14080064 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:.�N DE ANZA BLVD CONTRACTOR:DRYCO CONSTRUCTION PERMIT NO: 14080064
OWNER'S NAME: VIDOVICH-CUPERTINO LIMITED PARTNERS 42745 BOSCELL RD DATE ISSUED:08/11/2014
OWNER'S PHONE: 4155950430 FREMONT,CA 94538 PHONE NO:(510)438-6500
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
S APPLE- MODIFY PARKING LOT CURBS,AC PATCH
License Class Lic.# J o 3 PAVING,
De s� ll NEW ADA RAMP W/TRUNCATED DOMES
Contractor Date 0
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.
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:$8000
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:32633]13.00 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 ISSUANC 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 LAST CALLED INSPE/CflION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the S�, �
°ranting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point urce re tions per the Cupertino Municipal Code,Section
9.18.
ll RE-ROOFS:
Signature Date 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
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(See.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). 1 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
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 5533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: � Lid Date:
AAA1 DALUA,50 *0(r
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,l CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 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 stale that the above information is
correct. 1 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
indemnity 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,ION PERMHT APPLICATION
IOtt
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE- CUPERTINO,CA 9501'-3255N'h1h
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(408) 777-322B • FAX(408)777-3333• buildino cQcuoertino.ora \
CUPERTfNO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION/DEFERRED ORTGTNAL PERI\4IT y
PROJECT ADDRESS ye-? /Z, ,f� I �P � �j2�O
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STRE_iADDRESS ! Irp /I /� I C,iY, STP.TE,Zi? Gu �n✓1�� CA. Y6014
CONTACT NA✓E v/✓s ` PHONE
STR ET.ADDRLSS # I CrrY,STATE, ZIP FpX
ow R ❑ OP ^R-nL�Ii DER ❑ oaTLR AGENT ❑ CONTK0.CTOR ❑CO?R,',CTOR AGEN 1 ❑ ARCI-M;CT ❑E-N,0121EEER ❑ DF_LCP--R ❑ - :, rr
CON-TRACTOR NaA E 7 LiCEIISFxru.i:?ER LICENSE TYPE BL'S.LIC 11
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STP`ET ADD?,.SS CITY,STATE,ZIP PI-10T IZ
.4RCHTCT/ENGNLER NP m: ( , 1�` 9� LICENSE NUh%LR BUS.LIC
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COPANY N-AME L(f/rte/( E-14A L F?X
STREET ADDRESS CITY,STATE,ZIP I PHONIE
DESCRIPTION OF WORK ` /`�
ve"i /4I0A fs, 7-46,vcWk e:'/'Q/d P_ Ilu r
EXISTING USE PROPOSED USE CONSTR TYPE I :STORLS
USE TYPE OCC. SQ.FT. VP.Lli.4T10N(5)
EXISTG Nnv FLOOR DE1,10 TOTAL
ARTA AREA AREA 1`�AREA
BATHROOM I;1?C_'?:'N 0-1-MR
RMODEL AREA R=MODEL AREA MvIODEL AREA
PORCH AREA DECK F.REATOTAL DECKIPORCH AREA GARAGE kREA: DETACH
❑ATTACH
9 DRELUNG UNITS: IS A SECOND UNIT ❑YES SECOKD STORY []YES
6£INGP.DDED? ❑No ADDITION? 7N--o
n1tSr: F';3-EDBYi
PLtAT'1NGAPPL.' [ANO ?L.it`T G APPRCVAL LE-11!R EICHLER HOME? []No
By nIy signature below,I certify to each of the following: I am the property ov er or authorized agent to act on the property o\aner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verity it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b * ina cors cti n. I authorize representatives of Cupertino to enter the above-identified propel for inspection Du loses.
Signature of Applicant/Agent: Date:
SUTPPL EME'N'TgL NFORMATION RE LTIRED
Q
1� Y ROII3'L1'G L.P_
New SFD or Multifamily dwellings: Apply for demolition permit for = . O
`—C OA R TAE COUATER BUS DLIGPL4'�REkTE�V e .
existing building(s). Demolition permit is required prior to issuance of building „
permit for new building. �❑ E�RESS�
P � x * , SPI 4 I1GPL 3RES � 4
_Commercial Bldgs: Provide a competed Hazardous Mate Disclosure rC7 STATDAT2D r rlrsLa�FORIs= ,
form if any Hazardous Mzterials are being used as part of this project. x j
❑ �CG1 3a" L SIRE DEPT
Co of Planning Approval Letter or Meeting�v�ith Planning prior to
pY o 4❑ �7370R ��x ❑ A^ITARIEIiER DISTRICT {
sublrittal of Euilding Permit application.
<'" -,,=-c��� �.,. -�� � � a_:��g E:�'L'IROT 4ENT�?3;�h'EA3i'L'A- ,k.-;�•
Bldg.4pp_2011.doc revised 06,/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
A
DDRESS:-1895 n de anza blvd DATE: 08/11/2014 REVIEWED BY: Mendez
PN: ja _� BP#: 8� "VALUATION: $8,000
PE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 GENCOM
USE: PERMIT TYPE:
WORK APPLE- MODIFY PARKING LOT CURBS AC PATCH PAVING NEW ADA RAMP W/TRUNCATED
SCOPE DOMES
Ll
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]only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff" 7,1,13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes (j) No $0.00 0 hours Plan Check, Hourly
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $143.00 ISTPL1vCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? Q Yes (j) No $0.00 G)
Advanced Plannint Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
Strom Motion Fee. IBSEISMICO $2.24 F-2.-07 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $286.00 ISTINSP Inspection, Hourly
SUBTOTALS: $3.24 $429.00 TOTAL FEE: 1 $432.24
Revised: 07/10/2014