13120171CITY OF CU PIEIR')cINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 13120171
20803 STEVENS CREEK BLVD CUPERTINO CA 95014 (326 32 042)
OWNER'S NAME: ( SAICH WAY STATION LLC)
DATE ISSUED: 07/22/2014
OWNER'S PHONE: 5592712167
PHONE NO: 4084180099
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Classic. # Z 3 2-
Contractor Date 2 2 2 l
— BLDG — ELECT — PLUMB
MECH RESIDENTIAL— COMMERCIAL
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.
JOB DESCRIPTION:
SAICH WAY STATION -BLDG I -NEW SHELL CONSTRUCTION
I hereby affirm under penalty of perjury one of the following two declarations:
(6,982 S.F.)
t. 1 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
12/3/14 - REV # 3 - UPDATE PLUMBING,
of the work for which this permit is issued.
ARCHITECTURAL, CIVIL & LANDSCAPING - ISSUED 2/23/2016
performance
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
REV # 2 - RELOCATE WATER METERS, DIVIDE ONE SUITE
this permit is issued.
IN TO TWO & REVISE M.E.P LAYOUTS FOR CHANGE IN
APPLICANT CERTIFICATION
LEASING REQUIREMENTS - ISSUED 12/3/14
1 certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
REV # I - ADD /CHANGE DOOR HARDWARE, RE -WORK CANOPY
ordinances and state laws relating to building construction, and hereby
LIGHTING & ADD (2) ROOFTOP HVAC UNITS.
authorize representatives of this city to enter upon the above mentioned
REVISE/RELOCATE WATER METER, GREASE INTERCEPTORS &
property for inspection purposes. (We) agree to save indemnity and keep
STORM DRAINS -ISSUED 10/13/14
harmless the City of Cupertino against liabilities, judgments, costs, and
Sq. Ft Floor Area:
Valuation: $450000.00
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
APN Number:
Occupancy Type-
Code, Section 9.18.
32632042
Signature Date 2/23/2016
PERMIT EXPIRES IF WORK IS NOT STARTED
OWNER-BUI DER DE TION
WITHIN 180 OAFS OF ]PERMIT ISSUANCE OR
I hereby affirm that 1 am exempt from the Contractor's License Law for one of the
fly® DAYS IFIR ®I�][ LAST CALLED INSPECTION.
following two reasons:
t. 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the stricture is not intended or offered
Issued by' PAUL O'SULLIVAN
$W4D��
for sale (Sec.7044, Business & Professions Code)
Date: 2 2 12016
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
RE- ROOFS:
I hereby affirm under penalty of perjury one of the following three declarations:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. I have and will maintain a Certificate of Consent to self- insure for Worker's
installed without first obtaining an inspection, 1 agree to remove all new materials for
Compensation, as provided for by Section 3700 of the Labor Code, for the
inspection,
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance, as provided for
Signature of Applicant
by Section 3700 of the Labor Code, for the performance of the work for which
Date: 2/23/2016
this permit is issued.
3. I certify that in the performance of the work for which this pen-nit is issued, I
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of Califomia. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
HAZARDOUS MATERIALS DISCLOSURE
Labor Code, I must forthwith comply with such provisions or this permit shall
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
be deemed revoked.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
APPLICANT CERTIFICATION
Health & Safety Code, Section 25532(a) should 1 store or handle hazardous
I certify that I have read this application and state that the above information is
material. Additionally, should I use equipment or devices which emit hazardous
correct. I agree to comply with all city and county ordinances and state laws
air contaminants as defined by the Bay Area Air Quality Management District I
relating to building construction, and hereby authorize representatives of this city
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
to enter upon the above mentioned property for inspection purposes. (We) agree
the Health &Safety Code, Sectio s 25505, 25533, and 25534.
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Owner or authorized agent:
consequence of the granting of this permit. Additionally, the applicant
Date: 2/23/2016
understands and will comply with all non -point source regulations per the
CONSTRUCTION L DIN AGENCY
Cupertino Municipal Code, Section 9.18.
1 hereby affirm that there is a constructiojlendinA agency for the performance
of work's for which this permit is issued ( S._ 97, Civ C.)
