13120164 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR:GIDEL AND KOCAL PERMIT NO: 13120164
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 574 DIVISION ST DATE ISSUED:01121/2014
OWNER'S PHONE: 4088730121 CAMPBELL,CA 95008 PHONE NO:(408)370-0287
Of LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E)
FLOORS 7&8,UPGRADE ALL RESTROOM FACILITIES(2
License Class__ Lic. //� ON EACH FLR,4 TOTAL)FOR ADA COMPLIANCE
Contractor &;4 e 1 �1 CCY'*�, Dal j'I'd I 11 L1
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:
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
(erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$150000
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:36901027,00 Oecnpancy 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 WITHIN 180 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 DAYS FROM ALLED 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 .Z
granting of this permit. Additionally,the applicant understands and will comply
with all nod-point source regulations per the Cupertino Municipal Code,Section
9.18.
.�`` e� RE-ROOFS:
Signature_/vs+ Date_,' p�-� 1 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.
❑ OIVNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: , ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(See.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. I 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
1 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 Owncr or authorized agent: —AW Date:
permit is issued.
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,I 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
CONSTRUCTION PERMIT
R T
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildingCct�.cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑l ALTERAlTION/TSI/ ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT DR�"CS y/Z�C�, 'T /JJJPN0 /5 Q( �V L/
OWNERN PHO 7E-MAIL_
STREET
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CONTACT N � AfPHO (� E-MAIL
STREECADDRES 11IV,5,r4,,-s ,,,,STA ,ZI, CA
FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT WCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRALTO E LICENSE NU ER LICENSE T E BUS.LIC H
l�Jn',tcti 3oS�
COMPANY NAG, , �_ / EMAIL FAX
STREET ADDRESS • ' � �1w �]r CITY,S E,ZIP
ARCHITECT 1NEERYAME `r- LICENSENUMBER BUS.LIC H
COMPANY NA E-MAIL P
STREET ADDRESS _./ rL�U C[TY�E Z
02 irs�-, J�qC '7
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTIL TYPE A SrOR}ES
USE TYPE OCC. SQ.FT. VALUATION(3)
EXISTG NEW FLOOR DEMO TOTAL (�
AREA AREA AREA hiE1'AREA �3a 0C
BATT-ROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKMORCH ARE GARAGE AREA: DETACH
A7TACH
H DWELLING UNrrS: ISASECONDUNrr ❑YES SECONDSTORY ❑YES
BEING ADDED? NO ADDITION! []NO
PRE-APPLICATION ❑YLS W YES,PROVIDE COPY OF t5 THE BLDG AN ❑VES RE D N:
PL4NNINGAPPLR ❑NO PIANNINGAPPROVAL LETTER EICHLERHOMEr F]N0
By my signature below,l certify to each of the following: 1 am the property owner or out agent to on the,PK
pe6 owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is ac e. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize represent the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMEN INFO TION REQUIRED PLAN CHECK TYP ROUTING SLIP
_New SFD or Mul ' ily dwellings: Apply for demolition permit for ❑ OVER-THF COUNTER ❑ BUILDING PLAN REVIEW
existing building(s . Demolition permit is required prior to issuance of building
permit for new building, jCANDARD
RFSs ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ PUBLIC WORKS
Form if any Hazardous Materials are being used as part of this project, ❑ LARGE ❑- FIRE-DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ sANIPARY SEWER D15TRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp 201].doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20450 STEVENS CREEK BLVD DATE: 12/1912013 REVIEWED BY: MELISSA
APN: 369 01 027 BP#: 0 1 'VALUATION: 1$150,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE:
1B T`
WORK FLOORS 7& 8 UPGRADE ALL RESTROOM FACILITIES 2 ON EACH FLR 4 TOTAL FOR ADA
SCOPE COMPLIANCE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES SP FEE ID
CONSTR. s-
B (Tenant Improvements) 117-B,III-B,IV,V-B 738 $2,061.55 IBTIPLNCK $902.85 IBTIINSP
TOTALS: 738 $2,061.55 1 $902.85
MECH,HOURLY Q Yes O No PLUMB,HOURLY Q Yes E) No ELEC,HOURLY Q Yes Q No
Mech. Plan Check Plumb, Plan Check Elea.Plan Check
1411,11.Permit Fee: Plumb.Permit Fse: Iilec•.Permit Fee:
Orher blech•Insp. 011ier Plumb Insp. Other Elec.lnsp, Ll
Aleeh.Insp.Fee: Pllarlb. I11sp. F11: Elce.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments fi.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the prelindua in ornration available and are onl an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff• 71111.3) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,061.55 Select a Misc Bldg/Structure
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $902.85
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee: Q
Work Without Permit? Q Yes Q No $0,00
Advanced Planning Fee: $0.00 Select a Non-Residential (�
Travel Documentation Fees: Building or Structure Q
I
Stroniz Motion Fee: IBSEISMICO $31.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $6.00
SUBTOTALS: $3,001.90 $0.00 TOTAL FEE: 1 $3,001.90
Revised: 10/0112013
Building Department
City Of'Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU P ERTI N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST r�
JOB ADDRESS: Z v I UU (j 4/s"�j S`C�� PERMIT# 1 31 1 C1 1 ,64 j 1 '2, 1-2 D 1
OWNER'S NAME: P,,7,,49-hic5 12.E : PHONE # `i06 - -?>70 - 02,;e c)
GENERAL CONTRACTOR: -r�1r! 4} �cr�i (GrS�rv�4 1 BUSINESS LICENSE#
ADDRESS:5q,t o,5�_,j CITY/ZIPCODE: (e,,A b,11 f lA l-'RX)
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
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 .................
-25�
Owner/Conti-actor Signature Date