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12110094A CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 19409 STEVENS CREEK BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 12110094 0 CONSTRUCTION, INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 1711 DELL AVE DALE ISSUED: 06/19/2014 OWNER'S PHONE: 6503441500 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ (� FLEX 2- CONSTRUCTION OF A NEW TWO STORY License Class p� — Lic. #1 �° OFFICE/RETAIL FLEX BUILDING SHELL 29,347 SQ -MAIN n STREET CUPERTINO Contractor � WQ�S'T Date REV # I - ADD ROOF WALK PADS TO PLANS (RFI 504) & MOVE (E) GAS METERS I hereby affirm that I am licensed under the provisions of Chapter 9 (PER PG&E)(RFI 559)- ISSUED 10/l/15 (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. z. 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 is issued.. 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 hereby 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, judgment 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 -poi ource reg lationSper the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: �. 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. 2, 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 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 hereby 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 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 Sq. Ft Floor Area:. I Valuation: $2328951 APN Number: 31620109.19409 ' Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180DAYS-f7FIE!M- ISSUANCE OR lAY5FRO _ CALLED INSPECTI N. . 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER. HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. ner or authorizedq en t Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION its COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 o FAX (408) 777-3333 • buil ding&cupertino.oEg ❑ NEW CONSTRUCTION n AnDITION n e r rr a n rrnn. i I J I X1.., , — ----"' ,--u AhKMIT#1111vv J�v 1131v1V / unr riKlIlr LJ kJKIIJIIVLY PROJECTADDRESS Flex 2 19409 Stevens Creek Blvd APN# !21L o1 (9(t` O dU OWNERNAMEMain Street Cupertino Aggregator, LL PHONE (650)344-1500 EMAIL STREETADDRESS 2882 Sand. Hill Rd, Suite 241 CITY, STATE,ZIP Menlo Park, CA 94025 FAX CONTACT NAME Paul Hansen PHONE E-MAIL phansen@shcmllc.com STREET ADDRESS 2882 Sand Hill Rd, Suite 241 CITY, STATE, ZIP Menlo Park, CA 94025 FAX ❑.OWNER ❑ OWNER -BUILDER 11 OWNER AGENT ® CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER 11 TENANT CONTRACTORNAME Mark Avila LICENSE NUMBER B336974 LICENSE TYPE BUS.LIC# 5655 COMPANYNAME South Bay Construction E-MAIL manila@sbci.com FAX (408)379-3256 STREET ADDRESS 1711 .Dell Avenue CITY, STATE, ZIP Campbell, CA 95008 PHONE (4 0 8) 3 79 - 5 5 0 0 ARCHITECT(ENGINEER NAME Keri Rodrigues LICENSE NUMBER C12,818 BUS. LIC # COMPANYNAME Kenneth Rodrigues & Partner, INC E-MAIL kenr@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.) Add walking pads to roof -mounted equipment, Sheet A4.2 -- RFI #504. 2.) Relocate gas meters from East wall of Flex 2 to planter area adjacent to east wall of Garage, Sheets Al. 1, A2.3 and P2.3 -- RFI #559. 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 DECK/PORCH AREA GARAGE AREA: DETACH - JOTAL I ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY E]YES BEING ADDED? nNO ADDITION? O PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YE - -' ;' _ '.. TOTAL VALUATION: PLANNINGAPPL# []NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO 07 By my signature below, I certify to each of the following: I am the property owner or aut a on the property owner's behalf. I have read this application and the information I have p , vided is correct. I have read the Description Work verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu' di g co s ctio I authorii7e representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PI ANCFIECi� _ ROUTING SLIP o R TIn Coz1i R C1 othllm G PLAN REVIEW . _ 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. 0 EirPRESs �-`� � .' CT PLANNINGPLANREVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure `:STANDARD . - Q PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. 