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13090044 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19652 STEVENS CREEK BLVD CONTRACTOR:ALL BAY PERMIT NO: 13090044 CONTRACTORS,rNC. OWNER'S NAME: EVERSHINE VI LP 43233 OSGOOD RD DATE ISSUED: 12r2Y2013 OWNER'S PHONE: 4084391881 FREMONT,CA 94539 PHONE NO:(650)298-0577 Lys LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] ERIK'S DELI-COMM T.I 2099 SQ FT License Class 4license y Contractor ate 12-14, I hereby affirm that I amnder 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:$120000 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:36906012.19652 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 DA" RMIT 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 7 LLED 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 a Z3 with all non-point source regulations per the Cupertino Municipal Code,Sectio 9.18. RE-ROOFS: Signature Date 1 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 14 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 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,Secti s 25505,24-14 ,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 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 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. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �� 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 V1" CUPERTINO (408)777-3228 • FAX(408)777-3333•buiiding(c�cupertino.orq ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRE:D ORIGINAL PERMIT g PROJECT ADDRESS 9(05^ &YD. APN N of'O(0--C)(-Z OWNER NAME PHONE E-MAIL �� 6 _ :3,9_ ' STJJ�DgRFSS CITY, STATE,ZIP 1� lFAX /_.uPEP-nNZ),_,!�,A ') 14 1 CONTACT NAME 3 E-MAILQt" 40-0 9 57 I Sr 4t7rf ST �.T ADDRESS CITY,STATE, L FAX San L CA 9S-6(10b ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LTC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/FNGIN'EER NAME LICENSE NUMBER 2G BUS.LIC N COMPANY NrVv1E E-MAIL FAX V C-7— b1�I� cow STREYJ ADDRESS CITY,STATE,ZIP PHONE I Z GA} 25U0 0 DESCRIPTION OF WORK _0y7_ 94—iqWEL OF W(E) S%t0tActA IDEW 1 S = WAvt,t C•tw Wv F1 M,SttES Cfis�A-V_ : 4SV46Vh1,o f V-B N I�JT-W EXISTING USE PROPOSED USE CONSTR,IYPE NSTORIES 5A h" PELIL 5ftad" t V— e USE TYPE, OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL. 99 /� AREA Z gyp(] AREA �j AREA NET AREA O a4g& ,VX/�� /,g ��/ y►'1 -- BATHROOV-1_t KITCHEN OTHER 1`'��"'-• �[• v REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA 7ALDECK/PORCHAR.EA GARAGE AREA: DETACH ❑ATTACH A`DWEIl wa UNITS-. IS A SECOND UNIT ❑YES SECOND STORY ❑YES NIA BEING ADDED? ❑NO ADDITION? RNO PRE-APPLICATION l[-]YES IF YES,PROVIDE COPY OF IS THE BLDG AN /[J YES RECEI BY TOTAL VALUATI_OIJ` PLANNING APPL N ❑NO PLANNING APPROVAL LETTER EIC'HLER HOME? �I,AIO 1_2 ( y ) By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I /1 0hav`efread WW�lthis "'III application and the information I have prov)ded is co t. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable Iocal ordinances and state laws relating X] Ion. authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ( -4f- 1 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER LDING PLAN REVIEW" existing building(s). Demolition permit is required prior to issuance of building permit for new building. RESS PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PLBLJC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE LL FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ALJ SANITARY SEWER DISTRICT submittal of Building Permit application. ENVIRONDIENTAL HEALTH BidgApp_20/1.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19652 STEVENS CREEK BLVD DATE: 09/04/2013 REVIEWED BY: APN: 369-06-012 --TB—P#. / (,1�� "VALUATION: 1$120,000 "PERIVIIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1A USE: PERMIT TYPE: WORK Interior remodel of an existing sandwich deli. Remodel includes n restroom & equipment, n ceiling SCOPE and wall finishes, (n) casework, removal of existing kitchen equipment, counters, flooring, ceiling tiles OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. A (Tenant Improvements) II-B,III-B,Iv� 2,099 $2,422,Q6 IA77PLNCK $1,217.24 IATHNSP TOTALS: 2,099 $2,422.96 $1,217.24 MECH,HOURLY () Yes Q) No PLUMB, HOURLY O Yes (F) No ELEC,HOURLY Q Yes Q No LJ NOTE: This estimate does not include fees due to other Departments(i.e,Planning,Public Works,Fire,Sanitary Sewer District,School District,etG). Thesefees are based on the preliminary information available and are only an estimate, Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-0 3_E n�l.'12) FEE QTYIFEE MISC ITEMS Plan Check Fee: $2,422.96 Select a Misc Bldg/Structure Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,217.24 Suppl. Insp. Feer Reg. ® OT 0.0 hrs $0.00 PN E Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? ® Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structt� Strong klotion Fee: IBSEIS19co $25.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $3,670.40 $0.00 TOTAL FEE: $3,670.40 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: tem x ,C C� I✓ PERMIT# I *? O) OWNER'S NAME: �,n,., PHONE # 4�50-VW-1--Oe4ii GENERAL CONTRACTOR: 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 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 w r/Contractor Signature Date