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15040206CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD CUPERTINO CA 95014 SOUTH BAY CONSTRUCTION 1711 DELL AVE OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/03/2015 OWNER'S PHONE: PHONE NO: 408-379-8800 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #336974 Contractor SOUTH BAY CONSTRUCTION Date 02/03/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 1. I have and will maintain a certificate of consent to self -insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F.) Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REV # 1 -ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED 2/3/16 z 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. Sq. Ft Floor Area: Valuation: $2150000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: 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, costs, and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal WITHIN 180 DAYS OF PERMIT ISSUANCE OR Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 02/03/2016 Issued by: MELISSANAMES Date: 02/03/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered inspection. for sale (Sec.7044, Business & Professions Code) z I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 02/03/2016 1 hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z I have and will maintain Worker's Compensation Insurance, as provided for I have read the hazardous materials requirements under Chapter 6.95 of the by Section 3700 of the Labor Code, for the performance of the work for which California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will this permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 02/03/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the ARCHITECT'S DECLARATION Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 02/03/2016 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:, CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD (316 20 112) SB CC INC CAMPBELL, CA 95008 OWNER'S NAME: SAND HILL CONST MANAGEMENT DATE ISSUED: 6/7/2016 OWNER'S PHONE:. 650-344-1500 PHONE NO: (408) 379-5500 LICENSED CONI:RACTORIS DECLARATION BUILDING PERMIT INFO: License Class B Lic. #336M Contractor S B C C INC Date 03/31/2016 —BLDG _ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 1. I have and will maintain a certificate of consent to self-insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F. Compensation, as provided for by Section 3700 of the Labor Code, for the ,,5 performance of the work for which this permit is issued. /I DEF # 5 - TRASH GATE SHOPS & CALCS - ISSUED 6/7/2016 have and will maintain Worker's Compensation Insurance, as provided for by DEF # 4 - ROOF JOIST SHOPS & CALCS.-ISSUED 5/13/2016 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION DEF # 3 - GLAZING SHOPS & CALC'S. ISSUED 3-16-16. 1 certify that I have read this application and state that the above DEFERRED #2 - STRUCTURAL DESIGN OF EXT. SLADDING - information is correct. I agree to comply with all city and county ordinances ISSUED 3/30/16 and state laws relating to building construction, and hereby authorize DEFERRED #1 - BUCKLING-RESTRAINED BRACES - ISSUED 3/1/16 representatives of this city to enter upon the above mentioned property for REVISION #1 - ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED inspection purposes. (We) agree to save indemnify and keep harmless the 2/3/16 City of Cupertino against liabilities, judgments, costs, and expenses which REVISION #2 -REVISE TRASH ENCLOSURE DOOR OPENING - may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point ISSUED 4/20/16 source regulations per the Cupertino Municipal Code, Sect' 9.18. Sq. Ft Floor Area: Valuation: $2150000.00 lgn tune _ 6/7/2016 OWNER-BUILDER DECLARATION APN Number: Occupancy Type: I hereby affirm that I am exempt from the Contractor's License Law for one of the 316 20 112 following two reasons: 1. 1, 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 PERMIT EXPIRES IF WORK IS NOT STARTED sale (Scc.7044, Business & Professions Code) WITHIN 180 DAYS OF PERMIT ISSUANCE OR 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm under penalty of perjury one of the following three declarations: t. I have and will maintain a Certificate of Consent to self-insure for Worker's Issued by: Legacy C(IN 0-4 Compensation, as provided for by Section 3700 of the Labor Code, for the Date: 6/7/2016 aak— performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance, as provided for by RE-ROOFS: Section 3700 of the Labor Code, for the performance of the work for which this All roofs shall be inspected prior to any roofing material being installed. If a roof is permit is issued. installed without first obtaining an inspection, I agree to remove all new materials for a. I certify that in the performance of the work for which this permit is issued, I inspection. 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 Signature of Applicant: exemption, I become subject to the Worker's Compensation provisions of the Date: 6/7/2016 Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is HAZARDOUS MATERIALS DISCLOSURE correct. I agree to comply with all city and county ordinances and state laws I have read the hazardous materials requirements under Chapter 6.95 of the relating to building construction, and hereby authorize representatives of this city California Health & Safety Code, Sections 25505, 25533, and 25534. I will to enter upon the above mentioned property for inspection purposes. (We) agree maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the to save indemnify and keep harmless the City of Cupertino against liabilities, Health & Safety Code, Section 25532(a) should I store or handle hazardous judgments, costs, and expenses which may accrue against said City in material. Additionally, should I use equipment or devices which emit hazardous consequence of the granting of this permit. Additionally, the applicant understands air contaminants as defined by the Bay Area Air Quality Management District I and will comply with all non-point source regulations per the Cupertino Municipal will maintain compliance with the Cupertino Municipal Code, Chanter 9.12 and Code, Section 9.18. the Health & Safetyode, Sections 05, 25533, nd 2 .3 . Signature Date 6177/22 16Ow� or authorized agent: -Date: 6/7/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • build ingCa_cupertino.org lQ� NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION EFERRED ORIGINAL PERMIT # PROJECT ADDRESS PROPOSED USE CONSTRTYPE APN # OWNER NAME L'" . A V� �� s KMIM .PHONE - _ E-MAII, STREET ADDRESS/ ? !� NEW FLOOR CITY, STATE; ZIP L FAX CONTACT NAME AREA AREA _ PHONE NET AREA E-MAIL STREET ADDRESS ` BATHROOM KITCHEN CITY, STATE, ZIP , FAX OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT WONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME t)o� Colo LICENSE NUMBER REMODEL AREA LICENSE TYPE n BUS. LIC # COMPANY NAME � M `a ®n ' ` l • t V � �� EMAIL �� a �/, � FAX /'- GARAGE AREA: ❑ DETACH STREET ADDRESS CITY, STATE, ZIP PHONE L CMTECT/ENG7n,RN C LICENSE NUMBER _ a�, s a��•r izi�i'l'ai1�1t"tt_t�lTl��l STREET ADDRESS�1... r �� a • i"j DESCRIPTIONOF • EXISTING USE PROPOSED USE CONSTRTYPE #STORIES-�e- I ""O EXISTG NEW FLOOR DEMO TOTAL 7 AREA AREA _ AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: ❑ DETACH ❑ ATTACH " ' # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? NO ADDITION? NO / PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OFPLANNER'S NAME: -R-ECEIVEDBY< r'TO A"LVALUATY02 = PLANNING ADPL# ❑ NO PLANNING APPROVAL LETTER' By my signature below, I certify to each of the 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 o Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rela ' g" building co7�Ttrize to enter the above%�(denh d property for;inspection purposes. Signature ofApplicanbAgent: 7��ino Date: I � SUPPLEMENTAL INFORMATION REQUIRED PLANcHECxTYri� New SFD or Multifamily dwellings: Apply for demolition permit for © OVEA TT3E COUNTER ❑ mNG PIA REVIEW existing building(s). Demolition permit is required prior to issuance of building ,Bair permit for new building. ©,=EXPR>•1ss L1 PANNING Y AN Rri rBW � Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L =;STANDARD � PUBLIC WORKS fo_rm if any Hazardous Materials are being used as part of this project. ❑ FIRISDERE'•` _ Copy of Planning Approval Letter or Meeting with Planning prior to _ aaOR ❑ SANITARY sEwx DISTRICT submittal of Building Permit application. , BldgApp_201 1. doe revised 03116/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD (316 20 112) SB C `C INC CAMPBELL, CA 95008 OWNER'S NAME: SAND HILL CONST MANAGEMENT DATE ISSUED: 09/03/2015 OWNER'S PHONE: 650 344 1500 PHONE NO: (408) 379-5500 s LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: I License Class GENERAL BUILDING CONTRACTOR Lic. #336974 Contractor S B C C INC Date: 03/31/2016 — BLDG ELECT _PLUMB I hereby affirm that Y am licensed under the provisions of Chapter 9 (commencing — MECH — RESIDENTIAL —COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty'of perjury one of the following two declarations: MERCANTILE OCCUPANCY (7,1,380 S.F.), INCLUDING 1. I have and will maintain a certificate of consent to self-insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. DEF # 4 - ROOF JOIST SHOPS , � CALCS.-ISSUED 5/13/2016 z. I have and will maintain Worker's Compensation Insurance, as provided for by DEF # 3 - GLAZING SHOPS & CALC'S. ISSUED 3-16-16. Section 3700 of the Labor Code, for the performance of the work for which this DEFERRED #2 - STRUCTURAL DESIGN OF EXT. SLADDING - permit is issued. ISSUED 3/30/16 APPLICANT CERTIFICATION DEFERRED #1 - BUCKLING-RESTRAINED BRACES - ISSUED 3/1/16 1 certify that I have read this application and state that the above REVISION #1 - ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED information is correct. I agree to comply with all city and county ordinances 2/3/16 and state laws relating to building construction, and hereby authorize REVISION #2 - REVISE TRASH ENCLOSURE DOOR OPENING - representatives of this city to enter upon the above mentioned property for ISSUED 4/20!16 inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which **BIN C-2** may accrue against said Cityin consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations ,per the Cupertino Municipal C e Section 9.18. Sq. Ft Floor Area: Valuations $2150000.00 Signature Q Date 5/13/2016 APN Number: Occupancy Type: 316 20 112 i OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: PERMIT EXPIRES IF WORK IS NOT STARTED m. I, as owner of the property, or my employees with wages as their sole WITHIN 180 DAYS OF PERMIT ISSUANCE OR compensation, will do the work, and the structure is not intended or offered for 180 DAYS FROM LAST CALLED INSPECTION. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed i contractors to construct the project (Sec.7044, Business & Professions Code). Issued by: ABBY AYENDE I hereby affirm under penalty of perjury one of the following three declarations: Date: 09/03/2015 !_ 1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the RE ROOFS: performance of the work for which this permit is issued. All roofs shall be inspected prior to any roofing material being installed. If a roof is 2. I have and will maintain Worker's Compensation Insurance, as provided for by installed without first obtaining an inspection, I agree to remove all new materials for Section 3700 of the Labor Code, for the performance of the work for which this inspection. permit is issued. s. I certify that in the performance of the work for which this permit is issued, I Signature of Applicant: shall not employ any person in any manner so as to become subject to the Date: 5/13/201 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the ALL ROOF COVERING$ TO BE CLASS "A" OR BETTER Labor Code, I must forthwith comply with such provisions or this permit shall I be deemed revoked.. HAZARDOUS MATERIALS DISCLOSURE APPLICANT CERTIFICATION I have read the hazardous materials requirements under Chapter 6.95 of the I certify that I have read this application and state that the above information is California Health & Safety Code, Sections 25505, 25533, and 25534. I will correct. 1 agree to comply with all city and county ordinances and state laws maintain compliance with the Cupgrtino Municipal Code, Chapter 9.12 and the relating to building construction, and hereby authorize representatives of this city Health & Safety Code, Section 2$532(a) should I store or handle hazardous to enter upon the above mentioned property for inspection purposes. (We) agree material. Additionally, should I use equipment or devices which emit hazardous to save indemnify and keep harmless the City of Cupertino against liabilities, air contaminants as defined by the Bay Area Air Quality Management District I judgments, costs, and expenses which may accrue against said City in will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and consequence of the granting of this permit. Additionally, the applicant understands the Health & Saf ode, Sections 25505, 25.33, and 2504. and will comply with all non!point source regulations per the Cupertino Municipal Code, Section 9.18. Owner or authorized agent: Date: 5/1=2 1 X Signature Date 5113/2016 CONSTRUC'I'fONLENDINGAGEN I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name *J ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buiidincIO-cupertino.orq nA nr iTrMnXT n , r �, „ .....�. , r41 Main Retail LL3 l nvtalvlN 1I rJ ttlt);ll ORIGINAL PERMIT # 1 0U4ULU0 PROJECT ADDRESS 19499 Stevens Creek Blvd APN# `NAME Sand'Hill Const Management PHONE650-344-1500 nkumar�shcmllc.com ADDRESS ' CITY, STATE, ZIP 2822, Sand Hill Rd Ste 241 Menlo Park 94025 FAX CONTACT NAME Nandy Kumar 650-344-1500 nkumar@shcmllc.com :[PHONE STREETADDRESS 2822 Sand' Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX OWNER ❑ OWNER-BUIIDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCMTECT iO ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Summer Olson -Todd LICENSE NUMBER 336974 LICENSE TYPE B BUS. LIC # 5655 COMPANY NAMESouthBay Construction E-MAILFAX solsontoddgsbci.com STREET ADDRESS 1711 Dell Ave CITY, STATE, Campbell, CA 95608 PH° 408-379-5500 ARCHITECT/ENGINEERNAME Cllff Chan V LICENSE NUMBER BUS. LIC# COMPANYNAME Chang Architecture E-MA1- cliff@changarchitectur;e.co FAX STREET ADDRESS 251 Park Road, #900 CITY, STATE,ZII'Burlingame, 94010 PHONE650-269-4213 DESCRIPTION OF WORK O i i EXISTING USE PROPOSED USE GONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA ,: AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ODETACH ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY OYES BEINGADDED? ONO ADDITION? ❑NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES $ TOTAL PLANNING APPL # ONO PLANNING APPROVAL LETTER EICHI.ER HOME? ❑ NO m I By my signature below, I certify to each of the following: I am the property owner or authorize a 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 v it is accurate. I agree to comply with all applicable local ordinances and state laws relating building contra uthoriz _ repres ves of Cupertino to enter the above -id e ed property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATI N REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for 1 OVER-T11EiCOUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS b PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ED STANDARD ❑. PUBLIC WORKS Form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ MMI)FPT _ Copy of Planning Approval Letter or Meeting with Planning prior to MANOR ❑ SANITARY SEWERDMIUCT submittal of Building Permit application., ❑ ENVIRONMENTAL HEALTH i BIdgApp_2011.doc revised 06121111 G CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD (316 20 112) SB CC INC CAMPBELL, CA 95008 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/03/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'$ DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #336974 Contractor S B C C INC Date 03/31/2016 _BLDG _ELECT _PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING i. I have and will maintain a certificate of consent to self -insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F. Compensation, as provided for by Section 3700 of the Labor Code, for the DEF # 3 - GLAZING SHOPS & CALC'S. ISSUED 3-16-16, performance of the work for which this permit is issued. DEFERRED #2 - STRUCTURAL DESIGN OF EXT. SLADDING - 2. I have and will maintain Worker's Compensation Insurance, as provided for by ISSUED 3/30/16 Section 3700 of the Labor Code, for the performance of the work for which this DEFERRED #1 - BUCKLING -RESTRAINED BRACES - ISSUED 3/1/16 permit is issued, REVISION #1 - ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED APPLICANT CERTIFICATION 2/3/16 1 certify that I have read this application and state that the above REVISION #2 - REVISE TRASH ENCLOSURE DOOR OPENING - information is correct. I agree to comply with all city and county ordinances ISSUED 4/20/16 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for Sq. Ft Floor Area: Valuation: $2150000.00 inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. APN Number: Occupancy Type: Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18, 3'16 20 112 gnature Date 4/20/2016 PERMIT EXPIRES IF WORK IS NOT STARTED OWNER-BUILDERDECLARATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: i. I, as owner of the propert3; or my employees with wages as their sole Issued by: ABBY AYENDE OAA &WX&- compensation, will do the work, and the structure is not intended or offered for Date: 09/03/2015 sale (Sec.7044, Business & Professions Code) z I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm under penalty of perjury one of the following three declarations: installed without first obtaining an inspection, I agree to remove all new materials for 1. I have and will maintain a Certificate of Consent to self -insure for Worker's inspection. