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15100205CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15100205 19319 STEVENS CREEK BLVD CUPERTINO CA 95014 ( S C BUILDERS INC) SUNNYVALE, CA 94085 OWNER'S NAME: DATE ISSUED: 01/05/2016 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 767196 Lic. # Contractor ( S C BUILDERS INC ) Date —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 ofthe Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: APPLE - T.I. ON FIRST FLOOR (18,980 SQ FT) I hereby affirm under penalty of perjury one ofthe following two declarations: OFFICE BLDG 2 MAIN STREET 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 DEFERRED #I - INSTALLATION OF ROOFTOP CANOPY (306 SQ performance ofthe work for which this permit is issued. FT)AND CONCRETE PADS FOR HEAT PUMPS. ISSUED 1-28-16. z I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 ofthe Labor Code, for the performance ofthe work for which this permit is issued. Sq. Ft Floor Area: Valuation: $500000.00 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 Issued b 1 y: - Date: 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 ofthe 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: 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 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 ofthe Labor Code, for the performance ofthe 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 ofthe 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: I 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 Licensed Professional ON v CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19319 STEVENS CREEK BLVD CONTRACTOR: SC BUILDERS INC PERMIT NO: 15100205 OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 910 THOMPSON PL DATE ISSUED: 01/05/2016 OWNER'S PHONE: 6503441500 SUNNYVALE, CA 94085 PHONE NO:(08) 328-0688 LICENSED CONT'RACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL APPLE - T.I. ON FIRST FLOOR (18,980 SQ FT) License Class Lic. #0� < (� OFFICE BLDG 2 MAIN STREET ,Contractor se- *U<Lb Date 01 D5 U1 d0 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $500000 ,performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31620109.19319 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ` granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section .9.18. _ 1 RE -ROOFS: ,Signature 't` Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ElOWNER-BUILDERDECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records, granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTIN0 ❑ NEW CONSTRUC G ?0: CC)NSTRUCTION PERMIT APPLICATION CO(Vi%1IUNI T Y DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ffo (408) 777-3228 FAX (408) 777-3333 • buHding ..cuUer<ino.org 171011 ❑ ADDITION . &TERATIONI TI ❑- REVISION / DEFERRED ORIGINAL PERMIT T PROJECT ADDRESS N311 / 1 1 I APN n _� j� . / C — OPINERNAI� Ni�t� S°C C,{I PHONE E•IfSIL S'T'REET ADDRESS CITY, STATE, ZIP FAX I 5400 Btu— F -R STE � MEN ?- CONTACT NA MIF . PHONE E -NAIL C�,a� I • (0. ci52,z vow@ L�e.«m STREET ADDRESSCITY, STATE, ZIP FAX I INF{avt"CO��// Loop GU ', CA R'S® I I] OWN -M ❑. OWNEP.-BUILDER CONTRACTOR ❑ CONTRACTORAGENT ❑ ARC?