Lender's Flame
Signature Date 212312.016
Lender's Address
Im
CITE' OF CU PERTINO BUILDING PERMIT
BUILDING ADDRESS: 20803 STEVENS CREEK BLVD
CONTRACTOR: SILICON X
PERMIT NO: 13120171
CONSTRUCTION INC
OWNER'S NAME: SAICH WAY STATION LLC
2051 JUNCTION AVE
DATE ISSUED: 07/22/2014
OWNER'S PHONE: 5592712167
SAN JOSE, CA 95131
PHONE NO: (408) 418 -0099
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
SAICH WAY STATION-BLDG ]-NEW SHELL
License Class VD Lic. # C932 9 Z
CONSTRUCTION
Contractor �'� c Date i Z — 3—%,4
`�—
(6,982 S.1'.)
t _ I
REV # 2 - RELOCATE WATER METERS, IDIVIIDE ONE
hereby affirm that 1 am licensed under the provisions of Chapter 9
SUITE IN TO TWO & REVISE M.E.P LAYOUTS FOR
(commencing with Section 7000) of Division 3 of the Business & Professions
CHANGE IN LEASING REQUIREMENTS - ISSUED 12/3/14
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: $450000
performance of the work for which this permit is issued.
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: 32632042.00
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 1S NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 18® DAYS IT �������� ®�
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 DA 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
granting of this permit. Additionally, the applicant understands and will comply
ate:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
9 °q 3
RE- ROOFS:
Signature Date l 4.
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:
1 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, 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. I will
1 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 1 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 agen . Date: i
permit is issued.
1 certify that in the performance of the work for which this permit is issued, T 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 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 (See. 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
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
CITY OF CUP]EllBTINO ]BUILDING PERMIT
BUILDING ADDRESS: 20803 STEVENS CREEK BLVD
CONTRACTOR: SILICON X
PERMIT NO: 13120171
CONSTRUCTION INC
OWNER'S NAME: SA1CH WAY STATION LLC
2051 JUNCTION AVE
DATE ISSUED: 07/22/2014
OWNER'S PHONE: 5592712167
SAN'JOSE, CA 95131
PHONE NO: (408) 418 -0099
nut LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
P_
License Class Lic. # (?3 Z c
SAICH WAY STATION -BLDG ]-NEW SHELL
CONSTRUCTION (6,952 S.F.)
Contractor �i 'C V\ 't CD"b- prUGi'16ate (e
REV # 1 - BLDG 2 - RE -WORK CANOPY LIGHTING, MAKE
PLAN ADJUSTMENTS & PROVIDE FRAMING & CURB
I hereby affirm that I am licensed under the provisions of Chapter 9
DETAILS. RELOCATE /REVISE WATER METERS, STORM
(commencing with Section 7000) of Division 3 of the Business & Professions
DRAINS & GREASE INTERCEPTORS - ISSUED 10/13/14
Code and that my license is in full force and effect.
1 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: $450000
performance of the work for which this permit is issued.
1 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: 32632042.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES P][][gES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WIT MN 15� ��� �T ISSUANCE ®�
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
18 ALLIED 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
/
by: Date: *3 // W_
granting of this permit. Additionally, the a licant understands and will comply
ed l
with all non - points urce r 1 ns p e Cupertino Municipal Code, Section
ROOFS:
4.18.
W,7 1RE-
1 3
Signature Date "
All roofs shall be inspected prior to any rooting material being installed. if a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
❑ OWNER - BUILDER DECLARATION
Signature of Applicant: Date:
hereby affirm that [ 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, 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).
1 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(x) 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
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio 1 550 5 , a 5534.
Section 3700 of the Labor Code, for the performance of the work for which this
�
/ 1 /�
permit is issued.
Owner or authorized agent / / Date:
I certify that in the performance of the work for which this permit is issued, 1 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. 1 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
CI'T'Y OF CUP ERTINO BUffLDING lP]ERMffT
BUILDING ADDRESS: 20803 STEVENS CREEK BLVD
CONTRACTOR: SILICON X
PERMIT NO: 13120171
CONSTRUCTION INC
OWNER'S NAME: DIANE TAYLOR TRUSTEE
2051 JUNCTION AVE
DATE ISSUED: 07/22/2014
OWNER'S PHONE: 5592712167
SAN JOSE, CA 95131
PHONE NO: (408) 418 -0099
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL L] COMMERCIAL
l
SAICH WAY STATION -BLDG 1 -NEW SHELL
License Class_ Lic. # 9 3 -�
CONSTRUCTION
Contractor���e�N?C�lo-e.� s;ti°- �-"�,- .Mate � — 1'3` I�
(6,982 S.F.)
I hereby affirm that l 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: $450000
of the work for which this permit is issued.
_Iperformance
'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: 32632042.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
D
PERMIT ]EXPIRES IF WORK IS NOT STARTED
correct. 1 agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS— ��IT 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
18® DA ]LIED INS P]ECTIO
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
ss Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
23 (
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, 1 agree to remove all new materials for
inspection.
❑ OWNER - BUILDER DECLARATION
Signature of Applicant: Date:
1 hereby affirm that 1 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, 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 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
1 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 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I 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
Date:
permit is issued.