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Applicant: 2. I have and will maintain Worker's Compensation Insurance, as provided for by Date: 4/20/2016 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 3. 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 HAZARDOUS MATERIALS DISCLOSURE exemption, I become subject to the Worker's Compensation provisions of the I have read the hazardous materials requirements under Chapter 34. of the California Health &Safety Code, Sections 25533, and I will Labor Code, I must forthwith comply with such provisions or this permit shall Municipal ter 9.1 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 andthe be deemed revoked. Health & Safety Code, Section 25532(a) should I store or handle hazardous APPLICANT CERTIFICATION material. Additionally, should I use equipment or devices which emit hazardous I certify that I have read this application and state that the above information is air contaminants as defined by the Bay Area Air Quality Management District I correct. i agree to comply with all city and county ordinances and state laws will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and relating to building construction, and hereby authorize representatives of this city the Health & Safety C de, Sectio s 5505, 533, and 2 534. to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Owner or authorized agent: - judgments, costs, and expenses which may accrue against said City in Date: 4/20/2016 r" consequence of the granting of this permit. Additionally, the applicant understands CONSTRUCTION LENDING AGENCY and will comply with all non -point source regulations per the Cupertino Municipal I hereby affirm that there is a construction lending agency for the performance Code, Section 9.18. of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Signature Date 4/20/2016 Lender's Address ARCHITECT'S DECLARATION AqAC PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DifiEVVIC104 �$ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 °ft (408) 777-3228 • FAX (408) 777-3333 • buildino(d)cuUertino.orct CUPERTINOt NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 4 PROJECrADDRESSAPN (L f' 0� D P OWNERNAME nn'nS) r� S PHONE( rsr )3 `Lj ` I✓U� E-MAIL 6 J� Ul STREET ADDRESS �ANQ NLL A CITY STATE ZIP FAX m a p o ��o CONTACT NAMEL1 �! C�16�n I PHOt E VJ C�'f0-t`�-1�/�3 ( --MAIL � STREET ADD C STATI ZIP FAX r E3 oxPmR 0. OWNER -BUILDER 01AINTRAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT ' CONTRACTOR NAME T LICENSE NUMBER ( LICENSE TYPE BUS. LIC f COMPANY NAhIE E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNP1,fE mr I LICENSENUMBER Bug. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHONE - DESCRIPTION OF WORK r . { - 'l d 7 ux? IQ EXISTINGUSE PROPOSED USE - - CONSTRTYPE #STORIES I USE TYPE ( OCC. SQ.FT. VALUATION($) EXISTG AREA NEW FLOOR. .p� AREA 11 3 v DEMO TOTAL AREA y NEI' AREA Z! (im. L l 0 y`�-��/� /� S" l ✓ " ✓ % `r 9 2 4- /7O BATHROOM.. REMODEL AREA KIT - - REMODEL REMODEL.AREA REMODEL AREA PORCH AREA DECK AREALT0TALDECYJPOPCHARFA GARAGE AREA: DETACH - - [I ATTACH S A SECOND UNIT El YES SECOND STORY ❑ YES DV�'ELLTNG UA7rSc 'SA" BEINGADDED? ❑NO ADDITION? E] NO ----- I e PRE-APPLICATION ❑YES TF YES, PROVIDE DOPY OF ISTHEBLDGAN ❑YESTOTAL UATION: PLANNINGAPPLR ❑NO PLANNING APPROVAL LETTER EICHLER HOME?By ld�ent my signature below, I certify to each of th o in I roperty owner or authorizto - o _ r�p�rL UWntr'S behalf IFave reau- his V1ork I to comply with local application and the information I have Prot i e is d the Description of and veri Is accurate. agree all applicable ordinances and state laws relating to buildin c nst i a t zedrep entatives'of Cupertino to enter the,'44� �roperty for in purposes. Signature of Applicant/Agent: Dater z r SUPPLEMENTAL INFORMA 0 — =3 _ NTew SFD or Multifamily d«rellings: Apply for e li erm t for T� v existing building(s). Demolition permit is required prix to is ce f building o�x TCOTP.TER s DInGr> Nv�w. �- permit for new building. - PLA?,fiLh�PLA'NrR�EvIE'•w -� 0-1 Commercial Bldgs: Provide a completed Hazardous Materials Disclosure _ sThngRD ruBc�oRzts _ form if any Hazardous Materials are being used as part of this project. - H.4RG,FZREDEP _Copy of Planning Approval Letter or Meeting with Planning prior to oRRE 21-S'nitaitY sRDIs�Ricr submittal of Building Permit application. = - �"� Bldg- pp 2011.doc revised 06/21/11 (/h CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD (316 20 112) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/03/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #336974 Contractor S B C C INC Date 03/31/2016 —BLDG —ELECT PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — — MECH RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 1. I have and will maintain a certificate of consent to self. -insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F. Compensation, as provided for by Section'3700 of the Labor Code, for the " ` DEF # 3 - GLAZING SHOPS & CALC'S. ISSUED 3-16-16. performance of the work for which this permit is issued. a DEFERRED #2 - STRUC'T'URAL DESIGN OF EXT. SLADDING - 2.o I have and will maintain Worker's Compensation Insurance, as provided for by ISSUED 3/30/16 Section 3700 of the Labor Code, for the performance of the work for which this DEFERRED #1 - BUCKLING -RESTRAINED BRACES - ISSUED 3/1/16 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above REV # 1 -ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED 2/3/16 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize Sq. Ft Floor Area: Valuation: $2150000.00 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, costs, and expenses which APN Number: Occupancy Type: may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point 316 20 112 source regulations per the Cupertino Municipal Code, Section 9.18. signature" A e Date 03/30/2016 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER -BUILDER DECLARATION 180 DAYS FROM LAST C LEJEI:WSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by: MELISS 1. L as owner of the property, or my employees with wages as their sole Date: 03/30/2016 compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed RE -ROOFS: contractors to construct the project (Sec.7044, Business & Professions Code). 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 I hereby affirm under penalty of perjury one of the following three declarations: inspection. 1. 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 Signature of Applicant: performance of the work for which this permit is issued. Date: 03/30/2016 2. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER permit is issued. 3. 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 HAZARDOUS MATERIALS DISCLOSURE Worker's Compensation laws of California. If, after making this certificate of I have read the hazardous materials requirements under Chapter 6.95 of the exemption, I become subject to the Worker's Compensation provisions of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Labor Code, I must forthwith comply with such provisions or this permit shall Health & Safety Code, Section 25532(a) should I store or handle hazardous be deemed revoked. material. Additionally, should I use equipment or devices which emit hazardous APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Management District I I certify that I have read this application and state that the above information is will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and correct. i agree to comply with all city and county ordinances and state laws the Health & Safety C e, Sections 2 05, 2553 and 25534. relating to building construction, and hereby authorize representatives of this city 7 to enter upon the above mentioned property for inspection purposes. (We) agree Owner or authorized agent: A \ I + to save indemnify and keep harmless the City of Cupertino against liabilities, I Date: 03/30/2016 \J judgments, costs, and expenses which may accrue against said City in CONSTRUCTION LENDING A EN consequence of the granting of this permit. Additionally, the applicant understands I hereby affirm that there is a construction lending agency for the performance and will comply with all non -point source regulations per the Cupertino Municipal of work's for which this permit is issued (Sec. 3097, Civ C.) Code, Section 9.18. Lender's Name Lender's Address Signature Date 03/30/2016 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Building Depaf•tment City Of Cupertino . 10300 Torre. Avenue ". Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPER 'I O Fax: 408-777-3333 CONTRACTORSUBCONTRACTOR LIST JOB ADDRESS: 19499 Stevens Creek Blvd - Main Retail PERMIT # 15040206 OWNER'S NAME:Sand Hill Management PHONE # _ _ GENERAL CONTRACTOR: South Bay construction _ BUSINESS LICENSE #'5655 ADDR ESS:1711 Dell Ave CITY/ZIPCODi :Campbell, CA 95008 *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 'I -m GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITE/ OF CUPERTINO BUSINESS LICENSE. I arrr not using any subcontractors: -_..,........_..T_..__. Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork X Cement Finishing Noah Concrete 29578-- X Electrical Wong Electric - 20368— X I Excavation Tucker Engineering 34378 Fencing Flooring / Carpeting - Linoleum / Wood X Glass I Glazing Classic Glass 25840-- X I Heating The Trillo Company - 29816.-- 9816.`X X I Insulation Central California Insulation 557 -- Landscaping X Lathing Oliveira Plastering 40153— 0153—X X Masonry Pacific Bay Masonry ` 25509— X Painting / Wallpaper Burdick Painting . 26007 — Paving X Plastering Oliveira Plastering 40153— X Plumbing Fresno Plumbing & Heating 32000-- X Roofing Statewide Roofing , " 23509— Septic Tank ..�. X Sheet Metal The Trillo Company 9816.1X 29816-- X Sheet Rock South Bay Interiors 25499 — X Tile Take It For Granite 26585 — Owner / Contractor Signature 4/27/16 Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 - buildingg3cupertino;org Sam Main Retail ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI [X REVISION / DEFERRED ORIGINAL PERMIT # 15040206 PROJECT ADDRESS 19499 Stevens Creek Blvd APN# OWNER NAME Sand: Hill Const Management PHONE650-344-1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park 94025 VAX CONTACT NAME Kumar PHONE 650-344-1500 E-MAILNandy nkumar(_Wshcmllc.com STREET ADDRESS 2822' Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX IXoWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT '❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Summer Olson -Todd LICENSE NUMBER 336974 LICENSE TYPE B BUS. LIC# 5655 COMPANYNAME South Ba Construction South y E-MAIL solsontodd�sbcl.com FAX STREET ADDRESS 1711. Dell Ave CITY, STATE, ZIP - Campbell, CA 95008 PHONE 408-379-5500 ARCHITECUENGINEER NAME/� I I ff Chan V LICENSE NUMBER BUS. LIC # COMPANY NAME Architecture E-cliff@changarch:ltecture.corTiFAx E-MAILhang STREET ADDRESS 251 Park Road, #900 CITY, STATE, ZIP Burlingame, 94010 PHONE 650-269-4213 DESCRIPTION OF WORK EXISTING USE - -PROPOSED USE - CONSTR. TYPE _. #STORIES USE. TYPE OCC.. SQ.FT'. VALUATION ($) EXISTG NEW FLOOR... - DEMO. .. TOTAL AREA AREA -. AREA NET AREA BATHROOM - KITCHEN.: OTHER. REMODEL AREA : REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑.YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? [:]NO TRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDGAN ❑ YES I D BY: TOTAL PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? []NO �UATIONt By my signature below, I certify to each of the following: I am the property owner or authoriz d agent to act on the property owner's behalf. I e read this application and the infonnatio have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with All applicable local . I autho ' e rep e tati s of Cupertino to enter the above-identifrriettd property for inspection purposes. ordinances and state laws Tela n to building conf1l Applicant/Agent: ` Date: Signature of SUPPLEMENTAL INFORMA—TrON—REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑p EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ` STANDARD ❑ rUBLIC 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 Fl MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.docrevised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE 4 CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • building(cDcupertino.org Main Retail CUPERTINfl F_1ATIIX1/ f'nATQPD T T("rTnAT n ATITIVPM&T I—1 AT TPD ATTnAT/TT lM P-m7mV1M/T)PPPRRPTI 0R1(7IMAT.PPRMTT* 15040206 PROJECT ADDRESS 19499 Stevens Creek Blvd APN# OWNER NAME Sand Hill Const Management PHONE E-MAIL nkumar@shcrniic.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 1 CITY, STATE, ZIP Menlo Park, 94025 FAX CONTACT NAME Nandy Kumar PHONE 650-344-1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 1 CITY, STATE, ZIP Menlo Park, 94025 FAX IRDWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Summer Olson -Todd LICENSE NUMBER 336974 7 LICENSE TYPE B o BUS. LIC# 5655 J COMPANYNAME South Bay Construction E-MAIL solsontodd@sbei.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP :Campbell,. CA 95008 PHONE 408-379-55.00 ARCHITECTIENGINEER NAME Jeff Brink LICENSE NUMBER BUS. LIC# COMPANY NAME DCI. Engineers E-MAIL brink@dci-engineers.c/�om FAX STREET ADDRESS One Post Street, Suit 1050 CITY, STATE, ZIP San Francisco, C: i 94104 PHONE (425) 781-1505 DESCRIPTION OF WORK Structuraldesign of exterior cladding system. Deferred submittal per plans — V1, M t EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. $Q.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL , AREA AREA AREA NET AREA ' BATHROOM KITCHEN - OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DECK AREA TOTALDECK/PORCH AREA GARAGEAREA: DETACH ❑ ATTACH 4 #DWELLING UNITS: ISASECONDUNIT ❑YES SECONDSTORY [YES BEING ADDED? []NO I ADDITION? []NO PRE=APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN [IYES 1 TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER. EICHLER HOME? ❑ By my signature below, I certify to each of the following: I am the property owner or authorized a o e property owner s bahal£ 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 rela ' g t building construc Ao I authorize mpresentativM of , pertmo to enter the above-identi edp rTei#y for inspection purposes. Signature of Applicant/Agent: '<� Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE. ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for 0 OVER-7TW-COUNTER(� -BUILDINGPLANREtIEW existing building(s). Demolition permit is requiredprior to issuance of building permit for new building. n EXPRESS Q .P]LANNINGrLANREVIEjt= Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD Cl PUBLIC WORKS _ form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FfRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to �1 MAIOR ❑ SANITARY EtiVERDIS TIUC'T submittal of Building Permit application. Q-ENVIRUIvhIEisTI"AI<HEALTH . B1dgAyp_2011.doc revised 06121111 BUILDING 19499 OWNER'S CITY OF CUPERTINO BUILDING PERMIT ADDRESS: CONTRACTOR: PERMIT NO: 15040206 STEVENS CREEK BLVD (316 20 112) SB C C INC CAMPBELL, CA 95008 NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/03/2015 OWNER'S PHONE. 408-725-1955 PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lie, #336974 BLDG ELECT PLUMB _ _ Contractor S B C C. INC Date 03131/2016 MECH RESIDENTIAL _ COMMERCIAL 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 JOB DESCRIPTION: license is in full force and effect. MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING i. I have and will maintain a certificate of consent to self-insure for Worker's RESTROOMS..& TRASH ENCLOSi7R,E (1,177`S.F.� Compensation, as provided for by Section 3700 of the Labor Code, for the DEF.#3-- GLAZING_ SHOPS &;CALLS: ISSUEDI-1:6-16. performance of the work for which this permit is issued. 2. 