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Home My WebLink AboutB-2016-1167CITY OF CUPERTINO. BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1167 19459 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112) L B COMMERCIAL CONSTRUCTION INC SUNNYVALE, CA 94085 OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC DATE ISSUED: 05/13/2016 OWNER'S PHONE: PHONE NO: (408) 844-8299 i ICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GLAZING Lic. #B Contractor L B COMMERCIAL CONSTRUCTION INC Date 10/31/2016 X BLDG _ELECT _PLUMB MECH RESIDENTIAL X 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: T.I. for 85 degree bakery (2,484 S.F.); Main Street I hereby affirm under penalty of perjury one of the following two declarations: 2. 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 performance of the work for which this permit is issued. ll 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 Sq. Ft Floor Area: Valuation: $350000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 316 20 112 316 A (Tenant Improvements),B (Tenant Improvements) 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, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 05/13/2016 Issued by: SEAN HATCH Date: 05/13/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wages as their sole installed without fust obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 05/13/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25_1%4, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 05/13/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDI G AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 05/13/2016 Professional 10 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 CWPERTINt] (408) 777-3228 • FAX (408) 777-3333 • building okupertino.org ❑NEwCON5'IRCICTION ❑ ADDITION (ZALTERATION/TI ❑ REVISION/DEFERRED 9-2016--116'�- 01UGINAL PERMIT d PROJECT.ADDRES5 -TFiAs LVp. �i-rte 0 APN tf O\VNERNAhlE PHONE�� J E-rrtAH. STREET ADDRESS CITY, STATF, ZIP FAX CONTACT xanfE o D STREETADDRESS r CITY, STATE, ZIP F.4X ❑ OWNER ❑ owmmnrimm ❑ OWNERAOENr ❑ CONTRACTOR ❑ CONTRAMI)RAOFNT ,ICi ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS, LIC4 COMPANY NAME- E-MAIL FAX STREET ADDRESS errY, STATE, ZIP PHONE AR 1 TECflEN ME _ LICCNSE NUMDER BUS. LIC 9 � 1 O COMPANY NAtvIN Go 17'5 G2�vVF' E-AfAIL 0 6 •' ., La FAX - 5' 9TNEEf ADDRESS �7 ��W Q CITY, STATE, ZlP fl cm ��o:S PHONE (>;3 DESCRIPTION OF WORK IWtL-VFM1W-f Or CSE. lWg4l, Ir' taa-=s 0rW tn)ALt s Gt;ILWE irk 1�+15f1r:S N-0 ge-s' ww5' ,�Y- — NV EXISTING USE PROPOS®USE CONSTR TYPE I STORIES +' - W V fl, . A USE TYPE OCC. SQ.F1'. VALUATION (S) EXISTO AREA NENPLOOR AREA n 6 nZ 4MCBEN4 DMO AREA TOTAL NEr ARE1 //LZ b q.y (,��/ .t V Kc:" 1 v -E{ l� �7 /.9 Y G 6`1- V(/U BATHROOM OTl1ER REMODEL AREA REMODELAREA REMODEL AREA PORCHAREA DECXAREA TOTALDEMPORCHAMA GARAGEARPA UDETAM ❑ ATTACH I C N DWELLING UNITS: ISASECOTDUNITLJ YES SECOND STORY []YES DEINOADDED7 []NO ADDI77ON7 ❑NO P�LANNINOAPPL# ®NO PLgNNINU APPROVAL LRiTER YES EICHLF.RHOAIE7 QNO EDH - - M.. -z: - -.=; TOTAL VALUATION: By my sigmdure below, I certify to each of the following: I ant the property owner ar authorized agent c act on the prop wnees behalf. I have read this escription of work and verify it is accurate. I agree to comply with all applicable local application and the information I have provided is correct, ha+ED ordinances and state larvs relating to bui consh otion. I aesentatives of Cupertino to enter (lie abovo-identified ropeny for inspection purposes. Signature ofApplieant/Agent: Date:SUPPLEM ALWFORMA NRLNew p R II oonNTRtY RurrDH.Grt�LL� rtt l� et\ SFD or Multifamily dwellings: Appl fordemlit for existingbuilding(s). Demolition