Owner or authorized agent: /
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
CONSTRUCT 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
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 time
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
1�r
12 COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION �E
10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255
CCQ,DPER TINO (408) 777 -3228 ^ FAX (408) 777 -3333 o buildingAcugertino.org
X❑ NEW CONSTRUCTION El ADDITION ❑ALTERATION /Tl ❑ REVISION/DEFERRED ORIGINALPERMIT#
PRodECTADDRES.S 20803 Stevens Creek Blvd.
APNI! 326 -32 -042
OWNERNAMIE Diana Taylor
PHONE (559) 271 -2167
E -MIAIL dmm.taylor93722 @yahoo.com
STREET ADDRESS 5539 W. Buff Ave.
CITY, STATE, zIF Fresno, CA 93722
FAX
covrncr NAME Tony Gonzalez, SiliconX Construction
PHONE (408) 418 -0099 E -MAIL tony @siliconxconstruction.com
STREET ADDRESS 2051 Junction Ave., Suite 100
crmsTATE, zip San Jose, CA 95131
PAX (408) 453 -5636
13 OWNER ❑ O\l a'NER•BUILDER II OWNERAGENT 0 CONTRACTOR ❑CONITACTOR AGENT ❑ ARcurrEcr ❑ ENGINEER Q DEVELOPER ❑ TENANT
CONTRACTORNAMn Tony Gonzalez LICENSENUMIBER
LICBNSETYPE
BUS. LICb
COMSPANYNANIE Sil[conX Construction
121-MAIL tony @sillconxconstruction.com
FAX (408) 453 -5636
sTREETADDRESS 2051 Junction Ave., Suite 100
CITY,STATE,2IP San Jose, CA 95131
P11oNE (408) 418 -0099
ARCHrrECT/ENG(N'EERNAME Cedric Craig
LICENSENUdIBER C -15490
BUS. L1Cb
COMIPANYNAMIE FCGA architecture
E -MtAIL ric @fcgainc.com
FAX (925) 820 -5858
''.. STREET ADDRESS 301 Bartz Ave., Suite 213
crrY,STATE,zIP Danville, CA 94526
rsoNE (925) 820 -7585
x103
''.. DISCRIPTIONOFWORK Building 1 - New shell construction, 1 -story Type V -B, and related site improvements.
EXISTING USE
PROPOSEDUSE CONSTP
TYPE
11 STORIES
Retail
V -B
1
1
USE
TYPE
OCC.
SQ.FT.
1'ALUATION(S)
EXISTO
AREA
NEW FLOOR
AREA x,982 S.F.
D&MO
AREA
TOTAL
NET AIREA 6,982 S.F.
Retail
V -B
Shell
6,982
$450,000
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODELAREA
I
REMIODELAREA
PORCHAREA
DECK AREA
TOTAL DECKlPORCIIAREA
OAKAGEAREA: DETACH
I
ATTACH
I
#DWELLINGUMTS:
ISA SECOND MIT ❑YES
SECONDSTORY OYES
BEING ADDED? QNO
ADDITION? []NO
PRE-APPLICATION' [M YES IF YES, PROVIDE COPY OF
IS THE BLDC ANN ❑ YES''
, ALUATION:
PIANNINGAPFLI []NO PLANNRGAPPROVALLETTER
EICHLERHOME? no
$450,000
By my signature below, I certify to each of the follo{ving: 1 am the property o{NiIer or authorized agent to act ,&P0591 perty oµiler's behalf. 1 have read this
application and the information I have provided is correct. I]lave read the Description of Work and verity it is accurate- I agree to comply With all applicable local
ordinances and state laws reI t�ing-to b i1 ng onstruction. I orize representatives of Qlpertino to enter the above - identified for inspection purposes.
]property
SignahueofApplicanUAg�- Date:
SUPPLEME ALINF01WXr kEQU1RED
pLA \Ci1tCK2]'PE
. ROUT[NCS[IP.:.'
❑ 0{ERTtlCOUNThR
❑ BUILD ? \GFLA \KEl1E {{
New SFD or Multifamily dwellings: Apply rordentolition permit for
existing building(s). Demolition permit is required prior to issuance Of building
S._ %:..;:. ,:
.- -:
penuit for new building•
-. , : ,,._: • : ;;w: :; .. ,
C1 E1PItES§r' '
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,PLin�tncPLAniIE {IE{{
— Conunercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ :STAavARI) y
PUBLIC {l ORKS
form if any Hazardous Materials are being Used as part of this project.
p LattcE
❑PIRLnEPT
_ Copy ofPlanning Approval Letter or Meeting with Planning prior to
�IAJPR
❑ sAi;2T AR{ SE { {EIiDI$TRiCT
submittal of Building Pemtit application.
