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15030193CHY OF CUP EI TRNO BUR LDRNG P ERMRT BUILDING ADDRESS: 20325 STEVENS CREEK BLVD CONTRACTOR: TICO CONSTRUCTION PERMIT NO: 15030193 CO OWNER'S NAME: W D V PROPERTIES 1585 TERMINAL AVE DATE ISSUED: 06/15/2015 OWNER'S PHONE: 8572317647 SAN JOSE, CA 95112 PHONE NO: (408)499 -0266 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] RUSSIAN SCHOOIL, OF MATH; COMM. TJ TO INCLUDE License Class Lic. Ii �I J S �' CREATING (3) CLASSROOMS, (2) OFFICES, A➢DA Contractor -"CD 'CO_Gl eAJQ?t (01(S i S UPGRADES (,pate 2486 SQ FT 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: $76092 performance of the work for which this permit is issued. 1 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: 31626090.20325 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 ���,� III® DAYS ®]F ]�]EIlBI�ii1«' ISSUANCE ®](g to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ISO IlD S IFlIB ®I II LAST CALLED 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%�i' granting of this permit. Additionally, the applicant understands and will comply Issued b " Y IIDate: with all non -point source re ulations per the Cupertino Municipal Code, Section 9.18. c lS RE- ROOFS: Signature Date � l 1 S 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, wil I 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 &c 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 ➢ 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 Area Air Quality Management District ➢ performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &: Safety Code, Sections 25505, 25533, ald 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner Date: ! S permit is issued. or authorized agent: 1 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20325 STEVENS CREEK BLVD CONTRACTOR: TICO CONSTRUCTION PERMIT NO: 15030193 CO OWNER'S NAME: W D V PROPERTIES 1585 TERMINAL AVE DATE ISSUED: 06/15/2015 OWNER'S PHONE: 8572317647 SAN JOSE, CA 95112 PHONE NO: (408)499 -0266 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COA' MERCIAL E] RUSSIAN SCHOOL OF MATH[; COMM. T.1 TO INCLUDE License Class Lic. # CREATING (3) CLASSROOMS, (2) OFFICES, AJ(DA UPGRADES Contractor %/�1r&Yr ate 2456 SQ FT I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Revision # 1: Revise the layout of the required fire separation wall between tenants. 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 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 Sq. Ft Floor Area: Valuation: $76092 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 APN Number: 31626090.20325 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IEF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 ���� OF PERMIT ISSUANCE ®� to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ECTIION. 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 by: � Date: ��'� 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. RE- ROOFS: Signat a�.�� 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 1 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, wil I 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. 1 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 Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. 1 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 1 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 l 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 ul CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMEN T$4mem S 10300TORRE AVENUE ^ CUPERTINO, CA 95014 -3255 {,„;�� -� (408) 777 -3228 • FAX (408) 777 -3333 e building(cDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI �gj REVISION / DEFERRED ORIGINAL PERMIT 4 -5-0-� 01 3 PROJECf ADDRESS �y p APN # 316 ^zz — ® � OWNER NAME f ` �fb(�I"S PHONE n E -MAIL STREET ADDRESS CITY, STATE, ZIP ®� y ye FAX j CONTACT NAME PHONE t/tGtW+ A (x'720 t%� 4/0 2 7 & 6 E -MAIL @ � STREET ADDRESS CI Y, STATE, ZIP A FAX