15010168CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20080 STEVENS CREEK BLVD
CONTRACTOR: TERRA NOVA
PERMIT NO: 15010168
INDUSTRIES
OWNER'S NAME: PREG BILTMORE
1607 TICE VALLEY BLVD
DATE ISSUED: 05/27/2015
ER'S PHONE: 6506548900
WALNUT CREEK, CA 94595
PHONE NO: (925)934-6133
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class//
SUITE 100 -THE COUNTER BURGER; COMM T.I OF AN
Lic. #
EXISTING EMPTY SHELL RESTAURANT 3400 SQ FT.
Contractor �Yt-�L t(.[�� • Date
REV # 1 - REVISION TO GAS PIPE SIZING, LOAD
,j��
SCHEDULES, WASTE CONNECTION & ELECTRICAL
I hereby affirm that I am licensed under the provisions o Ch ter 9
LOADS - ISSUED 7/9/15
(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:
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: $350000
rformance of the work for which this permit is issued.
e 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.
APN Number: 36903009.20080
Occupancy Type:
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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS + + T ISSUANCE OR
upon the above mention property for inspection purposes. (We) agree to save
18 ROM LA ED INSPEC ION
indemnify and keep h ess the ity of Cupertino against liabilities, judgments,
costs, and expenses wBfnst said City in consequencegranting
ofthis perm tpplicant understands an wi mplyIssuedwith
all non -points e Cupertino Municipal Code, Section
9.18.
Signature Date
RE -ROOFS:
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
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 255#(a) should I store or handle hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
material. Additionally, should I u equipment or devices which emit hazardous
air contaminants as defined by t ay it Quality Management District I
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
will maintain compliance with t e Cupe ti unicipal Code, Chapter 9.12 an
the Health &Safety Code, cti s 55 3, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner
permit is issued.
or authorized agent: Date:
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
Lender's Address
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,
ARCHITECT'S DECLARATION
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
CUPERTINO
I 1 -1 -T T�nA
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 = building(aD-cupertino.om
I I AnnTTTnXT I/VI AT'PUT)ATTn'IT/TT IT1 T)WVTcTr)' /j PRRRRT=.II ORIGINAL PRRMiT9 15010168
PROJECT ADDREss 20080 Stevens Creek Blvd. suite loo
7APN# ?> 6 G r d '3 - O O
6 _T
OWNERNAME Peter Katz �Y- `�; (¢-rte-�l'�
PHONE 650-654-8900
E-MAIL pkatz@thecounterburger.co
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME he Counter, LLC C70 G o en -Fro- pert
i
PHONE 916-316-0005
E-MAIL Mike@goidenpd.com
I
Development LLC Attn: Mike Ramirez
STREET ADDRESS 10 S. Grant St.
CITY, STATE, ZIP Roseville, CA 95678
FAX
1-1OWNER❑ OWNER -BUILDER ICI OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Bob Dugan
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME Terra Nova Industries
E-MAIL bobd@terranova-ind.com
FAX
STREET ADDRESS 1607 Tice Valley Blvd
CITY, STATE, ZIP Walnut Creek, CA 94595
PHONE
ARCHITECT/ENGINEERNAME .Josh COOT
LICENSE NUMBER
BUS. LIC#
COMPANY NAME Innovation & Design
E-MAIL jcool@idaexperience.com
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE 562-206-7720
DESCRIPTION OF WORK Revise gas pip sizing, remove gas pressure reg., revise make-up air unit, revise MAU-1 sequence
of operation to include evaporative cooler, revise gas load schedule, add waste connection, revise electrical load.
EXISTING USE
PROPOSED USE CONSTR.
1
TYPE
I # STORIES
USE
7
TYPE OCC. SQ.FT.
VALUATION1 ($)
EXISTG
NEW FLOOR
DEMO
TOTAL 3,400
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
OTHER
REMODEL AREA REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: ❑ DETACH
I
N/p ❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT [] YES
NO
SECONDISTORY [] YES
ADDITION? NO
BEING ADDED? ®
®
PRE -APPLICATION YES IF YES, PROVIDE COPY OF
Is THE BLDG AN YERECEIV TOTAL VALUATION:
PLANNING APPL # NO PLANNING APPROVAL LETTER
EICHLER HOME?
By my signature below, I certify to each of the following: I am the property owner or authorized a nt t act on the property owner's . I have read
application and the information I have provided is correct. I have read the Description of Work and veri is ac e o comply with all applicable local
ordinances and state laws relating to buildin construction. I a t orize representatives of Cupertino to enter the above -identified property for inspection purposes.
6/17/2015
Signature of Applicant/Agent: % Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
El EXPRESS
❑ PLANNING PLAN REVIEW
X Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC 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 06121111
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
1AADDRESS:
20080 Stevens Creek Blvd
DATE: 06/18/2015
REVIEWED BY: Paul
APN: 369 03 009
BP#: 15010168
*VALUATION:
Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
hrs
PENTAMATION
PERMIT TYPE:
WORK
Revision #1 - MEP
SCOPE
;leech. Plan (Ff<:G'If Phtwb. Plait Check Elec. Plan Check
;i.lech. l'enilil Fee: Plumb. Permit Fee: I I Elec. Permir Fee:
t'hher:ilec'h. Insp.
A4cech. Insp. Fee:
Other Plumb lnsl .
F'1700. litsp. Fee:
Other Iskc'. bap.
Elec. Insp, Pee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District etr_ )_ These fees aro ha.aod nn tho nroliminary infarmadnn availahle and are anly an octimatn_ Contart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Su 1. PC Fee: Re OT
PP � g• � .
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction 7a:r:
� dinir�ristr alive I'ec>:
0
E)
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
A
Crw,el Docuinenia.lion 1f'c�ats�:
Strong Motion Fee:
$0.00
1 # Revisions
$859.00 IREVC0 I Tenant Improvement
Bldg Stds Commission Fee:
$0.00
SBT(TALS
$0.00
$859.00 TOTAL FEE ,
$859.00
Revised: 05/07/2015
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: Z 00 80 Sf e vel7g C ree k B /Vc�PERMIT # _/-50/0/ (�
OWNER'S NAME: 7 -he Unkep-1 g'? mOr� PHONE # (925 93 /33
GENERAL CONTRAC �-�- N !/4 / r BUSINESS LICENSE # 2/773
ADDRESS:/&,07 ✓q / CITY/ZIPCODE: A1,7117WA-Creek VV59
*Our municiaal code reauires all buSrinesses working in the city to have a ON of C'.unertino husinecs licence
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 Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR
Cabinets & Millwork
Cement Finishing
✓ Electrical
Excavation
-- Fencing
Flooring / Carpeting
BUSINESS NAME
%J /cC E/ectri
BUSINESS LICENSE #
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Plumbing
Roofing
Septic Tank
Sheet Metal
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