15030014CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10191 S DE ANZA BLVD
CONTRACTOR: C & L BUILDERS INC PERMIT NO: 15030014
OWNER'S NAME: HEINE MARYLOU A TRUSTEE & ET AL
14235 ACAPULCO RD DATE ISSUED: 08/14/2015
OWNER'S PHONE: 6509415211
SAN LEANDRO, CA 94577 PHONE NO: (415) 748-2672
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
1. Q
License Class Lic. # p 6 72-9
STERLING BANK & TRUST; COMM. T.I (2433 SQ FT) TO
INCLUDE CONVERSION OF STORAGE TO CONFERENCE
�,^ ® @ ''^
ROOM,
Contractor Date r
T CEILING SYSTEM, CLOSE
-BAR (E) SERVICE DOOR AT
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: $120000
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: 35910015.10191
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 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 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
Issued b /��: Date: f
granting of this permit. Additi Wally, the applicant understands and will comply
y
with all non -point source r la ions per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
Signature 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
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
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 Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cup tin Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
751.5533,
Q
Date: Q `f'�' Al
permit is issued.
Owner or authorized agent:
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPER71N0
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org ElNEW CONSTRUCTION ❑ ADDITION [� ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS ®� P �A p �y/
1 1),,M/
APN# /�.,�I, B ® V1 /
�"�'
(
q� AA��'4�9,,p�6�:
OWNER NAME
II aa,,
MARY 6s8V IV^ ..tl` ld��IR
' I'7
PHONE���`° A
E
STREET ADDRES s�®Q s P
!! !Jd
CI'FpY, STATE � X o !
e&)6®
FAX
CONTACT NAMEiii /V i
Pf
pH Is
AMAIL
, r
STREET ADDRESS O 1� AVE 1
CITY SCdA E! ZIP
FAX 1 w t
❑ OWNER ❑ OwNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT Ih ARCHITECT ❑ ENGINEER ❑ DEVELOPER/ ❑ TENANT
CONTRACTOR NAME A ®
LICENSE NUMBER��
LICENSE TYPE
BUS. LIC #
COMPANY NAMEry - ffirC,
E-MA`. eiQ yV(t.�1 �g y
FAX0LP
..
STREET ADDRESS rM✓
CITYZ.������
P
-2,67L
ARCHITECTIEIQ�NAME gll����11�
LICENSE NUMBER %1 r I r !^
BUS. LIC #
COMPANY NAME (EL,AgITILIT5 rg/V
E L I�(�J ��7VV YLCll6j6>.
FAX(C)
STREET ADDRESS 5 r' ( -
V� ���
CI S ATE, ZIP
C&O �z�-
Tri
t �� -��D
DESCRIPTION OF �tc� le T����
Ixfg, - - v &� t GE % RCf
Yr1 % (ft1 (L (low(�) v oto
o '/z,Tc f 11VfrN� AUTVUfiTicf F6MA510DR
EXISTING US C' B®
��� �
PROPOSED USE CO1JSTR
�o
5Wk
TYPE
I -8
V
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA � �
NEW
AREA FLOOR /A
EPf
AREDEMA
TOTA
NET AL—
—
BATHROOM! KITCHEN
REMODELAREA REMODELAREA `
OTHER p
REMODEL AREA 2 Z 4, p .—
PORCH Q A/RQEA
DECCCCKK AREA
�A
TOTAL DECK/PORCH AREA
g%X
�Y
!` GARAGE AREA: DETACH
y�g ❑ATTACH
# DWELLING UNITS:
IS A SECOND UNIT [I YES
SECOND STORY ❑ YES
RA
BEINGADDED? qNO
ADDITION? JMNO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑YES
RECEIyE BY r t
'� TOTAL VALUATION:
PLANNING APPL # ®NO PLANNING APPROVAL LETTER
EICHLER HOME?c( NO
+ '; ' F w, 5 .
X< 's(
�� d/
i�—
v . M ,
d
By my signature below, I certify to each of the foil wing: 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 rrect. 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 cons t I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicann_9-__t,_
Date: _ t!
suPPLIMENTAL iNFoRmATI N REQUIRED
s
w PLAN CHECK,TYPE ..- _.,
n
' ROUTINiG SLIP
_ New SFD or Multifamily dwellings: Apply r demolition permit for
❑ OVER THE COUNTER
r BUILDING PLAN REVIIIW r
existing building(s). Demolition permit is requil d prior to issuance of buildingi%Zi
permit for new building.