0 k'11tEbEPT`.. _ Copy of Planning Approval Letter or Meeting with Planning prior to C1sAaoH ' j_j sAAlvNrraliX s> Six >SlsTxrex submittal of Building Permit application. E. "ONM NTAL HEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 19409 STEVENS CREEK BLVD �DATE: 08/2812015 REVIEWED BY: MELISSA - APN: 31620109.19409 BP#-. 12110094 *VALUATION: $o 'PERMIT TYPE: Building Permit IPLAN CHECK TYPE: Alteration-/ Addition/ Repair PRIMARY Commercial Building Civil / Religious activities PENTAMATION USE: 1GENCOM 7in BQ zone? 0 Yes E) No PERMIT TYPE: WORK REV # 1 - ADD ROOF WALK PADS TO PLANS (RFI 504), SCOPE & MOVE (E) GAS LINE (PER PG&E)(RFI 553) Other.-A,lech- hvvp, (Vier Plumbbal:2. 01,her Elee. lm�p. lyeLh. I.p. Fee: 1; s 'Plzimb, Imp, Fee: k-lec. Imp. Fee: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etr.). These fopv are hated nn the nrolimi"ary infnrmafin" availahlo and are n"Iv an Pvfimyyto_ Cnnhyrt the Dent fnr addnl info. FEE ITEMS (Fee Resolution 1.7-053 Eff. 711113) FEE QTY/FEE I MISC ITEMS Alech. 111a (..'heck $0.00 hours Plan Check, Hourly $286.001 ISTPLNCK A I 1'hanb. Maw (71jeek 1 hrs $0.00 I L,-, le c, 111an Cheek Permit Fee: $0.00 I-Veck llerrzii fee: hrs $0.00 I Ilumb, Peivn;? Fee: PME Unit Fee:. $0.00 I L"h-c. J?errnit F'oe: Other.-A,lech- hvvp, (Vier Plumbbal:2. 01,her Elee. lm�p. lyeLh. I.p. Fee: 1; s 'Plzimb, Imp, Fee: k-lec. Imp. Fee: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etr.). These fopv are hated nn the nrolimi"ary infnrmafin" availahlo and are n"Iv an Pvfimyyto_ Cnnhyrt the Dent fnr addnl info. FEE ITEMS (Fee Resolution 1.7-053 Eff. 711113) FEE QTY/FEE I MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 hours Plan Check, Hourly $286.001 ISTPLNCK A Suppl. PC Fee: (F) Reg. 0 OT 10.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee:. $0.00 PME Permit. Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 Ahninistrative Fee: 0 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential (E) Building or Structure 0 I 'A 7 Yep,,el Docuirentalion F'eew: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 $0.001 $286.00 TOTAIJTE $286.00 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19409 STEVENS CREEK BLVD CONTRACTOR:. SOUTH BAY PERMIT NO: 12110094 CONSTRUCTION, INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL 1711 DELL AVE DATE ISSUED: 06/19/2014 OWNER'S PHONE: 6503441500 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # � BUILDING PERMIT INFO: BLDG ELECT PLUMB ri. r /� MECH RESIDENTIAL COMMERCIAL Contractorso- '4 (j��r Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: MAIN STREET CUPERTINO- FLEX 2- CONSTRUCTION OF (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. A NEW TWO STORY OFFICE/RETAIL FLEX BUILDING SHELL 29,347 SQ I hereby affirm under penalty of perjury one of the following two declarathonsi : DFERRE� #1 I1�STALL (9) FABRIC AWNINGS= ISSD 4/15/201'5 " 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 Sq. Ft Floor Area: Valuation: $2328951 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 is issued. APN Number: 31620109.19409 Occupancy Type: APPLICANT CERTIFICATION I 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 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR AST CALLED 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 J� Issued by: Date: granting of this pen -nit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signatures Date , -f �� All roofs shall be inspected prior to any roofing material being installed. If a roof is w - ,x - installed without fust obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one 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 compensation, 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 licensed 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 thus 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 b p P y the Health & Safety Code, Sections 2550 25533 and 34. