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15060020CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15060020 19479 STEVENS CREEK BLVD CUPERTINO CA 95014 (S B C C INC) CAMPBELL, CA 95008 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/21/2015 OWNER'S PHONE: PHONE NO: 408-379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #336974 Contractor ( S B C C INC ) Date 02/16/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - SHOP 6 - CONSTRUCT (N) 6,798 S.F. I hereby affirm under penalty of perjury one of the following two declarations: CORE & SHELL FOR FUTRE RETAIL 1. I have and will maintain a certificate of consent to self -insure for Worker's DEF#2 - STRUCTURAL DESIGN FOR EXT. CLADDING SYSTEM Compensation, as provided for by Section 3700 of the Labor Code, for the DEF# 1 - BRB SHOPS AND CALCULATIONS.- ISSUED 2/16/16 performance of the work for which this permit is issued. z 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 Sq. Ft Floor Area: Valuation: $1019700.00 this permit is issued. 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 APN Number: Occupancy Type: 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, costs, and PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. Signature Date 02/16/2016 Issued by: MELISSA NAMES Date: 02/16/2016 OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: z I, as owner of the property, am exclusively contracting with licensed Date: 02/16/2016 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: Date: 02/16/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Signature Date 02/16/2016 Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15060020 19479 STEVENS CREEK BLVD (316 20 112) SB CC INC CAMPBELL, CA 95008 OWNER'S NAME: SAND HILL CONST MANAGEMENT DATE ISSUED: 09/21/2015 OWNER'S PHONE: 650-344-1500 I I PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #33QM Contractor S B C C INC Date 03/31/2016 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing 'ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. 2. 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 1 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, costs, 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 Cuertino Municipal Code, Section 9.18. Signature d Date 5/13 /1 W I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: t. 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 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 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. Signature Date BLDG —ELECT -PLUMB MECH RESIDENTIAL COMMERCIAL } JOB DESCRIPTION: MAIN STREET - SHOP 6 = CONSTRUCT (I) 6,798 S.F. CORE & SHELL FOR FUTRE RETAIL DEF # 4 - ROOF JOIST SHOPS & CALCS. ISSUED 5-13-16 DEF # 3 -GLAZING SHOPS & CALCS. ISSUED 3-16-16 DEF#2 - STRUCTURAL DESIGN FOR EXT. CLADDING SYSTEM ISSUED 3-30-2016 ' DEF#1 BRB SHOPS AND CALCULATIONS.- ISSUED 2/16/16 REVISION #1 - HVAC ROOFTOP UNITS; (I) DEMISING WALL FOR FUTURE TENANTS; (N) ELECTRICAL SUB PANELS; (N) GAS METERS ****BIN C-2*** Sq. Ft Floor Area: I Valuation: $1019700.00 APN Number: Occupancy Type: 316 20 112 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE g Date: 09/21/2015 &KQ RE -ROOFS All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to, remove all new materials for inspection. Signature ofApplicant: Date: TO BE CLASS "A" 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 contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Cp #e, Sections 25505, 25533, and 25534. Owner or authorized agent: L A Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address CONSTRUCTION PERMIT APPLICATION Lill COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION �,++" 10300 TORRE AVENUE • CUPERTINO, GA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildin (a)CUDertino.org V Shop 6 CUPERTINO M XTCRTil TFTDTTf-PTn'&T 1 1 ATITITrPMM F1 ATTPP A MrYkT./TT -MY PVWTQTOVI FT.TRR-FT]/ 0TZTr;TNAT.PRRTATT1i 1.5060020 PROJECT ADDRESS 19479 Stevens Creek Blvd 7,12N # O` N°I�ffi Sand Hill Const Management PHON1650-344-1500 E-MAII nkumar cr shcmllc.corn STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE'S Menlo Park 94025 FAX CONTACT NAME _ Nandy Kumar PHONE 650-344-1500 E -MALI, nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CIT Y°STATE, ZIP Menlo Park, 94025 FAX DOWNER ❑ OWNER BUILDER ❑ OWNER: AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT.... CONTRACTORNAME Summer Olson -Todd LICENSE NUMBER 336974 LICENSE TYPE B BUS. LIC# 5655 cOMPANYNAME South Bay Construction E solsontodd@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE408-379-5500 ARCHITECT/ENGINEERNAME _ Cliff Chang LICENSENUMBER BUS. LIC# COMPANYNA"'E Chang Architecture cliff@changarchitecture.co FAX' STREET