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10120138CITY OF CUPERTINO BUILDING PERMIT B1 ILDING .ADDRESS: 22445 CUPERTINO RD CONTRACTOR: SAMUEL CONSTRUCTION PERMIT NO: 10120138 ON%NTEIR'S NAMFI: FRONT PORCH COMMN & SFRVS 2141 C.AROBWOOD LN DATE ISSUED: 09/06/2011 ONN N'ER'S PHONE: 4084545600 SAN JOSE, CA 95132 PHONE NO: (408) 262-2727 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG (v ELECT � PLUMB //�� Class Lic. # t5&4 -) / i I.icense --- _ MECH RESIDENTIAL COMMERCIAL lP7� Contractore -,Q x"15'} Date '7// -�►1'llti�'L JOB DESCRIPTION: T' I REMODEL 3426 SQ FT AND ADD 282 SQ FT TO MUL H I hereby affirm that I am licensed under the provisions of Chapter 9 PURPOSE ROOMS AND ADJACENT 11ALL,WAYS RENOVATION (commencing with Section 7000) of Division 3 of the Business & Professions ('ode and that nuv 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 Workers Compensation. as provided for by Section 3700 of the Labor Code, for the pertunmance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Ft Floor Area: Valuation: $200000 Sccuon 3700 of the Labor Code, for the performance of the work for which thisSq. pernui is issued. APN Number: 32615 130 22445 Occupancy "Type: kPPLICAN"1' CERTIFI(:ATION I ccrtilN that I have read this application and state that the above information is correct I agree to crnnply with all city and county ordinances and state law's relating to hudding 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 indemnitj and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs. and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM=STALLED INSPECTION. Nidi all non -point source regulations per the Cupertino Municipal Code, Section �) Issued by Date: Si��nalure Date -- - - - - - C C OWNER -BUILDER DECLARATION RE -ROOFS: hN affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any rooting material being installed. If a roof is luh, rollowing two reasons: installed without first obtaining an inspection, I agree to remove all new materials for L a, owner of the property. or my employees with wages as their sole compensation, inspection. kill 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 proper(\, am exclusively contracting with licensed contractors to -------- --- :onstniet the project (Sec 7044, Business & Professions Code) ALL ROOF COVE:KINGS'TO BE CLASS ":*," OR BET7_ER I hereby affirm tinder penalty of perjury one of the following three declarations: have and will maintain a Certilicatc of Consent to self -insure for Workers HAZARDOUS MATERIALS DISCLOSUREI (compensation, as provided for by Section 3700 of the I.abor 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 Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this Additionally, should I 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 that in the performance of the work for which this permit is issued, 1 shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not crmploy 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 this certificate of exemption, hecomc subject to the Worker's Compensation provisions of the Labor Code, I must Ow ser or auth rized agent: �'t u>� Date: oil f0rthwnh comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certifx that I have read this application and state 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 and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to huiklmg construction, and hereby authorize representatives of this city to enter Lender's Name upon the aho%e mentioned property for inspection purposes. (We) agree to save indeninit\ and keep harmless the C N ot'C'uperuno against liahilitics, 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 compl} ;kRCHITECT'S DECLARATION ;I non ,x�int ouu�cc rogulati�trs per the Cupertino Nlu1116pitl Cody, Sce[ion - I understand my plans shall be used as public records. Su,nature Date licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22445 CUPERTINO RD CONTRACTOR: SAMUEL PERMIT NO: 10120138 CONSTRUCTION OWNER'S NAME: FRONT PORCH COMMN & SERVS 2141 CAROBWOOD LN DATE ISSUED: 09/06/2011 OWNER'S PHONE: 4084545600 SAN JOSE, CA 95132 PHONE NO: (408) 221-7900 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIALE] License Class_ _ Lic. # 55'7 7 2 T.I REMODEL 3426 SQ FT AND ADD 282 SQ FT TO MULTI -,:5 my,_eL /d � 3 PURPOSE