12010129I CITY OF CUPERTINO BUILDING PERMIT 1
BUILDING ADDRESS: 16 RESULTS WAY
OWNER'S NAME: ECI TWO RESULTS LLC
OWNER'S PHONE:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class_ Lic. # vr�
Contractor Date L.2
I hereby affirm that I am licensed under the provisions of Ch Ater 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.
I have and will maintain Worker's Compensation Insurance, as provided
Section 3700 of the Labor Code, for the performance of the work fo s
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 haonless the 07 of Cupertino against liabilities, judgments,
costs, and expensesI
may acc a against said City in consequence of the
granting of this peditional , the a licant understands and will comply
with all non-poin sgulatio s per th upertino Municipal Code, Section
9.18. ,
Date 9_1Z Z Z/j 5
❑ /7 OWNER -BUILDER DECLARATION
I hereby affrrin 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)
1, 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 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.I8.
Date
CONTRACTOR: XL CONSTRUCTION
851 BUCKEYE CT
MILPITAS, CA 95035
JOB DESCRIPTION: RESIDENTIAL
PERMIT NO: 12010129
DATE ISSUED: 05/10/2012
PHONE NO: (408) 240-6000
COMMERCIAL
APPLE- 1ST & 2ND FLOOR- COMM T.I 30,670 SQ FT TO
INCLUDE OFFICE SPACE, KITCHEN, RESTROOMS,
LOCKER
ROOM, NEW WALL FIXTURES & (M,E,P)'S-TI PREP
9/21/12- EVISION 93- REVISE TRASH ENCLOSURE-ISSD IlAx
Ft Floor Area: 1 Valuation: $2800000
APN Number: 35720041.16 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY ROM LAST CALLED INSPECTION.
.a
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 Mumc' al Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) shoul tore or handle hazardous
material. Additionally, should I us a ipm t oq devices which emit hazardous
air contaminants as defined by th Are Air u Management District I
will maintain compliance with th perti o M i p 1 Code, Chapter 9.12 and
the Health &Safety Code, Sect' 5505, S53 , a d 5534.,
Owner or authorized
Date:
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
LL I --
CITY OF CUPERTINO BUILDING PERM -� Z--
BUILDING ADDRESS: 16 RESULTS WAY
CONTRACTOR: XL CONSTRU ON
PERMIT NO: 12010129
OWNER'S NAME: ECI TWO RESULTS LLC
851 BUCKEYE CT
DATE ISSUED: 05/10/2012
OWNER'S PHONE:
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
K LICENSED CONTRACTOR'S DECLARATIONr
I
'
/ t b r l
License Class Lie. # (� "l '"
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r F
COMMERCIAL
Contractor. N Date 2
MECH RESIDENTIAL
hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: APPLE- IST& 2ND FLOOR-COMMT.1 30,670 SQ FTTO
(commencing with Section 7000 of Division 3 of the Business & Professions
( g )
INCLUDE OFFICE SPACE, KITCHEN, RESTROOMS, LOCKER
ROOM, NEW WALL FIXTURES & (M,E,P)'S-TI PREP 6/19/12 -REVISION #1 -MODIFY OF A TOWEL
Code and that my license is in full force and effect.
STORAGE INTO A LAUNDRY ROOM, CHANGE SAUNA ROOM INTO STORAGE, INCREASE SHOWERS
FROM 4 TO 5 AND REMODEL RESTROOMS IN MAIN LOBBY - 7/19/2012 - REV#I ISS'D
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.
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
Sq. Ft Floor Area:
Valuation: $2800000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 35720041.16
Occupancy Type:
I certify that l 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,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this p rmi . Addition lly, the plicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -poi so cc regula s per t Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date
q/1
?/I
fif
Issued b)b - Date.;2— q 2/
11
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove a]I new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
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
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, l shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Saf y Code, Sectio s 255, 25533, and 25534.
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.
Own r thorized age
6t /I
Date: C
—V
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that l 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
I hereby affirm that there is a construction lending agency for the performance of work's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
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.
