13120161CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20450 STEVENS CREEK BLVD
CONTRACTOR: GIDEL AND KOCAL
PERMIT NO: 13120161
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS
574 DIVISION ST
DATE ISSUED: 12/19/2013
OWNER'S PHONE: 4085730121
CAMPBELL, CA 95008
PHONE NO: (408) 370-0287
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
FLOORS 4 & 5, UPGRADE ALL RESTROOM FACILITIES ( 4
License Class_ Lic. # a '2��'
TOTAL, 2 ON EACH FLR) FOR ADA COMPLIANCE
Contractor :) i .�", i - � Date .,pNrZf/
I hereby affirm that I am licensed under the provisions of 6bapter 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:
1 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
Sq. Ft Floor Area:
Valuation: $150000
performance of the work for which this permit is issued.
tiave and will maintain Worker's Compensation Insurance, as provided for by
Section 370.0 of the Labor Code, for the performance of the work for which this
APN Number: 36901027.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
1 DAYS FRµ LED INSPECTION.
�...,�
indemnify and keepharmless the City of Cupertino against liabilities, judgments,
_, ...
W �
costs, and expenses which ma�accrue against said City in consequence of the
a
granting of this permit. Additionally, the applicant understands and will comply
Iss Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date,41,, �'
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.
❑ ^'f OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
1 have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
�"'""` `.
Owner or authorized agent -Date m�
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
CONSTRUCTION LENDING AGENCY
Compensation laws of Califomia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, 1 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
APPLICANT CERTIFICATION
Lender's Address
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 to enter
upon the above mentioned property for inspection purposes. (We) agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
1 understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations 'per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature....,,w.. �......� ... Date' �� yr
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
'im
ADDRESS: 20450 STEVENS CREEK BLVD
DATE: 12/19/2013
REVIEWED BY: MELISSA
PC FEE ID
AP'N: 369 01 027
BP#: j zr, e)l FP;
'VALUATION: 1$150,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial BuildingT
USE:
IBTIPLNCK
PENTAMATION 1 B TI
PERMIT TYPE: 19
WORK
FLOORS 3 & 4 UPGRADE ALL RESTROOM FACILITIES 4 TOTAL 2 ON EACH FLR FOR ADA
SCOPE
COMPLIANCE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
11-B,111-B,IV,V-B
738
$2,061.55
IBTIPLNCK
$902.85
1BTIINSP
Permit Fee:
$902.85
Suppl. Insp. Fee.e Reg. Q OT
T0.0
rhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_T
ConstruclionTON.,
F7
ridmb,iist6"!X;"lve F'ec:
4
E)
Work .Without Permit? 0 Yes E) No
$0.00
TOTALS:
738
$2,061.55
l ictlwl 00cr(11neatution Fee"":
$902.85
Strong Motion Fee: IBSEISMICO
��,�� �,�����,,�,��„���
Irr, f i ,i;
,r,,,,,,, ,fir,,,,,,,tCl[JZ2T�Y
' r
Vc(h. illof'Y ('I)eL'41
/,
1,hwdh, Noll Clwf A
IJcc:. t h,i ,C f
"'1c'.h, f c%ontt€ f'('C”
PCI na J``t r,':
LIt r ],cv ivit I gee:
0, her .��L'ch. %Fist").
�lII)cr Phltnq� 7
,I'Te(I?, tkl o. 1 ee:
P/ZvO)� �71.p. /,cc,
1-3(-(. %fdstJ. Fee'
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Hire, Sanitary Sewer District, School
Worirt oh 1 Thoco foot aro hacod nn tho nrolimi"ary infnrmn6nn nvailahlo and aro nniv an ovimato_ Cantart tho Dont far addn'1 infra_
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,061.55
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
1 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$902.85
Suppl. Insp. Fee.e Reg. Q OT
T0.0
rhrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_T
ConstruclionTON.,
F7
ridmb,iist6"!X;"lve F'ec:
4
E)
Work .Without Permit? 0 Yes E) No
$0.00
Advanced Planninng Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
A
l ictlwl 00cr(11neatution Fee"":
Strong Motion Fee: IBSEISMICO
$31.50
Select an Administrative Item
Bldy, Stds Commission .Fee: IBCBSC
$6.00
$3,001.90
$0.00 `�
$3,001.90
Revised: 10/01/2013
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
19
ADDRESS: 20450 STEVENS CREEK BLVD
DATE: 12/19/2013
REVIEWED BY: MELISSA
PC FEE ID
APN: 369 01 027
BP#: l
'VALUATION: 1$150,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
IBTIPLNCK
PENTAMATION 1B TI
PERMIT TYPE:
WORK
FLOORS 3 & 4 UPGRADE ALL RESTROOM FACILITIES 4 TOTAL 2 ON EACH FLR FOR ADA
SCOPE
COMPLIANCE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
sJ.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,111-B,IV,V-B
738
$2,061.55
IBTIPLNCK
$902.85
IBTIINSP
f"k,( fnsp Fcc,
$902.85
Suppl. Insp. Fee:Q Reg. O OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
,1d11ael>istr,,11 eFee°
Q
E)
Work Without Permit? 0 Yes No
$0.00
TOTALS:
738
$2,061.55
�f-`
$902.85
'
I�%
FEE
QTY/FEE
,�Ic(.h. Nan t
N"ri f c� A
l:f_>,rayon Uhf ck
i,fPC 17. f"Ph 1}I /l l i°C'.
