15040190CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 5 RESULTS WAY
CONTRACTOR: SC BUILDERS INC
PERMIT NO: 15040190
OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET
910 THOMPSON PL
DATE ISSUED: 05/07/2015
OWNER'S PHONE: 6504211832
SUNNYVALE, CA 94085
PHONE NO: (408)328-0688
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
License Class_ Lie. # '� �p1`Cl P
APPLE - T.I. 1ST FLOOR RECONFIGURE EXISTING AREA
(100 SQUARE FT)
Contractor Date ' <S
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:
1 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.
Sq. Ft Floor Area:
Valuation: $65000
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
APN Number: 35720042.5
Occupancy Type:
permit 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
PERMIT EXPIRES IF WORK IS NOT STARTED
relating
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS RMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 DAY CALLED INSPECTION.
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
SUe Date:
with all non -point source regul er the Cupertino Municipal Code, Section
9 18.
I
Signature i Date 05(�� 15—
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a rooii:.
installed without first obtaining an inspection, I agree to remove all new mateitil`s for
❑ OWNER -BUILDER DECLARATION
inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
1, 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)
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
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
declarations:
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
material. Additionally, should I use equipment or devices which emit hazardous
performance of the work for which this permit is issued.
air contaminants as defined by the Bay Are Quality Management District 1
will maintain compliance with the Cupertin al Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, S7iFw
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent:Date; 6S�0'11 �^
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
1 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
CONSTRUCTION PERMIT APPLICATION �1
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �O
(408) 777-3228 • FAX (408) 777-3333 • building (7Qcupertino.org \�
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❑ OWNER ❑. OWNER -BUILDER ❑ OWNER AGENT
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CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSENUNIBER
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LICENSE NUMBER
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DESCRIPTION OF WORK
_ C�JS;sZISC i Aqwh JHS ��'1j
6LJ,}^Lt rVES- C)A1ELI 7Z;) gL 5- Lds
(� LloC? Lv $ =QAI 1I VELA (1C:''GI~e I LI
EXISTING USE
PROPOSED USE
CONSTR TYPE
I STORIES
I
USE TYPE OCC. i SQ.FT.
I
VALUATION,S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
irt= I c,-(� I t t l 3
BATHROOM
KITCHEN
OTHER
4T
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA DECK AREA
TOTAL DECK/PORCH
AREA
GARAGE AREA: LIDETACH
❑ ATTACH
I
# DWELLING UNITS:
ISA SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEING ADDED? C] NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNGAPPL. ❑NO PLANNING APPROVAL LETTER
n4
IS THE BLDG AN❑ YE5 Y
EICHLER HOME? ❑ �x .T,. ,,..€,£ -
� �ALUATIIOON: -\
U
By my signature below, I certify to each of the following: I am the property owner or au zed agent to ace th perty owner's behalf. I have read this
application and the information I have provided is correc a� d the Description of Work and ve ' ccurate. I agree to comply with all applicable local
ordinances and state laws relating to ding co fru( I a ori re ori Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:
Date: IV-- Z 1L_ ;L4 I oleo 1S �
SUPPLEMENTAL TNFOR
ON
pp e city P f.§'
NU si>P h
New SFD or Multifamily dxvellings: Apply
for demolition permit for
`�- 4 �}.-F. i.'TPo4 *i.'�'. �+4' S .p"'
❑ OVER �r ,
4 $
REVJE.W
existing building(s). Demolition permit is required
prior to issuance of building3
SHE -COUNTER
�zBUIIDII�GpL 1 r
permit for new building.nlrtzvGPrnN��w�
ZZ
Hazardous Materials Disclosure
L m�xnt
�
_Commercial Bldgs: Provide a completed
- ,� k
�
form ifany Hazardous Materials are being used
as part of this project.IN
L5Co
Losi-1-11,11
ofPlannin A royal Letter or Meetin
g PP
with Plannin riot to�PY
g g P❑1pdQRsubmittal
Permit
ofBuilding application.