ADDRESS 251 Park Road, #900 CITY, STATE, ZIP Burlin\ are 94010 PHONE650-269-421 3 DESCRIPTION OF WORK S EXISTING.USE .PROPOSED USE - CONSTR.TYPE #STORIES USE TYPE OCC.. SQ.FT. NEW FLOOR -DEMO TOTAL AREA. AREA. AREA NET AREA ' MUATIONAREA BATHROOM - KITCHEN. OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: HDETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES - BEINGADDED? []NO ADDITION? ❑NO -. --- PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALU N; PLANNING 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 authorizag t c n the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Workd verify it i accurate. I agree to comply with all applicable local Ordinances and state laws relatin o building cons on. Ian rite re entatives of Cupertino a above-iden " ed property for inspection purposes: Signature of.SpplicantlAgent: � Date; SUPPLEMENTAL INFORMATION REQUIRED PLAN cIIECKTYPE ROUTING SLIP 0 Gym �cOUNTER 0 BunzINGPLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPRESS ❑rrr PLANNING PLAN REVIEW h Commercial Bldgs; Provide a completed Hazardous Materials Disclosure ❑ sTANDARD ❑ PUBLTc woRm _ form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑; FDIE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT . . submittal of Building Permit application. El ENVIRONMENTALHEALTu BldgAp, 2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15060020 19479 STEVENS CREEK BLVD (316 20 112) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: DATE ISSUED: 09/21/2015 OWNER'S PHONE: PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lia #336974 Contractor S B C C INC Date 03/31/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL _ COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET -'SHOP 6 - CONSTRUCT (N) 6,798 S.F. I hereby affirm under penalty of perjury one of the following two declarations: CORE & SHELL FOR FUTRE RETAIL 1. I have and will maintain certificate of consent to self -insure for Worker's REVISION #1 - HVAC ROOFTOP UNITS; (N) GAS METERS. - 5/31/2016 Compensation, as provided for by Section 3700 of the Labor Code, for the DEF # 4 - ROOF JOIST SHOPS & CALCS. ISSUED 5-13-16 performance of the work for which this permit is issued. DEF # 3 - GLAZING SHOPS & CALCS: ISSUED 3-16-16 2. I have and will maintain Worker's Compensation Insurance, as provided for by DEF#2 - STRUCTURAL DESIGN FOR EXT. CLADDING SYSTEM - Section 3700 of the Labor Code, for the performance of the work for which this ISSUED 3-30-2016 permit is issued. DEF#1 - BRB SHOPS AND CALCULATIONS.- ISSUED 2/16/16 APPLICANT CERTIFICATION I certify that 1 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 Sq. Ft Floor Area: Valuation: $1019700.00 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, costs, and expenses which APN Number: Occupancy Type: may accrue against said City in consequence of the granting of this permit. 31620 112 Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. PERMIT EXPIRES IF WORD IS NOT STARTED Signature Date WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by: Legacy following two reasons: Date: 09/21/2015 1. 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 ROOFS: sale (Sec.7044, Business & Professions Code) t an material being installed. If roof is All roofs shall inspected prior to any rooting z 1, as owner of the property, am exclusively contracting with licensed , I e installed without first obtaining an inspection, I agree to remove all new materials for t contractors to construct the project (See.7044, Business & Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: r. I have and will maintain a Certificate of Consent to self -insure for Worker's Signature of Applicant: Compensation, as provided for by Section 3700 of the Labor Code, for the Date: performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health & Safety Code, Sections 25505, 25533, and 25534. I will Worker's Compensation laws of California. If, after making this certificate of maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the exemption, I become subject to the Worker's Compensation provisions of the Health & Safety Code, Section 25532(a) should I store or handle hazardous Labor Code, I must forthwith comply with such provisions or this permit shall material Additionally, should I use equipment or devices which emit hazardous be deemed revoked. air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and APPLICANT CERTIFICATION the Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 Owner or authorized agent: to enter upon the above mentioned property for inspection purposes. (We) agree Date: CONSTRUCTION LENDING AGENCY to save indemnify and keep harmless the City.of Cupertino against liabilities, in I hereby affirm that there is a construction lending agency for the performance judgments, costs, and expenses which may accrue against said City of work's for which this permit is issued (Sec. 3097, Civ C.) consequence of the granting of this permit.. Additionally, the applicant understands and will comply with all non -point source regulations per the CupertinoMunicipal Lender's Name Code, Section 9.18. Lender's Address Signature Date ARCHITECT'S DECLARATION understand my plans shall be used as public records. . 