12110086CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19439 STEVENS CREEK BLVD
CONTRACTOR: SOUTH BAY
PERMIT NO: 12110086
CONSTRUCTION, INC
OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR
1711 DELL AVE
DATE ISSUED: 08{21/2014
OWNER'S PHONE: 6503441500
CAMPBELL, CA 95008
PHONE NO: (408)379-5500
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
MAIN STREET PAD 1, 2;077 SQFT NEW ONE STORY RETAIL
License Class Lic.# j _ q t
BLDG SHELL
Contractor L\ b)A`j eW1 T Date
REV # 1 - ADD ROOF WALK PADS TO PLANS (RFI 504) & SHOW DOOR/EXTERIOR
—!p
COLOR (RFI 447) -ISSUED 10/l/15
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,
Sq. Ft Floor Area:
Valuation: $542857
1 hereby affirm under penalty of perjury one of the following two declarations:
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
APN Number: 31620085.19439
Occupancy Type:
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 of the work for which this
PERMIT EXPIRES IF WORK IS NOT STARTED
permit is issued.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
180 DAYS F ST CALLED INSPECTION.
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
Dater
upon the above mentioned property for inspection purposes. (We) agree to say----.'--
a
-
indemnify
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 with
RE -ROOFS:
all non-po'rtt source reguions peItheCupert' o Municipal Code, Section 9.18.
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
SignaturateAJQ1JJ
inspection.
Signature of Applicant: Date:
OWNER -BUILDER DECLARATION
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. I, as owner of the property; or my employees with wages as their sole
HAZARDOUS MATERIALS DISCLOSURE
compensation, will do the work, and the structure is not intended or offered for
I have read the hazardous materials requirements under Chapter 6.95 of the
sale (Sec.7044, Business & Professions Code)
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
2. I, as owner of the property, am exclusively contracting with licensed contractors to
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
construct the project (Sec.7044, Business & Professions Code).
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should Luse equipmentor devices which emit hazardous air
I hereby affirm under penalty of perjury one of the following three declarations:
contaminants as defined by the Bay Area Air Quality Management District I will
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
maintain compliance with the Cupertino Municipal. Code, Chapter 9.12 and. the
Compensation, as provided for by Section 3700 of the Labor Code, for the
Health & Safety Code, Sections 25505, 25533, and 25534.
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
QWner or ori ag� '
Date: JAA5
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I shall
CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's
I hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of Califomia. If, after making this certificate of exemption, I
for which this permit is issued (Sec. 3097, Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code, I
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
Lender's Address
revoked.
ARCHITECT'S DECLARATION
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I understand my plans shall be used as public records.
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
Licensed Professional
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
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
1ILI
I j, ;..� �.
COMMUNITY DEVELOPMENT DEPARTMENT ® BUILDING DIVISION
10300 TORRE AVENUE a CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX 1408) 777-3333 a building (n17CUnertino orq
V
CUPERTINO I
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI I" 1 RF,VISTON / DFFFRRFD ORIGINAL PF,RMIT # 12110086
PROJECTADDRESS Pad 1 19439 Stevens Creek Blvd
LICENSE NUMBER B.3 3 9 6 7 4
APN#// 2-0
l'lj
BUS. LIC # 5655
OWNERNAME Main Street Cupertino Aggregator LLC
PHONE (650) 344-1500
7
E`--MAIL1
STREETADDRESS 1711 Dell Avenue
STREETADDRESS 2882 Sand Hill Rd, Ste 241
CITY, STATE,ZIP Menlo Park, CA 94025
ARCHITECT/ENGINEER NAME Ken Rodrigues, FAIA
FAX
CONTACT NAME Paul Hansen
COMPANY NAME Kenneth Rodrigues & Partners, INC
PHONE (408)442-2121
E-MAIL
phan.sen@shcmllc.com
STREETADDRESS 2882 Sand Hill Rd, Suite 241
CITY,STATE, ZIP Menlo Park, CA 94025.
NET AREA
FAX
1 1 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT I
CONTRACTOR NAME Mark Avila
LICENSE NUMBER B.3 3 9 6 7 4
LICENSE TYPE
BUS. LIC # 5655
COMPANYNAME South Bay Construction
E-MAIL mavila@sbci.com
FAX (408)379-3256
STREETADDRESS 1711 Dell Avenue
CITY,STATE,ZIP Campbell., CA. 95008
PHONE (408)379-5500
ARCHITECT/ENGINEER NAME Ken Rodrigues, FAIA
LICENSE NUMBER C12, 818
BUS. LIC #
COMPANY NAME Kenneth Rodrigues & Partners, INC
E-MAILkenr@krparchitects.Com
FAX (650) 960-0707
STREETADDREss 445 N Whisman Rd, Suite 200
CITY,STATE,ZIP Mountain View, CA 94043
PHONE (650) 965-0700
DESCRIPTION OF WORK
1 1. Add paint color P 1 - Georgia Clay - to the exterior elevations, Sheet A5.1 - RFi #447. 1
1 2. Add walking pads to roof -mounted equipment, Sheet A4,1 - RFI #504.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC..
