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12100187CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18880 HOMESTEAD RD CONTRACTOR: XL CONSTRUCTION PERMIT NO: 12100187 OWNER'S NAME: CUPERTINO OFFICE PARTNERS LLC 851 BUCKEYE CT DATE ISSUED: 12/17/2012 OWNER'S PHONE: 4087997346 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: I License Class Lic. #IYL dry I ivt C, BLDG ELECT PLUMB C_ . v1 F MECH RESIDENTIAL COMMERCIAL //'�� Contractor Date �� (lj �� VZ, �J I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: TENANT IMPROVEMENT -APPLE OFFICE SPACE MINOR (commencing with Section 7000) of Division 3 of the Business & Professions STRUCTURAL, INCLUDES MECHANICAL, ELECTRICAL, NO Code and that my license is in full force and effect. PLUMBING I hereby affirm under penalty of perjury one of the following two declarations: 1 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 Sq. Ft Floor Area: Valuation: $350000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31609037.00 Occupancy Type: 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, andnhereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. - Issued — - Date` 2 Signature Date i ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, 1 agree to remove all new materials for 1, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. 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 o utt ze agent: Own11 forthwith comply with such provisions or this permit shall be deemed revoked. ate: CONSTILCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CUPERTINO C4,� )Z7,170 Sall r-1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION 10300 TORRE AVENUE ' CUPERTINO, CA 95014-3255 (408) 777-3228 ' FAX (408) 777-3333 ' buildino cDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION Y ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 1<20 So N*mVs APN k OWNER NAME / E Ma .+ VIAv A JQ+ • CO� lw�� STREET ADDRESS ! si/�f/1 J� ^ LITY STATE, ZIP q s� F , I ( � CONTACT NAME AV h(I , D N PHO b Ne E- _II. • w lJ� STREET ADDRESS I t • 'v ' � CIT , STA_TE1 , P A F X N O , 0 -IoLA ❑ OWNER ❑ OWNER -BUILDER 9 OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAN "k_q LWZX BER LICENSE YPE BUS. L[ -.,,� 0 COMPANY NAMEE-MAI FA STREET ADDRESS I t �! _ _ CITY, STATE, ZIP � OI P NE z 641 4 ` (�� n ` ndf O _ J ARCHITECT/ENGINE NAM LICENSE NUMBER BUS. LIC # ( o ►� — 1 COMPANY NAME ZeAF E-MAIL FA G STREET ADDRESS.CITYcA TATE, ZI t P 783 DESCRIPTION OF WORK 1 ' (.ehsT r4AC : VVV%- rain IV, A m,,0,0 r- . ca4• ce. t.,+' Lle, as � �►co►� o��l�'� :n'S�e atn Wit V% JS ,". o EXIS�TIN�U E•� PROPOSED USE �� G DNS E 4STO�ES �fl f USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG A ^ AREA -� NEW FLOOR AREA o DEMO TOTAL AREA 1'L' ) NET AREA •� 111 �} 1 \1 4 , 3So 000 1 l 1 ` `D V lVJ r BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? I]NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL k ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO VD, 0' O By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 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 relating to bui ingc nstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanUAgent , Date: SUPPLEMENTAL I RMATION FMQUIRED PLAN CHECK TYPE ROUTING SLIP _ New SFD Or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER DING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ ExPRE.SS Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 5 STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE Xel�FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FM -1 FEE ESTIMATOR - BUILDING DIVISION 1A SS: 18880 homestead rd. DATE: 10/25/2012 REVIEWED BY: bobs. PC FEE ID LAPN BP#: *VALUATION: $350,000 *PERMIT TYPE: Building Permit PLAN CHECK PE: Tenant Improvement PRIMARY Commercial Building USE: IBTIPLNCK PENTAMATION 1 B TI PERMIT TYPE: WORK comm offices ace minor structural includes M E no Ps. �t.i. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-8,111-B,IV,V-B 1,237 $1,999.00 IBTIPLNCK $1,182.70 IBTIINSP $0.00 PME Plan Check: $0.00 Permit Fee: $1,182.70 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 1,237 $1,999.00 $1,182.70 MECH, HOURLY 0 Yes G No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY 0 Yes O No` MISC ITEMS Plan Check Fee: $1,999.00 Select a Misc Bldg/Structure or Element of a Building Ll 0.0 I hrs $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These fees are teased on the nreliminary information available and are only an estimate. Contact the Dent for addn I info. FEE ITEMS (Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,999.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. C) OT 0.0 I hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,182.70 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 7 9t4UrGI?L41%'r iat'; f': " T 0 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Strong; Motion Fee: IBSEISMICO $73.50 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $14.00 SUBTOTALS: $3,269.20 $0.00 TOTAL FEE: 1 $3,269.20 Revised: 10/01/2012 r La CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 18NO PERMIT # o? s_ OWNER'S NAME: A PHONE # SMO z-qc)- GENERAL CONTRACTOR: YL CPrS+rL,(-+-'0V)BUSINESS LICENSE # ADDRESS: 20(a? -0 ✓', CITY/ZIPCODE: rd` :no $"0� *Our municipal code requires all bdsinesses working in the city to have a City of Cupertino business llicense. NO BUILDING FINAL OR FINAL. OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AL.L SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date fn V---, 1, /,- - 2 IZ 6ivn-67 Con 0actor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical �-;,�b V 9- ,/', Excavation Fencing Flooring / Carpeting �Y,�k0 rOS• Z.5 Z-40 Linoleum I Wood Glass I Glazing Heating �� 00 Insulation cJt 5 ; OSS 25'Qj 1 Landscaping Lathing Masonry Painting / Wallpaper C~✓ Paving Plastering Plumbing Roofing Septic Tank Sheet Metal -7 gQb Sheet Rock CitySiam � ri ' - i o rS Tile fn V---, 1, /,- - 2 IZ 6ivn-67 Con 0actor Signature Date