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. Sq. Ft Floor Area: Valuation: $2150000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 316 20 112 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 Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED of may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the Cupertino Municipal Code, Section 9.18. _S gnature t Date 03-16-16 Issued by: Sean Hatch Date: 03-16-16 OWNER BUILDER DECLARATION RF-ROOFS;. I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for i. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 03-16-1-6 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued.I have read the hazardous materials requirements under Chapter 6.95 of the 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Health & Safety Code, Sections 25505, 25533, and 25534. I will California Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, laws of California. If, after making this certificate ofp p p Chapter 9.12 and Worker's Compensation exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety de, Sections 25505, 2 33 and 25 4. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. / Owner or authorized agent: H ` Date: 03-16-16 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. i agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 03-16-1f! Professional CONSTRUCTION PERMIT APPLICATIC COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING Dl 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 buildinq@cupertino.org F] NEW CONSTRUCTION Q ADDITION FJ ALTERATION/T1 [X REVISION /DEFERRED ORIGINAL PERMIT # 15040206 PROJECT ADDRESS 19499 Stevens Creek Blvd APN# OWNER NAME Sand Hill Const Management PHONE." - 5` E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY STATEZIP , Menlo Park 94025 FAX CONTACT NAME ` _ Nand Kumar PHONE 650-344-1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX TOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑. CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Summer Olson -Todd LICENSE NUMBER ^36^74 3 y LICENSE TYPE B BUS. LIC# 5655 COMPANY NAME South Ba Construction Bay E-MAIL solsontodd@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408-379-5500 ARCHITECT/ENGINEER NAME Cliff Chan LICENSE NUMBER, BUS. LIC# COMPANY NAME Chang Architecture E-MAIL cliff@changarchitecture.co FAX STREET ADDRESS 251 Park Road, #900 CITY, STATE, ZIP Burlin ame 94010 PHONE DESCRIPTION OF WORK C p U Y EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES. USE TYPE OCC.. SQ.FT, VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECONDSTORY []YES BEING ADDED? ❑NO ADDITION? NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF 1S THE BLDG AN YES - N: PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ONO By my signature below, I certify to each of the 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 tnuilding constructio authorize eprose . s of Cupertino to enter the above -identified property for inspection purposes. Date: Signature of Applicant/Agent: C SUPPLEMENTAL INFORMATIO REQUIRED PLAN CITEGK f] PE _^, G SLIP . ,tliTLI.. u n oxexcourT>ER ❑' BuILbrNG PLArivY New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building n,�= permit for new building. :0 EXPRESS - �'„ L'LAJviVI<NG PT+AI�`'iiEVIEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure srArtnnRD YUBLTCwORKS _ form if any Hazardous Materials are being used as part of this project. p LARGE CaII:J IIrT Copy of Planning Approval Letter or Meeting with Planning prior to -0 MA1oR ~ (]A[TpRv s> wEinls�rltlCT _ submittal of Building Permit application. 'a ` iti�vt Ro E ai HFALTW. BldgApp_2011.docrevised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD (316 20 112) (S B CCINC) CAMPBELL, CA 95008 OWNER'S NAME: Main Street Cupertino Aggregator DATE ISSUED: 09/03/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: SOUTHBAY CONSTRUCTION LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #a3L974 Contractor ( S B C C INC ) Date 03/01/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 1. 1 have and will maintain a certificate of consent to self-insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F.) Compensation; as provided for by Section 3700 of the Labor Code, for the DEFERRED #2 - STRUCTURAL DESIGN OF EXT. SLADDING / performance of the work for which this permit is issued. DEFERRED #1 - BUCKLING-RESTRAINED BRACES - ISSUED 3/1/16 I have and will maintain Worker's Compensation Insurance, as provided for **IOCATION B5.5** f (f \ by Section 3700 of the Labor Code, for the performance of the work for which —�' this permit is issued. REV # 1 - ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED 2/3/16 APPLICANT CERTIFICATION I certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $2150000.00 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 anter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep APN Number: Occupancy Type: harmless the City of Cupertino against liabilities, judgments, costs, and 316 20 112 expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal PERMIT EXPIRES IF WORK IS NOT STARTED Code,. Sejn9.118.'WITHIN 180 DAYS OF PERMIT ISSUANCE OR 0Date 180 DAYS FROM LAST CSPECTION. Signature��S4 03/01/2016 � OWNER-BUILDER DECLARATION Issued 0 MELISSA fg .Date: 03/3/01/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, T, as owner of the property, or my employees with wages as their sole RE-ROOFS: compensation, will do the work, and the structure is not intended or offered All roofs shall be inspected prior to any roofing material being installed. If a roof is for sale (Sec.7044, Business &Professions Code) installed without first obtaining an inspection, I agree to remove all new materials for 2. I, as owner of the property, am exclusively contracting with licensed inspection. contractors to construct the project(Sec.7044, Business & Professions Code). Signature of Applicant: I hereby affirm under penalty of perjury one of the following three declarations: Date:. 03/01/2016, 1. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER performance of the work for which this permit is issued. 2. 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 HAZARDOUS MATERIALS DISCLOSURE this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 3. I certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous Worker's Compensation laws of California. If, after making this certificate of material. Additionally, should I use equipment or devices which emit hazardous exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I Labor Code, I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino 1YIunfci al Code, Chapter 9.12 and be deemed revolted. the Health & Safety Code, SectikwN 255051 33 a5q 2#34. APPLICANT CERTIFICATION . -. I certify that I have read this application and state that the above information is Owner or authorized agent_:-1' correct. I agree to comply with all city and county ordinances and state laws Date: 03/01/2016 relating to building construction, and hereby authorize representatives of this city CONSTRUCTION LENDING AGENCY to enter upon the above mentioned property for inspection purposes. (We) agree I hereby affirm that there is a construction lending agency for the performance to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.) judgments, costs, and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Lender's Address Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 03/01/2016 Licensed CONSTRUCTION. PERMIT APPLICATION 6F*J COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingCa.cupertino.org Mahn Retail INFW('()NCTRITCTION I I AT)TITTTC)N I I .AT.TFRATT(17,J/TT FM RFVTCTnV/TIFFFRRFTI nRTC;TNAT.PFRMTT#. 15040206 PROJECT ADDRESS 19499 Stevens Creek Blvd APN# Q r OWNER NAME Sand Hill Const Management PHONE E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY' STATE°ZIP Menlo Park 94025 FAX CONTACT NAME Nandy Kumar PHONE 650-344-1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX DOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT '❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Bummer Olson -Todd LICENSE NUMBER 336974 3 LICENSE TYPE B BUS. LIC# 5655 COMPANY NAME South Bay Construction E-MAIL solsontodd@gbcl.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408-379-5500 ARCHITECT/ENGINEER NAME Cliff Chang LICENSE NUMBER BUS. LIC # COMPANY" Chang Architecture. E-MAIL cliff@changarchtecture.co FAX STREET ADDRESS 251 Park Road, #900 CITY, STATE, ZIP Burlingame, 94010 PHONE DESCRIPTION OF WORK \ ` S - P Lffl_ EXISTING USE -PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG - NEW FLOOR DEMO - TOTAL AREA AREA AREA. NET AREA - -- BATHROOM .:...KITCHEN .. ,� .:OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA. TOTAL DECK/PORCH AREA GARAGE AREA: DETACH - .:ATTACH - - # DWELLING UNITS: IS A SECOND UNIT [:]YES SECOND STORY [:]YES BEING ADDED? []NO ADDITION? ONO PRE -APPLICATION [:] YES IF YES, PROVIDE COPY OF IS: THE BLDG AN ❑ YES RECEIVED BY; TOTA L VALUATION: PLANNING APPL # rl NO PLANNING APPROVAL LETTER EICHLER HOME? NO By my signature below, I certify to each of the 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 relaf to building co ct on. I a thorize rep sen tives of Cupertino to enter the�a7bo e--i�d tipfied property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ 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 ❑ PUBJJC WORKS _ form if any Hazardous Materials are being used as part of this project. El LARGE ❑ , FME DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO -UUV T`i C9r11V4 A rrnR — RTTTT .D1Nf DIVT4ION s ADDRESS: 19499 Stevens Creek Blvd DATE: 02/05/2016 REVIEWED BY: PAUL AFN: 316 20 112 BP#: *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: _ PENTAMATION PERMIT TYPE: 1 GENCOM WORK DEFFERED #1 - BUCKLING -RESTRAINED BRACES SCOPE hrs '1i ch, t r s x..?. NOTE. This estimate does not Other Ahw,,b 11,41wix Imp, fees due to other Departments (i.e. Planning, i3rJt#>> I 11�4SIJ, u orks, Fire, Sanitary Sewer District, School - — .. , 1 - ,_.- n - --- District, etc.. mese ees are oasea urt trio reurr-r— FEE ITEMS fFee Resolution 11-033F,ff. 7/1/13) �.� �,r��wr. •� �.w•... FEE w QTY/FEE - - MISC ITEMS Plan Check Fee: $0.00 LL -j $286.00 Deferred Submittal 1DEFSUBM Suppl. PC Fee: Q Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cof �°Practio oto{{ drmnist rall1V 'A"CC: Work Without Permit? 0 Yes (j) No $0.00 Advanced Plainin Fee: $0,00 Select a Non -Residential Building or Structure . - 0 - I' Fees: {F`<J: x.� g�f�x'tir P:'t,�f �ti�l �#✓I s' ees. Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBT©YACs::. r7 $0.00 �.y $286.00,TQTAL:F+EE: $286.00 RCVIJCU. V UV uw iv CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD CUPERTINO CA 95014 SOUTH BAY CONSTRUCTION 1711 DELLAVE OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED:. 09/03/2015 OWNER'S PHONE: PHONE NO: 408-379-8800 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #336974 Contractor SOUTH BAY CONSTRUCTION Date 02/03/2016 _BLDG _ELECT _ PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 1. I have and will maintain a certificate of consent to self -insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F.) Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REV # 1 -ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED 2/3/16 i 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. APPLICANT CERTIFICATION Sq. Ft Floor Area: Valuation: $2150000.00 t certify that I have read this application and state that the above APN Number: Occupancy Type: 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, costs, and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations per the Cupertino Municipal Code, Se 180 DAYS FROM' CALL SPECTION. �,,,on,9.118. Signature ate 42/03/2016 Issued by: MELISSA NAME Date: 02/03/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons' All roofs shall be inspected prior to any roofing material being installed. If a roof is 1.. I, as owner of the property, or my employees with wages as their sole installed without. first obtaining an inspection,. I agree to remove all new materials for compensation, will do the work, and the structure isnot intended or offered inspection. for sale (See.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 02/03/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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 performance of the work for which this permit is issued.. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for I have read the hazardous materials requirements under Chapter 6.95 of the by Section 3700 of the Labor Code, for the performance of the work for which California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safetyode, Sections 05, 255 ,and 25533. Labor Code,, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 02/03/2016 I certify that I have read this application and state that the above information is city county ordinances and state laws CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all and relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the ARCHITECT'S DECLATION Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date 02/03/2016 Licensed Professional CONSTRUCTION ION PERMIT APPLICATION COMK4UNI IY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTtNO, (408) 777-3228 • FAX (408) 777-3333 - building o(�.cupeiLino.org ❑ Ngg pEW CONSTRUCTION ❑ ADDTTiON . ❑ ALTERATION / TI REVISION / DEFERRED ORIGATAT_ PT;R MTT� li h. A L4f't `7 0 L PROJECTADDRESS G APN n s� / J �y �j OWNER NAS C 1 . '� (�(\S Ji. P ?HONE E tai �` v 06 k 14 ff STREET ADDRESS Z c' (' 1 �J �l IP14 I CRY, STATE, ZIP $t� I FAX +{i I� L4 0� CONTACT ACT N 4UE r I PE "ONEE L j r I v� �7 jl I E-MAIL l/� �j(lrc STREET ADDRESS Z C Z1 e, �n CRY, STATE, ZIP FAX I❑ O%�-T R. ❑, OWNER -BUILDER ❑ OWNERACENi ❑CONTRACTOR ❑ COhTdACTORAGEhT ❑ ARC= --CT ❑ ENGLNi'zR ❑ DEVELOPER ❑ TENANT , - LICENSENT011BER LICENSE TYPE CONTRACTOR NAME ' s0 � CM I BUS. LIC m COMPANY NAME E-MAIL I FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCH TECT(ENGINEER NAtdE LICENSENUMEER BUTS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CRY, STATE; ZIP I PHOI1IE DESCRIPTION OF WORK �j` o EXISTL'GUSE I PROPOSED.USE Ici E ?STORLFS (\ USE I TYPE I OCC. SQ.FT. I VALUATION (S) F X2STG AREA h'EW FLOOR I AREA Z I� DEMO I AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHEt REMODEL AREA - PORCH AREA DECKAREA TOTAL DECK/PORCH 7GAR.AGE AREA: DETACH ❑ ATTACH n DWELLING UNITS: I5 A SECOND UNIT ❑ YES BE'G ADDED? ONO SECOND STORY ❑YES ADDrrION? ❑NO PREE-APPLICATION ❑ YES IF ITS, PROVIDE COPY OF PLANNINGADPLm 0 N PLANNTLNGAPPROVAL LETTER IS THE BLDG AN ❑ I EICHLERHOME. TOTAL VALUATION: By my sienature below, I cerci y to each of e fNO wine: I a p eI ty o� mer or authorized Qent to the grope. oumer's behalf. I have read this application and the information I have prov ded or, e e end t Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build'( const ti I th rize ep sentatives'of Cupertino to enter the above-ident red pro ery for inspection purposes. Signature of Applicant/Aeent: Date: V SUPPLEIl4ENTAL MT ORl�aTIO QUI Mew SFD or llQultifamily dwellings: Apply for oli on pe it for existing building s). Demolition permit is required p o to is_ ce of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure for( if any Hazardous blaterials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to47oR=sA1.%iYsERDlsrurcr submittal of Building Permit application ❑ O«R SH�COU�TER� _ - >rsEss =� i� cSL�DARD r � BIIII.DL�GPL4NREVI£4Y PL4"�I�ZZGEL4Tv RAE; PUELTGwoRxs - __ - � FiFiE�EPT L�7 L�RGIt: �— - � _�- �-'� - —� - E1a'Y:3RO.ii'MEI�Tr4LEJ;AlTA -_ Bldgtlpp_20I L do revised 06121/11 vA I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 19499 STEVENS CREEK BLVD I CONSTRUCTION, OR: SOUTH BAY I PERMIT NO: 15040206 I OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 11711 DELL AVE I DATE ISSUED: 09/03/2015 1 OWNER'S PHONE: 6503441500 1 CAMPBELL, CA 95008 I PHONE NO: (408)379-5500 I LICENSED CONTRACTOR'S DECLARATTION License Class_ Lic. #_ S 3 1. L ` A. Contractor 0oZt4 i7gv & k&s. j Date \ 3 � L , 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: t. 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 ormance of the work for which this permit is issued. e 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. 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the lic t understands and will comply with all non -point s u=reis pe a ert' o Municipal pCo , S tion 9.18. Signature Date 1 3 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 1, 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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 performance of the work for which this permit is issued. 2. 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. s. