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11010110CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19052 STEVENS CREEK BLVD CONTRACTOR: SMI CONSTRUCTION INC PERMIT NO: 11010110 OWNER'S NAME: UNITED POLARIS INC 595 MONTAGUE AVE DATE ISSUED: 07/18/2011 OWNER'S PHONE: 4083323122 SAN LEANDRO, CA 94577 PHONE NO: (510)351-3288 ❑ LICENSED CONTRACTOR'S DECLARATION License Classy Lic.# Contractor :S. t T Date % I hereby affirm that I am licensed under the provisio s of Ch pter 9 (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. 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. 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 indemnify and keep harmless the City of C no against liabilities, judgments, costs, and expenses which may accrue inst sa< City in consequence of the granting of this permit. Addition b e applic understands and will comply with all non -point source regul pe the Cupertino mcipal Code, Section 9.18. � / BUILDING PERMIT INFO: BLDG I— ELECT F PLUMB I— MECH F RESIDENTIAL F COMMERCIAL r— JOB DESCRIPTION: DIM SUM SPOT-1200 SQ FT, NEW KITCHEN W/ TYPE I HOOD RELOCATE RESTROOMS ADA, PARTITION WALLS AND LIGHTING NON -STRUCTURAL -SANITARY IS SUNNYVALE'S Sq. Ft Floor Area: Valuation: $80000 APN Number: 37507046.19052 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Date / xjl I Issued by: ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). 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 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. I certify that in the performance of the work for which this permit is issued, I shal I 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 p perty for inspection purposes. (We) agree to save indemnify and keep harm) s the City of Cupertino against liabilities, judgments, costs, and expenses whic rue against said City in consequence of the granting of this permit. ddition ly, the applicant understands and will comply with all non -points re ations pe a Cupertino Municipal Code, Section 9.18. , Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of %ork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Date %Z / 7> 1I I Licensed Professional CITY OF CUPERTINO BUILDING PERMFVIZAUN Ifs BUILDING ADDRESS: 19052 STEVENS CREEK BLVD I CONSTRUCTION ONIINC I PERMIT NO: 1 1010110 I OWNER'S NAME: UNITED POLARIS INC 1595 MONTAGUE AVE I DATE ISSUED: 07/18/2011 I OWNER'S PHONE: 4083323 122 I SAN LEANDRO, CA 94577 I PHONE NO: (510)351-3288 I ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # ��CS 6 Contractor:5A4 Date /A 2/ J 1 hereby affirm that I am licensed under the provisio s of C apter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 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. 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 hereb authorize representatives of this city to enter upon the above mentioned prope for inspection purposes. (We) agree to save indemnify and keep harmless e City of Cupertino against liabilities, judgments, costs, and expenses which y accrue against said City in consequence of the granting of this permit. A ition , the applicant understands and will comply with all non -point sour egu ion per thupertino Municipal Code, Section 9.18. � � Signature ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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 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. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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. ZAddinally,the applicant understands and will comply with all non -point sourations per the Cupertino Municipal Code, Section 9.18. r f- F BUILDING PERMIT INFO: BLDG ELECT PLUMB rr F_ rr MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: DIM SUM SPOT-1200 SQ FT, NEW KITCHEN W/ TYPE 1 HOOD RELOCATE RESTROOMS ADA, PARTITION WALLS AND LIGHTING NON -STRUCTURAL -SANITARY IS SUNNYVALE'S 1 1/22/201 1 REVISION #I - REVISE OCCUPANCY CLASS- KITCHEN EQUIPMENT & RESTROOM LAYOUT- ( NEW LEASE FOR NEW RESTAURANT)- ISSD 12/21/201 1 Sq. Ft Floor Area: Valuation: $920000 APN Number: 37507046.19052 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Are_ it Quality Management District 1 will maintain compliance with the Cupert' unicipal Code, Chapter 9.12 and the Health & Safety Code, Sections 