ROOMS AND ADJACENT HALLWAYS Contractor 16 r'1 cz Date —'0 RENOtATION I hereby affirm that I am licensed under the provisions of Chapter 9 8 7/13 DEFERRED 41 ADA RAMP- ISSD 10/4/2013 (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 dc ns: I have and will maintain a certificate of consent to self -insure fors A Compensation, as provided for by Section 3700 of the Labor or the ®� performance of the work for which this permit is issued{ Sq. Ft Floor Area: Valuation: $200000 1 have and will maintain Worker's Compensation Insurare, as pro ' ed y Section 3700 of the Labor Code, for the performance of the wa ich this APN Number: 32615130.22445 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating building hereby this to WITHIN 18 PERMIT ISSUANCE OR to construction, and authorize representatives of city enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F LA§Y 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 f granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. Signature- Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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) I, 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 1 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 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, 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, 1 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. 1 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 1 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22445 CUPERTINO RD CONTRACTOR: SAMUEL CONSTRUCTION PERMIT NO: 10120138 OWNER'S NAME: FRONT PORCH COMMN & SERVS 2141 CAROBWOOD LN DATE ISSUED: 09/06/2011 OWNER'S PHONE: 4084545600 SAN JOSE, CA 95132 PHONE NO: (408) 262-2727 A, LICENSED CONTRACTOR'S DECLARATION r License Class 1_11SLic. # S_&' 4-) 7?_I BUILDING PERMIT INFO: BLDG ELECT PLUMB Contractor _`zLW12�.� � nS �- Date % �P ��. Contractor MECH. RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: T.I REMODEL 3426 SQ FT AND ADD 282 SQ FT TO MULTI (commencing with Section 7000) of Division 3 of the Business & Professions PURPOSE ROOMS AND ADJACENT HALLWAYS RENOVATION 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. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $200000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 32615130.22445 Occupancy Type: APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 D YS FROM ST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. G y ; f Signature ° " Date Issued by: %4Q Date: C*�4-, 7 r�' ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I 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, 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 structure is not intended or offered for sale (Sec.7044, Business & 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 & 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 the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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(a) should I store or handle hazardous material. Additionally, should I 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 that in the performance of the work for which this permit is issued, l 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 this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must Ow er or auth rized agent: X +rte G'cyV] k,oa 1 Date: forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of cork's correct. I agree to comply with all city and county ordinances and 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 ARCHITECT'S DECLARATION with 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 APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ Ti ❑ REVISION/ DEFERRED U10`W O ORIGINAL PERMIT # PROJECT ADDRESS APN # OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP ��E7 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME $,q614 UL' / 4ti �- - LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE __7ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 11 -OA ,J/"q EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: EIDETACH ❑ ATTACH �r # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? 