Loading...
B-2016-1676G CITY OF CUPERTINO BUILDING PERM T BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1676 10900 N BLANEY AVE CUPERTINO, CA 95014-0599 (316 03 045) GOWAN CONSTRUCTION COMPANY INC TRACY, CA 95376 OWNER'S NAME: PACIFIC GAS AND ELECTRIC CO ( PACIFIC GAS AND DTE ISSUED: 07/28/2016 ELECTRIC CO) OWNER'S PHONE: 415-470-6916 PE ONE NO: (209) 836-2482 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT O: License Class GENERAL ENGINEERING CONTRACTOR Lic. #62E797 Contractor GOWAN CONSTRUCTION COMPANY INC Date 10/31/2016 X BLDG _ELECT _ PLUMB — I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH — –"RESIEDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: PG&E CUSTOMER SER CE CENTER - T.I. REPLACE (E) TELLER I hereby affirm under penalty of perjury one of the following two declarations: LINE WITH ADA COMPLIANT TELL STATION 756 SQ.FT. ADD 1 (I) 1. 1 have and will maintain a certificate of consent to self -insure for Worker's ELECTRICAL CIRCUIT. Compensation, as provided for by Section 3700 of the Labor Code, for the REV #1 - REMODEL MEN & WOMEN'S RESTROOMS TO BE ADA r ,efformance of the work for which this permit is issued. COMPLIANT - ISSUED 1/10/2017 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; $44660.00 permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 316 03 045 A Tenant Improvements),B (Tenant Improvements) 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. % Harpn17SignatF12 IssuedbY1vWLM S OWNER D ARATI )N Date: 07/28/2016 -BUILD .R 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 first obtaini ig 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) i. 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: 01/10/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COV TSRINGS TO BE CLASS "A" OR BETTER s. 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 ATERIALSDISCLOSURE z. 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 & Saf Ay Code, Sections 25505, 25533, and 25534. I will maintain compliance with he Cupertino Municipal Code, Chapter 9.12 and the permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, sho ld I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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 ivith 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 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized age . } APPLICANT CERTIFICATION Date: 01/10/2017 1 certify that I have read this application and state that the above information is CONS RUCTION LENDING AGENCY I hereby affirm that there i a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 01/10/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING CTA N �j .j�7T. 10300 TORRE AVENUE • CUPERTI O, CA 95014-3255 �••� ISIO1 V (408) 777-3228 - FAX (408) 777-3333 ® building(a) CUPERTINO cupertino.org—�.•••�� -- - - -n, k T--— - -- -- - - - - -.-� :nom114- - -- `Pa OJECT AMPES5 s0 to1 T 1 C951� I APN# r � _• � _+ 1':��0°0 N. BLAvEY AVE,��. 14 ; 316 ,0..3 X45 i •^ l s w., v, � PHoNc 1 C. 1. t '�i �i — 911 1 E-vAII L'+ r.l Q � OWNER NAME p 1.1 _ a.��__� 1G�.� � sect�.ic j ;�4" ..,t, � 6+ 6+t N1;'�PG,,�,. �,.OML i � i STREET ADDRESS % 4 _ Ma V k et } = e et CITY , . STATE, Z - - - _ 'ranc_' Sco, _ 1 FAX - Cl 9410 CONTACT NAME Nida Mehtab PHONE 415. 470 . 6916 E-MAIL NlMV@PGE.com STREETADDRESS 245 E. Market Street CITY, STATE, ZIP FAX .San Frar>_cisco-, CA _9410.5 T, T'1 T, 0,ngvr�Ta'g 1 srP@VNER-B?In,:9.ER 01.raWN1F_.PAF-.'.ENT utLO:I�PI'91?.C•,rr�¢ 21O0N1C"_(,-rORAUENT s i NRURTT = CT 01 I;NL,wFEP. L0 DEVELOPER LD TENANT N 2, aC I .moi R ;v:'xry, r-* C,S _� ✓-* ... _ _, ... ' •T;' ;'d R NI-1NI-1"TI.'