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B-2019-0409 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0409 20674 HOMESTEAD RD CUPERTINO,CA 95014-0451(326 10 066) COLONY CONSTRUCTION SACRAMENTO,CA 95826 OWNER'S NAME: Si 38 LLC Etal DATE ISSUED:05/30/2019 OWNER'S PHONE:408-228-2583 PHONE NO:(916)417-7260 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#306512 Contractor COLONY CONSTRUCTION Date 11/30/2019 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: PHO-HOA RESTAURANT T.I.(1527 SF) 1. I have and will maintain a certificate of consent to self-insure for Worker's i Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 2. 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 permit is issued. Sq.Ft Floor Area: Valuation:$100000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 10 066 A(Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE Additionally,the applicant understands and will comply with all non-point OR source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 5/30/19 Issued by:Haley McKee Date:05/30/2019 OWNER-BUILDER DECLARATION 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. I,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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:5/30/19- I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certifythat in the performance of the work for which this permit is issued I Health&Safety Code,Section 25532(a)should I store or handle hazardous p p shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:5/30/19 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date 5/30/19 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT D�� . �� .., d..,eA��T.d.V��NT * LU:i. 'D .N'G IVISION / 10300 TO RRAVENUE C •�_ �,. UPERTINO, .,�°'"9 A 950 .4--3 55 lid (408) 777-322 CUPERTMO PERMIT#P- RE�# DEE# NEW CONSTRUCTION .ADDITIONDAL TERATION �T.I. ❑MEP RE_R PROJECT.ADDRESS ❑ OOP ❑ SWIMMING POOL/SPA .20674 Homestead.Road Cuvertino CA 95014 ' OWNERNAME Hc�I1�l,Tran 1082C2 PHONE E-MAIL STREET ADURF 4 - 8- 5 Slicovalle@rcai .e 3197 Napa Drive STATE,Z..T:P om San Jose,CA 95148 WONTRACTOR NAME OWNER-BUILDER COMPANY NAME LICENSE NUMBER Ca v, t*o---i V. Z LICENSE TYPE t v r,1 STREET ADDRESS - 3 ob s� 2 C t ass 6,, 1 . Av�..�w{� =CITY, TE, QIP E-MATE g Z (� PHONE H,ir.oct a.n, C mow, _ -� BUS.LIC# A.Rc i-irrEcT 0 OWNER 0 OWNER AGENT 57 3CCCTOR AGEmrEl ENGINEER D CONTACT NAME EVELarER TEN ,NT Stephanie Wong E-MAIL Swig.a reogrn a i.l.corm STREET ADDRESS 4 9 rV' I1"�Street C1°I`Y,STA"T"E,ZIP ...................... r_ . �, San Rafael,CA 94901 P DESCRIPTON W (415)939HONE - 944 TI of an existin restaurant, leolish eitn +cabin r etre and rer�aa�e existin flo�rin in: itd3.en Dix�.ian ,Ro oxn.anal restroOms.Instar new rile at reshroe► s. Construct,new non-load bearing malls at Kitchen.Construct new 80ffxt at portion of Dining room.Install.new kitchen ecltatip:rnent and hood at ' I�.I.tchen.Install neva make-up air unit and e �. blast � exhaust fan. at roof. []SINGLE-FAMILY/DUPLEX ]MULTI-FAMILY p INDUSTMAL CEJ COMMERCIAL EX15TING USE EXISTING SF NEW FLOOR SF TIORC.Ii SF DECK SF I7 EN40 SF STORIES� �C)T�L N��'SF A- 2,036 USE TYKE OCC SQ.FT. VALUATION I2EMODEC.. REMODEL KITCHEN REMODEL C1THR GARAGE BATHROOM.SF SF 0 A"ITACIiED SF SP [I DETACHED *"' 9 Ex1$rNG �YE.S [�YES . 100,000 FIRE SPRINKLERS[1 NO ��CFII.�R IN NO SECOND STORY ADDITION �YC; 19 NO UNITS SECOND DWELLING ❑YES ❑ATTACI-IEU['�DETACHED OTHER NITS# UNIT ADDITOP�J: ❑NU SF POOLS ❑FIBERGLASS [ VINYL-LINED 0 GUNITE PREFABRICATED POOL-SF SPA-SF _ SPA tTTA.Ci f ELSE NO TOTAL.