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B-2016-1363CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1363 19459 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 1 2) BOAZ RENOVATIONS INC SAN JOSE, CA 95117 OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATO LLC DATE ISSUED: 05/12/2016 OWNER'S PHONE: 408-777-3081 PHONE NO: (408) 279-0300 LICENCFD CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ELECTRICAL Lic. #943011 X BLDG PLUMB Contractor BOAZ RENOVATIONS INC Date 03/31/2017 _ELECT _ 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 Co a and that my license is in full force and effect. JOB DESCRIPTION: CREATE 2 (1) UNISEX RESTROOMS FOR PUBLIC USE (132 sq ft). I hereby affirm under penalty of perjury one of the following two eclarations: t. I have and will maintain a certificate of consent to self-ins a for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the rformance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by 60 Section 3700 of the Labor Code, for the performance of th work for which this Sq. Ft Floor Area: Valuation: $10000.00 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 lordinances 316 20 112 A (Tenant Improvements),M (Tenant Improvements) and state laws relating to building construction, and hereby aut orize representatives of this city to enter upon the above mentioned roperty 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 sai .Gi a uence of the granting of y g ty-in-`°� g g this permit. p WITHIN 180 DAYS OF PERMIT ISSUANCE OR ,,,d Additionally, the pplicant understands nd will comply with all source regulafpns per the ertino Muriicipal Code, Section on-point .18. 180 DAYS FROM LED INSPECTION. Signature _= d —� Date05/12/2016.1, Iss Y.MEL Date: 05/12/2016 { I I he eby affirm that I am exempt from the Contractor's LicenseI aw for one of the RE-ROO>nc All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: t. I, as owner of the property, or my employees with wages as their sole installed without first 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) z. I, as owner of the property, am exclusively contracting wit licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 05/12/2016 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-in sure 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. I have and will maintain Worker's Compensation Insurance, as provided for by Ihave 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. s. I certify that in the performance of the work for which thispermit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I us�quiprneLlt or devices which emit hazardous shall not employ any person in any manner so as to beco i laws California. If, a subject to the this certificate of air contaminants as defined,by'(Ci Bay Area Ai naW Management District I Chapter 9.12 Worker's Compensation of after in g will maintain compliance , ith the Cupertino Municipal'Code, and exemption, I become subject to the Worker's Compensatic n provisions of the the Health &afetyCode, Sections 25505, 2553.3, nd 25534. Labor Code, I must forthwith comply with such provisionsor this permit shall be deemed revoked. Owner or authorized igen APPLICANT CERTIFICATION Date: 05/12/2016 I certify that I have read this application and state that the above information is CONSTRCTION I MGAGEN I hereby affirm that there is a construction len cy for the performance correct. I agree to comply with all city and county ordinances a d state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize represer{tatives of this city to enter upon the above mentioned property for inspection purroses. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino ag inst liabilities, judgments, costs, and expenses which may accrue against sai City in Lender's Address consequence of the granting of this permit. Additionally, the ap licant understands and will comply with all non-point source regulations per the C pertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 05 12/20 1B professional --Q NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE * CUPERTINO, GA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buiiding0cupertino.gAr a--Zo Q ADDITION [B/ALTERATION/Ti F itt2visioN / i)m FRRFn n1trt;tWA1 PP11n, IT H 0. ,a] PROJECT ADDRESS " ejs' C- -�"L- V R S V ac -( 0 nPN 0 1 i OwNBIiNAiviB�.,1W. Ii.Lw ,n �� t'�rJ` A4I9A,1t- PIIaNl;,y�p �y --y •� �, g� i `4 0U "' (� ! " :WCJ 1 L'.MAiL �,,) � �j ILS Ir0kGR -564o' cow, STREET ADDRESS 1 D •. CITY, STAGIP 'uPTE e2T� C> nk �' E FAX NAMii 17�TAD,�DD^''R�pESS PtiONB E•MA1G1 PCONJACT r� ?