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11040026 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20450 STEVENS CREEK BLVD STE 220 CONTRACTOR:GIDEL AND KOCAL PERMIT NO:11040026 OWNER'S NAME: PROMETHEUS 574 DIVISION ST DATE ISSUED:04/25/2011 OWNER'S PHONE: 6509313457 CAMPBELL,CA 95008 PHONE NO:(408)370-0287 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I- ELECT r- PLUMB License Class Lic.# { U 3 O 5-6 MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby a at thI am licensed under the provision of C apter 9 JOB DESCRIPTION:STE 220-COMM'L TI(2700 SQFT)DEMO OF PARTIT ,DOORS,FRAMES& (comm mg with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL FINISHES.CONSTRUCTION OF NEW 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 Sq.Ft Floor Area: Valuation:$44750 permit is issued. APPLICANT CERTIFICATION APN Number:36901028.220 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, 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 LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 7 � � Issued byd Date: / Signature Date ❑ 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: 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: 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 Owner or orized agent_ Date: forthwith comply with such provisions or this permit shall be deemed revoked. 1� 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 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 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. I understand my plans shall be used as public records. Signature Date Licensed Professional ,/f Ov � 1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �� I 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 C L (408)777-3228 - FAX(408)777-3333•building okupertino.org RT ❑NEW CONSTRUCTION ❑ ADDITION 51ALTERATION/TI' ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS •7.n /C� S C� /! APN# ,S OWNER NAME ocry J GJjyZ PHONE,d(!J 875-o% EMAII } r V 7' ^� ry STREET ADDRESS 6 t y05' �f / CONTACT NAME �yyi/�/� G� P O���G �G Yj �`tGfs1 r 1 K0C G.�I(2 STREET ADDRES57 -�Jq /, ` Z 4 9SO ❑ OWNER �J❑'TOWNER-BuiLDER. ❑ OWNERAGENT ❑ CONTRACrOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACT RL /J LICEN nN�UMBER LICENSE�'YPE BUS.LIC# COMPANYNAME E-MAIL /� F STREET ADDRESS CITY,ST E,ZIP P ARCHITECT/ENG ERN ME LICENSE NUMBER BUS.LIC# COMPANYNAME E-MAIL FAX s STREET ADDRESS CITY,STATE,ZIP ✓ (A ®&6 P ou DESC TION OF W. •Y lN/1 C1✓dt (Jjj EXIS GUSSE�y PROPOSED LISE CONSrR TYPE #STORIESF'TICi:-USE ONLY - ���rn f u - y, OCQ TYPE' DESCRIP ION` ''S .Er ALUATI0 EXISTG NEW FLOOR AREA AREA DEMO TOTAL - AREA NET AREA .. `` ` BATHROOM KITCHEN OTHER REMODEL AREA - REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH F - _ ❑ ATTACH - _- NDWELLING UNirS: ISASECOND UNIT YES SECOND STORY ❑YES - BEING ADDED? ❑NO ADDITION? ❑NO = PRE-APPLICATION ❑ YES IF YRS,PROVIDE COPY OF PLANNER'S NAME: LYALUATION :; PLANNING APPL 9 ❑NO PLANNING APPROVAL LETTER 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 to building con tion. I authorize representatives of Cpecile tester the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT ORMATION REQUIRED �LArrexEcxiYP Rou�rrc sL� New SFD or Multi Ily dwellings: Apply for demolition permit for p ovER T couNTER ]T KING$LANREYIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑'"'ExpR�s$` LtT AN}YIN(rPLAIY REVtER _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure RD ❑ POBr Tc Woiixs form if any Hazardous Materials are being used as part of this project. ❑ LARGE _ DEPT —submittal of Planning Approval Letter or Meeting with Planning prior to p ivrAaoR ❑ SArFITARY sEwERDYSTxrcr submittal of Building Permit application. ENUlxormlErFTAz«nzTx - BldgApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20450 stvns crk blvd. #220 DATE: 04/05/2011 REVIEWED BY: bobs. APN: BP#: VALUATION: 1$44,750 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial BuildingPENTAMATION 1B TI USE: PER TYPE: WORK ��Comm. offices ace non structural include M E Ps. SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) I-A,I-B � 0 $6,755.84 1BTIPLNCK $23,991.40 IBTIINSP 0 TOTALS: 44,750 $6,755.84 $23,991.40 MECII,HOURLY 0 Yes 0 No PLUMB,HOURLY 0 Yes Q No ELEC,HOURLY 0 Yes Q No F-1 IET OiL lo;v�, F�,,,e: — b."."