OWNER ❑. OWNER - BUILDER V OWNERAGEN'T ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCH] ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME '� W �'i N.J L 6�vL�l�i LICENSENUhIBER LICENSE TYPE qy�� BUS.LIC# COI.IPANY NAME E -MAIL FAX STREET ADDRESS ���'.A9_ CITY, STATE, ZIP gy (n�� iy q 9�/ PHONE f9 /p�y�� / LICENSE NUMBER �_7�/ !I ? p ARCHITECTIENGINEER NAME ) w,„�r�y `Q BUS. LIC k %7 r �J' 1 ^Jr�` COMPANY NAME �� 1 E -MAIL FAX �� STF.EET ADDRESS O Z CITY, STATE, ZIP C Z P PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES T) V—A aO ..1- USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA �l � A? AREA AREA I Ap i C o ry _ I / {J `(/►e• + ' 1 l BATHROOM KITCHEN OTiER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA7 GARAGE AREA: El DETACH I ❑ ATTACH m DA'E.LINGUNITS: 1S A SECOND UNrr ❑ YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRP•.4PPLiCAT]ON ❑ 1'ES IF YES, PROVIDE COPY OF PLANNIN- GAPPL# NO PLANNINGAPPROVAL LETTER is THE BLDG AN ❑YES EICHLERHOME? NO dtEC IVEDBY ., " "s +:r --- -:-', "rte 'i "'- TOTAL VALUATION: By my signature below, I certify to each of 1he 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 construction. I authorize representatives of Cupertino to enter the above- identified property for inspection purposes. Signature of Appl icant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily d%vellings: Apply for demolition permit for 5 �v ®aO�ER "Ti=OIJ)'TER�,;,�� ' � t �BUILDIINGPL�Nd21 VIEFi'i �& existing building s). Demolition permit is required prior to issuance of building 4 I�� K& - z r permit for new building. FF'410-xPss PLANC�II�GPL�ATIBEVIEw ' Y g 77 zK r��a 7, _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure s n tRD I- jg pup —.'Mn � form if any Hazardous Materials are being used as part of this project. 01 0 s Copy of Planning Approval Letter or Meeting with Planning prior to a ti �x submittal of Building Permit application. 'ERDIST, SER RIC'� r TAS'I:HEA.[3 T,FIi�r`�. BIdgApp_2011.doc revised 06121111 CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255 (408) 777 -3228 a FAX (408) 777 -3333 • building(a.cupertino.org ❑ NEW CONSTRUCTION El ADDITION E ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECTADDRESS 20325 Stevens Grp_d 51yJ. APN9 (0-10 _ 09D OWNER NAME �I ���� ,^ j PHONE ���v l I� /t (p �.� E -MAIL na�ha�i�lt' �n STREET.ADDRESS Wo `wr,^II� I,p� n� C�'A CITY, STATE, ZIPe, ,,,�, vE- FAX CONTACT N,AM ' C r�G P �J1� f MAIIV��IV1 1`✓\ ED 3C CAVAJ STREET .ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OwNER- BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME qCfD cmmucft LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER /' �y 336 BUS. LIC # COMP ANYNAME r n � � jLjllocxq� EdvIAIL -Se Cr\e,++.P- hl +ZCfS.(O FAX 1 jry,•) �1411�— 1 141 T STREET ADDRESS ,r`lI'S Wenvc CITY, STATE, ZIP ��r � CA gCo`l� 1 PHONE DESCRIPTION OF WORK N l0, On Additlon vrtm1 to zxAihno� Nn TrA (f r %w dY *Y) 4LA- Loon arj U b11 m ,, ifv Ibr 3 rata CI lIrr 4 cl� 2 Y-"e of�iceS (1vk\n, cx'vi� S tc EXISTING USE t�h� -iuuC PROPOSED USE CONSTR. � �Ih �C11 TYPE 41 � i #STORIES / J- USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA '] � Q / `/ W NEIN FLOOR DEMO AREA ��J' 1 Q� AREA TOTAL NET AREA 2� - 1 //A 4/ d'1 ^n ,// [ O •"� '.. BATHROOM KITCHEN OTHER '.. REMODEL AREA -- REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LJDETACH ' []ATTACH I # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEINOADDED? ;R�NO ADDITION? PFNO '........ PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN El YES RECEIVED BY: TOTAL,V, .UAT].ON� PLANNING APPL # 2NO PLANNING APPROVAL LETTER EICHLER HOME? aNO By my signature below, I certify to each of the following: I am the property owner or authorized agent t property owner's behalf. I have red this application and the information 1 have provided is correct. I have read the Description of Work and verify it is accura e. agree to comply with all applicable local ordinances and state laws relating co ruction- 1 authorize representatives of Cupertino to enter the above - identified property for inspection purposes. yto/b}}}`���ilding Signature of Applicant/Agent. v� Date: �� Z�IJ SUPPLEMENTAL IN ATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER- THE - COUNTER 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 Cormnercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ 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 ❑ MAJOR SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 /.doe revised 06121111 ) CChO I(& -f (ts •(OW) ext-. ioy FM--7 CffTY OF CUPER7M FEE ESTIMATOR — BUILDING I➢IVISRGN OCCUPANCY TYPE: ADDRESS: 20325 scb blvd FLR AREA s.f. DATE: 03/39/2096 RIEWEWED ]BY: Mendez BP FEES APN: I BP #: ✓� *YALUATIION: $76,092 *PERMIT TYPE: Building Permit $5,043.80 PLAN CIHECK TYP1E: Tenant Improvement PRIMARY Commercial Building USE: IETIINSP PENTAMATION 1E TI PERMIT TYPE: W ®RIt Russian School of math; comm. U to include creating 3 classrooms 2 offices ada upgrades SCOPE $0.00 PME Unit Fee: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FETE RD E (Tenant Improvements) II- A,111-A,V -A 2,486 $5,043.80 IETIPLNCK $5,050.15 IETIINSP ISIL'C. Imp, $5,050.15 Suppl. Insp. Feel@ Reg. COT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tcir: Administrative Fee: Work Without Permit? 0 Yes (D No $0.00 TOTALS: 2,486 $5,043.80 7rm,el Doctonenlalion Fees: $5,050.15 Strong Motion Fee: IBSEISMICO MECH, HOURLY 0 Yes .G No PLUMB, HOURLY Yes Q No ELEC, HOURLY Q Yes Q No dtecli. Plan Check 1'lruirb. Clem Check Elec. Plan Check dlech. Permit Fee: Plumb. Permit Fe(:: Is'l" Per nzit Fee., Other lllec °lr. Imp: 01hen- Plunib Insp, Other ISlec. Insp. lizsp. Fee: 7l174ob. hasp. Tee: ISIL'C. Imp, NOTE: This estimate does not include fees due to other Departments fl e. Planning, Public Works, Fire, Sanitary ,ewer District, School District. etc.). These fees are based on the nretiminary information available and are onlv an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11 -053 Ef. 711113,) /FEE QTY/FEE MRSC ITEMS Plan Check Fee: $5,043.80 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. C OT 0.0 Ill's $0.00 PME Plan Check: $0.00 Permit Fee: $5,050.15 Suppl. Insp. Feel@ Reg. COT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tcir: Administrative Fee: Work Without Permit? 0 Yes (D No $0.00 Advanced Plannin& Fee: $0.00 Select a Non - Residential Building or Structure Gi 7rm,el Doctonenlalion Fees: Strong Motion Fee: IBSEISMICO $21.31 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $10,119.26 $0.00 TOTAL FEE: 1 $10,119.26 Revised: 02/1412015 CUPERTONO CONTRACTOR / SUBCONTRACTOR MST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telepbone: 409-777-3228 Fax: 408- 777 -3333 JOB ADDRESS: 20 2-1z 1MAJA G PERMIT # 5' OWNER'S NAME: PHONE #^]• Gad GENERAL CONTRACTOR: j 1'GO 1`,on mi" o v-\, ! 11G BUSINESS LICENSE # `oZS a-7 I ADDRESS: 1,585 M1'kj O-LrP - . CITY /ZIPCODE: ,SCLn Cb ,&e. qS:lf� *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) WDLL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPIER) INO BUSINESS LICENSE. I am not using any subcontractors: Signature 1Please check applicable subcontractors and complete the following infformadon: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Q ppw Excavation ti�V s�32 Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal ," Sheet Rock LC lNei—brS J nC. � l Tile �3/9-k Nos Date ALTERNATE HATE ALA AND METHODS I MODIFICATIPH Fdn .• COMMUNITY DEVELOPMENT DEPARTMENT r BUILDING DIVISION ( �•� 10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255 (408) 777 -3228 FAX (408) 777 -3333 building Ocupertino.orq s �• CUPERTINO ® REQUEST FOR MODIFICATION OF CODE (CBC 104.10, CFC 104.5) ❑ REQUEST FOR ALTERNATE MATERIAL, DESIGN OR METHOD OF CONSTRUCTION (CBC 104.11, CFC 104,9) TA annlu fnr !hie ron,eaell rmmnlala aarHlinne 1 9 R 3 link nr twnpl SITE ADDRESS 20325 ftven Creek Blvd. �H 366. 