.?'I' Y_. F 1 L7L3 YS COMPANY NAME E-MAIL Carl@GowanConst.com FAX 209.835-6618 GOWAN CONSTRUCTION CO. INC. Marc@GowanConst.com STREET ADDRESS 15 W. 8th Street, Suite C CITY, STATE, zIP PHONE2 0 9. 8 3 6. 2 4 82 TRACY, CA 95376 ARCHITECT/ENGINEER NAME LICENSE NUM FIR - BU& LIC # - __ _T. �_- Tr.7 T nom.-_"- -•- --.--".. r CQY_?,ANYNAME E-*tAIL rAX r "'7� Ilr• "fiT- rfi vfi1T?::l i . T�%xa v``'`-,+:: P�1`3e!:e'-r`.ti ss: ri :,Fi �. i ¢'�:: `;•'Iv'�. �� r--7 . �e tI _ 2cs 7610 NESTREET S ATH COURT 45 SUITE 101 � LM SAM TATE, zTr�L 3313 8 � PHONE r`v1 � 305.576.200��y� DESCRIPTION OF WORK C fJ (/IV /+ T7Z_ DIRECT REPLACEMENT OF EXISTING WITH ADA COMPLIANT TELLER ® STATION. ADDITION OF ONE ELECTRICAL CIRCUIT. NO MEC ANTCAL; NO T, 0 PL������ O R SITE WORK ALL�C ���ED T� TT��T ' �'��P� �� WORK. .STRUM^U� i EX S.S.;G_U91. `s r '_rYP l SE OCC. SOFT. 1 VALIjATION (s) EXISTU NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA FORM AREA, DECK ARTA 'rOTM, T)F.CK/PORCH AREA GARAOr. AREA: .. 'DFTACN, __— _-_ _ ], p iiD iLLuiG,I•I 11. s: i a.�.�k �Ti�>�v'l�t,�i�.i�i,,iiT- u 4'✓� � r�}.T�Vii;,su1�: �u'iVu Vi{E�' � ' ' ' I - I PeaY•.--.s ts4rDEW r_1 NO 1 ABF=� ® --- PRE -APPLICATION .l Yi•S -1IF YES, PROVIDE COPY OF Is THE BLDG AN 0YES -i7� �- - '. �iLi AL VALUATION, APDL # []NO - PLANNING APPROVAL LETTER - EICHLER HO -AW? 0 NO I'IT, 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. l h read this application and the information I have provided is correct. I have read the Description of Work and verify it is aecura e_ I agree to comply with all applicable local ordinances and state laws relating to b .+ ing cons ciion. authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: ' 30- t S€13'PLEMENTALINFORMATION? iZ 3 PIANCHECK T E -ROUTINGSLIP j El OVER -THE COU- R BMLD �G pLAX-REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building perniit forneur building: -EXPRESS . 7 A;ix PEA-MRivII 33 _ Commercial Bldgs: TOVld 2. CDmp et8d'IlSZardF3uS Muterkal5- i5£lA;Sllre --S`£A�d57!AR13-- PUBLIC'WoRmi _.form-if-any.11azardous. Materials . axe_being_used-as_part.of this.project_ __Copy of Planning Approval Letter- or. Meeting -with Planning prior.% - IVIAdtIR CI. S ihiilARY SEWER—DISTRICT CT submittal of Building Permit application. EJ EIN'VIRONNMENTALREALTEE Bldg4pp_201 Ldoc-revised06121111- CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1676 10900 N BLANEYAVE CUPERTINO, CA 95014-0599 (316 03 045) GOWAN CONSTRUCTION COMPANY INC TRACY, CA 95376 OWNER'S NAME: PACIFIC GAS AND ELECTRIC CO (PACIFIC GAS AND DATE ISSUED: 07/28/2016 ELECTRIC CO) OWNER'S PHONE: 415-470-6916 PHONE NO: (209) 836-2482 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL ENGINEERING CONTRACTOR Lic. #B91797 Contractor GOWAN CONSTRUCTION COMPANY INC Date 10/31/2016 X BLDG _ ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH — RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: PG&E CUSTOMER SERVICE CENTER - T.I. REPLACE (E) TELLER I hereby affirm under penalty of perjury one of the following two declarations: LINE WITH ADA COMPLIANT TELL STATION 756 SQ.FT. ADD I (I) s. I have and will maintain a certificate of consent to self -insure for Worker's ELECTRICAL CIRCUIT. 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 [C>S ction 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $44660.00 APPLICANT CERTIFICATION 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 and state laws relating to building construction, and hereby authorize 316 03 045 A (Tenant Improvements),B (Tenant Improvements) 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 this permit. may accrue against said City in at nee f the granting all Additionally, the,ap licant underststa nd com "hall non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulats r e - e ' uni ode, ction 9.18. 