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15120058I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19449 STEVENS CREEK BLVD CONTRACTOR: BOAZ RENOVATIONS PERMIT NO: 15120058 INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 701 KINGS ROW l IC DATE ISSUED: 12/18/2015 OWNER'S PHONE: 6503441500 SAN JOSE, CA 95112 PHONE NO: (408) 873-1685 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑, License Class Li.. #_% t f w O SUITE #1007 "HOWARDS / SHOES FOR CHILDREN" T.I. S.F.)(SHOP _ (800 8-MAIN STREET) Contractor 0,42- &P7U4, a, �1 t� gate / Z 2 c C" 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 erformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $30000 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 erm is iss d. APN Number: 31620112.19449 Occupancy Type: APPLICANT CERTIFICATION 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 Igo DAYS +'' T ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DA L E' LED 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 b • ate: _ with all non-point source regulatio r th Cupertino Municipal Code, Section Signatur Date Z2�le_ 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. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS 'A" OR BETTER 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 Jicensed 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, 2 end 25534. Section 3700 of the Labor Code, for the performance of the work for which this " permit is issued.---� Owner or authorized a 5 Date: 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 PROJECT ADDRESS OWNER" I STREET ADDRESS CONSTRUCTION IT APPLICATIONj COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildingAgu�org ALTERATION / TI (J REVISION / DEFERRED ORIGINAL PERMIT # 'C P'xV .SV 1r& too APN # p� PHONEEMAIL . a PA,' (o• -as f SLS JYYIOr ffP' T S Q,. v072- p r I tZ CITY STATE, ZIP I FAX 2 M L0 PlZK CI ¢!� L CONTACT NAME y� �'- HONE I1 RVA b, J. LSAEMAIL- ,'� SLS � 2�a3 r��� 1�irJu�Ii✓f STREETADDRESS �L'I¢t; CITY, STATE, ZIP 3C A4717- pig i7. � ^ FAX OWNER ❑ OWNER -BUILDER UdOWNERAGRNT 11 rn�rroerrnn 1'4 n EXISTING USE .�-VUu=,n u unvnl.vrl;R LJ TENANT CONTRACTORNAME T' LICENSE TYPE BUS. LIC # COMPANYNAME D' STANDARD form if any Hazardous Materials are being used as part of this project. VA'C�f; wj — a PAX STREET ADDRESS ZIP PHONE ARCHITECTIENGMER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME D - �1"r-tve E-MAIL ,`aa' i yy //�� "j�i�., �-Abg6(°CCk &A- 6ee�Cj: n FAX -4� *oG o Gei•'V� ]TYPE y STREET ADDRESS ,2� y l ILAt- i71Ar"3LD ?-;Wpy CITY, STATE, ZIP 1-4 A aef(ry C* Ci PHONE IZj - 253 '-�Zi7© EXISTING USE PROPOSED USE QONSTR TYPE # STORIES permit for new building. ❑ EXPRESS `Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D' STANDARD form if any Hazardous Materials are being used as part of this project. VA'C�f; wj — _ Copy of Planning Approval Letter or Meeting with Planning prior to D �IAao USE OCC. SQ.FT, VALUATION ($) EXISTG AREA NEW FLOOR AREA AREA DEMO AREA TOTAL NETAREA L;UO u ]TYPE y OVO BATHROOM KITCHEN OTTER REMODEL AREA iq`A_ REMODEL AREA /� REMODELAREA „,+f PA I PORCH AREA ECK AREA TOTAL DEC"0RCH AREA GARAGE AREA DETACH I ATTACH # DWELLING UNITS: IS A SECOND UNIT Q YES SECOND STORY ❑ YES , BEING ADDED? [3 NO ADDMON? []NO PRE -APPLICATION ❑ YFS - IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY T TAL VALUATION; PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO : �'30' dw;� r ==v =s= w•� w, 1--..y IV Vag.. v1 LIM ry u 1am tae property owner or autnonzea agent to act on me property owner -s nenair, 1 nave reaa mIs application and the information k We c t. I ha a read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat' g to building sfu 'on. I thorize representatives of Cupertino to