15060177 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10600 S DE ANZA BLVD CONTRACTOR:BEVILACQUA &SONS PERMIT NO:15060177
OWNER'S NAME: SI 24 LLC 451 VICTORY AVE STE 5 DATE ISSUED:09/15/2015
OWNER'S PHONE: 4085091575 S SAN FRANCISCO,CA 94080 PHONE NO:(650)616-9900
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
LEAPSTART-T.I.OCCUPANCY CHANGE TO BUILD OUT
License Class Lic.# 57 VACANT BUILDING(2556 S.F.)INCLUDING 2 ADA RESTROOMS
Contractor i el •. Date �Ibes REV#1-MINOR ELECTRICAL CHANGES AND CONFIRM OCCUPANCY FROM E TO
B PER CODE ERRATA FOR 2013 CBC.
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:
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 Sq.Ft Floor Area: Valuation:$10000
perf ance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this APN Number:36938037.10600 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST 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 A itionally,the applicant understands and will comply with Issued by° Date:
all non-point rce r 1 ' s per upertino Municipal Code, ect on 9.18. a
Signature Date
« C
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
❑ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: Signature of Applicant: Date:
1. I,as owner of the property,or my employees with wages as their sole ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
ol
I hereby affirm under penalty of perjury one of the flowing three declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I. I have and will maintain a Certificate r Consent to fself-insurewfor Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section I use equipment
should I store ce handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
performance of the work for which this permit is issued. contaminants as deft edby the Bay Area Air Quality Management District I will
2. I have and will maintain Worker's Compensation Insurance,as provided for by maintain compliane ith the Cupertino Municipal Code,Chapter 9.12 and the
Section 3700 of the Labor Code,for the performance of the work for which this Heal4&SafeoC ,Sectio 5505,25533,and 25534.
permit is issued.
s. I certify that in the performance of the work for which this permit is issued,I shall O a t:
Date: %
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 CONSTRUCTION LENDING AGENCY
must forthwith comply with such provisions or this permit shall be deemed I hereby affirm that there is a construction lending agency for the performance of work's
revoked. 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 ARCHITECT'S DECLARATION
upon the above mentioned property for inspection purposes.(We)agree to save I understand my plans shall be used as public records.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Licensed Professional
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,GA$5014-3255
CUPERTINO (408)773-3228 f FAX(408)773-3333•bU(Id1W@rupgdpg,org
El NEW CMSTRUCITDN Q ADDITION 11 ALTERATION!TI REVISION 1 DPYERRBD ORIGINAL PERNT# 15060177
FROIEC'T ADDRESS:100 SOI3TM DEANZA BLVD,CUPERITNO_irAA 45014 ® 7677-37-0.5-70,7066,0
LiwNER NAME HYER PROPBRTIESPHONE:(409}509-1575 i A1L: In titlgfl t?z yer.cc3m
STREET ADDRESS.66 POTRERO AVENUE CITY,STATE,ZIP:SAN FRANCISCO,CA 9$103 FX:(415)626.2767
CONTACT NAME.CARTER LEUNG 1 PHONE:(590}841.3555 7
E-MAIL:carted@kai"arketey.mn
STREET ADDRESS:1810 SIXTH STREET CITY,STATE, ZIP:BERKELEY,CA 94710 FAX (5i0}841-1225
®OwN� . 0 owe->;u1LDER O OWNERAct ❑ coNnAcroR CicoNmkcmitAGEKT 11 ARCEITEcr 0 mmmm 0 Dcvmop¢R 13 TMAW
CONIRACTORNAME PAULBAVILACQUA LICENSENUMBER. 36575 T=F-T;7
BUS.LIC#
COMPANYNAME BAVILACQUA&SONS E-MAIL FAX
STREET ADDRESS 453 VICTORY AVE STE 5 CITY,STATE,ZIP S SAN FRANCISCO,CA 99080 PHONE 650-616-990
ARCHITEC ffiNGINEER NAM13 A3IARLES KAHN LICENSE NUMBER#COI6027 BUS.LIC
COMPANY NAME:KAHN DESION ASSOCIATES E-MAIL:hu1esk@k&4wke1ey=n FAX-FAX(510)841-1225
STREET ADDRESS: 1810 SIXM STREET CITY,STATE,23 P:BERKELEY,CA 94710 PxtlAiB:(510)sOt-3555
DESCRIPTION OF WORK:
RL.WMICAN DRAWINGS SSMO 31 6 R2 RMSIONS AND um REVISONS ON COYER aGOOD BUBO ON CNANOa XN OCCUPANCY FROM.GROUP Is' TO GROUP '9'.