180 DAYS FRROR -t CTION. Sign re' J Date 07/28/2016 Issued by: MELISSANAME Date: 07/28/2016 OM2T,E[-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is i. 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) 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: 07/28/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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. I 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 3. 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 a 't hazardous air contaminants as defined by the Bay Area Air Qu nag ent istrict I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance itlff ilie Cupe tino M C de ap 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the HuSafety Code,: ctions 2 Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized age APPLICANT CERTIFICATION Date: 07/28/2016 1 certify that I have read this application and state that the above information is NST TION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm at 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 07/28/2016 Professional CUPERTI+NO i i�i�I7�lyhTC.T.A,T,;/iT.L -r .1J CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT < BUILDING DIVISION 10300 TORRE AVENUE • CUf ERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingL&cupertino,arcl• t n.x�r,.x-rannx Ste: - �i ,",.-...: .a +anv+..pa .+.u. y,.,�..v y+ .a nisL. i:::' • irItRY JGC� AQSi3R�5S 15( �' ?�© Bldg4pp,2011,ftoc revi,sed-06121111 N. RLANEY AVE, 9r-51014 APN 316—'03-04 } i -_ B cTwNsa NAME P a.c i f i c Gas i_ e Ct r i D I PH©NE ( 415,) 4 7 0— 6i, 916 I ,E-IIIAI � j N1MVaP,O:E , eom i [STRPETADDREss 2.45 E. Market Street CITY. STATE. ZIPI PAX —� Scan Francisco, CA 94105 CONTACT NAME Nida Mehtab PHONE 415.470.6916 P -MAIL N1MV@PGE.com STRLiETADDRT?SS 245 ZMarket Street CITY,STATE,ZIP PAX _San Fraruciaco, CA _991.05 `'❑?WI:101 E'.f sUiNNE3t$'L7IClJER u •OWNTERAC'EMf ❑ •C-,ONTRACTOP N,uDX1{rRAcToXAcIpvT ❑ A'p.S:fWrBCT ❑ ENG'INEEP IJ A: ❑TENANT All?VE(ioP$a BfX,i:,:-TTOM INA _� w 1 !L:tCL•'�I�E:�TLrT9T91iTs rb,fl�.'"� L1 .T?Tw.SP,�I'i,'P1s F� 's'� c 33U�_tiiCti COMPANY NAME GOWAN CONSTRUCTION CO. INC. P3MAlL Carl@GOwanConat. com .' Marc@GowanConst.com FAX 209.835. 661.8 STRFBTADDitESS 15 W. $th Street, Suite C CITY, STATE, ZIP PHONE209. 836. 2482 TRACY, CA 95376 AttRCIRT/EECT/ENGINEERNAME - LICENS113�RJMBFR Inns. LIC # - '� 7"GOL'3 TAN t1i.R, 'i R -D' ...*, .. C i � r r 9s G �f��R.k J w - COMPANY NAME E-Molm FAX a ....T�SAO DESTON GROUP R JHAQ0PI:AN9T,SACfDESI ON _ QCW1 3&5-.576.2005, STRP.ET ADDREss 7610 NE 4TH COURT *5 SUITE 101 CTTY, STATE, ZIP MIAMI, FL 33138 PHONE 305,576.2006X15 --DES( RIPTION`Or,W0 K n DIRECT REPLACEMENT OF EXISTING TELLER LINE WITH ADA COMPLIANT TELLER STATION. ADDTTION OF ONEELECTRICAL CIRCUIT. NO MECHANICAL, NO STRUCTURAL NO PLUMBING OR SITE 'FORK INCLUDED IN THIS SOO_PE OF WORSE. � R'si;Tt'iV „'G4if38 FTtOOr�39t;T3'I:r3E C3;+w-m. wy""Z: USE TYPE OCC. SQ.PT. VALUATION ($} EXISTG ARRA NER'FLUUR AREA DETvfU AREA TOTAL NET AREA - BATHROOMICrrCHEN OTHI?R - REMODEL AREA REMODEL AREA REMODEL AREA I PORCH ARRA - DECTC ARRA TOTALDECKIPORCH ARRA GARAC.TR ARP.A: Q:DrtT,ACId, - - ragF ' IFiAEVELL11,4GIN,rrs:. 191ASECEi"sIom.T ❑5IE5 ST3CGND--M'Gr`,i ❑YE.S- RP'2.'G1I'IFMI? ONO, I'RI:APPLICATfON :Q YE.T iPYES,PROVIDE COPY OIi i6 THE BLDG All ;❑YESMBY:TAI. VALUATION: PLANNINGAI'PLW ONO PLANNING APPROVALLPTTL>12 -EiCDL1;R.ItO�1tL+? .