[TECT ❑ 1TGLNtcR ❑ DEVELOPER ❑ TENANT CONTRACTORK-AME G Sz?4AQk C.Z LICEI SE TI}1BERI LICENSE TYPE73g. ( BUS. LIC Y COI RANY NAS S<. tL E -NAIL I G FAX MV®6-� N ®A,1 STREET ADDRESS ltd l76mpwj )P�tE CITY, STATE, ZIP "NNid dLe , of 5g PHON • 3ve o(. BS, ARCMTFCT/ENGI..NFFRNAJ✓.E I� LICENSEhUMBER �I � BUS LI s COMPANY NA1 S I E-MAIL FAX STREET ADDRESS ,q � ` S t't4WALO ST . STe +0 CITY, STATE; ZIP . W%L0 Cl+105 I PHONE DESCRY TION OF WORK i 1 1-0 _ r EXISTING USE PROPOSED USE CONS -IR -TYPE 4 STORIES - - - i USE I TYPE I OCC. ( SQ.FT. ( VALUATION (S) EXLTG AREA NEW FLOOR ( AREA DEMO I AREA TOTAL NET AREA BATHROOM KITCHEN Oil -LER REMODEL AREA REMODEL :4REA REMODEL AREA PORCII AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH DVIELLINGUNTIS: ISASECOND UNIT E] YES SECOND STORY ❑IcS BEING ADDED? EINO ADDITION? 7NO I I PRE-A-pPLICATION ❑ YES. IF YES, PROVIDE COPY OF PLANNINGAPPL.m ANO PLANNING APPROVALLETTEIt IS THE BLDG AN ❑ I1 --s EICHLERHOME? E] NO \�_ I �. = R_ TQTAL VA-LUATION: °( ' By my signature below, I certify to each of the following: I am the property o%�neror authorized agent to act on the property ov,ner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and Yerify it is accurate. I agree to -comply with all applicable local ordinances and state laws relating to buildingn2 I authorize representatives of Cupertino to enter the above-identiied propei ty for inspection purposes. Signature of Applicant/Agent: Date: SL'PPLEAZENTAL Il`TFORMATION REQUIRED pear cx PE_ �_-zinGSln OC R THE COULTER BunDz.GPLANREi7Eii 1\Tew SFD or 1N4ultifamily dvvelli=: Apply for demolition permit foY❑ existing building s). Demolition permit is required prior to issuance of building - - - _ permit for new building z �I�r;IiL�GPL;,t� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure PUB1 c�ouric cTr N9ARD _ farm if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with PIanning prior to f M47oR 4 z��nY sEtExvzsricr = submittal of Building Permit application. r Bld,—App_�011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — RITILDING DIVISION mlADDRESS: 19319 Stevens Creek Blvd FEE DATE: 10/26/2015 REVIEWED BY: Sean APN: BP#: Select a Misc Bldg/Structure or Element of a Building #VALUATION: 1$500,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PME Plan Check: $0.00 PENTAMATION 1B TI PERMIT TYPE: WORK Apple Tenant Improvement on first floor 18980 sq ft). SCOPE p 0 hrs OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) 11-B,11I-B,IV,V-B 18,980 $3,089.60 IBTIPLNCK $9,411.60 IBTIIINSP TOTALS: 18,980 1,---$3,086 60-11"_ mss,_ _'- $9,411.60 :Rech. Plena Check I°h nh. Plan Check I'Iec. Plan Check .fleck Permii Fee: Plalmb� Per reit Fee: Elec. Per; -nit F'ee: Olher.Adech. €nspz Cither Plunn5Ins'p, 011ier, Elea Insp. ilech. Imp Pee: PhimL Insp. Fee: Elee. Insp. Fee: NOTE: This estimate does not include fees due to other Denartmentc (i.e. Planning. Puhlic Wnrkc. Fire. Sanitary Newer Dictrirt District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 1.1-053 Ef 7/1/13, FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,089.60 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Reg. 0 OT F7 F; $0.00 PME Plan Check: $0.00 Permit Fee: $9,411.60 Suppl. Insp. Fee -0 Reg. 0 OT p 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C.`ons=tr~uerion ax: _1thninisir~txtive Tee: Work Without Permit? 