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Z"°~ 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 I I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provision of the Labor Code, must forthwith comply with such provision 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 properly 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 plan shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulation per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date w5i.79J� a CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c�euGertino.org ❑ NEW CONSTRUCTION ❑ ADDITION I I AI.TF.RATION /TT lt u>~vrcrnxr nnV'- Ter —AA— & 1911MAd PROJECT ADDRESS 19409 Stevens Creek Blvd APN # OWNERNAME Sand Hill Const Management PHONE EMAIL nkumar@Shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 1 FAX CONTACT NAME Nand Kumar Y PHONE 650-344-1500 V V E-MAIL nkumar@shcmllc,com STREETADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER 13 TENANT CONTRACTOR NAME Summer Olson -Todd LICENSE NUMBER 336974 LICENSE TYPE B 1 BUS. LIC# 5655 COMPANY NAME South Bay `7 Construction E-MAIL solsontodd@sbci.com CiI.riom FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408-379-5500 ARCHITECT/ENGINEER NAME Kevin Jones LICENSE NUMBER BUS. LIC # COMPANY NAME KRP Architects E-MAIL kevinj@krparchitects.Corn FAX STREET ADDRESS 445 N. Whisman Rd, Ste 200 CITY, STATE, ZIP Mountain View 94043 PHONE DESCRIPTION OF WORK Flex 2 Aluminum framed glass shop drawings revised deferred submittal EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION($) 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: EIDETACH I []ATTACH I #DWELLINGUNITS: IS A SECOND UNIT [-]VES SECONDSTORY []YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECE - $Y = a - TOTAL VALUATION - PLANNING APPL# r] NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to At on the p perry owner's behalf. I have read th' application and the information I have provided is correct. I have read the Description of W ork and verify�,lira Id. I agree to comply with all applica a local ordinances and state laws rela' o building construc ' n. authorize resentati sof upertmo to enter the above Iden 'feed property for inspection purposes. i Signature ofApplicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED Q PLANECKTXPE . r , r R015:TIBI(vSLIP; New SFD or Multifamily dwellings: Apply for demolition permit for❑ URTHE-eovl•ITER I� BurLDINGi LAN R> W _ existing building(s). Demolition permit is required prior to issuance of building i permit for new building, IrPRFss 'CI pLpiyNII�IIsPLAPI7iEYW fb Disclosure �� N x I s PUBLIC AVtiRKS Commercial Bldgs: Provide a completed Hazardous Materials g P t _ form if any Hazardous Materials are being used as part of this project. k3Zx h d FA6-0 x%cE Copy of Planning Approval Letter or Meeting with Planning prior to k R submittal of Building Permit application. `� BidgApp M Ldoc revised 06121111 CONSTRUCTION PERMIT APPLICATION COMMUNITYDEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCcDcupertino.org ClJPERTIPIO ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION/ DEFERRED ORJGINALPERMIT,917.11QOq PROJECT ADDRESS rlA. rN,�yI C.%�,�p�,ONE APN #OWNERNAME `�J\ `(��jl��'(AE-MAIL lull / r%k !C°T M A Vinl; n— - Qi& .417 .%1 ? t STREET ADDRESS ,ter, ,,� � em%_cn__r % I I CITY, STATE, ZIP �fi/�9AIAMIY1PaIi'CI ;g4TYAI FAX CONTACT NAME - PHONE E -MAIC,' 1(� �'j ^ p,g 1 �/► /�� (- STREET ADDRESS >) rN � n �y A � - � (� CITY, STATE, ZIP � C\ -,C;4 111D6 FAX COD 'OWNER ElO`WNER-BUILDERV�d/❑v4OWNER AGENT .CONTRACTOR ❑COMRACTORAGENT ❑ ARCHITECT 13ENGINEER 11 DEVELOPER 11 TENANT LICENSE NUMBER �l�'�� LIC ;u'SETYPE BUS. LIC k CONTRACTOR NAME - COMPANY NA\4E C ® E-MAILC. C y�I l�c�an ��(IEf" p1,®A FAX CITY, STATE, �cC1 1, �7 PHONE` (V STREET ADDRESS (; (1/ LICENSE NUMBER BUS. LIC # ARCHITECT/ENGINEERNAME t, `. A'�� FAX COMPANYNAME. emu .P E-MAIL �` u+V CITY, STATE, ZIP� /1��'� 'PHONE STREET ADDRESS tAI JA � s <�V . ' (T ( ( DESCRIPTION OF WORKC �. %R1 USE PROPOSED USE CONSTR. IYPE I k STORIES I USE TYPE I OCC. I SQ.FT. I VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL ARL'A REMODEL AREA REh10DEL AREA ATTACH 9 DWELLING L'KITS - ISASECONDuiru ADDITION? 'i U"=' "'""'""� -- QNO BEING ADDED? ❑ NO IS THE BLDG AN ❑ YES RECEIV BY: PRE -A ❑YES IF YES, PROVIDE COPY OF NO PLANNING APPROVAL LETTER EICHLER HOME? - TOTAL VALUAT[O`:. PLANNING AER.9 ❑NO agent to act on tl erty owner'sbehalf. I have read this By my signature below, I certify to each of the following: I am the property owner or authorized Work it is ides tee Description ree to comply th all le tried rec.Ilhavereadproperty tortinspectiontparposesal of Cupertiof applicationno to enter theuabovet the information e pro id n g to construction. ordinances Date'. Signature ol'Applicant/Agent: ROUTING SLIP SUPPLEMENTAL INFORMATION REQUIRED PLAN cIItiCICT'YPE