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14120107I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10033 SAICH WAY CONTRACTOR: BOTTENFIELD PERMIT NO: 14120107 CONSTRUCTION I OWNER'S NAME: SAICH WAY STATION LLC 24832 APPLE ST I DATE ISSUED: 07/17/2015 1 OWNER'S PHONE: 5594320399 NEWHALL, CA 91321 j PHONE NO: (661) 260-1720 W LICENSED CONTRAC�TyOR''SS DECLARATION License Classy9. #!_/ Lie. _ a 9/ L Contractor 130rrtr,W�!f &7-p Date 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 pe Frm of the work for which this permit is issued. and will maintain Worker's Compensation Insurance, as provided for by on 3700 of the Labor Code, for the performance of the work for which this it is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature (. Date rl OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL [:] COMMERCIAL BLAST 825- COMM. T.I ON SHELL BUILDING Sq. Ft Floor Area: Valuation: $150000 I APN Number: 32632041.10033 I Occupancy Type: I PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS F _ CALLED INSPECTION. Date: N rr 31/,6_ i RE -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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 2550 ,ZS3, and 25534. y Owner or authorized agent: Date: ` I U /0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cu perting.ong ❑ NEW CONSTRUCTION n ATnT)TTIOM IYI ATrU:DATTnXT/— 1-7 , •,�,/. �� u �vi�ivly i uCrbKKbll UKA-ANAL PERMIT# PROJECT ADDRESS 00 3 APN # OWNER NAME � SOH N rrrz_o►n!,•f-►p)( PHONE 432 b_3Xri E-MAIL STREET ADDRESS G��ZGI lv, C�taLpn ST-� Z17�)1'L1LSl�/G CTTY, STATE, ZIP CA G'(3� FAX CONTACT NAME r Vi tv 010,z PHONE Sl% -7 01 rive E-MAIL VE01 ! EP (6ti"ot(OErsu.H . C;;.K STREET ADDRESS Z Q 2Z 1 01 C:I/-�, l/iwcxor� err lo � CITY, STATE, ZIP �4600P_* lay.>`S Cl(3 0 FAX E3 OWNER El OWNER -BUILDER L7 OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ) LICENSE NUMBER j LICENSE TYPE BUS. LLC # COMPANY NAME � I 0 �7 h-91i4J o ll! 1 E-MAIL._g- 1� V Iltd 1 1 �t1e ► M F �' 2-uGv (�!� l`O l f STREET ADDRESS 2— 32- „ : -e S n4,)+ CITY, STATE, ZIP 1 ��� r yY �� r (�b"4 U PHONE ARCHITECT/ENGINEER NAME _DA W Ll~ L I�f=1 r (z t"Z LICENSE NUMBER / „ O C((jZ C• BUS. LIC Al COMPANY NAME rF�L (= t'vTZ IA 2GL4 tT a LT S E-MAIL VAN W L t�� t f -A I 4 C a ryl FAX STREET ADDRESS C14•Cv, n CITY,STATE,ZIP `.JkIZZJ1 RN �1��S lgz3 PHONE Q yo� / Q DESCRIPTION OF WORK 1tSlT�zQrb� j►zr�i�Atil� (MP/tac�emolvl OF St+EL-L- EXISTING USE PROPOSED USE CONSTR TYPE # STORIES TZrV_SiAvR/�fX* e USE TYPE OCC. SQ.FT. VALUATION (S) EXIST �� c� AREA ZJ� • 9 AREA V AARREEO AREA �� li TOTAL NETAREAZP?O�L 'l/fn4fi f p�j 6 cr, BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH. []ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECEIVED BY TOTAL VALUATION: Q 1727 cvo C, By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the 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 laws relating to building c nstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature - of Applicant/Agent: Date: /I SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for El existing building(s). Demolition permit is required prior to issuance of building OVER -TRE -COUNTER __U -BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS 'PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD rr J+] --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 submittal of Building Permit application. ❑ MAJOR .© SANITARY SEWERDISTRICT B ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06121/11,_ - CITY OF CUPERTINO ISM -ft, FEE ESTIMATOR - BUILDING DIVISION iaADDRESS: 10033 saich way DATE: 12/22/2014 REVIEWED BY: Mendez PC FEE ID APN: BP#: A (Tenant Improvements) *VALUATION: 1$150,000 PERMIT TYPE: Building Permit PLAN CHEC TYPE: Tenant Improvement PRIMARY USE: Commercial Building IATIINSP PME Plan Check: PENTAMATION PERMIT TYPE: 1A TA WORK 825- comm. t.i on shell building Permit Fee: [blast SCOPE Suppl. Insp. Fee -.E) Reg. Q OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID A (Tenant Improvements) II-B,III-B,IV,V-B 2,809 $2,551.36 IATIPLNCK $1,613.28 IATIINSP PME Plan Check: $0.00 Permit Fee: $1,613.28 Suppl. Insp. Fee -.E) Reg. Q OT Q p hrs $0.00 PME Unit Fee: $0.00 PME Permit Flee: $0.00 _FT TOTALS: 2,809 $2,551.36 $1,613.28 �. No MECH, HOURLY 0 Yes . G PLUMB HOURLY` . f Yes Q No TELEC HOURLY-, 0 Yes Q No , oi =L•.m ('Tr:<cit iter h. Insp. 1; ;.r . 1'hvinb ""crrni" Pec:: $2,551.36 i7 <' "'..rnrit 01dwr f:r.'ec'. Imp. 1; <': C. hul.7, Vec.: Select a Misc Bldg/Structure or Element of a Building Coro P?vI i) 7nsp f'i'(lUI; ittj J, Fee: NOTE: This estimate does not include fees due to other Departments (Le. PlOning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the vreliminary information available land are only an estimate. Contact the Dept_/or addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef 7/1113) FEE QT /FEE MISC ITEMS Plan Check Fee: $2,551.36 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,613.28 Suppl. Insp. Fee -.E) Reg. Q OT Q p hrs $0.00 PME Unit Fee: $0.00 PME Permit Flee: $0.00 _FT 0 0 Work Without Permit? Q Yeses No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 A /r, . T� �,. r, •.. ,. r+'c'l, t}f tfra,<'rtr::r1,`:: r'i .F'r:'G�,S'. Strong Motion Fee: IBSEISMICO $42.00 Select an Administrative Item Bldg Stds Commission .Fee: 1BCBSC $6.00 SUBTOTALS: ` $4,212.64 $0.00 TOTAL FEE; $4,212.64 Revised: 10/01/2014