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11090071 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20425 STEVENS CREEK BLVD CONTRACTOR:DPR CONSTRUCTION PERMIT NO: 11090071 INC OWNER'S NAME: WESTWOOD COMPANY-CUPERTINO LLC 1450 VETERANS BLVD DATE ISSUED: 10/17/2011 OWNER'S PHONE: 4157103063 REDWOOD CITY,CA 94063 PHONE NO:(650)474-1450 i 13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALF License Class 1 C— Li,.# C?' APPLE-COMM T.I(2737SQFT)OFFICE SPACE NON LOAD BEARING WALLS,NEW T-BAR,REPLACE ELECTRICAL Contractor 1 ) �w�tw ee AND I hereby affirm that I am licensed under the provisions of Chapter 9 PLUMBING FIXTURES,INTERIOR ACCESSIBILITY (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 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. Sq.Ft Floor Area: Valuation:$1300000 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 APN Number:31626094.20425 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST 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 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 9.18. F , RE-ROOFS: Signature _Date �U All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I 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 I 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 whichthis permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I 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: �1 L ,,° t� Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall 19 not employ any person inany 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.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 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 I 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. i Signature Date i I CONSTRUCTION PERMIT APPLICATION Ir � � ver COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CVPERTINO (408)777-3228- FAX(408)777-3333•building(a)cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#_ _ PROJECT ADDRESSAPN m � # Gas c�c a. 0 '61 L 2 ,l Ck.a- -9-( OWNER NAME PHONE P,-MAIL POC 1 G €S.7to, 3(p Lt, (2 NL57Cee • old STREET ADDRESS -- CITY, STATE,ZIP FAX ;s1i ` SC>! CONTACT NAME PHO E E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX 5D Ups• Z c icyn� <' (!,A 1063 qog, 7(k 3 ❑OWNER ❑ OWNER-BUILDER a OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRAC �R NAME A LICENSE N EAR LICENSE TYPE ` BUS.LIC#/ 330 3 3 0 2 COMPANYp�NA�yMEh3 E-MAIL a G� } } } FAX �' "f 2 E?0 Al �".''�Eii.�A� ,.3 b 1' V"(,-4 r�r L✓7 S �JCi t✓\ v` f t t C.� STREET ADDRESS 4/ CITY,STATE,ZIP n / PHONE �• C l tt 5o E� t1�, 2 t.�ocnnl `�- -1 t�}.� (-5 env} t 2- ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# C- 153 rl COMPANY NAME EMAIL FAX -(PAC, 6�� c� � ]z e � �.� x(03. 2g�, STREET ADDRESS CITY,STATE,ZIPS PHON[40 Z5�?.,7833 r DESCRIPTION OF WORK 7D CSV TZ' 0 is r'"� • EXISTING USEPROPOSED USE CONSTR.TYPE #STORIES d �� USE TYPE OCC. SQ.FT. VALUATION($) AREAEXISTNEW(,02- AREA FLOOR b7_ h AREA NET AREA BATHROOM KITCHEN OTHER ENIODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: ❑DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY OYES BEING ADDED? $No ADDITION? NNO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF-^- IS THE BLDG AN ❑YES RECEIVED BY: - TOTAL VALUATION: PLANNING APPL# NO PLANNING APPROVAL LETTER -EICHLER HOME? WO ! 1 F By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property 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 buil Ingnstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. t Signature of Applicant/Agent: Date: SUPPLEMENTA ORMATIONREQUIRED PLAN'cxEcrcTYPE RouTINGSIIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BuILDING.PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building - permit for new building. ®E7 PRESS - ❑ PLANNING P17AN RFVI EW, Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ 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 ❑ DIAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc I•evised 06121111 i Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT!N Fax: 408-777-3333 CONTRACTOR SUBCONTRACTOR LIST JOB ADDRESS: 2A4,f v L t✓1 PERMIT# OWNER'S NAME: PHONE# a $ GENERAL CONTRACTOR: BUSINESS LICENSE# 1,33 o ADDRESS: Iqeb CITY/ZIPCODE: *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 i Please check applicable subcontractors and complete the following information: 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 Owner/Contractor Signature Date