pennitisrequired priortoissuance ofbuddmg permit for now building, pi: FxPREss <r{I Av`IEy i i vXRe\E\v Co1llmercial Bldgs: Provide a completed Hazardous Materials Disclosure sfA1YAAItD, r -g�sJd �YpjtKS - form if any Hazardous Materials are being used as pact of this project. FntLtngP�r ... _ Cu ofPlanning - Copy g Approve] Tetter or Meeting wEth Plarwng phot to _=_ _:e_'-_ , € ;____ -_; _____;: �; twtaoR . _ — - ..._. . ..., .... ,;:_.._-- =:- - e-=__-_ __•_c Ll-g,�tt,�t(Xer�\t�RRISFRrCr submittal of Building Permit application. . _ ::=-=_ENVIRONAIENrAGHEAG3II _ _ : RldgApp 2011.doc revised 06121/11 9,.10-)s CITY OF CUPERTINO WWII FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: - ADDRESS: 19459 Stevens Creek Blvd DATE: 01/12/2016 REVIEWED BY: Phuong PC FEE ID APN: 316 20 112 BP#: *VALUATION: $350,000 *PERMIT TYPE: Building Permit PLANCHECKTYPE: Tenant Improvement PRIMARY Commercial Building USE: $2,965.68 PENTAMATION 1BTI PERMIT TYPE: WORK Ti for 85 degree baker - Main Street SCOPE 0,0 OCCUPANCY TYPE: - TYPE OF CONSTR. FLR AREA s.£) PCFEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-A,111-A,V-A 2,622 $2,917.96 IB'17PLNCK $2,965.68 IBTIINSP Eaac. ,'rasp. j ee: $2,965.68 Suppl. Insp. Feer Reg. 0 OT 0,0 I firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (: `onstruc cow Tar: ,Wininisiraiiw, Fee: 0 Work Without Permit? ® Yes (F) No $0.00 TOTALS: 2,622 1 $2,917.961-1- Tae�e(Z>n<�rr�retar9r7necs: $2,965.68 Strong -Motion Fee; I BSEISMICO MECH, HOURLY, Yes' No PLUM$, HOURLY ®Y.osQ No El LI;C,HOT7RLY° _ Yes ,.Ns I fe•ch. Plan Check Plc xh. Pima C#e, P, lice. J'iay: t tro-c;: !iferh. Perm[! hze: lh,wh. Parmit 1,ee: tifec. Natani[ (3zher Afe,h, h,». Ochzr Plwnh Ircp_ 01her E;t,z. artstzET hfeclr. Jrrsp. ren-: PAamb. fns{z fee: Eaac. ,'rasp. j ee: NOTE: This estimate (toes 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 only an estimate. Contact the Dept for addn't info. FEE ITEMS (Fee Resolgtion II:O 3 1:7/!/13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,917.96 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,965.68 Suppl. Insp. Feer Reg. 0 OT 0,0 I firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (: `onstruc cow Tar: ,Wininisiraiiw, Fee: 0 Work Without Permit? ® Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 A Tae�e(Z>n<�rr�retar9r7necs: Strong -Motion Fee; I BSEISMICO $98.00 Select an Administrative Item Bldg Stds Commission Fee: UCBSC $14.00 SUBTOTALS:;1 $5,995.64 $0.001 TOTAL FEE:.' $5,995.64 Revised: 10/01/2015 Building Department Ci Of Cupertino 10300 Torre Avenue Cupertino, C 95014-3255 Telephone:408-777-3228 C U P RT i N p pax: 08-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS:, 7 ERIIT # •: E r (((� SUBCONTRACTOR OWNER'S NAME:),j PH NE #l - BUSINESS LICIENSE GENERAL CONTRACT R: 60415 � a BU INESS LICENSE # ADDRESS: 30 lkW EXJV o CA.' CITVZIPCODE: Ll *Our municipal code requires all businessk working in the city to have a City of Cupertino business 1 NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTTON(S) NVILL BE SCHEDULED GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF BUSYNESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: TETE 0 ) J,4 I - Or ner / ntracto Sig tore TO/TO 39"Vd Date " O tT:9T 9TOZ/TT/LO SUBCONTRACTOR BUSYNESS NAME BUSINESS LICIENSE # Cabinets & Millwork Cement Pinishing n,`j Electrical - J Excavation �TR Fencing Flooring / Carpeting '� G . Linoleum / 'Wood .y Glass / Glazing 'Heating ! q 2- g Insulation Landscaping �( Lathing /A Masonry Painting / Wallpaper Le/M aeci 2 G' 3 Paving r r i v Plastering Plumbing kjtj(� Roofing Z. Septic Tank h Sheet Metal hj Sheet Rock VL "Tile 0 ) J,4 I - Or ner / ntracto Sig tore TO/TO 39"Vd Date " O tT:9T 9TOZ/TT/LO