1508018611,
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19800 VALLCO PKWY
CONTRACTOR: AMERICAN
PERMIT NO: 15080186
TECHNOLOGIES, INC
OWNER'S NAME: CUPERTINO PROPERTY DEVELOP LLC
25000 INDUSTRIAL BLVD
DATE ISSUED: 08/26/2015
OWNER'S PHONE: 4088580065
HAYWARD, CA 94545
PHONE NO: (510)429-5000
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
**ONLY UNITS 353 & 253** WATER DAMAGE REPAIR
I ( i
License Class (3 , C, t*�"ZLic. # S-1
FROM
Va l Z(� /
PREVIOUS WATER LEAK (CEILING DAMAGE ONLY)
Contractor lel t:�h In TELI NU)a.es
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: $27381
performance 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
APN Number: 31620108.19800
Occupancy Type:
permit is issued.
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 F D INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of th
o Clt/A
granting of this permit. Additionally, the applicant understands and will com
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
'
RE -ROOFS:
Signatur Date !X/ t
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 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
Section 3700 of the Labor Code, for the performance of the work for which thisOwner
the Health & Safety Code, Sectio 25505, ;=Date:Z�
or authorized ag t
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
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ^
(408) 777-3228 • FAX (408) 777-3333 • buildinga-cupertino.org I D
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESSrPi v , A t IL /
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APN # -316?-0 / O S . I 1 O 0
OWNERNAME + -E ��
PHONE 44 ? . oo & `
E-MAIL
STREET ADDRESS
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CITY, STATE, ZIP
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FAX
CONTACT NAME W, 12 b ItS
PHONE t, 16
E-MAIL ,
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STREET ADDRESS
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CITY, S AT IP
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ISCONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR MB
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LICENSE NUMBERLI
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BUS. LIC #
COMPANY NAME
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STREET ADORESS2 ^� r n c� •�
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CITY, STATE, ZIP W O
PHONE5(O qZ �O
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
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DESCRIPTION OF WORK
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EXISTING USE PROPOSED USE CONSTR TYPE # STORIES
USE TYPE OCC. SQ.FT. VALUATION (S)
I
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
I DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
[]ATTACH
4 DWELLING UNrrS:
IS A SECOND UNrr ❑ YES
SECOND STORY []YES
BEING ADDED? []NO
ADDITION? N
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE AN ❑ YES
r RECEI V - BY::
- TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOPIE? ❑ NO
p /
By my signature below, I certify to each of the following: I am the property owner o Iz agent to act on the property owner's behal I have read this
application and the information I have pr ided is correct. I h read the Descri n of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu i ons ion. I ze representatives of Cupertino to enter the above-intified pro erty for inspection purposes.
Signature of Applicant/Agent: Date: <i t7 6 d
SUPPLEMETV INFORMATION REQUIRED
PL AN CHECK TITS
ROUTING SLLP
❑ OVER -THE COUNTER
BUILDING PLAN RE IES
_ 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
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SER'ERDISTRICr
submittal of Building Permit application.
❑. ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
h
C-0 A- -
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc )_ Thece fees are haced on the nreliminary information available and are only an estimate. Contact the Dent for addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1'13)
ADDRESS: 19800 VALLCO PKWY
DATE: 08/26/2015
REVIEWED BY: MELISSA
rbfeeh. Permit Fee
APN: 31620108.19800
BP#:
*VALUATION: 1$27,381
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: Commercial Building
Civil / Religious activities
in BQ zone? 0 Yes (F)No
PENTAMATION
PERMIT TYPE: 1 GENCOM
WORK
**ONLY UNITS 353 & 253** WATER DAMAGE REPAIR FROM PREVIOUS WATER LEAK CEILING
SCOPE I
DAMAGE ONLY)
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc )_ Thece fees are haced on the nreliminary information available and are only an estimate. Contact the Dent for addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1'13)
lfech. Plan Check
Plumb. Plan Check
Elec. Plan Check
rbfeeh. Permit Fee
Plumb, Permit 1,ee.
Elec. Permit fee:
Other Afech. Inv-, 07-Ot/ae,
Pbl raft Irslr.
Other Elcc. Insp.El
Suppl. PC Fee: (F) Reg. ® OT
0.0
Insp. l<<.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc )_ Thece fees are haced on the nreliminary information available and are only an estimate. Contact the Dent for addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1'13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes 1G) No
$0.00
1 hours
$143.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: (F) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? ()Yes (D No
$0.00
Suppl. Insp. Fee -.0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$0.00
sic/ministrolive Fee:
E)
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential E)
Building or Structure
Strong Motion Fee: 1BSEISMICO
$7.67
3.0 hrs
$429.00
Inspections
IsTINSP Inspection, Hourly
Bldg; Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$9.67
$572.00
TOTAL FEE:
$581.67
Revised: 07/02/2015