11040173CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD
CONTRACTOR: GIDEL AND KOCAL
PERMIT NO: 11040173
O1"NER'S NAME: PROMTHEUS
574 DMSION ST
DATE ISSUED: 05/19/2011
.,ER'S PHONE: 4088730121
CAMPBELL, CA 95008
PHONE NO: (408) 370-0287
U LICENSED CONTRACTOR'S DECLARATION
f— r �
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class 10 Liee) 3 ° Sy
MECH RESIDENTIAL COMMERCIAL
d# y �f
Contractor Date
�i��./ �CV S�q /
I hereby affirm that I am licensed under the provisions Chapter 9
JOB DESCRIPTION: STE 370/390 - COMMERCIAL TENANT IMPROVEMENT
(commencing with Section 7000) of Division 3 of the Business & Professions
NON-STRUCTURAL DEM OF NON-BEARING PARTITIONS,
Code and that my license is in full force and effect.
DOORS, FRAMES & FINISHES. CONSTRUCTION OF NEW
I hereby affirm under penalty of perjury one of the following two declarations:
[ 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: $34683
Section 3700 of the Labor Code, for the performance of the work for which this
3ermit is issued.
APPLICANT CERTIFICATION
APN Number: 36901028.00
Occupancy Type:
[ certify that I have read this application and state that the above information is
;orrect. I agree to comply with all city and county ordinances and state laws relating
:o building construction, and hereby authorize representatives of this city to enter
1pon the above mentioned property for inspection purposes. (We) agree to save
PERMIT EXPIRES IF WORK IS NOT STARTED
ndemnify and keep harmless the City of Cupertino against liabilities, judgments,
;osts, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
;ranting 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
).18.
Issued by. Date:
iiR^ature Date 5
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
:he following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
, 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,
3usiness & Professions Code)
Signature of Applicant: Date:
as owner of the property, am exclusively contracting with licensed contractors to
.onstruct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
hereby affirm under penalty of perjury one of the following three
leclarations:
have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
:ompensation, 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
have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
lection 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.
iermit is issued.
Additionally, should I use equipment or devices which emit hazardous air
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
iot employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
;ompensation laws of California. If, after making this certificate of exemption, I
oecome subject to the Worker's Compensation provisions of the Labor Code, I must
Owner or ized agent:
brthwith comply with such provisions or this permit shall be deemed revoked.
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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 Aork's
orrect. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
building construction, and hereby authorize representatives of this city to enter
Lender's Name
the above mentioned property for inspection purposes. (We) agree to save
nify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
and expenses which may accrue against said City in consequence of the
.ing of this permit. Additionally, the applicant understands and will comply
pith all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
.18.
I understand my plans shall be used as public records.
ignature Date
Licensed Professional
I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20400 STEVENS CREEK BLVD CONTRACTOR:GIDEL AND KOCAL PERMIT NO:11040173
OWNER'S NAME: PROMTHEUS 574 DIVISION ST DATE ISSUED:05/19/2011
i
OWNER'S PHONE: 4088730121 CAMPBELL,CA 95008 PHONE NO:(408)370-0287
❑ LICENSED CONTRACTOR'S DECLARATION r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lia# /40c)3 S C7 J
MECH" RESIDENTIAL COMMERCIAL
Contractor
I hereby affirm that I am licensed under the provisions Chapter 9 JOB DESCRIPTION:STE 370/390-COMMERCIAL TENANT IMPROVEMENT
(commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL DEM OF NON-BEARING PARTITIONS,
Code and that my license is in full force and effect. DOORS,FRAMES&FINISHES.CONSTRUCTION OF NEW
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:$34683
permit is issued.
APPLICANT CERTIFICATION APN Number:36901028.00 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.