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING RESTROOMS & TRASH ENCLOSURE (1,177 S.F.) Sq. Ft Floor Area: Valuation: $2150000 APN Number: 31620085.19499 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR ;180DAYS NSPECTION. Y: Date: 3 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. Signature of Appl Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sectio 25505, 25533, and 25534. n or z g t: A�/3` (i(/ Date: IF J CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional A� �l CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(I�ou ertino or C'-�U P E RT I N O � Eg ( I I \TRW C--0N.RTRT IC'TT01J F-1 e r�r 111T I7 . T ren �A I�1 D �O �"kO� o PROJECT ADDRESS g irlAPN # l' 1 CJ 12_ OWNER NAME C i PHONE��5r03 'A- E-MAIL '�ob STREET ADDRESS ? �R Z �� 1� G -A f1 FAX CITY^^ \ � CONTACT NAME (' t1(• (� C�Gtfl �/ PHONEa l�CI 66 � v�IJ�_ItJ�3 E-MAII 4, �I, STREET AD SS CTT STAT) ZIP � FAX r Lloo 13 OWNER ❑. OWNER -BUILDER OWNER AGENT -1 CONTRACTOR ❑ CONTIRACTOR AGENT ARCHITECT 1-1ENGINEEREl DEVELOPER ❑ TENANT CONTRACTOR NAME 12 LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGIA'EER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK L uj _ I 16 A / t' r ` �'J� EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. I SQ.FT. VALUATION ($) EXISTGNEW AREA — FLOOR AREA ZtQ V y O DEMO AREA TOTAL' NET AREA -7 j :Zl 1 `I V" l/ -7--1 �4 BATHROOM KITCHEN OTHERL REMODEL AREA REMODEL AREA REMODEL AREA � �►- 5-L I t fi PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LJDETACH ❑ ATTACH I 4 DN,TLLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? [3NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER -"`� ❑ IVEI)_ TOTAL VALUATION: EICHLER HOME? `$ IS THE BLDG ANYES Ell- Bymy signature below, I certify to each of th owinOW, operty owner or authorized agent to o roperty owner's behalf. I have read this application and the information I have provi ed is ITe the Description of Work and veri Is accurate. I agree to comply with all applicable local ordinances and state lays relating to buildin const ti epresentatives'of Cupertino to enter the abo e identi led property for inspection purposes. Signature ofApplicant/Agent:Date: I— SUPPLEMENTAL ]N`FORMATIO Q RE Q �P.Iv1N CHECK TY�E� },� � � t� •: '"�..�e�:�20UTII�G SLIP Q -OV -.-.T 3 =Yxs New SFD or Multifamilydwelling A 1 for b PP Y� e551 molit n ermit for existing building(s). Demolition permit is required permit for new building. prior to is ce of building a 4?P� BUIIDINGPL Bldgs: Provide Hazardous Materials Disclosure LIST �D _Commercial a completed Pusp form if any Hazardous Materials are being used as part of this project.* _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. a� .. € Bld,-App_2011. do c revised 06/21/11 IM, CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 19499 STEVENS CREEK BLVD DATE: 04/28/2015 REVIEWED BY: MELISSA PC FEE ID APN: 316 20 112 BP#: "VALUATION: 1$2,150,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY Commercial BuildingCivil USE: / Religious activities in BQ zone? 0 Yes (F) No PENTAMATION 1 SHELLBLDG PERMIT TYPE: WORK MAIN STREET - CONSTRUCT N SHELL FOR FUTURE MERCANTILE OCCUPANCY (21,380 S.F. SCOPE INCLUDING RESTROOMS & TRASH ENCLOSURE (1,177 S.F.) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID Shell Bldgs II-B,111-B,IV,V-B 21,380 $11,148.66 10SPLNCK $15,566.22 1OSINSP S-1 (Moderate -Hazard) II-B,111-B,IV,V-B 1,177 $6,459.42 1SIPLNCK $1,437.64 ISIINSP PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $66,092.01 .1cltninistraiive F,,e: 0 Work Without Permit? O Yes Q No $0.00 TOTALS: 22,557 $17,608.08 TrCn;rl 1�nrtrrntsrutxtion Iecs. $17,003.86 Strong Motion Fee: 1BSEISM1CO NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 E f' 711113) r; at. 1'iun ('r;rek Pltuuh. Plotj ('herd: Elec, Plan Check sJtr�h. Pe; erra l cc- Plumb. Permit Fee: le, c. Pert;iit Fee: )1!2, 1!. !rt>t, Other Plumb lash. Other Elec. Ann. i,rc r 1, Sp 1 ,,: Phtruh, hrx)z Fce: 17ec, Imh 1°ec NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 E f' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $17,608.08 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (j) Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $17,003.86 Suppl. Insp. Fee.e Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $66,092.01 .1cltninistraiive F,,e: 0 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fee. IPLLONGC $6,541.53 Select a Non -Residential 0 Building or Structure A TrCn;rl 1�nrtrrntsrutxtion Iecs. Strong Motion Fee: 1BSEISM1CO $602.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $86.00 SUBTOTALS:$107,933.48 $0.00 TOTAL FEE: $107,933.48 Revised: 04/01/2015 OFFICE Copy STATEMENT OF SPECIAL INSPECTIONS, 2893 GBc COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E,, C,B..O., BUILDING OFFICiAL Ct1p I TIIWCy 10300 TORRE AVENUE - CUPERTINO, GA 96014-3255 (408) 777-3228 • FAX (408) 777-3333 • buiidin cuxree�tino.t�rg Owner .,,,.QA1JV..n.tI1.�QU-5,1.J.V1a(Ii-:Jgi'i.%11' ...,...... ..... . Contrsator...5t3uth Bay GonslruCttort - 2822 Sand Hll1 Rd St 2# Address 1711 C1E.l Ciiylst................Menl.O,.P.A6494A2a ..Phan§SQ:34a.15Q4 citylst Campbell CA ...............zip ... .Phone.. `108 379 b500 Appiicant...,S.Quth,.Islay,,CDD.istructinri................................................... Engineer/Architect..P.Pl.�Pai!!"r€.. Address R.I.J..Dell-Avatim.................. .... too Post Street, su�ie 1050 ....................... Address .. ..... , .. CitylSt...Campbe11... ............Zip..... 9j(jOB......... PhO40'a-379.550Q CitylSt SanFrancls�rr!?t A ......,.,..,Zip. ?.l' $,.... Phone r4i5j 781 1545 PROJECT bESCRIPTiON- M This "STATEMENT OF SPECIAL INSPECTIONS" Is submitted In fulfillment of the requirements of C8C Sections 1704 and 1705. This form is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAONC) mode statement of Special Inspections. Also, included with this form Is the following: Q "LIST OF SPECIAL INSPECTION AGENCiES (page 2). A list of testing agencies and other special inspectors that will be retained to conduct the tests and inspections for this project Q "SCHEDULE OF SPECIAL INSPECTION" (page 3 -- 6). The Schedule of Special Inspections summarizes the Special Inspections and tests required. Special Inspectors will refer to the approved plans and specifications for detailed special Inspection requirements. Any additional tests and Inspections required by the approved pians and specifications shall also be performed. Special inspections and Testing will be perforated In accordance with the approved pians and specifications, this statement and CBG Sections 1704, 1745, 1706,1707, and 1708. Interim reports will be submitted to the Building Official and the Registered Design Professional in Responsible Charge In accordance with CBC Section 1744.1,2, A Final Report of Special Inspections documenting required Special inspections, testing and correction of any discrepancies noted in the inspections shalt be submitted prior to issuance of a Certificate of Use and Occupancy (Section 1704.1.2). The Final Report will document. Required special Inspections, Correction of discrepancies noted in inspections. The Owner recognizes his or her obligation to ensure that the construction complies with the approved permit documents and to implement this program of special inspections, In partial fulfillment of these obligations, the Owner will retain and directly pay for the Special Inspections as required in CRC Section 1704. 1. This pian has been developed with the understanding that the Building Official will: Review and approve the qualifications of the Special Inspectors who will perform the inspections. i Monitor special Inspection activities on the Job site to assure that the Special inspectors are qualified and are Performing their duties as called for in this :Statement of Special Inspection. • Review submitted inspection reports, Perform Inspections as required by the local building coda. S�iecrrrlesl�e.[ariarl nrnt 1U11.rinr res:%scut ()910&12 LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF SPECIAL INSPECTORS: Each special inspection agency, testing facility, and special inspector shall be recognized by the Building Official prior to performing any duties. Special Inspection agency's listed on this form must be pre -approved and listed on Cupertino's approved Special Inspector's list. Special inspectors shall carry approved identification when performing the functions of a special inspector. Identification cards shall follow the criteria set by the California Council of Testing and Inspection Agencies. No personnel changes shall be made without first obtaining the approval of the Building Official. Any unauthorized personnel changes may result in a "Stop Work Order" and possible permit revocation. To be pre- approved by the City of Cupertino, refer to the SPECIAL INSPECTION CRITERIA handout. Please allow two weeks to complete the application process. The followinq are the testing and special in-ninpi-tine nnannice fhOf XAAH k. -f-;. A f- A-4 &--4- 11 agencies speeded on this form must be pre -approved, and listed on the City of Cupertino's Approved Special Inspector's List. SEISMIC REQUIREMENTS (Section 1705.3.6)\ Description of seismic -force -resisting system and designateO seismic systems subject to special inspections as per Section 1705.3: N/A The extent of the seismic -force -resisting sysApm is ,e _Opfinod in more detail in the p construction documents. P@ppription of mein wind -force -resisting system and -designated wind resistingcomponents subject to special al ins apti ns in --goac rdonp-a with Section -1705-42 N/A The extent of the main w1nd,Aqrqerrepj§t1ng system and wind resistingqqrripq;iqn defined construction oppyrripritp. # 1- 0 fi in more detail in the co SPe4q1?;sPec#4?Y;FQrm_201Zdoc revised 09106112 EXPERTISE FIRM / INSPECTOR INFORMATION 1. Special Inspection (except for geotechnical) F 1 r m.CO. K -M -L ..D. T M .... LAW ........... Addr... ZOD-1 W -C &A X. :MW... City, ... .................... .. ....................................... State ..... ... Tplephone.T5... 11.:AOD ......... Fax.., .......... ......... ......... Email. 2. Material Testing Firm... .Nl............ ......................... Addr ................... city.................................... .................................................................. State ........... ......... Zip ...... k ............ Telephone.................. \, ................,Fax,.. ......................................... Email ................... \ .................................. 3. Geotechnical Inspections Firm ..................................................................... Addr ................................ City............................................................................. ...... *Email........... State ....................... Zip ....................... Telephone............................ ......... Fax... ......................................... I .................................................... 4. Other: Firm ..................................................................... Addr ................................ City....................................................................................................... ... State ....................... Zip ...................... Telephone............ ; ......................... Fax.... ......... ......... ......... Email ' ........................................................ 11 agencies speeded on this form must be pre -approved, and listed on the City of Cupertino's Approved Special Inspector's List. SEISMIC REQUIREMENTS (Section 1705.3.6)\ Description of seismic -force -resisting system and designateO seismic systems subject to special inspections as per Section 1705.3: N/A The extent of the seismic -force -resisting sysApm is ,e _Opfinod in more detail in the p construction documents. P@ppription of mein wind -force -resisting system and -designated wind resistingcomponents subject to special al ins apti ns in --goac rdonp-a with Section -1705-42 N/A The extent of the main w1nd,Aqrqerrepj§t1ng system and wind resistingqqrripq;iqn defined construction oppyrripritp. # 1- 0 fi in more detail in the co SPe4q1?;sPec#4?Y;FQrm_201Zdoc revised 09106112 U0 PROJECT DESCRIPTION; Notation Used in Table: Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and/or contract documents should clarify. Box entries: X Is placed in the appropriate column to denote either "C" continuous or "P" periodic inspections. --- Denotes an activity that is either a one-time activity or one whose frequency is defined in some other manner.. Additional detail regarding inspections and tests are provided in the Droiect specifications or nntps nn the r9rnwinnc V VERIFICATION AND INSPECTION C P REFERENCED IEC REFERENCE. STANDARD INSPECTION OF FABRICATORS 1. 0 Inspect fabricator's fabrication and quality control I I I ( 1704.3 procedures. --- INSPECTION OF STEEL 1. Material verification of high-strength bolts, nuts and washers. 0 Identification marking to conform to ASTM stds RISC 360, specified in the approved construction documents. -_- X Section AM and applicable ASTM material standards 0 Inspect fabricator's fabrication and quality control procedures. X 2. Inspection of high-strength bolting: 0 Snug -tight joints. ®v_ X 0 Pretensioned and slip -critical joints using turn -of -nut with matchmarking, twist -off bolt or direct tension --- X AISC 360, indicator methods of installation. Section M2.5 1704.3.3 Pretensioned and slip -critical joints using turn -of -nut without matchmarking or calibrated wrench methods X --- of installation. 3. Material verification of structural steel and cold -formed steel deck. h For structural steel, identification markings to conform_ - - X AISC 360, to AISC 360. Section M2.5 For other steel, identification markings to conform to ASTM standards specified in the approved `-- X Applicable ASTM construction documents. material standards Manufacturer's certified test reports. _-_ X SpecialnspectionForm 2012.doc revived 09/06/12 VERIFICATION AND INSPECTION 7 C P REFERENCED FSTANDARD IBC REFERENCE 4. Material verification of weld filler materials: Identification marking to conform to AWS specification in the approved construction documents. --- X ASC 360, Section A3.5 and applicable AWS A5 documents 1704.3 ® Manufacturer's certificate of compliance required. --- X --- --- 5. Inspection of welding: a. Structural steel and cold -formed steel deck: ❑ Complete and partial joint penetration groove welds. X --- AWS D1.1 1704.3.1 Multipass fillet welds. X --- • Single -pass fillet welds > 5/16" X --- ❑ Plug and slot welds. X -.- ❑ Single -pass fillet welds <= 5/16" --- X ❑ Floor and roof deck welds. --- X AWS D1.3 b. Reinforcing steel: ❑ Verification of weldability of reinforcing steel other than ASTM A 706. --- X AWS DIA ACI 318: Section 3CI --- ❑ Reinforcing steel resisting flexural and axial forces in intermediate and special moment frames, and boundary elements of special structural walls of concrete and shear reinforcement. X Shear reinforcement. X --- Other reinforcing steel. --- X 6. Inspection of steel frame joints details for compliance: El Details such as bracing and stiffening. --- X --- 1704.3.2 ❑ Member locations. --- X ❑ Application of joint details at each connection. --- X VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE INSPECTION OF WELDING 1. ❑ Welded studs when used for structural diaphragms. --- X --- 1704.3 2. ❑ Welding of cold -formed steel framing members. --- X r3. ❑ Welding of stairs and railing systems. --- X SpecialnspectionForm 2012.doc revised 09106112 VERIFICATION AND INSPECTION C I P REFERENCED IBC STANDARD REFERENCE INSPECTION': OF CONCRETE 1. ❑ Inspection of reinforcing steel, including prestressing tendons and placement. --- X ACI 318:3.5,7.1-7.7 1913,4 2, ® Inspection of reinforcing steel welding in accordance AWS D1.4 ACI 318: with Table 1704.3 Item 5b.3.5.2 --- --- 3. ❑ Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable ACI 318: 8.1.3, loads have been increased or where strength design X --- 21.2 .8 1911.5, 1912.1 is used. 4. ❑ Inspection of anchors installed in hardened concrete. --- X ACI 318: 1912.1- 5. ❑ Verifying use of required design mix. 1904.2.2,1913.2, --- X ACI 318: 1913.3 6. ❑ At time fresh concrete is sampled to fabricate ASTM C 172 specimens for strength tests, perform slump and air content tests and determine the temperature of the X --- ASTM C 31 1913.10 concrete. ACI 318: 5.6, 5.8 7. ❑ Inspection of concrete and shotcrete placement for X ___ ACI 318: 5:9, 5.10 1913.6, 1913.7, proper application techniques. 1913.8 8. ❑ Inspection for maintenance of specified curing temperature and techniques. - - X ACI 318: 5,11-5.13 1913.9 9. Inspection of prestressed concrete: 13 Application of prestressing forces. X --- ACI 318: 18.20 ❑ Grouting of bonded prestressing tendons in the --- seismic force -resisting system. X --- ACI 318:18.18.4 10. ❑ Erection of precast concrete members. --- X ACI 318: Ch. 16 --- 11. ❑ Verification of in-situ concrete strength, prior to stressing of tendons in posttensioned concrete and prior to removal of shores and forms from beams and --- X ACI 318: 6.2 --- structural slabs. 