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B-2017-0610 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0610 10881 N WOLFE RD CUPERTINO,CA 95014-0605(316 05 053) STIDHAM CONSTRUCTION • CHICO,CA 95926 OWNER'S NAME: CUPERTINO VILLAGE LP DATE ISSUED:07/11/2017 OWNER'S PHONE:530-591-7975 PHONE NO:408-307-3542 LICENSED CONTRACTOR'S DECLARATIONBUILDING PERMIT INFO: License Class B Lic.#755478 Contractor STIDHAM CONSTRUCTION Date 10/31/2018 X BLDG _ELECT _PLUMB MECH_RESIDENTIAL X 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: • T.I.-TEN REN TEA(823 S.F.) ' I hereby affirm under penalty of perjury one of the following two declarations: REV#1-REMOVE EXISTING STORE FRONT DOOR;INSTALL NEW 1. I have and will maintain a certificate of consent to self-insure for Worker's DOOR 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. Sq.Ft Floor Area: Valuation:$50000.00 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 APN Number: Occupancy Type: • and state laws relating to building construction,and hereby authorize 316 05 053 A(Tenant Improvements),B(Tenant Improvements) 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 regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. .!Signatur a`•a>'_ 41 (-, 114.___14.___ Date 10-9-2017 Issued by:Abby Ayende Date:07/11/2017 OWNER-BUILDER DECLARATION I hereby affirm that I ant 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. 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:10-9-2017 • i• I hereby affirm under penalty of perjury one"of the following three declarations: „A„ 1. I have and will maintain a Certificatelof Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS OR BETTER Compensation,as provided.for by Section 3700 of the Labor Code,for the performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's CompensatiotrInsurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,forthe 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 a. 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'sCompensation 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 25505,2 533,an' 25534. Labor Code,I must forthwith comply�with such provisions or this permit shall ' f t ' 1 be deemed'reyoI Owner or authorized agent. ,1 ! '0 APPLICANT CERTIFICATION Date:10-9-2017 `r I certify that I have read this application and state that the above information is CONSTR ICTION LENDING AGENCY 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 withlall',non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 10-9-2017 Professional CONSTRUCTION PERMIT APPLICATION \ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION V 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • w •,s (408) 777-3228 • building@cupertino.org PEMIT#B- 20/7 - ®tie, CUPERTINO REVS i DEFS ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION VT.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS 1 o/t nI . ` ./G APN I 31 r - ��, 0 S 3 OWNER NAME }V1lh IV''vl!/`jl PHONE (1�^ E-MAIL Parti LII LIDOS Z ID? 351/2 STREET ADDRESS ' 84^ r N. �a o CITY, STATE,ZIP ��B CA gs�r4 r {vd,1111 if ?-01 ['CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICE SE NUMBERCtea'rLICENSE TYPE / IV �lu l J4W bF4i�rpt �1<tit( �v�s'- 7S5j7 8 -Gewe/NAe REET ADDRESS CITY,STATE, ZIP I ,4/�G c urs CI/<C_c) E-MAIL PHONE BUS.LIC A 51-7�4Jan-t 0 C _co Sib -7O 1S-A. xARCHITECT 0 OWNER ❑OWNER AGENT D CONTRACTOR AGENT❑ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME tt E-MAIL �11�rnc1� 2n Wehaki e imicaag. Cool STREET ADDRESS CITY,STAT ZIP PHONE 2b 60 C�nCour'se_ Dr ta ' n jive. . (4 It/31 408 -91 - 7 Ydg DECRIPTON ' isiDrl tb Clsst. ern Ipxis-ri'rei swell-49Th deo-e- Q. ,tei49 G-f/brp{- ot.i It''r It 4tte i- (aQxPen. skaskv, O,) ?keit s - • ❑SINGLE-FAMILY/DUPLEX ❑MULTI:FAMILY 0 INDUSTRIAL ❑COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF ❑DETACHED EX1SiNG ❑YES EICHLER D YES SECOND STORY ADDITION D YES FIRE SPRINKLERS❑ NO ❑ NO ❑NO DWELLING SECOND'DWELLING ❑YES ❑ATTACHED DETACHED OTHER UNITS a UNIT ADDITON: ❑NO S F POOLS' ❑FIBERGLASS D VINYL-LINED 0 GUNITE D PREFABRICATED POOL-SF SPA-SF - I SPA ATTACHED ID YES ❑ NO I