,� ��
Signature Date 5 Issued by: Dater
❑ 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 j
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 Owner or rized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Dater
CONSTRUCTION
APPLICANT CERTIFICATION 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. 1 understand my plans shall be used as public records.
signature Date Licensed Professional
E
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTlNO (408)777-3228• FAX(408)777-3333•building
Ccr�cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFER,,,///R``^���ED ORIGINAL(PERMIT#
PROJECT AI1pRESvU v f �2 �Ub APN# d' �, %�!
OWNER NAME
c( J PHON!C' JO�a E-MAIL
STREET PA%RES ✓l+hr �,�T/�P/�/�J i^- PHO EgC.y�yCAySy7�v f /3
CONTACT NA _ p7E!4
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STREET ADDRE CITY,S TE, Z P FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT ME^f ♦ / � LICENSEBERc)5® LICENSE TYPE BUS.LIC#
COMPANYF.'✓W+uty � E-MAIL
GWKOGR/l�i FAX
STREET ADDRE//S$54/ I1VJSr0&" S ► CITY, TATE,Z S O®� PHONE
ARCHITECT/ GIN ERN/AME �--' LICENSE NUMBER J BUS.LIC#
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COMPANY NAME E-MAIL FAX
STREET ADDRES�, CIE,ZIP 9y0 r� PHOI/Lv hl�v3uN^yt- v,_r 22&0 S,VU a
DESCRIP NOF\VORKK 1 /1
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&4
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES OFFICE USE ONLY
OCC TYPE DESCRIPTION S .FT. VALUATION S
EXISTG NEW FLOOR 1—DEMO TOTAL
AREA AREA 7v TREA NET AREA
BATHROOM KITCHEN OTHER /
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH
❑ ATTACH
#DWELLING UNITS: ISA SECOND UNIT El YES
SECOND STORY E]YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑No IF YES,PROVIDE Corr OF PLANNER'S NAeIE: RECEIVED BY: TOTAL V LU TION:
PLANNING ADPL# ❑NO PLANNING APPROVAL OF
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 const o I authorize representat' Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: � Date: /�
SUPPLEMENTAL ATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifarnil ellings: Apply for demolition permit for ❑ VER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). De ition permit is required prior to issuance of building
permit for new building. EaTRESS ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC\VORKS
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 ❑ ALIJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONi\'IENTAL HEALTH
i
BldgApp_201 Ldoe revised 03116/11
i
I
MAPN:
CITY OF CUPERTINOFEE ESTIMATOR-BUILDING DIVISIONDRESS: 20400 stvns crk blvd. #370,390 DATE: 04/25/2011 REVIEWED BY: bobs.
BP#: *VALUATION: 1$30,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 B TI
USE: PERMIT TYPE:
WORK t.i comm. offices ace non structural include M E no plumbing
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 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOURLY Oyes O No PLUMB,HOURLY Q Yes Q No `ELEC,HOURLY Q Yes Q No
;r'a:+z�t. r"Irrii?.h:<?. ','rtssttf. •a C"'ir<'4'`s r;f, .?krst(-s��h
LJ
t.fi:S�;, d�)ft;e�A'r r.,13�.r7;tLsPi. Ll
..1:�fi;t
fi_;J,. Free' Jit �cCa fp."o'
NOTE: These.fees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resokrtion 09-051 Aff, 7i1/I0� FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes (j)No $0.00 11 hours Plan Check,Hourly
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $1,386.00 1STPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Feer Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: 0 Yes G No $0.00 Q
Work Without Permit? 0 Yes 0 No $0.00 0
Planning Fee: $0.00 Select a Non-Residential Q
7r,f�� �.I,:c�r =frr�rt;rtr�tt "r. Building or Structure 0
Strong Motion Fee: 1BSEISMICO $6.30 F10.0 1 hrs Inspections
Bldg Stds Commission Fee: 1BCBSC $2.00 $1,260.00 1INSPMIS Standard Inspections
SUBTOTALS: $8.30 1$2,646.00 TOTAL FEE: 1 $2,654.30
I
Revised: 04/01/2011