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15110179CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15110179 19389 STEVENS CREED BLVD CUPERTINO CA 95014 ( METHOD CONSTRUCTION INC) GILROY, CA 95021 OWNE A DATE ISSUED: 02/23/2016 j OWNER'S PHONE: PHONE NO: 408857112 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #764938 Contractor ( METHOD CONSTRUCTION INC) Date 2/23/2016 —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: TENANT IMPROVEMENT OF (N) WINE BAR "ROOTSTOCK WINE I hereby affirm under penalty of perjury one of the following two declarations: BAR" (1731 SF) 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 r _ performance of the work for which this permit is issued. ) I have and will maintain Worker's Compensation hisurance, 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: $82500.00 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 ordinances and state laws relating to building construction, and herebyf APN N ber: 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the granting of this permit. Additionally, t applicant derstands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source re lata ns pert a Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9;1 Signature Date 2/23/2016 Issued by: PAUL O'SULLIVAN ��.-.---- Date: 2/23/2016 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 r. 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) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 2/23/2016 contractors to construct the project (See.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 performance 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. 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 whit it 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 Ma agem atDistrict I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Co e, Cha ter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health &Safety Cod tions 25505, 25533 and Z55 4. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revolted. Owner or authorized agent: Date: 2/23/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDIN NCY 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 ARCHITECT'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 2/23/2016 Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building Qcupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION M ALTERATION / TI r-1 REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ® �� j340 APN11 OWNERNAME,�yJ I`7 f/J��.M/e/M���m� PHON,F �i®D E_MAH. S ET AD SS C STATE, ZIP a .� ® go ' j ` rw ?410cp� _ Ftcsa)?#4-- o6`s-o- CONTACT NAME r� < [+VI f' PHONE (� -96Z-51!67 E M/AIIJj 1. (! . I STREET ADDRESS z7a fr. '. ® Pte"' s JzGc e/� C S� s I / ®�AJg% FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT X ARCHITECT ❑ ENGINEER ❑ DEVELOPER 11 TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC COMPANY NAME - E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARC CT/ENGIINE�ER NAME �� .may-^ LICENSE NUMBER l �B �.® lH 4 BUS. LIC # /` °�P� COMPA�"�0"&7elay. P:7 �AGm'O44M STREEADDRESS ,/�T ward• ,ZIP DESCRIPTION OF WORK A� ® Vo EXISTINGUSE - PROPOSED USECONS � TYPE #STORIES / USE TYPE OCC. SQ'FT. VALUATION ($) EXISTGf AREA Bg NEW FLOOR AREA DEMO AREA TOTAL NET AREA �d ?.�7 -- A--2— a f I l •J 6 BATHROOM KITCHEN BATHROOM OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLINGUNITS: ISA SECOND UNIT OYES SECOND STORY OYES BEING ADDED? ONO ADDITION? ONO - PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES = ;$'ECEIVEI�' '';+ ` TOTAL VALUATION: PLANNING APDL# 1-1 No PLANNING APPROVAL LETTER EICHLERHOME? 0 N By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the o rLy owner's behalf. I have read this application and the information I have provided is co - t. I ave read the Description of Work and verify it is accurafej agree to comply with all applicable local ordinances and state laws relating to buil ' au a epresentatives of Cupertino to enter the above-identi p erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO ION REQMRED E OYER THE-EOUNTER BIALDR%WL N.REvrr,;w 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. Q EXPRESS rLAtv�IiluG Pr xEvrEw _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ['StkNUARD 1]a PUBLICIYORKS form if any Hazardous Materials are being used as part of this project.ID 00'. FIRE11EVE _ Copy of Planning Approval Letter or Meeting with Planning prior to MAJEIl€" 0. SAALWITARYS> WEItDISTRICT submittal of Building Permit application. IIVYIAONMBNTALHHEALTH BldgApp_2011.doc revised 06121111 CITE' OF CUPERTINO FEE ESTIMATOR — HITILDING nIVIRInN imlADDRESS: 19389 Stevens Creek Blvd FEE DATE: 11/25/2015 REVIEWED BY: Phuong APN: . 316 20 112 BP#: Select a Misc Bldg/Structure or Element of a Building 'VALUATION: $82,500 *PERMIT TYPE: Building Permit PLAN CBECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PME Plan Check: $0.00 PENTAMATION 1A TI PERMIT TYPE: WORK Tenant improvement of N wine bar "Rootstock Wine Bar" 1731 SF SCOPE 0,0 hrs TYPE OF FLR AREA OCCUPANCY TYPE: CONSTR., s.f. PC FEES PC FEE ID BP FEES BP FEE ID A (Tenant Improvements) 11-B„111-B,IV,V-B 1,73`1 $2,484.71 IATIPLNCK $1,129.55 1ATIINSP ' TOTALS: I 1,731 I $2,484.71 I $1,129.55 FIZA 0iher blec"h—hap, (Mber Pl roti} 1 ee. i ip, Fee: TOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). Yhese_fees are based on the preliminary information available ana are only an estimate. contact the uept_for aaan't info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13, FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,484.71 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Reg. 0 OT FO,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,129.55 Suppl. Insp. Feer Reg. 0 OT 0,0 hrs $0.00 PME'Unit Fee: $0.00 PME Permit Fee: $0.00 21 iniYs Zstra-live `W. O Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure O Strom Motion Fee: IBSEISMICO $23.