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13120163 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20450 STEVENS CREEK BLVD CONTRACTOR:G1DEL AND KOCAL PERMIT NO: 13120163 OWNER'S NAME: CUPERTINO CITY CENTER BUILDINGS 574 DIVISION ST DATE ISSUED:01/21/2014 OWNER'S PHONE: 4088730121 CAMPBELL,CA 95008 PHONE NO:(408)370-0287 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL RESTROOM ACCESSIBILITY UPGRADE ON FIRST FLOOR License Class Lic.# qV 50,5-D (644 Contractor tnJ o l A koc-1 0454% Date Z1 19 SQ FT) 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 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:$90000 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 APN Number:36901027.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 180 DA ALLED 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 granting of this permit. Additionally,the applicant understands and will comply < Date: Zit with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 2( < All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 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: 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 LENSING AGENCY 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 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 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 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. Date f n� XJ CONSTRUCTION PERMIT APPLICATION ELI] COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \ CUPEItTINO (408)777-3228•FAX(408)777-3333•buildinq�Dcupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT AWRESS APN# 3 / 07 OWNERNAME ) / PHOE-MAIL STREET ADD SS r` "� ,f CITN STATE,ZIP e c �. FAX --�✓y<.;�. f"li"�' �C". ��1c', �d,3ri CONTACT NAME._ ''-,y- A / PHO I�E�,,- TE-MAIL ��'XS s' C'l t%%)•�."�,. �C_-SSS � al'�i—i/v�-�s-: ...___ STREET ADDRESSr. -, CITY,SXATE, qP ` .fTFAX___ jk"> Cr ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT WONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME !' J, LICENSE NVMBER LICENSE TYCPE BUS.LIC# l COMPANY NAME,- E-MAIL FAX 7t�- [- !Lcr+ __.. STREET ADDRESS�., P e CITY,5TAIE,ZIP yi I✓ .? �) PHONE j /a i -�' £.l l.x�iy,G� ',E•7';''C 'yt�.�--yi ARCHITECT/ENGINEI1NAME LICENSE NUMBER BUS.LIC# COMPANY NAME �-,a E-MAIL FBiX, STREET ADDRESS ., CITY STATE,ZI , j r. PHONE,w .'-�-' � DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STQRIES, USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH If DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION! []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION: PLANNING ADPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? NO �w777 M nr,vP s ,z, By my signature below,I certify to each ofthe following: I am the property owner or autho a ent to ac th perty 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 curate. 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/AgenC '" Date: SUPPLEMENTAL-NFORMATION REQUIRED pitaw New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s),,Demolition permit is required prior to issuance of building _ permit for new building. El tpR�gg qt � Y �y4 j n i�� ` d _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure F� T A N atasM4W form if any Hazardous Materials are being used as part of this project. A�vp n iea _Copy of Planning Approval Letter or Meeting with Planning prior to � � submittal of Building Permit application ,»IAOt7�'At.iYCA�,TR BldgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20450 STEVENS CREEK BLVD DATE: 92/19/2093 REVIEWED BY: MELISSA APN: 369 01 027 BP#: / 3 Cj ' *VALUATION: 1$90,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1B TI USE: PERMIT TYPE: WORK 1ST FLR UPGRADE RESTROOM FACILITIES 2 TOTAL FOR ADA COMPLIANCE SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. sJ. B (Tenant Improvements) II-B,III-B,IV,V-B 644 $2,056.44 IBTIPLNCK $836.48 IBTIINSP TOTALS: 644 $2,056.44 $836.48 MECH;HCIURLY 0 Yes 0 14 PLUMB,HOURLY ® Yes ONo ELEC,HOURLY Yes Na Li I 0l,r::.'(. I,f?v NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelimina information available and are onjV an estimate Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution 11-053 Elf 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,056.44 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. Q OT 0,0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $836.48 Suppl. Insp. Fee:Q Reg. OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 )n.slrrnction Tax: 9du2iuLsn=uriti'e 1�>�. Work Without Permit? 0 Yes (F) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Ti ure�l L)n��rrrrtc�rrtalio;r !''crz s: Building or Structure Strong Motion Fee: 1BSEIS1L11Co $18.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS, $2,915.82 $0.001 TOTALFEE: $2,915.82 Revised: 10/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 7,0 S-D SC- PERMIT# 312=01 6 OWNER'S NAME: Apme*%w5- 12-0. PHONE # ye)r?- 3 7V -Ozr o GENERAL CONTRACTOR: lriclel 4 koctl Cv,�sfru&iorl BUSINESS LICENSE# ADDRESS: $'.7y sfarr yAlut- CITY/ZIPCODE: ,K hill Ctl- 4 Qv *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 T //z1//Y Owner/Contractor Signature I Date