10120147 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19620 STEVENS CREEK BLVD STE 150 CONTRACTOR:EVERSHINE VI,L.P. PERMIT NO: 10120147
OWNER'S NAME: EVERSHINE VI,L.P. 19770 STEVENS CREEK BLVD DATE ISSUED:06/15/2011
OWNER'S PHONE: 4083431088 CUPERTINO,CA 95014 PHONE NO:
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❑ LICENSED CONTRACTOR'S DECLARATION T
BUILDING PERMIT INFO: BLDG ELECT PLUMB
I
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:GYU-KAKU RESTAURANT-T.I OF 2,416 SQ FT TO (2)5
(commencing with Section 7000)of Division 3 of the Business&Professions TON HVAC,(1)8.5 TON HVAC,(2)PCUS TOILET AND
Code and that my license is in full force and effect. KITCHEN EXHAUST FANS,DINING AREA DOWNDRAFT
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
Section 3700 of the Labor Code,for the performance of die work for which this Sq.Ft Floor Area: Valuation:$350000
permit is issued.
APPLICANT CERTIFICATION APN Number:36906010.150 Occupancy Type:
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 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued bye 5`7 Date: CJ
Signature Date `
V 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
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: HAZARDOUS MATERIALS DISCLOSURE
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 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. 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(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,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 this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owne•or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. �� '�� Date: /
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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 Nwrk'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 ,
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECTS DECLARATION
9.18. I understand my plans shall be used as public records.
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Signature - - Date / l� Licensed Professional
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CITY OF CUPERTINO BUILDING PERMIT m ;�"
BUILDING ADDRESS: 19620 STEVENS CREEK BLVD STE 150 CONTRACTOR:EVERSHINE VI,L.P. `PERmtT N`(_"Ii)2Mr
OWNER'S NAME: EVERSHWE VI,L.P. 19770 STEVENS CREEK BLVD DATE ISSUED:06/15/2011
OWNER'S PHONE: 4083431088 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# r r
MECH' RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:GPU-KAKU RESTAURANT-T.I OF 2,416 SQ FT TO (2)5
(commencing with Section 7000)of Division 3 of the Business&Professions TON HVAC,(1)8.5 TON HVAC,(2)PCUS TOILET AND
KITCHEN EXHAUST FANS,DINING AREA DOWNDRAFT
Code and that my license is in full force and effect. 8/8/2011-REV#1-REVISE HVAC DUCTWORK&RELATED SHAFTS-9/1/2011-
REV#1 ISS'D
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
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$350000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:36906010.150 Occupancy Type:
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
indemnify and keep harmless the City of Cupertino against 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 Issued by;: ? Date:
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for j
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I 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 HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
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(x)should I store 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 as 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 Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith cool with such provisions or this permit shall be deemed revoked. Owner o} �utnzed agent:
comply p p vim. Date:
APPLICANT CERTIFICATION CONSTRUCTION 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 and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Dat
c
Licensed Professional
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CONSTRUCTION PERMIT APPLICATION �
COMMUNITY DEVELOPMENT DEPARTNIENT• BUILDING DIVISION
j
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPI_RT1N0 (408)777-3228 • FAX(408)777-3333 • building(aDcupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERNIIT# < z
PROJECT ADDRESS , f
f f L APN Ie
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OWNER NAME y �:�- fL i n.Iu zI PHONE E-MP II
k
STREET ADDRESS CITY, STATE,ZIP FAX
t.
CONTACT NAME \ 'A-t. / PHONE :1' E-MAIL
C✓€ 4e�<<'4 o' ,
I
STREET ADDRESS/?f t,/ CITY,STATE, ZIP FAX bf
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER TENANT
CONTRACTOR NAME LICENSE NUMBERLICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAIME -, 6 a LICENSE NUMBER f 7 BUS.LIC#
k4 I
COMPANY NAME } E,MAIL FAX
/<
STREET ADDRESS CITY,tJ€ STATE,ZIP ONE
qq p
P
cl 72... a:_.'"k k..v`b'? J{' (.- lC —c.�%e;.r%t bi ��"�^� t/{✓ v' ,, !` x
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA ,S'✓ .�.d p P... 4-111
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREATOTAL DECKIPORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT C]YES SECOND STORY ❑YES
BEING ADDED4 [-]NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BYE TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �--
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prrperty 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 buildrng,.con�tcuqtion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQ=D PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for 171 ov _ _couNTER CHUII nuvG PLAN REv>Ew
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. REss ❑ PLAMUNG PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIcw PM
form if any Hazardous Materials are being used as part of this project. ❑ LARGE C ' E DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
i
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
TENANT IMPROVEMENT
CITY CUPS TING PERMIT APPLICATION FORM
l❑` O ( q
APN# 360-06-01 Q . Date: -12/17/10
Building Address: 196320 `3toven's en's cr It Blvd,, 'Suite 140
Mailing Address (if different from building address): 13t,trt° fc� € lv ,
Tenant ❑ (If tenant please provide a letter from the building owner approving the tenant improvement.)
Building Owner ❑
Tenant/Building Owner's Name: 13ay Area Y„ti;iniku 1.1C Phone#: (408) 343-1088
Contractor: _` D Phone#:
Fax#:
Contractor License#:
Cupertino Business License#:
Contact: KCR De,.v E!oi:3ii ent Phone#: (1408) 4 8
Ldw,ird Chan
Fax#: (4081) 3-7,333_
Alternate Contact: KOPhone#: , 8 �I
Davis ch'-'In ( 1.018) 863 r X3:3
Fax#: _
Valuation(cost of project) `r;350,000
Job Description(be specific):
km rc_.;Iiar_:ranf P.en:rin( ir3ipro€ri<mon , (2) ) ion 11-1V.?,C: (1) 8.J ..carp i�1���>, 2) PCLJ,1, toil(.,[ �<nd
a xhaust furls, t it fing area downdraft ndra exh LlSt, Htchen, re:3t tit rns.