❑NO _ J1J- t `jc> By my signature below, I certify to each of the following: I am the properly owner or authorized agent to act on the broperty owner's behalf. I have read tris application and the inforination I havQprovided 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 bn' Ing cans actiion. Iauthorize representatives of Cupertino to enter the above-identiftedproperty for inspection put poses, Signature ofApplicantlAgent: Date- . R C2 SUPPLEMENTAL INFORMATION RC.QlfMED e?;4N cxEctt TYPE. . riolrrr 3G sI tP. p avEtt- x couN €I >z' BUILDINC. rLarza> vil W _ New SFD or Multifamily dwellings: Apply for de.; ition permit for existing building(s). Demolition permit is required prior to issuance of building ._ permit• fornew building; E mssC7 rt oTiviNs PiA.REVIEW w - Commercial -Bldgs: "i-ovida-a completed Hazardous Materials-Di'selosure :0 sTANDARD " Cl -PUBLIC Woxxs _.formi£any.Hazardou&M itea_ials.a.te being used as.pamef.this project, LARGE E i}EPT .Copy -of Planning Approval Letter. nr Meeting with Planning prior to ElnL4SOli Q SANITARY SRV&.R DISTRICT* submittal of Building Permit application. FNVIROI^4 NTALDEALTIr - - Bldg4pp,2011,ftoc revi,sed-06121111 UNREASONABLE HARDSHIP EXEMPTION FORM 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 - building(cDcupertlno.or (For Tenant Improvements where the Cost of Construction does not exceed $139.934.00) SITE ADDRESS 10900 N. BLANEY AVE, 95014 APN BP# B-2016-1676 CITY Cupertino current standards? ZIP 95014 TOTAL CONSTRUCTION COST A $ 44,.660 ............. 1. Path of travel to accessible entrance. DIRECT REPLACEMENT OF EXISTING TELLER LINE WITH ADA COMPLIANT TELLER STATION. ADDITION OF ONE DESCRIPTION OF WORK: $ 30,000- 0,000-2. 2.Cost of providing a primary entrance. (Including but ELECTRICAL CIRCUIT. NO MECHANICAL, NO STRUCTURAL, NO PLUMBING OR SITE WORK INCLUDED IN THIS SCOPE OF WORK. The following is a list of costs to provide access features in order to comply 100% with the current State Title -24 Disable Access Standards. (All costs to be documented by actual bids or other information accented by the Building Official.) Accessible Features Complies with If not, list required upgrades in order for Cost to make feature current standards? features to fully comply? fully accessible? 1. Path of travel to accessible entrance. NO $ 30,000- 0,000-2. 2.Cost of providing a primary entrance. (Including but not limited to, thresholds, landings, door hardware, Yes $ max. door pull, etc. 3. Cost of providing the primary path of travel to the specific area of alteration, structural repair, or Yes $ addition. 4. Cost of providing accessible restroom facilities. NO Demo I toilet in mens restroom. $ 10,081 Demo existing partitions and 5. Cost of providing an accessible drinking fountain. (If N/A install new. Repair ceramic tile on $ required or if a drinking fountain is provided.) walls. Lower HC toilet in Womens 6. Cost of providing accessible public telephones (if Yes Restroom. $ provided) 7. Cost of providing other accessible features, including Yes $ but not limited to, parking, storage, alarms etc. TOTAL COST OF ACCESS FEATURES (B): $ 40,081 Has the same tenant performed work in the ° 92.0 ° same tenant space within the last three years? NO Calculate (B / A) x 100 /o /o Description of access features to be provided: I TOTAL COST OF 1 $ 10, 081 I PERCENTAGE (20% minimum 22 PROPOSED UPGRADEexpenditure is required) ARCHITECT OR ENGINEER OF RECORD INFORMATION: I certify that the above noted information is true and correct. Name (print): Jason Hagopian Signature: J Date: 01/10/17 Firm address: 7610 N.E.4th Court Ste 101 Title: Principal Phone:305.576.2006 --------------------------------------------------------------------------- FOR DEPARTMENT USE ONLY --------------------------------------------------------------------------- ❑ The above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 11346.2.1. ❑ The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR -Title 24 (Regulation for the Accommodation of the Disabled) pursuant to 2010 CBC Section 1134B.2.1. COMMENTS: e °ii j d ilii tI 1) e lea Ir'h line Iin't Building Official Designee (print): Si t Date: ilii „ -�-���-�u� �u:�'��-�. IIevOe ed ByC ��..