0 Yes No $0.00 Advanced. Planning Fee: $0.00 Select a Non -Residential Building or Structure Travel €'l It�ccrrrr:atrataott fie€ .s°°. Strong Motion Fee: IBSEISMICO $140.00 Select an Administrative Item Bldg- Stds Commission Fee: IBCBSC $20.00 z7BOTAL 12,661.20 $0.00 TsiA%Et_ $12,661.20 Revised: 10/01/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15100205 19319 STEVENS CREEK BLVD CUPERTINO CA 95014 (S C BUILDERS INC) SUNNYVALE, CA 94085 OWNER`S NAME: Main Street Cupertino Aggregator DATE ISSUED: 01/05/2016 OWNER'S PHONE: 650-344-1500 PHONE NO: 408-328-0688 i IGEN ONT A TOR'S DECLARATION BUILDING PERMIT INFO: License Class 6 Lic. #767196 Contractor (S C BUILDERS INC) Date —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: APPLE - T.I. ON FIRST FLOOR (18,980 SQ FT) I hereby affirm under penalty of perjury one of the following two declarations: OFFICE BLDG 2 MAIN STREET 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 DEFERRED performance of the'work for which this permit is issued. 2. I have Worker's Compensation Insurance, - - and will maintain as provided for-�����`i5� by Section 3700 of the Labor Code, for the performance of the work for which I / �.r�� %✓f �« this permit is issued. Sq. Ft Floor Area: Valuation: $500000.00 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations per the Cupertino Municipal Code; Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION. 'Signature Date bk 9 (2$�Ztllis by: .4 Issued b y OWNER-BU DERDECLARATION Date: 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. 1, as owner of the property, or my employees with wages as their sole installed without fust 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 construct the project (Sce.7044, Business & Professions Code). Date: 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 this permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. 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 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 & Safety Code, Sectio 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: �Z Dt 2At (o APPLICANT CERTIFICATION - Date: I certify that I have read this application and state that the above information is CONSTRUCTION LENDINGAGENCY 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, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date Professional CONSTRUCTION PERMIT APPLICATIONEMMA Y' C, T ,- rE4 03000EAVECtUE�CUP-RTlttOIiCrAr N5014-25 - (403) 777-3228 - FAX (408) 777-3333 buildinolac ` Ora C:UPERTINO- ; 1--1, �n r I .-rrrsr�iY n eT=M 7,-rTn%T/TT I]C'1 R77vicTrW /T1FrF'R12 n n"R TCrI t T AT, Pi<R 1\1T7 k1 gi, ; ..P.-2011. doc revised 06121111 PRomc-r ADDF.-SS Lj A2N � _ W SIT OR?vERNA7J� 3ON^ r STREET ADDRcSS ji j, C) -i1, STAT,, ZIP. m I AX t ✓i'[ 1 {�Ul'c� �/8 if I 1I Yif I Ci CONTACT NAMEP i0N u.Ss. XW w' k'7q _ btu, ! me "V & APple- � STz2EETAT�DR SS WV' p m llq-) 4 I C"Vr f4we/ 0, ""�� i FAX ED OR tR I]. 01 NT_t'-3USDE$ ❑ oR^,'RAc-: it CON1PkC'TOR D CONIi XTORAC-=IirrAAC?1 QCT El BNon` �R ElDE =LOPS. 13 CON—IRAC10RNAN,$0t/ �G�' i I LICE SBr,0�li8ER id l Y/ I LICETSETYPE I BUS.LICf ( oOiaAlYNA.hS'-- Q ` I E-7✓SIL I FA STREET hDDRFSS CITS', STAT -n, ZiP 6110 "t�-�.c0.L1LSQKj P ! SiR�i�ii'1�AL� . C�1 �14d?'i'i� PHONE � .`3,2,5•�C��� APC?17ECTrNCT ER NA'✓>E �/� j1} j� ((� LICE1SEhr? vER 15L'S. LIC 9 kr r 7J.AsL .o D' w. 7 Ah E 94469444" FAX I , STF'-T A DDP = S CiY, STA i r: ZIP � q�j- 66 v, 6p--! i o -ROI ® ' 1 ' '—t I - DESCR3TIGN OF WORK t U1 /�� Jay /-►' �flp 1�/-/�l ® A �n � � �F l•! 