....::.: .:..".. " :....;: .:::..:
-.. ❑- :EN\7RON�rE \TAY:IIEALTII• ._:.
BldgApp_2011.doc revised 06/21/11
MY OF CU? EllB'ICENO
RTT.;_:1M IFIEIE ]ES'ICRMA'I OR - BUR LICDIIl` G DIVIISRON
-
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FIEF IdD BP FEES BP FEE IdD
CONSTR. s.f.
Shell Bldgs II- B,III- B,IV,V -B 6,982 $9 . 0 10SPLNCK $7,128.40 1OSINSP
TOTALS: 6,982 4", -7� $7,128.40
,;•: 'Cl; r �cdi ?1:1. I ti;; ?:.,lira; {.. F1N' ", 1''ti ? %: C..�r't::Ci•;
flf�ria, P'e;; -tnlP 3� "ee: P!trr�L'. ;rt: ?•t7th h'e�'•: E >'ec;. l'tc ?;arit 1 ° {�,.�:
?dtc:% :lta�r.>'t. irz;;�. � (.),A; >, lart,. =,•�h Irrrr�, (.)i;atr 1�:ia.., lr. <sl.;.
/ °<'�'.' rPi17..(7 ?�L'. ."�¢C: rC'E ;. it7 +,7. t'L:4:
t . t l'rrr. 1. Ps''
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the orelitninary infortnation available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 E(f' 711113)
ADDRESS: 20803 STEVENS CREEK BLVD
DATE: 0212712014
REVIEWEdD BY: MELISSA
Plan Check Fee:
APN: 326 32 042
BP #: 13120171
*VALUATION:
$450,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRd1MARY
USE: Commercial Building
Civil / Religious activities
� No
inBQ zone? 0 Yes o
PENTAMATION
PERMIT TYPE: 1SHELLBLDG
WORK
B SHELL BLDG 6 982 S.F.
SCOPE
0.0
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FIEF IdD BP FEES BP FEE IdD
CONSTR. s.f.
Shell Bldgs II- B,III- B,IV,V -B 6,982 $9 . 0 10SPLNCK $7,128.40 1OSINSP
TOTALS: 6,982 4", -7� $7,128.40
,;•: 'Cl; r �cdi ?1:1. I ti;; ?:.,lira; {.. F1N' ", 1''ti ? %: C..�r't::Ci•;
flf�ria, P'e;; -tnlP 3� "ee: P!trr�L'. ;rt: ?•t7th h'e�'•: E >'ec;. l'tc ?;arit 1 ° {�,.�:
?dtc:% :lta�r.>'t. irz;;�. � (.),A; >, lart,. =,•�h Irrrr�, (.)i;atr 1�:ia.., lr. <sl.;.
/ °<'�'.' rPi17..(7 ?�L'. ."�¢C: rC'E ;. it7 +,7. t'L:4:
t . t l'rrr. 1. Ps''
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the orelitninary infortnation available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 E(f' 711113)
FEE
QTYIFEE
1MISC ITEMS
Plan Check Fee:
Select a Misc Bldg /Structure
or Element of a Building
Suppl. PC Fee: (E) Reg. () OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$7,128.40
Suppl. Insp. Feet) Reg. () OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1 BCONSTAXC
$19,759.06
Fee:
0
Work Without Pen-nit? Yes (D No
$0.00
Advanced Planning Fee. 1PLLONGC
$1,954.96
Select a Non - Residential E)
Building or Structure 0
d
/ y
.T ;'c7Pe'l . /Jr.)(iPi�f(;iit(P7 tfJn .1'£'¢'.S:
Strong Motion Fee: 1BSEISMICO
$94.50
Select an Administrative Item
,3g /12 %.
Bldg Stds Commission Fee: 1BCBSC
SUBT®TA]C S:
4$18.00
$0.00
TOT AL FEE: ,
3(&,z %,S� Revised: 01/15/2014
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255 B\ \1�1
C�tlJ1(�fEPlif9f l® (408) 777 -3228 o FAX (408) 777 -3333 a buildino(dcugertino.orq
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑x REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECTADDRIss 20803 Stevens Creek Blvd.
APN# 326 -32 -042 13120171
OWNER NAME Diana Taylor
PHONE. (559) 271 -2167
E -MAIL dmm.taylor93722 @yahoo.com
STREET ADDRESS 5539 W. Bluff Ave.