12. ❑ Inspect formwork for shape, location, and dimensions of the concrete member being formed. --- X ACI 318: 6.6.1 ""- 13. ❑ Bolts Installed in Existing Masonry or Concrete ❑ Direct tension testing of existing anchors. --- X See ICC ES Reports form special inspection requirements for proprietary products Direct tension testing of new bolts. --- X ❑ Torque testing of new bolts. ___ X ❑ Prequalification test for bolts and other types of anchors. - "' X 14.X Other: - Periodic inspection screw & bolt size and spacing. SpecialnspectionForm 2012.doc revised 09106112 SpecialnspectionForm 2012.doc revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- X --- --- Art. 1.5 submittals shall be verified. 2. ® Verification of f,and fAAc prior to construction except where specifically exempted by this code. X "'- --- Art. 1:48 3. ❑ Verification of slump flow and VSI as delivered to the site for self consolidating grout. X '"' -"- --- Art. 1.56.1.b.3 4. As masonry construction begins, the following shall be verified to ensure compliance: Proportions of site -prepared mortar. --- X --- --- Art. 2.6A Construction of mortar joints. --- X --- --- Art.3.313 13 Location of reinforcement, connectors, prestressing tendons, and anchorages. --- X - '"- Art. 3.4, 3.6A Prestressing technique. --- X --- --- Art. 3.613 0 Grade and size of prestressing tendons and anchorages. _-- X - _ --- Ark. 2.48, 2.4H 5. During construction the inspection program shall verify: Size and location of structural elements. --- X --- --- Art. 3.3F Type, size, and location of anchors, including other details of anchorage of masonry to __- X ___ Sec. 1.2.2(e), _ "_ structural members, frames or other construction. 1.16.1 Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and --- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. Welding of reinforcing bars. x --- --- _-- [3 Preparation, construction and protection of masonry during cold weather (temperature below X Sec. 2104.3, 40 degrees F) or hot weather (temperature above ___ 2104.4 -" Art. 1.8C, 1.81) 90 degrees f). 13 Application and measurement of prestressing X force. -_- --- __. Art. 3.613 6. Prior to grouting the following shall be verified to ensure compliance: • Grout space is clean. --- X --- --- Art. 3.20 • Placement of reinforcement and connectors and ___ X --_ Sec. 1.3 Art. 3.4 prestressing tendons and anchorages. El Proportions of site -prepared grout and -__ X _-- -_- Art. 2.613 prestressing grout for bonded tendons. Construction of mortar joints. --- X --- --- Art. 3,313 7. Grout placement: ® Grout placement shall be verified ensure X "-` --- --- Art. 3.5 compliance. Observe groutinglof prestressing bonded X --- .-_ ___ Art 3.6C tendons. SpecialnspectionForm 2012.doc revised 09/06/12 SpecialnspectionForm 2012.doc revised 09106112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION_ 530/ASCE 5 530/ASCE 6 8. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be --- X 2105.2.2, --- Art. 1.4 observed. I 1 1 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- X -_- --- Art. 1.5 submittals. 2. ❑ Verification of f n, and f,nac prior to construction and for every 5,000 square feet during --- X --- -- Art. 1,48 construction. 3. ❑ Verification of proportions of materials in premixed or preblended mortar and grout as --- X --- --- Art. 1.58 delivered to the site. 4. p Verification of slump flow and VSI as delivered to the site for self consolidatingrout. X --- --- Art. 1.58.1.b.3 5. The following shall be verified to ensure compliance: Proportions of site -prepared mortar, grout, and prestressing grout for bonded tendons. --- X "' --- Art. 2.6A ❑ Placement of masonry units and construction of mortar joints. --- X -_- ___ Art. 3.38 Placement of reinforcement, connectors and prestressing tendons and anchorages. --- X ___ Sec. 1.15 Art. 3.4, 3.6A ❑ Grout space prior to grouting. X --- --- --- Art. 3.21) ❑ Placement of grout. X --- --- --- Art. 3.5 Placement of prestressing grout. X --- --- --- Art. 3.6C ❑ Size and location of structural elements. --- X --- --- Arta 3.3F Type, size, and location of anchors, including other details of anchorage of masonry to X --- --_ Sec.1.2.2(e) --- structural members, frames and other construction. Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and --- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. Welding of reinforcing bars. X --- Sec. 2.1.9.7.2, --- 3.3.3.4 (b) Preparation, construction, and protection of masonry during cold weather (temperature below ___ X Sec. 2104.3, _-- Art. 1.8C,1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X _-_ --- -__ Art. 3.613 force. 6. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be X --- 2105.2.2, --- Art. 1.4 observed. 2105.3 SpecialnspectionForm 2012.doc revised 09106112 VERIFICATION AND INSPECTION C I P REFERENCED ]IBC STANDARD REFERENCE INSPECTION OF WOOD 1. ❑ Inspect prefabricated wood structural elements and assemblies in accordance with Section 1704.2. ___ 1704.6 2. ❑ Inspect site built assemblies. 3. Inspect high -load diaphragms: ❑ Verify grade and thickness of sheathing. _._ ___ Verify nominal size of framing members at adjoining panel edges. --- 1704.6.1 13 Verify nail or staple diameter and length, --- --- • Verify number of fastener lines, --- _-- • Verify spacing between fasteners in each line and at edge margins. 4. p Metal -plate -connected wood trusses spanning 60 feet or greater: Verify temporary installation restraint/bracing and the permanent individual truss -- X --- 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ID Verify materials below footings are adequate to --� X achieve the desired bearing capacity. 2.. ❑ Verify excavations are extended to proper depth and --- X have reached proper material. 3. 0 Perform classification and testing of compacted fill X materials. --- Table 1704.7 4. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X --- compacted fill. 5. ® Prior to placement of compacted fill, observe subgrade X and verify that site has been prepared properly. REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify element materials, sizes and lengths comply X with the requirements. 2. ❑ Determine capacities of test elements and conduct X additional load tests, as required. 3. ❑ Observe driving operations and maintain complete X and accurate records for each element. 4. ❑ Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per --- Table 1704.8 foot of penetration, determine required penetrations to X --- achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. ❑ For steel elements, perform additional inspections in accordance with Section 1704.3. 6. E3 For concrete elements and concrete filled elements, perform additional inspections in accordance with --- --- Section 1704.4. SpecialnspectionForm 2012.doc revised 09106/12 VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD REFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in --- --- --- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST -IN-PLACE DEEP FOUNDATION ELEMENTS 1 0 Observe drilling operations and maintain complete and accurate records for each element. X 2. ❑ Verify placement locations and plumbness, confirm element diameters, belldiameters (if applicable), lengths, embedment into bedrock (if applicable), and X --- --- Table 1704.9 adequate end -bearing strata capacity. Record concrete or grout volumes. 3. ® For concrete elements, perform additional inspections in accordance with Section 1704.4. HELICAL PILE FOUNDATIONS 1. ❑ Record installation equipment used, pile dimensions,X tip elevations, final depth, final installation torque. ___ ___ 1704.10 SPRAYED FIRE-RESISTANT MATERIALS Physical and visual tests 1. Condition of substrates. Inspect surface for accordance with the approved' fire - resistance design and the approved manufacturer's --- written instructions. Verify minimum ambient temperature before and after x application. Verify ventilation of area during and after application. --- X 2. ® Measure average thickness per ASTM E605 and-'- Section 1704.12.4. ""- ___ 1704.12.1 3. ® Verify density of material for conformance with the approved fire-resistant design and ASTM E605. (Ref. --- - Section 1704.12.5) 4. ❑ Test cohesive/adhesive bond strength per Section 1704.12.6. 5. ® Condition of finished application. MISCELLANEOUS 1. Mastic and Intumescent Fire -Resistant Coating.: --- --- --- 1704.13 2. Exterior Insulation and Finish Systems (EIFS). Water - resistive barrier coating when installed over a sheathing --- --- --- 1704.14 substrate. 3. Special Cases --- --- --- 1704,15 4. Smoke Control System --- --- --- 1704.16 5. Seismic Resistance ❑ Suspended ceiling systems and their anchorage. --- --- --- 1705.3 [4.3] SpecialnspectionForm 2012.doc revised 09106112 VERIFICATION AND INSPECTION TCT P REFERENCED IBC STANDARD REFERENCE 6. Wind Resistance ❑ Roof cladding and roof framing connections. ❑ Wall connections to roof and floor diaphragms and framing. -'- --- --- ® Roof and floor diaphragm systems, including collectors, drag struts and boundary elements. ❑ Vertical wind -force -resisting systems, including braced frames, moment frames, and shear walls. --" --- _-" ❑ Wind -force -resisting system connections to the foundation. '-- -'- '- ❑ Fabrication and installation of systems or components required to meet the impact resistance requirements --- --- of Section 1609.1.2. SPECIAL INSPECTIONFOR WIND REQUIREMENTS 1. Structural Wood ❑ Inspect field gluing operations of elements of the main wind -force -resisting system. X - -- ___ 1706.2 Inspect nailing, bolting, anchoring, and other fastening of components within the main windforce-resisting system, including wood shear walls, wood X diaphragms, drag struts, braces and hold-downs. 2. Cold -Formed Steel Framing ❑ Welding of elements of the main wind -force -resisting system. X Inspection of screw attachments, bolting, anchoring, and other fastening of components within the main - _ 1706.3 - wind -force -resisting system including shear walls, --- X braces, diaphragms, collectors (drag struts) and hold- downs. 3. Wind -resisting components ❑ Roof cladding. --- X --- 1706.4 Wall cladding. --- X SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1. ❑ Special inspection for welding in accordance with theX 1707.2 quality assurance plan requirements of AISC 341. 2. Structural Wood Inspect field gluing operations of elements of the X _ seismic -force -resisting system. Inspect nailing, bolting, anchoring, and other fastening of components within the seismic -force -resisting 1707.3 system, including wood shear walls, wood --- X diaphragms, drag struts, braces, shear panels and hold-downs. 3. Cold -Formed steel light -frame construction ❑ Welding of elements of the seismic -force -resisting X 1707.4 system. SpecialnspectionForm 2012.docrevised 09106112 ® Inspection of screw attachments, bolting, anchoring, and other fastening of components within the seismic- force -resisting system including shear walls, braces, --" X diaphragms, collectors (drag struts) and hold-downs. 4. Storage racks and access floors ❑ Anchorage of storage racks 8 feet or greater in height and access floors. "- X 1707.5 5. Architectural components ❑ Inspect erection and fastening of exterior cladding weighing more than 5 psf and higher than 30 feet --- X above grade or walking surface. 0 Inspect erection and fastening of veneer weighing more than 5 psf.and higher than 30 feet above grade --- X or walking surface. --- 1707.6 Inspect erection and fastening of all exterior non- bearing walls higher than 30 feet above grade or --- X walking surface. ❑ Inspect erection and fastening of all interior non- bearing walls weighing more than 15 psf and higher --- X than 30 feet above grade or walking surface. 6. Mechanical and Electrical Components ❑ Inspect anchorage of electrical equipment for emergency or stand-by power systems. �- X ❑ Inspect anchorage of non -emergency electrical equipment. """ X Inspect installation of piping systems and associated mechanical units carrying flammable, combustible, or --- X --- 1707.7 highly toxic contents. Inspect installation of HVAC ductwork that contains X hazardous materials. Inspect installation of vibration isolation systems where required by Section 1707.7. --- X 7. ❑ Verify that the equipment label and anchorage or mounting conforms to the certificate of compliance when mechanical and electrical equipment must be _ -- 1707.8 seismically qualified. 8. ❑ Seismic isolation system: Inspection of isolation ___X _-_ 1707.9 system per ASCE 7 — Section 17.2.4.8 9. ❑ Obtain mill certificates for reinforcing steel, verify compliance with approved construction documents, --- --- --- 1708.2 and verify steel supplied corresponds to certificate. 10. ❑ Structural Steel: Invoke the QAP Quality Assurance 1708.3 requirements in AISC 341. 11. ❑ Obtain certificate that equipment has been seismically --- -"- --- 1708.4 qualified. 12. ❑ Obtain system tests as required by ASCE 7 Section--- --- --- 1708.5 17.8. SpecialnspectionForm 2012.doc revised 09106112 El 2001 Crow Canyon Road, Suite 100 San Ramon, CA 94583-5387 J. 925 314-7100 Fax. 925 855-7140 RE: Main Street Cupertino -Main Retail Rpt City of Cupertino To: 10300 Torre Avenue Cupertino, CA 95014 Permit 15040206 CEL# 1030949 Attn: Albert Salvador In accordance with S the requested special These inspections were State of California. Det the course of constructi Based solely upon the in judgment that the inspeci specifications, approvals Building Code. CC: City'of Cupertino (P) Placeholder(ER) Cupertino (ER) Cupertino (ER) SBCI (ER) All reports are submitted as FINAL. REPORT FOR SPECIAi, INSPECTION AND MATERIALS TESTING SERVICES (For Services Through 7/ l/16) 1704 of the California Building Code, Consolidated Engin tion and testing on the subject project as listed below: arcing steel placement or bolts installed in concrete rete placement and testing tural steel shop & field welding, non-destructive testing strength bolting .ural masonry placement and testing, (Base Plates) lation of screw anchors Formed by personnel under the general supervision of a. Re€ of our work on this project are contained in our testing and ctions and tests performed and upon our substantiating rep( work was performed substantially in conformance with the the Engineer of Record and the applicable workmanship pi Reviewing Engineer: Chris Kavalaris, PE Laboratories has provided and material ID Civil Engineer in the ion reports, issued during it is our professional roved plans and ;ions of the California confidential property ofclients. Publications of statements, conclusions, or extracts is reserved pending our written approval. Ole sOUDATED E L A R 0 n Date Of Isgue: 8/26/2016 RE: Main Street Cupertino -A Rpt City of Cupertino To: 10300 Torre Avenue Cupertino, CA 95014 Attn: Albert Salvador Special inspection and i design drawings and sp should it in any manner either the construction c We appreciate the opport feel free to contact us at i CC: City of Cupertino (P) Placeholder (ER) Cupertino (ER) Cupertino (ER) SBCI (ER) All reports are submitted as Retail FINAL REPORT FOR SPECIAL INSPECTION AND MATERIALS TESTING SFR31C ES (Fnr Services Thran gh 7/21 j 6) s testing is the observation of construction for general co ons. It should not be relied upon by others as acceptance any contractor, or any other party, from their obligations or generally accepted industry custom/practice. i of working with you. If you have any questions or require convenience. Reviewing Engineer: Chris Kavalaris, PE 2001 Crow Canyon Road, Suite 100 San Ramon, CA 94583-5387 J. 925 314-7100 Fax. 925 855-7140 15040206 1030949 irmance with the approved as a guarantee of work, nor d responsibilities under information, please property of clients. Publications of statements, conclusions, or extracts is reserved pending our written approval. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19499 STEVENS CREEK BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 15040206 CONSTRUCTION, INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 1711 DELL AVE DATE ISSUED: 0910312015 OWNER'S PHONE: 6503441500 CAMPBELL, CA 95008 PHONE NO: (408)379=5500 215 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE f+��° a►—} P` " '4 MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING License Class Lie. # L [ � �.t;i. �"�` Contractor sQo- 17 — Date * r RESTROOMS & TRASH ENCLOSURE (1,177 S.F.) 1 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: Sq. Ft Floor Area: Valuatiou: $2150000 1. 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 rmance of the work for which this permit is issued, APN Number: 31620085.19499 Occupancy Type: e and will maintain Worker's Compensation Insurance, as provided for by Ki on 3700 of the Labor Code, for the performance of the work for which this permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 180 DAYS SPECTION. 