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15050110CITY OF CU PIEllgTINO BUILDING PERMIT BUILDING ADDRESS: 20688 STEVENS CREEK BLVD CONTRACTOR: '1'a� C : PERMIT NO: 15050110 GeAe�l OWNER'S NAME: BYER PROPERTIES LP DATE ISSUED: 07/14/2015 OWNER'S PHONE: 7609298226 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ License Class Lic . h ct; 313 3 RU BIO'S - T.I. (E) RESTAURANT SPACE TO REMOIIEL/R ECON F)OJR E SPAC E (2,365 S.F.) &14J( Gllb'A I CAlte I 19 Contractor 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: $199000 performance of the work for which this permit is issued. 1 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: 35908020.20688 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ]P]Ci RMffT EXPIRES IEF WORK ffS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WffTHM I RMffT ff SSUANCIR 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 S FROM CALLED INSP ECTEO . 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 pplic t understands and will comply Date: with all non -point so urc reg [ions per ape mo Municipal Code, Section 9.18. jU �� RE- ROOFS: Signature Date b l 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. ❑ 0"1141111 nFR DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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 HAZARDOUS MA'T'ERIALS 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. 1 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 a m pment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Ba Area Air Quality Management District T performance of the work for which this permit is issued. l C will maintain compliance with the Cu rtino Manic' aode, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the of the work for which this the Health & Safety Code, Sections 25 05, 2 533, an 255 4 performance Owner or authorized agent: ) Da te: 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 CONSTRUCTI LADING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a constructs n I ding 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 ; l• f RT O W 0 EI NEW CONSTRUCTION CONS RUC Ij'110 nH pERVivd11T APPL1C AMOO N p \` COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE e CUPERTINO, CA 95014 -3255 (408) 777 -3228 ^ FAX (408) 777 -3333 ^ buildinglecupertino.org ❑ ADDITION X ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 20688 Stevens Creek Blvd APN# 3 S C Ci ' C) OWNER NAME Rubio's Fresh Mexican Grill, In NE 00" Rubio's 760- 929 -8226 E -MAIL "biefferies@rubios.com �p� STREET ADDRESS 1902 tltlright Place, Ste 300 CITY, STATE, ZIP Carlsbad, CA, 92008 FAx760 -929 -8203 CONTACT NAME Jimmy Comerford F;HCNE 916-719-2338 F-"'A[Ljimmyc@hmrarchitects.cor STREET ADDRESS21 30 21 st Street CITY, STATE, `Sacramento, CA 95818 FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 229 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME o LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAM>Scott Pullen LICENSE NUMBER 24706 BUS. LIC# COMPANYNAMEHMR Architects E- MA[Lscottp@hmrarchltects.com FAX STREET ADDRES&2 130 21st Street CITY, STATE," Sacramento, CA 95818 PHO1916- 736 -2724 Df` ffT LA"ffls a Tenant Improvement for a Rubio's Fresh Mexican Grill restaurant in a existing space: that already had a restaurant in it. Rubio's intends to provide a new restaurant along with outdoor dining. ''. XISTING USE te PROPOSED USE CONSTR. TYPE # ST RTES USE TYPE OCC. SQ.FT. VALUATION staurant Restaurant V -B ($) ARG A E FLOOR 2365 AREA NETAREA2365 Restaurant V-B A-�?