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11100167CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19620 STEVENS CREEK BLVD CONTRACT OR: JK BAKER PERMIT NO: 11100167 CONSTRUCTION INC R'S NAME: KCR DEVELOPMENT 226 MCEVOV ST DATE. ISSUED: 11/3012011 O ER'S PIIONE: 4083431088 SAN JOSE, CA 95126 PHONE NO: (408)882-0199 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB Lieedse Class. `c ;'h_. '. Lic. N S 7> 3(o 4418 r— r r >=-s' MECH RESIDENTIAL COMMERCIAL Contractor j^Ic ?30(f2 Date 11 - 3o •11 Wi060)! ' ""' "` ' ' 1 heretiy aRrm"abet Pam Iiceb3ed Min der the provisions of Chapter 9 JOB DESCRIPTION: COMM T.12,519 SQ FT TO OFFICE SPACE, CONFERENCE (commencing with Section 7000) of Division 3 of the Business & Professions ROOMS, M,E,P'S, NEW SUB PANEL, NEW HVAC ROOF TOP Code and that my license is in full force and effect. UNIT hereby affirm under penally 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. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ff Floor Area: Valuation: $135000 Section 3700 of the labor Code, for the performance of die work for which this Permit is issued. APN Number: 36906010.00 Occupancy Type: APPLICANTCERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnifysthe of Cupertino against liabilities, judgments, DAYS OF PERMIT ISSUANCE OR osts,a dexpenses which cru costs, and expenses which may accrue against said City in consequence of the WITHIN 180 granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source r�ulatints per the Cupertino Municipal Code, Sectiat 9.18. / n-- Issued by: Date: sure�u,=v:n..,,.,:.,..,:.....rDate,mh�gn ❑ OWNER-RIIILDER DECLARATION RE -ROOFS: hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, 1 agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant:_ Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of [he work for which this permit is issued. California Beallh & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(1) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air Permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify ilial in the performance of the work for which this permit is issued, I shall, maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code„Sections 25505, 25533, and 25534. Compensation laws of California. If, after making [his certificate of exemption, I become subject to the Worker's Compensm ion provisions of the Labor Code, 1 must O C-er.1aut e a ent: '^ 11 •301 l forthwith comply with such provisions or this permit shall he deemed revoked. i .....,.a.; r �, ,- .r �, .. ; ,. Dale: .. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances mid state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction• and hereby authorize representatives of this city [o enter Lender's Name u the above mentioned property for inspection purposes. (We) agree to save uty and keep harmless the City of Cupertino against liabilities,judgments, Is, Lender's Address_ c and expenses which may acerae against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHIT'ECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional i CONSTRUCTION PERMIT APPLICATION a i COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildinga cupertino.org o0 CUPERTINO �— ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# j PROJECT ADDRESS APN OWNER NAME PHONE E-MAIL t GY STREET ADDRESS . CITY, STATE,ZIP FAX Ev E CC: CONTACT NAME PHONE E-MAIL tri` C:5(fQt L>C. :lit, S22(, STREET ADDRESS CITY,STATE, ZIP FAX El OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NU ER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 27 J. DESCRIPTION OF WORK �Ct IiL s("T t tv'4TL c;( t=4�I �Cs`�s )19��J ',�; i��v t�F"���� RCUA � G;i s "cCo's� (. ' tac' 5th Cl J E4t i C. Te{— .fit > C" IfQ1S EXISTING USE PROPOSED USE CONS�TrR.�,TYPE #STORIES O USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL g AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER T REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH []ATTACH #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 RECEIVED BY: T TAL VALUATION; PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLERHOME? []NO [ V415' � ,C ,._. By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prr.Terty 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 is accurate. I agree to comply with all applicable local ordinances and state laws relating to building_c nstruction, I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: / G' ( ., - Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CBECK TYPE ROUTING SLIT _New SFD or Multifamily dwellings: Apply for demolition permit for El OVER-THFcouNTER ElBuu DnvG PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS Tor—in if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ I=DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH. BldgApp 2011.doc revised 06/21111 f` , I �` COURTESY INSPECTION REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ' t ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINU (408)777-3228• FAX(408)777-3333•buildingQcupertino.org SITE BUILDING APPLICATION#: DATESU MIT`TED: ADDRESS: ) e ° t APN BUILDING PERMIT* fljooji OWNER'S NAME: PHONE#: FAX#: MAILING ADDRESS(if different from site address): i CONTRACTOR: PHONE#: FAX#: CONTACT: PHONE#: FAX#: LIMITS OF WORK REQUESTED FOR COURTESY INSPECTIONS: s oAJ I request to start construction work in which a building permit has not been completely secured. I have obtained a tenant improvement preparation permit which covers the removal of interior non-structural elements within the building. Furthermore, I have submitted a building permit application and plans for the tenant improvement project and it is currently in the plan review process. I agree to call for courtesy inspections for the limited work as noted on this application. I fully understand that I will be responsible to redo the work performed under courtesy inspections if the work does not fully comply with the approved set of plans and all State and local rules and regulations. Owner:...............................................................................Print:.........................................................................Date:...I.......................... Contractor:...............................................................................Print:.........................................................................Date:.............................. -OFFICE USE ONLY- The Request is: El GRANTED El DENIED Bldg Official/Inspector:......................................................................Date:................................ i INSPECTION RESULTS INSPECTION TYPE INSP.DATE TIME *RESULTS INSP. COMMENTS(REASON IF INSPECTION FAILED) SPENT INIT. U eL , �D ^ 83' " Ll 1 7 *RESULTS: P—Pass,F—Fail,C—Cancel,I—Incomplete,N—Not Required,R—To be Rescheduled CourtesylnspForm 2011.doc revised 08118111 I R, I I COURTESY INSPECTION REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO,CA 950143255 OttQ>zRTlN4 (408)777-3228• FAX(408)777-3333•buildingCcDcupertino.org SITE BUILDING APPLI ATI N#: DATE SUBMITTED: ADDRESS: ��ti�c srEVENS CPJe BLVD rl 8 it APN TI PREPARATION 3&o 0(o o I© OWNER'S NAME: PHONE#: I✓v r-- FAX#: MAILING ADDRESS(if different from site address): (9(020 S'rr�W-�US Ch(G AWP2LG Ciif thTfNo CA � 501� CONTRACTOR: PHONE#: FAX#: CONTACT: PHONE#: 1.0$, 5 i5• vgo pvv��ua�cst2 FAX M.- LIMITS OF WORK REQUESTED FOR COURTESY INSPECTIONS: I request to start construction work in which a building permit has not been completely secured. I have obtained a tenant improvement preparation permit which covers the removal of interior non-structural elements within the building. Furthermore, I have submitted a building permit application and plans for the tenant improvement project and it is currently in the plan review process. I agree to call for courtesy inspections for the limited work as noted on this application. I fully understand that I will be responsible to redo the work performed under courtesy inspections if the work does not fully comply with the approved set of plans and all State and local rules and regulations. Owner:.............. ...............................................Printtp ? -12—:-0...0 .............................................. ............. ............ ....... ...................... .... Date:........... ......... Contractor:...... . � . ......... ....... .. O . ...........................Date:.® r .16=77. INSPECTION RESULTS - INSPECTION TYPE TIME *RESULTS INSP. COMMENTS(REASON IF INSPECTION FAILED) SPENT NIT. ri 9 a i i *RESULTS: P—Pass,F—Fail,C—Cancel,I—Incomplete,N—Not Required,R—To be Rescheduled CourtesylnspForm 2011.doc revised 07/12/11 i I i CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19620 stvns crk blvd #220 DATE: 10/24/2011 REVIEWED BY: bobs. Al BP#: "VALUATION: 1$135,000 '-,PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 B TI® WORK U. comm. offices ace conference room MEPs new sub panel, 1 new hvac roof top unit. SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-A,111-A,V-A 2,519 $2,643.28 IBTIPLNCK $2,611.72 IBTIINSP TOTALS: 2,519 $2,643.28 1 $2,611.72 MECH,HOURLY 0 Yes O No PLUMB,HOURLY 0 Yes Q No ELEC,HOURLY 0 Yes Q No Mech.Plan Check "00 $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. M7rs $44.00 Ofh"),t'i,a;,:i;;,:;,>; IW,,-w, El 'VA j< rtr;j'. FCf,',' �3f }) f eo lav,. 1 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 prelinina information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resohitiorl 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,643.28 0 # Mechanical Suppl.PC Fee: Q Reg. 0 OT 0,0 hrs $0.00 $130.00 IBCAIRHA Air-Handling(<=10K cfm) PME Plan Check: $0.00 Permit Fee: $2,611.72 Suppl.Insp.Fee:Q Reg. 0 OT 0 0 his $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 r. tr'trz Wl ,T,(". .:'i'tF 37?ttr i'7 r"""r7r11%t' �"<•�'' � '.. Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning g i $0.00 Select allon-Residential Q Travel Documentation Fee: ITRAVDOC $44.00 Building or Structure 0 Strong Motion Fee: 1BSEISM1CO $28.35 Select an Administrative.Item I Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS.-, $5,377.35 $130.00 TOTAL FEE: 1 $5,507.35 Revised: 10/01/2011