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15010153 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20330 STEVENS CREEK BLVD CONTRACTOR:DEVCON PERMIT NO: 15010153 CONSTRUCTION INC OWNER'S NAME: SVF CUPERTINO CITY CENTER CORPORATI 690 GIBRALTAR DR DATE ISSUED:01/27/2015 OWNER'S PHONE: 4086666614 MILPITAS,CA 95035 PHONE NO:(408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL q APPLE- IST FLOOR-COMM.T.I 566 SQ FT;TO INCLUDE License Class 413 Lic.# 13 q ! I HARD WALL OFFICES W/ASSOCIATED MECH AND Contracto,14'XtfK ��}'y� AY� Date ELECTRICAL 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: 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. Sq.Ft Floor Area: Valuation:$80000 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:36901020.00 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. 1 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 FR,70CALLED 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 17 1C' granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature �i-)—�ADate _1/�- All roofs shall be inspected prior to any roofing material being installed.If a roof is �� Tinstalled 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 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(See.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. 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(a)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 Owner or authorized agent: Date: permit is issued. 1 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 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, ARCHITECT'S DECLARATION 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 APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION `�1 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building aacupertino.org } CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN#0©210 sC/� o 1 0-20.1)1),OWNERNAME P NElav(-6(vl y E-MAIL � STREET ADDRESS CITY STATE,ZIP FAX n 'n Le too tv �-i n o CONTACT NAME PHONE E-MAIL �s f Ice 5 832 a,rd&C7-Z('e��,���- STREET ADDRESS CITY, ;%TE, ZIP, f FAX Gld �Ibri'10- ( t ❑ OWNER ❑ OWNER-BUILDER ❑ OWNTERAGENT ACONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME DC1.rG�� � , Z LICENSE NUMBE51 G I LICENSE TYPE BUS.LIC# COMPANY NAME V 'µv V!! E-MAIL" (/ FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGRJEERNAME LICENSENUMBER 1 BUS.LIC# COMPANY NAME E-MAIL AS\ F 1� N1 STREET ADDRESS c �'^ CITY,STATE,ZIP J /� PHONE DESCRIPTION OF WORK �Vyv( &0 Va 0 64-a� at� ca-') pec v,- EXISTING USE PROPOSED US++E CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL f\r AREA AREA AREA NET AREA •\. f P BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECIUPORCH AREA GARAGE AREA: LJ DETACH I]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 TOTAL VALUATION: PLANt.TNG ADPL# ❑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 Xeprdperty 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 a6Krate. I agree to comply with all applicable local ordinances and state laws relating to building constructio I thorize representatives of Cupertino to enter the above-'dentified property for inspection purposes. Signature of Applicant/Agent: Date: l5 SUPPLEMENTAL INFORMATION REQUIRED HEciz"TYPE . - ROU iING silP New SFD or Multifamily dwellings: Apply for demolition permit for ovER TH><counTER uILDINc PLAN REviEw existing building(s). Demolition permit is required prior to issuance of buildm permit for new building. D EXPRESS PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure CQ sTAI;nARD. Cl `PUBLIC woRxs , form if any Hazardous Materials are being used as part of this project. DEPT Copy of Planning Approval Letter or Meeting with Planning prior to LARGE 31 AR El"'ATITARYEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION WPERMIT DDRESS: 20330 scb DATE: 01/27/2015 REVIEWED BY: Mendez PN: 359 31 008 BP#: ,SC 015 `VALUATION: $80,000 PE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 B TA WORK �apie- 1st floor- comm. t.i 566 sq ft; to include hard wall offices w/associated mech and electrical SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-A,III-A,V-A 566 $2,640.77 IBTIPLNCK $991.35 IB7IINSP TOTALS: 566 $2,640.77 $991.35 MECH,HOURLY 0 Yes E) No PLUMB,HOURLY Q Yes E) No ELEC,HOURLY Q Yes Q No E]__L_ NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 11-053 Eff' 7,1'13/ FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,640.77 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. Q OT0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $991.35 Suppl. Insp. Feer Reg. ® OT F-01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? Q Yes Q) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential G Building or Structure i StromMotion Fee: IBSEISMICO $22.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $3,658.52 $0.001 TOTAL FEE: $3,658.52 Revised: 01/06/2015 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 9.Og3p - PERMIT# / S0 / 0 /5& OWNER'S NAME: le PHONE # '/&W $ SR2 / GENERAL CONTRACTOR: lDe v,i5 N BUSINESS LICENSE # ADDRESS: 6 90 Dc CITY/ZIPCODE: i/ S S63S *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. I 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 G( l Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank V Sheet Metal LAi�f04 eCAa-njCAW 9 v1 Sheet Rock n vn1 w I 5�l Tile Owner/tontractor Signature Date