B-2017-0917MA
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0917
10145 N DE ANZA BLVD CUPERTINO, CA 95014-2262 (326 34 043)
DAVID A SANTANA
MODESTO, CA 95355
OWNER'S NAME: CUPERTINO 10145 LLC
DATE ISSUED: 07/24/2017
OWNER'S PHONE: 650-949-0960
PHONE NO: (650) 444-4300
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-12 Lic. #Z29$2$
Contractor DAVID A SANTANA Date 08/31/2018
X BLDG _ELECT _PLUMB
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 Code and that my
license is in full force and effect.
JOB DESCRIPTION:
MARINA MARKET - T.I.; ADA COMPLIANCE UPGRADE
I hereby affirm under penalty of perjury one of the following two declarations:
a. 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.
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: $18000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to complywith all city and county ordinances
326 34 043
326
A (Tenant Improvements)
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)ee to save indemnify and keep harmless the
City of Cupertino against ' ilities, 'udg ` ents, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against sai i 'n enoe of the granting of this permit.
WITHIN 18O DAYS OF PERMIT ISSUANCE OR
Additionally, the appli' n er �1 and will comply with all non -point
source regulations` rf0 cipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature ! Date 07/24/2017
Issued by: Kim Dunbar
'
Date:, 07/24/2017
,'-B D R DECLARATION
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:
a: T, as owneiof the pro`perty,• or my employees with wages as their sole
installed without first obtaining, an inspection, I agree to remove all new materials for
compensatio' , ill 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 with licensed
Signature of Applicant:
contractors to construct the project (See.7044, Business & Professions Code).
Date: 07/24/2017
I hereby afSrm,under penalty of perjury Ione of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
i. I have and will'mainWn, 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 695 of the
Section 3900 of the Labor Code, performance of the work for which this
California Health & Safe Code, Sections 25505, 25533, and 25534: I will
Safety
permjt i§ issued.
ermcertifythat
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
ed. performance of the work for which this permit is issued I
a. I
Health & Safety Code, Section 25532(a) should I sto or handle h rdous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or des wh' mit azardouI
� ,
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area 63i1f gely nt District I
will maintain compliance with the Cupertin ' ci e,� apter 9.12 and
exemption, Iibecome'subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sec. ' "�55 3 fid 25534.
Labor Code,, must fo_ rthwith comply with -such provisions or this permit shall
be deemed•revoked.
Owner or authorized agent: t
APPLICANT CERTIFICATION
Date: 07/24/2017
I certify that I have read this application and state that the above information is
CON TON TYNI
correct. I agree to comply wit all city and county ordinances and state laws
I hereby affirm that 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,wl ich may accrue against said City in
Lender's Address
consequence of the grantingof 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 07/24/2017
professional
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SON APICATiONSRPERMIT
is COMMUNITY DEVELOPMENT DEPAP.TMENT - BUILDING DIVISION
i�
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228, FAX (408) 777-3333 a buildinc(,cuoertino.orq
CTI?ERT 1NQ
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OWN -ER NAME PHONE D E-MAIL`
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CONTACT NAME PHONE E-IIAIL
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CONT LkCTOR NA,' (� LICENSE NUMBER '.'LICtN'SE TYPE �
BUS, LIC #
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STREET ADDRESS 9W.LAW WEA C- �)(�(Z1rS5VJPsY) �'Yj0
CITY, STATE, ZIP S uNN�V ALIc`A CA 9 qo 8 s
PHONE 40'R-2-45-09( 1
ARCH'iTECT/ENGIlT'ER NAME
LICENSE NVNtiflER 91
BUS. LIC
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STREET .ADDRESS
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DESCRIPTION of woR c `'AIIDA PwKWCsf CoMeum-105 OP4 "Vt
EXISTING. USE
PROPOSED USE
CONSTR.'riPE T STORIES
1.
USE
TYPE
OCC. I
SQ;FI'.
VALUATION (S)'
=STG
NEW
FLOOR
DF -MO
TOTAL
-. AREA
AREA
AREA
I NET AREA
.. .
BATHROOM
TKRCY,:tN
. ' OTHER
KEIvfODEL AREA
P-T-zMODEL AREA
REMODEL AREA
PORCHAREA
DECK ARE&
TOT.LT DEC.UPORCH.AREA
GARAGEAREA:
Lj DETACH
'
I
❑?.TTACH
n DWELLING UN?TS -
IS SECOND U\TT ❑Ye.S
SECOND STORY
❑YCS
• `
BEING ADDED? []NO
ADDITION?
❑NO•
PRE -APPLICATION
❑YES
LF YES, PROVIDE COPY OFIS
TEE BLDG }„'Y
❑YES
TOTAL. VALUATION:
,PLANT ING APPL R ❑ NO
PLAAlN1NG APPROVAL LET -1-a
EICHLER &Olg'.?
❑ NO
aF,, >= O
By my signature below, I certify to each of toe following: Iark th, roperty
application and the in -formation I have provided is correct: -1-55.,e read the�-
ordinances and state laws relating to building co)a5trtiction. I auth ' r�" e
Signature of Apnlicant/Agent: r'
authorized agent to act oif the prlperty owner's behalf. I have read this
of 'Work and'verify it is accurate. I agree to comply with all applicable local
of Cupe Lino to enter the above -Id nt ^ed,pro erty for sspection purposes.
Date: � � ,
SUPPL , MENTAL INFORMATION REQUIRED
New SFD,ef<ultifamily dwellings: Apply for demolition permit for
existingbu<<i`ng(s). Demolition permit is required prior to issuance of building
permit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
'10-1 1 ifany Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting wish Planning prior to
submittal of Building Permit application.
Blda Kpp_2011.doc revised 06/?1/11
UPGRADE 9 ACCESSIBLE PARKING SPACES.
RESTRIP EXISTING STANDARD PARKINGS.
INSTALL 3 TOW SIGNS.
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06/28/17
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Abby Ayende
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