9 CUPERTINO IEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING i 1SI0 10300 TORRE AVENUE • CUPERTINO, CA 95014 -!VIN C 5 N # (408) 777-3228• FAX (408) 777-3333 • building(cD-cupertino.org 1506 00;-`0 ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT PROJECT ADDRESS i bC� i C = fJ! APN f 2 6 F7 V 8LJ ( { q—, OIANERNAME YY l `�°) C �f(1AP { �.. (� PHONE 5c)— -d C) E-MAIL STREET ADDRESS .. ,nnt �j!J / l�p �� CITY, STATE, ZIP ky4llo, y, /k t FAX j n CONTACT NAME p PHONE'/ 0 �f /��Y? F A fl% G✓ LJf j/ 111 1 C _ (�J (/(i STREET ADDRESS .may _ _p i' ' CITY, STATE, ZIP = " FAX ❑ OWNER ❑ OWNEREERR ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGDMR -❑ DEVELOPER ❑ TENAISf R--B�UI CONTRACTORNAME / ry LICENSENUMBER LICENSETYPE BUS. LIC COMPkNY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME �"C.� 1 j11&`� ( a C?! LICENSE NU YBER BUS. LIC R COMPANYNAME�� nGy f/E 1� (fES f rr E-MAIL � C�6�6 #rGr�� �(O� FAX STREET ADDRESS 5(j �!'� CITY, STATE, ZIP r 6 PHONE DESCRIPTION OF WORkReq EXISTINGUSE PROPOSED USE .- �.�y CONSTR TYPE 4-STORI_FS @I 'B - USE T YPE ) OCC. SQ.FT. - VALUATIONS) 70?) 1�019 E.l'ISTG NEW FLOOR - AREAa7J 91 DEMO AREA BATHROOM KITCHEN OTHER. REMODEL AREA REMODEL AREA -.� REMODEL AREA PORCH AREA DECK AREA _�®> TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ST ❑ ATTACH - �DWELLINGUNITS: ISASECONDUNIT ❑YES SECOND STORY- ❑YES - BEING ADDED? -&NO ADDITION? ).NO PRE -APPLICATION ❑YES 1F YES, PRO\ ,�'DE COPY OF IS THE BLDG AN ❑YESR= - t .- - - 6 _TOTAL.. _ _ UATION: PLAMNING ADPL r ❑ NO ' PLANNING APPROVAL LETTER EICHLER HOME? "NO B}, my signature below, I certify to each f the oil a I the perty owner Or Ike ac e property owner's behalf. I ave read this information I halve i t. Descriptio t Wor and ve ' rt is accurate. I agree to comply wi all applicable local application and the pr vid a r ad e ordinances and state Iaws relating `- ` `. .iz- tt esentanves of Cupertino to enter the;pbo-'e,id• rTed nroperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL ORl� N QUI D wrt_.L� ccx� DESIRE Mew SFD er h4ultifamily dv�>ellings: Appl rd oliti permit for—� existing building(s). Demolition permit is require pno to suance of building OYRTHE-CO'QhTER 7' BUII,DLRGPLANILEY�tV _ permit for new building. 1� BEss5 1�� ALTiGPI ANREVTEFT Commercial Bldgs: Provide a completed Hazardous Materials Disclosure _Ta.nsxD r ruBLzv�oRxs _ form if any Hazardous Materials are being used as part of this project. - FZIZE�EPS x Copy of Planning Approval Letter or Meeting with Planning prior to ££ T - � _ submittal of Building Permit application. h3A7OR � �� � SA�'iLARYSEiiO1R�ISTRICT 3 BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15060020 19479 STEVENS CREEK BLVD (316 20 112) SB C C INC CAMPBELL, CA 95008 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/21/2015 OWNER'S PHONE: 408-725-1955 PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #336974 Contractor S B C C INC Date 93/31/2016 BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH _ RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: MAIN STREET - SHOP 6 - CONSTRUCT N 6,798 S,R I hereby affirm under penalty of perjury one of the following two declarations: CORE & SHELL FOR FUTRERET-AIIT----------- -'"\ 1. I have and will maintain a certificate of consent to self: insure for Worker's D ## 3 - GLAZILIG SHOPS & CALCS.—IS-SUED.-3-16-16---' Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 'N 2. 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. Sq. Ft Floor Area: Valuation: $1019700.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Typc: and state laws relating to building construction, and hereby authorize 316 20 112 - 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, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source ripulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Q Date 08/1616 Issued by: Sean Hatch 1/ Date: 03/16/16 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the properly, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (See.