11090028CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD I CONTRACTOR: GIDEL AND KOCAL I PERMIT NO: 11090028
IV
NER'S NAME: CUPERTINO CITY CENTER BUILDINGS 1574 DMSION ST I DATE ISSUED: 10/21/2011
�, _4ER'S PHONE: 4088730121
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor i,�U9Wil ��c�� Date
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.
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
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 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 keepharmles the City of Cupertino against liabilities, judgments,
costs, and expenses which accrue against said City in consequence of the
granting of this permit. Ad iti nally, the applicant understands and will comply
with all non -point source u ations per the Cupertino Municipal Code, Section
9.18.
Signature Z Date GD/2(_14
❑ OWNER-BIVILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
u- - - the above mentioned property for inspection purposes. (We) agree to save
i iify and keep harmless the City of Cupertino against liabilities, judgments,
cu�.�, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
CAMPBELL, CA 95008 1 PHONE NO: (408) 370-0287
BUILDING PERMIT INFO: BLDG f— ELECT r- PLUMB r
MECH f— RESIDENTIAL T_ COMMERCIAL f—
JOB DESCRIPTION: STE 450 - FT DEMOLITON OF NON-BEARING PARTITION
WALLS, CONSTRUCTION NEW NON-STRUCTURAL PARTITION
WALLS, DOOR & FRAMES, FINISHES, LIGHT FIXTURES,
Sq. Ft Floor Area: I Valuation: $85000
APN Number: 36901028.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by. �� Date:
._
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
con tam nts as defined by the Bay Area Air Quality Management District I will
main in pliance with the Cupertino Municipal Code, Chapter 9.12 and the
Healfh & Safety Code, Sections 25505, 25533, and 25534.
ora tl ized agent:
rd l
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of %ork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional
\d,
` CONSTRUCTION PERMIT APPLICATION
k-'\ COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(a)cupertino.org
CUPERTINO
'` ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT DRES APN#
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ExISTmG USE PROPOSED USE C0IF-r— Owl ONST .TYPE TORIES USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑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 BY: TOTAL VALUATION: s
PLANNING APPL# ❑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 the pr_', erty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work an4yeafy"it is accurate. I agree to comply with all applicable local 6
ordinances and state laws relating to building construction. I authorize representatives to enter the above-identified property for inspection purposes. (y
Signature of Applicant/Agent: - Date: 4
SUPPLE NT -TNF0RMATMN REQUIRED PLAN CHECK E ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ;E1 E ss ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ElPUBLIC WORKS
Tor—in 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 ❑ rrAaoR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1.doc revised 06/21/11
i
COURTESY INSPECTION REQUEST FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C,B.O., BUILDING OFFICIAL12
to
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
C U P E RT I N O (408)777-3228• FAX(408)777-3333•building @cupertino.org
SITE WAN, Bt�, RI G APPLICATION#: DATE SUBMITTED:
ADDRESS: U00 170
APN TI PREPARATION
BUILDING PERMIT#:
OWNER'S NAME: PHONE#:
FAX#:
MAILING ADDRESS(if different from site address):
CONTRACTOR: �,A '' PHONE#:
Yf V V - FAX#: tv
CONTACT: PHONE#:
FAX#:
LIMITS OF WORK REQUESTED FOR COURTESY INSPECTIONS:
I request to start construction work in which a building permit has not been completely secured. I have obtained a tenant improvement
preparation permit which covers the removal of interior non-structural elements within the building. Furthermore, I have submitted a
building permit application and plans for the tenant improvement project and it is currently in the plan review process. I agree to call for
courtesy inspections for limited work as noted on this application. I fully understand that I will be responsible to redo the work
performed under courtes i spections if the work does not fully comply with the approved set of plans and all State and local rules and
regulations.
Owner:................... ........V....................I..............................Print:................................ .................I......................Date:......... ........ ...........
