B-2017-1987 'CITY OF CUPERTINO BUILDING PERMIT •
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1987
20330 STEVENS CREEK BLVD CUPERTINO,CA 95014-2268(369 01 020) TCG BUILDERS INC
MILPITAS,CA 95035`
OWNER'S NAME: SVF CUPERTINO CITY CENTER CORPORATION DATE ISSUED: 11/16/2017
OWNER'S PHONE:408-996-1010 PHONE NO:(408)321-6450
LICENSED CONTRACTOR'S DECLARATION - BUILDING PERMIT INFO:
License Class B Lic.#835597
Contractor TCG BUILDERS INC Date 04/30/2018 X BLDG X 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:
APPLE- 1ST FLOOR;T.I.-CONSTRUCT(N)WALL AND DOOR FOR
I hereby affirm under penalty of perjury one of the following two declarations: EMERGENCY WORK SPACE;RELOCATE ELECTRICAL SWITCHES
1. I have and will maintain a certificate of consent to self-insure for Worker's (4)
Compensation,as provided for by Section•3700 of the,Labor Code,for the
Igerformance of the work for which this permit is issued.
" ave and will maintain Worker's Compensation Insurance,as provided for by
.al Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. • Sq.Ft Floor Area: Valuation:$12000.00
APPLICANT CERTIFICATION
I certify that l 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 369 01 020 A(Tenant Improvements),A(Tenant Improvements),A
representatives of this city to enter upon the above mentioned property for • (Tenant Improvements),A(Tenant Improvements),A
inspection purposes. (We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant lmprovements),A
City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant Improvements),A
may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements),A
Additionally,the applicant understands and will comply with all noh-point (Tenant Improvements)
source regulations per the i pertino Municipal Code,Section 9.18.
PERMIT EXPIRES IF WORK IS NOT STARTED
Si.���re , ILL/• :CfDate 11/16/2017
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECL2ATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: Issued by:Abby Ayende
1. I,as owner of the property,or my employees with wages as their sole Date: 11/16/2017
compensation,;will do the'work,and the structure is not intended or offered for
sale(Sec.7044,'Busiiless&Professions Code) RE-ROOFS: •
2. 1,as owner of•the property,am exclusively contracting with licensed
All roofs shall be inspected prior to any rooting material being installed.If a roof is
contractors to construct the project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
I hereby affirm under penalty of perjury one of the following three declarations:
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 Signature of Applicant:
performance of the work for which this permit is issued. Date: 11/16/2017
2. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
permit is issued. • -
3. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERI•
ALS DISCLOSURE
shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California. If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will
exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(4 should I store or handle hazardous
be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous
• air contaminants as defined by the Bay Area Air Quality Management District I
APPLICANT CERTIFICATIONwill maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I certify that I have read this application and state that the above information is the Health&Safety Code,Se tions ,:505,25533,and 25534.
• 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
r t^ er or authorized agent:
to enter upon the above mentioned property for inspection purposes. (We)agree ../4( /
to save indemnify and keep harmless the City of Cupertino against liabilities, rm ate: 11/16/2017
judgments,costs,and expenses which may accrue against said City in CONSTRUCTION LENDI'GAGEN6
consequence of the granting,of this permit. Additionally,the applicant understands I hereby affirm that there is a construction lending agency for the performance
and will comply with all'hon-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ C.)
Code,Section 9.18. Lender's Name
Lender's Address
Signature Date 11/16/2017
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CONSTRUCTION PERMIT APPLICATION
c` '...' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
1 B
,.,,, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
,• aA r.s •
(408) 777-3228 • build ng@lcupertino.org PEMIT#B- 213l T - 6r
CUPERTINO' REVB DEFB
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION Ir I T,I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESSX2033 C / ,L azek APNA (ept
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OWNER NAME A� PHONE 40�pme,to` E-MAIL
ADDRESS/' STREETADD �'�� TATE ZII'
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• €ONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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ARCHITECT ❑.OWNER.❑OWNER AGENT ❑CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT •
CONTACT N fE 12 ilialp.L. E-MAIL
STREET ADDRESS/REC �� CITY 5,piwitia I n 1/Le 0. i (% p� / W ye
DECRIPTON ��// ,50-0,5441
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❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL yr COMMERCIAL I
EXISTING USE EXISTING SF NEW.FLOOR SF PORCH SF DECK SF DEMO SF STORIES F TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
Sas 3A5
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING
kffYES SPRINKLERS 0 NO ,EICHLER0 YES SECOND STORY ADDITION ❑YES •
FIRE • ❑NO.
DWELLING SECOND DWELLING ❑YES ❑ATTACHED DETACHED OTHER
UNITS UNITADDITON: ❑NO 5F
POOLS, 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF
R' I�Y: TO L VALUATION:
Conmrerriul�m�Multi-FamilyBuildi�igs with Public Stviniiviue Pools remrircs Dram-intent ofEttvirwavenlal Heath anprm�ul /`l I 60-1600
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑'A" ❑3/5" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES k OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:DBUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES OWOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF :of SQUARES
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 I have provided 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 building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspect' n purp -es. I acknowledge and authorize all information contained on this application form
to be made available for public record. / /,,
Signature of Applicant/Agent: / c Date://-*/ 1?
SUPPLEMENTAL INFORMATION REQUIRED v
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.,'
*HOA-Provide a letter of approval from the Home Owner's Association
Bldg.-Ipp_2017.doc revised 08/01/17