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 03/16/16 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to 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 Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safetyode, Sections 2 505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked Owner or authorized agent: APPLICANT CERTIFICATION Date:03116/16(11 I certify that I have read this application and state that the above information is V CONSTRUCTION I ENDINGAGENCV correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S FC RATION Code, Section 9.18, 1 understand my plans shall be used as public records. Licensed Signature Date /0316/16 g Professional • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DI + 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.org Shop 6 [_1 NEW CONSTRUCTION ❑ ADDITION F] ALTERATION / Ti FR REVISION / DFFFRRF.D ORICANAI. PERMIT # 15060020 PROJECT ADDRESS 19479 Stevens Creek Blvd APN# OWNER NAME Sand Hill Const Management PHONE [� E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 G CITY, STATE, ZIP Menlo Park 94025 FAX CONTACT NAME Nandy Kumar PHONE 650-344-1500 E-MAIL n'kumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX OWNER.. ❑. OWNER -BUILDER ❑ OWNER AGENT 11 CONTRACTOR El CONTRACTOR AGENT 11'ARCH ITFCT ARCHITECT ElENGINEF,R ElDEVELOPER ❑TENANT CONTRACTOR NAME Summer Olson -Todd LICENSE NUMBER 836974 v LICENSE TYPE R BUS. LIC# 5655 COMPANY NAME South Bay Construction E-MAIL solsontodd@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408-379-5500 ARCHITECT/ENGINEER NAME Cliff iff Chan V LICENSE NUMBER BUS. LIC # COMPANY NAME Chang Architecture E-MAIL cliff@changarchitecture-con I FAX STREET ADDRESS 251 Park Road, #900 CITY, STATE, ZIP Burlingame, 94010 PHONE 1 DESCRIPTION OF WORK 6 EXISTING USE. - PROPOSED USE CONSTR. TYPE - # STORIES - USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG. NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL-DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UMTS: ISA SECOND UNIT - ❑ YES SECOND STORY BEING ADDED? ❑ NO ADDITION? NO PRF, -APPLICATION ❑YFS IF YES, PROVIDE COPY OF I, F. BLDG A YES - TOTAL VALUATION, PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER E - the property owner's behalf. I have rea By my signature below; I certify to each of the following; I am the property owner or auth a�vq,.,t application and the information I have provided is correct. I have read the Description of Wo andccurate. I agree to comply with all applicable loc ordinances and state laws relating building const on. I autho 'ze represent fives of Cu above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN`CIIECI rYPE xUUTiNo AP . n O -Q� ER rxE co[tNTEx silr� nrN PLANJREvrEW '' New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑` EXPRESS _ ❑ , rLANN3IV+ PLA1�.1t£vlLw ` _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure©' sTAlvna rcD ❑ PUBLT, WORT v form if any Hazardous Materials are being used as part of this project. >ARSE ` ❑ FIrzE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to lviA�SANIT113T swEbisTicm'° submittal of Building Permit application.' L; ENVIRONMENTALi3EALTI3 •., . B1dgApp_2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15060020 19479 STEVENS CREEK BLVD (316 20 112) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/21/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lie. #336974 BLDG PLUMB Contractor S B C C INC Date 03/31/2016 — _ELECT — MECH —COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ——RESIDENTIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: MAIN STREET - SHOP 6 - CONSTRUCT (I) 6,798 S.F. I hereby affirm under penalty of perjury one of the following two declarations: CORE & SHELL FOR FUTRE RETAIL 1. I have and will maintain a certificate of consent to self-insure for Worker's DEF # 3 - GLAZING SHOPS & CALCS. ISSUED 3-16-16 Compensation, as provided for by Section 3700 of the Labor Code, for the DEF#2 - STRUCTURAL DESIGN FOR EXT. CLADDING SYSTEM - performance of the work for which this permit is issued. ISSUED 3-30-2016 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by DEF#1 - BRB SHOPS AND CALCULATIONS.