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15120115I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 20525 MARIANI AVE �' CONSTRUCTOR: INC CON I PERMIT NO: 15120115 I OWNER'S NAME: 20525 MARIAM DRIVE LP 1 690 GIBRALTAR DR 1 DATE ISSUED: 12/14/2015 1 OWNER'S PHONE: 4084721275 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # 6 9 i (03 Contractor hie; (Q��j1tj(jate��C a 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. J 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. 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 ot 1 In r Date RA � ❑ OWNER -BUILDER 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. MILPITAS, CA 95035 PHONE NO: (408)942-8200 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL T.I. PREP DEMO - GROUND FLOOR (WEST WING) / 6265 S.F. (REFERENCE PERMIT#15080104) Sq. Ft Floor Area: I Valuation: $14000 I APN Number: 32656001.20525 1 Occupancy Type: I 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 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPE TI N. 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 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 Code, Sections 25505. 25533, and 25534. % Owner or authorized agent: 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional DEMOLITION PERMIT APPLICATION 1 J 1 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildincJCo)-cupertino.ora C PROJECT ADDRESSAPN # r� � i C� jb OWNER NAMEi PHONE 1 E-MAIL DQ LPF 7 - 144 , 9Ai C -a Ma loraw P tZaD� STREET ADDRESSCITY, STATE,. ZIP FAX .CONTACT NAME f PHONE , -Nl� E-MAIL _ CU o'n @N_u_cop- co STREET ADDRESS } ,- FAXr - ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT - CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER(s LICENSE TYPE BUS. LIC FAX .,: .....- ;X.~ + @�.3"T COMPANY NAME _0 € kn( E-MAIL - 1 ., t. x!11 C Gi }J , ~ . STREET ADDRESS��° �I CI Y, STATE,ZIl PHONE A s `fi • 1 DESCRIPTION OF WORK r £ n o d , o r1 Qs'. �I•) fitn�,, �g �llq ft t t C �t kmfto V W7 -t 4 i. o ' .S. r 9kiJi7. E,� a r Lda/tlV itl ee�V (D ice,\1f Vi✓{'IS ,M fWco Y), VS L t 'SA/®b` Yl. di.7L 0�9.,w/1obU- 64"2 CWSVXU RR RESIDENTIAL # DWELLING "OFFICEU --USE VALUATION - FLOOR AREA UNITS COMMERCIAL //�� FLOOR AREA (o - TYPE OF CONSTRUCTION #STORIES AQMD JOB NUMBER T tRECEIVEDBY f� TOTAL VALUATION: 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 relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: fi Date: I '' / a moi"` f i 53 SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT .OFflTCE u -SE ONLY -: Provide Job Number from Bay Area Air Quality Management District www.baggmd.org @ 415-749-4762. r cREcK'TYPF _ Provide three copies (Residential) or six copies (Commerical) of a site plan showing protection for any trees 10"ss in diameter or more at 3' above grade. STANDARD _ Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) L MAJOR _ certified in asbestos, mercury and/or hazardous material examination. Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. _ Provide letter of clearance of all vermin from a licensed pest control contractor. — Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection. Provide signed Debris Bin and Recyclable Materials form. DemoApp_2013.doe revised 02/13113 coin CITY OF CUPERTINO 1%.L011,5 FEE ESTIMATOR - RITILDING DIVISION IADDRESS: 20625 Mariani Ave ---FBP#: & DATE: 1 211 41201 5 QTY/FEE REVIEWED BY: PAUL APN: 326 56 001 - $0.00 *VALUATION: 1$14,000 'PERMIT TYPE: Building Permit Suppl. PC Fee: (E) Reg. 0 OTF7oo PLAN CHECK TYPE: Alteration I Addition / Repair PRIMARY USE. Commercial Building 0 $O.Od Civil / Religious activities in BQ zone? 0 Yes (F) No $0.00 PENTAMATION PERMIT TYPE: ITIPREP WORK DEMO - GROUND FLOOR (WEST WING) 16265 S.F. (REFERENCE PERMIT #15080104) SCOPE FLEKP Q•0 hrs P Ak""b.hisp. NOTE: This estimate does not fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc These ees I are based on the relimina information available and are onlyan estimate. Contact the Dept for aaan't mfo. FEE ITEMS (Fee Resolution 1.1-053.tff 7/11.13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $417.00 Tenant improvement Prep 177PREP 1 'A Suppl. PC Fee: (E) Reg. 0 OTF7oo I hrs 0 $O.Od PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp, Fee.E) Reg. 0 OT Q•0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC F-71 $0.00 tro'lit,c, Fee: Work Without Permit? C) Yes E) No $0.00 Advanced Plannin&Fee- _ $0.00 Select a Non -Residential Building or Structure 0 Str2ng Motion Fee: IBSEISMICO $3.92 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 T, 9i JL $4,92 $417.00 $421 . 92 _j