, Morgan Hill, and Saratoga FIRE DEPARTMENT SANTA CLARA COUNTY 14700 Winchester Blvd., Los Gatos, CA 95032-1818 (408) 378-4010 •(408) 378-9342 (fax) • WWw.sccfd.org PLAN REVIEW No. 12 2548 BLDG PLAN REVIEW COMMENTS PERMIT No. jComment #8: A site inspection will occur by this department prior to opening of the fair. The organizer is requested to make contact with Deputy Fire Marshal 1Nayne Hokanson a 408-341-4424 to schedule the pre -event inspection. 'Comment #9: 'Provide a copy of these review comments to the carnival operator specifically for the purpose of items 4, 5, 6, 10, & 11 contained herein. (Comment #10: Carnival operator to provide physical barrier preventing incidental public contact with any power (distribution equipment. ;Comment 911: The fire department access onto the site via Stevens Creek Blvd and N. De Anza Blvd and through the site via the noted emergency vehicle and public access lanes shall be maintained passable at all times to fire apparatus. Submittal approved, pending compliance with the above noted comments and site inspection. CRY PLANS SPECS NEW RMDL ASOCCUPANCY CUP ❑ ❑ ❑ ❑ ❑ CONST. TYPE AppllcpnlNonw St. Joseph Of Cupertino School DATE 8/13/2012 PAGE 2 OF 2 5EG LOOK I AREA LOAD PROJECT DESCRIPTION Special Event PROJECT TYPE OR SYSTEM Festival NAME OF PROJECT ST. JOSEPH OF CUPER'IINO CARNIVAL LOCATION 10120 N. De Anza 131 Cupertino TABULAR FIRE FLOW REDUCTION FOR FIRE SPRINKLERS REQUIRED FIRE FLOW 0 20 PSI BY Hokanson, Wayne Organized as the Santa Clara County Central 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