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
I
[]ATTACH
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY []YES
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YE - TOTAL VALUATION:
PLANNING APPL # ❑ NOPLANNING APPROVAL LETTER
EICHLER HOME? _
By my signature below, I certify to each of the following: I am the property ownereraumonzeo w
application and the information I ha e provided is corre I have read the Description of W enfy it is
ordinances and state laws relating t b ildm c trucf n. I t orite representatives of Cupertino to enter the
Signature of Applicant/Agent: Date: _
AL INFORMA
_ 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.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
YavF—y ......... ..... -.- _ ----- --- -
a ee to comply with all applicable local
e-identifie t' ' for inspection purposes.
BldgApp 2011.doc revised 06121111
CITY OF CUPERTINO
FFF. F.CTIMAT(lR — RITILDING DIVISION
lialADDRESS: 19439 STEVENS CREEK BLVD
DATE: 08/28/2015
REVIEWED BY: MELISSA
APN: 31620109.19439
BP#:12110086
*VALUATION:
Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY
Commercial Building
USE: Jin
Civil / Religious activities
BQ zone? 0 Yes No
PENTAMATION
1GENCOM
I PERMIT TYPE:
WORK
REV # 1 - ADD ROOF WALK PADS TO PLANS RFI 504 & SHOW DOOR COLOR RFI 447
SCOPE
District, etc.). These fees are based on the preliminar
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
Plan Check Fee: Hourly Only? 0 Yes E) No
Suppl. PC Fee: (E) Reg. 0 OT0.0 hrs
PME Plan Check:
Permit Fee:
Suppl. Insp. Fee: Reg. 0 OT0,0 hrs
PME Unit Fee:
PME Permit Fee:
Construction Tax: IBCONSTAXC
Work Without Permit? 0 Yes E) No
Advanced Planning Fee:
Travel .l ocwnenlalion.F['c;s.
Strong Motion Fee:
Bldg Stds Commission Fee:
. ` : SUBT(ITALr
-mation available ana are ony an esurnute. l.V/ tu- 6/LG LG
FEE QTY/FEE MISC ITEMS
$0.00 21 hours Plan Check, Hourly
$0.00 $286.00 ISTPLNCK
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
X
$0.00
$0.00 Select a Non -Residential
-T-=-.,Building or Structure 0
i
$0.00 Select an Administrative Item
$0.00
$0.00 $286.00 TQ"P= $286.00
Revised: 07/02/2015
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR fSUBCONTRACTOR LIST
JOB ADDRESS: 19439 Stevens Creek Blvd - Pad 1
PERMIT # 12110086
OWNER'S NAME:Sand Hill Management
PHONE #
GENERAL CONTRACTOR: South Bay Construction
BUSINESS LICENSE # 5655
ADDRESS: 1711 Dell Ave
CITY/ZIPCODE: Campbell, CA 95008
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 'IME
GENERAL CONTRACTOR AND ALI, SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: . ... ............... . . . . . . . .......... ................... ...
Signature Date
Please check applicable subcontractors and complete the following information:
4)"M.
Owner / Contractor Signature
Date
5/12/15
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
X
Cement Finishing
Techcon
23513
X
Electrical
Redwood Electric Group
................ - .
. .......... . . . ..... 21108
X
Excavation
Doyle's
356111
Fencing
Flooring / Carpeting
Linoleum / Wood
X
Glass / Glazing
Classic Glass
25840
X
Heating
The Trillo Company ............. ..... ..........
29816
X
Insulation
...... ...
Central California Insulation
557
Landscaping
X
Lathing
Cen Cal Plastering
33021
Masonry
American Tile & Brick Veneer
35158
X
Painting Wallpaper
G&G Painting
34391
Paving
------- .
. . . ......... . ... .. .............. . ...
X
Plastering
Cen Cal Plastering
33021
X
Plumbing
Fresno Plumbing & Heating
32000
X
Roofing
Statewide Roofing
23509
Septic Tank
X
X
Sheet Metal
Sheet Rock
The Trillo Company
South Bay Interiors
29816
25499
Tile
4)"M.
Owner / Contractor Signature
Date
5/12/15