13080216 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20401 STEVENS CREEK BLVD CONTRACTOR:NOVO CONSTRUCTION PERMIT NO: 13080216
OWNER'S NAME: WDV PROPERTIES 1460 O'BRIEN DR DATE ISSUED:09/05/2013
OWNER'S PHONE: 4082887833 MENLO PARK,CA 94025 PHONE NO:(650)701-1500
B",...-.._ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL E]
License Class Lic.# `Z APPLE-ADD 2 PARTIAL HEIGHT FRAMED WALLS AND 2
r DOOR TO MAKE SECOND FLOOR SECURE
c
Contractor 13
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:$6000
/flhave and will maintain Worker's Compensation Insurance,as provided for by
'Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31626090.20401 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws.relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA F OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: _
with all non-point source,!$ lations per the Cupertino Municipal Code,Section
9.18.
r v RE-ROOFS:
Signature Date 7 J 3 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
iI 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
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. 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 hs:zardous
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 25505,2 and 25534.
i
Section 3700 of the Labor Code,for the performance of the work for which this ar !'
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall f
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
i
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 U
(408)777-3228• FAX(408)777-3333• building(cDcupertino.org
CUPERTINO lJ
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIoG�INAL PERMIT#
PROJECT ADDRESS C) V C APN# /1 I/A 2'(/I � ,2 0
OWNER NAME ,! f1 �� PI I �r•n eQs�J E-MAIL
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1 6/ �iQ f
STREET ADDRESS CITY, STATE,ZIP FAX
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E-MAIL
CONTACT NAME PHONE fin_ �� ,
STREET ADDRESS CITY,STATE,ZIP FAX
t�fratJ '22 p+
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
7710 zz-
COMPANY NAME E-MAIL FAX
AAL
Sn
STREET ADDRESS CITY,STATE,ZIP PHONE
As.Vf-
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX li
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
enr
;apt
EXISTING USE PROPOSED USE CONSTR TYPE #STORIFS USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA ,+° AREA f°`) AREA NET AREA „�
BATHROOM ee KTT;J1tN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑AETI,AACH
#DWELLING UNITS: ISASECONDUNIT ❑YES SECONDSTORY El YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEI BY' TOTAL VALUATION:
PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? E]NO66<3
By my signature below,I certify to each of the following: I am the property owner or authori;A_age9t 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 W k and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. thorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: /r
�—
SUPPLEMENTAL INFORMATION REQUIRED PIAN CHI CK TYPE. ': ROUTnvc sL>P-
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ovEx TFI�cOUNTER BucLDIIVG PLAN REXIEw
existing building(s). Demolition permit is required prior to issuance of building '
permit for new building. ❑ ExPxEss ElPLANNBVGPLANREVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure TANDARD ❑ ruBLrcwoRxs
form if any Hazardous Materials are being used as part of this project. ❑ iAxcE FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑.,rrAaoR ❑ SANriABX s�wERDISTxICT
submittal of Building Permit application. ENVIRONMENTa H>Ai Tii:
BldgApp_2011.doc Devised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20401 scb DATE: 09/09/2013 REVIEWED BY: Mendez
APN: BP#: � U � f EVALUATION: $6,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 GENCO
WORK APPLE- ADD 2 PARTIAL HEIGHT FRAMED WALLS AND 2 DOOR TO MAKE SECOND FLOOR
SCOPE SECURE
i:. Ll.= ,..c'i _F.�'j`',
f.yf).
NOTE: This estimate does not include fees due to other•Departnzeuts(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the relinrinary information available and are only an estimate. Contact t/ze De t or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check,Hourly
Suppl. PC Fee: Q Reg. 0 OT 0.0 1 lirs $0.00 $417.00 ISTPLNCK
PME Plan Check: $0.00 I
Pen-nit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp. Fee:) Reg. Q OT 0,0 lirs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure r
Strong Motion Fee: IBSEISMICO $1.261.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $139.00 ISTINSP 7 Inspection,Hourly
SUBTOTALS: $2.26 $556.001 TOTAL FEE: 1 $558.26
Revised: 07/01/2013
UNREASONABLE HARDSHIP EXEMPTION FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building()cupertino.org
For Tenant Improvements where the Cost of Construction does not exceed $136,060.00
SITE ADDRESS APN BP#
CITY 6(,)--r1 ZIP 50 14 TOTAL CONSTRUCTION COST A $....... . l.. !.€d......................
DESCRIPTION OF WORK: pyw t'>Oot2-�
The following is a list of costs to provide access features in order to comply 100%with the current State Title-24 Disable Access Standards.(AII
costs to be documented by actual bids or other information accepted by the Bui ding Official.
Accessible Features Complies with If not,list required upgrades in 777for Cost to make feature
current standards? features to fully comply? fully accessible?
1.Path of travel to accessible entrance. " _ $
2.Cost of providing a primary entrance. (Including but
not limited to,thresholds,landings,door hardware, $
max.door pull,etc.
3.Cost of providing the primary path of travel to the
specific area of alteration,structural repair,or A $
addition.
4.Cost of providing accessible restroom facilities. , I $
5.Cost of providing an accessible drinking fountain. (If $
required or if a drinking fountain is provided.)
6.Cost of providing accessible public telephones(if � y $
provided) t" s
7.Cost of providing other accessible features,including $
but not limited to,parking,storage,alarms etc.
TOTAL COST OF ACCESS FEATURES(B): $
Has the same tenant performed work in the
same tenants ace within the last three ears? Calculate(B/A)x 100% � (e'7)4>
Description of access features to be provided:
F VA A-r ACeS9 - IN. Mks pSND Yv We, F -
TOTAL COST OFPERCENTAGE 20%minimum
PROPOSED UPGRADE $ 2,0 � (
expenditure is required)
ARCHITECT OR ENGINEER
}O,F�,RECORD INFORMATION: I certify that the above noted information is true and correct.
Name(print): I !d `" Signature: Date:
Firm address: � Title: ! Phone: j of, t -2"0
---------------------------------------------------------------------------- FOR DEPARTMENT USE ONLY ----------------------------------------------------------------------------
❑ The above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 1134B.2.1.
❑ The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR-Title 24
(Regulation for the Accommodation of the Disabled)pursuant to 2010 CBC Section 11346.2.1.
COMMENTS:
Building Official Designee(print): Signature: ZZYDate: `l
HcrrdshipExen7ptionForrtn 2012.doc revised 06/25/12