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13060174CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20700 STEVENS CREEK BLVD CONTRACTOR: DSC GROUP PERMIT NO:' 13060174 OWNER'S NAME: BYER PROPERTIES LP 639 WILLOW ST DATE ISSUED: 06/25/2013 OWNER'S PHONE: 4156262937 SAN JOSE, CA 95125 PHONE NO: (408) 316 -4543 AA CONTRACTORS DECLARATION JOB DESCRIPTION: RESIDENTIAL E COMMERCIALS License Class Li.. # e-( �2 J ,� COMM. T.I ON VACANT SPAC FT TO INCLUDE NEW Contractor b—�f— CA,0((.i�rp Date j alp, ADA SINGLE OCCUPANCY RE ROOM, W SUSPENDED I hereby affirm that I am licensed under the provisions of Chapter 9 CEILING AND FLOO , MOD ICATI NS TO (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 performance of the work for which this permit is issued. S Ft Flol Area: aluation; $19500 I have and will maintain Worker's Compensation Insurance, as prod ed for by Section 3700 of the Labor Code, for the performance of the work r which this AP Nu ber: 359080 0.20700 Occupancy Type: permit is issued. I certify that I have read this application and state the a e infFalaws lion is g �P RMIT EXP IF WORK IS NOT STARTED APPLICANT CERTIFICATION correct. I agree to comply with all city and coon ordinan s d s rel tm W Time 80 AYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives f th' to ent r upon the above mentioned property for inspection purposes. a agree to sau 180 DAY OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against lia rties, judgme s, // », costs, and expenses which may accrue against said City in co s quence of a Issued by Date: & - - -ZJ • 12� granting of this ermit. Additionally, the applicant understands d wi omply ' with all non -po' t source regulations er the Cope ino Municip C e, Section 9.18. RE- ROOFS: Sigma ""` Date - A I All ofs shall be inspected prior to any roofing material being installed. If a roof is t_ - - - -- _ i tailed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER- BUILDER DECLARATION Signature of Applicant:i Date: I hereby affirm that I am exempt from the Contractor's License Law for o c 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 corn ensation, will do the work, and the structure is not intended or offered for sale (S .7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with license 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 follo g 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, Secti ns 255 , 2553A, and 25534. S Section 3700 of the Labor Code, for the erformance of the work for which this — y'©�'� p Owner or authorized agen^ ti 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a constriction 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 CITY OF CUPERTINO FF. , F.CTIMATOR - RITII.DING DIVISION ADDRESS: 20700 SCB DATE: 0 612 012 01 3 REVIEWED BY: Mendez APN: BP #: ] � � *VALUATION: 1$19,500 *PERMIT TYPE: Building Permit PLAN CHECK TY E: Tenant Improvement PRIMARY Commercial Building Suppl. PC Fee: (j) Reg. Q OT PENTAMATION 1 B TI USE: $0.00 I PERMIT TYPE: WORK Comm. T.I on vacant space 772 sq ft B (Tenant_ Improvements) 11- 8,111- B,IV,V -B SCOPE $1,974.50 OCCUPANCY TYPE: TYPE R. FLR AREA PC FEES; PC FEE ID BP FEES BP FEE ID Suppl. PC Fee: (j) Reg. Q OT CONSTR. s.f. $0.00 PME Plan Check: $0.00 B (Tenant_ Improvements) 11- 8,111- B,IV,V -B 772 $1,974.50 1BTT,LNeK 1,864.85 IBTIINSP PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction :Tax: A.(Imini,str ative :Fees: 1 \ $0.00 Advanced Planning Fee. $0.00 Select a Non - Residential 0 Building or Structure r. Strong Motion Fee: 1BSEISIIIC0 $4.