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12110123CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRI'.SS: 19625 STEVENS CREEK BLVD CONI'RACfOR: -- PERMITNO:12110123 OWNER'S NAME: PORTAL PLAZA LP PL)oc;- S L t o DA'Z'E ISSUED: 1120/2012 OWNER'S PHONE: 4088651577 1 PIIONE NO: 0, LICENSED CONrI'RACI'O/fR'S DECLARATION r rl BUILDING PERMIT INFO: BLDG C License Class Lie. #_ 6 / r(7 / ELECT PLUMB _ n7 - DIECfI (- RESIDENTIAL r COMMERCIAL 1� Contractor '1 Date I hereby affirm this I am licensed under the provisions of Chapter 9 •JOB DESCRIPTION: EAST WEST BANK- ADD ONE DOOR AND SIDELIGH I'AT (commencing with Section 7000) of Division 3 of the Business & Professions AN INTERIOR OFFIC LOCA'T'ION THAT IS CURRENTLY OPEN. 10 Code and that lnr license is in fall force and effect. - FEET TOTAL IN LENGTH 1 hereby affirm under penally of perjury one of the following two declarations: Ihave and will maintain a certificate of consent Io 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 Workcf s Compensation Insurance, as provided 1Ur by Section 3700 of the Labor Code, for the performance of die work for which this Sq. Ft Floor Area: Valuation: $8000 permit is issued, APP LICANI' CERTI FICAT ION AI ;\ Number: 31620083.19625 Occupancy Type: 1 certify that I have read this application mid state that the above information is correct. I agree to comply with all city and county ordinances and state Imus 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 (he City ofCupertinoagainst liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this Permit. Additionally. the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code. Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date t( A Y Issued bye - Date://--,2.-- ate:`/26a❑ 0OWNER-BUILDER DECLARATION hereby affirm that 1 am exempt from the Contractor's License Law for one of RF; ROOFS: the following Ivo reasons: All roofs shall be inspected prior to any roofing material beiig installed. If a roof is 1, as owner of the property, or my employees with wages as their sole comp:nsmion, installed without first obtaining an inspection, I agree to remove all new materials for will do the wolf:, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to Signature of ApplicanC Date: construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's IIA'LAR1)Of1S \IA"I'ERIAIS DISCLOSURECompensation, as provided for by Section 3700 of the Labor Code, for the performance of work for which this pemmit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain Worker's Compensation Insurance, m provided for by California Ilealth & Safety Code, Sections 25505. 25533. and 25534. 1 will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section _5532(a) should I stare or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants ns defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino NL unicipal Code. Chapter 9.12 and the Compensation laws ofCalifomia. I(, after making this certificate of exemption, I Ilealth & Safety. Code. Sections 2,5505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this pcmmit shall be deemed revoked. Owner or nuthuri al agora: I Date: � VY API'I.IGkN'I' Cl?RT'IFIGVf101N CONSTRIJC'I'ION LENDING AGENCY 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 mid state laws relating I hereby abrin that there is a construction lending agency for the performance of work's to building construction, mid hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Cir C.) upon the above mentioned properly for inspection purposes. (We) agree to save Lender's None indemnify and keep harmless the City of Cupertino against I iabilities, judgments, costs. and expenses which may accrue against said City in consequence of the Lender's Address granting of this pemmil Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section ARCI11TE,CI"S DECLARATION 9,18. 1 undersand my plans shall be used as public records. Signature Dale Licensed Professional % � 0 z |9 2a � | ;|2.9 � j ° § zi Rf: %®� i)) \ \\ t §\\ /)§ )0® § % � 0 z |9 \ § Za | ;|2.9 � j ° § zi Rf: %®� i)) t /)§ )0® § §E :\ ) 22(rw ,E� CL O{ {;;\ §a � o,m;.o §k I W / / k' < a�w§ &2 �& (K =_am Fr. t+k� [ k� §¥\)moo& % � 0 z |9 | ;|2.9 � j Rf: |)) t CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina0cuoertino.oro ❑ NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT �F F PROJER ADDRESSI <-D OWN ER N •�f(/ `C1\Wl� Y' Yi (/u''� o AAJL STREETADDRESS CITY, STATE, ZIP FAX CONTACT NAMEi„ PHONE ! 