CITY, STATE,zIP Fresno, CA 93722
FAX
CONTACT NAME Tony Gonzalez, SiliconX Construction
PHONE (408) 418 -0099
E-MArLtony@siliconxconstruction.com
STREET ADDRESS 2051 Junction Ave., Suite 100
CITY, STATE, ZIP San Jose, CA 95131
FAX (408) 453 -5636
❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRAC[ORNAME Tony Gonzalez
LICENSE NUMBER
LICENSE TYPE
BUS. LIC9
COMPANY NAME SiliconX Construction
E -MAIL tony @siliconxconstruction.com
FAX (408) 453 -5636
STREET ADDRESS 2051 Junction Ave., Suite 100
CITY,STATE,ZIP San Jose, CA 95131
PHONE (408) 418 -0099
ARCHITECT/ENGINEERNAME Cedri c Craig
LICENSENUMBER C -15490
BUS. LIC4
COMPANYNAME FCGA architecture
E -MAIL ric @fcgainc.com
FAX (925) 820 -5858
STREETADDRESs 301 Hartz Ave., Suite 213
CITY,STATE,ZIP Danville, CA 94526
PHONE (925) 820 -7585
x103
DESCRIPTION OF W': 1D ► �p ® r�,, a
7?� JAOT,^Q_`1JAi1� � —') y
D... (y✓,{�AI'`�T�yMy�I
,�IV�3s0�
qM
AB
,
�0-f -i �.t � o .,..� ._ -
•.— ,,.w 1 i
a.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
#STORIES
Retail, Restaurant
V -B
1
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA 6,962 S.F.
DEMO
AREA
TOTAL
NET AREA 6,982 S.F.
Retail
V -B
Shell
6,982
$0.0
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: LIDETACH
[]ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑YES
SECONDSTORV ❑YF.S
BEING ADDED? []NO
ADDITION? NO
PRE - APPLICATION ®YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY:- -
TOTAL VALUATION:
PLANNING APPL# []NO PLANNING APPROVAL LETTER
EICHLERHOME? ONO
$0.0
By my signature below, I certify to each of the following: I am the property owner or authorized 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 din c t c 1 au a representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: Date: /
SUPPLEME F D
PLAN CHECK TYPE
,
ROUTING SLIP '
❑ OVER COUNTER
BUILDINGPLANREVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
-THE-
permit for new building.
❑ EXPRESS ` "'
LJ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PnsucwoRKS `
form if any Hazardous Materials are being used as part of this project.
El LARGE
❑FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
El MAaoR..
El sANITARYSEWER'DISTRICT
submittal of Building Permit application.
l
El ENVIRONMENTAL HEALTH
BldgApp_201 I.doc revised 06121111
(CET Y ®IF (C1t P EIS' ENO
k ,
FEE IESTRMATOR — BIH LDIIN` G BMSEON
.. AD DRESS: 20803 STEVENS CREEK BLVD
!DATE: 0812912094
REVIEWED BY: MELISSA
MISC DIEMS
APN: 326 32 042
BP #: 13120171
*VALUATION: Iso
*PERMIT TYPE: Building Permit
PILAN CHECIK TYPE: Alteration /Addition/ Repair
PRDM ARY Commercial Building
USE:
I
PENTAMATION
I PERMIT TYPE:
W®RIK
8/29/14 - REV # 1 - ADD /CHANGE DOOR HARDWARE RE -WORK CANOPY LIGHTING & ADD 2
SCOPE
ROOFTOP HVAC UNITS RCo a e9 6 C4sk, W vhgAg
�rj_
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 addn't into.
!FEE ITEMS (Fee Resolution 11 -053 E . 711113)
r9e0 ;r. /'Ictn t'hsaJ-
frrr7tr). 1'Irz;r (:'6az`c °6r
MISC DIEMS
1/e h. N.rr,nit Fee,
1 ?urr;h. Perr.it f <c .
1, s,
$0.00
Select a Misc Bldg /Structure
or Element of a Building
C)frrc' ?' £Vi;'1'h, Al$p,
(lli'r';^ f'f'rrri -ilJ 1',v,:. t�j:?.
(ll.+':i: t' Elec. 17;a'r
El L_
.1 reclt. Imi). 1'E`d:
Nw:,h, hl,,jo.
PME Plan Check:
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 addn't into.
!FEE ITEMS (Fee Resolution 11 -053 E . 711113)
!FEE
QTY/FEE
MISC DIEMS
Plan Check Fee:
$0.00
Select a Misc Bldg /Structure
or Element of a Building
Suppl. PC Fee: E) Reg. 0 OT
0.0
Lhrs_
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee :(D Reg.
