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11090116 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR:DPR CONSTRUCTION INC PERIMIT NO: 11090116 OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 1450 VETERANS BLVD DATE ISSUED: 10/13/2011 OWNER'S PHONE: 4088730121 REDWOOD CITY,CA 94063 PHONE NO:(650)474-1450 I Ed LICENSED CONTRACTOR'S DECL RATION' 453 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor 1U.12ate I hereby affirm that I am licensed older the provisions of Chapt r 9 JOB DESCRIPTION:SUITE 800-COMMERCIAL TENANT (commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL, INCLUDE PAR CWEL CT(TI-CEIEING, Code and that my license is in full force and effect. NON-STRUCTURAL,INCLUDE MECH/ELECT(TI-PREP 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 Sq.Ft Floor Area: Valuation:$1392125 permit is issued. APPLICANT CERTIFICATION APN Number:36901027.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupe 'no against liabilities,judgments, costs,and expenses which a accrue again id City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. dd'Tonally,the a plicaut understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point sour e r ulati s per 1e. upertino Municipal Co ,Sec n 9.18. Issued by Signature y6 ,� Date � �� ci 1 ❑ OWNER-BUILR DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(See.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material. Additionally,should I use equipment9 evices which emit hazardous air permit is issued. contaminants as efined by the Baa✓Arca Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain con 1!a ce with the�dpertin Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&S ety ode,Sectio s 25505, 5533,and 25534. / 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 Owner r at ho•i• g t: /1 forthwith comply with such provisions or this permit shall be deemed revoked. % at i APPLICANT CERTIFICATION C l ISTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that th e is /construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit s is Ted(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgmehts, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITEC"T'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional i I j CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 GIJPERTtNO (408)777-3228•FAX(408)777-3333•build i nq(Qcupertin o.o rq ❑NEW CONSTRUCTION ❑ ADDDITI0N ALTERATIION�/�TI1 ❑ REVISION/DEFERRED ORIGINAL PERMIT# p: , 1 `._M4-VP--t,6 A a t- lJ4m p• ()2_ dam PROJECT ADDRESS�`_'W�En oo cA. { �Nou - V- ,° ,.J # j OWNERNAME ` - PHO E-MAIL a ft �f�y�` �[�+ �p � tit z-1 STREET ADDRESS�� ETEV0745 C- -`-6 CITY, STATE,ZIP CW� r" � TS-6 FAX CONTACT NAME 1_�e�.. \ PHO E-MAIL STREET ADDRESS CITY,STATE ZIP FAX rSiv s. 0c0cr4� 1IL-4 7-051 gSr'i ❑OWNER ❑ OWNER-BUHDER ❑ OWNERAGENT -*CONTRACTOR ❑CONTRACrOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑'TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE K7 BUS.LIC# COMPANY NAME V ►�✓l ice' E-MAIL f FAX 4 STREET ADDRESS CITY,STATE,ZIP P NE f�lc� S , 4StI�C�tiir aray' sQc,633 l�- ARCHITECT/ENGINEERNAME ,/ P 2 e r LICENSE NUMBER BUS.LIC# COMPANY NAME lit C E-MAB. 6�- FAX (iii t'i�_Z�i, H' , STREET ADDRESSCITY,STATE,ZIP PION DESCRIPTION OF WORK Ft-"L_ FL4ild>o- F_1OX5 Nv$ 'p\W,o EXISTINGUSE PROPOSED USE CONSIR.TYPE I #STORIES o 1 r'1 Gr✓� _T USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO J�TOTAL /} _ AREAL) AREA ` ��g{� AREA NET AREA/p r`7 C1 On _ 1 \ � I .�jq�, BATHRO`@MjD 0 KITCHEN OTHER 1 Y, J U •J_l`_'` REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH ❑ATTACH #DWELLING UNITS: ISA SECOND UNIT LI YES SECOND STORY []YESBEEVGADDED? LINO ADDITION? []NO PRE-APPLICATION G APPON ❑YES IF YES,PROVIDE COPY E IS THE BLDG AN ❑YES RECEIVED BY; TOTAIiVA�,UAT N: PLANNING APDL# ❑NO PLANNING APPROVAL LETTER EICHLER HO\fE? ❑NO 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 bel alf I have read this application and the informatio 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 IaWs re g building construction. I authorize representatives of Cupertino to enter the above-identi/feed property for inspection purposes. Signature of Applicant/Agent: Date: N ( �( SUPPLEMENTA ORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER Er DING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ E. SS El PLANNING PLAN REVIEW , _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDAIRD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE El FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 I �\I Building Department City Of Cupertino 10300 Toile Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 j U P E RT i N O Fax: 408-777-3333 CONTRACTOR UT CONT CT LIST JOB ADDRESS: PERMIT# OWNER'S NAME: o PHONE# - C GENERAL CONTRACTOR PP101 BUSINESS LICENSE# ADDRESS: _ j CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) 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 Linoleum/Wood = Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile .9;Z-�--:�y;Owner/Contractor Signature Date f CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20450 stvns crk blvd.#800 DATE: 09/19/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$1,392,125 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION 1 B TI USE: Commercial Building PERMIT TYPE: WORK U. comm offices acepartition, t-bar ceiling, non structural include M Es. 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 16,388 $4,122.44 IBTIPLNCK $12,002.02 IBTIINSP TOTALS: 16,388 $4,122.44 $12,002.02 MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY 0 Yes Q No 't�e'. r. fteJt t7'c1- '•{,ag� :._r.E.:,£'s£'>r �,tr.�,F'ir 3�..:o<;li' i t.r`1,e 1ii::'1t zir8J:, f I��te�"i d.?s.: i;i'f 3. F�`i7£a'1- [<;. �17:Y 11, E3 NOTE.This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminary inform tion available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Kesohrtiorr 11-053 Ejf. 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $4,122.44 Select a Misc Bldg/Structure Suppl.PC Fee: 0 Reg. 0 OT 0.0 lus $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $12,002.02 Suppl.Insp.Feer Reg. 0 OT Fo.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 E7i'1 %Tff:'1ISf. 3},` t-(fit'. 0 Work Without Permit? Q Yes Q No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential tc,? ,rii;,r r:," :,: Building or Structure 0 i Strong;Motion Fee: IBSEISMICo $292.35 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $56.00 SUBTOTALS: $16,472.81 $0.001TOTAL FEE: 1 $16,472.81 Revised: 09/02/2011