-5*1 ktr, 17i 1�.kwoo_ .5f)t'ie 'Z C I'Y, STATP GIP � G"g'01NER FAX ❑ OWNER-DERLDER 0 OWNERAGENT ® CONTRACTOR 000NTRACrORAGENT ARCHITECT Ci ENGINFEP ❑ DBVBLOPiiR EI TENANT CONTRACTOR NAME LICENSE NUMBER L[CBNSBTYPE HUS. LIC# COMPANY NAME E-MAIL PAX STREET ADDRESS CITY, STATE, ZIP PRONE ARCHI' CTIENGENEER NAMlf M%,Coach [LICENSE NUMBER. � G B i �lv BUS. LIC # COMMPPANYNAME 7fijG. SAWGI E- 11. ( �Et �x �F t t' 6044. PAX STREI1' AD RBSSq CITY, STATE,—LA yt� ��, PHONE p y J( JV i`�' V�YSt..rlii,Ji�I�1' aZ1 3r�ZCl�•.�`f DESCRIPTION OP WORK EXISTINouse PROPOSCAUSL' CONS7ti.'l'YPE #S'iORIES qk-V-Vfi�It.. ' , USI; i'YPB OCG. SQ:fT. VALUATION (S) 18i:T 11MSTO NEWFLOOR DEMO TOTAL AREAARBA AREA � � NET ARE i5_1 ^/\ ('�`i' ,..r 1 / v ` 5i t BATHROOM KrrCt3EN QTIfIIR IMMODELAREA ! REMODELAREA REMODBLARBA � PORCH AREA DECK AREA TOTAL DECKWORCII AREA GARAGE AREA: DETACH - ATTACII # D4YELLING UNrrS: ISA SECOND UNif- SECONf3 STORY YES TIEING ADDED? []NO ADDITION? NU IS'1HE BLDG AN V- 705 L ALUA�TIOO1� EICHLER;ROME? l/ [�1 PRE -APPLICATION © YES. IP YES. PROVIDE COPY OF PLANNING APDL IR ❑ NO PLANNING APPROVAL LETTER BY my signature below, I certify to each of the f Ing: I an the property owmer or MR iorized agent to act on the properly owner's behalf. I have read this application and the information I provR s n'ect. I h e read (lie Description of Work and verily it is accurate. I agree to comply with all applicable local ordinances and state laws rel ' g to btlildin o i etion. ' authorize representatives of Cupertino to enter the above�epti i property for inspection purposes. Signature of Applicant/Age t: Date: W� ll SUPPi..FML ATION REQUIRED PLAN CuECK,rx ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER 11 BUILDING PLNN existing building(s). Demolition permit is required prior to issuance of building permit for new building, ❑ rxPREss ❑ PLANN1NG PLAN nvFr%v _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ .STANDARD ❑ PuRme wOlI KS form if any 1-lllzardous Materials are being used as part of this project. p 1ARGE ❑ Fl".1i'IarT Copy of Planning Approval.I,etter or Mooting with Planning prior to p MAJOR SANITARY 9ElYIIR AaST141CT submittal of Building Permit application. ❑ ENVIRONMENTAL FiG+ALTII Bldg tj)p__,201I.docrevised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - RITTIDING DMRION OCCUPANCY TYPE: ADDRESS: 19469 STEVENS CREEK BLVD BATE: 02116/2016 REVIEWED BY: MELISSA, PC FEE ID APN: 316 20 112 BP#: B-2016-1362 "VALUATION: j$10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IAHIPLNCK PENTAMATION 1M TI PERMIT TYPE: WORK CREATE 2 N UNISEX RESTROOMS FOR PUBLIC USE SCOPE Suppl. Itisp. Fee:(Reg. 0 OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (S -f.) PC FEES PC FEE ID BP FEES BP FEE ID M (Tenant Improvements) I1-B,111-B,IVN-B 51 $2,878.00 IAHIPLNCK $575.00 IA41'lINSP 1 :e,. ;r.5_?t, $575.00 Suppl. Itisp. Fee:(Reg. 0 OT Q.O hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (..Yt1FR'atrurtion d lit: � t #72Zi7ii`Y7'Ct1''fl E.' 1--ee: 0 G) Work Without Permit? 0 Yes) No $0.00 TOTALS: 51 $2,878.00 D'ati£'11.)ft€'u#7tefZkctEiCAia $575.00 Strong Motion Fee: 1 BSEIISMICO MEC%IU�JRLY g -✓ .x il', 4 D I7RLY Q:' Yes : Q� ' ELEC HOITRLY`) des !Nor: MISC ITEMS Plan Check Fee: $2,878.00 �. ,pewn YtE e.- E-111-11 l'Ir2mb, f'4; orf j'e't'; ��af1 t JI-feeh. [n,, 3' [Jfijr..'r Phffn1; Awp . =Fl--7,mv, - Mkixli. hap..1'ee: P11,1116rasp? 1;�'C: 1 :e,. ;r.5_?t, IVUIL. 3IUS estimate does not 111ejulle fees elite to other Deliartaxerrts (i.e. Plarwing, Public Warks, Fire, Sartitaty Setter District, School District.etc). Thine, foov ara havi'd a" flip m•n]irniam•u iso fnr:aanrima n nirnhln irrad mn nes/v n ncfiaaentn ('n■efnn{ Aon Il.,:,f fn. mld:. �1 :..f FEE ITEMS (Fee Resolution 11-053 E . 711113,) FEE QTYIFEE MISC ITEMS Plan Check Fee: $2,878.00 Select a Misc B1dglStiucture or Element of a Building Suppl. PC Fee: (2} Reg. 0 OT 0.0 his $0.00 PME Plan Check: $0.00 Permit Fee: $575.00 Suppl. Itisp. Fee:(Reg. 0 OT Q.O hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (..Yt1FR'atrurtion d lit: � t #72Zi7ii`Y7'Ct1''fl E.' 1--ee: 0 G) Work Without Permit? 0 Yes) No $0.00 Advanced Planning Fee: $0,00 Select a Non -Residential G Building or Structure C) D'ati£'11.)ft€'u#7tefZkctEiCAia Strong Motion Fee: 1 BSEIISMICO $2.80 Select an Administrative item. Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTAIySf $3,456.$0 $0.00-7TOTAL I+EE ......$3,456.80 Revised: 01101/2016