20-090 DATE 06! 0312015 owner De Anza Properties, (contact manager Carla Wi!.key) ....... PC# 15030193 V -A Address g60 n San Antonio Rd, Los Altos CA 94022 ......I...... ......... .. I ............... : ... ............................... Permit #: Type:..... ............................... 1 Et nall Phone408- 738 - 4644 ............................... St ones:.. ............................... B 11 .�ga(.deanzaprop.erliescom ................. LNa:....................... Dept./Div ............................... Occu an Floor Area:.SUlte 2,486SP ..,....... Jessie Delucchi, JCA Architects Pro'ect Designer ..................... .............. Applicant .......... ..............................' ... Title .. .....�......................... Address 1028 Lincoln Avenue San Jose, CA .............................................................................. ............................... Job Status: ........................... Occ. Load:..�� ....................... essie 'ra architects corn 4Q8- 278 -1166 Email�.......... Q�.).....� ..................:... ....................... Phone... . ............................... Use aiBldg:! ! ed,USe 2 I REQUEST: For code modifications, please state the appilcabte code requirement and the exlent of relief desired. For anemate requests, state the type of system Request to use B occupancy for the proposed tutoring center, per CBC 304.1 (see description below). 3 JUSTIFICATIONIFINDINGS OF EQUIVALENCY: For code modifications, applicant shall demonstrate that Code Section(s): special, Individual reasons exist that make compliance with the strict letter of the ordinance impractical and that CBC 304.1 equivalency is provided. For alternate requests, applicant shall demonstrate suitability, strength, effectiveness, fire resistance durability, safely and sanitation that is equivalent to the code for a similar use. Attach additional sheets if necessary. An errata is Issued to allow the use of B occupancy for tutoring club. It is to take effect on July 2015. Is application requesIs Me application s code towards the proposed project S 3 ReviewPetitionefs Project Designeri nature:............ .............. Posilion:. Date: ed ...... ............................... Date:.......................... The Request is: ❑ GRANTED ❑ DENIED Dept. Comments: CONDITIONS OF APPROVAL: No_ of Items: ............................. FeeDue: S . ............................... Date Paid: ................................ Receipt No,: ......................... Processed by: ............................ Buildin Official: ...... .............. �L� .-....... : . ..........I S Date:. f ........ .......... . ...........,............ .............. /........... Fire Marshal :................. ... ........ DEPARTMENT A nON: Attyr determination, copies lo: 1) applicant, z) permit file -tit 2(NS.doc revised oii1n6i15 CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 o building(Ocupertino.org APN 3i ©q(0 BP 7.5-0 FLOOR AREA DA LEVEL PROJECT VALUATION: ®� SITE ADDRESS: 3 25— .S' 2 ❑APPROVED ❑ APPROVED WITH CONDITIONS- OWNER'S NAME: 9-b Date:...................... PHONE #: V ❑ APPROVED FAX #: im Date:. MAILING ADD S (if diffefen ro site a 0a ' till 9,+0'2 �ffi 00 ,�t�v CONT ACTOR: _ E0 COPS-0401-7-MO Lr(— PHONE #: FAX #: fi 7 d — 7^ c17(N CONTACT: P4 C4-- 6) PHONE #: FAX #: yo?- v gar z— TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND Jill_ (1% VALUATION n CODE CHECK ❑ CA O in -lOK max S;00 (BLDBONDSJ EDITION :. TCO EXPIRATION / o,= DATE (6 MONTH AX): �® I EE' $ZS6.00 /f110 TOTAL FEE: $ .