- ISSUED 2/16/16 �( Section 3700 of the Labor Code, for the performance of the work for which this ? \ permit is issued. APPLICANT CERTIFICATION Sq. Ft Floor Area: Valuation: $1019700.00 1 certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 316 20 112 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, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal ode, Section 9.18. n, 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 3/30/201 Issued by: ABBY AYENDE Date: 3/30/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS,: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sce.7044, Business & Professions Code). Date: 3/30/2016 1 hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this. California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of air contaminants as compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the will maintahr 5 the Health & Safety de, Sections 25505, 233, 553 Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. G Owner or authorized. agent: APPLICANT CERTIFICATION Date: 3/30/201 I certify that I have read this application and state that the above information is CONSTRUCTION LENDINGAGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C,) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 3/30/201 Q Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION B 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 buildingCo-kupertino.org Shop 6 El NEW CONSTRUCTION ❑ ADDITION L I ALTERATION / TT FX RFVTSTON / T)F.FFRRFTn [iRIC:TNAT PFRMTT H 1 ioRon2o PROJECT ADDRESS 19479 Stevens Creek Blvd APN# OWNERNAME Sand Hill Const Management PHOm650-344-1500 E -MA, nkumar@shcmllc.com STREET ADDRESSCITY 2822 Sand Hill. Rd, Ste 241 STATE, ZIP Menlo Park 94025 FAX CONTACT NAME Nand Kumar y PHONE 650-344-1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX IXOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ElARCHITECT ' ElENGINEER ElDEVELOPER 11TENANT CONTRACTOR NAME Olson -Todd J Summer LICENSE NUMBER 336974 LICENSE TYPE B BUS. LIC# 5655 COMPANYNAME South Bay Construction E-MAIL solsontodd@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408-379-5500 ARCHITECT/ENGINEER NAME Cliff V l I ff Chan LICENSE NUMBER BUS. LIC # COMPANYNAME -Chang Architecture E-MAII cliff@changarchitecture.coniFAx STREET ADDRESS 251, Park Road, #900 CITY, STATE, ZIP Burlingame, 94010 PHONE650-269-4213 DESCRIPTION OF WORK e s Tim. L o a 2 (_C EXISTING USE 'PROPOSED USE CONSTR. TYPE # STORIES _ USE TYPE OCC. SQ.FT. VALUATION ($} EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM _. KITCHEN _ OTHER - .. REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH I # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY OYES BEING ADDED? E]NO ADDITION? []NO - PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES EI D BY:: TOTAL V CATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICI-ILER HOME? r1 - 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 behalf. I hake read this application and the information I have provided is correct. I have read the Description of W • rk and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat building construction. I t ri represe tives C ertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: r Date: SUPPLEMENTAL TION PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building 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 ❑ MAJOR, ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ENVIRONMENTAL HEALTH. B1dgApp_2011.doe revised 06/21/11 X5.5 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDINGDIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.org Shop 6 F-1 T.Taw rnT.TrPDTT Prn1U n AnT)TTI(IN 1-1 AT TFR ATTON / TT I XI REVISION /DEFERRED ORIGINAL PERMIT # 15060020 PROJECT ADDRESS 19479 Stevens Creek Blvd T7 # OWNER NAME Sand Hill Const Management PHONE E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822. Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX CONTACT NAME Nandy Kumar I PHONE 650-344-1500 E-MAIL nkumar@shcmllc.com STREETADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX RONERW ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Summer Olson -Todd LICENSENUMBER 336974 LICENSE TYPE p G7 BUS. LIC# 5 J655 COMPANY NAME South Say Construction South E-MAIL - solsontodd@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408-379-5500 ARCHITECT/ENGINEERNAME Jeff Brink LICENSENUMBER BUS. LIC# COMPANY NAME DCI Engineers E-MAIL jbrink@dci-engineers.com FAX STREET ADDRESS One Post Street, Suit 1050 CITY, STATE, ZIP San Francisco, CA 94104 PHONE (425) 781-1505 DESCRIPTION OF WORK Structural design of exterior cladding system. Deferred submittal per plans — SV �. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM - KITCHEN - REMODEL AREA REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: IS A SECOND UNIT [-]YES BEINGADDED? []NO SECONDSTORY- []YES ADDITION? [:]NO PRE -APPLICATION [I YES IF YES, PROVIDE COPY OF PLANNING APPL # rl NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES - BY' EICHLER HOME? TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or ed e o 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 Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rela to building constr eti, . I autho - e representati es of Cupertino to enter the abo� nhired r erty for inspection purposes. ate: Signature of Applicant/Agent: ( (xJ D 6/7 SUPPLEMENTAL