B-2016-1372 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1372
10475 S DE ANZA BLVD CUPERTINO,CA 95014-3011(359 17 019) CHAI CONSTRUCTION
511 SHADOW CT
OWNER'S NAME: BDC HAYWARD LP DATE ISSUED:02/16/2016
OWNER'S PHONE:415-812-8996 PHONE NO:408-677-6006
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT.INFO:
License Class a Lic.#1000313
Contractor CHAT CONSTRUCTION Date 02/16/2016 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
LOVING HEART-T.I.TO RECONFIGURE EXISTING AREA(1290 SQ
I hereby affirm under penalty of perjury one of the following two declarations: FT)
rI have and will maintain a certificate of consent to self-insure for Worker's
1compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2.,A have and will maintain Worker's Compensation Insurance,as provided for
y Section 3700 of the Labor Code,for the performance of the work for which
this permit is issued.' Sq.Ft Floor Area: Valuation:$10000.00
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 APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 359 17 019 B(Tenant Improvements)
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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
Code,Section 9.18.
Issued by:SEAN HATCH
Signature '� C . '')_ Date 02/16/2016 Date:02/16/2016 � G�
-OWNER-BUILDER 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,asowner 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) Signature of Applicant:
2. 1,as owner of the property,am exclusively contracting with licensed Date:02/16/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
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 HAZARDOUS MATERIALS DISCLOSURE
perfdrmance of the work for which this permit is issued.. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. 1 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
Health&Safety Code,Section 25532(a)should I store or handle hazardous
this permit is issued.
s. t 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 pdefined the Bay Area Air Quality Management District I
will.maintain compliance with
the Cupertino Municipal Code,Chapter 9.12 and.
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the fF'
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date:02/16/2016
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant
understands and will comply with all non-point source regulations per the I understand my plans shalt be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date 02/16/2016
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• building
-CU �cupertino.org
- _ �---
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑_ REVISION/DEFERRED ORIGINAL PERMIT#
PROSECT ADDRESS (19 • f'T(y {-yL Vp APN# 3 t
OWNERNAME PHONE E-MAIL
STREET ADDRESc — — CITY, STATE,zTT
CONTACT NAME PHONE V E-MAIL,J
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CO RACTORNAME LICENSE NUMBER [CENSEWE BUS.LIC-#
COMPANY NAME E-MAIL � FAX
nal 01'I'Mc
ET
ADDRESS CITY,STATE,ZIP y PHOAE
S
ARCHITECT/ENGINEERNAMU"D RAI r t4NO LICENSE NUMBER " S a j r� S BUS.LIC#
COMPANYNAME �r W ap,, F`X
NIN
STREET ADDRESS d Z B G j CITY,STATE,ZIPC 4t u�(p PHONE
DESCRIPTION OF WORK /
"to nroN- �� tr r: ���t�®� � ono� �xt.�T?�v Moe
EXISTING USE PROPOSED USE - CONSTR.TYPE STORIES
oAgw1z I A4uaNCTvwC I Ni-113 !e USE TYPE OCC. SQ.FT. VALUATIONS)
EXISTG NEW FLOOR DEMO TOTAL /
AREA A O AREA AREA NET AREA
BATHROOM KITCHEN OTHER !�
REMODEL AREA ® REMODEL AREA 4// REMODEL AREA
PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA GARAGE AREAi U DETACH
ATTACH
#DWELLING UNITS: ISA SECOND UNIT LJ YES SECONDSTORY ❑YES
BEING ADDED? []NO ADDITION? E]NO
PRE-APPLICATION' ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ElYE VE -. a TOTAL VALUATION:
PLAN'NTING APPL# ❑NO PLANTING APPROVAL LETTER EICHLER HOME? ❑
5
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act�on the ertyowner'sbeha fI avereadthis
application and the information I have provided is correct. I have read the Description of Work and verify it c ate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter tabove-Ide tiffied property for inspection purposes.
IN
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED '
;• t,k�' xa?:� a mac, - c &' t_ v _ z` _ ,`'
_New SFD or Multifamily dwellings: Apply for demolition permit for 2 �O}ER rxE coII�TEu � L7' $UILDI�G�LA\ItEi IE\F�t ��
existing building(s). Demolition permit is required prior to issuance of buil,dmggt
�, ; T
permit for new building.
EI2ESS c ❑: PLAY�L\G PIy4Iv RE�TETi' T
a
xs'� '�
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Lfl sTA\DARD ti ❑ PUBLIc��'oRis -
a� „y 9 w
fonn if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or Meeting with.Planning prior to 1] MAaox� � fl s��ITAR]sEt�ERDISTRIcr
submittal of Building Permit application. .