TOTAL-SF REK B TOTAL VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools reauires Department of Environmental Heath approval RE-ROOF'EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACED NO IF NO PLYWOOD El 1/2" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS , DYES SOF LAYERS THICKNESS El 5/8" OTHER ❑OSB ❑CDX OTHER .12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES D WOOD SHAKES DWOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF Sof SQUARES 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,•nspection purposes acknowledge and authorize all information contained on this application form to be made available for public record. Signature of Applicant/Agent: . 1- A ill ..A I Date: a01 SUPPLEMENTAL INFORMATI aN REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. "Commercial Buildings: 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. *HOA.Provide a letter of approval from the Home Owner's Association , .1 BldgApp_2017.doc revised 08/01/17 ' 1 1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10881 N WOLFE RD CUPERTINO, CA 95014-0605 (316 05 053) OWNER'S NAME: CUPERTINO VILLAGE LP OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class D Lic. #973916 Contractor TONKKS CONSTRUCTION Date 06/30/2018 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: 1. I have and will maintain a certificate of consent to self -insure for Worker's pensation, as provided for by Section 3700 of the Labor Code, for the erformance.of thework 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. 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. Date 8/21/2017 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) z. 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: 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. 3. 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. Date 8/21/2017 CONTRACTOR: PERMIT NO: B-2017-0610 TONKNS ' CONSTRUCTION MENLO PARK, CA 94025 DATE ISSUED: 07/11/2017 PHONE NO: (650) 906-1446 BUILDING PERMIT INFO: X BLDG —ELECT _ PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: T.I. - TEN REN TEA (823 S.F.) Sq. Ft Floor Area: Valuation: $50000.00 APN Number: Occupancy Type: 316 05 053 A (Tenant Improvements),B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 07/11/2017 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 of Applicant: Date: 8/21/2017 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 coin 'ance with the Cupertino Municipal Code, Chapter 9.12 and th&l it & Safety Code, Sections 25505, 25533, and 25534. Owethrized agent: D 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 CUPERTINO CONTRACTOR / W ONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone:: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: (" si UJOVE 9-t? PERMIT # - 13 Z-0 14 - 0610 .OWNER'S NAME: U `N o `f � tt AC L -P PHONE # `)O q0 L GENERAL CONTRACTOR:, C, S D CA L% �o 1 ✓a BUSINESS, LICENSE # 'AJQ3 ADDRESS:. CITY/ZIPCODE: cT460 Z *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE . SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS. HAVE OBTAINED A CITY OF CUPERTINO" BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check. applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #1 Cabinets' & Millwork smr VC -1 or, 10�- Cement Finishing Electrical Excavation 'Fencing'' Flooring / Carpeting .Linoleum / Wood Glass / Glazing- lazing Heat' Heating; Insulation Landscaping Lathing. Masonry ,Painting /,Wallpaper Paving. Plastering Plumbing Roofing Septic Tank Sheet Metal P,'- Sheet Rock Tile Owner / Contractor- Signature Date CSD California August 17, 2017 To whom it may concern Hereby I authorize Mr. Isidro Diaz Mendez (License No B 973916) to act as our licensed contractor for the job site on 10881 N Wolfe Road, Cupertino, CA 95014 Thank you for your consideration Hans Dornseif General Manager CSD California LLC Bank Name: BBVA Compass 2982 Pacific Avenue Account No: 6749544889 Livermore, CA 94550 Routing No: 321170538 i} a k J]J33 i 5 t t 3 2 1� p�p 7� g� 9jgg �t CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0610 10881 N WOLFE RD CUPERTINO, CA 95014-06015 (316 05 053) OWNER'S NAME: CUPERTINO VILLAGE LP DATE ISSUED: 07/11/2017 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION i BUILDING PERMIT INFO: License Class Lic. # Contractor Date i X_ BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: T.I. -.TEN REN TEA (823 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: 1. 