OT 0 0 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
�
_lo,ministratil "c Fee:
0
E)
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
Q
d
F�t)C:L£iDlE:19rC.dtZf1T� I''£'�'.S:
Strong Motion Fee:
$0.00
1 #
$859.00
Revisions
IREVCOMTI Tenant Improvement
Bldg Stds Commission Fee:
$0.00
SUII$TOTALS:
$0.00
$859.00
' PT4 ]FIEIE. $859.00
CON' STRUCT11ON pEf° M111T APPLL11CQTIION1
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 o building(cDcupertino.org
[:1 NEW CONSTRUCTION [_1 ADDITION El ALTERATION / TI 0 REVISION / DEFERRED ORIGINAL PERMIT # �' � _(V I ��
PROJECTADDRESS 20803 Stevens Creek Blvd.
APNN 326 -32 -042 13120171
OWNERNAME Diana Taylor
PHONE (559) 271 -2167 7E-MA]Ldmm.taylor93722@yahoo.com
STREET ADDRESS 5539 W. Bluff Ave.
CITY, STATE, zip Fresno, CA 93722
FAX
CONTACT NAME Tony Gonzalez, SiliconX Construction
PHONE (408) 418 -0099
E -MAIL tony @siliconxconstruction.com
STREETADDREss 2051 Junction Ave., Suite 100
crrY,STATE, ZIP San Jose, CA 95131
FAx (408) 453 -5636
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Tony Gonzalez
LICENSENUMBER
LICENSE TYPE
BUS. LICK
COMPANY NAME SiliconX Construction
E -MAIL tony @siliconxconstruction.com
FAX (408) 453 -5636
STREET ADDRESS 2051 Junction Ave., Suite 100
CITY, STATE, ZIP San Jose, CA 95131
PHONE (408) 418 -0099
ARCHrrECT/ENGINEERNAME Cedric Craig
LICENSENUMBER C -15490
BUS. LIC4
COMPANYNAME FCGA architecture
E -MAIL ric @fcgainc.com
FAX (925) 820 -5858
STREET ADDRESS 301 Hartz Ave., Suite 213
CITY, STATE, zip Danville, CA 94526
PHONE (925) 820 -7585
x103
DESCRIPTION OF WORK Revise water meter, BFP's for domestic and fire, PIV, and FDC locations. Revise landscaping to reflect these revisions.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
Retail, Restaurant
V -B
1
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA 8,982 S,F,
DEMO
AREA
TOTAL
NErAREA 6,982 S.F.
Retail
V -B
Shell
6,982
$0.0
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
❑ AT
N DWELLING UNITS:
IS A SECOND UNIT [YES
SECOND STORY ❑YES
BEING ADDED? [NO
ADDITION? -NO
PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
„R
- '
TOTAL VALUATION:
PLANMNGAPPL# ❑NO PLANNING APPROVAL LETTER
EICHLERHOME? []NO
�r`
$0.0
By my signature below, I certify to each of the following: I am the property owner or authorized o he 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 It is accurate. I agree to comply with all applicable local
�oenter
ordinances and state laws relating to bu' onstrucI I authorize representatives of Cupertino the above - identified property for inspection purposes.
Signature ofApplicant/Age Date: _X/ q0Z
SUPPLEMENTAL INFORMATION REQUIRED
w ''PLAN CHECK TYPE
ROUTINGSLIP ,
❑ OVER-THE-COUNTER
❑ BiJILDINC PLAIN REVIEW,
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
a
permit for new building.
❑ EXPRESS
❑' PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
I ❑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 -� � -� °-
❑ �
submittal of Building Permit application.
�
SANITARY SEWER DISTRICT,�.
,.i
i ❑. ENVIRONMENTAL HEALTH ,
BldgApp_201 1. doc revised 06 /21/11
cCl[T Y OF cCUP EIE TI NO
Ft %r
FEE IESTE MIATOR — BUILDING ING DIVISION
�..
L
ADDRESS: 20803 STEVENS CREEK BLVD
DATE: 10/15/2014
REVIEWED BY: MELISSA
�4
APN: 326 32 042
BAP #: 13120171
*VALUATION: Iso
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
'rotiuh. hip. rec,.
PENTAMATION
PERMIT TYPE: d
WORK
10/15/14 - REV # 2 -RELOCATE WATER METERS DIVIDE ONE SUITE INTO TWO & REVISE
SCOPE
M.E.P LAYOUTS FOR CHANGE IN LEASING REQUIREMENTS
L
FEE
Otool, Plon C, :01711
L:(ec'. flan C'hc>ck
rrit 1'2 %r +��t /ire:
111umh. Pcrrmi/ Pei'
ia�r.. A��rrnif (ee'
$0.00
Otlrrf /'h�mb hTS;r
Oiher Elec_ hup.
'rotiuh. hip. rec,.