-, L t=.r 't'li.I;zSt, ltTte i 1'lia;trt'i Ttt.;j7. NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Tee Resolution 09-05I Eff. 7111101 FEE QTY/FEE MISC ITEMS Plan Check Fee: $6,755.84 Select a Mise Bldg/Structure Suppl.PC Fee: 0 Reg. 0OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $23,991.40 Suppl.Insp.Feer Reg. 0 OT F0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Ta": F Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Planning Fee: $0.00 Select a Non-Residential Q Building or Structure 0 ti 11'ce..s Strong Motion Fee: IBSEISMICo $9.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: 30,758.64 $041 TOTAL FEEL $3 58.64 Revised: 01/15/2011 I Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C P E RT 6 N Fax: 408-777-3333 1 CONTRACTOR SUBCONTRACTOR LIST JOB ADDRESS: k5w ,,, ,� � PERMIT# ZI f ' OWNER'S NAME: PHONE# 3'-o -OA60 GENERAL CONTRACTOR: ;CLI ��,/' �,,�pi-. BUSINESS LICENSE# ADDRESS: to I CITY/ZIPCODE: Ce 64 Xr ''Our municipal co a requires all usinesses working in the city to have a City of Cuper mo 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 Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # ICabinets &Millwork J( �j '0' do Cement Finishing Electrical Excavation _---- Fencing Flooring/Carpeting ----�- Linoleum/Wood —� Glass / Glazing _----- Heating Insulation Landscaping Lathing — Masonry ---' Painting/Wallpaper Ljow Paving Plastering �— Plumbing G� t�(ac `��C04 Roofing ----- Septic Tank Sheet Metal - - Sheet Rock 4urdr^d �r w � 0 t� Tile //rte-/� V51 0 S- O er/Contractor Signature ate I I I I ON: BOB GREGORY DATE: PERMIT NUMBER: P� ADDRESS: IOZ01 4 Vy INSPECTION TYPE: �L0�19//V6- Adovc' �p COMMENTS: -77 d 1102 6d� RESULTS: P-PASS, F-FAIL, C-CANCEL, I-INCOMPLETE, N-NOT REQUIRED R-TO RESCHEDULED IF FAIL, LIST REASON: TIME SPENT: NO. OF UNITS: CLOSE PERMIT? YES NO J i UNREASONABLE HARDSHIP EXEMPTION FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION i ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL G U P EtiTt N O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-33$3°building0cuaertino.ora For Tenant Improvements where the Cost of Construction does not exceed $128,410.90) SITE ADDRESSAPN BP# CfVs �Zd l5. --08'cY, -00 CiTY Pe,g;;. N 0 I ZIP950tq I TOTAL CONNSTRUCTION COST A 4 ».................... DESCRIPTION OF WORK: DE M 1 SE i TE -b I)EdtiC © ) The following is a list of costs to provide access features In order to comply 100%with the current State Title-24 Disable Access Standards.(All costs to be documented by actual bids or other informalien accepted by the Bu ding Official. Accesslbie Features Complies with If not,list required upgrades In order for Cost to make feature current standards? features to fully com fully accessible? 1.Path of travel to accessible entrance. M/? •NON 60114 PQAt4-1 2.Cost of providing a primary entrance. (Including but M O rJ J to t~SSV'1� not limited to,thresholds,landings,door hardware, max,door pull.etc.) /457A u_ Au7z Oft N t /V 3,Cost of providing the primary path of travel to the i specific area of alteration,structural repair,or �� $ addition. 4.Cost of providing accessible restroom facilities. 1\10 ' 7 ov` io)l�ISr WF1t t 5, rwT�'. s 75 Qc 5.Cost of providing an accesslbie'drinking fountain, (If $ required or if a drinking fountain is provided.) 6.Cost of providing accessible public telephones(If provided) $ ' i T.Cost of providing other accessible features,Including Q X455 but not limited to,parking,storage,alarms etc. TOTAL COST OF ACCESS FEATURES(8): $Z-224 4 Has the same tenant performed work in the Calculate(0 t A)x 100% / some tenantspace within the last three ears? Dea� onof gcesss featur s to be provided: , K086l ' 4 i�tri t r7 U� �L �' 2. .SS cw 5 Cm P-6CT- -A 76.1 r S_ = ' eQ U )5-i? " COR '{Mo( or A-0 6-r,46- rte. TOTAL COST OFPERCENTAGE (20%minimum PROPOSED UPGRADE $ �� � expenditure is re ulred) �0 ARCHITECT OR ENGINEER OF RECORD INFORMATION: I certify t ?the above noted information is true and correct."7v T►� PW/r V� ~ Name(print): I L `�ture: y/ Date: �JZ)rru_` �l /1G// .CP ,a: 1 Z Phone: S Firm address: r ......................................._............................... FOR DEPARTMENT USE ONLY —.. »...............r......._..................................... O The above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 11340.2,1. Ll The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR-'RUO 24 (Regulation for the Accommodation of the Disabled)pursuant to 2010 CBC Section 11346.2.1. COMMENTS! {M, ' A F 1 Building Official Designee(print): a Signature:- _ � t;, Date � Hai•dsl,ipF-renrlrriorrForrrr_2011.doc revised 02/25/11 i.