1:] NO r PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RE TOTAL VALUATION: PL4NNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLERHOME? NO By my signature below, I certify toe of the following: I am the property owner or authorize a to act on the property owner's behalf. I have read this application and the information I h e JYRvided is correct. I have read the Description of Work an verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating o Yiilqing construction. I authorize representatives of Cupertino to enter the above -identified property for inspection proposes. Signature of Applicant/Agent: a/ Date: ?z2 a 6 SUPPLEMENTAL INFORM T N REQUIRED PLAN C14ECKTYPIr R IUrrNq$LIP New SFD or Multifamily dwellings: Apply for demolition permit for E OVER-THE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXP S 0 PLANNING PLAN REVIFW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD C1 PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO F -M7 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dietrirt etr_ L Thr_ce fops are hated on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711112) ADDRESS: 22445 cupertino rd DATE: 08/07/2013 APN: BP#: REVIEWED BY: MENDEZ "VALUATION: 1$21,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: $0.00-F-27 PENTAMATION 1 GENRES PERMIT TYPE: WORK DEFERRED #1 ADA RAMP SCOPE 0.0 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dietrirt etr_ L Thr_ce fops are hated on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00-F-27 hours $278.00 Plan Check, Hourly 1STPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes F) No $0.00 Suppl. Insp. Feer Reg. () OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i ,lit"' Work Without Permit? C) Yes (F) No $0.00 Advanced Planning Fee: $0.00 2 hours $278.00 Inspections 7ST7NSP Inspection, Hourly �A Strong Motion Fee: IBSEISMICR $2.10 0.5 hrs $44.00 Admin./Clerical Fee /ADMIN Bld& Stds Commission Fee: 1BCBSC $1.00 5t tTOTAAL'S: ' $3.10 $600.00 � TOTAL VEE,` ' $603.10 Revised: 07/01/2013 CITY OF CITY OF CUPERTINO TENANT IMPROVEMENT PERMIT APPLICATION FORM APN # ,5VS__4 Date: Building Address: - Mailing Address /'U, _�if different from builling address): e;u 1/ -77, lq- �y�/" -7 777 's Tenant r_1 (If tenant please provide a letter from the building owner approving tl!V tenant improvement.) Building Owner 9 Are Hazardous Materials being used as part of this project? Yes E] No Tenant/Building Owner's Name: Phone #: Contractor: c- e c) ri Phone #: Alo �Z`2 i y 0 Fax #:;V 06�' '214" Z- - 20 - Cupertino Business License: State Contractor License #: 7 2 Contact: (2 rl c v�-x _,L Phone #: j4i,_70 '�2_-Z_A Fax #: z - Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less, compliance with the Landscape Water -Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: El Plant Type 0 Water Budget Job Description (be specific): 5 S tc L fA -4- �- vz L + ;j Tenant Improvement Includes Re -Roof: YesEl No Rl_ If yes, number of squares Tenant Improvement Includes Structural Yes PNo El Type of Construction (Usage Class): Occupancy Type: A --z I -A, I -BE] WI]II/V-A � II/III B, IV -HT, V -BEI Valuation: Project Size: Express ❑ Standard Large F-1 Major [I Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable, include in plans & sheet index LEED Points Achieved *** For Office Use Only*** Over The Counter El Revised 05/18/10 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 2244Y Cupertino rd. DATE: 12/20/2010 REVIEWED BY: bobs. PC FEES APN: I BP#: *VALUATION: 1$200,000 *PERMIT TYPE: Building Permit II-A,111-A,V-A PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IATIPLNCK Pl00R �l'l;,4: PENTAMATION 1A TI PERMIT TYPE: WORK 11-A,111-A,V-A 3426 SCOPE IBTIPLNCK $3,344.50 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID A (Tenant Improvements) II-A,111-A,V-A 282 $2,697.00 IATIPLNCK $656.00 ]ATHNSP B (Tenant Improvements) 11-A,111-A,V-A 3426 $2,650.00 IBTIPLNCK $3,344.50 IBTIINSP $4,000.50 Suppl. Insp. Fee. -G Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 3,708 $5,347.00 $4,000.50 NOTE: These fees are ha.ced an the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 E '. 7ILLD FEE QTY/FEE MISC ITEMS Plan Check Fee: $5,347.