Isles. insp, 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 Preliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Eff 7/1.%13)
FEE
QTY/FEE
I01[ISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
IF I
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-.E) Reg. Q OT 0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
"cho", 0ox:
Ll
0
Work Without Permit? C) Yes D No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
0
d
Strong Motion Fee:
$0.00
1 #
$859.00
Revisions
1REVCOMNEW Commercial New
Bldg Stds Commission Fee:
$0.00
SUBTOTALS: 1
$0.001
$859.00
TOTAL FEE: 1 $859.00
Revised: 0812012014
CONSTRUCTM PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255
(408) 777 -3228 ^ FAX (408) 777 -3333 ^ building(a7cupertino.org
r
r
I I MPW rnT1cTR1IrTInN F-1 er)T)T-rinN 1 I A1.TF.RATION / Ti I xI REVISION I DEFERRED ORIGINAL PERMIT # '\
PROJECTADDRESS 20803 Ste ens Creek Blvd.
APN# 326 -32 -042 13120171 4'
a
� o `40 0®u
OWNER NAME Diana Taylor
PHONE 1559) 271 -2167
E -MAIL dmm.taylor93722 @yanro.corn
STREET ADDRESS 5539 W, Bluff Ave.
CITY, STATE,zIP Fresno, CA 93722
FAX
CONTACT NAME Tony Gonzalez, SlliconX ConStrU' -tb i
PHONE (408) 418- 099
E -MAIL tflny @siliconxconstrui;tiCn.com
STREET ADDRESS 2051 Junction Ave., Suite 100
CITY, STATE, ZIP San Jose, CA 95131
FAX (408) 453 -5636
❑ OWNER ❑ OWNER - BUILDER ❑ OWNERAGENT la CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Tony Gonzalez
LICENSE NUMBER
LICENSE TYPE
BUS. LIC4
COMPANY NAME JclliconX Construction
E -MAIL tonj /`s�,jiliconxconstruction.com
FAX (408) 4553 -5636
STREETADDRESs 2051 Junction Ave., SUite 100
CITY,STATE,ZIP San Jose, CA 95131
PHONE (408) 418 -0099
ARCHITECT/FNGINEERNAME Cedric Craig
LICENSE NUMBER C -15490
BUS. LIC#
COMPANYNAME FCGA arch iteeture
E -MAIL rlc@fcgainc.corn
FAX {925)820 -585E3
STREET ADDRESS 301 Hartz Ave., Suite 213
CrrY, STATE, ZIP Danville, CA 94525
PHONE (925) 82C -75£35
x103
DESCRIPTION OF WORK Architectural, Civil, Landscape, Electrical & Plumbing site plan drawings updated to
show proposed concretelpavers walkway layout along Saich Way. Sheets C8 & C81 updated to
reflect previous approved revisions. PIT
EXISTINGUSE
PROPOSED ISE CONSTR.
TYPE
# STORIES
1
USE
TYPE
OCC.
SQ.FI'.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORar ARE
GARAGE AREA: DETACH
❑ ATTACH
I
#DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY []YES
BEINGADDED? []NO
ADDITION? []NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
TOTAL VALUATION:
PLANNING AP, # ❑NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
$(W
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided i correct. I have read the Description of Work and verify it is accurate. agree o comply with all applicable local
ordinances and state laws relati bull ing c struc ' n. I authorize representatives of Cupertino to enter the above i ntine pro for inspection purposes.
Signature of Applicant/Agent: Date: Q
SUPPLEMENTAL ON REQUIRED Q
� PLAN CHECK T E
' ROUTING SLIP
❑ OVER - THE COUNTER ' .
❑ BUH D1NG PLAN REVIEW
_ New SFD or Multifamily dwefor demolition permi t for
Uings:Appl
existing building(s). Demolition ped prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
_❑ PUBLIC WORKS
To—nn if any Hazardous Materials are being used as part of this project.
p LARGE'
El FIRE' DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANTIARY SEWER DISTRICT '
submittal of Building Permit application.