Ne.v SI'D or Multifamily dwellings: Apply for dempolition ermit for El OVER-THGCOUNTF11 UILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building El EXPRESS NNING PLAN REVIEW permit for t:ew building. ElPUBLICWORKS Comltrucial Bldgs: Provide a completed Hazardous Materials Disclosure sTANDAR6 ❑ rIREDEPT _ form i f am Hazardous Materials are being used as part of this project. ❑ LARGE J ❑ MAJOR Cop) vl�Planning Approval Letter or Meeting with Planning prior to ❑ SANITARY SEWER DISTRICT _ Submittal of Building Permit application. ❑ ENVIRONMENTAL HE.tLTH B1c1gt1pp_201I.doc reviser; 06121111 CITY OF CUPERTINO Fm__1 FEE ESTIMATOR - BUILDING DIVISION 19409 scb . —I------- FEE DATE: 10/28/2014 REVIEWED BY: Mendez jigADDRESS: APN: BP#: "VALUATION: 1$14,150 PERMIT TYPE: Building Permit 0111)(f P ., _, - PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building it : -ttj)) _�. rP :.,, - PENTAMATION PERMIT TYPE: 1GENCOM WORK flex 2; install 9 fabric awnings Z SCOPE $0.00 NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fare, Sanitary Sewer Distract, Schoo n.1-1-: J� a nH 11� . V 1::,,::, .ear i/vfnvw/ntinn avnilnhly and Ore Only an estimate. Contact the Dept for addn'l,info. LbJL/ Lcl, G . 1ILGJG GGJ ee/ G LeelG vre Lrce FEE ITEMS (Fee Resolution 11-053 Ey. 7.x`1/13) . —I------- FEE .----- --- - (QTY/FEE - --- MISC ITEMS 21 $0.00 0111)(f P ., _, - Cfi,t,� E3 i it : -ttj)) _�. rP :.,, - t r. 'fes Z hrs $0.00 Z NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fare, Sanitary Sewer Distract, Schoo n.1-1-: J� a nH 11� . V 1::,,::, .ear i/vfnvw/ntinn avnilnhly and Ore Only an estimate. Contact the Dept for addn'l,info. LbJL/ Lcl, G . 1ILGJG GGJ ee/ G LeelG vre Lrce FEE ITEMS (Fee Resolution 11-053 Ey. 7.x`1/13) . —I------- FEE .----- --- - (QTY/FEE - --- MISC ITEMS Plan Check Fee: $0.00 # Awning / Canopy (Supporta by Bldg) IAWNATTBLD Awning i Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp, Feer Reg. Q OTT -0.01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee:$0.00 (,."Or-1,-i-l'-,,,(,tz",-,�-I 7­'Uv._ 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select allon-Residential Building or Structure 0® Strong Motion Fee: 1BSEISMICO $3.96 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS $4.96 $1 . TOTAL FEE. n-71enf'nIA %CV IJCu. v,r r -e I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 19409 STEVENS CREEK BLVD f CONSTR CTOR SOUTH BAY PERMIT NO: 12110094 I I OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL 11711 DELL AVE I DATE ISSUED: 06/19/2014 1 PHONE: 6503441500 Ll LICENSED CONTRACTOR'S DECLARATION License Class Lic. # B Contractor Qk& V Date t 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 performance of the work for which this permit is issued. J 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 is issued. APPLICANT CERTIFICATION I certify that 1 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 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 regul tions per the Cupertino Municipal Code, Section 9.18 Signature ?/dL� Dated t OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, 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 licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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 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. Date CAMPBELL, CA 95008 ! PHONE NO: (408)379-5500 JOB DESCRIPTION: RESIDENTIAL R COMMERCIAL MAIN STREET CUPERTINO- FLEX 2- CONSTRUCTION OF A NEW TWO STORY OFFICE/RETAIL FLEX BUILDING SHELL 29,347 SQ Sq. Ft Floor Area: I Valuation: $0 APN Number: 31620109.19409 1 Occupancy Type: 1 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1801AYS OF PERMIT ISSUANCE OR 180 DAYS URI MJAST CALLED INSPECTION. Issued by: Date:' 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, Segf ns 25505, 25 3, and 534. Owner or authorized agent +/ (rl �% . Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional CONSTR S77—rON PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION I 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 CtJPERTtN.O (408) 777-3228 • FAX (408) 777-3333 building aecuoertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT PR03 C ADDRESS _. , APN k B"70 o 5 MWERNAME 6V lA r �S L-� b PHOVS—-3+4-)E0() V E-MAIL STREETADDRESS �t4 CITY, STk;q 2.b3 f:Z c vvoGi 5hc res � 2-ObcNFAX W6 J C CA a�fUtoS I 6 3 -IJ. 0 9 CONTACT NAME , PHONE en h C� Y 2 �cc%iYiPrt'S CPSD` Lt --C»OU VAIL ni�K,- crC%t��ec�s .Cdr STREET ADDRESS A4 WhL5rMA J2 -d, s�v4e Z00 CITY, STATE, ZIP Vie'N c -A QtI013 FAX IL050 _ 906 - 04-0 -- ® OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT EI ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME V I LICENSE NUMBER LICENSE TYPE BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC r COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE 4 STORIES USE TYPE I OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODEL AREA REMODEL AREA MIODFL AREA PORCH AREADECK AREA TOTAL DECKIPORCH AREA GARAGE AREA DETACH []ATTACH RDWELLINGUMTS: ISASECONDUNIT AYES SECONT STORY ❑YES BEINGADDED? E3 No ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF I PLANNING APPROVAL LETTER IS THE BLDG AN El YES EICHLERHONIE? E]NO RECEIVED,BIs TOTAL VALUATION: Nam, PLANINING APPL-. ❑NO By my signature below, I certify to each of the following: I am the property owner or authorized anent to act on the property mvner s behalf. I have read this application and the information I ha • provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin- 'Iding construction. I authorize representatives of Cupertino to enter the above-' entifi property for inspection purposes. Signature of Applicaht/Agent: c V' z - Date y _ INFOR14ATION REQUIRED � i' cxE%moiPE ( RovT HGsLIP � SUPPLEMENTAL ^* �.t.mha New SFD or Multifamily dwellings: Apply for demolition permit for ❑ oF�R T1�couhz�R SD��L beg;GPi existing building s). Demolition permit is required prior to issuance of building -'-`4W5 a❑'E�RESS�h� '�� � PLAh'h'IhGPLAh RES'IER��� permit for new building. K Lc Bldgs: Provide a completed Hazardous Materials Disclosure yt]s A�F ❑ PUBLIC MM,NIMMILx�� �. _Commercial form if any Hazardous Materials are being used as art of this project. P P J tTli� `.r 'mrd . 4 ❑ FIItEDE�� r�, �"" L❑ L31clTE`y iF.,"r. If z� � "� fes, ca.�33 � � - .vi � � -nz ��+�A.. �r'Gs+ 7".'� �"a..�Y4� �-{ •c^' .,,- �-m�.� .._ �' � �,s'� 'Y4 �...y-�a..-2-.x.:. � Copy of Platming Approval Letter or Meeting with Planning prior to ❑ as�aoR s _ ,��% �tY$E�i�'ERDI�FRICT _ submittal of Building Permit application. HE:AI.TH [�- � `3 e:�..r,�,:u yr <a.,�;r. m....:.�fi � aY . ;:.❑�` �h'YIRO'�'h1ENTAL Bld.-App_201 ].doe revised 06/21/11 CITE' OF CUPERTINO BUILDING PERMIT BUH,DINGADDRESS: CONTRACTOR: PERMIT NO: 12110094 19409 STEVENS CREEK BLVD CUPERTINO CA 95014 SOUTH BAY CONSTRUCTION, INC 1711 DELL AVE, CAMPBELL, CA 95008 OWNER'S NAME: MAIN STREET AGGREGATOR DATE ISSUED: 06/19/2014 OWNER'S PHONE: 650 344 1500 PHONE NO: 408 379 5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #336974 Contractor SOUTH BAY CONSTRUCTION, INC Date 2/10/2016 —BLDG _ELECT _ PLUMB MECH RESIDENTIAL_ COMMERCIAL 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. JOB DESCRIPTION: FLEX 2- CONSTRUCTION OF ANEW TWO STORY I hereby affirm under penalty of perjury one of the following two declarations: OFFICE/RETAIL FLEX BUILDING SHELL 29,347 SQ -MAIN 1. I have and will maintain a certificate of consent to self -insure for Worker's STREET CUPERTINO Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REV # 1 - ADD ROOF WALK PADS TO PLANS (RFI 504) & ,. I have and will maintain Worker's Compensation Insurance, as provided for MOVE (E) GAS METERS (PER PG&E)(RFI 559) - ISSUED by Section 3700 of the Labor Code, for the performance of the work for which 10/1/15 this permit is issued. APPLICANT CERTIFICATION X�'; 9 ' # MIA, %D V M47 f' - !''S UE1102,0,0000-061W 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 DEFERRED #1- INSTALL (9) FABRIC AWNINGS- IS SD ordinances and state laws relating to building construction, and hereby 4/15/2015 authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep Sq. Ft Floor Area: Valuation: $2328951.00 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 APN Number: Occupancy Type: comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature. - Date 2/10/2016 WITHIN 180 DAB'S OF PERMIT ISSUANCE OR OWNER -BUILDER DECLARATION 180 DAB'S FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued PAUL O SULLIVAN r. I, as owner of the property, or my employees with wages as their sole Date: 2//10 10/2016 compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed RE -ROOFS: contractors to construct the project (Sec.7044, Business & Professions Code). 