__ � s ' Q°.EN`��IRO\MENTAUHEALTH. z.
Bldg4pp_2011.doc revised 06121111
i
CITY OF CUPERTINO
FEE ESTIMATOR BUILDING DIVISION
ADDRESS: 10475 DE ANZA BLVD DATE: 02/1612016 REVIEWED BY: ABBY
APN: 359 17 019 BP#: *VALUATION: j$10,000
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY Civil/Religious activities PENTAMATION
USE: Commercial Building inBQ zone. 1GENCO A
� � Yes �No PERMIT TYPE:
WORK LOVING HEART-T.1. TO RECONFIGURE EXISTING AREA 1290 SQ FT
SCOPE
..
,G'eY,atf;,id� ,����. ;.r .za F:.._iC.. .z. 3 r:r r.. Fee,
frty g7'f 33s.) Ug,
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.. Theseees are based on the prelimina information available and are onl an estimate. Contact the De t or addn'l info.
FEE ITEMS flee Resolution 11-053 ' . 7i1/13L FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = l.f. Interior Partitions
SuppI.PC Fee: Reg. Q OT 0.0 hr's $0.00 $1,145.001-
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee:Q Reg. Q OT -o- hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax: IBCONSTAXC $0.00
Work Without Permit? 0 Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
StrgDg Motion.Fee: IBSEISMICO $2.80 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS:; $3.80
$1,145.00[
TOTAL FEE: $1,148.80
Revised: 01/01/2016
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PLAN REV-1-:1W COMMENTS
xistina-ilrc s?r, kle, &ilrc alar-,-n s t %a shall It)e rriGrii3 ass rtcC.SSar' C' ��
LW1 lid e-tS Ot Qi tdlt �$
cL ^let-d -'-- r,it_p lic_tion cs t0 r :cu t2 1F -
r r' r� -r C:c7_CO1P,iy Y`lr -i. tGi appy0 '-lor t0 _lt ,ina
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11 ,.,CnS Gt i':° L_i:.�_ lI be v'li:i.Z %� . t Of IIiF �_. i�_I t,�, =vi l�?riinl: , iciii;_0=
z.1 o-BC, CFc aos
�(J4Com:-n ir,ial Dockin- cCui'�7, .t_-BA be provided , iul a Cl -T L - -
`i 5 , 1- � Lis��O1 LGkJIc:li c C:�`Tt�: �lor,= O .
_0 ,�;t off e eCiuipTetnt and in he r_.h o -:::it :.I. CFC.�'o u
F -"� shall�- � r �_Y '
•arcz. dDOrs s a ..teacily Oren€ble born the _7ess s1Cc 1=1iu110L'�special IC?0�'I�Oc' i�J -,r•
r' r>II not
c /1 )r5.-,u ir tight Espine,tight D'InDhlnQ or tvd.stiP 0- til h',,st t.0 07�:ctc, Key orcrc.cj I•CI�: 6' vic S a,c
when .e--di1y cisti,- „i `,_bl..as to--ked and si',aea 1n-IS DOOR 10 ULOCKED
iWHEN 3UILDTING IS OCCUPIED, CBC '. .tea
Z
e_ns ofFegress shall be llu—�irra:ed tip s tiil �O TllrLiC bcCC l \
Or in0r5 - arsall
rewired, CBC 1005.3
��C— kxi�s Shall be mazlsd by ilIuri���ted _ it suns. Signs shall be i flu iir, ted�t all tii les andt1 50 :nir,tt=:
O e: , ,RenCy baSkUp POWe7, CBC 1011
ContL -tor shall fieId verify the ,n Fanny or existing r `Cd consW'Uv ion asse lb Has and r--CP@ D, -pair=s
G `2 � n5cesa P neu_ti0ns 1n ra-ted walls/ceilings s`?all be protected lc' �`,
�.� jam' I �- �' p- d b� 1'_�ed :ire rat�d assemblies a,; ers,
doors,cculking, :ire stopping, etc.) CFC 703
All
In 1 i x.. sli&lI provid a labeled P-mcr=cr-ic ecCc:s k57v iDr p1accTlcL,t l l ui'c1Jt!]1C1 � - - C a
L [[ rl m=rgeinc cess lacy
&. CFC
1'his plan c :cit does not perm the>>=B c ace di; c, d
p , _tC� or , s� �or hazardous malerials, 07c'ai107a CT i?acic,
te.nantshall provide_co,;, leted HM11S to _' , :.:c d ?a,.... in 's ha-ardo�_s rr_t.-, I, s-€ 'al
r p' _ r ist or
and commend, CLOSU--RB PF'.R�,/I_IT !s required prior tC terr:,ina .ng the stOra.c. ;' _= l^ !S
a 0_ ii QC_a,T:a,cr?_
ci S` -ed d
a.p"rrili icd StOTa_- :acilii' D=-Moliiic7 o any iacilityl-torac., 2.-a that'Ore-vio��slyd � t,
.w u_-_ 0i s
`raieri2i5S 1811 not -- ='Cp:Qled pr;Or to Cb`a1PiP=_CT•O�f��� PERMIT,
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