The URL can be used to link to this page

14110071 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10123 N WOLFE RD CONTRACTOR'TSD="Pa"BE PERMIT NO: 14110071 D9TC-Rfdit, ;D OWNER'S NAME: PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL LOCATION TOWARD BACK DOOR OF ICE RINK-INSTALL License Clas Li .# �O(�(�Z� 211 Contractor 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 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2500 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of*Labor Code,for the performance of the work for which this APN Number:31620100 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT 80 DAYS O 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 DAYS LAS 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 Issued b Date:—l/La,1� granting of this permit. Additionally,the applicant understands and will comply y' with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature 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) I,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 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 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, Date: permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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. S ignature Date Mu GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ` misc CUFERTINt) (408)777-3228•FAX(408)777-3333•building(lcupertino.org it� LUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEQUS PROJECT ADDRESS „ �� APN 6 2 �y I Co.O OWNER MAIL STREET ADDRESS f///)�� CITY, STATE,ZIP FAX CONTACT NAME f/� I�^ O E //)/� / E-Iy1AIL ST MESS CIT „SATE,ZIP FAX 7 u �J fYJ� ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO C NAM i^ LICFW BZD BUS.LIC# CO `YaNA�ME �+e x E FAX STREET R CrfY( OE_7y�P ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD-DUPLEX ❑ MULTI-FAMILY PROJECT IN WMDLAIm ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK REC1 hTYED BY: TOTAL VALUATION_ By my signature below,I certify to each of t ollowing: I am the property owner or authorized agent to act on the property er's behalf. I have read this application and the information I have pr rde 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 b d sonstructi I authorize representatives of Cupertino to enter the abov ide ri led pro e for inspection purposes. Signature of Applicant/Agent: Date: � _ / SUPPLEMENTAL REQUIRED - oPcE USE ONLY W BE-COUNTER EXPRESS �` STANDARD P, LARGE MAJOR MEPMiseApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10123 n wolfe rd DATE: 11/12/2014REVIEWED BY: Mendez ll APN: I BP#: *VALUATION: 1$2,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY Commercial Building PENTAMATION 1 CPBF USE: PERMIT TYPE: A WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Vacuum Backflow 1PATMOBF 1 # $72 TOTALS: $72.00 11 1 �Vcc1.. Pharr Ciwr.,k Plumb.Plan Check 0.0 hrs $0.00 Pef'inil Dere: Plumb.Permit Fee: IPPERMIT c)rire, tfEci�. 