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11110125CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18920 FORGE DR CONTRACTOR: DEVCON PERMIT NO: 11110125 CONSTRUCTION INC OWNER'S NAME: FORGE DRIVE INVESTORS, LLC 690 GIBRALTAR DR DATE ISSUED: 11/22/2011 OWNER'S PHONE: MILPITAS, CA 95035 PHONE NO: (408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION i BUILDING PERMITINFO: BLDG ELECT PLUMB License Class Is Lic. 9`10 1 _ C T V�� 67"T /� 1 Contractor e Date INIECH RESIDENTIAL COMTIERCIAL JOB DESCRIPTION: SHORING AND EXCAVATION OF CHAMBER PIT 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: 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 Sq. Ft Floor Area: Valuation: $100000 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 APN Number: 31609030.18920 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. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF 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 FROM LAST 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 Date: - — granting of this permit. Additionally, the applicant understands and will comply ssue✓ `s Issued b with all non- 'no Municipal Code, Section RE -ROOFS: 9.18, J 1/ 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 I14ATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of' tile 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 Dlunicipal 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 upertino Municipal Co ,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Cod Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen Date:2� ZQ 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 CONSTRUCTION LENDING AGENCY 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, Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED II I (D� 1 � . ORIGINAL PERMIT # PROTECT ADDRESS jig 2® ® `� , ®• ®� (PHONE 1��3®®`��®,T APN # e 6 O NAME S®6'gt l®1 E-MAIL opw o SIRE ADDRESS• . 7 '� fLh- 1 CITY, STATE, ZIP 1 ' FAX CONTACT NAMESW0 9 1 PHONE 4� e E L. 40 e STREETADDRESS` Dt ,bap CITY,STATE.cU W -II FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER KENANT CONTRACTOR NAME % ! tE 0 �J 6 LICENSE NUMBER C! 9 LICENSE TYPE BUS. LIC # ( , COMPANY NAME V �6 e ® 41 E-MAII,.SLr_ 1 & Lo , 1 N ® �S f . J FAX46(3, e 2.� , � STREET ADDRESS t T . CITY, STATE, ZIP t LPI TAI, .1561 PHOTS 7 ' .-),1 OLe ARCHITECTIENGINEERN ,ro-i1 LICENSE NUMBER BUS. LIC# COMPANY NAME ®� MAIL ET ADD S e S�. ` CITY, STATE, ZIP um . ( 4WD Th PHO' HO 17. 1 r DESCRIPTION OF WORK EXISTING USE IC PROPOSED USE CONSTRTYPE t ! II #STORIES 1 USE TYPEEyy OCC. SQ.FT. VALUATION (S) EXISTAREAS IS AREA ARE AREA TOTAL NErAREA yy BATHROOM KITCHEN REMODELAREA REMODELAREA OTHER REMODEL AREA 7 FOR AR p p DECKAREA TOTAL DE K/PORCHAREA GARAGE�REA: DETACH A . ( ❑ AT'CACH ®# I DWELLING UNITS: IS A SECOND UNIT E] YES BEING ADDED? $NO SECOND STORY []YES ADDITION? NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLERHOME? lrNO RECEIVED BY: -{' t p TOTAL VALUATION: %R By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr_rpJerty owner's behalf. I have read this application and the information I have is correct. I have read the Descripti rl Work and verify it is accurate. I agree to comply with all applicable local ordinances and State laws relating t uildin constructio a horize represen ve f Cupertino to enter the above -I ntlfie property for inspection purposes. Signature of Applicant/Agent: Date: / SUPPLEMENTAytNFORMATIMREQUIRED PLAN CHECK TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for oVER-THE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ ExPRESS ❑ PLANNING PLAN REVIEW —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ElsTANDARD ElPUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH . BldgApp 2011.doc revised 06/21/11 us Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: - PERMIT # "Ls OWNER'S NAME: PHONE # 1 GENERAL CONTRACTOR: \/ BUSINESS LICENSE # ADDRESS: p CITY/ZIPCODE: %yV 1TA� *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: f Date 41 Owner / &44ractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation , Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 41 Owner / &44ractor Signature Date __ CITY OF CUPERTINO FFF ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. P/muting, Public Works, tire, sauttarysewer uistr/cg scuoo/ M. 4-'_ „i., 1 'rl,.,..., £non n 6ncnd ni, f/ n nroltsri»nvu to Fnr»snt/mf Dunt/nh/o nif// nra nN/» ON ocf/»in/O. rniitart the Dent for oddn'l info. FEE ITEMS (Fee Resohi ioit 11-053 E '. 7/1111 ADDRESS: 18920 forge dr. DATE: 11/21/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: j$100,000 y PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building USE: Suppl. PC Fee: Q Reg. 0 OT PENRM` ATION 1GENCOM WORK shorin and excavation of chamber pit. SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. P/muting, Public Works, tire, sauttarysewer uistr/cg scuoo/ M. 4-'_ „i., 1 'rl,.,..., £non n 6ncnd ni, f/ n nroltsri»nvu to Fnr»snt/mf Dunt/nh/o nif// nra nN/» ON ocf/»in/O. rniitart the Dent for oddn'l info. FEE ITEMS (Fee Resohi ioit 11-053 E '. 7/1111 FEE % MISC ITEMS Plan Check Fee: F-1 I itt?}'i'i?.?1?i: fi:,iji.El ti7f''-r''. li7>f3. Suppl. PC Fee: Q Reg. 0 OT 0,0 NOTE: This estimate does not include fees due to other Departments (i.e. P/muting, Public Works, tire, sauttarysewer uistr/cg scuoo/ M. 4-'_ „i., 1 'rl,.,..., £non n 6ncnd ni, f/ n nroltsri»nvu to Fnr»snt/mf Dunt/nh/o nif// nra nN/» ON ocf/»in/O. rniitart the Dent for oddn'l info. FEE ITEMS (Fee Resohi ioit 11-053 E '. 7/1111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 it $783.00 Foundation Repair IFOUNDREP,4 Suppl. PC Fee: Q Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:G Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Flee: $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning_. ee_ $0.00 Select a Non -Residential Building or Structure 0 0 cds,r'? l.)r�< dtt?'rr'7T,,t' f3,,i17"', k.:4A Strom>, Motion Fee: IBSEISMICO $21.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $4.00 SUBTOTALS: $25.00 $783.00 TOTAL FEE: $808.00 Revised: 10/01/2011