RxI9TJKGU9E:VA T PROPOSE USE: CONSTR"TYPE: #STORIES:I
TUTORIN4 CENTER V D USE TYPE OCC. SQ.PT. VALUA71ON
MOSTO NEW rLOOR DEMO TOTAL
AREA:2,556 Sr AREA:0 ARRA:D NEr ARE&:2,556 91=
BATHROOM WCHEN I OTHER
RIMMI3&L AREA REMODEL ARBA RMOD10.AREA
PORCHARBA, BECK AREA TOTALD1i!K1P01LCH AREA I fiARAGE AREDk`IItiCK
A'nrACtt
9 DWELLIMOUNITS: IS A swoN5 uNrr OyEs SLCoMD SToRy YES
REMPGAnOW? ONO ADDITION? ONO
[PRE,APPLWA,noN OYHS lirYBS,PROYIDECOPYOF ISTmaunGAN
PL4NNWoMPL# OXG MAAI MOAPPROVALLETPHR TICRI.ZItriOM£Y
By my signature below,I certify to each of the following: I am the property owner or audtoriZed t to oz's behalf. I have read this
application and the information i have provided i orrect I have read the Description of Work and v i rt is accltrate. I agree to comply With all applicable local
ordinances and state laws relating to building co tion. I authorize representatives ofGuperdno to enter the above- arty for inspection purposes.
Signature.of ApplicantfAgent: i?ate:
SUPPLEMENTAL lNFqWATTnNR.EQLIIRED PI.ANC$ECKITM RO1PTINGSLIP
New SFD or Multifamily dwellings: Apply f demolition permit for O OvBR THE-Coumviz ® BU"MG PL"REVIEW
existing building(s). Demolition permit is required rior to issuance of building
permit for new building. C7Expam 0 PLANNWG PLAN wt_w
C,
_ ommercial Bldgs: Provide a completed Hazardous Materials Disclosure summw CI PUBLIC WORM
form if any hazardous Materials are being used as part of this project. 0 LARGE ❑ 3 DEPT
Copy of Planning Approval better or Meeting with Planning prior to O Io JOR ® y.6E;W nwW .
Submittal ofBuikhng Permit application.
11 I3NYIIt€1NA#EEP3TdL 33iEhI,T1I
BidgApp mi.doc revised ,21J'II
WIPVRMIIrT
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
DDRESS: 10600 S DE ANZA BLVD DATE: 09/25/2015 REVIEWED BY: MELISSA
PN: 36938037.10600 BP#: 15060177 `VALUATION: $0
PE: Building Permit PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY Commercial Building Civil/Religious activities PENTAMATION
USE: in BQ zone? Q Yes1 GENCO
!< No PERMIT TYPE:
WORK REV# 1 - MINOR ELECTRICAL CHANGES AND CONFIRM OCCUPANCY FROM E TO B PER
SCOPE PREVIOUS CODE ERRATA FOR 2013 CODES
� k
:V.£:Ci2.?�:i.23:i..:e{•C:;< f<E%??,i..< „.;L:j;S;C.r;' .._ �. t',�??:C.'ii.x..
sTe• ED�t :€•r ..� . .. {- .:} s'�?},n.z. r'is;1J. {fit' .:;Ir...,li:.
f.Rea
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the reliminai information available and are only an estimate. Contact the De t for addli'l iia o.
FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (F) No $0.00 2 hours Plan Check,Hourly
Suppl.PC Fee: ) Reg. 0 OT 0.0 1 hrs $0.00 $286.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insm Feer Reg. 0 OT 0 0 hrs $0.00
PME Unit Fee: $0.00
PME Pen-nit Fee: $0.00
Construction Tax: IBCONSTAXC $0.00
Work Without Permit? 0 Yes (j) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure 0
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
UBTUTALS $0.00 $286.00 �. OTLTE $2$6.00
Revised: 07/02/2015