-SF SO- C rrintcr c ictl or Mtt.ti-Fctrft'l2 Btst�l zv't I'ar Ii Sxr�'r1t»tint Pcwls re ttire!7e rtrttcat P a L`r i t ytrJtea Ertl RECY�A'O 'F [4oaf t a r z aI TOTAL'VALUATION: IZ�--ZG►UF EXLSTING RC}CIF'TYPE: ❑BU11��"-t:IP I CC OF r ' 100,000 .. ASPHALT SHINGLES❑%,OOD SHAKES❑�O(DD SHINGLE i TILE. OTHER REIvi�'�VE/REPLACE❑NC) IF ND I'LY�`VO(�D �r�" S Sir ❑ (SPECIFY) �1 [� /� PLYWOOD TYPE: PITCH: ❑YES #OF LAYERS THICKNESS❑5/8" OTHER______-� ROOF CLASS PROPOSED ROOF TYPE:OBUILT-UP ROOF ❑ASPHAL D OSB ❑CDX OTHER :�� A T SHINGLES❑i��►�OOD 5N�►KES Q t�t�}I3 SHINGLES C7 DIRER *Provide a signed copy of the Cupertino`s Tear-Off policy By any signature below I certify to each of the following: am the property SF #of SQUARES--., la p �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 to cor��pi�r with all applicable local ordinances and state I.avvs relating have read the Description of'�'V�ork and verify it is accurate. I agree ting to building c�anstrr.��-bion. I authorize representatives of Cupertino enter the above-identified property For inspection purposes. I acknc�wied e a 1� to to be made available for public record, g and a�-ithnriz all information contained on this application form Signature of Applicant/Agents Date:4:y -12, SUPPLEMENTAL INFORMAN REQUIRE *New SFDISecond Dwelling Units/li/rultrfamily Dwellings:A Demolition erinit is - . *�.'un�x�nercial Buildings: Provide a completed Hazardous Materials Disclosure form if prior to issuance of a building permit for all new c�zlsfructian. *Copy of I'1a1u1in�Approval Letter or Meeting with Pl��tl�zin prior to sub � zf any Hazardous.Materials are being used as part of this project. ��' rruttal of Building Permit application, P l *HOA-Provide a letter of approval.from the Home Owner's Association BUILDING PERMIT CUPERTINO CITY HALL 10300 Torre Avenue • Cupertino, CA 95014-3255 PHONE 408-777-3228 WWW.CUPERTINO.ORG BUILDING ADDRESS: OWNER'S NAME: Not provided OWNER'S PHONE: Not Provided CONTRACTOR: COLONY CONSTRUCTION, 1501 JOBY LN SACRAMENTO CONTRACTOR PHONE: DATE ISSUED 12/2/2019 10:12:34 AM ISSUED BY: HALEYM VALUATION: $100000 JOB DESCRIPTION T.I. (1527 SF) REV #1 - INSTALL TYPE 2 HOOD OVER DISHWASHER - ISSUED 12/2/19 REV #2 - CHANGES TO NOTES REGARDING CALIFORNIA FIRE CODE AND FIRE SAFETY; INTERLOCK BETWEEN MOLITRON ODOR ABATEMENT SYSTEM AND THE KITCHEN HOOD SUPPRESSION SYSTEM - ISSUED 10/11/19 REV #3 - REPLACE VENTLESS DISHWASHER - ISSUED 12/2/19 PHO-HOA RESTAURANT- CONSTRUCTION SITE ORIGINALLY WITH LICENSED CONTRACTOR DECLARATION 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full CONTRACTOR: COLONY LICENSED B GENERAL LICENSED 306512 EXP 11/30/2019 I hereby force I hereby CONSTRUCTION CLASS: BUILDING NO: DATE: affirm that and effect. affirm under I have and will for which this I have and will I certify that in laws with such CONTRACTOR I am licensed under the provisions of Chapter penatly of perjury one of the following three maintain a certificate of consent to self -insure permit is issued. maintain Worker's Compensation Insurance, as the performance of the work for which this permit of California. If, after making this certificate of provisions or this permit shall be deemed revoked. declarations: for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is is issued, I shall not employ any person in any manner so as to become subject to the Worker's exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith issued. V Compensation comply HAZARDOUS MATERIALS DISCLOSURE 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance I have read the hazardous materials requirements under Chapter the Cupertino Municipal Code, Chapter 9.12 and the Health V with equipment Municipal & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino 25505, 25533, and 25534. this project. Firm Certification No: or devices which emit hazardous air contaminants as Code, Chapter 9.12 and the Health & Safety Code, Sections An EPA Lead -Safe Certified Renovator will be responsible for Firm Name: No EPA Lead -Safe Certified Firm is required for this project. Certified v CONSTRUCTION LENDING AGENCY lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code). Lender's Address: I hereby Yes affirm under penalty of perjury that there is a construction No V Lender's Name: APPLICATION CERTIFICATION information is correct. I agree to comply with all city and county ordinances and state laws relating to building