1 lI O`er vii f'+' V � ". �. - o 1r t!yr - ��TC1�F�" E:CSTD.GUSE I PROPOS-FID USE F CONS TY E I r' STOPUTES jl I USE � TYPE I OCC. � SQ.FT. I V.kLUATI01`J(S) EXL G FG AREA I ?\rNFLOOR AREA I DEIdO I TOTAL AREAN.=i AREA - !BA HKOO?, i.EIIODELARZA. AYEA REMODEL AREA �. pORCHARBA I. 1 D=CK:As,_=.A I TOTAYDECKTORC ARBA I G.-.ZSGEf.R-A; MDETACH ❑ hiTAC3 I. I I I .. , MWELL \GUlTFS; I SSASEC'OND.UNIT []Y=S BEING ADDED? ANO` SECOND STORY ❑YIS ADDITION? ❑NO I. - PP e n iCA.TiON ❑ YES r LYES, PRovm-- COPY OF PLAN'hrLNG A3Pa,0\'ALL=—y rER. IS THE BLD G A -N ED YES EICHLEzZ'SOhiE? El NO .- - TOT." -L U.4'i 70?�; - - _ - .N -. PLA',T7TG A.PPL R. ❑ NO By my sig n -.tune Wow, I certify to each or the foilmvi,_: I am the property o, mer or authors dLagent to act on the property ov ;per's behalf I t e read this application and the information I have p,ov ided is cc e t. I have- read tht Description ion of «'ork and � en j< it is accurate. I a ee to-ornply -with a i �DplicabI local and state ��� s r ]�tin� to buvc' g ` as` I a rthori represen__ .cos -of Cupertino to enter the aboee is al. ed prope for inspection purposes. orecr_aces vt�Dto��t� S Rratnre of Applicant/Agent _ Dom` SUPPLE> FENT L D\IFORMATi N REQUIRED _ ]� 'O��R T COL�iTs'R -` BLTr�.Di'�GPT jN 1Z:T_7L'-'tit _ y. Ne SM or Muhi!`=HY d ��'elling5:.�_pply Ior dC 701i' O--1 p0:I11?t -Or n� m -ia t it is _eQuiled pnOI i0. 1S .L -'?Ce OI 011ilo II� eKisti_ g b ldi .a(s). Dernolition pe, _. _ -- _ E��SS= - -- _ _ - PI�i �L\GYLd 4 PT�ZEFi pe tit for nes, building. _ _ __ _ _ Co nmercizl Bldzs: Pro~. i de a completed Ha-7ardous M_t rials Disclos' ure 7—n T��e.Rn — PLBL�c oliTcs 1r Fny Hazardous Mate iais arebtip� used as parr of This pro)..ct• Copy oft 1=1 - Approval Letter or ?fieetin�Q with Pl�-im..a pri.or to submittal of Building Pmmit appllcatiorl. _.—EA'=FiROn?iYx''�T .Z,:fiE4LT7-_ k1 gi, ; ..P.-2011. doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION - iaADDRESS: 19319 Stevens Creek Blvd --TDATE;' 01106/2016 REVIEWED BY: PAUL APN: 316 20109 BP#: *VALUATION: I$o' *PERMIT TYPE: Building PermitPLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE. PENTAMATION PERMIT TYPE: 1 GEN WORK Deferred #1 - Installation of Rooftop Mechanical Equipment SCOPE PME Plan, Check: A"'ech. Pk�"' Check pe�w�'4 Fee, hisp" fee: NOTE. This estimate does not --dPlu;0, Plan Check I I 1-111-Z.O7b. 1 1 "ce" fees due to other Departments (i.e. Plai Ele�" Plan eonif Fee: irks, Fire, Sanitary District, etc.). Illesefees are based on the preliminary inlormation available and are only an estimate. Contact the Dept.jor aaan'l info. FEE ITEMS (Fee Resolution 11-053 U,-ff 7/7/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $286.001 Deferred Submittal IDEFSUB Suppl. PC Fee: (E) Reg, 0 OT:=hrs $0.00 PME Plan, Check: $0,00 1 Permit Fee: $0.00 Suppl. Insp. Fee: (E) Reg. 0 OT:= hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced. PlannjngjFee: $0.00 Select a Non -Residential Building or Structure Strong Motion Fee: $0.00 Select an Administrative Item Bldg Suds Commission Fee: $0.00 —,,SUBT0,TA,LS4` $0.00 $286.00 —TOTAL,FfE $286.00 Revised: 10/01/2015 CUPERTINO PURPOSE UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinga-cupertino.orp For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Download this form at: http://www.cupertino.org/index.aspx?page=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 