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 16 RESULTS WAY
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 12010129
OWN'ER'S NAME: ECI TWO RESULTS LLC
851 BUCKEYE CT
DATE ISSUED: 05/10/20 12
OWNER'S PHONE:
M.ILPITAS, CA 95035
PHONE NO: (408) 240-6000
❑ LICENSED CONTRACT'OR'S DECLARATION
]
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.4 � � � `� �
f_.
�r
Contractor � l-.d'1/l�-�l/i, ate
MECII RESIDENTIAL COMMERCIAL.
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: APPLE- I ST & 2ND FLOOR- COMM 'LI 30,670 SQ FT TO
(commencing with Section 7000) of Division 3 of the Business & Professions
INCLUDE OFFICE SPACE, KffCIIEN, RFS"IROOMS, LOCKER
ROOM, NEW WAIL FIXTURES & (M,Ii,P)'S-TI PREP
Code and that my license is in full force and effect.
7/19/2012- REV42 - REVISE GREASE DUCT TIRE WRAP DkITAII.- ISSD
1 hereby affirm under penalty of perjury one of the following two declarations:
8/3/12
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: $2800000
performance of the work for which this permit is issued.
1 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
APN Number: 35720041.16
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 ofthis city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAY ROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses hich may acer e against said City in consequence of the
(�
r
granting of this per t. Additional , the plican[ understands and will comply
Issued by: Date: (x/
with all non -point u e regulatio per e Cupertino Municipal Code, Section
9.18.
RE -ROOF'S:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. 11'a roofis
installed without first obtaining an inspection, I agree to remove all new materials lir
inspection.
❑ WNER-BUILDER DECLARATION
Signature of Applicant: Date.
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGSTO BE CLASS "A" OR BETTER
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)
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 2-5-505, 2-5-533, and 2-5-534. 1 will
1 hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
llealth & Safety Cade, Section 25532(x) should 1 store or handle hazardous
I have and will maintain a Ccrtif icate of Conscnt to self -insure for Worker's
material. Additionally, should 1 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 uali Management District 1
performance of the work for which this permit is issued.
will maintain compliance with the pertino M icip Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Ilealth & Safety Code, Sectio s 5505, 2553 , and 5534. tt /
Section 3700 of the Labor Code, for the performance of the work for which this
r - "
Owner or authorized agent:' Dater -_
permit is issued.
i
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
('ONS"TRUC"TION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this peril is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that 1 have read this application and stale that the above information is
correct. I agree to comply with all city and county ordinances and slate laws relating
to building construction, and hereby authorize representatives ofthis 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,
ARCI IIITF,CT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting ofthis 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 Date
CITY OF CUPERTINO
Fm_� FEE ESTIMATOR - BUILDING DIVISION
imADDRESS: 16 results way
FEE
DATE: 07/19/2012
REVIEWED BY: bobs.
APN:
BP#: 12010129
'VALUATION: Iso
xPERMIT TYPE: Building Permit
4 hours Plan Check, Hourly
$532.00 1S111NCK
PLAN CHECK TYPE: Alteration I Addition I Repair
PRIMARY Commercial Building
USE:
ED
hrs
PENTAMATION 1GENCOM
PERMIT TYPE:
WORK
revise grease duct fire wrap detail.
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt otr 1_ Thovo foot aro hncod an the nroliminary information avoilahle and aro only an octimato_ Contact the Dent for addn'l info_
FEE ITEMS (Fee Resolution 11-053 Eff /7,11j]
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes 0 No
$0.00
4 hours Plan Check, Hourly
$532.00 1S111NCK
Suppl. PC Fee: E) Reg. 0 OT
ED
hrs
$0.00
PME Plan Check:
$0.00
Lj
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt otr 1_ Thovo foot aro hncod an the nroliminary information avoilahle and aro only an octimato_ Contact the Dent for addn'l info_
FEE ITEMS (Fee Resolution 11-053 Eff /7,11j]
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes 0 No
$0.00
4 hours Plan Check, Hourly
$532.00 1S111NCK
Suppl. PC Fee: E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Work Without Permit? 0 Yes D No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg* Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$532.00
TOTAL FEE:
$532.00
Revised: 07/01/2012
CITY OF CUPERTINO
FEW FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 12 Results Way
DATE: 06/19/2012
REVIEWED BY: RDW
APN:
BP#: 12010094
*VALUATION: 1$75,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
1,000
PENTAMATION
PERMIT TYPE: 1B T�
WORK
Revision #1 - Modifications of a towel storage into a laundryroom change sauna room into storage,
SCOPE
increase showers from 4 to 5 and remodel restrooms in main lobby.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
1,000
$1,945.60
1BTIPLNCK
$972.24
1BTIINSP
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$972.24
Suppl. Insp. Fee:Q Reg.