;
D ss r
xPIIr
3PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sTANnARD °
xF 3A y AJ l 1
❑ ruBLIC woRxs, Y
_
form if any Hazardous Materials are being used as part of this project.
D
,, t
_ Copy of Planning Approval Letter or Meeting with Planning prior to
ItARGE �
Q MASOR r'c
FIItEDEPT �
❑
submittal of Building Permit application.
1 k
,SANITARY SEWERDISTRICI
,;Y; „__ r
„£R.cENViRONMENTAIAEALTH_�' _
BldgApp_201 Ldoc revised 06121111
S 69i
NA
,�,���—,� CITY OF CUPERTINO
li' �{�I FFF FNTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10191 s de anza blvd
FLR AREA
s.f.
DATE: 03/02/2015
REVIEWED BY: Mendez
161
APN:
BP#:
II-B,III-B,IV,V-B
*VALUATION:
1$120,000
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: tenant Improvement
PRIMARY Commercial Building
Lilac. Insp. Fee:
$2,212.10•
PENTAMATION 1 B TI
PERMIT TYPE: i
USE:
hrs
$0.00
PME Unit Fee:
WORK
sterlin bank & trust; comm. t.i 2433 sq
ft to include conversion of storage to conference room t -bar
SCOPE
ceiling system, close (e) service door at side of bldg
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,IV,V-B
2,433
$2,305.60
1BTIPLNCK
$2,212.10
IBTIINSP
Lilac. Insp. Fee:
$2,212.10•
.-,e_ rv__r__
c:-- C'__: ...... Q,.,. rl, -f .Cehnal
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Ta,: T71-
A.dininistrative Pee:
Select allon-Residential
Building or Structure 0
Work Without Permit? 0 Yes (j)No
$0.00
TOTALS:
2,433
$2,305.60
Travel Doett(nentalion Fees:
$2,212.10
.- -
® No
M.ECH, HOURLY .Yes.., . •
PLUMB, -HOURLY :. -0Yes No
EI�I;C, HOURLY; ;Yes - . No,
;tlech. Plan Cheek
Phwib. Plan (.heck
Elec..Plan Check
rblech. Penmil Fee:
Plumb, Perini( Fee:
I h7ec. Permit Fee:
(7rlrer ,1le crr. Insp.
other Plumb l7T,Sjr_Lj
Other Ilea. Insp.
Li
oder./r. Lap. Yee:
l'luulb. hrsp. Fee:
Lilac. Insp. Fee:
$2,212.10•
.-,e_ rv__r__
c:-- C'__: ...... Q,.,. rl, -f .Cehnal
NOTE: This estimate does not include fees due to other Departments (t.e. Planning, ruouc rrurn3, 1'91c, �suiusuiy •+�-�•-�-•
__�__.___..•.... ,. ,.: L.RI., ...,.J n.o nuly nn ordmntn_ Contact the Dent for addn'l into.
District, etc.). "These fees are based on the preurnmunur
FEE ITEMS ITEMS (Fee Resolution 11-053 Eff. 7/1/132
ca urniauuic uvaecuuio
FEE
....» ..•.
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,305.60
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. OT
0.0
hrs
$0.00T__=
PME Plan Check:
$0.00
Permit Fee:
$2,212.10•
Suppl. Insp. Fee -.(E) Reg. Q OT
O,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Ta,: T71-
A.dininistrative Pee:
Select allon-Residential
Building or Structure 0
Work Without Permit? 0 Yes (j)No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure 0
Travel Doett(nentalion Fees:
Strong Motion Fee: IBSEISMICO
$33.60
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$5.00
SUBTOTALsi "
$4,556.30
$0.00 TOTAL FEE„
$4,556.30
nor
Revised. 04,1-4015
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: 10 1 t'Z1.A5AVA9W>
PERMIT # 03 00 lip
OWNER'S NAME: ftWlb fqhM L,p U
C<AL PHONE # (. Q
GENERAL CONTRACTOR: L
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE: CA. ft!rztj
*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
Please check applicable subcontractors and complete the following information:
Date
j/
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
p
30 a? At;
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
eWQS
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
3076
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
"Cry C& '� u/C� /.JC/ l
Owner / Contractor Signature bate
-2