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 �-€€� . SI7BT©YACs $3,641.36 $0.00 TOTAL�EE $3,641.36 Revised: 10/01/201 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT 1 N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: I GJjI .S &f a ,(jL,o PERMIT # A-5110177 OWNER'S NAME: D C PHONE # � 2--005- GENERAL CONTRACTOR: 7-Ujnej USINESS LICENSE # ADDRESS: , Ai9(-- 2,70Z CITY/ZIPCODE: r& -9y fs-0 *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 THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date 6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork 2(, Cement Finishing Electrical 3 % Excavation Fencing Flooring / Carpeting Cp 1 C �1 tet: t i C l GQ Linoleum / Wood Glass / Glazing Heating 2,5 % Insulation K 07'406 G Landscaping Lathing Masonry Painting / Wallpaper TCL{-( Z j g Paving Plastering Plumbing s D6-or Z Roofing Septic Tank Sheet Metal Sheet Rock Tile &O Owner / C-on—firfictor Signature -zo q --(-)l 6 Date I&Method coustruction, Inc. License #857112 July 7, 2016 City of Cupertino Attention: Albert Salvador IZE: Temporary Certificate of Occupancy for: Rootstock Wine I3ar 19389 Stevens Creek Blvd. This letter is to request temporary occupancy for the above referenced location. The items remaining for final permit sign off are listed below: 1. Adjust stair riser to be no more than 3/8" difference in lieight. (estimated completion date 7/15/16) I Adjust stair handrail. (estimated completion date 7/15/16) 3. Provide building shell fire alarm sign off. (estimated completion date 7/13/16 ---inspection is scheduled) If you have any further questions please call my office (408)842-0054 Contra - igi ere Date Property Owner/Representative Signature D, to F.O. ,Box 2702 • Gilroy, CA 95021 • Phone: (408) 8,12-005,1 0 Fax: (108) 84.8-0906 PERMIT FEE RECEIPT Case # 15110179 Date Printed: 07/08/2016 CUPERTINO CITY OF CUPERTINO - FEES RECEIPT Case Number: 15110179 Permit No: 15110179 Project Valuation: 82500.00 Date Submitted: 11/25/2015 Permit Type: 1A TI Address/APN: 19389 STEVENS CREEK BLVD (316 20 112) Receipt #: 205625 Scope of Work: TENANT IMPROVEMENT OF (N) WINE BAR "ROOTSTOCK WINE Payment Date BAR" (1731 SF) Contact Type: Applicant Full Name: MAIN STREET CUPERTINO AGGREGATOR Primary Phone: (916) 503-1073 Address: 2882 SAND HILL RD STE 241 MENLO PARK, C. Email: mrohde@vallcoshoppingmall.com Fee Information Amount Building - Bond TCO GOOD TILL 818/2016 $5,000.00 Temporary Occupancy TCO GOOD TILL 8/8/2016 $296.00 Payment Information Payment Date Patron Payment Type Amount Building - Bond 07/08/2016 METHOD CONSTRUCTION Check $5,000.00 Temporary Occupancy 07/08/2016 METHOD CONSTRUCTION Check $296.00 FEE TOTAL $5,296.00 AMOUNT PAID $5,296.00 BALANCE DUE $0.00 07108/2016 - 1 2:50:42 PM - Generated by: seanh t CUPERTINO TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build incl cupertino.ona APN: TYPE OF CONSTR DATE: l [PROJECT VALUATION $ 2-70 D a SITE �J Jvi�/V r� ADDRESS: / / ��� lJL (f,� []APPROVED OMER'S AME: vL Z L C J n1 /� PHONE' FAX M 766 MAI ING ADDRESS (if different froT site'address): ❑ APPROVED WITHCONDITIONS- er. Signature:........ . ..................... N // Date: ..�/. 7. ./ APP,ROVED �3 APPROVED WIT CQ,1�4DyjIONS' CON I RACTOR/POINT OF�,C TCT: PHONE #: y V I t. GA� FAX #: �r O REEFFUND/P/OINTOF CONTACT: / (n`v c' M 1NG AAt)DR SS: eok uo f! 4 .-o �o z io,a TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND AMOUNT (1 % VALUATION CODE �) HECK ❑ CASH BOND F BOND: 5K min -10K max) $ 1 L L toL-DBONDS] EDITION: D% 3 TCO EXPIRATION _ ri} '' -/4 FEE: 32A00/mo TOTAL FEE: $ Cj (1TEMPOCCJ DATE (6 MONTHS MAX): USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT []APPROVED APPROVED WITHCONDITIONS- PublicWorks Signature: .............................................Date:....................... O APPROVED ❑ APPROVED WITHCONDITIONS- er. Signature:........ . ..................... N // Date: ..�/. 7. ./ APP,ROVED �3 APPROVED WIT CQ,1�4DyjIONS' OTHER DEPARTMENT I AGENCY APPROVALS: annina Signature: ...... ..Date ................................................ :..................... ❑ APPROVED ❑ APPROVED WITHCONDITIONS' ire Signature:.. ..................................Date:... / ..(.. []APPROVED APPROVED WITHCONDITIONS- PublicWorks Signature: .............................................Date:....................... O APPROVED ❑ APPROVED WITHCONDITIONS- er. Signature:........ . ..................... N // Date: ..�/. 7. ./ APP,ROVED �3 APPROVED WIT CQ,1�4DyjIONS' 'CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for c:arh individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeit d the non-compliance may result in an enforcement action. OwnerContractor ^^77 // Signature: ............................................... Date:.. . /.(o...... Signature: ...... j .... ... Date: ..L..:,b�. This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and approved for the specKj� rea of j� building specified above to provide a reasonable degree of safety to the occupants from fire and similar emeroencies. � jy' i Building Official:....✓. /j�. .. ., �.................................Pdnt:.D1z�'. x..'.. k .. /',�" <,— I. Date . ......................... DEPARTMENT MENT ACTION: After determination, copies to: 1) applicant, 2ypermit file empOceForm_2011 doc revised 6.'30'16