10120153April 13, 2016
City of Cupertino Building Department
10300 Torre Avenue
Cupertino, CA 95014
RE: Permit # 10120153
To Whom It May Concern;
The managing partners of Marketplace located at 19770 Stevens Creek Blvd would like
to cancel the permit for this project, Back in'2012, we had a lease in the works, but it has
since fallen threw. Please consider our request to close this permit.
Sincerely,
Mark Battistini
Project Manager
K CR Development
19620 Stevens Creek Blvd #200
Cupertino, CA 95014
650.776.3226
CITE' OF CUPERTINO BUILDING NG PERMIT
BUILDING ADDRESS: 19770 STEVENS CRK BLVD CONTRACTOR: EVERSHINE GROUP
PERMIT NO: 10120153
OWNER'S NAME: EVERSHINE GROUP 1 19770 STEVENS CREEK BLVD DATE ISSUED: 03/01/2011
OWNER'S PHONE: 4083431088
LICENSED CONTRACTOR'S DECLARATION
License Class Lie.
Contractor
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.
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
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
permit is issued.
APPLICANT CERTIFICATION
I certify that l 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 rela
to building construction, and hereby authorize representatives of this city to cut
upon the above mentioned property for inspection purposes. (We) agree to s e
indemnify and keep harmless the City of Cupertino against liabilities, judents
costs, and expenses which may accrue against said City in consequence f the
granting of this permit. Additionally, the applicant understands and II comply
with all non -point source regulations per the Cupertino Municipal ode, Section
9.18.
Signature
OWNER -BUILDER DECLA PION
I hereby affirm that I am exempt fr/inten:ded
ractor's License Law for one of
the following two reasons:
1, as owner of the property, or my empwages as their sole compensation,
will do the work, and the structure is nor offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (See -7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three ��
declarations:
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
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
permit is issued.
Icertify 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, l
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
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-po' sour a egulations per the Cupertino Municipal Code, Section
9.18. 2
Signature Date
CUPERTINO, CA 95014•
PHONE NO:
BUILDING PERMIT INFO: RLI3G r 1ELEC PLUIa B r
J^.
M ECH r— RESIDENT167M
JOB DESCRIPTION: T.I OF EXIST OFFICE TO DEMISE INTO (3) RETAIL
SPACES (2) NEW DEMISING WALL, WTALL I HVAC,
ADDITIONAL ELECTRICAL MET NEW ADDRESSES E
1I
Q�"p
Sq. Ft Fedor Area: II Valuation: $30000
Numbef. 3696600 f pp / \� I Occupancy Type:
PERM T X FIRES IF WORK IS NOT STARTED
E➢D
WITHIN IN ]180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by•� Date:�?_/_/Y
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505; 25533, and 25534.
Owner aurized agent:
Date 3 1 1
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF C'U]FERTINO BUILDING NG P ERMllT
BUILDING ADDRESS: 19770 STEVENS CRK BLVD
CONTRACTOR: EVERSHINE GROUP PERMIT NO: 10120153
OWNER'S NAME: EVERSHINE GROUP
19770 STEVENS CREEK BLVD DATE ISSUED: 03/01/2011
OWNER'S PHONE: 4083431088
CUPERTINO, CA 95014 PHONE NO:
P_ LICENSED CONTRACTOR'S DECLARATION
r �
BUILDING PERMIT INFO. BLDG ELECT PLUMB
License Class Lic. #
r—FF1ViIlEC1<11[ RESIDENTIAL COMMERCIAL RCI[A L
Contractor Date
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: T.1 OF EXISTING OFFICE TO DEMISE INTO (3) RETAIL
(commencing with Section 7000) of Division 3 of the Business & Professions
SPACES (2) NEW DEMISING WALL, INSTALL I HVAC,
Code and that my license is in full force and effect.
ADDITIONAL ELECTRICAL METER -NEW ADDRESSES HAVE
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
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $30000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 36906009.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN ]1h 0 DAYS OF PERMIT ISSUANCE (DR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM (LAST CALLED ffNSPIEC'If ffON.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Issued by_—�� - Dater/—�i�
Signature Date
OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business &Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three /�
Ila -
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health do Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health .& Safety Code, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
®caner au orized agent: I
3
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non-po' sour a egulations per the Cupertino Municipal Code, Section
9.18.
I understand my plans shall be used as public records.
Signature Date 1 `
Licensed Professional
CITY OF CUPERTINO
TENANT IMPROVEMENT
CUPER,TINO PERMIT APPLICATION FORM
APN Culp d
12120/" - —_— —
Building Address: 1977 t ve ' Creek Blvd,
Mailing Address (if different from building address):
Tenant ❑ (If tenant please provide a letter from the building owner approving the tenant improvement.)
Building Owner
Tenant/Building Owner's Name: Feer seine V1
Phone #: iii 343-1088
Annie Chan
Contractor: BD
Phone #:
Fax #:
Contractor License #:
Cupertino Business License #:
Contact: KCR Developnnent
Phone #: (408) 343-1088 x 7233
Edward Chn
(408) 863-7'333
Fax #:
Alternate Contact: CR Development
Phone #: (408) 34,E-1088 x 8118
Lisa Lim
(408) 863-7333
Fax #:
Valuation (cost of project): $30,000
Job Description (be specific):
Existing is to, demise into 3 retail spaces, () new d rnising walls, install $`t HVAC unit, (I
additional electrical rester.