°�: e6 [1TEANPOCCJ USE CONnnS--TR FLOOR AREA OCC LOAD LEVEL COMMENT APPROVED APPROVED WITH CONDITIONS` Public VTorks ❑APPROVED ❑ APPROVED WITH CONDITIONS- Signature.. .......................... ............................... Signature Date:...................... ❑ APPROVED ❑ APPROVED WITH CONDITIONS' Signature: ..... .......... Date:. OTHER DEPARTMENT 1 AGENCY APPROVALS: Planning Signature:......................... ............................... Date:........................ ❑ APPROVED El APPROVED WITH CONDITIONS' ire Signatur . ... Dater k.1-AP .... APPROVED APPROVED WITH CONDITIONS` Public VTorks ❑APPROVED ❑ APPROVED WITH CONDITIONS- Signature.. .......................... ............................... Signature Date:...................... ❑ APPROVED ❑ APPROVED WITH CONDITIONS' Signature: ..... .......... Date:. *CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and i.n compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non - compliance may result in an enforcement action. Owner Contractor cc�� Sign ature :........� .................. ................ Date:�.9...oj:. I }. Signatur .......... Date:.!. �....` ..... This temporary certificate nsures that all fire protection and life safety systems have een completed, inspected, successfully tested and approved for the specifi r of b ilding specified above to provide a reasonable degree of safety to the occupants from fire and similar emer encies. 2, Buildinq Official:......... . o ..... .....`•;164 .....................Print: ....... .. ..... .. .. fi ...................... . Date:.. `... .. . ... DEPARTMENT ACM-N: After- determination, copies to: 1) applicant, 2) permit file TempOccForm_2013.doc revised 717114 W CUPERTINO TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingecupertino.org 14� 1 x611 y 2O -Ord BP # 3 G 1 G; 3 D° LEVEL VALUATION: $ 9 SITE _ SIT ADDRESS: S 2 5 S�-il Z /L Q .... ... Date: i I. AP15. APPROVED $ OWNER'S NAME: s PHONE #: APPROVED WITH CONDITIONS- Signature: wb V FAX ther: MAIL LNG ADDR S (if diffefen ro site a r s ): -9 1 1�- Signature: .................................................... .... Date:...................... L (' v CONT ACTOR: r L i] C d f-% . TI2 v �— 1 C. PHONE #: FAX #: CONTACT: Pf) (/L Gj t;2 - PHONE #: FAX #: n.1- 2 " TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND T (1 % VALUATION BLDBONDS] CODE •CHECK ❑ CA OF in- 10Kmax $ �000 EDITION: TCO EXPIRATION / 'b 0.`. DATE (6 MONTH AX): Co I E $286.00/mo TOTAL FEE: $ �� [1TEMPOCCJ USE UP CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT V -4 01Y6 5r- Q .... ... Date: i I. AP15. APPROVED $ Public o s ❑ APPROVED APPROVED WITH CONDITIONS- Signature: .......................... ............................... Date:...................... ther: ❑ APPROVED ❑ APPROVED WITH CONDITIONS' OTHER DEPARTMENT / AGENCY APPROVALS: Planninq ❑ APPROVED ❑ APPROVED WITH CONDITIONS` Signature: ....... I ................................................ Date:........................ ire Signature. Q .... ... Date: i I. AP15. APPROVED ❑ APPROVED WITH CONDITIONS` Public o s ❑ APPROVED APPROVED WITH CONDITIONS- Signature: .......................... ............................... Date:...................... ther: ❑ APPROVED ❑ APPROVED WITH CONDITIONS' Signature: .................................................... .... Date:...................... *CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non - compliance may result in an enforcement action. Owner Contractor c� Signature:........ .................. i................. Date: �.9...".!2i-. 5. Sign atur ........ ,� ��r ............. Date: .F �.. ..... This temporary certificate nsures that all fire protection and life safety systems have`t een completed, inspected, successfully tested and approved for the specifi r oft b Iilding specified above to provide a reasonable degree of safety to the occupants from fire and similar emergencies./ d , I _ a 11 1 IBuilding Official...o.`�„Y . 11•�'•`Y"_ ..................... Print: �.L.�L.�{'.....tl.L/.. Date:..?../ ..r ..... I DEPARTMENT A : Afte etermination, copies to: 1) applicant, 2) permit file TempOccForm_2013.doc revised 717114