°'SII""' t,pQ ""') Dee lets HardshipE'xemptionForm_2012.doc revised l0/17/13 Date. 01110117 COMMUNITY DEVELOPMENT DEPARTMENT « BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE CUP'ERTINO, CA 95014-3256 (408) 777-3228 • FAX (408) 777-3333 . buiildin cu ertinp.csr For Tenant Improvements where the Cast of Construction dues not exceed $139,934.00 SITE ADDRESS APN BP## 10900 N. BLANEY AVE, 9.5014 CITY Cupertino zip 95014 TOTAL CONSTRUCTION COST A x&4.,.66 DESCRIPTION OF WORK: DIRECT REPLACEMENT OF EXISTING TELLER LINE WITH ADA COMPLIANT TELLER STATION. ADDITION OF ONE - — — ELECTE2ICAL CIRCUIT. NO MECHANICAL, NO STRUCTURAL, NO PLUMBING OR SITE WORK INCLLUDED IN THIS SCOPE OF WORK. The following is a list of costs to provide access features in order to comply 100% with the current State Title -24 Disable Access Standards.(All costs to be documented by actual bids or other information accented by the Bui'ldino Official_y Accessible Features Complies with It not, list required upgrades in order for I Cost to make feature current standards? features to fully comply? fully accessible? 1. IPath of travel to accessible entrance. No Add new sidewalk and painted pa th travel driveway, includ $9,500.00 $dome of across 2. Cost of providing a primary entrance. (IncluT'ung but Yes q not limited to, thresholds, landings, door hardware, $ max. door pull, etc. 3. Cost of providing the primary path of travel to the No See item #1 above specific area of alteration, structural repair, or $ addition. 4. Cost of providing accessible restroom facilities. No Mens room requires removal and$ $250.00 replacement of fixtures. Womens 5. Cost of providing an accessible drinking fountawn. (If N/A can to t1lipLuved wtth do" --J correction $ required or if a drinking fountain is provided.) B. Cost of providing accessible public telephones (if No Customer service phone to be $100.00 provided) relocated $ 7. Cost of providing other accessible features„ including N/A but not limited to, parking, storage, alarms etc. $ TOTAL COST OF ACCESS FEATURES (B): $ $9,850.00 Has the same tenant performed work in the No same tenant space within the last three years? Description of access features to be provided: Calculate (131 A) x 100% DIRECT REPLACEMENT OF EXISTING TELLER LINE WITH ADA COMPLIANT 'TELLER STATION & new b -level ADA compliant writing station. TOTAL COST OF 1 $9,850.00 OSED UPGRADE PERCENTAGE (20% minimum 22 expenditure is required) noted in „ ARCHITECT OR ENGINEER OF RECORD INFORMATION: I certify that he ab ve.. f mation is t�'b and correct. Name (print) Signature: Date: . ,,3 ), 74 Firm address: 7, 11 4016+ !:k75' Title: LA - phone: .1-0,45 � M AIM F. .... .........I"-4 _-,------._--) __--- ----- .----- FOR DEPARTMENT USE ONLY .__ _______-_ _•__-___._-__-_____. -.-_ _ ❑ The above named project has been denied an unreasonable hardship exemptions under 2010 CBC Section 11348.2.1. ❑ The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR -Title 24 (Regulation for the Accommodation of the Disabled) pursuant to 2010 CBC Section 1134B,2.1. Building Official Designee (print)= �I E.. .....Sie ,. Date: Revue ed l yw ) l'IL01g L " / les l'Tan-d"sliipE.YerraptiaarFnrta�r_ 012.(toe i-ev s'ed 10/17113 )3°Qc, P n71�,:::'7116