i"hi b I,(,) trt itc.'(."
(�,1r; f` ( i,(,/ nw ec"
err . 2, frts/`�-E1__t_
i)lhr'Y f'Ir�i�rb ly'v" ,
ELLLJ
i)llwr' C1e((tr,51).I I
4�f (h. Tarp. i,G'(;'
f'Ili r,tb. h, /). / ",,
f"k,( fnsp Fcc,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Eire, Sanitary Sewer District, School
Di.ctriet. etc )_ These fees are based an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 ETf 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,061.55
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. O OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$902.85
Suppl. Insp. Fee:Q Reg. O OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
,1d11ael>istr,,11 eFee°
Q
E)
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
)ae �e l Fees:
Strong Motion Fee: IBSEISMICO
$31.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$6.00
%i,,,,
$3,001.90
$0.00 ►F;%'
$3 001.90
Revised: 10/01/2013
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
Ll 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPERTINO (408))1777-3228 - FAX (408) 777-3333 - buildinq(c�cupertino.orq
MFW CY)N.vTR I 1('TIC)M I I ADr)ITIOM I I AITFRATIC)N/Tf F1 RFvLQTom/T)FPFPRFr)
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C)PICANAL PFRMIT fi
PROJECT ADDRESS oq
ARN 4
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OWNERNAME PHONP
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E-MAIL
STREET ADDR
CITY,,STATE, Zi
CONTACTPH
EMAIL
STR.EETADDRES$,_
"Y4
CITYS TE, IP
T�l
FAX
❑ OWNER ❑ OWNER-BWLDER ❑ OWNER AGENT FCONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTO
LICENSE NIS I,
LICENSE TY7
BUS. LTC 9
COMPANY NAME
E-MAIL
FAX
STREET ADDRJr
CITY'S E, ZIP dP
ARCHITECT/ENGINIF CENSE NUMB
BRNAMEJ LI 7
,,_92 2 1
BUS. LTC 4
COMPANY NAME
E-MAIL
FA�iC�w
STREET ADDRESS
CITY, , STATE, ZIP_-
PHONE
DESCRIPTION OF WORK°7 Jz
V�, "v"A
V Von"
EXISTING USE
PROPOSED USE CONSTR,
TYPE
# STORIES
USE TYPE
OCC,
SQFT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
(c
_t -,y
�'15
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: LJ DETACH
0 ATTACH
�
4 DWELLING UMTS
IS A SECOND UNIT El YES
SECOND STORY ❑ YES
I BEING ADDED? []NO
ADDITION? ❑NO
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
NO LETTER
IS THE BLDG AN [:] YES
EICHLER HOME?
VALUATION:
PLANNING APPL 9 0 PLANNING APPROVAL
]NO
[:IT
5C;
,", I I I'll,
1
By my signature below, I certify to each of the following: I am the property owner or a orized agent to act on the 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 ace OelI agree to comply with all applicable local
ordinances and state laws relating to building construct%c+w 'i authorize representatives ofCupertinoto enter the above -identified property for inspection purposes.
Signature of Applicant/Agent Date: I d
SUPPLEMENTAL, INFORMATION REQUIRED
pq
z,
New SFD or Multifami , 1� 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
ionn 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.
B1dgApp_2011.doc revised 06121111
3to y/4 /;o �
CONTRACTOR / SU CONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
PERMIT # (31"t-9Tt♦�»
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
BUSE'VESS LICENSE #
ADDRESS: 57�z,/�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 INSPECTION(S) 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:
V
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
-
Owner / Contractor Signature
ate