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 =so4� $2,844.451 $0.00 $2,844.45 TOT 772 1,974.50 _ $864.85 Me., -, . flan Check Plumb. Plan Check Math. Permit l" e: Plumb. Permit Fee: Other Tech. Insp.. Other Plumb Insp El A ech. Insp..Fee: Plumb. Iris /r. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Elec. Plan Check f=lee•. Permit Fer . Other Elee. 1-P, Elec. &Y Fee; Public Works, Fire, Sanitary Sewer District, Sc D' tr' t t These ees are based on the relimina information available and are on1v an estimate. contact me ue t for aaan -z info. zs zc,ea. V. FEE ITEMS (Fee Resolution 11 -053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,974.50 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (j) Reg. Q OT 0.0 h s $0.00 PME Plan Check: $0.00 Permit Fee: $864.85 Suppl. Insp. Fee: Reg. 0 OT 0,Q 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction :Tax: A.(Imini,str ative :Fees: . Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee. $0.00 Select a Non - Residential 0 Building or Structure Travel Documentation Fees: Strong Motion Fee: 1BSEISIIIC0 $4.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 =so4� $2,844.451 $0.00 $2,844.45 Revised: 04/29/2013 El NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building@cupertino.org ❑ ADDITION M ALTERATION / TI ❑ REVISION / DEFERRED �a. o` ®u ORIGINAL PERMIT # 1 n \' PROJECT ADDRESS 20700 Stevens Creek Blvd APN # 9-0:8-023 35 OWNERNAME Byer Properties PHONE 415 -626 -2937 .s STREETADDRESS 66 Potrero Ave CITY, STATE, zIPSan Francisco, CA 9 03 CONTACTNAMEViet Q. Truong c/o Kahn Design PHONE510 -841 -3555 E-MAIL viett @kda- berkeley.COm STREETADDRESS 1810 Sixth St. CITY,STATE, ZIP Berkeley, ';CA 94710 FAx 510 - 841 -1225 ❑ OWNER. ❑ 'OWNER- BUn.DER ❑ OWNER AGENT `❑ CONTRACTOR ❑ CONTRACTOR AGENT I@ ARCHITECT ❑ ENGINEER ❑ DEVELOPER 11 TENANT CONTRACTOR NAME Dan Sope s c/o DS C Group LICENSE NUMBER 6 LICENSE TYPE BUS. LIC # cowANYNAME DSC Group E -MAIL dan @dscgroupinc.com FAX 408 - 693 -3698 STREETADDRESS 1297 Weibel Way CITY,STATE,zIP San Jose, CA 95125 PHONE408 -693 -3698 ARCHITECT/ENGINEER NAME Charles F. Kahn LICENSE NUMBER 3 5 5 3 5 3 BUS. LIC # 1100007110 COMPANYNAME Kahn Design g Associates FmAIL charlesk @kda -1 �erkeley.com FAX 510 -841 -1225 STREET ADDRESS 1810 Sixth Street CITY,STATE,zIP Berkeley, CA 94710 PHONE 510 -841 -3555 DESCRIPTION OF WORK Interior spec tenant improvement for future retail store. Upgrade existing unisex restroom to comply to ADA standards. EXISTINGUSE B PROPOSED USE CONSTR. B TYPE VB # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) 1 EXISTG AREA 772 SF NEW FLOOR AREA N/A -. DEMO 4 0 S F AREA TOTAL 772 . S F NETAREA V- B B 772 19,500 BATHROOM REMODEL AREA 56. SF KITCHEN REMODEL.AREA N/A OTHER REMODELAREA N/A PORCH AREA DECK AREA TOTAL DECK /PORCH AREA GARAGE AREA: DDETACH N/A N/A N/A N/A 11 ATTACH # DWELLING UNITS: IS A SECOND UNIT [-]YES SECOND STORY ❑ YES . N/A BEINGADDED? ONO ADDITION? ®NO. PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF/ IS THE BLDG AN ❑ YES RECEI BY: TOTAL VALUATION: PLANNING APPL # ®NO PLANNING APPROVAL LETTER EICHLER HOME? ® NO 19,500 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 correc . I ha ye read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin stru Io . uthorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent:� Date: �u�i t3✓ 2a� 13 SUPPLEMENTAL IN FORMAT N REQU D PLAN CfWCKTYPE ROUTING s n' OVER- TH&COUNTElt, BUILDING PLAN REVn 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. ❑', EXPRESS ` ❑ "PLANNINGPLAN'REVIEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑, STANDARD ; ❑ PuBuc-wolms 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 ❑' wAJoR ❑ SANITARY SEWFR DISTRICT submittal of Building Permit application. ❑ ENVMONMENTALIIEALTH BldgApp 2011.doc revised 06/21/11