15100206 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR:DPR CONSTRUCTION,A PERMIT NO: 15100206
GENERAL
OWNER'S NAME:. CUPERTINO CITY CENTER BUILDINGS 1450 VETERA14S BLVD DATE ISSUED:10/26/2015
OWNER'S PHONE: 6509313400 REDWOOD CI11.Y,CA 94063 PHONE NO:(650)474-1450
® LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL F1TI PREP ON 7T4 FLOOR-21,793 S.F.
License Class p-& Lie.#
Contractor Pr P1 (01144 Date
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.
Sq.Ft Floor Area: Valuation:$150000
I hereby affirm under penalty of perjury one of the following two declarations:
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�. I have and will maintain a certificate of consent to self-insure for Worker's APN Number:36901027.00 Occupancy Type:
Compensation,as provided for by Section 3700 of the Labor Code,for the
t
performance of the work for which this permit is issued, --
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 PERMIT EXPIRES IF WORK IS NOT STARTED
permit is issued.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is 180 D YS FROM LAST CALLED INSPECTJON.
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 Issued by° t
Date:' t
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 may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply with RE-ROOFS:
all non-point source regulations.per the Cupertino Municipal Code,Section 9.18. 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
Signature Date (at inspection.
Signature of Applicant: Date:
❑ OWNER-BUILDER DECLARATION ALL'ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 I have read the�azardous materials requirements under Chapter 6.95 of the
sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
2. I,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
construct the project(Sec.7044,Business&Professions Code). Safety Code,Se4tion 25532(x)should I store or handle hazardous material.
Additionally,shpuld I use equipment or devices which emit hazardous air
I hereby affirm under penalty of perjury one of the following three declarations: contaminants asi defined by the Bay Area Air Quality Management District I will
a. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compli'4nce with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Safety;Code,Sections 25505,25533,and 25534.
performance of the work for which this permit is issued. Ownerpr author�z�d agent
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by e t� j Date: t O `1 ?__11 iS
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. CONSTRUCTION LENDING AGENCY
a. 1 certify that in the performance of the work for which this permit is issued,I shall j
not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If,after making this certificate of exemption,I for which this permit is issued(Sec.3097,Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name
must forthwith comply with such provisions or this permit shall be deemed Lender's Address
revoked.
ARCHITECT'S DECLARATION
APPLICANT CERTIFICATION I understand my plans shall be used as public records.
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 Licensed Professional
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 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.
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Signature Date
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- - CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
2-mum Ilk 10300 TORRE AVENUE•CUPERTINO,GA 95014-325!5
GUPERT[t10 (408)777-3228-FAX(408)777-3333-building c)cuperlino.org
NTEW CONSTRUCTION ❑31k--V
. ❑ALTERATION I TI ❑ REVISIpN f DEFERRED ORIGINAL PERMIT
PROM PDDRESS 20,45 ik✓V is t 9 !_Vb •I APNu
OWNERNAIL PHONE �i ' j v� E-NLA.IL
$?BEET ADDRES: ? �. 'J'CITY,
Y, STATE,ZI' r FAX
CONTACT,NAME J&`Vi &Af7 % t'F I PHONTE/ ."°
STREET ADDRESS CITY,S1-4
TATE,ZIP AJOV d, FAX
O'A%Ta 13 OWNER-BUILDER ❑ Mq--R AGENT ❑ Co TRACTOR ❑coN RACTOR AGENT PeARCHITECT r"NCTUMER ❑ DEV ELOPER ❑TENANT
CONTRACTORNAME � LICENSENUh4EEIjy I I LICENSETYPE (� I BUS.LICR
COMPANY NAME I E-MAIL FAX
STREET ADDRESS $ V k SW CITY,STATE,ZIP + PHOINS)t
ARCHITECTrNGINEERNANM I LICENSEh^.i'NMER BUS.LICR
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION?OF WORK ramom v ep r 1
d
EXISTING USE PROPOSED USE CONSTR TYPE STORIES
U$E TYPE ( OCC. SQ.FT. I VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA ( AREA.. NET AREA .
BATHROOM KITCHEN OTHER - j -
REMODEL AREA REMODEL UREA REMODEL AREA
I
PORCHAREAT DECK AREA TOTALDECKIPORCHAREA GARAGE AREA: EJDETACH
ATTACH
n DAELLINGUNITS: ISA SECOND UNrr []YES SECOND STORY ❑1 S
BEING ADDED? ❑NO ADDITION? ❑NO
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PP.E•.LnPLICATION ❑YES ff YES,PROVIDE COPY OF IS THE HLDG ATI ❑YES _ VW
_:= _ TOTAL VALUATION:
PLAN'NTNGAPPLm ❑N'0 PLANNLnGAPPROVAL LETTER I EICHL£RHOME? rNO _ - — .-. a'}
_ rte` (1 �dl
By my signature below,I certify to each of the following: I am the property owner or author! ed agent to act on the property owner'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 buildingMru . au 'ze representatives of Cupertino!to enter the above-identifiedpro Or fo X-C
Signature
purposes.
Signature of Applicant/Agent: Date: [ J
SUPPLEMENTAL INFORMATION REQUIRED �zovzznGSL>�.-
_ - r
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New SFD orMultifamily di'ellings: Apply for demolition permit forte QR�z �couTEx $uaDL�GPLI �T -
existing building s). Demolition permit is required prior to issuance of building311
--�
permit for new building. � SS `
— M MUM o. S
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ssAnDA _ {
orrif any Hazardous Materials are being used as part of this project.
p d r� I74RG _ � FII.E D1 k -
Copy of Planning Approval Letter or Meeting with Planning prior to 7 Fp� sisraiicr
submittal of Building Permit application.
BldgApp_O11.doe revised 06121111
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CITY OF CUPERTI O
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20450 Stevens Greek Blvd DATE: 10/1612015 REVIEWED BY: PAUL
APN: 369 01 027 BP#: *VALUATION: $150,000-�
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building PENTAMATION
PERMIT TYPE: 1TIPRE;
WORK TI PREP ON 7TH FLOOR-21,793 S.F.
SCOPE
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Plrwib. Plan£heoZ; 1 lcc. Pian(heck
Afech. Periii t Fee: I'/r<mb. Perrz Fee: ' I;iec. I ccrrtzzi Fee
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i itG`"'Alecp'% /Yf.SYl. 0;rel`PfUnlb Ins,n. ! Other 1 Iec.Insf).
11Iec/z.fnzst). Fee: Phaab. blsp. Fee: � Dec'Ins 1"ee
NOTE.This estimate does not include fees due to other Departments(i.e.Planninj Public Works,Fire,Sanitary Sewer District,School
District,eta). These,fees are based on the prefiWdna information available and aile only an estimate. Contact the Dept for addn'1 ht o.
FEE ITEMS fFee Resolution 11-053 Eff.`7,/L113 FEE QTY/FE]t MISC ITEMS
Plan Check Fee: $0.00 0 #; Tenant Improvement Prep
Suppl.PC Fee: Q) Reg. 0 OT0. hrs $0.00 $417.00 1TIPREP
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee:Q Reg. 0 OT 0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
COMII-Uefiopy Tar: —T
;�.dinit2isttPaltti'a FaL°'
Work Without Permit? 0 Yes (j) No $0.00 j 0
Advanced Plannin Fee: $0.00 Select a Non-Residential
1€t. l Building or Structure
Doeuinenlation Fees:
Strong Motion Fee: IBSEISMICO $42.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $6.00
91
U$T+DTALS: $48.00 $417.00 TOT AL FEE: $465.00
Revised: 10/01/2015