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15090058CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19500 VALLCO PKWY CONTRACTOR: DEVCON PERMIT NO: 15090058 CONSTRUCTION INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 690 GIBRALTAR DR DATE ISSUED: 09/11/2015 OWNER'S PHONE: 9165031073 MILPITAS, CA 95035 PHONE NO: (408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ TRAFFIC SIGNAL CONTROL BOX METER RELEASE AT THE �('�((�� INTERSECTION OF VALLCO AND UNNAMED - REFERENCE License Class Lic.�"1"► I APPROVED APPLE MITIGATION PLANS (L-M) PAGE T-9. Contractor Q� DateA:11 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: Sq. Ft Floor Area: Valuation: $5000 i. I have and will maintain a certificate of consent to self-insure for Worker's ompensation, as provided for by Section 3700 of the Labor Code, for the RA&erformance of the work for which this permit is issued. APN Number: 31620109.19500 Occupancy Type: ave 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. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 180 DAYS FROM LAST CALLED INSPECTION. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ��Gl7 indemnify and keep lig le a City of Cupertino against liabilities, judgments, Issued by: _�/� Date: costs, and expenses whi may a rue against said City in consequence of the granting of thi ermit. (Additiional'N the applicant understands and will comply with all non-poin ce regillationsj2CLIke Cupertino Municipal Code, Section 9.18. RE-ROOFS: 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 1 I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. i. I have and will maintain a Certificate of Consent to self-insure for Worker's Additionally, should I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the 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 performance of the work for which this permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. 2. 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 Owe r r rt�dg l/ permit is issued. Date: a. 1 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional 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. Signature Date CUP_ERTINO R1 NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(okupertino.orcl El ADDITION 0 ALTERATION /T1 n REVISION / ISI -f FRRFr) ORVIINAI Pppmrr i, PROJECT ADDRESS 19500 A Vallco Parkway APN 0 . I OWNI"R NAME PHON'r E-MAIL lllAd_$— CITY ':I'A,rr zip FAX AEC, —'f72F '57'// e4 CONTACT NAME PRONE 1323.919.4460 Sarah Nelson s.nelson@ccm.to STREET ADDRESS CITY, STATE, ZIP FAX 1 Infinite Loop MS -21 -1 AC2 Cupertino, CA 95014 1 11 OWNER El OWNER -BUILDER 0 OWNER AGENT 0 CONTRACTOR 13CONTRACTORAGEN'T 11 ARCHITEcr 13 ENovmFit 13 DEVELOPER ❑ TENANT CONTRACTOR NAME Devcon Construction Incorporated LICENSE NUMBS CIA Lic 39916.3' LICENSE TYPE 1 BUS. LIC!4 COMPANY NAME Devcon Construction Incorporated (,-MAIL tcleveland@Devcon-const.com FAX STREET ADDRESS CITY, STA6TE.ZTP PHONE 690 Gibraltar Dr Milpitas, CA 95035 408.636.0900 ARCHITECT.IENGINEER NAME Stephen Yazalina 1,1(:'FNSI- NUMBER SBE# 19730 BUS, LICj COMPANY NAME E-MAIL FAX -Sandis syaz@sandis.net S STREFT ADDRESS CITY, STA I E, ZIP PHONE 1700 Winchester Blvd Suite 200 Campbell, CA 95008 408.636.0900 DESCRIPTION OF WORK Traffic Signal Control box Meter Release at the intersection of Vallco and Unnamed - reference approved Apple Mitigation Plans (L -M) Page T-9 EXISTING USE PROPOSED USE CONSTR,TYPE AfSTORJES N/A I I I USE TYPE OCC. SQ,FT, VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AIR FA AREA AREA NET AREA Electrical Met ar $5000 BATHROOM KlIC14EN OTI IER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK Altkilk TOTAL GARAGE AREA' DETACH DE,CK.,`PORCH AREA DETACH J ... 0 WELLING UNITS IS A SECOND UNIT ;iis SECOND STORY BEING ADDED! ONO ADDITION? ONO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL 0 ONO PLANNING APPROVAL LEITER,EICIILFRHONIE? IS Tit E SLOG AN [] YES ONO RECEIVEDBy,?- TOTAL VALUATION, I -- 5000 By my signature below, I certify to each orthe following: I am the property owner or authorized agent to act on the property owner's belialf. lhave read this application and the information I have provided is correct. I have read the Description of Work mid verity it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction, I authorize representatives of Cupertino to enter die above-identiped p, perty for inspection purposes. Signature ofApplicant/Agent: Date: SUPPI. INFORMATION REQUIRI-15—Ji PLAN CHECK TYPE ROUTING SLAP New Sl -D or Multifamily dwellings: Apply for demolition permit for 'Zr OVER Tiff BUILDING PLAN existing building(s). Demolition permit is required prior to issuance ol'building r 'p, REVIEW permit ror new building. n EXPRESS D PLANNING PLAN REVIEW — Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD 0 PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE 11 FIRE DEPT — Copy of Planning Approval Letter or Meeting with Planning prior to ❑ submittal of Building Permit application. MAJOR El SANITARY SEWER DISTRICT -- 1 11 ENVIRONMENTAL HFAUTII H1dg,4p1)_201 I. doc revised 06"21.4 1 CITY OF CUPERTINO I/1 FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 19500 A Vallco Parkway DATE: 09/10/2015 REVIEWED BY: Sean UNITS APN: BP#: *VALUATION: 1$5,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: Amps PENTAMATION 10EAP2 PERMIT TYPE: WORK Traffic si nal control box meter release at the intersection of vallco and unnamed - reference approved SCOPE Apple Mitigation Plans (L -M) Page T-9. APPLIANCE / EQUIP TYPE FEE ID Plnnib. Plan Check QTY UNITS BP FEES Elec. Permit Fee: I EPERMIT Services 1ECT<200 Other Elec. Insp. 0.0 hrs $48.00 100 Amps $48 Permit Fee: Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Q Yes (j) No $0.00 TOTALS: TravelDocumentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICO 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 based on the nreliminary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) Mech. Plan Check Plnnib. Plan Check Elec. Plan Check 0.0 1 hrs $0.00 Mech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: I EPERMIT Other Mech. Insp. Other Plumb /nsp. Other Elec. Insp. 0.0 hrs $48.00 Mech. hasp. Fee: Plumb. Insp. Fee: Elec. hzsp. Fee: 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 based on the nreliminary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Q Yes (j) No $0.00 Advanced Planning Fees.- ees:Travel TravelDocumentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICO $1.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $191.401 $0.00 TOTAL FEE: $191.40 Revised: 07/02/2015