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13110185CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20370 TOWN CENTER LN CONTRACTOR: DOYLE CONSTRUCTION PERMIT NO: 13110185 INC OWNER'S NAME: FUND VIII CUPERTINO LLC 48521 WARM SPRINGS BLVD STE 307C DATE ISSUED: 11/27/2013 OWNER'S PHONE: 4089730783 FREMONT, CA 94539 PHONE NO: (510) 687-1771 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class Lic. #_ �—1� 1ST FLOOR COMM.TI DIVIDE EXISTING SUITE EN (2) Contractor boQ E dmg,uL4totV Date It 2'7 SEPERATE SUITES TOTAL OF 2407 SQ FT NEW CONFIGURATION 413 AND 1994 SQ FT I hereby affirm that I am licensed under the provisions of Cha ter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 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 Sq. Ft Floor Area: Valuation: $4800 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 APN Number: 36940059.20370 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHII�I DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY FROM LAST CALLED INSPECTION. 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 Issued by: Date: //,9P-3 with all non -point source regulations r the Cupertino Municipal Code, Section 9.18. _ t t Z RE -ROOFS: Signature Date 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. OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit permit is issued. 4- Date: �7 Owner or authorized agent: I certify 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date �� 27 CUPERTINO 116@04_9411 l�= ','iT `.P'P'!'C,`�,T'C J COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 ^ building(a)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION 9 ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # jO �tCf Q� V O ER NAME / PHONE e�,� I c -- c17 3 07 3 E-MAIL 1 C� �1 STREET ADDRESS r '+ CTCX, TATE, ZIP�) O FAX - ql7 3 - X187 CONTACT NAME P ONE E-MAIL G4 (1_11W .-'21 1_M4vMa EZrr15a STREET DRESSQ CI STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT i CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME - LIC ' E NUMB R LICENS TYPE BUS. LIC # n ©N 57- -OCTto N L COMPANY NAME C& E-MAIL p0 FAX v C - ,a CSttT1a.( STREET DDRESS CI STATE, ZIP PHONE ' t S c it x'31 O -v,) ? C P 4 -AIICHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # J ,vim e ,R-VJF019-9 OMPANY NAME q-Aw . R -C f C: E-T4AJJ. J b GPtQ k1C,. Nt'tGoin.C6C11 FAX `IOQ'- (?IF3- t17 5 STREET ADDRESS C STATE QJ r�` q5w PHONEL `�v �G�� ' 00 d4� _N f- � 3 77 AA DESCRJkTION OF WORK c-$cs> L'lv L Wog U. `UtA 2 WFC t t _ V I�r' EXISTINE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA V6 ) DEMO AREA (C/ TOTAL NET AREA �O �o AilO�l C�CIf.I J BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGEAREA; DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING .APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 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. I have read this application and the information ovided is correct I have r�thescription of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws rel ing to build g construction. I authoentatives of Cupertino to enter the above -identified roperty for inspection purposes. Signature of Applicant/Agent: Date: 1 y� 13 SUPPLEMENTAL INFORMATION REQUIRED" ri i ciIECKTYeE RoaTiNc'sLIP D OVERTHE-COUNTER, .b ❑ BUILDING PLAREVIEW N' _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ` peClTllt for new building. L� EXPRESS .� r � ❑ �PLANNINGPLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ,,CJS sranvaRD ❑. PUBLIC WORKS fonn if any Hazardous Materials are being used as part of this project. ❑ ❑ LARCE�" :>FI>ir DEPT,- Copy of Planning Approval Letter or Meeting with Planning prior to " " "- A4AJOR � �-• ❑. SANITARY"SER'ERDISTRICT submittal of Building Permit application. r �.: ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 JP�TrrmNIT /r'h-" r'1TrTTM7"TMrrr1TrTZ\T?T OCCUPANCY TYPE: TYPE OF 1F1LR AREA PC FEES PC FEE ID IBP ]FEES IBP IFEE ID CONSTR. s.ff. B (Tenant Improvements) II-B,111-B,Iv,v-B $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH, HOURLY 0 Yes O No 14 IL ll ll \LY V W Y 1P� lLi\ ll ll1 V slU FEE ESTIMATOR - BUILDING IDEWSM ELEC, HOURLY ®i es No ADDRESS: 20370 town cwnter lane DATE: 19/27/2013 REVREWED BY: larrya Phunb. Plan Check APN: 1BP#: 13 //0 -7 'dAILUJATiON: 1$4,800 *PERMIT TYPE: Building Permit PILAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building Other Elec. Insp. . PENTAMATION 1 B TI 1 USE: Elec. Insp. Fere: PERMIT TYPE: 1 3 Suppl. Insp. Feer Reg. 0 OT 0,0 hrs WORK divide existin suite into two se erate suites. existin s ft 2407. new confi uration is 413 and 1994 s . SCOPE ft. OCCUPANCY TYPE: TYPE OF 1F1LR AREA PC FEES PC FEE ID IBP ]FEES IBP IFEE ID CONSTR. s.ff. B (Tenant Improvements) II-B,111-B,Iv,v-B $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH, HOURLY 0 Yes O No PLUMB, HOURLY ®Yes (I) No ELEC, HOURLY ®i es No X/Mi. Plan Check Phunb. Plan Check Elec. Plan Check !Ffech. Permit Fee: Plumb. Permil Fee: 1, lec. Permit Fee: Other illech. Insp• Other Plunah Insp.Ell L_ Other Elec. Insp. . RLech. Insp. Fee: Phrmb. lisp. Fce: Elec. Insp. Fere: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, .unitary Sewer District, .school District. etc-). These fees are based an the nreliminary information available and are only an estimate Contact the Dent for addn 11 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/F1EIE M1<SC I[T]EMS Plan Check Fee: Hourly Only? 0 Yes E) No $0.00 3 j hours Plan Check, Hourly $417.00 ISTPLNCx Suppl. PC Fee: Q Reg. ® OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? O Yes Q No $0.00 Suppl. Insp. Feer Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction .Tax: Administrative F'ee: Work Without Permit? O Yes E) No $0.00 Advanced Plannin& Fee: $0.00 Select a Non -Residential Building or Structure (� 4 Travel Documentation Fees: Strom Motion Fee: IBSEISMICO $1.01 F-3-.01 hrs Inspections $417.00 ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.01 $834.00 TOTAL FEE:IF— $836.01 Revised: 10/01/2013