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B-2016-2126CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2126 20576 HOMESTEAD RD CUPERTINO, CA 95014-0451 (326 10 066) 3 M STITT CONSTRUCTION INC CORONA, CA 92280 OWNER'S NAME: SOBRATO INTERESTS 1 ETAL OWNER'S PHONE: 408-446-0700 LICENSED CONTRACTOR'S DECLARATION License Class GENERAL BUILDING CONTRACTOR Lic. # N272 Contractor J M STITT CONSTRUCTION INC Date 09/30/2016 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: 1. 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, 2,11 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signatures Date 08/02/2016 ISSUED: 08/02/2016 NO: (951) 271-3440 BUILDING PERMIT INFO: X BLDG —ELECT _ PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: STE # 100 & 102 - T.I. - CONSTRUCT N DEMISING WALL WITHIN A VACANT BUILDING TO SEPARATE TWO SUITES FOR FUTURE TENANTS. TENANT AREAS ESTABLISHED: (1719 S.F.) AND (3486 S.F.) Ft Floor Area: I Valuation: $5000.00 APN Number: Occupancy Type: 326 10 066 1 A (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons; All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 1, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. h as owner of the property am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 08/02/2016 I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 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 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that 1 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 08/02/2016 COVERINGS TO BE CLASS "A" OR HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health B& Safety Code; Sections 25505 25533, and 25534. Owner or authorized agent: Date: 08/02/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 96014-3255 U1? RTINO (408) 777-3228• FAX (408) 777-3333 buildingOlcupertino.orsl i❑ NEWCGNS'iRUCTION D ADDITIONALTERATION/11 n REv18fDN/DEFP.RRRD 2, "2'0 E U - Z 12, (.o ORTOWAT, PF..RMTT it PROIECTADDRESS " +�� Homestead Rd DPN# y . ,py,! _ (m�(9 OWNER NA Ii 9 a GY r 7 { '` '' " HONE P MATI, h „ 4y& a STREET ADDRESS C ITY, ' A7'E, ZTP i AX CONTACT NAME Dan Papa PHONE (949) 923 G905 MAIL dan.popa@stallteo.com STREETADDRESS' 38 Technology Dr, Ste 100 CITY, STATE,, ZIP Irvine, CA 92618 FAX (949) 923-6190 ❑ G"M El OWNfIR-M -DER 0 OWNERAOENT ❑ CONTRACTOR Q CONTRACTOR AGENT M ARCmMCT i]. ENGINEER 11 DEVELOPER l] TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LTC # COMPANY NAMB EMAIL FAX STREG'I' ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENOINEERNAME GarySelnling LICENSE NUMBER 0,21541 Bus, LTC it COMPANYNAME Stantec Architecture, Ino B -MAIL gary.semlillg@stantec,com FAX STREET ADDRESS 1383 N McDowell Blvd. CITY, STATE, ZIP Petaluma, CA 92618 PHONE (707) 658-4717 DESCRIPTION OF WORK Construct a new demising ~Nall within a Vacant building which will separate into two SUiteS for future tenants. Tenant areas established: 1,719 sf and 3,486.sf =STING USE PROPOSEOUSH. CONSTRTYPII $STORIES Vacant shell bldg Business / Bank 5B 1 USE TY E OCC. SQ.irr. VALUATION($) IDiST'G AREA 5,205 MWFtOOR AREA n1a DEMO ARBA n1a - TOTAL NFr AREA 5,205 Business 5B 16 1,719 - 'BATHROOM - REMODELARBA n/aRI'sMODELAREA ITCHW riaRHMODSLAREA 0' U n1a Bank 583 35 3,486 PORCII AREA DECK ARBA TOTAL DECKIPORCH AREA GARAGB ARBA: .DETACH n/a n/a n1a ATTACH /17 #DWELLINGUNITS; '18 A SECOND UNIT _ YES' SECONDSTORY QYES�T n/a BIZINGADDLD? ®NO ADDITION? ]ENO ME -APPLICATION l] YES IF YR3, PROVWH COPY OF LS TRE BLDG AN ❑ YES RUCE1TOTAL VALUATION: P.LANNINGAWL4 ©NO PLANNWGAPPROVALLET= EICHLB.RHOrT1E? ENO A� ZL=2, 1 $,9,0()0 By roy'signature below, I certify to each ofthe fdllawing: I AUT the property owner or authorized hezfta ac on the property owner's behalf. 1 have reals this application and the information I have provided is correct. I have read the Description. of WoTkand verify It is accurate. I agree to comply with all applicable local ordinances and state laws relalingA4ilding co ct o . I authorize re res n ves o iu lino to enter the above-ide ttfted property for inspection purposes. / Signature o£A licant/A nt � _ . s ,l ; l,. zc Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN C=-ECK TYPL ROUTING SLIP [l ovjm Tnr coumfER ❑ BUILDING PLAN REVIBw New SFD or lylultifall sly dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ FxPItEss ❑ PLALjNaNG PLAN RCVILR` _ Commercial Didgs; Provide a completed Hazardous Materials Disclosure 1:1 STANDARD ❑ PUBLIC woRKs form if any Hazardous Materials are being used as part of this project. El 7 ARC E p FIRGDERT _ Copy of Planning Approval Letter' or Meeting with. Planning prior to ❑ MAIt)Iz El sAmTARYSEwR1IDISTItYCT submittal ofBuilding Permit application. ❑ ENVIRONMENTAL 11LALTII Bldg.App_2011,dot, revised 06121111