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, y: Date: ,i costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the alTliciAt understands and will comply with all non -point u e re i s pe a ert' o Municipal Cot, -"f tion 9.18. RE -ROOFS: IAll Signature ':r ° -' Date i'-`. roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OR+NER-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. 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 HAZARDOUS MATERIALS DISC OSURE sale (Sec. 7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505,25533v and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Additionally, should I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the performance of the work for which this permit is issued. 2. 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 Health & Safety Code Sectio 25505, 25533, and 25534. Ior*11 . t ! permit is issued. :,{/ I Date a IF F J W a. 1 certify that in the performance of the work for which this permit is issued, I shalli not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked, Lender's Address APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD CUPERTINO CA 95014 SOUTH 13AY CONSTRUCTION 1711 DELL AVE OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/03/2015 OWNER'S PHONE: PHONE NO: 408-379-9800 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #33D974 Contractor Date 02/031201 _ BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two deelarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 2. I have and will maintain a certificate of consent to self-insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F.) Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REV # 1 - ADD PATIO (I600 S.F.), REVISE FACADE - ISSUED 213116 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. Sq. Ft Floor Area: Valuation: $2150000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: 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, costs, and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal WITHIN 180 DAYS OF PERMIT ISSUANCE OR Code, Se tion 9.18. 180 DAYS FROMCALL SPECTION. Signatur ate 02!0312016 Issued by: ME] A NAME Date: 02/03/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS: following two reasons: All roofs shall be inspected prior to any roofingmatedal being installed. Ifa roof is >. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered inspection. for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construet the project (Sce.7044, Business & Professions Code). Dat,-02/03/2 I hereby affirm under penalty of perjury one of the following three declarations: 1, I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETPER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which ibis permit is issued. HAZARDOUS NIA ERIALS DISCLOStlizE~ 2. I have and will maintain Worker's Compensation insurance, as provided for I have read the hazardous materials requirements under Chapter 6.95 of the by Section 3700 of the Labor Code, for the performance of the work for which California Health & Safety Code, Sections 25505, 25533, and 15534. I will this permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California, If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety See, 255 2nd2553 . ode, Seed 05, a be deemed revoked. owner or authorized agen APPLICANT CERTIFICATION Date: 02103/2016 I certify that I have read this application and state that the above information is CDNSTRUCTiONLENDiNC AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lenders Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the ARCHITECT'S DECLARATION Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 02103/2016 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD (316 20 112) (S B C C INC) CAMPBELL, CA 95008 OWNER'S NAME: Main Street Cupertino Aggregator DATE ISSUED: 09/03/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: SOUTHBAY CONSTRUCTION LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #336974 Contractor ( S B C C INC ) Date 03/01/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL_ COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING r. I have and will maintain a certificate of consent to self-insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F.) Compensation, as provided for by Section 3700 of the Labor Code, for the DEFERRED #2 - STRUCTURAL DESIGN OF EXT. SLADDING performance of the work for which this permit is issued. DEFERRED #1 - BUCKLING-RESTRAINED BRACES - ISSUED 311116 1 have and will maintain Worker's Compensation Insurance, as provided for **IOCATION B5.5** by Section 3700 of the Labor Code, for the perfonnance of the work for which this permit is issued. REV # 1 - ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED,213116 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 Sq. Ft Floor Area: Valuation: $2150000.00 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 APN Number: Occupancy Type: harmless the City of Cupertino against liabilities, judgments, costs, and 31620 112 expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal PERMIT EXPIRES IF WORK IS NOT STARTED Code, Sect' n 9.118 WITHIN 180 DAYS OF PERMIT ISSUANCE. OR L 180 DAYS FROM LAST C SPECTION.. SignafD Date 03101C201s OWNER-BUILDER DECLARATION Issued by: MELISSA;A Date: 03/01/2416 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 1, as owner of the property, or my employees with wages as their sole RE-ROOFS: compensation, will do the work, and the stricture is not intended or offered All roofs shall be inspected prior to any roofing material being installed. If a roof is for sale (Sec.7044, Business & Professions Code) installed without first obtaining an inspection, 1 agree to remove all new materials for 2. I, as owner of the property, am exclusively eontracting with licensed inspection. contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: I hereby affirm under penalty of perjury one of the following three declarations: Date: 03/01/2016 1. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER performance of the work for which this permit is issued. 2. 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 whieh HAZARDOUS MATERIALS DISCLOSURE this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the s. I certify that in the performance of the work for which this permit is issued, I California Health & Safety Cade, Seetions 25505, 25533, and 25534. I will shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9,12 and tIre Health & Safety Code, Sectiou 25532(a) should 1 store or handle hazardous Worker's Compensation laws of Cal ifomia. If, alter making this certificate of material. Additionally, should I use equipment or devices which emit hazardous exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I Labor Code, l must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and be deemed revoked. the Health &Safe Code, Sect' 25505, 33 a 2 34. APPLtQANT CERTIFICATION I certify that I have read this application and state that the above information Is Ownerj�r thwizft correct. l agree to comply with all city and county ordinances and state laws Date: 03101/2016 relating to building construction, and hereby authorize representatives of this city CONSTRUCTION LENDING AGENCY to enter upon the above mentioned property for inspection purposes. (We) agree I hereby affirm that there is a construction lending agency for the performance to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.) judgments, costs, and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Lender's Address Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATIO-N I understand my plans shall be used as public records. Signature Date 03/0112016 Licensed CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD (316 20 1 l2) S B C C INC CAMPBELL, CA 95006 OWNER'S NAME: MAIN STREET AGGREGATOR OWNER'S PHONE: 406-725-1955 LTC CONTRACTOR'S DECLARATT0N_ License Class GENERAL BUILDING CONTRACTOR Lic, #336974 Contractor S B C C INC Date 03/31/2016 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: 1. 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 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. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the 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. Date 03-16-16 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's Lieense Law for one of the following two reasons: I. 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 (See.7044, Business & Professions Code) 7. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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 performance of the work for which this permit is issued. 2. 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. 3. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any wanner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, i must forthwith comply with such provisions or this permit shall be deemed revoked. d 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with ail non -point source regulations per the Cuperfino Municipal Code, Section 9.18. Sig Date 03-16-16 DATE ISSUED: 09/03/2015 PHONE NO: (408) 379-5500 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTLAL _ COMMERCIAL DESCRIPTION: q STREET - CONSTRUCT (N) SHELL FOR FUTURE CANTILE OCCUPANCY (21,390 S.F.), INCLUDING Sq. Ft Floor Area: ' Valuation: 52150000.00 APN Number: Occupancy Typc: 316 20 112 PERMIT EXPIRES IF WORK IS NOT STARTED WITIIIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by; Sean Hatch R 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. Lure of Applicant: 3�6 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS D1SCL SURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safetyde, Sections 25505, 2 33 and 25 4. 0 1 Owner or authorized agent: Date: 03-16-16 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lenders Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK 13LVD (316 20 112) SD CC INC CAMPBELL, CA 95008 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 09/03/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: (408) 379-5500 LICENSED—CONTRACTOR—'S—DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #336974 Contractor S_B_C_C_INC Dale D313112015 — BLDG _ELECT _PLUMS MECH RE, SIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (1) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 1. I have and will maintain a certificate of consent to self-insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F. Compensation, as provided for by Section 3700 of the Labor Code, for the DEF 13 - GLAZING SHOPS & CALC'S. ISSUED 3-16-16. performance of the work for which this permit is issued. DEFERRED ##2 - STRUCTURAL DESIGN OF EXT. SLADDING - 2. I have and will maintain Worker's Compensation Insurance, as provided for by ISSUED 3130116 Section 3700 of the Labor Code, for the performance of the work for which this DEFERRED ##1 - BUCKLING-RESTRAINED BRACES - ISSUED 3/1/16 permit is issued. REVISION ##1 - ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED APPLICANT CERTIFICATION 2/3/16 1 certify that I have read this application and state that the above REVISION ##2 - REVISE TRASH ENCLOSURE DOOR OPENING - information is correct. i agree to comply with all city and county ordinances ISSUED 4/20/16 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for Sq. Ft Floor Area: Valuation: $2150000.00 inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. APN Number: Occupancy Type: Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 316 20 112 signatuDale 4120I2016 re PERMIT EXPIRES IF WORK IS NOT STARTED OWNER-BUILDER DECLARATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 1, as owner of the property, or my employees with wages as their sole Issued by: ABBY AYENDE f[ _ compensation, will do die work, and the structure is not intended or offered for Date: 09/03/201501ACUAX. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm under penalty of perjury one of the following three declarations: installed without fust obtaining an inspection, I agree to remove all new materials for 1. I have and will maintain a Certificate of Consent to self-insure for Worker's inspection. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Applicant: 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Date: 412012016 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 2. 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 HAZARDOUS MATERIALS DISCLOSURE exemption, I become subject to the Worker's Compensation provisions of the I have read the hazardous materials requirements under Chapter 6.95 of the Labor Code, I must forthwith comply with such provisions or this permit shall California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the be deemed revoked. Health & Safety Code, Section 25532(a) should I store or handle hazardous APPLICANT CERTIFICATION material. Additionally, should I use equipment or devices which emit hazardous I certify that I have read this application and state that the above information is air contaminants as defined by the Bay Area Air Quality Management District I correct. I agree to comply with all city and county ordinances and state laws will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and relating to building construction, and hereby authorize representatives of this city the Health & Safety C de, Seco s 5505, 533, and 2 534. to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City cf Cupertino against liabilities, nor or authorized agent: judgments, costs, and expenses which may accrue against said City in ate: 4/2012016 i consequence of the granting of this permit. Additionally, the applicant understands CONSTRUCTION LENDING AGENCY and will comply with all non-point source regulations per the Cupertino Municipal [ hereby affirm that there is a construction lending agency for the performance Code, Section 9.18. of work's for which this permit is issued (Sec. 3097, Civ C.) Lenders Name Signature Date 4/20/2016 Lender's Address R TE T' DF T CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD (316 20 112) S B C C INC CAIVTBELL, CA 95009 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 0 910 312 0 1 5 OWNER'S PHONE: 650-344-1500 PHONE NO: (408) 379-5500 i.ICF.NSF.D_CONTRAC.TOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #336974 Contractor S_B C CJN_ C Dale 0313112016 — BLDG _ELECT _PLUM$ MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 1. I have and will maintain a certificate of consent to self -insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F. Compensation, as provided for by Section'3700 of the Labor Code, for the ' DEF ## 3 - GLAZING SHOPS & CALC'S. ISSUED 3-16-16. performance of the work for which this permit is issued. • DEFERRED ##2 - STRUCTURAL DESIGN OF EXT: SLADDING - 2.' 1 bave and will maintain Worker's Compensation Insurance, as provided for by ISSUED 3/30/16 Section 3700 of the Labor Code, for the performance of the work for which this DEFERRED #1 -BUCKLING-RESTRAINED BRACES - ISSUED 3/1/16 permit is issued. APPLTCAN1cEgTIF1cATroN I certify that I have read this application and state that the above REV # 1 -ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED 2/3/16 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize Sq. Ft Floor Area: Valuation: $2150000.00 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, costs, and expenses which APN Number: Occupancy Typc: may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point 31620 112 source regulations per the Cupertino Municipal Code, Section 9.18. Signature) c Date 03/3012016 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR S)WNER-BUMDFR DECLARATION 180 DAYS FROM LAST C SPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by: MELISS 1. I, as owner of the property, or my employees with wages as their sole Date; 03/30/2016 compensation, will do the work, and the structure is not intended or offered for sale (Sce.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed RE -ROOFS: contractors to construct the project (Scc.7044, Business & Professions Code). 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 I hereby affirm under penalty of perjury one of the following three declarations: inspection. 1. 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 Signature of Applicant: performance of the work for which this permit is issued. bate; 03!30!2016 z. I bave 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER permit is issued. 3. 