enter th7above-'dentified property for inspection purposes. Signature of Applicant/Agent. Date:f --New SFD or Multifamily dwellings: Apply for demolition permit for Q OVER THE -COUNTER existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS `Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D' STANDARD form if any Hazardous Materials are being used as part of this project. ❑ LARGE _ Copy of Planning Approval Letter or Meeting with Planning prior to D �IAao submittal of Building Permit application. Q BUUXINGPLANREViEW ❑ PLANNING PLAN REVIEW ❑ PUBLIC WORKS ❑ P'IREDEPT ❑ sANrrARY SEWER DigmiGT BldgApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR BUILDING DIVISION kAPN: DRESS9 Stevens Creek Blvd DATE: 12/07/2015 REVIEWED BY: PAUL 316270112 BP#: "VALUATION: $30,000 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMUSE. Commercial Building PENTAMATION 1 M TI PERMIT TYPE: WORK Suite #100 - "Howards I Shoe's for Children" T. 1. 800 S.f. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA PC FEES PC FEE ID BP FEES, BP FEE ID M (Tenant Improvements) 11-B,III-B,IV,V-B 800 $2,914.15 I1kfT7PLNCK _ $908.95 IMTHNSP $0.00 PME Plan Check: $0.00 Permit Fee: $908.95 Suppl. Insp. Fee:Q Reg. 0 OT 00 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 800 $2,914.15 $908.95 ": ME 1% H"RllY Yes . No PLUMB, Hf3URLY "Yes N� ELEC.; I30URLY _ "Yes F No,ee NOTE. This estimate does not include fees 0ihd i'.' laRbED e to other Departments (i.e. Planning, Public A. sr i Fr. , 1 ' I. - irks, Fire, Sanitary Sewer District, School District, etc-). These fees are based on the jurelimina in ormation available and are on1v an estimate. Contact the Dept -for addn'l info. FEE ITEMS Fee Resolution 1.1-053 E . 7.11/13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,914.15 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Reg. OT 0.0 ' hrs $0.00 PME Plan Check: $0.00 Permit Fee: $908.95 Suppl. Insp. Fee:Q Reg. 0 OT 00 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 pp Fec'. 0 Work Without Permit? O Yes E) No $0.00 Advanced. Planning F eq: $0.00 Select a Non -Residential Building or Structure 0 0 Strong Motion Fee: IBsErsmico $8.40 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 .. SUBTOTALS: $3,833.50 $0.00 =TOTAL FES• $3,833.50 Revised: 10/01/2015 03/02/2016 13:06 CUP'E:IRTINO ALPHA ENERGE CONTRACTOR / SUBCONTRACTOR LIST PAGE 01/01 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 013 ADDRESS: Ig4u9 �ve�s��s^'K i'�1�� ^�Q_o_C PERMIT i'7 a�-o,��g OW1,,11"R'S NAME:I�io,rh ,}. �„ b�^kvr4 — PHONE # 5IS - -_7 -7tr� GEN i32AL CONTRACTOR.:83oa��Rc��,e,t' lrc BUSINESS r TCENSE # 366LIQ nf)DRES : -Io ,," _ f b —G CTTY/ZT.PCOD'E *Our municipal code re sires all businesses wrrrlcing in the city to have a City of. Cupertino business license. NO 1T[1TLI)ING FTNA.T-, OR FINAL OCCUT"ANCY INSPECT'TON(S) WILL RE SCHEDULED UNTIL TTiE GFNTt,JtA1 CONTRACTOR AND ALL. SU.RCONTRrACTORS HAVE OBTAINED A CITY OF CUPERT.INO BUSINFSS LICENSE. I am not using any subcontractors: v Sign. - to re Date Please check: applicable subcontractors and complete the following information: V W13CONTRA,CTOR BUSINESS NAME BUSMSS LICENSE # ��'abinels & Mill.worlc Cement Finishing �~ _ k31 ectri cal.__.- 2-xcavatioli Fencing -� Iooring / Carpeting - Atwl.et ni. / Wood �.�. r_ Glass / Glazing 1_Heating -Insulation :.a.ndscaping�.�� :�at11i11g :oasonry ?a.inting / Wallpaper °aving J_?lastering- Numhina j R.00Ting Leptis Tanlc— - -� �hcct Metal _ _ Sheet Rock Owner / Contractor Signature Date // 06,5-5, Philz Coffee will allow the employees of Capezio and Howard's Shoes for Children to use their restroom during the period of restroom construction at Main St., Cupertino. The restroom within 30-45 days. should be constructed Signature;