1
Tenant Improvement Includes Re-Roof: Yes ❑ No ❑ If yes,number of squai;;s
Tenant Improvement Includes Structural Yes Q No ❑
Type of Construction(Usage Class): Occupancy Type:
I-A, I-B ❑ 11/IIIIV A ❑ Il/I11 B,IV-HT, V-B ❑
Project Size: Express ❑ Standard 0- 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 8/08/08
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HtVlZjIL)N IF
CITY OF CUPERTINO BUILDING PERMIT
13I11.DING ADDRESS: 19620 STEVENS CREEK BLVD STE 150
CONTRACTOR: EVERSIfINE VI, L.P.
1: 10 120147
0N1'NE:R'S 'NAME:: EVERSHINE VI, L.P.
19770 STEVENS CREEK BLVD
DATE ISSUED: 06/15/2011
' 'NER'S PHONE: 4083431088
CUPERTINO, CA 95014
PHONE NO:
V LICENSED CONTRACTOR'S DECLARATION
( F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
I Ieen)e ( lass I.Ic. #
� f.....
MECH RESIDENTIAL COMMERCIAL'
Contractor Date _
I herchy affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: GYU-KAKU RESTAURANT- T] OF 2,416 SQ FT -1-0 (2) 5
(commencing with Section 7000) of Division 3 of the Business &Professions
TON HVAC, (1) 8.5 TON HVAC, (2) PCUS TOILET AND
Code and that my license is in full force and effect.
KITCHEN EXHAUST FANS, DINING AREA DOWNDRAFT
8/8/2011- REV#I - REVISE HVAC DUCTWORK & RELATED SHAFTS- 9/1/2011 -
REV# 1 ISS'D
hereby af7irin 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
pertornrtnce of the work for which this permit is issued.
I 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
Sq. Ft Floor Area:
Valuation: $350000
permit is issued
APPI,ICAN"T CER"TIFICA"PION
APN Number: 36906010.150
Occupancy Type:
I :cmt\ 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs. and expenses which may accrue against said City in consequence of the
eranting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
�N ith all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
,.i is
SI_'natoIC Date --
Issued by-:.. .: F� -� Date: %
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roots shall be inspected prior to any roofing material being installed. If a root is
L as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec. 7044,
inspection.
Business K Professions Code)
I_ as owner of the property, am exclusively contracting with licensed contractors to
Signature of'Applicant._ Date.
constnlct the project (Sec.7044, Busmcss & Professions Code).
---
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
(_compensation, as provided for by Section 3700 of the Labor Code, for the
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
tircuun 37(10 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 25532.(a) should 1 store or handle hazardous material.
I'enmlt n "sued
Additionally, should 1 use equipment or devices which emit hazardous air
ccnil} that m the performance of fife work for which this permit is issued, I shall
contaminants as 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 Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
hceomc subject to the Worker's Compensation provisions of the Labor Code, I must
torth�aith axnpl� with such provisions or this permit shall be deemed revoked
Owner or tit tzed agent: j
i J
�• Date:
�-
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I cernk 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
I hereby affirm that there is a construction lending agency for the performance of mork's
to building construction. and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
Indcmnit\ and keep harmless the City of Cupertino against liabilities, judgments,
culls. and expenses which may accrue against said City in consequence of the
Lender's Address
i!_, of this permit. Additionally, the applicant understands and will comply
n,,n-point source regulations per the Cupertino Municipal Code, Section
ARCHTI EC l `S DECLARATION
I understand my plans shall be used as public records.
tilgnature -- __ Date 1
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
I
ADDRESS: 19620 stvns crk blvd. DATE: 12/20/2010 REVIEWED BY: bob s.
APN: BP#: *VALUATION: 1$350,000
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'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY TOl;l L PENTAMATION
USE: Commercial Building 0,00E;ih'BIi: PERMIT TYPE: 1A TA
WORK t.i. commercial restauarant space includes M E P structural.
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.L
A(Tenant Improvements) II-A,111-A,V-A 2,416 $2,778.20 1ATIPLNCK $1,571.00 1ATIINSP
TOTALS: 1 2,416 1 $2,778.20 1 $1,571.00
MECH,HOURLY 0 Yes (E) No' PLUMB,HOURLY Q Yes Q No ELEC,HOURLY ® Yes Q No
l-fcch. Plon Chet, plumb. Niru Clue/, Elec. Plan C cck
F,�11/1 Iit-f11/r. Permit Fee: P/rdrrh. Permit FCC, Elec. Pcrmil F'cc.
Other A9ech. Inv'. Other phtmlr Insp, Usher Elec.Insp,
llec/r.
limp. Fee: Phimb, In.V). Tea: E1eC.Insp,Fee:
NOTE: 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 09-051 Eff. 7/1/10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,778.20 Select a Misc Bldg/Structure
Suppl.PC Fee: G Reg. 0 OT hrs $0.00 or Element of a Building
0.0
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PME Plan Check: $0.00
Permit Fee: $1,571.00
Suppl. Insp.Fee'O Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construclion Tax
Acoustical Fee: 0 Yes ) No $0.00 Q
Work Without Permit? 0 Yes No $0.00
Plamling Fee: PLLONGRNGC $0.00
Tl"C(I'Bl D(X'11711Et71C117(7T7 I'E''C',S': �
Stronf4 Motion Fee: IBSEISMICO $73.50 Select an Administrative Item
I
Bldg Stds Commission Fee: IBCBSC $14.00
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SUBTOTALS: $4,436.70 $0.00 TOTAL FEE:' $4,436.70
Revised: 12/07/2010
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