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 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. Sq. Ft Floor Area: Valuation: $50000.00 APPLICANT CERTIFICATION 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 05 053 A (Tenant Improvements),B (Tenant Improvements) 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 Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date Issued by: Abby,erg Date: 07/11/2017 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. 1, 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 (See. 7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: I hereby affirm under penalty ofperjury 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 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 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 tp 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: APPLICANT CERTIFICATION Date: I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 Licensed Professional CITY OF CUPERTINO B UILDING P IIT BUILDING ADDRESS: CONTRA it: PERMIT NO: B-2017-0610 10881 N WpLFE IID GtJPERTIP7ED,' A95424 Ofi05 (316 05 053) CT1(}N VC0 CO 926 OWNER`SNAME: CUPERTINO VILLAGE LP DATE ISSUED: 0711112017 OWNEWS PHONE: 408-321-9988 PHONE Nti> (530) 624 283G LICENSED COiTRACTOWS 114CLARATION BUILDING G 1"i1RM1T INFO: License Class B. Lic. ##63M Contractor t IGGAN CONSTg .TIiTR Date f)313112018 X BLDG ELECT ! PLUMB I hereby affirm that I am licensed tender the provisions of Chapter 9 (comme ng MECH — RESIDENTIAL X COMMERCIAL with Section 7000) of Divislon 3 of the Business & Professions Code and t my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty ofperjury one of tele following two eclaratlous: \ / T.I. - TEN REN TEA (823 S.F.)�Y I I have and will maintain a certificate of consent to self ' sure for Worker's Compensation, as provided for by Section 3700 oft Labor Code, for the p'erformanca of the work far which this permit is' shed. ai x. I have and will maintain Worker's Compensa ' Insurance, as provided for by Section 3700 of the La6'or Corte for the. ormance of the work for which h _. > .. this r permit is issued. i Sq. Ft Floor Area: Valuation: $50000.00 I certify that I have read this appilication nd state that the above APN Number- Occupancy Type: Information is correct. I agree 10COM with ell city and county ordinances and state Issas relating to building " nstruetion, and hereby authorize 316 05 053 B (Tenant Improvements) representatives of Is city to en � upon the above mentioned property for inspection ptatposes. (Vete) a e to save indemnify and keep' harmless the City of Cupartin0 against Iia i ides; judgments,costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against Id tY In rouse of the ta of hats permit Additionally, #heap I underst rt an ¢-will comply ly wiwithhall non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR. source regulation n. 'Munlbipai Code, section 9.18, 1,80 DAYS FROM LAST CALLED .INSPECTION. Signature �-" DateZt,1112QJZ issued ,Ayende I iOW Date: Q2(1LZ I her y affirm that I am exempt from the Contractor's License Law for one of the I2E-ROOFS: fol wing two reasons' All All roofs shalt be inspected prior to any roofing material being installed. If a roof is 7r. 1, as owner of the property, or my employees with wages as their sole 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, Rosiness 4. Professions Code) L as owner of the property,, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & professions Code). Date: 7111120 I hereby affirm under penalty of perjury one,of the fuliowing three declarations: 1 have and will maintairi a Certificate ofConsent to self insure for Worker's I ROOF COVERINGS TO ISP. t LASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. NAZARQQLJ!J NIATF IAL§ Ql9QL-Q§URC z. I have and will maintain' Worker's Compensation Insurance, as provided for by I have road the hazardous materials regi4ements under Chapter 6.95 of the Section 3700 ofthe Labor Code, for the performance of the work for which this California health & Safety Cad; Sections 25505, 2,`+533, and 25534. 