15010139CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6 RESULTS WAY
CONTRACTOR: SC BUILDERS INC PERMIT NO: 15010139
OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET
910 THOMPSON PL DATE ISSUED: 01!26/2015
OWNER'S PHONE: 6504211832
SUNNYVALE, CA 94085 PHONE NO: (408)328-0688
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E]
�i(p�
APPLE TENANT IMPROVEMENT (FIRST FLOOR) (1182 SQ
License Class Lie. 4 �qlP
FT).
4
Contractor_:3�—C., Date d, IOI IV
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.
1 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: $40000
performance of the work for which this permit is issued.
l have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 35720041.6
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
WITHIN 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 INSP CTI N.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
/
costs, and expenses which may accrue against said City in consequence of the
�, A� l
by: �?Wy v Date: S
granting of this permit. Additionall , the applicant understands and will comply
Issued
with all non -point source re ti ns p &1he Cupertino Municipal Code, Section
9.18.
Signature Date + •fib —Z311—
KE -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.
❑ OWNER -BUILDER 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 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
1 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 rea uality Management District I
performance of the work for which this permit is issued,
will maintain compliance with the Cu m 'pal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Se s 5, _ 33 an 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: _At aOb o13
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
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
1 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.
Date
CUPERTINO
150 / o i3 g
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildincl cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/ Ti ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
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PHONE
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STREET ADDRESS
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CONTACT NAMEPHONE
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STREET ADDRESS
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME //�,,, 2
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LICENSE NUD4BER
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LICENSE TYPE
BUS. LIC #
COMPANY NAMEE-MAIL
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STREET ADDRESS
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PHONE
ARCHITECT./ENGINEER NAME U t S P ,D, VWL
LICENSE NUMBER e 1 S� ��
BUS. LIC #
COMPANY NAME
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FAX
STREET ADDRESS
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CITY, STATE, ZIP
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PHONE
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DESCRIPTION OF WORK
o35T4.UC� o%V1 C%e-ae oF Y IGt :Vs 171
1 !1 .- A,& I I I I I . ri- I 1 1 USE I TYPE I OCC. I SQ.FT. VALUATION ($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA I AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA i DECK AREA TOTAL DECKTORCH AREA I GARAGE AREA: DETACH
ATTACH
# DWELLING UMTS: IS A SECOND UNIT ❑ YES SECOND STORY []YES
BEING ADDED? NO ADDITION? FIND
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVE.EY TOTAL VALUATION:
PLANNING ADPL# 'O PLANNING APPROVAL LETTER EICHLER HODIE? 5e0 e;o -0
By my signature below, I certify to each of the following: I_amtH owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is av read the escription of Work and verify itis accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to ]din on ructio aut orize esentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent Date: U
BldgApp_201 Ldoe revised 06121/11
SUPPLEMENTAL INFO ON REQUIRED
; PialvCHECK TYpE
ROUTIAG SLIP'S
New SFD or Multifamily dwellings: Apply for demolition permit for
ovER T>couNTEx;
: ButiDnvGPLANREv1Ew
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS ., -
_ ❑ PLANNING PLANS REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
QsTnNnARd.
Pus3acwoxits
_
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
AiAJQx
❑
submittal of Building Permit application.
sANTARY sER ER DISTRICT
r `=
BldgApp_201 Ldoe revised 06121/11
CITY OF CUPERTINO
ismi FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
6 Results Way
DATE: 01/26/2015
REVIEWED BY: Sean
PC FEE ID
APN:
BP#: L%
'VALUATION: $40,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
-7USE:
PENTAMATION 1 B TI
PERMIT TYPE:
WORK
A le Tenant Improvement First Floor 1182 sq ft).
SCOPE
PME Plan Check:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,MV-B
1,182
$2,144.34
1BTIPLNCK
$1,203.24
1BTIINSP
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,203.24
Suppl. Insp. Fee:Q Reg.
Q OT
p p
hrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
1,182
$2,144.34
$0.00
$1,203.24
MECH, HOURLY ()Yes E) No
PLUMB, HOURLY ® Yes Q No
ELEC, HOURLY Q Yes 0 No
MISC ITEMS
Plan Check Fee:
$2,144.34
ET
ET
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc L The.ce fees are hated nn the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7,1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,144.34
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,203.24
Suppl. Insp. Fee:Q Reg.
Q OT
p p
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
P u)1`+r'7"f4.61r1(f 7L1-":
0
0
Work Without Permit? Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
�.
Strong; Motion Fee:
1BSEISMICO
$11.20
Select an Administrative Item
Bldg,, Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
1 $3,360.78
$0.00
TOTAL FEE:
1$3,360.78
Revised: 01/06/2015
C iS 65b 7,�0 5W cpt1
CUPERTINO
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS SO PERMIT # i 5 t
OWNER'S NAME: p- 04L PHONE # SIO ,3Z
GENERAL CONTRACTO (>ejZBUSINESS LICENSE #
ADDRESS: d 40 CITY/ZIPCODE: �`io 5
*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.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
✓
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
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Owner / Contractor Signature Date