Tenant Improvement Includes Re -Roof: Yes ❑ NoD9 h yes, number of squares
Tenant Improvement Includes Structural Yes o No
Type of Construction (Usage Class): Occupancy Type: iii
I -A, I -B Q I1/1IIN-A II/lI1 B, IV -HT, V -B ❑
Project Size: Express ❑ Standard 0 Large ❑ Major ❑
Green Building: Please complete Leed for commercial interiors checklist & attach it to the application
or if applicable, include in plans & sheet index
LEED Points Achieved ...,
*** For Office Use Only*** Over The Counter 11 Revised 8/08108
d"Ur MT A-hT" if`ITr TTrb Tr" Trh RT TT'NT?T
NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff 7.i1i10)
\l.11 ll ll \Lyl \1.. U II 1Lll0 ll lll N \U/
FEE ESTIMATOR - BUILDING DffVffSffCN
QTY/FEE
ADDRESS: 99770 stvns crk blvd DATE: 92/29/2090 REVIEWED BY: bob s.
Plan Check Fee:
APN:
DP#: a 1 pZQ��
*VALUATION:
1$30,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
Commercial Building
TOT.1L
PENTAMATIION
1GENCOM
USE:
FLOOR 4RE,a:
PERMIT TYPE:
wORIC
construct new demising walls new hvac unit 100amp electric service.
SCOPE
100 amps Electrical
$42.00 IECT<200 Services
NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff 7.i1i10)
FEE
QTY/FEE
Iyii ISC ITEMS
Plan Check Fee:
$0.00
150 l.f. Interior Partitions
$823.00 IPARTICOMM
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
0 # Mechanical
$126.00 IBCAIRHA Air -Handling (<=10K cfm)
Permit Fee:
$0.00
Suppl. Insp. Feed Reg. 0 OT
0.0
hrs
$0.00
100 amps Electrical
$42.00 IECT<200 Services
PME Unit Fee:
$0.00
PME Permit Fee:
$84.00
Construction Tax
Acoustical Fee: 0 Yes 0 No
$0.00
E)
Work Without Permit? 0 Yes G No
$0.00
Planning Fee:
$0.00
i
Travel Documentation Fee: 1TRAVDOC
$42.00
Strong Motion Fee: IBSEISMICO
$6.30
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$134.30
L $991.00
TOTALF'EE:
$1,125.30
Revised: 12/07/2010
CUE"E EZEINOO
'\
Building Department
City Of Cupertino
10300 Tone Avenue
Cupertino, CA 9501.4-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: E S��,V Creej,, F I K l
PERMIT # 17101
OWNER'S NAME: gvei jhr ^e +!i f P
PHONE #
GENERAL CONTRACTOR: 1 13 P
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to hzve a City of Cupertino business license.
NO BUELIDING FINAL OR FINAL OCCUPANCY RNSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
PRease check applicable subcontractors and complete the ffoflowong nnfformafion:
d
SUBCONTRACTOR
BUSEN ESS NAME
B USMSS ILIIC]ENSIE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
— �,u
Owner / Contractor Signature
(7,1-2a 1aC)
Date
CUPERTONO
OWNER-EUILDER DISCLOS RE FORR�I
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE e CUPERTINO, CA 95014-3255
(408) 777-3228 > FAX (408) 777-3333 > buildina(aDcupertino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS 01gqo S-k-ye,,i APN / �jo
lJ
BPI' 2
C.�
i !1 L,,?
OWNER NAMECv�-s king.,
OWNER ADDRESS S(f/ 1n
DESCRIPTION OF WORK: cs rkin WatLs . V A -L uk,4,z i G GCc^2�S
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. elle
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT ARID VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
-&. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
W-2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
_ib- I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
44.1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
P 0. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer' under state and federal law.
—/A. I understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
'&7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
A8.'I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForn: 2010.doc revised 04/14110
understand I may obtain more information regarding my obligations as an "employer" from the Internal
evenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed
,contractors.
0 710. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
'11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by 'a 1l applicable laws and requirements that govern Owner -Builders as well as employers.
-. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued
to verify the property owner's sin e.
Property Owner's Signature: Date: 1
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner -Builder).
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature:
Date:
OwnerBuilderForm 1010.doc revised 04/14/10
j
Building Department
CITY OF CUPERTINO
10300 TORRE AVENUE o CUPERTINO, '::A 95014-3255
CUPERTINO TELEPHONE: (408) 777-3228 ° FAX: (401.3) 777-7606
I
OFFICIAL NOTIFICATION OF N]EW/A»nR ESS CHANGE
GIE
TO: All Agencies
FROM: City of Cupertino
DATE: February 1, 2011
RE: New/ Change of Address APN #369-06-009
Please note the following address change: IW70 Stevens CCreek Blvd is being divided into
3 units. 19770 Stevens Creek Blvd will remain and 19762 & 19766 Stevens Creek Blvd
have been assigned to the new units. See attached map.
The new addresses will take effect 30 days from the date cif this letter. If you have any
questions, please call me at (408) 777-3246. 1
Sincerely,
Susan Winslow
Administrative Clerk
�----- — —----———— — — — —--
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