Contractor:.......... ......... ... .. ...........................I..............Print:........ Ckv-:V7,..... ...... f ...............Date:....W ..... .....0........
OFFICE USE ONLY-
The Request is: ❑ GRANTED ❑ DENIED Bldg Official/inspector:.......................................................................Date:................................
INSPECTION RESULTS
INSPECTION TYPE INSP.DATE TIME *RESULTS INSP. COMMENTS(REASON IF INSPECTION FAILED)
SPENT INIT.
53
"RESULTS: P—Pass,F—Fail,C—Cancel,I—Incomplete,N—Not Required,R—To be Rescheduled
i
CourtesylnspForm_2011.doc revised 08118111
Ip 1.- .
COURTESY INSPECT ON REQUEST FORM I 6
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL f I�
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 I r ��'ll�-'
Cl1Q>RT11140
(408)777-3228• FAX(408)777-3333 buildin4(a.cupertino.org
SITEBUILDING APPLICATION#: DATE SUBMITTED:
ADDRESS: k�z
APN TI PREPARATION oo„ ,„
BUILDING PERMIT#: ��
OWNER'S NAME: PHONE#:
FAX#:
MAILING ADDRESS(if different from site address):
CONTRACTOR* *Sr- PHONE
1-t L�g FAX#:
CONTACT: PHONE#:
cly� �Ii FAX#:
LIMITS OF WORK REQUEST D FOR COURTESY INSPECTIONS:
I
I request to start construction work in which a building permit has not been completely secured. I have obtained a tenant improvement
preparation permit which covers the removal of interior non-structural elements within the building. Furthermore, I have submitted a
building permit application and plans for the'tenant improvement project and it is currently in the plan review process, I agree to call for
courtesy inspections for the limited work as noted on this application. I fully understand that I will be responsible to redo the work
performed under courtesy inspections if the work does not fully comply with the approved set of plans and all State and local rules and
regulations.
Owner:....................................................................................Print:.........................................................................Date:..................:...........
Contractor:...................................... .................Print:.........................................................................Date:..............................
INSPECTION RESULTS
INSPECTION TYPE TIME *RESULTS INSP. COMMENTS(REASON IF INSPECTION FAILED)
SPENT L INIT.
�(�35
i
*RESULTS: P-Pass,F-Fail,C-Cancel,I-Incomplete,N-Not Required,R-To be Rescheduled
CourtesylnspForm_2011.doc revised 07112111
I
I
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION j
ADDRESS: 20400 stevens creek blvd. DATE: 09/06/2011 REVIEWED BY: larry s
APN: BP#: "VALUATION: 1$85,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial BuildingL_ � PERMIT TYPE: 1 B TII
WORK demo non partion walls construct new non structural partition walls from 8 existing to 15 offices.
SCOPE
OCCUPANCY TYPE: TYPE OF . FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) I-A,I-B 1,400 $2,947.31 IBTIPLNCK $1,832.28 1BTIINSP
TOTALS: F 1,400 1 $2,947.31 1 1 $1,832.28
MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes 0 No
"h.,;<
t'�1hr':?Ic't°it lush;• t}fJr�-r r <., .;itsr, E3
NOTE. Thesefees are based on the prelintinary in ormation available and are only an estimate. Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resohition 11-033 E/f 7/l�U] FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,947.31 Select a Misc Bldg/Structure
Supp/.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00
or Element of a Building
PME Plan Check: $0.00
Permit Fee: $1,832.28
Suppl.Insp.Feer Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: 0 Yes'0 No $0.00 0
Work Without Permit? 0 Yes 0 No $0.00 0
Plaunina Fee: $0.00 Select a Non-Residential 0
Building or Structure
yn.,wel j-Strong Motion Fee: IBSEISMICO $17.85 Select an Administrative Item
I
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $4,801.44 $0.00 TOTAL FEE: 1 $4,801.44
i
Revised: 07/04/2011