13080146 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD CONTRACTOR:GIDEL AND KOCAL PERMIT NO: 13080146
OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 574 DIVISION ST DATE ISSUED:08/20/2013
OWNER'S PHONE: 4088730121 CAMPBELL,CA 95008 PHONE NO:(408)370-0287
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
License Class 15 Lic.# �1(934.5—CD 5TH&6TH FLOORO COMM.T.I(2)EXISTING
tt RESTROOMS
Contractor 61 d� 1/t Date 738 SQ FT
1 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. Sq.Ft Floor Area: Valuation:$150000
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:36901028.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the /3
granting of this permit. Additionally,the applicant understands and will comply Issued by: C Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date �3 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that 1 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)
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. 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(x)should I 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 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 o2n /
Owner or authorized agent: Date
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 CONSTRUCTION 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
CONSTRUCTION PERMIT APPLICATION
Is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINC (408)777-3228• FAX(408)777-3333•building aAcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJWT ADDRESS APN# 119
OWNER . 25. PHO EE E-VIAL - - -
STREET ADDRESS C STATE, IP FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT R NAME LICENSE NUMBER LICENS TYPE BUS.LIC 9
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DESCRIPTION OF WORKJJ
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6f1211,&41 Sly /r '
EXISTING USf� PROPOSED USE CONSTR,TYPE 4 STORIES
ff/ri/� r///U USE TYPE OCC, SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL _
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA RENIODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: UDETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEINGADDED? ONO ADDITION? ❑NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES =RECE V. BY: TOTAL VALUATION:
PLANNING APPL O []NO PLANNING APPROVAL LETTER EICHLER SOME? ❑NO
By my signature below,I certify to each of the following I am the property owner or authorizedlageentt 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 Des c . non 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 re ntatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicanb'Agent Date: q11 3
SUPPLEMENT FORMATION REQUIRED PLAYCHECKTY'PE _ ROUTING SLIP
New SFD or Multif dwellings: Apply For demolition permit For
existing building(s). olition permit is required prior to issuance of building ovER-THE-COUNTER ❑ BUILDING PLA REVIEW'
permit for new building. ❑ EXPRESS ❑ PL kXNING 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 ❑ FrRE DEPT
Copy of Plarming Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONNIEiNTM,IIEALTH
B[dgApp_201 Woe revised 06/2////
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
WIPERMIT
DDRESS: 20400 Stevens Creek DATE: 08/20/2013 REVIEWED BY: Sean
PN: BP#: �� "VALUATION: $150,000
PE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 B l-1
USE: PERMIT TYPE:
wORK Tenant improvement of 2 existing restrooms 738 sq ft 5th and 6th floors
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (s.f.
B (Tenant Improvements) II-B,III-B,IV,V-B 738 $2,061.55 IBTIPLNCK $902.85 1BTIINSP
TOTALS: 738 $2,061.55 $902.85
MECH,HOURLY ® Yes (D No PLUMB,HOURLY Yes (E) No ELEC,HOURLY 0 Yes Q No
.7mi?Fee' . . ir.rt fc .{lCCt,lr'eYflllT 1` 'i':
Other dk:ch.Insp, E1__L_ ED E1__L_
ins1�.
'aeon. in,pFe,: F hor,•%.Its/3.fee" ?ec:. hrsp. iFoe.
NOTE: This estimate does not include fees due to other Departments(4e. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,061.55 Select a Misc Bldg/Structure
Suppl. PC Fee: 0 Reg. 0 OT 1 0.0 1 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $902.85
Suppl. Insp. Fee( Reg. Q OT ro,0 hrs $0.00
PME Unit Fee: $0.00
PME Pen-nit Fee: $0.00
("onsrt uction .Tax.
J.,,ninistrative Fee: 0
Work Without Permit? 0 Yes j) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential G
7 1V;-t11 Building or Structure 0
Strong Motion Fee: IBSEISMICO $31.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $6.00
SUBTOTALS: $3,001.90 $0.00 TOTAL FEE: $3,001.90
Revised: 07/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: ,771-61r43 OCl/ PERMIT#
OWNER'S NAME: PHONE# 321
GENERAL CONTRACTOR: ,c-1yI BUSINESS LICENSE#
ADDRESS: 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 Mfr 3--5 1S/
Excavation
Fencing -
Flooring/_Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper .� C u, !;T, ,a::,7,:� ;ZZ
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock GrUr ��v �,��,r��/f 1-0-70
Tile k
dwner/Contractor Signature Date