11010041 r
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20371 STEVENS CREEK BLD CONTRACTOR:SONAL ABHYANKER PERMIT NO: 11010041
OWNER'S NAME: SONAL ABHYANKER 20371 STEVENS CREEK BLVD DATE ISSUED:03/04/2011
OWNER'S PHONE: 4084179803 CUPERTINO,CA 95014 PHONE NO:
a
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALS
License Class Lic.# BONJOUR CREPE-COMM'L TI(NON-
STRUCTURAL)PARTITION
Contractor Date WALLS.INSTALL ONE TYPE-1 HOOD.INSTALL ELECTRIC
I hereby affirm that I am licensed under the provisions of Chapter 9 COOKING EQUIPMENT.DO ELECTRICAL,PLUMBING
(commencing with Section 7000)of Division 3 of the Business&Professions WORK AS
Code and that my license is in full force and effect. �
I
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:$100000
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:31626090.20371 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 WIT�IIN 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. �/ y — - T Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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
AM
inspection.
OWNER-BUILDER DECLARATION
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hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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(x)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 which this 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,anij 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent:-� 1� Date: i
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 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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 IS-gulatiis the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature G P Date 3A /
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CITY OF
CITY OF CUPERTINO
TENANT IMPROVEMENT
"PERT'"° PERMIT APPLICATION FORM
APN# Date: '
J 4 oI D6
Building Address: 2-o";-7 I -"D*v-r s C r a k_ 9 V),
Mailing Address (if different from building address): 95� v3e+k At ,
Tenant 0 (If tenant please provide a letter from the building owner approving the tenant improvement.)
Building Owner ❑ Ke+- zl--- , c
Are Hazardous Materials being used as part of this project? Yes ❑ No
Tenant/Building Owner's Name:�0n Q,, �n�1„ �n Phone#: u�, L` '1 ,G(?03
Contractor: ��(J Phone#:
�J Fax#:
Cupertino Business License: State Contractor License#:
Contact: i(; Phone#: 65v-
&-
5v-&— 1�U04,V4 Fax/e-mail: +,6 l®C-r5lcc�� (o
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas):
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): AOA 396
Tenant Improvement Includes Re-Roof. Yes ❑ No If yes, number of squares
Tenant Improvement Includes Structural Yes ❑ No
Type of Construction (Usage Class): Occupancy Type: �?
1-A, 1-B ❑ IMII/V-A ❑ II/III B, IV-HT, V-BAP
I'a (•
Project Size: Counter ❑ Express ❑ Standard Large ❑ Major ❑
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 i
*** For Office Use Only*** Revised 12-06-10
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: DATE: 01/06/2011 REVIEWED BY: bob s.
APN: BP#: *VALUATION: j$100,000
YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION 1 B TI
USE: Commercial Building PERMIT TYPE:
WORK �t.i commercial restaurantspace;non structural include M E P.
SCOPE
TYPE OF FLR AREA
OCCUPANCY TYPE: CONSTR. s.f. PC FEES PC FEE ID BP FEES BP FEE ID
B (Tenant Improvements) II-B,111-B,IV,V-B 1,077 $1,893.28 1BTIPLNCK $1,004.08 IBTIINSP
TOTALS: 1,077 $1,893.28 $1,004.08
MECH,HOURLY 0 Yes E) No PLUMB,HOURLY Q Yes (E) No ELEC,HOURLY ® Yes E)No
Xtech. Non C'hcc); Phunb. Flair Cheek Elec.glair Chcch
rltech. Pernrrt Fee: Phrmb. Per mil Fee: Flee, Permit Fee:
Other Alech. hasp. Other Plaurb hist. Ober Dec hasp.
1lieciz hasp.Fere: Phnuh, hasp. Fey., F,le(,htsp.Fee:
NOTE: These ees 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 Eff. 7/1/101 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,893.28 Select a Mise Bldg/Structure
Suppl.PC Fee: G Reg. 0 OT F. hrs $0.00 or Element of a Building ,
PME Plan Check: $0.00
Permit Fee: $1,004.08
Suppl.Insp.Feer Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: -T-T $0.00
Coll'yInIctlon
Acoustical Fee: 0 Yes E) No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 G
Planning Fee: PLLONGRNGC $0.00 G
Trm,el DoctuneWatinrr Fees:
A
Stroniz Motion Fee: IBSEISMICO $21.00 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $4.00 �
SUBTOTALS: $2,922.36 $0.00 TOTAL FEE: ' $2,922.36
Revised: 12/07/2010
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