building a,cupertino.org 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (4404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN BLDG PERMIT #: 15; 100210S DATE: SITE 9 31 ADDRESS: q S f eV-eVt S Gr-ce k.. `F.j Vd, e.ulaer -zK O c A 1'J O B OWNER'S NAME: A PP%E TAX PHONE#: ?3 22- , . FAX #: MAILING ADDRESS (if different from site address): Gv t._ G © `, I - 00S 119 - D Ci CONTRACTOR:G ��i `�ers Inc,PHONE #: y _ FAX #: 4 p R - 3 2 - b CONTACT:/ T,DO£. A S co to S G PHONE #: 6570- fo b `i 3 02 FAX #: o k- 2 °- b ,f I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occupancy for the building. Owner: ... ..... ......... Print:.: t ? /:. Date: ..... 'e.5....... Contractor: ........._ 4 ............... Print: ....�.JU.................... Date:...1�l..Sl..f .7 ........ I UtilityReleaseForm_201 Ldoc revised 08/09/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1147 19319 STEVENS CREEK BLVD CUPERTINO CA 95014 (S C BUILDERS INC) SUNNYVALE, CA 94085 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 01/26(2016 OWNER'S PRONE: 408-639-9322 PHONE NO: 408-328-0698 LICENS .DCONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Ja Lie, #767196 Contractor ( S G BUILDERS INQ-) Date 0 112612016 X BLDG _ELECT _PLUMB I hereby affirm that T am licensed ander the provisions of Chapter 9 (commencing — MECH '—' RESIDENTIALXCOMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is In full force and effect. JOB DESCRIPTION: 15100205 DEF# 2 - RF Chambers submittal. I hereby affirm under penalty of perjury one of the following two declarations: s. I have and will maintain a certificate of consent to self -insure for Wor'ker'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 ofthe work for which "C this permit is issued. Sq. Ft Floor Area: Valuation: $10000.00 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 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply call non -point source regulations per the Cupertino Municipal ti Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION, a Signature Date 09126/2016 Issued by: ���►��,(T� Date: 01/26/2016 OWNER -B IIAMR DECLARATION RE -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 1. I, as owner of the property, ormy 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) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 2016 contractors to construct the project (See.7044, Business & Professions Code), I hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVF,RTNGS TO BE CLASS "A" OR BETTER n. 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 California health & Safety Code, Sections 25505, 25533, and 25534, I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. 1 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 bocomo subject to the 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 & Safety Code, Sections 25 5, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemcdrevoked, Owner or authorized agent; Date: 01/2612016CONSTRUCTION APPLICANT CERTIFICATION LENDING AGENCY 1 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 wNch may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITFCT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records, Cupertino Municipal Code, Section 9.'18. Licensed Signature Date 09/26/2016 Professional CUPERTINO, CCNSTRUC T [ON PERMIT APPLICATION COMIVUNI T 1' DEVELOPMENT DEPARTIdiehl T : BUILDING DIVISION S 0300 T 0RRE AVENUE • CUPE.RTINO, CA 95014-3255 (408) 777-3228 . FAX 1408} 777-3333 - buildino ..cuoerino.oro Ammcu _ LJ ALTIRATION/Tl PRarzct?.)DRESS kP� m vJ 113�4IA cTt�,�w, c �n � 4-3. ,� 3;ziw "f e - 2vfb- nip 0Vn LRY AI✓� T PRopolli:DvaCONST&TYFB 9HON `a ayf��µ�, Lnj yS eJ �J I •yckow 1 1 S • �. _ l ` - . LY /- 1 . 