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 I hereby affirm under penalty of perjury one of the following three declarations: inspection. r. 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 Signature of Applicant: performance of the work for which this permit is issued. Date: 2/10/2016 2. 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 is issued. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER s. 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 HAZARDOUS MATERIALS DISCLOSURE Worker's Compensation laws of California. If, after making this certificate of I have read the hazardous materials requirements under Chapter 6.95 of the exemption, I become subject to the Worker's Compensation provisions of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will Labor Code, I must forthwith comply with such provisions or this permit shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the be deemed revoked. Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Management District I I certify that I have read this application and state that the above information is will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and correct. I agree to comply with all city and county ordinances and state laws the Health & Safede, Sections 25505, 5533, d 5534. relating to building construction, and hereby authorize representatives of this city` n, to enter upon the above mentioned property for inspection purposes. (We) agree Owner or authorized agent: I to save indemnify and keep harmless the City of Cupertino against liabilities, Date: 2/10/2016 judgments, costs, and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY consequence of the granting of this permit. Additionally, the applicant I hereby affirm that there is a construction lending agency for the performance understands and will comply with all non -point source regulations per the of work's for which this permit is issued (Sec. 3097, Civ C.) Cupertino Municipal Code, Section 9.18. Lender's Name Signature Date 2/10/2016 Lender's Address CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19409 STEVENS CREEK BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 12110094 CONSTRUCTION, INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL 1711 DELL AVE DATE ISSUED: 06/19/2014 OffNER'S PHONE: 6503441500 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ MAIN STREET CUPERTINO- FLEX 2- CONSTRUCTION OF License Class 4� Lie. # BZZ67 A Contractor a J� `�?7��S j Date 0 t NEW TWO STORY OFFICE/RETAIL FLEX BUILDING SHELL I hereby affirm that I am licensed under the provisions of Chapter 9 29 347 SQ (commencing with Section 7000) of Division 3 of the Business & Professious 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 Sq. Ft Floor Area: Valuation: SO performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by tection 3700 of the Labor Code, for the performance of the work for which this APN Number: 31620109.19409 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I 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 180 AYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F OM AST CALLED 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 by: Date: with al I non -point source regul tions per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Si nature i/ „_ Date 6 V All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one 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 compensation, will do the work, and the structure is not intended or offered for sale (See.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed 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, Seft• ns 25505, 25 3, and 534. 3, d Section 3700 of the Labor Code, for the performance of the work for which this (� 4 permit is issued. Owner or authorized agent /i%1, 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 x CONSTRUCTION PERMIT APPLICATION - - CONiIJiUN1T1( DEVELOP1diENi-DERI RTI�4ENT -BUILDING DIVISION 10300TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building ancuoertino.orcl CUrERTIhfO' I 1— 1 [] NEW CO -,S -,-,',UC TIO; I LJ ADDITION ION . D =.LTE-ATl0W l TI N?/aEViSiON I DEFERRED O'RIGiN a T PERI/ ;L2 r-" t'xal:cr f ullxrss ! 