10090011 CITY OF CUPERTI140 BUILDING PERMIT
BUILDING ADDRESS: 19929 STEVENS CREEK BLVD CONTRACTOR: PERMIT NO: 10090011
OWNER'S NAME: BONJOUR CREPE COMPANY L�C —L DATE ISSUED:09/02/2010
XER'S PHONE: 4084179803 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION r— r r
��JJ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C� Lie.# `� o 9 C)11 MECH r RESIDENTIAL F COMMERCIAL
Contractor rt r�r �_��C��.---yy tt Date ! Z Z0�L
[hereby affirm that I am Itc ns`L� under t 6rovisions of Chapter 9 JOB DESCRIPTION:BONJOUR CREPE COMPANY-RELOCATE&REPAIR
(commencing with Section 7000)of Division 3 of the Business&Professions WIRING
Code and that my license is in full force and effect. TO CORRECT HAZARDOUS CONDITION PER FIRE PREVENTION
INSPECTION REPORT.RELOCATE WIRING FOR FOUR(4)
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. �� Sq.Ft Floor Area: Valuation:$2385
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:31621090.19929 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations er the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature r Date 9 Issued by;%i' :- Date: f Z-moo
L OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
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.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I 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
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code ctions 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must �aiflit&6, a ent•forthwith comply with such provisions or this permit shall be deemed revoked. 9 Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building constriction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
unify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the Lender's Address
g.a.rting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR.- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: `VALUATION: 1$2,300
RkPERMITTYPE: Electrical Permit PLE►N CHECK TYPE: Alteration/Addition/ Repair
PRIMARY '/'()I t_ PENTAMATION 1 CEAP 10
USE: Commercial Building 1.100 I ;�i-� PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Recep/Switch/Outlets 1BREMRECEP 4 # $42
TOTALS: $42.00
Elec.Plan Check 0.0 I hrs $0.00
/,c- Elec.Permit Fee: IEPER11fIT
Other Elec.Insp. 0.0 hrs $42.00
/ltw. VCC: 111e<_ h1y.
NOTE: Theseees are based on the preliminaryinformation available and are onlyan estimate. Contact the De t or addn'1 in o.
FEE ITEMS('Fee Resolution 09-051 Ef'. 7%li/Oj FE]Z QTY/FEE MISC ITEMS
Plan Check FCC.,
.S1fppl. Pt'Fee
PME Plan Check: $0.00
Pe rinit
sup qtr. hIS/) l'e'i'
PME Unit Fee: $42.00
PME Permit Fee: $42.00
�oFX.tifruclion Tax
'1( 1&,vicil ['C("
Work Without Permit? 0 Yes (F) No 10.00
Travel Documentation Fee: ITRAVDOC $2.2.00
,S`11-orig Vol ion h cc. Select an Administrative Item
B1dyStds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1 x'7.00 $0.00 TOTAL FEE: $127.00
Revised: 9/01/2010
CITY OF CUPERTINO
4 ITEMS OF 5 PERMI`C RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blit: Lot:
APN . . . . . . . . : 31S21090 .19929
DATE ISSUED. . . . . . . : 09/02/2010
RECEIPT #. . . . . . . . . BS300011364
REFERENCE ID # . . . : 10090011
SITE ADDRESS 19929 STEVENS CREEK BLVD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BCNJOUR CREPE COMPANY
ADDRESS 859 BETTE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CHET BARRACLOUGH
CONTRACTOR TPD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TED - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ----
1BCBSC VALUATION 2, 385. 00 1 .00 0. 00 1.00 0 .00
1BREMRECEP NO. OUTLETS 1. 00 42 . 00 0 .00 42 .00 0 .00
1EPERMITFE FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 .00
1TRAVDOC FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 .00
- --------- ---------- ---------- ----------
TOTAL PERMIT 127 .00 0 .00 127. 00 0 .00
M.Indoor Air Quality an n s es
..... .._._ 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes. 2 IAQ/Health pts yqes. 0
lobs, 31AQ/Health pts yeses 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
p
6.Use Exterior Grade Plywood.for Interior Uses 1 IAQ/Health pts y=yes
�• -- 41AQ/Health. pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
' 9 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes D
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
Total Points Availa le: 1401 1301 57
Total Points Project Deceived: 01 0 0
-'~
912-12-Q)
Mdata/prDpIgr:enbuildngguideliIn;eointsflns1212D4pnrtertedAs
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 9 L`� '� vK-v PERMIT
OWNER'S NAME: I � v.�tL Ct1 1C PHONE# \A Ll
GENERAL CONTRACTOR: kc+-4-c C---Tfi'C: BUSINESS LICENSE#
ADDRESS: -7L 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 CONTRACTOR AND ALL SUBCONTRA.0 RSH E OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. Z
I am not using any subcontractors: Date
Sid nat re
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS 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
a
CITY OF C,UPERTINO
c1TY OF
CUPER7INO GENERAL BUILDING
PERMIT APPLICATION FORM
APN
1 , Date: 2
# �-
Building Address:
-�J I � z 1) F_:,�Ls (
Mailing Addre�,�.ss (if different from building address):
e.
Are Hazardous Materials being used as part of thi: project? Yes No
HOA: xterior work ons ) Yes ❑ No ❑ If-Kes, provide letter from HOA
O 's Name: Ph ne lk q,
C tr , t
actor: — _ Phone: _'.Z7--- WQ'D
Contractor License#: m v7 d 4
-Cupertino Business License#:
Contact: Phone:Fax: 1��oR\
t'I �LO�� �'
2,esidential L Commercial
Job Description:
V 1 !1-1r�(
rl"9-,'J-0 �•�j -�-+J S 1 ��T7 b "�
Go�, 4,`�0� I
�K
Building Permit Info:
' Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ U/UI/V-A ❑ II/VI B, IV-HT, V-
Valuation: Square Footage:
Project Size: ExpressM ExpressStandard ❑ Large ] Major ❑ �
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicably:, include in plan set & the sheet index.
'oints Achieved:
r'or help, contact Build it Green at www.builditZr,!en.oriZ
Revised 07/14/09
i