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11040172CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20400 STEVENS CREEK BLVD I CONTRACTOR: GIDEL AND KOCAL I PERMIT NO: 11040172' I OW'NER'S NAME: PROMTHEUS r .,BR'S PHONE: 4088730121 ❑ LICENSED CONTRACTOR'S DECLARATION License Class / �J/'/ l/ Liicc. # 703U S Contractor Date I hereby affirm that I am licensed under the provisio s of Chapter 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 perjuryone 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 thi permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. l 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 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) 1, 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 shall 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 11 the above mentioned property for inspection purposes. (We) agree to save nify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the .,ing of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 574 DIVISION ST CAMPBELL, CA 95008 DATE ISSUED: 05/04/2011 PHONE NO: (408) 370-0287 BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB r MECH I— RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: STE 750 - COMM'L TENANT IMPROVEMENT(1,000SQFT) DEMO OF UNDERGROUND WALLS, DOOR, FRAME & HARDWARE. CONSTRUCTION OF ONE NEW ROOM, DOOR & FRAME; Sq. Ft Floor Area: I Valuation: $30000 APN Number: 36901028.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. '' Date:—>— `'7 tz Issued by:'' 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, C"pter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Wrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20400 STEVENS CREEK BLVD CONTRACTOR:GIDEL AND KOCAL PERMIT NO: 11040172' OWNER'S NAME: PROMTHEUS 574 DIVISION ST DATE ISSUED:05/04/2011 OWNER'S PHONE: 4088730121 CAMPBELL,CA 95008 PHONE NO:(408)370-0287 ❑ LICENSED CON'TRACTOR'S DECLARATION r r /t J/ _ BUILDING PERMIT INFO: BLDG ELECT PLUMB 7 License Class // Lie.# &?.3U 5 (D I j / l/ MECH' RESIDENTIAL COMMERCIAL Contractor ('/ J �/�C�i;� Date Chapter 9 I hereby affirm that I am licensed under the provisio sof JOB DESCRIPTION:STE 750-COMM'L TENANT IMPROVEMENT(1,OOOSQFT) (commencing with Section 7000)of Division 3 of the Business&Professions DEMO OF UNDERGROUND WALLS,DOOR,FRAME&HARDWARE. CONSTRUCTION OF ONE NEW ROOM,DOOR&FRAME; 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 thi Sq.Ft Floor Area: Valuation:$30000 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.1 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 by:" _ — Date— - `l 4 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 1,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 n •• ed agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: 5 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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-,wrk'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. i Signature Date Licensed Professional i i 6 �.��� � - CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 1 (408)777-3228- FAX(408)777-3333• buildingCa_cupertino.orq CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION/DEFERRED( ORIGINAL PERNIIT# APN# w / n PROJECT ADDRESS S / -7- °i" o2ecj OWNERNAM PHONE E-MAIL STRE TADDREUS� / ,,_ X13 a CIT . TATOE,ZIIP__ ^ ' d� F 4FI �'b�3 CONTACT VNAMIE �Y PH'ON t+,�� (�7( E-bIAIL ara �✓ H GAS'S��/-/vyS .�,u� STREET ADDRES G ^V! e C[TY,STA , ZIP ^ .'v FA/iv�r r,3 .435 ❑MVNrR ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# enu �w r+ln- 0 3 0 5_C) COMIPANY NANI FAX fJ$-��-U t �� eG✓ uh � /koCs✓/r,/Cv SJ STREET ADDRESS CI STATE, iP Op PHOT E roV_/4,�� q�" Y ARCHITECT/ENGN ��EER NIE LICENSE NUIVIBER BUS.LIC# CONIPANY NANIEn E-MG\IL FAX STREET AADDRESa // CITY,STATE,ZIP PHONE s a�a 3G6 �� (P 9y�� s _3ag- DESCRIPTIO OF wORKQ �• / 10 I/ 14J (n/Gfre�♦ nSV/1t. n W AA, GM EXISTING USSEE' PROPOSED USE CONSTR.TYPE #ST§ES OFFICE USE ONLY GU7 -0CC. - TYPE DESCRIPTION S .FT. VALUATION(S) EXISTG NEW FLOOR ENIO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHBR REMODEL AREA RENIODEL AREA REMIODEL r\REA - - PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA:❑ DETACH C3 ATTACH ATTACH - - - #DWELLING UNITS: IS A SECOND UNr' ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION". ❑NO - raE>Arruamos ❑ YES P Yes,PROVIDE corn or rLAN• eR s NAnfr:: RECEIVED BY: TOT.53 �7yVALUATION: z5j PLANNING APPL# ❑NO PL\NNfNG APPROVAL LETTER - ✓0 U V� 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 c coon. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 7 �5 SUPPLEME INFORMATION REQUIRED PLAT CHECICTYPE ROUTING SLIP New SFD or Mul amily dwellings: Apply for demolition permit for r�It [�`BUILDINGPLANREVIEW existing building(s). Demolition permit is required prior to issuance of building ,�,� � permit for new building. ° f � P1'LANNINCPLANREIVIEW, Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLICwoRKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE 9L15iDEPT I Copy of Planning Approval Letter or Meeting with Planning prior to ❑ nrAaoR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONAIENTAL-HEALTH i B1dgApp 201].doe revised 03/16111 4 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N® Fax: 408-777-3333 CONTRACTOR SUBCONTRACTOR LIST JOB ADDRESS: 2,00 U V PERMIT# OWNER'S NAME: &W �L;r�{' PHONE# "j"?0`.?0 GENERAL CONTRACTOR: \4--OC eA CUiCIT- BUSINESS LICENSE# ADDRESS: 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 CONTRAC'T'OR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITE' 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 BUSYNESS 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 I I I ____ CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20400 stvns crk blvd. #750 DATE: 04/25/2011 REVIEWED BY: bobs. APN BP#: ^VALUATION: $34,683 '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 1,000 $2,833.00 IBTIPLNCK $1,416.32 IBTIINSP TOTALS: 1,000 $2,833.00 1 $1,416.32 MECH,HOURLY O Yes • No PLUMB,HOURLY 0"Yes 0 No ELEC,HOURLY 0 Yes' 0 No 0 .,ieFa-.b. E"it't3t fihSj:. { IfI£s'f'lilail;,'t Lt'zi. F)'7F} ;. �1'00.fi�sj,. 11r'_✓'.' 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 E_ 7/UI O,� FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,833.00 Select a Misc 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: $1,416.32 Suppl.Insp.Feer Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Plasmin Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 i Strong Motion Fee: IBSEISMICO $7.28 Select an Administrative Item i Bids;Stds Commission Fee: IBCBSC $2.00 SUBTOTALS:_ $4,258.60 $0.00 TOTAL FEE:`; $4,258.60 Revised: 04/01/2011 i