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13040004 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20030 STEVENS CREEK BLVD CONTRACTOR:JOHNSTONE MOYER, PERMIT NO:/3040004 INC. OWNER'S NAME. PREG BILTMORE 1720 S AMPHLETT BLVD STE 250 DATE ISSUED:06104/2013 OWNER'S PHONE: 6509313457 SAN MATEO,CA 94402 PIIONE NO:(650)570-6161 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL I] COMMERCIALU ;Li ( cense Class Lic.#� ! C l FOUNDATION ONLY—BUILDING B Contractc ah i9r Datc 6" **SEE NOTES" If Z_ 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: 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:$0 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:36903004.00 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 WITHIN80 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 OM 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 13 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-po source r guoations per the Cupertino Municipal Code.Section 9.18. RE-ROOFS: gnattt 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 I hereby afFrm 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 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(See.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 I have and will maintain a Cert ificale 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 1 performance of the work for which this permit is issued. will maintain compliance with th upertino Municipal Code,Chapter 9.12 a I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se 4 2N54,d5533,5573-dk-2-534. Section 3700 of the Labor Code,for the performance of the work for which this (IFgr permit is issued. s.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 ofCal iforia. If,after making this certificate of exemption,I CONSTRUCTION LENDING 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 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 U� COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �a 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 Y PERTINO (408)777-3228•FAX(408)777-3333•building(acupertino.org 1 NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION 1 TI ❑ REVISION/DEFERRED ORIGINAL PERMIT 11 PRorEGTADDRESS< /I�/IIID �'" t �^a��GC�' QLYI([' r� OWNERNAME y'�L1t- - - � �' P �? � E-MAIL STREET ADDRESS iy©V�ry} WI�4a_ _l� CCIY,STATE, L /+ f, FAX _r• OC�� CONTACT NAME C/[{ b Wry ��JI-' VO 1�Ef M�� STM(5pclsS. ts'� � t�� c" �=' '�.g CA- `OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT F CONTRACTOR ❑CONTRACTOR AGENT ❑ ARcHr Ecr ❑ENGINEER ❑ DEVELOPER ❑TENANT D 4 J L SEN >RUCENSETYPE BUS.LIC 9 �, sno r V;211TTERl , BUM L.tio>��tcrtit �9 C��`–•�� G� i�r3�h�� a�� .Gc3+1'1/t ��rr�j'-r E� DESCRIPTION OF WORK F, til 'GIR,F O�()S�EFf SFS CONS R TYPE 0 STORIES ��1♦ 4tJ',_�o�r �� /a4 USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL r� AREA AREA AREA NET AREA BATHROOM KITCHEN ` OTHER REMODEL AREA REMODEL AREA V 1 -, REMODEL AREA PORCH I�GEA DEC A TOTAL DEPIUP+OjR�CFI AREA GAG�AR.EA: DETACH �44r•(� Lj� ❑ATTACH ISAS➢WELL�ITS: T ❑ SECON0BEING ADDED? WO ADDITION? q PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDC AN ❑YEs 7CEIVEn MN $ I' ' TOTAL VALUATION• PLANGAPPL0 ❑NO PLANNING AP AOVALLETTER EICHLERHOME? dN0 ' By my signature below,I certify to ac f e fallowing: I am the property owner or authorized agent O act on the property owner's behalf. I have read this application and the information I h e p vi is cOrreeL I have read the Description of Work and ve fy it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating bui its c trucsion—1 authorize representatives of Cupertino to enter the above-identifi property for inspection purposes. Signature of Applicant/Agent: t Date: SLIPPLEMENTO�RMATION REQUIRED PLAN CHECICTYPE ROUTINGSLIP. _New SFD or Multifamily wellings: Apply for demolition permit for ❑ OVER-WEECOUN`TERLDINGPLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ iEXPRirss y_ ae" GPiAN REVMw _Commercial Bldgs: Provide a completed Hazardous Materials DisclosureSTANDARD PUBLICPVORKS form if any Hazardous Materials are being used as part of this project. sA , ❑ LARGE'` FiRG DEP_I _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ TL4f0R SANITARYSEIVERDISfRICTI submitlal of Building Permit application. = Y � , 4 ❑ EIVViRONMEIVTAL$EALTH r B1dgApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20030 Stevens creek blvd DATE: 03104/2013 REVIEWED BY: Mendez f AP N' .- BP#: I V q-000 "VALUATION: iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1GENC0 WORK 13ILTMORE PROJECT-FOUNDATION ONLY FOR RETAIL BUILDING A-C. SCOPE Nfech. Plan Check Plrrrnb.Plan Check EJec.Plan Check hfech.Permit Fee: Phimh.Per7nir Fee: Dec.Pennir Fee: Other Meeh.Insp. Other Plumb Insp. Oiher Elec,Insp, Alech.Insp.Fee" Plrrrnh. lrrsp. Fee: Elm Insp.Fere: NOTE:This estimate does not include fees due to other Departments(r.e Planning,Public Morks,Fire,Sanitary Sewer District,School District etc). Theseees are based on the preliminary information available and are only an estimate Contact the De t or addn'I info. EEE ITEMS (Fee Resolution 11-053 Eff. 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? O Yes Q No $0.00 16 hours Plan Check,Hourly Suppl.PC Fee: Q Reg. () OT 0,0 1 hrs $0.00 $2,128.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes Q No $0.00 Suppl. Insp.Fee:Q Reg. (D OT 0.0 hrs $0.00 PME Unit Fee: $0.,00 PME Permit Fee: $0.00 C'Onsfrlx ion Tax: Adminisirafive FCL: O Work Without,Permit? O Yes Q No $0.00 G) Advanced Plannins Fee: $0.00 16 hours Inspections 0 Ti cry-e!Dncznnenlutian Fees: $2,128.00 ISTINSPInspection,Hourly 0 Strong Motion Fee: $0.00 Select an Administrative Item Bldp-Stds Commission Fee: $0.00 •$UBTOTALS: 1 $0.00 $4,256.00 TOTAL FEE: $4,256.00 Revised: 07/0112013