1O 6,•� Ln -CA K `�'. irfil STREET hDDRESS 14$Iq sTsveNs CITY, STATE. Zig+ 4 (-gP5P-npjg..0 CA g5lll,#— FhX COMIACT 1..I, E v4we5s q-P?Iox-� Ulf Aee t4 • earvl USE I (¢a32_1—uEi? Qg . $9. STRS_t ?)DRESS N tJN�� t��oP YAI UAT10 (S) CITY, STAYBE ZIP I Nd 0r4-.-2AcmT FAX ow, - ❑ col.°aZi ACTOR 1:Co\rr?,•?_CToKA,,`c1.rP ❑ AR=T l Q cNC-Wr- B EI AAPr CONDI ACTOP,KAh ` � � L1Cn,A*SE?JtI1 SER f L1cZNlsB 7Y -P-- 181)5. �—e I l LIC C01,plxy 1QA1 SL L 17� G3 = N�41 4Aerrs Tants,& � 'FAX STR:ET ADDRESS CTY, STATE, ZI? �y qI.D Yul(TSotJ _ Q ( S4dNPe)Y✓4LS 1�;E+5 Pi'01 --3Se11J16$ & o5- r ---^ ARC,'-iTcC t1v0II3=rZNAME L�IId n1 L1CZNSc-:XulsER � BUS. TIC,". COMP 01v Nil ME 571cul?c STREET?DD?,`.n 4�G�? �..� u� 9 � CTI -Y% MT E, ZIP - SW � use ,► c�► x-105 - Paor r 415.Jaz . 538n DESCPZ—;ION OF WORK 5! E)_'IST12,011SE PRopolli:DvaCONST&TYFB ( }I USE I TYPE ( OCC, S�.FT. YAI UAT10 (S) JOniG NEW FLOOIR DEMO .TOT?S I £AT=T.001 =1C:>�i Py7riODEL?.R=A R*I40DEL'L?3-EA R:MODFL?.Pc A PURCH l R'?A� DFC.K k% --A A GF.RACc ".RZA:DETACH [] ATTACH I Ij rDV, --LLAGti,TiS; ISA SECOND UNIT lDY_.S S£CONIrSTORY L]Y?S"— B£TTGADD£D? L3 K-0 ?_DDrTIOA? � IS TFR BLDG Ah L] ?,,o ❑ S?a- x.` =_' 7.--,��-'•:�. 4-t �. m�` ' =e^ II` TpT }:? � U.4:?OI`1: PPS• LP?LICATIOId [317S TF YFS, f'ROYME COPY OF PLANNING, !.PPL []1,O PLAe,--NGAPPP,O}VAL Lei,_3 � SICELERI-IOi,4e7 h0 ��-�,_=� _ ms's-- _-==_----=tt---=-� �i000 tsy my sl�Dature oeio�r, I cera y Io eCCh Or Lhe EClloi, ln?: 1 am the proper), owmer or authorized tivar,t to act on th.Vo ooe, oH�er's behzlf. I have ;tad this Dplic2tion znd thein: s,,.ation I have provided is co„ec#, 1 Iz}•e read i a Description of lajork and t erij it is accuL��:'e, I zeree to comply with all-pplicable local ordinamrs and State laws relatin to building, on!;w lcbon, I 2uthoTi7e represent lives of al peTi_rJo to enter the above -identified propaa.y for inspection pu-rposes. SimalurtofApplicznt!kgcnt: `Z Caw,- Ws*Vw426z DFte: 01111 hMiv SUPPL EXrENTAF REC h ATION REQUITREDr Rte,= =_= _ __ -__ __ w - • =_ _ _ s= t. New SFDor ML_11. 1.y d i ll'_.__.AD ply for de Joli#ioz pe:::__t for {i`; —=- Y , = _'{`—_ mcc'-'�i s-,'x'ti-= �- existing v t111 C'�ir1a S . �eTiOlif1071 ea'i'ui# 15 require, r' is is. P s,i v BVERzT C r HT37I:DL'h'�G i.z .1 .i _x. b g() p prior #o __si 7c., of b__Idin� permit for new building.L7MIMI .�c�� _ c i 'r 1 tr ti, F_ is DT's lo's it - CD.:aai•ercialld�s; Pro a coa_tp.eted r_z_2zeo_s A_ ter_ IS J'JC.4 L. 30ru1 1? 2T 1-lczarL10LS lvlciCri2l5 are. bCinQ LSC€I 2S pa rt O If ih•S pr qj Copy oPIaILaJv Approval Ler or heRtir�a with Plymn� prior #a St!b7nii l2l of PuLlding.IPan-nit application, N3 -FP.' OF L ..;,%-,-_- 1 Y=��� � •-� •:3�:c>,,}p RTsTC G I •81:�'arn�_?01 J.r'ac revived 06/illl7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19ADDRESS: 19319 Stevens Creek Blvd DATE: 10/2612015 REVIEWED BY: Sean PC FEE ID 1 APN: BP#: *VALUATION: 1$500,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 1BTIPLNCK PENTAMATION 1 B TI PERMIT TYPE: WORK A le Tenant