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 HAZARDOUS MATERIALS DISCLOSURE Worker's Compensation laws of California. If, after making this certificate of I have read the hazardous materials requirements under Chapter 6.95 of the exemption, I become subject to the Worker's Compensation provisions of the California Health & Safcty Code, Sections 25505, 25533, and 25534. I whl maintain eampliance with the Cupertino Municipal Code, Chapter 9.12 and the Labor Code, I must forthwith comply with such provisions or this permit shall Health & Safety Code, Section 25532(a) should I store or handle hazardous be deemed revoked, material. Additionally, should I use equipment or devices which emit hazardous APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Management District I I certify that I have read this application and state that the above information is will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and correct. I agree to comply with all city and county ordinances and state laws the Health & Safety C e, Sections 2 05,2553 and 25534. relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree Owner or authorized agent: to save indemnify and keep harmless the City of Cupertino against liabifitfes, Date: 03/30/2016 judgments, costs, and expenses which may accrue against said City in CONSTRUCTION LE E consequence of the granting of this permit. Additionally, the applicant understands I hereby affirm that there is a construction lending agency for the performance and will comply with all non -point source regulations per the Cupertino Municipal of work's for which this permit is issued (Sec. 3097, Civ C.) Code, Section 9,18. Lender's Name Lender's Address Signature Date 0313012016 ARCHITECT'S DECLARATION understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15040206 19499 STEVENS CREEK BLVD (316 20 112) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: SAND HILL CONST MANAGEMENT DATE ISSUED; 09103/2015 OWNER'S PHONE. 650 344 1500 PHONE NO: (408) 379-5500 LICENS' D BUILDING PERNUT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #336974 Contractor S B C C INC Date 03/31/2016 — BLDG _ELECT PLUJ4IB MECH RESIDENTIAL COMMERCLAL 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. JOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 1. I have and will maintain a certificate of consent to scif-insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. DEF # 4 - ROOF JOIST SHOPS & CALCS.-ISSUED 5/13/2016 2. I have and will maintain Worker's Compensation Insurance, as provided for by DEF # 3 - GLAZING SHOPS & CALC'S. ISSUED 3-16-16. Section 3700 of the Labor Code, for the performance of the work for which this DEFERRED #2 - STRUCTURAL DESIGN OF EXT. SLADDING - permit is issued. ISSUED 3130116 APPLICANT CERTIFICATION DEFERRED #1 - BUCKLING -RESTRAINED BRACES - ISSUED 311116 I certify that i have read this application and state that the above REVISION #1 - ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED information is correct. I agree to comply with all city and county ordinances 213116 and state laws relating to building construction, and hereby authorize REVISION #2 - REVISE TRASH ENCLOSURE DOOR OPENING - representatives of this city to enter upon the above mentioned property for ISSUED 4120116 inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which **BIN C-2** may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal C % Section 9.18. Sq. Ft F1oorArea: Valuation: $2150000A0 Signature Date 511312016 APN Number; Occupancy Type: 31620 112 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: PERMIT EXPIRES IF WORK IS NOT STARTED 1. 1, as owner of the property, or my employees with wages as their sole WITHIN 180 DAYS OF PERMIT ISSUANCE OR compensation, will do the work, and the structure is not intended or offered for sale (See.7044, Business & Professions Code) 180 DAYS FROM LAST CALLED INSPECTION. i. I, as owner of the property, am exclusively contracting with licensed contmetors to construct the project (See.7044, Business & Professions Code). Issued by ABBY AYENDE I hereby affirm under penalty of perjury one of the following three declarations: 312 0 1 5 Date: 02&312W 1. 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 Cade, for the RE -ROOFS: performance of the work for which this permit is issued. All roofs shall be inspected prior to auy roofing material being installed. If a roof is a. I have and will maintain Worker's Compensation Insurance, as provided for by installed without first ohtaining an inspection, I agree to remove all new materials for Section 3700 of the Labor Code, for the performance of the work for which this inspection. permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I Signature of Applicant: shall not employ any person in any manner so as to beeome subject to the Date: 5/13/2016 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. HAZARDOUS MATERIALS DISCLOSURE= Arles NT CERTIFICATION I have read the hazardous materials requirements under Chapter 6.95 of the I certify that 1 have read this application and state that the above information is California Health & Safety Code, Sections 25505, 25533, and 25534. I will correct. I agree to comply with all city and county ordinances and state laws maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the relating to building construction, and hereby authorize representatives of this city Health & Safety Code, Section 25532(a) should I store or handle hazardous to enter upon the above mentioned property for inspection purposes. (We) agree material. Additionally, should I use equipment or devices which emit hazardous to save indemnify and keep harmless the City of Cupertino against liabilities, air contaminants as defined by the Bay Area Air Quality Management District 1 judgments, costs, and expenses which may accrue against said City in will maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and consequence of the granting of this permit. Additionally, the applicant understands the Health & Saf 25505, 2 33, and 25 4. and will comply with all non -point source regulations per the Cupertino Municipal �ode,Sectlons Code, Section 9.18. - Owner or authorized agent: Date: 5L13l2Q16 Signature Date 5/13I2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Flame CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMITNO:16040206 19499 STEVENS CREEK BLVD (316 20 112) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: SAND HILL CONST MANAGEMENT DATE ISSUED: 6/7/2016 OWNER'S PHONE: 650-344-1500 PHONE NO: (08) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Lic. #336974 Contractor S 8 C C INC Data 0313112016 — BLDG _ELECT _PLUMB MECH RESIDENTIAL COMMERCIAL I hereby affirm that I are 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. SOB DESCRIPTION: MAIN STREET - CONSTRUCT (N) SHELL FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: MERCANTILE OCCUPANCY (21,380 S.F.), INCLUDING 1. I have and will maintain a certificate of consent to self-insure for Worker's RESTROOMS & TRASH ENCLOSURE (1,177 S.F. Compensation, as provided for by Section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. DEF # 5 - TRASH GATE SHOPS & CALCS - ISSUED 6/7/2016 I have and will maintain Worker's Compensation Insurance, as provided for by DEF # 4 - ROOF JOIST SHOPS & CALCS: ISSUED 5/13/2016 Section 3700 of the Labor Code, for the performanee of the work for which this permit is issued. APPLICANT CERTIFICATION DEF # 3 - GLAZING SHOPS & CALC'S. ISSUED 3-16-16. 1 certify that I have read this application and state that the above DEFERRED #2 - STRUCTURAL DESIGN OF EXT. SLADDING - information is correct. I agree to comply with all city and county ordinances ISSUED 3/30/16 and state laws relating to building construction, and hereby authorize DEFERRED #I - BUCKLING-RESTRAINED BRACES - ISSUED 3/1/16 representatives of this city to enter upon the above mentioned property for REVISION #1 -ADD PATIO (1600 S.F.), REVISE FACADE - ISSUED inspection purposes. (We) agree to save indemnify and keep harmless the 2/3116 City of Cupertino against liabilities, judgments, costs, and expenses which REVISION #2 - REVISE TRASH ENCLOSURE DOOR OPENING - may accrue against said City in consequence of the granting of this permit. ISSUED 4/20/I6 Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Secti 9.18. Sionatur, 6/7/2016 Sq. Ft Floor Area: Valuation: $2150000.00 OWNER-BUMDER DECLARATION APN Number: Occupancy Type: I hereby affirm that I am exempt from the Contractor's License Law for one of the 316 20 112 following two reasons: 1. 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 PER RT EXPIRES IF WORK IS NOT STARTED sale (Sec.7044, Business & Professions Code) WITHIN 180 DAYS OF PERMIT ISSUANCE OR 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Issued by: LegaCV Compensation, as provided for by Section 3700 of the Labor Code, for the Date: 6/7/2016 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by RF ROOFS: Section 3700 of the Labor Code, for the performance of the work for which this All roofs shall be inspected prior to any roofing material being installed. If a roof is permit is issued. installed without first obtaining an inspection, I agree to remove all new materials for 3. I certify that in the performance of the work for wbicb this permit is issued, I inspection. 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 Signature ofApplieant: exemption, I become subject to the Worker's Compensation provisions of the Date: 6!712016 Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is HAZARDOUS MATERIALS bISCLOSURE correct. I agree to comply with all city and county ordinances and state laws I have read the hazardous materials requirements under Chapter 6.95 of the relating to building construction, and hereby authorize representatives of this city California Health & Safety Code, Seetions 25505, 25533, and 25534. I will to enter upon the above mentioned property for inspection purposes. (We) agree maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the to save indemnify and keep harmless the City of Cupertino against liabilities, Health & Safety Cade, Section 25532(a) should I store or handle hazardous judgments, costs, and expenses which may accrue against said City in material. Additionally, should I use equipment or devices which emit hazardous consequence of the granting of this permit. Additionally, the applicant understands air contaminants as defined by the Bay Area Air Quality Management District I and will comply with all non-point source regulations per the Cupertino Municipal will maintain compliance with the Cupertino Municipal Cade, Cha er 9.12 and Code, Section 9.18, the Health &Safety ode, Sections 05, 25533, nd Signature bate 6/712016 ner or authorized agent; ate: 6171201 CONSTMTCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance CONSTRUCTION PERMITAPPLICATION hL� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �O CUPi;RTINO (408) 777-3228 • FAX (408) 777-3333 • buildingCcDcupertino.orq n NEW CONSTRUCTION n ADDTTTON n ALTERATION / TI n REVISION I bEFF_RRED ORIGINAL PERMIT N PRorECr ADDRESS I f1i 1, 91 g �u�l APN -3 OWNERNAME . yr� /s+�L ! ti Tn, P110N'( ')3gLj v ISO 0 E-MAIL STREET ADDRESS r1 {�71 &ANp�iAL .rf+ C ��`/iz �j[.�Q� FAX CONTACT NAME �i ('.� r �►G�� PHDNE �� •y j [j, J, f7/13 E-MAII� 1� �(� (�G� 1��V11f STREET lop CiT STAT ZIP FAX ❑ ORTNFR OCJ OWNER-BUQAER - ❑ 0AwmA= ❑ CONTRACTOR ❑ CONTRACTOR AGENT ,�16,cHIr= ❑ ENG:NEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Li SENUMBERLICENSETYPF. BUS.LIC 6 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME IICENSENUMBER BUS, LIC# A me ops a v COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE _ DESCRIPTION OF WORK IV tda UJCON,�gkdl J Y c -' JY 1 EJffSTlNG USE PROPOSED USE CONSTIL TYPE # STORIES USE TYPE OCC. SQ.F�T.7��jJ� VALUATION (S) BXISTAREA EWFLOOR Qty NAREA �i d V 1 DEMO AREA IOTAL NET AREA 'Z V ✓ C, �} 9 Lr 7 4 V BATHROOM REMODEL AREA KITCHENOTHER RI.A4017EL AREA REMODEL AREA � l 12 V PORCH AREA DECK AREA TOTAL DECKRORCH AREA GARAGE AREA: DETACH M ATTACH 9 DIYELLDNG UNITS: IS A SECOND) UNIT ❑ YES SECOND STORY ❑YES BEING ADDED; []NO ADDITION? ❑NO PRE4PPUCATTOIN ❑YES IF YES. PROVIDE COPY OF IS THE BLDG AN ❑YES - ]VEp = `�"-"-,v TOTAL VALUATION: PLAINNING APDL # NO PLANNING APPROVAL LETTER ❑ EICHLER HOME?_, # r - h 2 150, ooa By my signature below, I certify to each of th owin I e roperty owner or authorized agent tpefo roperty owner's behalf. I have read this application and the information I have provi ed is rre r d the Description of Work and veri ' Is accurate. I agree to oomply with all applicable local ordinances and state laws relating to buildin cons ti . a 0 ze epresentatives of Cupertino to enter the abo a identi red property for inspection purposes. S ignature of Applicant/A.ent: Date: Z SUPPLEMENTAL INFORMATIO140MVRE �'Ne`v SPD or Multifamily dwellirNgs: Apply for emorntit for existing bading(s). Demolition permit is required prior tcc of building 911Z` , permit for new building. i��xESS r _SPI AI4t�IIVGYLATk uv Commercial BldgS: Provide a completed Hazardous Materials Disclosure xxr"' `MW91grmaRT3" ! dzx� s a "1 P Ts> e�ptucS _ _ form if an Hazardous Materials are being, used as art of this project. Y � P P J � F� ASP 1 'DEPT � M _ Copy of Planning Approval Letter or Meeting with Planning prior to w r ,.��Y� F®,. R`' y �''rfti * N Y �. x�]❑,Si1IVTT':AR$ 'EitD75T1tIGT2 3- submittal of Building Permit application. �a 1r.EI\'XII20NivAL�111'Ai;1�A7'�Tfis,u'k.., BIdgApp 2011.doc revised 06121111 GM CONSTRUCTION PERMIT APPLICATION COWNUNI TY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 0300TORRE AVENUE • CUPERTINO, CA 95014-3255 CiJPERT[h!O (408) 777-3228 • FAX (408) 777-3333 - buildina(a).cuoeitno.ora ❑ XIEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION 1 TI REVISION 1 DEPERR D ORIGINAL PERMIT n ZOIij PROfECf ADDRESS ff S �W APN t1) OWNER NAI Cc, ,�„ rt� �11R5i JT,Aq re P30N£ 1`� E•IJAIL �liC (' v � �% �j STREET ADDRESS �/ {� ` MAir VCrry, STATE, ZIP � / l ✓`i 4 FAX CONTACT NAE PHO> L y O L s ]ZIP STR t3 AADRESSZ L(� 4 l! V CrfY, STATE, 0+FAX of o (c) l❑ oWI4ER Q OW),rk-BUILDER ElORRva+ AGENT ❑ CO*ETR0.CTOi1 ❑ CONrFACTOi1AG:N7 ElARCRIT£C, 0 rTGIIht�r* L❑ DE\.LOPa7L ❑ "rcNAJ r CONT[tACfORNAME JQ �� %� _ _ S� �(f LICcT'SE3iLAS3EX I GCENSETYFB I BUS. LIC COb�AIY NAAM E-MAIL FAX STREET ADDRESS CITY, STATE. L. ZIP PHONE ARCHITECirNGNBER N/ - .ME L1Cc4\1SE KuiJDER BUS. LIC m COMPANY NAME E-MAJL FAX STP.EET ADDRESS CITY, STATE, ZIP I Pi4011TE } DESCRIPTIO] 037 WORK EX7sTLVGUSE PROPOSED USE CoTYPE "(lug 11 111�77TOTAL fi STORIES USE TYPE OCC. SQ.FT. VALUATION (S) F aSTG AREA NEW FLOOR AREA Z 15n DE2<i0 AREA NET AREA Dl! HATMOOM KITCHEN 0-1-HIER REMODEL AREA REMODEL AREA REMODEL.1.REA PORCH AREA DECK AR: -A TOTAL DECYIPORCH F.R'.A GARAGE AREA: DETACH I ❑ Ai TACH 4I m DWELLING UNTrS: I5 ASEUNrr ❑ YES SECOND STORY ❑YES BE1NC ADDED? ANO ADDITION: No PRE.AP;LTCATION ❑m'c YES IF YES.PROVCOPYOF is THE BLDM!G ❑ - -�r��?�',.; �-..,V�=s?_-_. TOTALVALU.4TI4N: FLANNT0GAPPL9 EJ1,0 PLANND\1GAPPROV?.LLETTER EICHLERHOMEf By my signature below, I certify to each of e fe awing: IPrize wner or authorized _ent to the property 0uIieT's behalf. I have read this application and the information I have prov ded i cone tion of lArork and verifyit is accurate. I agree to comply -with all applicable local ordinances and state laws relating to buildin const ti Itives �f Cupertino to enter the above-ident'fsed pro erty r'or inspection purposes. Signature ofApplicantlAgent: Date: �i SLPPLEMENTAL iNF0R3ti4ATI0 QUI s,. �vCHECiC2]E�T.20i3ITh_GSI Imo;y' New 5FD or 2.4ultifamily d%Nellings: Apply for oli .0p -it for I]a OST R TEF CO]IM1TER�4iBTLDI �GPLAT RnST1EFLh'> existing building(s). Demolition permit is required p a to is 0e of buildings permit for new building._ssk`"' si' _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure�maxn� s N >eL os, 3 form if any Hazardous Materials are being used as part of this project. r = t €".Dr�PT` _ Copy of Planning Approval Letter or Meeting with Planning prior to NINE 1, —� ��• I�,x �: �SATTLA1Z K`�s%Fuckk�-- submittal of BuildingPernit application. s sE�i : oM • -6 —pro - -- NM E* T Aiig Bld.-Xpp_1011. doc revised 06121/11 CONSTRUCTION PERMIT APPLICATIONJ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DI �y �$ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 r. `P� CUPERT[ND (406) 777-3228 • FAX (408) 777-3333 - buildinga(5cucertino.org 17NFWC0NRTRTTCTT0N F-1ADDTTTON . F1 F1 RFVTRT0-W/T)FFFRRF_n C)RTC;TNAT-T>FRMTr:V PROISCf ADDRESS I DI )� q (/l 5 � % _ ��lYr� APN: OR'NERNAME �n'^f , / _ , PHONE�(ptj"U`1 E-MAIL. f� sTREE7 ADDRESSQ z SAA > l L(_ C " 1 �j'�IP Q 5 FAX CONTACT NAME '�+ i� r ` ,l FHON£�6 J ��l j�}� E-MAIi O �l l� sTREE7 AI)f C sTAT1 ZIP FAX C 0)kWE6R ❑ OWNER -BUILDER ❑ 01WERAGENT ❑ CONTRACSOR ❑CONTRACTORAGENT XARCHnECT ❑ ENGINTM ❑ DEVELOPER ❑ TENANT LICENSENIAIBER LICENSETYPF CONTRACTOR NAM£ ry BUS. LIC# COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHiTECT/ENGINEERNAME LTC£i SENUMBER BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CrIY, STATE, ZIP PHONE DT_SCRIPTTON OF WORK VG j- rl j\ 0L 0 { 7 - � A � 1r tW�!"� r''(,jil'rl o f �+�vv 1 v 11~ u W �'V ■ I t— E-aSTING USE PROPOSED USE CONSTRTYPE ISTORIES I USE TY�P�{jE OCC. SQ.FT. VALUATION (S) Ex7sT AREA .