1 will j permit is Issued, maintain compliance with the Cup 'tido Municipal Code, Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issuer}, I Health & Safety Code, Section 2 532(a) should I stare or handle hazardous shall not employ any persona in any manner so as to become subject to ilte mural. Additionally, should.f use equipment or devices which emit hazardous i Worker's Compensation latus of California. If, after making this certificate of air contaminants as defined by the Bay res Air Quality 1Ylanagearent District i will maintain compliance with the C o:Muni d ; Chapter 9.12 and exemption, I became subject to the Worker's Compensation provisions of the the Health & Safety God ctlons 255 , 5533, d25534. Labor Code; I must forthwith comply with such provisions or this permit shall be deemed revoked. owns ! or authorized agent: APPLICANT CERTIFIGAT Date: 7111129 17 I certify that i have read this application and state that the above information is (.ON. IRLiCTIt?N LENDING AGZMY correct. I agree to comply with all city and county ordinances and state laws t 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 G.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's frame to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, crisis, and expenses which may accrue against said City in Lenders Address consequence of the granting of this permit. Additionally, the applicant understands,Ct;C and will comply with all non -point source regulations per the Cupertino Municipal f'S Dh GL.ARATION Code, Section 9.18. l understand m fans shelf be used as public records. y p Date 7/1112017 LicensedSignature Professional CONSTRUCTION POkMIT Adt-OCATION 2&01?%, -0610 COMMUNITY DEVELOPMENT MPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPE"NO, CA 05014-3255 �408) 777-3228 * FAX (408) 777-3333 - building(Mouperfingorg CU• IF, vp:w 4*1 1 MORICrADOM118 AM OWNERNAMB a '60 MONE 'E A4ATL - STRMADDRM MY, SrATA wtjFAX %M I ABE M. C(XffALCr NAME I L"Iff 1^11A A PBONE 44.JBM-AIL * P -W Z - STREBTADDRESS Y*3TA111217 aiR4 IS! 6-A Oloivtm E3 owNst-uunpva! 13 OWNEXAG&W 13 CONTRArl0k, 13CONTItACTORAGENT ARcHrrEcT, 13mmait 13 DEv&opm 13-TmANT N"6 BTJ>oc 4q cow NAME 'ATL .v ciry S,ATH,Z;,,'FHONF uc&NSENUMBM - COMPANYNAME "AIL FAX uoa , T,,- con 7 1, MWADDRM CITY, STAM ZIP, PPttim 4-4 -,saa - D&V-R11M0N0FVMn, Ana, 14 Ift, ira .............. Jqw, f Virg, AIC PR PCisACiTSR CONMTYPE #STORM ..41 r VIA I USE T)Tri 0M SQXT� ArALUATION(p AREA A"A: TOTAL AREA KhT A RFA PIN 4000 "NN11ILPINELAREA MU0019,AIRBA REMODELAREA KARBA TOTAL DMCK&Okai GARAGIAREk'BDETACH I ATTACK rowEU,wuwrs;- 1BAW=?MUN1T UY133 SECONDSTOPll YES "M"Usur ONO AMMON? No PRE -APPLICATION 137as JFYEWFR0VW5WFY0F IST119JUDGAN T VAL11ATION: VIAWtMAKILN MO 11AMIMAPMOVALLETTER ETCHLERTIOME? 13th BY raysizastam below, I certify to each Of the following. [an dieproperlyownerorauthwz&I a$w to suan the properiyourner's behatf. 1h&PxeadWs application and the infornzation I have prbvided is correct. I have rand the Description ofwork and verify it iseocaeatc. lagree to winplywitli all applicable local ordi,num end state laws relating oto bul no ruc.on, I authorize Wwentatives of Cuporina, to entec the above-idendfied p-opetty for inspection purposes. Signature 17 1,201 1 al!ApplicantlAgwt. SUPPL11MIDITAL INFMAXTl0N REQUIRED 196C �WNWVI-11- New SFD or Multifinnily dwallhigs. Apply for demolition pelmit for e�tsiinghwldi Demolition permit is required prior to issuance of building permit for now building. I Commercial Bldgs: Provide a completed Ha2atdoua Malmials Disclosure fmm if any Hozardous Materials are being used as part cif fiats project. Copy of Planning Approval Letior or Meeting with Planni n g prior to iubmiffal ofBuilding. Pomit application. BldgJpp__201 1.doc revised 