7�>r�- Other Plumb Insp. Ehrs $48.00 rPhwib. has 3. Fee 17ex:.ly s , }'-CCc, p2LJ NOTE: This estimate does not include fees due to other Departments(Ge.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are on2 an estimate. Contact the De t for addn'1 info. FEE ICheck TEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS t /an PC 1,ec PME Plan Check: $0.00 PME Unit Fee: $72.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? ®Yes (j) No $0.00 E L`tlFtt'e' Ptuninno 1`c'es Travel Documentation Fee: ITR,4VDOC $48.00 i Strong Motion Fee: 1BSEISMICO $0.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 -- g $214.701 $0.00 TOtAL FEE: $214.70 Revised: 10/01/2014 �'•'•�t� - � I r t�.i .v �` , �- � -�" �8 .«z. r € � •yam ;e � - � _ k t � ,,, dC,-. +,,� ^�� 5 �.'• { Ir 4�+.. \ . . • • - , e ;. „„�a•�^.�.:.w,. ._( ',�;0k. � '.�' P"� R, r .r,M1`•:, , 1 '-..., \\• , -;,;u \ 1 , ti:: 7.;«,,. °� t�`_ i �- a•4:,�. .. :co „ ,c� f^!'' c„ �A, tis ,.. jj� �,'a, . • . . qyr rJ ;„r .:�± C •-- •^..._. •.. ,w,.:, ,,rn P m` 'C"srt. ¢�. 411'' : `°,''bn= \ 71 • .. . • •- • • 1 .- w.,,��6a»..,*.�5,;_.'�;r:1:_.7�..x��€^r"�,-^„>kPiz.”4r1r9.9'.i. ,•1;',..•".,ti,�o ,iy;0:•�.0xsed,•,„4/n 33I43s15r79 7�24_:7�1"1?5'+_Y5,,^7,d..'..,1o-aN -t.`•'�I,te6s`7i1.°I.}+111ay�1:,1{'..�.''."+ .••_�'_lLIIz;,-II�II II,�II;I,II�1l`,,II.1I�.'r,�.�{I.,-..:':"ea.'�`,."a�Ie.,,`.1.,u�t.':i'.:.','F,', r0y'I:....d:„.1,,.�l:r•».,�ya'.,.�•7{-/I`,-+,cEJ�'.i:.,.•1rr.0�va(d03-,�-,1`'.3•.32�2i.>..,�-,v^A3o.-(1.P�1.��..5l4.01ttn8--.94�•.,1x-. �:,c-.,7l::-..-tiv e-...1.f'..•.r,l^—;nv.„.,w7,�y7 ta,_,0r�,•_9.: .;.'2,•_,1e7p.-l9�,.4,1 1:0,.A,7,7 J+5•f72.-304,.:^mc 3r.`-_„.9_oT..:J2;5 -`:t:.-°.-r.•,,m 9.-,i-,.,.{,.._s.-.+Ir":::_:.,,.�2,P,Ip-..4f`I1I,�.III 9'f�,,Ier,•,kj.'-^.,r.;.•,.1,1)l I,,IIIII�1II ILI zl—r t,.`�'::3p_-.-'_.',h,<a„a t•!q ,s....,.1 3.,.8—s.1�,9 16.9D1u,s'B:�-�IIx�t,��•+kT<�,-”'ItI,III:,777{`1'�.�#10�9�e'.•I.r.-_i.•I1r..-.,,+i:,—_:-.1_�III�II iI .I(I1I�..I r.,Y!}°7.,}s,.::..5„1,a;.,,;u.i.;,i—,7:...c..a,a_@':,-.CI...17,I'',:'ti:;'...,I.1..22�.c�ao.,1+..scm°8i.vz1-..F—r-.[sI:63F,),Lw3331s34,.1;,;-sa4 r3 0`2:,-,.:P a�v.t�T'1,,�10.i,D,.1 yc:�:�II�:ca.J•, io,>II.I,>�~,.• •a3$,-d.`Ir,,�y"r;.1-�•1.If;,.n..ds,,,;�-J,;: `rn_•-.: 1,=�-:.„-:.,j:.,r�_1:.'.;,,.*a«.;''i1:.•,w�<.'.,�2:,r,,—�,,,�6r,{,1—.`,+_.°z°t-`;”-.`�,.f^7..+—,.+d.:'.7,_{,'-�,,.;':y.�4,_tit'.^.:.,',O.-,':.'•-�7,G.i.,.�•., ..•1-:.y+0'Ia�I� .1I II,,�2,:,�-•>w,`..'1'�.��.+u�gJ',:":�Y.�:.:ii`,t gye;.,i-.:..s,m,..,:s+.,ti.`',.2 _.•,•—,�:.�....6,.', !.r„$---F'•€ xd. °r.,�--Pt4+—t'i"t.5._:.'.-,'§--h:H;\,'•,'a.-;--�•g`.°,�.'�-.,t-n~a-,.; A ' }3 5 1, rn104210429 I042.1421.142{ � :0380 t ^ a(aoR340 ' 0, oao I 4a7 393 tU38944 10 --#�E•y-.,\°rr..�_s'r-t_-t—�\'"d-_@_•:�`",-*-',� mo•',�"a,—,i{v,; a.,�y\�..,�f•• �k- � ,,..•-�A.�',.•':.