Improvement on first floor 18980 sq ft). SCOPE Suppl. Insp. Fee:Q Reg. Q OT OCCUPANCY TYPE: TYPE OF CONSTR.. FLR AREA (s.f) PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) 11-B,III-B,IV,V-B 18,980 $3,089.60 1BTIPLNCK $9,411.60 1BTIINSP Nuc, Insp. Fee, $9,411.60 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cofnsiruclion Tax.' A(lininislraln'e Fee: O O Work Without Permit? I) Yes (F) No $0.00 Advanced Planning Fee: $0.00 TOTALS: 18.980 1 $9,411.60 Select an Administrative Item MECH, HOURLY O Yes O No PLUMB, HOURLY Q Yes (j) No ELEC, HOURLY O Yes Q No 3•lech. Plurr Check Plumb, Plan Check Elec, Plan Check hleclr. PcrrrtR ! ie: Plumb. Perurit Fee: 11ec. Permit Fee: Other Alcull. Insp.ET-L- Other Plumb Insp. Lj Usher• Elec. Insp dlech. Insp. Fee: Plumb. Insp. Fee: Nuc, Insp. Fee, NOTE: This estimate does not include fees due to other Deparlmenls (Le. Planning, Public Works, Fire, Sanitary Sewer District, Sehool District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'1 info. FEE ITEMS (Fee Resolution 11-053 EfL' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,089.60 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (D Reg. Q OT 0.0 1 hrs $0.00 PME PIan Check: $0.D0 Permit Fee: $9,411.60 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cofnsiruclion Tax.' A(lininislraln'e Fee: O O Work Without Permit? I) Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure O Trcn:el Doe irmenlulion Fees: Strong Motion Fee: IBSEISMICO $140.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $20.00 SUBTOTALS: 12,661.20 $0.00 TOTAL FEE: 1 $12,661.20 Revised: 10101/2015 CITY OF CUPERTINO FM -,7 FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 19319 Stevens Creek Blvd DATE: 01106/2016 REVIEWED BY: PAUL i'1.'r;. I'htr• r'1,ru;! APN: 316 20 109 BPH: °VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building GPi;a�l" i�h,'ra fY�7t1.Lj PENTAMATION PERMIT TYPE: 1GENC0 WORK Deferred #1 - Installation of Rooftop Mechanical Equipment SCOPE $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fare, Sanitary Server District, School District, eta). These fees are based on the prelintinary information available and are only an estimate. Contact the Dept for aeldn7 info. FE7— FE E ITEMS (Fee Resolution 11-053 Es'f: 711/13) isec;+. 1?),:Fn C`l��r;'d 1'l�nr!�, F'knrC beck i'1.'r;. I'htr• r'1,ru;! :kelt. ?'et;rr;r 1;�e. Piar�n?s, I'r�riri i��:c�; %k't. Yerrrrii (`� ". r, ��Diit?r° ,vic fW. OIh�IS. GPi;a�l" i�h,'ra fY�7t1.Lj ;' lxz;?t. li sp. l r3e'_: rllNl;lJ, ]r[i_r7. 1 d P: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fare, Sanitary Server District, School District, eta). These fees are based on the prelintinary information available and are only an estimate. Contact the Dept for aeldn7 info. FE7— FE E ITEMS (Fee Resolution 11-053 Es'f: 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $286.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: Q Reg. () OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg, Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ..f,�lYllll�S1€ftlll'[' f'�tr�; C) Work Without Permit? Q Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 1�•rx•��:;. f.3 �„r.„t�t r „ ,..uitiai,ia+t s_ 1•' Strom Motion Fee: $0.00 Select an Administrative Item Bldg, Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.00 $28(1001' TOTAL FEE: $286.00 Revised: 10101/2015