06121111 I Is CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0610 10881 N WOLFE RD CUPERTINO, CA 95014-0605 (316 05 053) DUGGAN CONSTRUCTION CHICO, CA 95926 OWNER'S NAME: CUPERTINO VILLAGE LP ISSUED: 07/11/2017 OWNER'S PHONE: 408-321-9988 1 1 PHONE NO: (530) 624-7836 LICENSED CONTRACTOR'S DECLARATION License Class 5 Lic. #639674 Contractor DUGGAN CONSTRUCTION Date 03/31/2018 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: t. I have and will maintain a certificate of consent to self -insure for Worker's BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL $ COMMERCIAL JOB DESCRIPTION: T.I. - TEN REN TEA (823 S.F.) Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. C2. 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: $50000.00 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 id City in copse a of the granting of this permit. Additionally, the ap Mid underst n an will comply with all non -point source regulation r n Muni ipal Code, Section 9.18. Signature ate 7/11/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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). I 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. 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. 3. 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 7/11/2017 APN Number: Occupancy Type: 316 05 053 B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende 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 ofApplicant: Date:7/11/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 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 rea Air Quality Management District I will maintain compliance with the C ino Muni i 2o, Chapter 9.12 and the Health &Safety Cod ctions 2550 , 55d 25534. Owner or authorized agent: Date: 7/1112017 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 CONSTRUCTION PERMIT A, It- l (CATION Baor -c&o ISO COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(cbcupertino.oM [—]NEW CONSTRUCTION [:1ADDITION L�,{ALTERATION ! TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # 316 ( � OS3 I OJ*N tk)OL' [/ OWNERNAME PHONE 111�� 1�,/�E-MAIL "((��/ a 1L� STREET ADDRESS CITY, STATE,,ZIP�f �� / - �i FAX CONTACT NAME PHONE E-MAIL ^'C STREETADDRESS J ITY, STATE, ZIP s� FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ARCHITECT ❑ ENGINEER ❑ DEvELOPER Ci TENANT AMS L[CENSEMIMDER J� > LICENSETYI'E BUS. LIC#jln�Jl� .� COMPANY NAME E-MAIL FAX STREET ADDRESS = CITY, STATE, PHONE li ARCHITECTIFNGINEERNAME LICENSENUMBER DUS.LIC # !moi COMPANY NAME E-MAIL tsc FAX STREET ADDRESS CITY, STATE, ZIPn PHONE V DESCRIPTION OF WORK !r s uz1 i D -r I am ! -7n RXIS�� SB PROPOSED USE CO R. TYPE # STORIES C •ted C/�dil—r�-G- �� V. , ij USE TYPE OCC. SQTT. VALUATION ($) EXISTG AREA NEW FLOOR AREA A,L2 DEMO TOTAL AREA �Q NEI'AREA K t goo BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK ARPA TOTAL DECKJPORCH AREA GARAGE AREA: DETACH I ATTACH N DWELLING UN'rrS; IS A SECOND UNITEl YES SECONDSTORY [3 YES BRING ADDED? CJ NO AUDI'rJON? ❑ NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OP IS THE BLDG AN ©YESRRED BY; TQTQT. VA�.IJf4T1QN; PLANNINGAI'PL# []NO PLANNINGAPPROVALLErTER EICHLERHOME? []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. 1Ave 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 struc ordinances and state laws relating to bui ing c n'on. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: o Date: /;29,7 SUPPLEMENTAL INFORMATION REQUIREDx s�' € ,_ PLAN CBECK TYPE AOIITIIV 3LL? ^,; x ' New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building �r ❑„5vlrrh � Ci3tt\*Iw ;*a M� Tl.*cPLAN , perrait for new building. ❑' EXPRESS : a ¢ � � PLA• GPLANREY D« r ty i }`tea 3OV _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if Hazardous Materials being this r r a. sir A•,. ak ❑=$ P DXRD �' E IRA,G �. � UBLiOd�ORKS ati , any are used as part of project. Copy of Planning Approval Letter or Meeting with Planning prior to ❑ - LA�tGIt �`���• T ; -"" -� � F i DEP'J� �� _ ❑:kAL1SOR, ��.x' SAi�iITARYSEWERDISTRICT submittal of Building Permit application. BldgApp_201 ].doe revised 06121111 l