10 t 10 g�;?.ER NA1J I 'cP s 7 7) 3M =•,� �t Z� • 6&e�Q s� . ; Al I I CITY, STATE, Zip STREET fDDRrSs ' G C� Er1`� f' % t , , 1 /+ I X C. 0./ D cry ! ZE0/,zD C01\TACT TAS✓- i N4'L � F�� b � I N/�� ✓0.L`u� r!� 11,,c 1 STREET TSU CITY, ST / 2 u 0t1? L3( ❑. OW=P.•BLiDD ❑ 01wI,ZAG'tir ❑ CO?.- ACTOR ❑ CON7KkCTORp.GT'T ❑ 2,C!-T'CT ❑ ENGL2_cR ❑ D5\rLOPER ❑ i_? AhI CONTRACTOR I LICm.S?TY'PH SUS.LICR � COl✓�I'At�Y Nfa�S E N_t.IL r.4.n 2 S SCS/ ST>`.cTADDR--SS �t lnva C7Y,STAic,Zi? r� CV4r Pii lakg —M- (c^® E' � sp _ ` V_` / b- �1/JC/ I r BUS. LIC ARCHIT=CTrdGII•i=rRNf�J,r - i, L10E:NS-1UV-,=' J � FAX col.�Ahv N.Aa� 1kUL STREET ADDPFSS I C7 Y, STATE, ZIP I PHONE — - DESCRIPTION OF WO? FV, 2 A b1) MST1INGUSE FRO?OSSDUSE� CONSTKT%PB €STOP.TS j USE TYPE I OCC. I SQ.FT.VALUATION (S) �rcTG 1+'EW FLOOR DE1.i0 TOTAL --; .AREA / v.EA f R EA BA T PP OO✓. KITC.-L='N OTS R P.r AOD'cL AREA R.M,10DEL AREA RFMODEL AREA - PORCH AREA DECK AREA TOTAL D=Ci-?O? C -I ARZA GA -RAGE AiZ.A: D-ETACH ❑ ATTl.C.1 I 77 nDR'ELLRgGT2'i1S: ISASECONDUNIT ❑Y?S SECOND STORY ❑1 s —' BEING ADDED? ❑NO I I ADDITION? ❑1+0 - pp` ;e oor iCATIO*! ❑1.S lF 1'.s, PROVIDE COPY OF IS THE BLDG AN ❑ 7 = TOTAL VA �A T ION: PLA'�?.7NGh??Ld ❑NO PLANK GAP?ROVhLL==1 ;L H EICHLEROMF1 El NO By my sieaature below, I ce iy to each of the following: I am the properq' owner or authoriz d agent to act on the property ov,-mer's behalf. I have read this application and the information I ave provided is coact. I have rend the DescriYtio r of `T ork and veri j' it is accurate. I agree to comply ; ith all zDplicF local ordinances and state !z;;s relztin o ilding const action. I authorize representatives'DI Cupertino to enter the above-identi-led prope, for inspection pu;7oses. SignzfireofApplicant/?cent: Date: SUPPLEME TAL IN OR��i..i' TION REQUIRED New SFD or Muhifam, Fly du%ellirg5; Apply rOr dei 1011tion De mit _OI e..xisling building(s). Dernolltion permit is :enuired prier t0 issiie-nce of build;_ -Ig O��RSfirCOL�TER Y -cm xE c UIIDL�GPZ3ARr[� i � F'", petTnit IOI ew buil di. �• - '--- c Ez��ESS — �HPL4'�A1}GPLj� F��ZEFF Co;_1mmIal Bldes: Provide a completed Hazardous Materials Disc!es`ure p �e u ?P _ form if any Hazardous Materiai_s are being used as part ofthis project. rPLELICROF n,Q Approval Le- or Meeting wit g Copy ofPlan,niQ h Plar�1lQ prior to = _ SUbID3tf23 , OI Building Pe -illi application. r Z 70R ; r _ TTT�18Fti�a�I5T12ICi �`+-_` 1-� �'.,�sF•-."ETa�2R01.n'IiY��T.4S.HE4�iTn:.:��,N:,"��,.. ��. i- .','= .t' �� .Bld��aa_?Ol.l.doc revised 06/21/11 CONSTRUIC N PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION VI� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \VO (408) 777-3228 • FAX (408) 777-3333 - building(aDcupertino.org ` 9 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT n PROJECT ADDRESS APN # , n 2-00 IyUln OWNER NAME � � PHON 5-b -3+4. 1 JOU E-MAIL sTREEZv3 sPedwooci Snores �wu 5"i; CITY, ST ZI wOIY( l l /-I ��U(D5 FAX cc • 3% ��/ CONTACT NAME Psi PHONE AICDs-D�Ov 4IL c�}�r en h ♦2� rl a e►'s CaSO- ti rC►II4ef-15 .C�r►� STREET ADDRESS 141-f5 IV W htsrt_Kr1 s iAi4e ?1�'w'ta CITY, STATE, ZIP -�A VICVJ CA qq05 9q05 FAX ass - qW - D�K -] ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE R STORIES USE TYPE OCC. SQ.FT. VALUATION (5) E)ISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REN40DEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LJ DETACH ❑ ATTACH RDWELLAGUNTTS: IS A SECOND UNIT El YES SECOND STORY ❑YES BEING ADDED? E] NO ADDITION? ❑NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN El YES RECEIVED BYr.,I -x TOTAL VALUATION: PLANNING APPL R ❑NO PLANNING APPROVAL LETTER EICHLER HO?, E? ❑ NO g' 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 haV provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state lawsrelatin Iding construction. I authorize representatives of Cupertino to enter the above-' entifie property for inspection purposes. Signature of Applicant/Agent: Date: _- SUPPLEMENTAL INFOPI\ZATION REQUIRED r `I cc�irE t,. ,X n RouTHc srrs -: New SFD or Multifamily dwellings: Apply for demolition permit for Psi ,� �Yr ❑ OVER THE-COUItTER , � g 3= i .. ❑ BUIIDIIGPLd A REVIEW existing building(s). Demolition permit is required prior to issuance of buildings�v for new building. ❑ ❑ permit EREss SPI AItRIncPIAI. REVIEw� N'> Commercial Bldgs: Provide a completed Hazardous Materials Disclosure '� ssi`DARv , ®Pusirc oRls _ form if any Hazardous Materials are being used as part of this project. &r _ k z FIREDEP� r{r x�az`. Copy of Planning Approval Letter or Meeting with Planning prior to NF}yk° �w x r _ submittal of Building Permit application. £ it ❑ni4JoR Y.