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15070066I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 19429 STEVENS CREEK BLVD OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL OWNER'S PHONE: 4084222121 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # q a 3 / & -3 Contractor %7�s1 z9 1/1 ]/1tY.LC t 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. (hereby affirm under penalty of perjury one of the following two declarations: 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. APPLICANT CERTIFICATION 1 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 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 permi Additionally, the applicant understands and will comply with all non - points rce regulations p the Cupertino Municipal Code, Section 9.18. _ Signature Dates ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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 constrdct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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, 1 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 -point source regulations per the Cupertino Municipal Code, Section 9.18. Date CONTRACTOR:' PERMIT NO: 15070066 IZ2 iv Cri/,�r7�Gi DATE ISSUED: 07/09/2015 Syr f �9/✓Lis�d- lq PHONE NO:.Z/ 1 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL CONSTRUCTION TRAILER FOR DESIGN CONSTRUCTION (504 SQ FT). Sq. Ft Floor Area: I Valuation: $0 APN Number: 31620109.19429 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 1 S FROM LAST CALLED INSPE Issued by at 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. I 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 1 will maintain compliance with the pertino Mun' pal Code, Chapter 9.12 and the Health & Safety Code, Sectio 2 0 1255 and 25534. Owner or authorized agent: Date^ / CONSTRUCTION LENDING AGENCY 1 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional FM--7 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 19429 SCB DATE: 07/0912015 REVIEWED BY: sean MISC ITEMS APN: BP #: "VALUATION: $950 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building Civil / Religious activities in B zone? •, Q ©Yes � No PENTAMATION PERMIT TYPE: 1 GENCO WORK Install construction trailer for Design Construction 504 sq ft). SCOPE $0.00 1! !ill jiiiiii�iiiiiiiiiiiiiiii lii ill NOTE: This estimate does not include fees due to other Departments (il Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt olr ) _ Thoco feoc tyro hncod on the nroliminary information availahle and are only an estimate_ Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 Eff 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? C) Yes Q No $0.00 0 hours $0.00 Plan Check, Hourly Suppl. PC Fee: (F) Reg. () OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 l l'c' L 0 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 0 # Commercial Coach (per unit) $859.00 ICOMMCOCN 0 Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item Bldg g tds Commission Fee: IBCBSC $1.00 s>'j, TAL , $1.50 $859.00 ; TOTAL FEE: $860.50 Revised: 07/02/2015 . .......... CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CUPERT(NO (408) 777 -3228 • FAX (408) 777 -3333 • building g( cuuettno.orq �� Znoo NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT M PRO=r ADDRESS f / _ APN 9 n I OWNER,NvA1� ©/ PHO ` _�[' / E -2 ✓AIL Cpl P(V'lG 1rP ctU�' STREET ADD S / �'/ CITY TATEV,IO �_�/J� FAX CONjA�N{p1¢E 1 PH as 1 A E �N �m �////���� llcr C�►� TT SD`� S'/0�/ �� - a r CITY SE��/I%J (Q _ ') FAX OWNER ❑. OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR// AGENT ❑ ARCHITECT CT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CON� NAMP I/. �` LICENSEI Ul �� LICENSE E 1 BUS. LIC k COMPANY NAb',1UJe n E -MAIL FAX STREET ADDRESS / Jv �n -/� h C12) 'C G CITY, ST ARCHITECTIENGINEFR NJ', LICENSE NUMBER BUS. LIC k COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ( n 2 - EXISTING USE PROPOSED USE CONSTR TYPE k STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA -- BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL F.REA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ ATTACH DR'ELLIIAGUNrI'S: ISASECONDUNIT El SECOND STORY ❑YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE - .APPLICATION FIVES IF YES, PROVIDE COPY OF PLANNING APPL k ❑ No PLANNING APPROVAL LETTER IS THE BLDG AN [I YES EICHLER HOME? ❑ NO , t f (` I J. ` �',?Sy, � } ' " ` '(I } ' fi, TO VALUATION: „,. �,�uji r GYP%' , . Y+i b..✓1 r at'��1i V By my signature below, I certify to ea/ofthe llowing: I am the pro perty veer or authorized agent to act on the property owner's behalf. I have read this application and the information I have s sect I have read ,e scription of \Fork and verify it is accurate. I agree to comply with al I applicable local ordinances and state laws relating to b Tact' I thor' re esentativ s'of Cupertino to enter the above - identified operty fq� inmection purposes. Signature of App] icandAgent Date: SUPPLEMENT RMATION REQUIRED g t r New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building �� �'rYr��{ �1 �I �,� �r� �$('fiM �o R -TPYE e TAR /91i�4uf~dhyt lt7MY. ".1 ��' .� � �9 t� ✓ 1 Y;u Starn�cIL4NRLVTI permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosurel�s vB e;wolt rud �a form if any Hazardous Materials are being used as part of this project. nmmWWnnII��,” Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. .1+iV`II201a B1dgApp_2011.doc revised 06121111