INFORMATION REQUIRED L _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECKTYPE POUTING BLIP C1 OVER-THE-COUNTER _ ❑ EXPRESS a ss n STANDARD F1 LARGE Q MAJOR CI BUILDING PLAN [ EVIMV Q PLAIt1NINGPLAN REV tL?1V F1 PUBLIC"NVORKS © DI P © s&vi'FA v swm I}lS icr El: Ei4-t'HbO,S'MENTALHEAE,TkE BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15060020 19479 STEVENS CREEK BLVD CUPERTINO CA 95014 (S B C C INC) CAMPBELL, CA 95008 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/21/2015 OWNER'S PHONE: PHONE NO: 408-379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 8 Lic. #336974 Contractor ( S B C C INC ) Date 02/16/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL. COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - SHOP 6 - CONSTRUCT (N) 6,798 S.F. I hereby affirm under penalty of perjury one of the following two declarations: CORE & SHELL FOR FUTRE RETAIL r. I have and will maintain a certificate of consent to self -insure for Worker's DEF#2 - STRUCTURAL DESIGN FOR EXT. CLADDING SYSTEM Compensation, as provided for by Section 3700 of the Labor Code, for the DEF#1 - BRB SHOPS AND CALCULATIONS.- ISSUED 2/1,6/16 ,performance of the work for which this permit is issued. 2. `' I have and will maintain Worker's Compensation Insurance, as provided for iAby Section 3700 of the Labor Code, for the performance of the work for which Sq. Ft Floor Area: Valuation: $1019700.00 this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: 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, costs, and PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. c Signature ' 'I Date 02/16/2016 Issued b y. v Date: 02/16/2016 -ROOFS: OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: z. I, as owner of the property, am exclusively contracting with licensed Date: 02/16/2016 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I, Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sectio 25505, 5533, a 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent _� Date: 02/16/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that t have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations perlhe I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Signature Date 02/16/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • buildin-gReupertino.org Shop 6 CUPERTINC ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI [ REVISIO / DEFERRED ORIGINAL PERMIT # 15060020 PROJECT ADDRESS 19479 Stevens Creek Blvd APN# OWNERNAME Sand Hill Const Management PHONE E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY' STATE°Z' Menlo Park, 94025 FAX CONTACT NAME Nandy Kumar PHONE 650-344-1500 E-MAIL nkumar@shcmllc.com STREET ADDREss 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX DOWNER ❑ OWNER-BUH:DER ❑ OWNER AGENT ❑ CONTRACTOR Il CONTRACTOR AGENT I3. ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT " CONTRACTOR NAME Summer Olson -Todd LICENSE NUMBER 33697^ `7 LICENSE TYPE B BUS, LIC# 5655 COMPANYNAME South Ba Construction Bay E-MAIL solsontodd@sbcl.com FAX STREETADDRESS 1711 Deli Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408-379-5500 ARCHITECT/ENGINEER NAME Cliff Chang LICENSE NUMBER BUS. LIC # COMPANY NAME ChangArchitecture E-MAIL MAIL cliff@changarchitecture.co FAX STREET ADDRESS 251 Park Road, #900 CITY, STATE, ZIP Burlingame, 94010 PHONE DESCRIPTION OF WORK A �v Jv 4 EXISTING USE PROPOSED USE CONSTR. TYPE - # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) 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: ISA SECOND UNIT []YES SECOND STORY OYES BEING ADDED? 'ONO ADDITION? ,ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: VALUAT TOTAL ION: PLANNING APPL # O NO PLANNING APPROVAL LETTER EICHLER HOME? O 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 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 accurate. I agree to comply with all applicable local ordinances and state laws relyjto building cons tion. I a yole repre nta 'ves of Cupertino to enter the above, -identified property for inspection purposes. 1�TI Signature of Applicant/Agent• , \., Date: , t i) SUPPLEMENTAL INFORMATION REQUIRED PLANCHECKTYPE ROUTING SLIP El OVER-THE-COUNTER ❑ BUH.DING PLAN REviEw New SED or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC Woltics form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ EIRE DEPT Copy of Planning Approval Letter or Meeting With Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp 2011.doc revised 06121/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19479 STEVENS CREEK BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 15060020 CONSTRUCTION, INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 1711 DELL AVE DATE ISSUED: 09/21/2015 OWNER'S PHONE: 6503441500 CAMPBELL, CA 95008 PHONE NO: (408)379-5506' - _ }; LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ MAIN STREET - SHOP 6 - CONSTRUCT (N) 6,798 S.F. License Class Lic. # +� �,f CORE & SHELL FOR FUTRE RETAIL Contractor c .