� ❑ S4T�IT�RYtSE« ER DISTRICTS E Bld,; 9pp_2011.doc revised 06/21/11 CITY OF CUPERTINO F,M--,7 FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 19409 Stevens Creek Blvd DATE: 02/10/2016 REVIEWED BY: PAUL $572.00 APN: 316 20 112 BP#: *VALUATION: Iso "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building 0,0 PENTAMATION PERMIT TYPE: 1GENC0 i WORK REVISION #2 - ADD COMMON GAS METER - ISSUED 2/10/2016 SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'1 info. FEE ITEMS (Fee Resolution 11-1133 Ef(' 711113) FEE QTY/FEE MISC ITEMS $572.00 Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 hours $143.00 Plan Check, Hourly 1STPLNCK Suppl. PC Fee: 0 Reg. Q OT 0,0 hrs $0.00 PME Plan Check: $0.00 Pen -nit Fee: Hourly Only? (:) Yes (@ No $0.00 Suppl. Insp. Fee -.(F) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i. onstP"uelk"n Rzv. taLGl ?37JC:5t3t7lfb't? /'i.'/.'': 0 E) Work Without Permit? Yes (j) No $0.00 Advanced Planning_Fee: $0.00 Select a Non -Residential Q Building or Structure i Favel Strong .Motion Fee: $0.00 3.0 hrs $429.00 Inspections �. u 15T1NSP Inspection Ho rl Bldg Stds Commission Fee: $0.00 SUBTQTALS: $0.00 $572.00 TOTAL F EE;: ] $572.00 Revis : 10/01/20 Date: February 9, 2016 City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 Project: Main Street Description: Main St. Flex 2 Permit No: 12110094 4LEAF Job #: J0525-95 (525-12-008) Owner: 500 Forbes LLC To whom it may concern, 0 AJ u. J: •4� m This letter provides explanation for changes on gas supply system for Flex 2 building in Main Street project. Per original design intent, whole second floor in Flex 2 building was supposed to be occupied by just one office tenant and just one gas supply service was assigned for the second floor. Eventually, the second floor has been occupied with two office tenants with common corridor and lobby area. Hence, gas supply system in Flex 2 building has been revised so that each tenant and common area (corridor and lobby) on the second floor is connected to dedicated gas supply service. So, instead one gas service that was planned to serve second floor of Flex 2 building, there are three spate gas services provided for second floor of Flex 2 building. rely, " CUPERTINO SrdjaRebraca, P.E.i, • •, •' ��'i 3i.;il �R�_.` Prin pal i': 4 ding Department FEB 10 2016 PUDE COMPLIANCE Reviewed By: nE G� 181®N 3371 Olcott Street, Santa Clara, CA 95054 phone(408) 522-5255 fax(408) 522-5260 APR 1 2 i i' �.. BY Ir. All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. 534 23rd Avenue Oakland„CA 94606-5307 CONSOLIDxrED ENGINEERING (510)436-7626 L A B O” R A T O R,1 E S COMPRESSION TEST REPORT DATE OF ISSUE: 12/4/2014 RPT TO: City of Cupertino RE: Main Street Cupertino - Flex Building 2 10300 Torre Avenue 19409 Stevens Creek Boulevard Cupertino, CA 95014 Cupertino, CA 95014 ATTN: . Albert Salvador Permit#: 12110094 A1bertSnucupertino.org Additional#: CEL #: 1028289B Lab #: 015706 PLACEMENT DATA Placement #: 1 Admixture type: Pozz 322N Placement date: 11/26/2014 Mix Number 5534FWR50 Sample date: 11/26/2014 Strength Spec: 4000 psi @ 28 days Total sets: 6' Agg. Size/Src: 3/4" / star Material type: Concrete Compression Cyl. ASTM C 39 Material Supplier: STAR Slump spec: 4.00 in SET DATA Set number : 4 of 6 Slump: 4.50 in ASTM C143 Sample time: 12:20 Air temp: 64 deg F Sampled by: Brandon Wells Mix temp: 66 deg F ASTM C1064 Ticket/Truck : 432130/,82 Mold type: CYL Placement Location Flex 2 footings at 1-9/2-E2 Sample Location: Flex 2 footing at 6/132 Comments: Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (int) (lb) Factor (psi) Type 015706A 7 ' 12/03/14 Lab 4.00 X 8.00 12.57 44,020 1.00 3,500 Side fracture at end 015706B 28 12/24/14 Lab 4.00 X 8.00 12.57 0 1.00 0 015706C 28 12/24/14 Lab 4.00 X 8.00 12.57 0 1.00 0 015706D 28 12/24/14 Lab 4.00 X 8.00 12.57 0 1.00 0 015706E H Lab 4.00 X 8.00 12.57 0 1.0.0 0 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador E -Reports placeholder - APR 1 2 i i' �.. BY Ir. All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval.