15090197CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19650 STEVENS CREEK BLVD
CONTRACTOR: J T CONSTRUCTION PERMIT NO: 15090197
OWNER'S NAME: EVERSHINE VI, LP
1720 OCALA AVE STE B DATE ISSUED: 12/11/2015
OWNER'S PHONE: 6505756822
SAN JOSE, CA 95122 PHONE NO: (408) 234-4340
Fl LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
CREPE FAST FOOD - T.I. FOR RESTAURANT (1,377 SQ
r� e,
License Class ,13 Lie. # �as � � J
FT).
Contractor Date,_1.2 f J/
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: 36906012.19650
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 INSPEC ION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the4"N��
elQ
�� )go
Issued by: Date:
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 1AIIIII&
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
47
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)
1, 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
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal 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 the Cupertino Municipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: o� `
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which'this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
_
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
ILI---- CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
GUPEEiT[[�f0 (408) 777-3228 - FAX (408) 777-3333 - building (a)cupertine.ora
NEW CONSTRUCTION ❑ ADDITION - SALTERATION I TI D REVISION / DEFERRED ORIGINAL PERMIT I-
PROJECf ADDRESS -7� /' O ,��
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I❑ OA`NER OWNER -BUILDER ❑ Olt ❑ CONTRACTOR ❑ CONMUCf'ORAGENT M ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAh E LI SENUMBER LICENSE TYPE
BUS. LIC 4
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECTIENGINEER NAME LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK - to p3`Y)O�L o? - !_ . JVi� �Gi2 •Y
i.._ ) l /✓�-f. Ue �%Ul��%✓SiP`� � ��-�
EXISTINGUSE PROPOSED USEI CONSTRTYPE I 4ST13 O ES
USE TYPE I
OCC. I
SQ:FT.
VALUATION(S)
1� F
V
EXISTG
AREA
NEW FLOOR
AREA.
-
DEMO TOTAL
AREA - NET AREA
y
L
y
L fff
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA/
<
PORCH AREA
DECK AREA
-
TOTAL. DECK/PORCH AREA.
GADETACH
RAGE AREA:
❑ATTACH
DWELLING UNITS:
ISA.SE-ONDUNrr ❑YES
ADDED?NO
SECOND STORY ❑YES
ADDITION?
-
BEING
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ 'CEIVED x - r- - MORK TOTAL VALUATION: -
I EICHLERHONIE? 30 u 6s
PLANNrNGAPPL4.2rRO PLANNINGAPPROVALLETTER ,,. _ �Y y
By my signature below; I certify to each of the following: I am the property ov mer or authorized agent to act on the property oumer'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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
t��ii 'Us Date:
Signature ofApplicantlAgent:
RE gT M
SUPPLEMENTAL IINFORMATION REQUIRED PS 1h CEECKIYE,.-
Q '
- -.�.} ...20UT1nGSLIR,_,_....
New SFD or Multifamily d\veilings: Apply for demolition permit for - r ` `
y a PP y p r� 04R TETrCOIihTER gBUILDI �G PL REVILiTr
existing building(s). Demolition permit is required prior to issuance of building
for new building_ XPI�ESS'�'RESTiEW
permit _ �_z
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure pedxxss:
v
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
i l�._3r7A70R �-.��' ,�'' ATTI�IRRYS�F.IRZtISI';RICT�- �,
submittal of Building Permit application.=
I
Bldggpp 20II.doc revised 06/11111
CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
=p ADDRESS: 1950 Stevens Creek Blvd DATE: 09/29/2015 REVIEWED BY: Sean
APN: --TB-P#: *VALUATION: 1$100,000 —�
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
IrcF:- Commercial Building pu,D,wUrr Tvp-v, 1 B TI
WORK I Tenant Improvement for Crepe Fast Food Restaurant 0377 sq ft).
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
11-B,111-B,IV,V-B
1,377
$2,154.86
1BTIPLNCK
$1,339.96
IBTIINSP
Permit Fee:
$1,339.96
Suppl. Insp. Fee. -(F) Reg. 0 OT
Q,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0,00
T
C.'onstr uetlon . ax:
tit/YtZP77,S t'L7t Zl £' F'ee:
Work Without Permit? Cl Yes ia No
$0.00
TOTALS:
1, 377
$2,154 86
=
$1,339.96
Strong Motion Fee: IBSEISMICO
11cE;da. 1'lcrra C.'laeik, I'lronb, I'lat? £.'lte:cly . Plan Check
aleck. /5ermil Fee. hirnL l'elwlir tee: 1 1eL Pei nrrt Fee:
Other _tk'ch. lnsp, OtIzer Plumb h,!sp. Other Elec. htsp..
it cta. Ir 3p fee: Pl imb. Imp, Fee: Alec. 1 rsp. Fee:
AWW17- Th.. bciicranfo .Inas Hnf s'»nulla foac thio in nthor DonartmPniv (Le. Planning. Public Works. Fire, Sanitary Sewer District, School
rn"iart tha )Tent for addn'l info.
Lcue• cu, cca.. . a rceue eeu u• a •iuucu we c•cc •,.cru«..:...,
FEE ITEMS (Fee Resolution 11-053 E . 7ff /LQ
�,. .., .........,.........A..__
FEE
�"-' -- -
QTY/FEE
- --- -.- - - _
MISC ITEMS
Plan Check Fee:
$2,154.86
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: i) Reg. OT�hrs
$0.00
PME Plan Check:
$0:00
Permit Fee:
$1,339.96
Suppl. Insp. Fee. -(F) Reg. 0 OT
Q,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0,00
T
C.'onstr uetlon . ax:
tit/YtZP77,S t'L7t Zl £' F'ee:
Work Without Permit? Cl Yes ia No
$0.00
Advanced Planninj Fee:
$0.00
Select a Non -Residential
Building or Structure 0
Nett el Docillne7 alion #'E'EN_ :
Strong Motion Fee: IBSEISMICO
$28.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
riTBT6TAT.S.
$3,526.821
$0.00 `. TpTAL ISE ' $3,526.82
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