0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
1,000
$1,945.60
$0.00
$972.24
MECH, HOURLY 0 Yes (E) No PLUMB, HOURLY 0 Yes (F) No ELEC HOURLY ® Yes Q No
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Divtriet otr_ 1_ The.ce fees are ha.ced an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft /71/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,945.60
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (F)Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$972.24
Suppl. Insp. Fee:Q Reg.
0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
E)
Work Without Permit? Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
Strong Motion Fee:
1BSEISMICo
$15.75
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$3.00
SUBTOTALS:
1 $2,936.59
$0.00
TOTAL FEE:
T $2,936.59
Revised: 06/30/2012
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 16 RESULTS WAY
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 12010129
OWNER'S NAME: ECI TWO RESULTS LLC
851 BUCKEYE CT
DATE ISSUED: 05/10/2012
OWNER'S PHONE:
MILPITAS, CA 95035
PHONE NO: (408) 240-6000
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic. # {p �( f J U
APPLE- I ST & 2ND FLOOR- COMM T.I 30,670 SQ FT TO
2
INCLUDE OFFICE SPACE, KITCHEN, RESTROOMS,
ContractorL lAi/L`✓ Date 0 i
LOCKER
I hereby affirm that I am licensed under the provisions of Chapter 9
ROOM, NEW WALL FIXTURES & (M,E,P)'S-TI PREP
(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
Sq. Ft Floor Area:
Valuation: $2800000
performance of the work for which this permit is issued.
1 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
.APN Number: 35720041.16
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. l 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
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City Cupertino against liabilities, judgments,
costs, and expenses w is may accru gainst said City in consequence of the
,
��/
granting of this per t. dditionally the applicant understands and will comply
Issued by: �4f�rt✓ ,+¢� ��1 Date:
with all non -point ur regulatio per the Cupertino Municipal Code, Section
9.18.
///Date C
RE -ROOFS:
Signature
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.
UR
❑ 4WINIF-R-RDECLARATION
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
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
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. 1 will
1 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(x) should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or evices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the ay rex Air uality Management District I
performance of the work for which this permit is issued.
will maintain compliance with th u ertino Mu icipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Secti 505, 2553 and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
tIq)l
Owner or authorized agent: Date:
permit is issued.
Ig
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
CONSTI�.UCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I 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 Date
PAVE wumell."M Hn IN" 11INN
imADDRESS: 16 results way 1st and 2nd floor.
DATE: 01/20/2012 REVIEWED BY: bobs.
! APN:
I BP#: 112-01 'VALUATION: 1$2,800,000
PERMIT TYPE: Building Permit
PLAN CHECK TYOE: Tenant Improvement
PRIMARY Commercial Building
USE:
PENTAMATION 113TI
PERMIT TYPE:
WORK U. comm. office space, kitchen, restroom, locker room, includes new wall, fixtures, mech., elect.,
SCOPE plumbing.
OCCUPANCY TYPE: TYPE OF
CONSTR.
FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
(s.f.)
B (Tenant Improvements) 11-13,111-13,1V,V-13
30,670 $3,179.45 IBTIPLNCK $11,289.39 1BT11,4TSP
Platt Check Fee:
$3,179.45
Select a Misc Bldg/Structure
or Element of a Building
TOTALS:
30,671 $11,289.39
MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes (j) No ELEC, HOURLY 0 Yes 0 No
Li
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sewer District, h Sanitary S er School
District. etc.). These fees are based on the Prelininary information available and are on1v an estimate. Contact the Dent for addn 7 info.
FEE ITEMS'�'�:� 114 11
FEE
QMFEE1
MISC ITEMS
Platt Check Fee:
$3,179.45
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OTFo
—.o I
hrs $0.00
PME Plan Check:
$0.00
Permit Fee: $11,289.39
SUPPI. Insp. Fee -0 Reg.