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT OA 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,000.50 Suppl. Insp. Fee. -G Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("on"' li' f�riYt Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Plannin�Fee: PLLONGRNGC $0.00 0 ' ra"'cl Strong Motion Fee: IBSEISMICO $42.00 Select an Administrative Item Bldg Stds, Commission Fee: IBCBSC $8.00 UB`T XXL : $9,397.50 $0.00 ` : TC?T F)E $9,397.50 Revised: 12/07/2010 CUP'ERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB � PERMIT # � O�WNERDS NAM ,,. 1G' -s- � PHONE # , GENERAL CONTRACTOR: /i - LICENSE # _ ADDRESS, (411�i�;(51 CITY/LIPCODE: *Our municipal code requires all businesses working in the city to have a Cite of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) 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 Please check applicable subcontractors and complete the following information: Date / Con ctor Signature / � / /?-0 r d Date SUBCONTRACTOR ------------- BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork —77' AD P ..... _..... __ Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving t Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / Con ctor Signature / � / /?-0 r d Date CITY OF CITY OF CUPERTINO TENANT IMPROVEMENT CUPERTI N PERMIT APPLICATION FORM 020 APN # 32s VSDate: _, 1?/7-014_-010 Building Address:_g-� Pr r4l»o /, d � Cc".per1--1,17 0 r 6A �%50 I`� Mailing Address_Qf different from buil ing address): _/It ; orcl� ��err� %1406a 7 �y Tenant ❑ (If tenant please provide a letter from the building owner approving t tenant improvement.) X,,4 Building Ownerp/ Are Hazardous Materials being used as part of this project? Yes ❑ No Tenant/Buildmg Owner's Name: Phone#: hG��_ �,�5"� shoo s CLVX VI/y Vi evt_9 L_z4_+ -�'r 41,rpt N9/►I`� Contractor: a,�� n r'u-c -icrrl Phone#: x{p,? -ZZ/ -?'/1-0 Fax #: J4 08 - Z- 829Z Cupertino Business License: State Contractor License #: 5 6-,;�172- Contact: 71Contact: Phone #: 4 a F- 2—,ZI --7 , o c� Fax #: 4,00 - Z4,-Z - �2 c,FZ_ Landscape Ordinance Compliance: Landscape area in sq.ft. (includes all irrigated areas): If 2,500 sq.ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Water Budget Job Description (be specific): 2e I'vl och9t' c�v�c� �1e1�/a 5 (Z-,e l e�►�6 ►�po5 GX.nd o_o(j n ce rLA- +AQ.C1r'A� add 29a, Tenant Improvement Includes Re-Roof: Yes ❑ No R/If yes, number of squares Tenant Improvement Includes Structural Yes ❑ No ❑ Type of Construction (Usage Class): Occupancy Type: _ Z 1-A, 1-B ❑ Il/III/V-A [N� 11/111 B, IV-HT, V-B ❑ Valuation: -'J� Project Size: Express ❑ Standard Large ❑ Major ❑ Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable, include in plans & sheet index LEED Points Achieved *** For Office Use Only*** Over The Counter ❑ Revised 05/18/10 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRE"224Cupertino rd. DATE: 12/20/2010 REVIEWED BY: bobs. APN: � - BP#: "; 'VALUATION: $200,000 R'PETYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building IulAL PENTAMATION 1A TI USE: FLOOR F1REA; PERMIT TYPE: WORK SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. A (Tenant Improvements) II-A,111-A,V-A 282 $2,697.00 IATIPLNCK $656.00 ]ATHNSP B (Tenant Improvements) 11-A,111-A,V-A 3426 $2,650.00 IBTIPLNCK $3,344.50 IBTIINSP TOTALS: 3,708 $5,347.00 $4,000.50 MECH,HOURLY Yes (F) No PLUMB,HOURLY Q Yes Q) No ELEC,HOURLY Q Yes Q No Mcch. Ilu;: c k u�u, !'lu.: J'er_ f'/ar7 A-titch. Perwia Plumh. PErrmit Fee: I I c.Permit Fee: Other Mech. Insp. :umh InrpLi Other Insp. Vech.Insp,1, phn:'. ,'Ii.% /'c". Glt NOTE: Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-051 E'. 7/I11j0j FEE QTY/FEE MISC ITEMS Plan Check Fee: $5,347.00 Select a Misc Bldg/Structure Suppl.PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $4,000.50 Suppl. Insp. Fee.-G Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C;onstr-w-tion Tax Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Plannin�Fee: PLLONGRNGC $0.00 0 I rui cel Documentation Fees: 0 Strong Motion Fee: IBSEISMICO $42.00 Select an Administrative Item Btdg Stds Commission Fee: IBCBSC $8.00 SUBTOTALS: $9,397.50 $0.00 TOTAL FEE: 1 $9,397.50 Revised: 12/07/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CO TRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS:' �ko CQ PERMIT# f OWNER'S NAME: �,- ; r ;�y.t},.1 PHONE# X09-'-ZI- GENERAL CONTRACTOR: o0,5- —iccf+ r$USINES S LICENSE# ADDRESS:-2-'ItI-/eet-O 5 �S ' CP-q5(5-,. CITY%ZIPCODE: 5,:Z-nSa6e I /jZ *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 Own4--/Con ctor Signature Date