255 3, and 25534. Owner or authorized agent: Dater CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Signature - Date CITY OF CITY OF CUPERTINO TENANT IMPROVEMENT CUPERTINO PERMIT APPLICATION FORM 1 A 0 16 APN # 5.01 0q .0� Date: / 172or Building Address: ©Sz S sck Mailing Address (if different from building address): Tenant (If tenant please provide a letter from the building owner approving the tenant improvement.) Building Owner ❑ Are Hazardous Materials being used as part of this project? Yes No TeparWB� ldin�Ov er's Name: Phone #: 'CX rV1 &P1 -CP(4— 4q- 3 2- Phone #: 4-7o r _�V Contractor: Fax #: Cupertino Business License: State Contractor License #: Contact: Phone #: ,'-10 — Fax /e-mail: Landscape Ordinance Compliance: Landscape in ft. irrigated 4J area sq. (includes all areas): •11+_ 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): -{- N� k I 7-\ / T1 YZ r- fladi �J " AVA hA-rorm , %�✓� 'e�'-tIU, �.-�( ' - gun .r-mil Tenant Improvement Includes Re -Roof: Yes ❑ No 0 / Tenant Improvement Includes Structural Yes ❑ No W[ Type of Construction (Usage Class): Occupancy Type: I -A, I-B ❑ II/III/V-A ❑ II/III B, IV -HT, V-B Valuation K , Project Size: Counter Express Standard Large MajorEl 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*** Revised 12-06-10 CU' PERTINO LJ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(ODcupertino.org ❑ ADDITION ❑ ALTERATION / TI p[J R.EVISION / DEFERRED ORIGINAL PERMIT PROJECT ADDRESS APN kD l� + OWNERNAME + PH NE, E-MAIL STREET ADDRE CITY, STA n �( FAX t CONTACT N PHObv _ _ E MAI STREET ADDRESS CITY STATE FAX r — ❑ 1 ClO)VZ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHTrECT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR _ T� LICENS / b LICENs BUS. LIC # COMPANY NAME E MAR- aA vim, 1 ERV FAJ / STREET ADD S 1ki 7�*M Lykhip PHO V •l _ _ 316 ARCHTTECUENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRD'TION OF WORK ` -X'?— OCCLOCote EXISTING USE P SED E CONSTR.TYPE "STORIES USE TYPE OCC. SQ.FT. VALUATION () _Jkt E ISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA /7„ _, OA--- �C[1J BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: U DETACH ❑ ATTACH N DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECE= BY. TOTAL VALUATION: PLANNING APPL N [:]NO PLANNING APPROVAL KICHLER HOME? ❑ NO / By my signature below, I certify to each of the fo o am the property owner or authorized agent to act on the property owner's be alf. I have read this application and the information I have pro S c 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 buil ' nstru . I n2pri representatives of Cupertino to enter the above-i ti5cd perty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INF RMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-TIE-COUMMR G PLAN REVIEW _New SFD or Multifamily dwell' gs: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPRESS TT � El-r NIIYG PLAN RVMW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �❑ srL'Y AtmARn ❑ PUBUC WORM form if any Hazardous Materials are being used as part of this project ❑ LARGE _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ I1"�ANrrARY SEWER DISTRICT submittal of Building Permit application. MAJOR ❑ ENVIRONMENTAL HEALTH, .I als's BldgApp_2011.doc revised 06121111 Fm_� CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 19052 stvns crk blvd DATE: 11/22/2011 REVIEWED BY: bobs. APN: BP#: 11010110 "VALUATION: 1$120,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: PENTAMATION 1GENCOM PERMIT TYPE: WORK revise occuDancy class kitchen and equipment la out restroom la out and ownership of restaurant. SCOPE NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District otc. )_ Thino fool an, hacod an the nrol3ninary intarmatian availahly and aro nnly an osti"mm Contact the Dent Far addn'1 info_ FEE ITEMS 6 ee Resolution 11-053 & 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 1 77 hours $2,210.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee,0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ,'�clA?tGi7r',;,. ...,. 0 G Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure A Strong Motion Fee: IBSEISMICO $25.20 0 # $0.00 Revision 1REVSFDWL Bldg Stds Commission Fee: 1BCBSC $5.00 SUBTOTALS: $30.20 $2,210.00 TOTAL FEE: $2,240.20 Revised: 1010112011