0 /t E-MAIL 7 STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ ORT'ER AGENT ❑ CONTRACTOR ❑ CONIRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME j' V LICENSE NUMBER -76797 LICENSE TYPE BUS. LIC9 , COMPANY NAME 0 E-MAIL FAX STREET `Do , I It 4' Vv CY, STATE, ZIP R Jr\•�� G �% PHONE sc.>> ',(_ r 16 6 ARCHITECTIENG!NEER NAME LICENSE NUMBER BUS. LIC N COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK dh12 9 -� f ERI P'G USE PROPOSED US � COt4S0STORIES USE TYPE OCC SQ.FT. VALUATION (S) EXISTO AREA NEW FLOOR AREA �— DEMO /T� AREA _--F—+} \JOTHEER TOTAL NET AREA LS BATI-BROOM KITCHEN l o11_r RFAIODELAREA REAIODELAREA REA10DEL AREA Y N�LL PORCH AREA DECK AREA TOTAL DECK ORCH AAFA GARAGE AREA: DETACH ATTACH M DWELLNG UNITS: ISASECONDUSIT ❑YES BELNOADDED? ONO SECOND STORY DYES ADDITION? ONO PRE.APPLICATION ❑tFs IF YES, PROVIDE COPY OF PLAN-NNGAPPLM ONO PLANNING APPROVAL LETTER IS TRE BLDG AN ❑YES EICHLER HO\IE? 0NZlqo RECEIVE BY"-i3:ti'�'s `.+pN ` T71 R_'�t(y'Y2 TO VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on tr6pWy owner's behair I have read this application and the information 1 have provided is correct. ave 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 conswetion. Ize representatives of Cupertino to enter the above-identifie propertjy for inspection purposes. Signature of Applicam/Aeent: Date: SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existine building(s). Demolition permit is required prior to issuance of bvildino permit for new building. _ Commercial Bldgs: Provide a completed Hazardous MaterialsDisclosure.F❑ form if any Hazardous Materials are being used as pan of this project _ Copy of Planning Approval Letter or Sleeting With Planning prior to submittal of Building Permit application. i `esia�;caecl T" r r Owl U�T,i.'ZOSTtP -t- A- i '=`�pr R=THE COUN-I'EH - �''`x7` ^� E •^s, '❑O EEU'RFSS � , aT sr,:nDARD Tc s;. ❑'E LARGE-��. +; x . I•❑O \L1JOR ,� C „ P?"'•ia1: ❑llNBDiNGPLLN RE\TEq' _ �© T LAANI '•t',sPLA\ RE\'IIiW ❑� t u¢"L'i ❑ 1111PDEPT r; 4 Yi "p ❑"'S\NITARI SEV\LR DISTRICT A r iEs)q RON IAL HE i?T j ..:. B1dg.4pp_2011.doc revised 06111111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION kDDRESS: --,F,APN: 19625 stevens creek blvd DATE: REVIEWED BY: larrys PC FEE ID BP#: 'VALUATION: 1$8,000 "PERNIITTYPE: Building Permit PIANCIILCI:'1'YPE: Tenant Improvement PRIMARY Commercial Building USE: $0.00 PENIAMAIION 1B TI PERDIIT "TYPE: WORK add one door and sidelight at an interior office location that is currently open. 10 feet total in le nth. SCOPE $0.00 OCCUPANCY •TYPE: OF 'I CONSTR. FLR AREA (s.L) PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 0 $0.00 Other Elec. Insp. $0.00 Plumb. /Pup. ree: Elec. hi.p. Fee: 'PME Plan Check:. $0.00 Permit Fee: $0.00 Supp). Insp. Fee -.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 1 0 $0.00 Construction '1'a1: $0.00 MFCI1, HOURLY C) Yes l7 No PLUMB, HOURLY Q Yes (' No ELEC, HOURLY Yes Q No .1ferb. Plan Cheek Plumb. Plmi Check Elec. Plar. Check Merl. Permit Fee: Plumb. Permit Fee:b'ler:. Permit Fce: Other Meeh. beep. Other Phawh Imp, Other Elec. Insp. Meds. trap. 1ee: Plumb. /Pup. ree: Elec. hi.p. Fee: NOTE: This animate doer not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Seieer District, School District, etc). There feev are bused or the prelintinan, information available and are onh• an estinmte Contact the Dept for addn'I info. FEE ITEMS (Fee Resolmion 11-053 Etf 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 10 1 Lf. $467.00 Interior Partitions IP,Ik7/COM,v Suppl. PC Fee: (E) Reg. () OT FO.0 hrs $0.00 'PME Plan Check:. $0.00 Permit Fee: $0.00 Supp). Insp. Fee -.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction '1'a1: Administrative Fee: Q G Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G Travel Documentation Fees: Strong Motion Fee: 11ISFISMICO $1.68 Select an Administrative Item Bldg Stds Commission Pee: IBCBSC $1.00 SUBTOTALS: $2.68 $467.00 TOTAL FEE: F $469.68 Revised: 10/01/2012