�'VIRONMENT�
RldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
WWW
err TCTT1%4ATn12 _ RTTII,DTN(. DIVISION
OCCUPANCY TYPE:
1'L'L' .•.V 11111�ai ...
ADDRESS: 5 RESULTS WAY
DATE: 04/27/2015
REVIEWED BY: PAUL
1121
APN: 357 20 042.5
BP#:
VALUATION:
1$65,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
$588.00
PENTAMATION 113 TI
PERMIT TYPE:
WORK
APPLE - T.I. 1 ST FLOOR RECONFIGURE EXISTING AREA 100 SQUARE FT
SCOPE
OrherL'1ec. lay.).
Lj
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,111-B,IV,V-B
100
$2,097.00
IBTIPLNCK
$588.00
IBTIINSP
I liienc. Permit Fee,
Oihe:r Alach. lrtsj.%.
011ier Pho-nb Insp.
OrherL'1ec. lay.).
Lj
1•I1',Ch. 1„aj). FeO.
P/rmrh. /r,sp. Fee:
lilec. ins;:,. hec.
PME Plan Check:
11/-
k F' Sanita Sewer District School
Permit Fee:
$588.00
Suppl. Insp. Fee -0 Reg. Q OT
FO -01
TOTALS:
100
$2,097.00
rs��[
$588.00
$588
PME Unit Fee:
_._,.. ,. .:,..� •. u.,,-; .., -.,.:. k.
... $I, cti +ei3�7t"• x �.;r h8a S 1!' wl, �� ;..jy,.. �. CNJ'fil'ai'Yt�g6x�
" �wYes,,�f��No
NOTE: This estimate does not include fees due to other Departments (r. e. Planning, PuLl.*-
P.,r, .x+kt';. „x r<b .s+, 11 M, aM, ti �^'.4w wtv� �'�¢pti ,;�((r
F• N ,7� .y� +fiv rh�k
PLIByQU.Y C! Yds Q 1`To
.rr -ss �! y+r 1,. sry-�a� t[lyP,� f�r �h
!� ly x 1,E 5� •
d�Yres , Q1No 7
MEC>�ItHb'
r
df. �ntv!. �dr.�n k,. .. i..P i''.4 •f.n I�, nine. w
+.moo. u.... ..... sv ,.5$I l�R lm le.,
QTY/FEE
,n r�Pi-iinf'M•,siR
Plan Check Fee:
ahcc b. Mora Ch'x-A
Plrrub. Plcup CJt c ic
lilnr. /11(v? Check
1lnc:lt. Permil 1•ern:
Ptcrrnh> Per,ni( Feat:
I liienc. Permit Fee,
Oihe:r Alach. lrtsj.%.
011ier Pho-nb Insp.
OrherL'1ec. lay.).
Lj
1•I1',Ch. 1„aj). FeO.
P/rmrh. /r,sp. Fee:
lilec. ins;:,. hec.
PME Plan Check:
11/-
k F' Sanita Sewer District School
r s, tie, .r,
rantact the Dept for addn'l into.
District, eta). "These fees are basea on the reuminur
anurosuuv a u�.......,.�
»•.» »• �
�•-- --- ---- - - -
FEE ITEMS (Fee Resolution 11-053 a. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,097.00
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:
$588.00
Suppl. Insp. Fee -0 Reg. Q OT
FO -01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C.'ans7rttc tivrr Tax:
O
„'j,L1772rr7!,CIrL!liVe Fd[':
Work Without Permit? C) Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
Building or Structure 0
Travel I?nc time nfarlhri Fees.
�
Strong Motion Fee: IBSEISMICO
$18.20
Select an Administrative Item
Bldg Stds Commission Fee 1BCBSC
$3.00
k4 {t d c Y•
$2,706.20
9 C i -�
$0.00 i ��;`�° �T $2,706.20
fiTAL�F�E
Revised: 04/01 /2015