15080007F11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20195 STEVENS CREEK BLVD
CONTRACTOR: HUETTIG & SCHROMM,
PERMIT NO: 15080007
INC
OWNER'S NAME: WDT-CUPERTINO
431 BURGESS DR STE 200
DATE ISSUED: 08/18/2015
OWNER'S PHONE: 6503222121
MENLO PARK, CA 94025-3478
PHONE NO: (650) 322-2121
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
License Class 12-9 O c
STE 100 - T.I. TO PREPARE SHELL FOR (1) TENANT
Lic, # O
(4,054 S.F.)
Contractorl �1c SG��OjR'M1/i0 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
CoTpensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $147500
per ormance of the work for which this permit is issued.
, ave 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: 31624047.00
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
to building construction, and hereby authorize representatives of this city to enter
WITfIIN 180 DAYS OF PE SSUANCE OR
upon the above mentioned property for inspection pure ses. (We) agree to save
indemnify and keep h less the City of Cupeki o aga4st liabilities, Jud
costs, and expen es whi may accrue against said City in conse e
D INSPECTION.
granting of is ermit Additi Wally, the a plicant und6rs will comply
with
Date: \
all no nt so rce reg tions pert Cupert' Municipal Code, Section
9.18. r
Signature W % Date 0 �� �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.
❑ 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:
I, as owner of the property, or my employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
'ch
Compensation, as provided for by Section 3700 of the Labor Code, for the
material. Additionally, should I use equipment or device emit hazardous
air contaminants as defined by the Bay Area Air Quali Man ement District I
performance of the work for which this permit is issued.
will maintain compliance wigt�e�ertino unicip Code, hapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, 505; 3, and 5534.
Section 3700 of the Labor Code, for the performance of the work for which thispermit
i
Owner
is issued.
or authorized agent:��, Date:
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
Lender's Address
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,
ARCHITECT'S DECLARATION
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 e FAX (408) 777-3333 • buildingQcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION I ;I ALTERATION / TI
SO�pOG�
❑ RFVIST(TN /TIFFFRRFTI r11?T(:TT.TAT PPT?TATT Y
PROJECT ADDRESS 2, l J 5 leV e_V\ G /CPt� Suit
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APN # 91&- Z 1 —047
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OWNERNAME
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❑ OWNER ❑ OWNER -BUILDER OWNER AGENT A CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER y� (� f
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LICENSE TYPE �j
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ARCHITECT/ENGTNEER NAMES
LICENSE NUMBER
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BUS. LIC #
COMPANY NAME ` �1-7-A C_ I
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DESCRIPTION OF WORK m n
lS'lC? r ror_�vVT.� r �?I�n ��� C��i IC_v.
g� °f
CV-,&,S�SeAN J a t.+ l l 0 -f
EXISTING USE
0 F PGE-
PROPOSED USE CONSTR.
MO &A.6' Ael <
TYPE
V_ F-1
# STORIES '
2— USE TYPE
OCC. SQ.FT.
VALUATION ($)
EXISTG UI L�
AREAL( G,✓L�'c.
NEW FLOOR
AREA Q.
DEMO /
AREA �/Q
1/
TOTAL
NET AREA �� � ��•� °
/
�C0 -
6 _
d *-7,
LLLL
BATHROOM '
REMODEL AREA 1 /G�
KITCHEN
REMODEL AREA V� IL�
OTHER'
REMODEL AREA /LJ p i� 6/ S ,
•
PWA
DECK AREA
TOTAL DECK/PORCH AREA
GARAG�j AREA: ❑ DETACH
�,�
Lti,
In
,� ❑ATTACH
# DWELLING UNITS:
jn ry
IS A SECOND UNIT ❑ YES
BEING ADDED? M'NO
SECOND STORY [:]YES
ADDITION? /'-" ,allo
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN VALUATION:
EICHLER HOME'S J ��
By my signature below, I certify to each of the following: I am t1V pr pe er or authori nt 2STi t e property owner's behalf. I have read this
application and the information I ve 'rovi d is Cprrect. I have ead the escription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t esentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: (� , *`
SUPPLEMENTAL NFOtAtON REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
11 BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply 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
❑ FUZE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
Bldg,4pp_201 1. doe revised 06/21/11
CITY OF CUPERTINO
IM -7 FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
20195 STEVENS CREEK BLVD
DATE: 08/03/2015
REVIEWED BY: MELISSA
IlaADDRESS:
APN: 316 24 047
BP#: 4oc_a9e'
*VALUATION: 1$147,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE:
IBTIPLNCK
PENTAMATION
PERMIT TYPE: 113 TA
WORK
T.I. TO PREPARE SHELL FOR N TENANT (4,054 S.F.
SCOPE
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
4,054
$2,416.82
IBTIPLNCK
$3,514.78
IBTIINSP
Eley. Itrsp. Fee:
PME Plan Check:
$0.00
Permit Fee:
$3,514.78
Suppl. Insp. Fee:Q Reg. Q OT
0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
4,054
$2,416.82
' ,
$3,514.78
MECH, HOURLY Yes No
PLUMB,,HOURLY , -. Yes : E) _ No
ELEC . HOURLY o Yes GNP
Nfech. Plan Check
l>IYtnib. N.UrI Check
Elec..Nan Ched-
:1.faclr. Permit Fee
Plumb. Permit Fee
Floc. Permit Fee:
lhhrr 1/e:cFr. frup.ofher
Plumb Inv?.
Other Laec. bzsp. Ll
Inc�tt. Imp. Fee:
Plumb. Insp. Fee:
Eley. Itrsp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,416.82
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,514.78
Suppl. Insp. Fee:Q Reg. Q OT
0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(."onstrurtion Tax:
'-tdrninistrative Fee:
0
G
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
Travel Doc°unzenfrztinrr Fees:�
Strong Motion Fee: IBSEISMICO
$41.30
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$6.00
_- .. SUBTOTALS;
_,,
$5,978.90
$0.00
-` TOTALFEE �_
$5,978.90
Revised: 07/02/2015