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15060132CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20525 MARIANI AVE CONTRACTOR: DEVCON PERMIT NO: 15060132 CONSTRUCTION INC OWNER'S NAME: 20525 MARIANI DRIVE LP 690 GIBRALTAR DR DATE ISSUED: 07/09/2015 OWNER'S PHONE: 4084721275 MILPITAS, CA 95035 PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] License Class Lic. # 1 1 �_� APPLE - T.I. ADD (N) LIQUID ARGON DEWAR & RECONFIGURE (E) STORAGE CABINETS IN STORE ROOM Contractor Df V c C:•,'\ Date 7 - I hereby affirm that I am licensed under the provisions 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 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 Sq. Ft Floor Area: Valuation: $20000 /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. APN Number: 32656001.20525 Occupancy Type: 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 tocomply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter WITHIN180 DAYS QE+ .RFrRAHT SUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save �"" A F 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 Date: with all non -point source regulations per the Cupertino Municipal Code, Sectio 9.18. RE -ROOFS: �� Signatu �F 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 inspection. ❑ OWNER -BUILDER DECLARATION I 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(a) 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 Section 3700 the Labor Code, for the Health & Safety Code, S7 7* ns�5505, 25533, and 25534. ! ' �j�j '71C of the performance of the work for which this !/ , �� Owner or authorized age ni:� YAF7 "' Date: permit is issued. . r 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date 4'W CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTIPIO I (408) 777-3228 FAX (408) 777-3333 - building(c-cunertino.ora ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI I I RFVTSTnN 1 T)FFF.RRF17 nRTGTNAT. PF.RMTT y PROJECT ADDRESS Lr� .APN R �1 OWNER NAME PHONE .,J 0l� "1-jg E � "Vt� STREET ADDRESS CITY, STATE, ZIP FAX CONIACT NAME PHONE('k - LD�' EMAIIb usgjk PRC_r-V8"6A, STREET ADDRESS ¢\\�'q CITY, STATE, ZIP ❑ OWNER- ❑ OWNER -BUILDER ❑ VANIER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT �ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME \ �1 ft LICENSE NUMBS - LICENSE TYPE tl0 Iji(ab BUS. LIC m COMPANYN"be'J Cc)q_i J�AO�- ygq`71 E-MAIL cmV,I zrs Cm -cm si.WP,-N STREET ADDRESS `^�� I CITY, STATE, ZIP PHONE qVi`J-Sicl ARCHITECT/ENGLNEER NAM�A1U LAIy iSZ a CrLICENSE NUMBER �?- � BUS. LIC O COMPANY NAIrfE P e 'E-MAIL la�GCs fAIe�.C.�®I^ FAXp a r� � STREET ADDRESS � ® CITY, STATE, ZIP C (� PHONEkql s -9 �) M q;' 66 Q �f DESCRIPTION OF WORK �p ryq �ry'".�`_'l.d•� gy,®��,\n -., e� rG��Q�^c�i 1` ( & �, l\Xa.6 k" FA14 E c_ Tk `' EXISTING USE PROPOSED USE CONSTR TYPE STORIES - cux, ale'_LE S - � SiWIa+� 9 \ USE I Ty -PH I OCC. SQ.FT. VALUATION (S) EXISTG AREA �5� NEW FLOOR. AREA Vf (D DEMO AREA TOTAL NETAREA BATHROOM. KrTCHEN.. OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDFTACH ❑ AT TACH 'DWELLINGUNTTS: IS ASECOND UNrr [3 YES SECOND STORY ❑YES ' BEING ADDED? E] NO ADDITION. [:]NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN = --= _ -z_-`"-. N: PLANNING APPL []NO PLANNING APPROVAL LETTER EICHLER HOAi NO By my signature below, I certify to each of the following: I am the property owner or autl onzed ag,-e 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 lays relating to building construction. I authorize representatives of Cupertino to enter the above -4 nt : ied property for inspection purposes. Signature of Applicant/Agent: �I __ � Date: Ix rI-S SUPPLEMENTAORMATION REQUIRED Cr ,ac>�cxx1�1� �`CoT3rrncsLrn�x New SFD or Multifamily d rellings: Apply for demolition permit for O�-ER"TH1+rCOiThTER r��$UILDIL�G PL13�TREYIEFir existing building(s). Demolition permit is required prior to issuance of building f = permit for new building. �xPxss �gl,JhGArrREvzEw Commercial B1dQs: Provide a completed Hazardous Materials Disclosures sTa�nARD PUBrcwoRxc _ form if any Hazardous Materials are being used as part of this project. L _ Copy of Planning Approval Letter or Meeting with Planning prior to I ��'Sx1T� �, 'Y.SERR�DIS submittal of Building Permit application. RIC'P'- - "TsIa`VSROZx'11'EI`i1'AI�I-IEATTiH t BldgApp_2011.doc revised 06/21/11 IM-7, CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 20525 MARIANNI AVE DATE: 06/19/2015 REVIEWED BY: MELISSA PC FEE ID APN: 32656001.20525BP#: �� =-:,)—*VALUATION: $20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building IBTIPLNCK PENTAMATION PERMIT TYPE: 1 B T� WORK APPLE - T.I. ADD N LIQUID ARGON DEWAR & RECONFIGURE E STORAGE CABINETS IN SCOPE STORE ROOM OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-A,111-A,V-A 156 $2,621.00 IBTIPLNCK $735.00 1BTIINSP Elec. Insp. Fee: PME Plan Check: $0.00 Permit Fee: $735.00 Supp/. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 156 $2,621.00 Conslruction .Ta : $735.00 `, �NPLUMOULY.Yes_, oMECH, alech. Plan Check Phtnib. Plan Checl, E'lec. Plan. Checks blech. Permit Fee: Plumb. Permlr Fee: Elec. Permir Fee: Ocher ilhwh. Insp. Qrher Plumb Irap. — -- - - - -Other Elec. Insp. it-lech. lase. Fee: Plumb. hish. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the nreliminary information available and are only an estimate" Contact the Dept for addn'1 into. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,621.00 Select a Misc Bldg/Structure or Element of a Building i Suppl. PC Fee: Q) Reg. 0 OT 0.0 I hrs $0.00 PME Plan Check: $0.00 Permit Fee: $735.00 Supp/. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslruction .Ta : Achninistr ative Fee: 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 Trm,el Doeumeniation Fees: Strong Motion Fee: IBSEISMICO $5.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:. $3,362.60 $0.00 ; ,TOTAL FEE: $3,362.60 Revised: 05/07/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: go5�.-Ls ..C -tire, I'S OIL, PERMIT # OWNER'S NAME: C-- PHONE # GENERAL CONTRACTOR Q,t Ctcc. e BUSINESS LICENSE # 0 U g ADDRESS: �q� C-�, ibC' Of'i�i� CITY/ZIPCODE: it CA Gsc�3 *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical ��, 1 C (�o 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 '"R.4-. O L\ 1'S --1 k. ' Date