� AREA t 7 (j� OOR '7 7 Q DEMO �. - AL pry rNEiAAREA LAD �l � �`1 �/"�/ � V J� Z1,��ll BATHROOM REMODEL AREA KITCHEN OTHER REMODEL AREA REMODEL AREA V PORCHAREA DECK.4REA TOT.ALDECK/PORCHAREA GARAGE AREA: DETACH ❑ A i rACH: DWELLING UNITS: IS ASECOND UNrr El YES SECONDSTORY DYES BEING ADDED? ❑NO ADDITION? []NO _. PLANNI LI APPLN ❑NO P 7'ES, PROVIDE COPY E IS THE BLDG AN El YES :.. :r+..�-��-t' �` x TOTAL. UATION: pLAT'MNG APPL O ❑ NO PLANNING APPROVAL LEl-LER EICHLER HOME? By my signature beloiv, I certify to each of roperty oiamer or authorized gent to 0 openY awcLcr's behalf. 1 have reap ,his application and the information I have provd the Description of %;7ork and veri s accurate. I agree to coulply with all applicable local ordinances and state laws relating to buildin t ze&rep entatives of Cupertino to enter the r' -; ^ j� rl property for inspection purposes. 7-VL�SIJ 5ignatureofApplicant/Agcnt: Date: SUPPLEMENTAL WFORMA'71b F sus P.7 A7�T C)3P.,C•KT�'PF. -� 5 –. A..L .,a<% 1\ew SFD or Multifamily d«vellings: Apply for e lit erm t for p : kw ' dB OVE. R �L7UhxER DAIGPLREVIEW eXisting building {s). Demolition permit is required OLID to is ce f building EG r� permit for new building. �� P Iiv> .G pLArr tVy rd� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure r ❑ PT�sLRr�Ros _ -M form if any Hazardous Materials are being used as part of this project.MaNA +�•r5 �`® �`DF�PtT'�"r� �� f€.., "E ,,�,� • �g�1;"'ARC��'�'�"�-L�''�rr ,.C,��' _ Copy of Planning Approval Letter or Meeting with Planning prior to r- F submittal of Building Permit application.�� 4fd`'�ris�plsxizrcl� „ �' �,� ' ' �•`=� ;.�_,.,�r ' � � ��EIL'ROIa'MET9T�47:HEA7SHa't -'-- BldgA4pp 2011.doc revised 06/21/11 (In CONSTRUCTION PERMIT APPLICATIONPFW�lw La COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinciCcDcupertino.org Main Retail CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION 1 Tl ® REVISION /DEFERRED ORIGINAL PERMIT #I 15040206 PROJECT ADDRESS 19499 Stevens Creek Blvd "PN# Z rI OWNERNAME Sand Hill Const Management PHONE EMAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park 94025 FAX CONTACT NAME Nandy Kumar PHONE 650-344-1500 LE-MA11L nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX DOWNER ❑ OWNER -BUILDER ❑ OWNtiRAGENr ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Summer Olson -Todd LICENSE NUMBER 336974 T7;SE TYPE B O BUS. LIC # 5655 COMPANYNAME South Ba Construction Y E-MAIL solsoniodd@�bei.com - FAX STIZEETADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408-379-5500 ARCHITECT/ENGINEER NAME Cliff Chang LICENSE NUMBER BUS. LIC a COMPANY NAME Chang Architecture E-MAIL cliff@changarchitecture.con I FAX STREET ADDRESS 251 Park Road, #900 CITY, STATE, ZIP Burlingame, 94010 PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTIL TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNTTS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL 9 ❑ NO PLANNING APPROVAL LETTER EICHLER ROME? ❑ NO By my signature below, I certify to each of the following: 1 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, 1 agree to comply with all applicable local ordinances and state laws relat' to building cMI a thorize rep sen fives of Cupertino to enter the abo a -id tifled property for inspeetion purposes. Signature of Applicant/Agent: Date: �� n SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-T1HF-COUNTER ❑ 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 0, 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 SEWER DISTRICT submittal of Building Permit application. El ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06121111 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • build ing(Ncupertino.org Main Retail ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION I TI I1A REVISION/ DEFERRED ORIGINAL PERMIT # 15040206 PROJECTADDRESS 19499 Stevens Creek Blvd APN0 OWNER NAME Sand Hill Const Management PHON'�650-344-1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park 94025 FAX CONTACT NAME Nandy Kumar PHONE 650-344-1500 E-MAIL nkumar@shcrnIIc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Summer Olson -Todd LICENSE NUMBER 336974 LICENSE TYPE B BUS. LIC 45655 COMPANY NAME South Ba Construction Bay E-MAa solsontodd@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 "" 408-379-5500 ARCHITECTIENGINEERNAME Cliff Chang LICENSE NUMBER BUS. LIC# COMPANYNAME Chang Architecture E-MAIL cliff @changarchitecture.cori I FAX STREET ADDRESS 251 Park Road, #900 CITY, STATE, ZIP Burlingame, 94010 PHONE 650-269-4213 DESCRIPTION OF WORK 3 EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) MSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODELAREA REMODELARFA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH - - - []ATTACH # DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY AYES BEINCADDED? []NO ADDITION? []NO .PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ED BY: TOTAL DATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? [:]NO By my signature below, I certify to each of the following: I am the property owner or authori d agent to act on the property owner's behalf. I W.'read this application and the informatie have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with 11 applicable local ordinances and state laws tela n to building confin. I auth a rep tati s of Cupertino to enter the above -identified property for inspection purposes. Signature of Applieant/Ageat: Date: 2/10 SUPPLEMENTAL INFORMEMN-REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ _ New SFD or Multifamily dwellings: Apply for demolition permit for building(s). Demolition permit is required prior to issuance of building OVER-THE-COUNTERBllILDING PLAN REVIEW permit for new building. ❑- EXPRESS ❑ PLANNING PLAN REVEEW _ Commercial Bldgs: Provide a completed Hazardous Materials DisclosureSTANDARD ❑ 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 SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONAIENTALHEALTH BldgApp 1011.doc revised 06121111 CUPERTINO (3.5.5 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION DEP 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(cDcuyertino.org Main Retail ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION I TI ® REVISION I DEFERRED ORIGINAL PERMIT 4 15040206 PROJECT ADDRESS 19499 Stevens Creek Blvd APN0 OWNERNAME Sand Hill Const Management PHONE E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park 94025 FAX CONTACT NAME Nandy Kumar PHONE 650-344-1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX ROWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHrrFCT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Summer Olson -Todd LICENSENUMBER 336974 LICENSETYPE B BUS. LIC 9 5655 COMPANY NAME South Bay Construction E-MAIL soisontodd@sbci-corn FAX STREET ADDRESS 1711 Dell Ave Cr1Y,STATE,ZIP Campbell, CA 95008 PHONE 408-379-5500 ARCHrIECTIENGINEERNAME Jeff Brink LICENSENUMBER BUS. LIC 0 COMPANYNAME DCI Engineers E-MAIL jbrink@dci-engineers.com FAX STREETADDRESS One Post Street, Suit 1050 CITY, STATE, ZIP San Francisco, CA 94104 PHONE (425) 781-1505 DESCRIPTION OF WORK Structural design of exterior cladding system. Deferred submittal per plans — jt MV1 :Fe •i Z4- EXISIING USE PROPOSED USE CONSTR TYPE N STORIES USE TYPE OCC. SQFT, VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELARFA RFMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AR£A GARAGE ARTA: DETACH []ATTACH A DWELLING UNITS: ISA SECOND UNIT DYES SECONDSTORY OYES BEiNGADDED? NO ADDITION? NO PRE -APPLICATION [:]YES IF YES, PROVIDE COPY OF Is TILE BLDG AN ❑ YES TOTAL VALUATION: PLANNINGAPPI-4 []NO PLANNING APPROVAL LETTER E[CRLERHOME? By my signature below, i certify to each of the following: I am the property owner or authorized a a c property owners half. 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. 1 agree to comply with all applicable local ordinances and state laws relati building construe ' I authorize resentativ of pertina to enter the above-identi -identified pr a for inspection purposes. Signature of Applicant/Agent: Date: 2-111 � SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER -TILE -COUNTER El BUILDING PLAN REVIE\V _ 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 ,❑, PLIN 1NG PLAN REVIEW, _ _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1STANDARD ❑ PUBLIC WORKS farm 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 ❑ SA.\[TARI'SE\l'ERU15CR1CT submittal of Building Permit application. ❑ Enl'IRO\.mL•NTALIIEALTII BidgApp_2011.doc revised 06121111 CUPERTINO CONSTRUCTION PERMIT APPLICATIC COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING Dl 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildlnq(Dcupertino;orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATIOIN 1 Tl ® REVISION / DEFERRED ORIGINAL PERMIT # 15040206 PROJECT ADDRESS 19499 Stevens Creek Blvd APN 4 OWNER NAME Sand Hill Const Management PHONE. 55 E-MAIL nkumar@shcmile.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park 94025 FAX CONTACT NAME Nandy Kumar PHONE 650-344-1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX DOWNER ❑ OWNFR-RUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Summer Olson -Todd LICENSE NUMBER 336974 LICENSETYPE IiUS.LIC 11 5655 COMPANY NAME South Ba Construction Y E-MAIL solsontodd@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE.408-379-5500 ARCH ITECTIENGINEER NAME Cliff Chang LICENSE NUMBER BUS. LIC N COMPANY NAME Chang Architecture E-MAIL cliff@changarchitecture.corT IFAX STREET ADDRESS 251 Park Road, #900 CITY, STATE, ZIP Burlingame, 94010 PHONE DESCRIPTION OF WORK ,EXISTING USE PROPOSED USE CONSTR-TYPE # STORIES - USE TYPE OCC. SQ.FT. VALUATION (S) 'EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA 13ATH ROOM KITCHEN OTHER REMODELAREA REMODELARF.A REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA CFARACJE AREA: LJ DETACH ❑ ATTACH I DWELLING UNITS: ISA SECOND UNIT' []YES SECOND STORY ❑ YES DKINCADDED:' El No ADDITION? NU ANF. -APPLICATION ❑ YES IF YES, PROVIDE COPY OF 15 THF. DI.DG AN YF.S .• - - N: PLANNING APPL k []NO PLANNING APPROVAL LEITER EICHLER HOME? 0 NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on ihe.properly owner's behalf. T have read [his application and Ihe'information I have provided is correct. I have read the Description orWork and verify it is accurate. I agree to comply with all applicable loeal ordinances and state laws relating uildii7g constructia authorize prose t' sof Cupertino to enter the above-ide tified property for inspection purposes. Signature of Applicant/Agenl: Date: SUPPLEMENTAL INFORMATi REQUIREbPLAN CHECK.TYPE, r ` 40b 1 GSLIP f ❑ °oVER=TH "COIUNTE13 �� '❑'Jeol%DnvcPi.a,N-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 ❑_ PLANNINCIPGAN REV_ IEW..y Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑«*STANDARD ❑ 'PIfBL1C WORKS'," - fo_rm if any Hazardous Materials are being used as part of this project. :e❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Lctter or Meeting with Planning prior to 0 ❑ ISANITARY SEWER DISTRICT submittal of Building Permit application. ,' HAJOR �_ �'T ❑ 'ENVIRONMENTAL HEALTH', BIdgApp_M Ldoc revised 06/21/11 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building((Dcupertino.org Main Retail ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Ti ® REVISION / EPERP-2) omalNAL PERMIT # 15040206 PROIECTADDRESS 19499 Stevens Creek Blvd APN9 OWNERNAhM Sand Hill Const Management PHONE650-344-1500 E-MAII, nkumar@shcmllc.com STREET ADDRESS2822 Sand Hill Rd, Ste 241 srnTE,zip Menlo Park 94025 FAx CONTACT NAME Nandy Kumar PHONE 650-344-1500 E-MAIL nkumargshcmllc.com I STREET ADDRESS 2822 Sand Hill Rd, Ste 241 Cr", STATE, ZIP Menlo Park, 94025, FAX DOWNER ❑ OWNER-BUUMER ❑ OWNE.RAGENT ❑ CONTRACTOR ❑ CONTRAGrORAGENT ❑ ARCHrrF.CT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNA"f Summer Olson -Todd LICENSEwU"mER 336974 L'CENsET"H B 1 BUS, LIC 4 5655 "A"'.ME South Bay Construction E-MAIL, solsontodd@Dsbci.com FAx STREETADDREss 1 71 1 Dell Ave CM, STATE, ZW Campbell, CA 95008 PHONE 408-379-5500 ARCFII'TECTIENGINP.EKNAME Cliff Chan 110E'SENUMBEER BUS.UC11 COMPANYNAME Chang Architecture a.MAm cliffC&changarchitecture.coni FA's STREET ADDRESS 251 Park Road, #900 CITY, STATE, MP Burlingame, 94010 PHONE 650-269-4213 1 DESCRIPTION OF WORK {� 1 EXISTING USE PROPOSED USE CONSTR. TYPE N STORIES USE TYPE OCC. SQ.PT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECKAR.EA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATrACH 1i DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES TREINGADDED? ONO ADDMON7 ❑NO PRE -APPLICATION ❑YP.S IF YES, PRoV WH COPY OF 15 "M BLDG AN ❑ YES B TOTAL VON: PLANNINGAPPLII ❑NO PLANNING APPROVAL LETTER EICM.ERBOMEP []NO By my signature below, I certify to each of the following: I am the property owner or authorize 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 vZWit is accurate. I agree to comply with all applicablc local ordinances and state laws relating building constru utho ' repres ves f Cupertino to enter the above-ide 'Sed property for inspcction purposes. Signature of Applicant/Agent; Date: 58 lip SUPPLEMENTAL INFORMATI N REQUIRED PIAN CHECK TYPE ROUTING SLIP ❑ OWR-TRF'.-COUNTER ❑ 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 WORM form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ "M DEFT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONN ENTAL HEALTH BldgApp_2011.doc revised 06/21/11 E CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 I �i CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingO)cupertino.org 1p ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION 1 TI REVISION DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # OWNER NAME PHONE - E-MAIL �Ll STREET ADDRESS CITY, STATE, ZIP FAX L CONTACT NAME PHONE ,` E-MAIL ` \ STREETADDRESS l ` CITY, STATE, ZIP \ 7AX- 'g,OWNEP,❑ OWNERBUU-.DER ❑ OWNERAGENT -CONTRACTOR ❑ CONTRACTORAGENr ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ` t� LICENSE NUMBER LICENSE TYPE BUS. LIC # 21 COMPANY NAMEl" E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP q� PHONE l / epLJ - bg ARCHITECT/ENG ' RN c,, Ld LICENSE NUMBER BUS. LIC # COMPANY NAME EMAIL FAX STREET ADDRESS STATE, ZIP ` PHON ICITY, 1� ® ' DESCRIPTION of WORK j EXISTING USE PROPOSED USE CONSTR TYPE # STORIES OFFICE USE ONLY 0 L- TYPE DE CRIP-1ION SO.FC, VALUATION ' EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NET AREA ' BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA. ❑ DETACH ❑ ATTACH 9 DWELLING UMTS: ISA SECOND UNIT ❑ YES SECOND STORY ❑ YES DEINGADUM? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IFYMPROVIDECOPYOF PLANNER'S NAM& RECEIVFD13Y, N TOTAL,VALUATIONM' . PLANNING ADPLp ❑ NO PLANNING APPROVAL LMTER I (�N By my Signature below, I certify to each of the following: I am the property owner or authorized agent to act on the V,rop-4 owner's behalf. I have read this application and the information I have provided is correct. I have read the Description o Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws resat g building constructio . I prize rep en t" f pertmo to enter the above-'denti d property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED Plain EHECkTYPE ROUTING SLIP,` ❑, OVER -THE -(O- UNTER ❑ BtiILDING PLAN RE 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 PLANI,'ING PLAN "VIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure fl STANDARD El, Puaic"tin 'IM: 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 El MAJOR SANTTARY'SEli'ER,DISTRICT submittal of Building Permit application. , ❑ ENVIRONMENTAL IIEALTH� B1dgApp_2011.doc revised 03/16/11 CUPERTINO CONTRACTOR 1 SUBCONTRACTOR LIST Building Department City OFCupertino 10300 Ton -c Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 10B ADDRESS: 19499 Stevens Creek Blvd - Main Retail PERMIT # 15040206 OWNER'S NAME:Sand Hill Management PHONE # GENERAL CONTRACTOR: South Bay Construction BUSINESS LICENSE~ #5655 ADDRESS -1711 Dell Ave C1TY1Z1PC0DE:CampbeU, CA95008 "Our municipal code requires ell businesses working in the city to have.0 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 Date Please check applicable subcontractors and complete. the following information: e/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork X Cement Finishing Noah Concrete 29578 l X Electrical Wong Electric 20368 X Excavation Tucker Engineering 34378 Fencing Flooring I Carpeting Linoleum I Wood X Glass I Glazing -Classic Glass 25840 X Heating The Triilo Company 29816 X Insulation Central California Insulation 557 Landscaping X Lathing Oliveira Plastering 40153 X Masonry Pacific Bay Masonry 25509 X Painting I Wallpaper Burdick Painting 26007 � Paving X Plastering Oliveira Plastering 40153 X Plumbing Fresno Plumbing & Heating 32000 X Roofing Statewide Roofing 23509, / Septic Tank w X Sheet Metal The Trillo Company 29816 i X Sheet Rock South Bay Interiors 25499 �- X Tile Take It For Granite 26585 X Owner/ Contractor Signature 4127116 Date }