—�L+- !} Date "Z G Chapter 9 I hereby affirm that I am license under the provisions of (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: . Ft Floor Area: Valuation: $1019700 Sq. 1. I have and willmaintain a certificate of consent to self -insure for Worker's _ .... Compensation, as provided for by Section 3700 of the Labor Code, for the APN Number: 31620085.19479` Occupancy Type: 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 EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS O + T ISSUANCE OR APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is 180 DAYS LAS LED INSPECTION. 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 Date: upon the above mentioned property for inspection purposes. (We) agree to save =by. 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 pe, 't. Additionally a applicant understands and will comply with -ROOFS: all non -point icer lation r the Cupertino Municipal Code, Secttion/9�18. All roofs shall be ins or to any roofing material being installed. If a roof is for .I installed without fitaining an inspection, I agree to remove all new materials Date_ Signature Jinspection. Signature of Applicant: Date: F1 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: t. I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the sale (Sec.70 44, Business &Professions Code) 2. I, le owner 4 the property, Pr exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain the Cupertino Municipal Code, Chapter 9.12 and the Health & construct the project (Sec.7044, Business &Professions Code). compliance with Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air I hereby affirm under penalty perjury' one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ti maintain co ' nee with the Cupertino Municipal Code, Chapter 9.12 and the Compensation, as provided for by Section 3700 of the Labor Code, for the Health afety ode, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Ow r r aut ze a ent• Date: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. 1 certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If, after making this certificate of exemption, I for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. correct. l 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 Licensed Professional 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 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. Signature Date CONSTRICTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX (408) 777-3333 • buildingna cupertino.orq �257 > W CONSTRUCTION ❑ ADDITION ❑ ALTERATION ! TI ❑ REVISION / DEFERRED ' ORIGINAL PERMIT # �J PROJECT ADDRESS v IVeCi APN 9 / Z 6 OWNER NAME J f a ( ,�� 0� PHONE 5c)- 1 -� ®�9 E-MAIL STREET ADDRESS ,� o8t (y J� 1� CITY, STATE, ZIP 1� ry, �L� FAX VV CONTACT NAME § r ,p PHONE�� �a (✓V � = �� F ��I �GJ d1%Lf'�I , { 'Nl�i,l STREET ADDRESS CITY, STATE, ZIP FAX 11 OWNER ❑ OWNER-BuiLDER ❑ 01AWERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT _ ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICEAISENUMBER T_ LICENSETYPE BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE j ARCHITECTIENGI1,1EERNAME / LICENSE NUMBER � BUS. LIC 9 OMPANY NAME - 1 i �l.m��y 111 CE-MAIL '? 1� � FAX STREET ADDRESS 2,5 g _ $/ �! g c)o CITY, STATE, ZIP &v v-1!' ��' L7• PHONE .® - DESCRIPTION OF WORK �aSX r %g �j dys Pps�(�11 \Bn/ (O ! `'✓ nnw fl QkaLv!9 D PU4W-+- QwOrke,*d 05 4f4 or bl�e_+Ski cy"�/w Y11 EXISTING USE PROPOSED USE CONSTR TYPE # STORKS USE TYPE OCC. SQ.FT. VALUATION (S) - . - EXISTG NEW FLOOR- I DEMO TOTAL AREA AREA AREA NET m BATHROOM. REMODEL AREA KITCHEN.. REMODEL AREA ..�` OTHER. REMODEL AREA ^-®--- TOTAL ALUATION: PORCHAREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDErACH - - e ac e property owner's behalf. I have read this application and the information I have provid i correct. ave read the Descriptio Wor and ve ' It is accurate. I agree to comply with all applicable local ordinances and state laws relating to uildi n tructi thorize r presentatives of Cupertino to enter the above -identified pr,perty for inspection purposes. ❑ ATTACH I Date: ` # DWELLING UNITS: ISA SECOND UNIT []YES - SECOND STORY []YES � _ Roirr�.c sr zP BEINGADDED? 