+. yny,A ”k � \� i,—yr+" rT;� , ti D 10385 0383„t 38 o 137. I 1(i37 036 1 \ q,+9,037U s5 10:ss, 3 lua 10A343 1c332 ,tU31 j 101V 0317 :'03a4- 1030 0.05 ALI 11,292 ..290 1029128h 'G27410272} 279: 272 10273 1979719(,41025 0,126 .)22 10212RJ 97 10 434 ,s3 11)177 . ": n kill r4! x3! 37'1il; . 11 ` _101 . 10P 2 .� 1017 b11-,1977`719683, zay 1t,{ 19550797 17 5 R« v Al of�IyMmeT ''tiTm-r 7 ,7 19500 {5424 H 19409C °. �>•`r, a � o:Sm .'' .., - ,Y, - Y _ `- !,A✓., �n.cy 1� r i� q[ICo7 � Service Address Backflow Prevention Assembly Test Report Location: Behind and across the street of Alexander steakhouse after meter Ice Center Enterprises Verify Assembly information,Note Any Corrections 10123 North,Wolfe Road Serial#: 3978817 Cupertino, CA 95014-25 Manufacturer: Wilkins Mailing Address Model: 975XL2 Ice Center Enterprises Type: RP PO Box 1433 size: 2" Alameda, CA 94501-01 Orientation: H Hazard ID: 1154234 Meter#:62270340 Mailing Phone: Protection: Service (Service,Internal) est3Due No Latef�hanf` Existing[] Removed❑ Commercial New® Replaced❑ Industrial © Residential❑ Construction❑ DomesticE] Irrigation❑ Fire❑ **Attention"` Yes Reduced Pressure Principle Assembly Air Gap Required separation ❑No ❑ **Do Not Use Black Ink"* CA-NV AWWA or ABPA Double Check Valve Assembly PVB/SVB Certification Required Check Valve#1 Check Valve#2 Relief Valve Air Inlet Check Valve INITIAL TEST Leaked ❑ Leaked ❑ Did Not Open ❑ Did Not Open ❑ Leaked ❑ Line Pressure 60 Closed Tight ® Closed Tight Meter Read 1071600 Opened at 2.4 PSID Opened at PSID Held at PSID Pass ® Fail ❑ Held at 8.2 PSID Held at t PSID Observed Fully Open❑ **NOTIFY CAL WATER IF FAILED ASSEMBLIES CANNOT BE REPAIRED WITHIN 3 DAYS- CALL PRIOR TO REPLACING A FAILED DOUBLE CHECK** REPAIRS Cleaned ❑ Cleaned ❑ Cleaned ❑ Cleaned ❑ Cleaned ❑ Repaired ❑ Repaired ❑ Repaired ❑ Repaired ❑ Repaired ❑ Date Parts Replaced: Parts Replaced: Parts Replaced: Parts Replaced: Parts Replaced: Time Repaired By: FINAL TEST Leaked ❑ Leaked ❑ Did Not Open ❑ Did Not Open ❑ Leaked ❑ Line Pressure Closed Tight ❑ Closed Tight ❑ Meter Read Opened at PSID Opened at PSID Held at PSID Pass ❑ Fail ❑ Held at PSID Held at PSID I I Observed Fully Open ❑ Initial Tester: Evan Cooper INITIAL TEST AWWA or ABPA Tester* 12711 Yes No 1/8/2014 Proper Installation ® ❑ Test Kit Serial#: 12071501 Calibration Date#: RV Exercised ❑ IR 11/12/2014 Time: 10:17 AM Before Test Date: V O. .Closed 91 Phone: 800-464-3569 S. 1771Signature:• On Arrival Service Restored IN ❑ I certify all information on this report is We and accurate,acknowledging incomplete reports will not be accepted. FINAL TEST S.O.V.Closed Yes No *Final Tester. *AWWAorABPA Tester#- On Arrival ❑ ❑ *Test Kit Serial#: ; *Same As *Calibration Date#: Service Restored ❑ ❑ ' Initial Test ; Date: ! ❑ Time: t *Signature: *Phone: I certify all Information on this report is true and accurate,acknowledging incomplete reports will not be accepted. 1 riser Is coming out o t e k sl ewa Comments: Return completed *a�°4NCALIFORNIA WATER SERVICE COMPANY Test Report to: