12080093 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20488 STEVENS CREEK BLVD CON"I'RACI'OR:AXIS CONSTRUCTION.INC PERMITN0: 12080093
OWNER'S NAME: STEVENS CREEK COMMERCIAL,LLC 2566 BARRINGTON CI' DATE ISSUED:08/092012
OWNER'S PRONE: 2096494493 IIAYWARD.C\ 94545 PBONF,NO:(510)732-6111
LICENSED CON\TRACPOR'S DECLARATION BUILDING PERtNIIT INFO: BLDG r ELECT r PLUMB r
License Class \LILic.N 6 17 6 �_ r r r
AA _ MECH RESIDENTIAL COMMERCIALContmaork j COIJ572.uc are �—/0—(Z
herehy affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG-STUCCO CRACK REPAIR(1100 LF);SEALANT/
(commencing with Section 7000)of Division 3 of the Business& ProfessionsBACKEROD AT WINDOWS,REPAIR ROOFING(2712 SQFT);
Cute and that my license is in full force and effect. NON-STRUCTURAL COLUMN CASING REPLACEMENT ON(76
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.
I have mad will maintain Worker's Compensation Insurance.as provided for by
Section 3700 of the labor Code,for the performance of time work for which this Sq.IY Floor Area: Valualiun:$877000
permit is issued.
APPLIC,yVT CERTIFICATION APN Number:36953999.00 Occupancy'I'spe:
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.;lad hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT IRES IF WORK IS NOT STARTED
indenmify and keep hamnless the City of Cupertino against liabilities,judgments,
WT DAYS OF PERMIT ISSUANCE 012
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands tad will comply 180 DAY LOM LAST CALLED INSPECTION.
with all non-point source regula i is per the Cupertino Municipal Code,Section
9.18. / ^)Z
�l��D I Z-
0
Issued by: — 1 o Date:
Signmure Dam
❑ OWNER-RUDDER DECLARATION
RF:ROOFS:
1 hereby affirm that I am evempl from the Contractor's License lawfor 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,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the slmeture is not intended or offered for sale(Sec.7044,
Business S Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044•Business E Professions Code).
AL1,ROOK CO\'IiRINCS"1'O RE CLASS'S\"OR HE 1"1'ISR
here[)%affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Cenilicatc of Consent to self-insure for Worker's LL\%ARDOUS INIATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued California I lcalth&Safety Code,Sections 25505,25533,and 25534. I will Inainlain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance will,the Cupertino\lunicipal Code:Chapter 9.12 and file llcallh&
Section 3700 of the Labor Code,for the perfornnance of the work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material.
Additionally,should 1 use equipment ur devices which emit hnzurdous air
permit is issued contaminants it.,defined by the Buy Area Air Quality Managennmrt District I will
I certify that in tine performance of Ore work forwhich this permit is issued,I shall maintain compliance wills the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner soils to become Subject to the Worker's I lcalth&Safet Cod^e. ctiun.s 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate ofexemption,I /�
become subject to the Worker's Compensation provisions ofthe Labor Code,I must cro orU d agent: 1_/"7
forthwith comply with such provisions or this pemnit shall be deemed revoked LGf' De1c'J' CJ L
If
A 11 11 LICA\I'CERTDFI CATION CONSTRl1C1'ION LENDING AGENCY
I ceri ly that I have read this application and sate that the above information is I hereby offinn that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinaries mid state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities.judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ,\RCII ll'IiCI"S DECLARATION
all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CONSTRUCTION PERMIT APPLICATIONI
CONINIUNIITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 7773228 • FAX (408) 777-3333• buildinot7p cupertino.oro
❑ NEW CONSTRUCTION ❑ ADDITION • ALTERATITN/TI ❑I REVISION/DEFERRED ORIGIIiAI.PERM-I'P4fN
PRO/ECT ADDRESS • • Jfl .APNE qEo QG� . `ems,
O\?'.R NAStE r PHONE. I CCJ/ L l ,—(IL _ _ J✓
r� 410 1 A uuL1 llae,2
STP'F:T ADURFSS p1'd�t/fCil�li)•I f1T1', $TATE.ZIP I FAS
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\•TACT NAS(E PHONE A
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SI'ftEEI'ADDRESS C11Y.STA rE. ZIP I _ FAS
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0 OWNER ❑ OwNER-RUILDFcR ❑ M\:\ER AGE?T COPTR,\CTOR EICO.NgR CTOR ADEPT El ARCHrtTQ ElEFOIIFFA 11 DEVELOPER 0 TE�AKr
fONT'RACTOR NASIE I ---� .LICENSE NUSf BER LICENSEE\'PE' 'PI I BUS.LICa
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COMPANY NASIE� -DIA(L 1 P'Ax
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STREETADDRESS cin rnrEZIP
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COMPANYNAME E-."AIL f FAX
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STREET ADDRESS CITY,SLATE.ZIP I PHONE
DESCRIPTION OF N' RR 1-7 2 �''_
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> S + cl. �.�..1'1".t_(/�,�Lrt �.(�aTt�dti\.c {DIYy�P Q�fL k� ✓lq 7 n.EXISTING USE PROPOSED USE CONSM,TYPE aSIORIES
USE TYPG OCC sQ.Ff. VALUATION(S)
E%ISTD NEAA'FLOOR DESIOTOTAL
AREA AREA AREA roTT l
BATHROOM KITCHEN IF I-
REMODEL AREA REMODEL ARE mDEI.AREA
PORCH AREA DECK AREA TOTAL:➢ECI:aVRCH.AREA GARAGE AREA: D DETACH
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DAV ELLI.YG UNRSy'�.' IS A SECOND UNIT 0YFS SECOIDSTONIONES I'
BEIFGADDED: C]so ADDITION! []SO 1
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PRL'JTGLICATION ❑YES IF YES,PROVIDE COPi'OF IS'I'IIE In.0 , ❑YES RCCEI DBY.' n na TOTAL VALUATION:
PI.x,."No Arm, ANO PLANNINO.APPROVAL Lmrt I:n`1nXHUOyLT p\O t: t1:•r"�Le...�5 -7
By my signature belo\v,I cenifY to each of the following: I am the property owner or audrorized agent to act on Ihe'propcny O\YncT,S behalf. I have read this
application and the information I have provided is coma. 1 have read the Description of Work,and verify it is accwate. I agree to comply with all applicable local
ordinances mrd state Imus rdaling�o built' _constnm' n nu Jizc rep• senuni\'es of Cupertino to enter the abov-iQ ified m 'for i ection rp ses.
Sienmureof Applic:utl/Agene c. Date: _
SUPPLEMEN'T'AL INFORMATION fcCQUIRED 'f Prr Aa CIIECK.rfEE, RouTi9c suP..
N ¢ �
New SPD or Multilmnily dA\elhng5 Apply for demolition permit for CU\'1 '+
8 +
[ LR lL!-COEN •J\ �BUiI Irl\G PIAT NfA If AI' "
eNistine building(s). Demolition permiti.required prior to isivar - .—nce of building � -
permit for new building. EcrdFss...+ F.,,<,,. :.�. _ '""" °` `•'''T' ' ''
� ®•jPLAN\i\G.PL\h'NE\ILw,^
_Commercial Bides: Provide a completed Hazardous N1ntcrials Disclosure .0 "STANDARD' El Pmit.IC\vouus
form if anv Hazardous Materials are being used as pan o'this project. ❑ LAaee.. I ❑�FINF➢!PT A._ _.-,
_Copy of Planning Approval Letter or Meeting\6th Planning prior to _
�❑ NAJOR',; O .SA\ITARI SF\Vl R.UISI RIF,
Submittal of Building Pernia application. r .TIE{4.
Bldg.-I pp-2011.doc 7-evised O6/?7/I 1
t
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20488 Steven Creek Blvd DATE: 08/08/2012 REVIEWED BY: Sean
APN: 369-53-991 RP#: VALUATION: $877,000
*PERMITTYPE: Building Permit PLAN CII ECK TYPE: Alteration /Addition/ Repair
PRIMAIiI' PENTAI4LTIO
N
USE: Commercial Building PER\IITTI'PE: 1GENCOM
WORK Stucco crack repair 1100 sealant/backerod at windows repair roofing 2712 sq ft); non-structural
SCOPE column casing replacement on (76 columns).
Atech. Plan Check Phaeh. Plan Check Flee. Plan Check
Alech. Permit Fee: Plumb. Permiu Fee: F.lec•.Permit Fee:
Oilier Alech.Insp. Other Plumh Insp. Ll I Other Elec.Insp.
klech. /asp.Fee: Plural. lrvp. Fee: Elm. lisp•Fee:
NOTE: This evtirnute does not include jeer due to other Departments(i.e. Planning, Public II'orks, Fire,Sanimgq Sewer District,Schaal
District, etc.). These fees are based on the prelintinan information arailahle and are onh•an estimate. Contact the De t or arldn'l in a.
FEE ITEMS (Fee Resolution 11-053 Lff 7/1111) FEE QTl'/FEE i111SC ITEMS
Plan Check Fee: $0.001,100 s.f. Restucco
Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $535.00 /STUCO.IPP
PME Plan Check: $0.00 2,712 s.f. Re-roof
Permit Fee: Hourly Only? 0 Yes Q No $0.00 $367.00 IRFROOFCO,11
Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 ]its $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consnvction Tax:
Administrative Fee: 0
Work Without Permit? 0 Yes No $0.00 G
Advanced Planning Fee: $0.00 0 hours Inspections 0
Travel Documentation Fees: $399.00 ISTINSP I Inspection, Hourly 0
Strong Motion Fee: IBSEISMICO $184.17 Select an Administrative Item
Bldg Skis Commission Fee: IBCBSC $36.00
SUBTOTALS: 1 $220.17 $1,301.001 TOTAL FEE: F$1,521,171
Revised. 07/01/2012
Building Department
City Of Cupertino
10300 Torre Avenue
bib II bhududlIdik
Cupertino, CA 95014-3255
Telephone: 408-777-3229
*Fax.4a8-ZZZ 3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# / O 4n'1
OWNERiS,NAME: (FEZ A PHONE # (0 9
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS:,S N CITY/ZIPCODE: /✓ /V
*Our municipal code requires all bu finesses 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.
Lam not using any subcontractors:
Signature Date:
Please check applicable subcontractors and complete the following infor.matiom,
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
Ory, cr/Contractor Signature Date
V !