• 2365 $199,000 BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA: EIDETACH ❑ ATTACH # DWFLI.ING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? ❑NO PRE- APPLICATION C] YES IF YES, PROVIDE COPY OF IS THE BLDG AN TOTAL V LUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HO. . V By my signature below, I certify to each of the following: I am the property owner or auth agent to act a owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and i I i rate. I agree to comply with all applicable local ordinances and state laws relating to b /ding constructi n. I ze repres tat' c p enter the abov�e - identified property for inspection purposes. Signature d D Date: V� °� 1 of Applicant/Age SUPPL MENT ORMA ON REQI I PLAN CHECK TYPE ROUTING SLIP ❑ OVFR -THE- COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifam[ y dwellings: pply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONNIENTAL HEALTH B1dgApp_2011.doe revised 06121111 CITY OF CUPERTINO PEE ESTIMATOR - BUILDING DIVISION Ell ADDRESS: 20688 STEVENS CREEK BLVD DATE: 06/04/2016 REVIEWED BY: MELISSA APN: 359 08 028 BP #: K5-0 *VALUATION: 1$199,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PIENTAMATIION 1A TI USE: PERMIT TYPE: WORK RUBIO'S - T.I. TO RESTAURANT TO RECONFIGURE AND REMODEL (2,365 S.F. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. IFLR AREA s.f. PC FEES PC F]EE ID 3P FEES 3P FEE IID A (Tenant Improvements) II- B,III- B,IV,V -B 2,365 $2,506.73 IATIPLNCK $1,377.65 1ATIINSP hlec. Imp, 1'ae' Q,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: atuninistrative Fee: Q E) Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 TOTALS: 2,365 1 $2,506.73 Stron)z Motion Fee: IBSEISMICO 1 $1,377.65 Select an Administrative Item MECH, HOURLY Q Yes E) No PLUMB, HOURLY Q Yes Q) No ELEC, HOURLY 0 Yes Q No l9ei;h. plan Check 11a1m17. Plan 01CCk filer. Plan Che=ck ; -Vech. Perrrril Fee: Plumf). Permit lw lslee, Permir t=ee: 0'11er il/ech. Ines[) Olker Plwnb Amur. � Odle]. L :lec °. 1nsp. DI "Wech, hlsp. hire: F'l oob. hrsp. Fee: hlec. Imp, 1'ae' NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc )_ Theee fees are haced an the nreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolulion 11 -053 ff. 7l1113) )FEE QTY/FEE MIISC ITEMS Plan Check Fee: $2,506.73 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. OT Q.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,377.65 Suppl. Insp. Fee:Q Reg. COT Q,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: atuninistrative Fee: Q E) Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential 0 Building or Structure 0 d Trm el l]ucurnr- ntaliurr hoes: Stron)z Motion Fee: IBSEISMICO $55.72 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $8.00 SUBTOTALS: $3,948.10 $0.00 TOTAL FEE: $3,948.10 Revised: 04/01/2015 SEP -02 -2015 13:21 CUPERTINO MITCHELL CONTRACTORS INC 949 387 4488 P.001 /001 -- ......... ..._.:.... Building Department City Of'Cupertino 10300 Torre AN enue Cupertino. CA 93014 -3255 Telephone: 408- 777 -3228 Fax: 408-777-3333 CONTRACTOR OR / SUBCONTRACTOR ILRST JOB ADDRESS: a06 '00 SkWe 9S 0Aj50?- - f�t/,_i PERMIT #' OWWI I('SNAN1E:A&6j&'s eog&j ex2A0 if _ - -- PHONE # ~� GENERAL CONTRACTOR: t;j a // *gger y I G0AjtAq A [3USINGSS LICENSl- ;y 3 b6�' ,Yv a CITYJZIPCODE: rP -Vjm)F (c6. 9 g6 6 £3 *Our municipal code requires all businesses .corking in the cite to have a Cite of Cupertino business license. NO BUILDING .FINAL OR FINAL. OCCUPANCY INSPECTION(S) WILL BI SCHEDULFD 1./NTIL, TH1F: GENERAL CONTRACTOR. AN[) ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: - -- ----- - - -... —._ Signature Date Please check applicable subcontractors and complete the following information: v SUBCON`I'RAC:TOR BUSINESS NAn1F -- — BUSINESS LICENSIE # Cabinets & M INvork a Cement Finishing I h,401/ C dr ®� �� Electrical Excavation Fencing 11PA i C0 i!� 00AP OVA Y9 -4� Y Flooring / C'arpetino I Linolemil / Wood Glass / Glazing Heating —_ -- -- Insulation Landscaping Lathing AtLA d¢ - - -- -------- - - - - -- Masonry e a�G�a �// C9oAld:f -A Painting / Wallpaper — gg V !2 - -- Paving .4 Plastering _— PIUi11bIii! _ —_ -_— CA -- Roofi n, Schtic `Tank Sheet Metal - -- Sheet Rock 4A I L��-- - - - - -` -- - - - -- — 4t4d 4 ! - -- fi'a e4a `$¢ - L i l e I - - - -- A , &H e ll 4 1 eom &Jz� QS � �� el � q /-241 ,, Owner / Contractor Signature Date TOTAL P.001 it f I