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09080116 - DEF2CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: LAYTON PERMIT NO: 09080116 CONSTRUCTION OWNER'S NAME: CUPERTINO PROPERTY DEVELOPMENT 19608 PRUNERIDGE AVE APT 5104 DATE ISSUED: 08/14/2012 OWNER'S PHONE: 4083431088 CUPERTINO, CA 95014 PHONE NO: (949) 429-6740 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIALL] License Class f7 Lie. #127i65 RASE 19OWL-MIXED USE RESIDENTIAL/RETAIL 476,016 Contractor ? 7 Date < SQF -INCLUDES 204 APARTMENTS, COMMON AREAS "RS I hereby affirm that I licensed am under the provisions of t - 9-M (commencing. with Section 7000) of Division 3 of e� Profession Code and that my license is in full force and effec 1/10/13- DEFERRED #2- FABRICATION & INSTALLATION OF I hereby affirm under penalty of perjury one of th ollllowing two declarations: STRUCTRAL TRUSS MEMBERS FOR THE ROOF OF THE BLDG - I have and will maintain a certificate of consent to self -insure for Worker's ISSD 2/8/13 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: $46000000 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. APN Number: 31620037.38CONDOS Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter WIT 80 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 180DA OM LAST CALLED INSPECTION. granting of this it. A it�onall a applicant understands and will comply Issued by: Date: / with all non oint ourc regula i n er Municipal Code, Section / 918. Si natur '` 3 g ate 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. ❑ /, OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property,.or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 (5ec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous. Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. I have and will maintain Worker's Compensation will maintain compliance with t uper ' opal Code, Chapter 9.12 and Health 'ons Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this the & Safety Code, S 5 05 3d i permit is issued. Owner or authorized aged - Date ¢ G 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 066 STRUCTION 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 Lender's Address 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 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 granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. With all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT m BUILDING DIVISI 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 e building(a�cupertino.or. ❑ NEW CONSTRUC-rioN I1 AiInITWYNT n A r TnD A—T / — LSF -—.^=L=�^=•�� ii LSI.nnvIJIViV� rr UKIUINALPERMIT# UUUbUi 16 PROJLCrADDRESS 19800 Vallco Parkway Cupertino, CA 95014 APN# o ry (_E-MAIL OwNr:a NAM'' Cupertino Property Development 1 LLC PHONE 408-343-1088 echan@k�crrdevelopment.com STREET ADDRESS 19620 Stevens Creek Blvd. Suite 200 CITY, STATE, ZIP Cupertino, CA 95014 FAX 408-343-1089 CONTACT NAME Douglas Schmoldt PHONE 702-664-5617 E-MAILdschmoldt@laytonconStructlon.com STREET ADDRESS 19800 Vallco Parkway CITY, STATE, ZIP Cupertino, CA 95014 FAX 408-777-8639 p 13 OWNER 13OWNER-BUILDER 11 OWNER AGENT L�'J CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Loren Konz LICENSENUMBER ##897169 LICENSE TYPE B BUS. LIC# COMPANY NAME BINK E-MAIL loren.konzga BuildWithBMC.com FAX 707-678-8602 STREET ADDRESS 1100 Business Park Dr. Suite B CITY,STATE,ZIP Dixon, CA 95260 PHONE 707-678-8600 ARCHITECT/ENGINEERNAME Michael Stanton LICENSE NUMBER BUS. LIC# COMPANY NAME Stanton Architecture E-MAIL mstanton@stantonarchitecture.com FAX 415-865-9608 STREETADDRESS 555 De Haro St. Suite 300 CITY, STATE, ZIP San Francisco, CA 94107 PHONE 415-865-9600 DESCRIPTION OF WORK Fabrication & Installation of Structural Truss Members for the roof of the building. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I 7 USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT [3 YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN 01MR EICHLER HOME? C1 NO B TOTAL VALUATION: By my signature below. 1 certify to each of the following: 1 am the property owner or aut razed agon the pr erty owner's behalf. I have read this application and the information I have provided is correct. I -have -r ad th` Description of Work and veri it is ac ate. I agree to comply with all applicable local ordinances and state laws relating to b ntitrucllat st' thorize fildiug)c 1 representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: -9-1 SUPPLEMENT,�L_.INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition PLAN .CHECK TYPE ROUTING SLIP _ permit for existing building(s). Demolition permit is required prior to issuance of building ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form 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 submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO I +I FEE ESTIMATOR - BlPILDI G nrvrRIox ' -,A 41r _ 19800 VALCO PARKWAY DATE: 01/10/2013 REVIEWED BY: MELISSA JimADDRESS: APN: 316 20 037 BP#: 09080116 *VALUATION: Iso. xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: • g Plumb. hisp. Fee: PENTAMATION PERMIT TYPE: 1 GENCOC WORK FABRICATION & INSTALLATION OF STRUCTURAL TRUSS MEMBERS FOR THE ROOF OF BLDG SCOPE -,A 41r _ Me& Plan C.'Fieck Plumb. Plan Check Elec. Plan Check lLtRCh. Iaertnil Fee: Phimb. Permit Fee, Elec. Permit Fee: Other illech. Insp.E3-L- Other Plumb Insp. Other Elec. Insp. Ak:ch. Insp. Fac: Plumb. hisp. Fee: Elec. Insp. Fee: AUIZ: 1ms estimate does not include•jees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are havod an Jho nroliminary infnrmafinn ounilnhla and nra nah, na avd fa rn.fnnf fha 7)onf fnr —d,4"'l infn FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (2) No $0.00 ® hours $532.00 Plan Check, Hourly 1STPLNCK Suppl. PC Fee:. (F) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 •Suppl. Insp. Fee:E) Reg. Q OT 0 0 hrs $0.00 PME Unit Fee:: $0.00 PMEPermit Fee: $0.00 Constr;u ion .Tax: Adihinistrative .Fere:. Work Without Permit? 0 Yes (D No $0.00 .Advanced Planning Fee: $0.00 ® hours $532.00 Inspections 1STINSP Inspection, Hourly Trvvel Documentation Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg; St& Commission Fee: $0.00 SUBTOTALS, $0.00 $1,064.00 DOTAL FEE $1,064.00 Revised: 10/01/2012 l