0 OTHIhrs
$0.00
PME Unit Fee: $0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes (D No $0.00
$0.00
Select a. Non -Residential
Building or Structure
0
1BSEISA11C.0
$588.00
Select an Administrative Item
--- - IBCBSC $112.00
------
SUBTOTALS:
15,168.84
j $0.00
TOTAL FEE: 1 $15,168.84
Revised: 1/19/2012
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION / DEFERRED
/�do1 2-q
ORIGINAL PERMI•T #
PROJECT ADDRESS 16 Results Way
7API# 3 5 7 2 0 0 41 , / tp
OWNERNAME ECI TWO RESULTS LLC
PHONE
E-MAIL
STREET ADDRESS 13 O 1 SHOREWAY RD STE 250
CITY, STATE, zIP Belmont CA 94002
FAX
CONTACTNAME Marco Innocenti
PHONE 408.240.60007
E-MAIL
minnocenti@xlconst.com
STREETADDRESS 8551 Buckeye Court
CrrY,STATE,ZIP Milpitas, CA 95035
FAX 408.240.6001
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Marco Innocenti
LICENSE NUMBER 6 4 7 4 8 0
LICENSE TYPE B
BUS. LIC # 21836
COMPANYNAME XL Construction
E-MAIL minnocenti@Xlcons t.Com
FAX 408.240.6001
STREETADDRESS851 Buckeye Court
CITY, STATE,ZIP Milpitas, CA 95035
PHONE408.240.6000
ARCHITECr/ENGINEERNAME David Sabalvaro
LICENSENUMBER C-015925
BUS. LIC#
COMPANYNAME Studios Arch
E-MAIlcrossman@studiosarch. COM
FAX 415 .398. 3829
STREET ADDRESS 4 0 5 Howard St Suite 588
CITY, STE, ZIP
bgan Francisco, CA 94105
PHONE 415.3 9 8. 7 5 7 5
DESCRIPTION OF WORK
Locker Room & Restroom demo/renovations including new wall construction,fixtures,lighting, finishes and interior
improvements to open office area for fitness club. New kitchen servery renovations including new wall construction
fixtures lighting, equipment and finishes and interior improvements to open office and e seating areas.
No exterior work, tree removal or landscape is included is included. J_,
21 PL
r� PL
EXISTING USE
Business Group B
PROPOSED USE CONSTR.
Business Group B TypeV
TYPE # STORIES
N 2
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA 3 0, 6 7 O
NEW FLQO
AREA .J 6 7 0
DEMO 0
AREA
TOOT AREA 0
BATHROOMKITCHEN
N`�
OTHER
N/A
REMODELAREA
REMODELAREAN/A
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECKTORCH AREA
GARAG AREA: DETACH
N/A
N/A
N/A
N/rA ❑ATTACH
# DWELLING UNITS
BENGADDED?NIT
YE
N/A
®NOS
ADDITION?SECONDSTORY ®NOS
PRE -APPLICATION Q YES IF YES, PROVIDE COPY OF
PLANNING APPL # NO PLANNING APPROVAL LETTER
IS THE BLDG AN E] YES
EICHLER HOME." NO
RECEIVED BY:
TOTAL `VtALUATION:
$ P
owing: I amt property wner or authorized agent to act on the property owner's behalf. I have read this
By my signature below, I certiAbu'd'
application and the informationcorrect. I hav read the escription of Work and verity it is accurate. I agree to comply with all applicable local
ordinances and state laws relattruction. I a orize ntatives of Cupertino to enter the above -id tified pfrol)pe for inspection purposes.
j�
Signature of Applicant/Agent: Date: V
SUPPLEMENTA F ATIO QUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
11_B�DINGPLAN REVIEW
New SFD or Multifamily dw pings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
❑
� �
permit for new building.
Ex Ss
LJ -TANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
1 'STANDARD
❑ PUBLIC WORKS
_
form if any Hazardous Materials are being used as part of this project.
El
-�
LARGE
. DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
El
,*IS',
IS
submittal of Building Permit application.
MAJOR
sANiTARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06121111