2KNO ADDITION? IgNO � BUII,DINGPLANI2EYIEYiT PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESRECHI VE - - TOTAL ALUATION: PLANNING APPL;f ❑ NO PLANNING APPROVAL LETTER EICHLER HOIvSE? `NO _g I y By my signature below, I certify to each of the following: I am the properly mvner or e ac e property owner's behalf. I have read this application and the information I have provid i correct. ave read the Descriptio Wor and ve ' It is accurate. I agree to comply with all applicable local ordinances and state laws relating to uildi n tructi thorize r presentatives of Cupertino to enter the above -identified pr,perty for inspection purposes. Date: ` Signature of Applicant/Agent: SUPPLEMENTAL VFOR34ATION REQUIRED, � _ Roirr�.c sr zP New SFD or Multifamily d«>ellings: Apply for demolition permit for � BUII,DINGPLANI2EYIEYiT existing building(s). Demolition permit is required prior to issuance of building for new building. ExPx�ss� © PANAII.c PLA�rxEylEw permit Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q saANva�zDPUSLIwoRres 10- �- _ form if any Hazardous Materials are being used as part of this project.. ' t LA12�> rFII2E�FT _� Copy of Planning Approval Letter or Meeting with Planning prior to 4 RIs uc _ Building Permit application._ AR submittal of BId,-App 2011.doc revised 06/21/11 CITY OF CUPERTINO WMA FEF, ESTIMATOR — BUILDING DIVISION 19479 STEVENS CREEK BLVD DATE: 06/03/2015 REVIEWED BY: MELISSA 1wADDRESS: APN: 31620085.19479 BP#: *VALUATION: 1$1,019,700 *PERMIT TYPE: Building Permit Shell Bldgs PLAN CHECK TYPE: New Construction PRIMARY Commercial Building USE: $9,430.46 Civil / Religious activities in BQ zone? 0Yes j No PENTAMATION PERMIT TYPE: 1SHELLBLDG WORK MAIN STREET - SHOP 6 - CONSTRUCT N 6,798 S.F. CORE & SHELL FOR FUTRE RETAIL SCOPE Suppl. Insp. Fee -(E) Reg. Q OT 0,0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID Shell Bldgs 11-8,111-B,IV,V-B 6,798 $9,430.46 IOSPLNCK $7,141.20 IOSINSP Permit Fee: $7,141.20 Suppl. Insp. Fee -(E) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0;00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $19,918.14 Adtifinistrative I.'ee O Work Without Permit? 0 Yes C No $0.00 TOTALS: 6,798 $9,430.46 I'r°Ovel Doeal nentotioll Fees: 1 $7,141.20 Strong Motion Fee: 1BSEISMIC0 NOTE: This estimate does not include fees due to other Departments (ie. Planning, Yuouc Works, Iire, Ounuury Sewer LrJrrrcg .zwav�s r —I , T,_....,. , - r a __ IL. nvallahlo and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 E . 711113) Alcon. Pear, Check Phardl;, Plan Check Alec, /an Check Tech. Pormit Fite: Phinih, Pern7ii F'(C--': Elec. PG' rinFee: Other l-fcch..irnpt Ocher Plumb b C�7 �Zt-'t`E i .. l;'SLr. I['ert If7Sl, `:'.£%.' lrnszy. -'.t lbd Insn. Fee: Elec. hul) tee. NOTE: This estimate does not include fees due to other Departments (ie. Planning, Yuouc Works, Iire, Ounuury Sewer LrJrrrcg .zwav�s r —I , T,_....,. , - r a __ IL. nvallahlo and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY, MISC ITEMS Plan Check Fee: $9,430.46 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: E Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $7,141.20 Suppl. Insp. Fee -(E) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0;00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $19,918.14 Adtifinistrative I.'ee O Work Without Permit? 0 Yes C No $0.00 Advanced Planning Fee: IPLLONGC $1,971.42 Select a Non -Residential E Building or Structure I'r°Ovel Doeal nentotioll Fees: Strong Motion Fee: 1BSEISMIC0 $285.52 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $41.00 SUBTOTALS: P38,787.741 $0.00 TOTAL FEE: 1 $38,787.74 Kevisea: uwulfzu 10 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue C:uperlino,.CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 19479 Stevens Creek Blvd -Shop 6 PERMIT # 15060020 OWNER'S NAM E:Sand Hill Management PHONE # _ GENERAL CONTRACTOR:Soutli Bay Construction BUSINESS LICENSE 4'5655 ADDRESS:1711 Dell Ave CITY/ZIPCODE:Campbell, CA 95008 `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. 1 am not using any subcontractors: ---- Signature Please check applicable subcontractors and complete the.following information: Date a/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork X Cement Finishing Noah Concrete 29578 X Electrical Wong Electric - 20368 X Excavation Tucker Engineering 34378 Fencing Flooring/ Carpeting Linoleum / Wood X Glass / Glazing Classic Glass 25840 X Heating The Trillo Company 2981.6 X Insulation Central California Insulation 557 --- Landscaping X Lathing Oliveira Plastering - 40153 r X Masonry Pacific Bay Masonry . 25509 X Painting /,Wallpaper Burdick Painting 26007 Paving X Plastering Oliveira Plastering - 40153 X Plumbing Fresno Plumbing &. Heating . 32000-- X Roofing Statewide Roofing 23509 r' Septic Tank X Sheet Metal The Trillo Company ! 29816 X Sheet Rock South Bay Interiors 25499 X Tile Take It For Granite ' 26585 ,el4z � 4/27/16 Owner /Contractor Signature Date