❑ ENVIRONiKENTALI- IEALTH
B1dgApp_2011.doc revised 06121111
CITY OF cCNIFIEllR'I<'>INO
E� � ''' 777 1F' q 7ifMATn11R'- 1RUMINN DIIVIISII®N
iy;.z=yf?P'ri e.11'V"
C).' %i1'. !,hfr�Lb 1", ,
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sever District, School
7)ictrirt_ otr_ )_ Thoco foot aro bawd nn tho nroliminary infarmatinn availahlo and nro nnlv an intimato_ Cnntart the nont far addn'l info-
F
EE ITEMS (Fee Resolution 11 -053 Eff. 7111131
ADDRESS: 20803 STEVENS CREEK BLVD
DATE: 12/03/2014
REVIEWED BY: MELISSA
Plan Check Fee:
APN: 326 32 042
BP #: 13120171
*VALUATION:
Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
$0.00
PENTAMATION
PIERMIT TYPE:
WORK
12/3/14 - REV # 3 - UPDATE PLUMBING ARCHITECTURAL CIVIL & LANDSCAPING
SCOPE
O,Q
iy;.z=yf?P'ri e.11'V"
C).' %i1'. !,hfr�Lb 1", ,
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sever District, School
7)ictrirt_ otr_ )_ Thoco foot aro bawd nn tho nroliminary infarmatinn availahlo and nro nnlv an intimato_ Cnntart the nont far addn'l info-
F
EE ITEMS (Fee Resolution 11 -053 Eff. 7111131
FEE
QTY/FEE
M[ISC ITEMS
Plan Check Fee:
$0.00
Select a Mise Bldg /Structure
or Element of a Building
Suppl. PC Fee: (D Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feeia Reg. OT
O,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
E)
Work Without Pen-nit? 0 Yes C) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential 0
Building or Structure 0
d
i
�f "'c�l'¢'l. i !l('t4iPL;Pit�ildrel7.l`¢?¢'S';
Strong Motion Fee:
$0.00
1
# Revisions
Commercial New
Bldg Stds Commission Fee:
$0.001
$859.00
1REVC0MNEw
S>rJI�I
$OAO
$859.00
,.
$859.00
Revised: 10/01/2014
)t
•
CUPERTINO
l
�v2t1�Q ?
TEMPORARY CERTIFICATE OF OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 - buildinq(a)cupertino.orq
Til
APN
- O1}
-7
BP #:
-0&01 7 %
DATES
S r� /S'-"
OCC
LOAD
PROJECT
I VALUATION:
COMMENT
V13
SITE
ADDRESS: c 2 V 8 0 3 STt
/
❑ APPROVED
OWNER'S NAME:
A,j
PHONE #:
IFAX #:
woof
MAILING ADDRESS (if different Mfrom site address):
S
�/� iN �-7/� /� /— V s �r
CONTRACTO
5,(71 TY� uc v7�- -�
PHONE #: S
FAX #: a� ,�7 9 _ `} 3 �° 3
CONTACT: .
PHONE #:
FAX #: O
J • 3 �.- 3
TFMPnRARY CERTIFICATE OF OCCUPANCY INFORMATION
BOND TYPE: ❑ SURETY BOND AMOUNT (1 % VALUATION S Q BLDBONDS CODE
KCHECK ❑ CASH BOND OF BOND: 5K min -10K max $ O O ] EDITION:
TCO EXPIRATION
FEE: $2$6.00/8'10 TOTAL FEE: $ � �. - - [1TEMPOCC]
DATE (6 MONTHS MAX): �� %i�/C 2--viS
USE
TYPE OF
CONSTR
FLOOR
AREA
OCC
LOAD
LEVEL
COMMENT
V13
ire
Signature: ........ ..:....`...�� .................
S
Date: s........
❑ APPROVED
APPROVED WITH CONDITIONS'
u is o s
�
❑APPROVED
PPROVED WITH CONDITIONS`
Signature:........
........... Date:...� ..!.5..
Other:
❑ APPROVED
APPROVED WITH CONDITIONS'
Signature: .........................................................
Date:......................
nTWGR rIPPARTI PNT 4r.FNCY APPROVALS:
I`
Planning ; -
''
❑APPROVED
APPROVED WITH CONDITIONS'
� ..............
Si natur � ..............
ire
Signature: ........ ..:....`...�� .................
S
Date: s........
❑ APPROVED
APPROVED WITH CONDITIONS'
u is o s
�
❑APPROVED
PPROVED WITH CONDITIONS`
Signature:........
........... Date:...� ..!.5..
Other:
❑ APPROVED
APPROVED WITH CONDITIONS'
Signature: .........................................................
Date:......................
*CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property
stating the list of items required to be completed for each individual Department before final occupancy
can be granted. Include approximate completion dates for each item.
The underspned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or
buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration
C specifi¢d. hi e porary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non - compliance
may result iA an en rc ment action.
owner i VVIIIIPVIVI Y
Sianature : ... ....... .... .. ........................... Date:. ..... ..� �.. Signature:....... .....
. <_.:.,........... .................... Date:..�....�.. /.�
This tempora e ifica assures that all fire protection and life safety systems have bekaeompleted, inspected, successfully tested and
approved for the specif a e building specified above to `provide a reasonable degree of safety to the occupants from fire and
similar emer e _
.... ... . Buildin O Prin... ? /. 0..... ....... .................. Date:..... .�. ......
DEPART.WNT A T r determination, copies to: 1) applicant, 2) permit file
TempOccForm_2011doc revised 717114