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15080040CITE' OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19409 STEVENS CREEK BLVD CONTRACTOR- PERMIT NO: 15080040 CO `% OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR I DATE ISSUED: 10/16/2015 OW ER'S PHONE: 6503441500 HI PHONE NO LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RES16ENTIAL ❑ COMMERCIAL FJ License Class_ CINARRA - STE 200 T.I. TO BUILD OUT SHELL FOR (N) Lic. #_ B OCCUPANCY (5,939 S.F.) (MAIN STREET - FLEX 2) / Contract Date g9 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: Sq. Ft Floor Area: Valuation: $249500 �. 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 is APN Number: T 620112.19409 Occupancy Type: permit 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. . PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 180 DAYS FROM LAST CALLED INSPEC ION® to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection �ta j " 6f purposes. (We) agree to save Issued by: Date: 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 pe . Additionally, the applicant understands and will comply with all non -point so ulati the Cupertino Municipal Code, Section 9.18. RE-ROOFS: ® _ All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature Date installed without first obtaining an inspection, I agree to remove all new materials for i inspection.. Signature of Applicant: Date: R- BUILDER DECLARATION I hereby affitn that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: t. 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 - HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2.. I, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain construct the project (Sec.7044, Business & Professions Code), compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, should I use equipment or devices which emit hazardous air 1. I have and will maintain a Certificate of Consent to self - insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the performance of the work for which this permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owne or authori d a ent: Date: /®' 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 Compensation laws of California. If, after making this certificate of exemption, I I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION 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 I understand my plans shall be used as public records. 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014 -3255 CUPERTIN 7 (408) 777 -3228 FAX (408) 777 -3333 • buildin- macupertino.org /.5� ® 4folo ❑ NEW CONSTRUCTION ❑ ADDITION TERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS /9�f�9 see &Vb k APN# E ' G POR SS x SG b` CIT ST TE IP i -.. F + &VX(e f'. i�. PHONE 1A, (.16 O/0C E� / may./ �j -/� �a p�� f�f /� _. I GdJ :tom i'! /f/ls ®sJ l ST E DR S Z CITY, ATE; Z P a F � t � 616 ❑ "OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT - ❑ CONTRACTOR ❑ CONTRACTOR AGENT ( ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C /L. //r!4y.� /�� (,(�(J`� LICENSE R LICENSEYPE BUS. LIC# COMP N _ ��-,��/y °�d E w a i � /) C S M (W VW CITY d f BJ s CA 241, Ldp ARCHI R) "J& � w M� 1.� ..LICENSE NUMBER ,5* (�/�+- .. (..,� d �. BUS. LIC # COMPANY N.. �Ae l _ .. E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ,00,01 N V -°" c y-- _ EXISTING USE - _PROPOSED USE CONSTR TYPE # STORIES - - - - - USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR DEMO AREA AREA TOTAL NET AREA . BATHROOM KITCHEN - OTHER - - -. - REMODEL AREA ® REMODEL AREA REMODEL AREA e� PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH - I ® ATTACH I - # DWELLING UNITS: IS A.SECOND UNIT ❑YES SECONDSTORY []YES -- BEINGADDED? ❑NO ADDMON? ;H*O PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YE CE " -- ' ' + T V UATION: PLANNING APPL # RIiFO PLANNING APPROVAL LETTER EICHLER HOME? -. By my signature below, I certify to ch o the following: I am the property owner or authorized agent o ac erty owner's behalf. I have—read-this application and the information I ve pr ed i ect I have read the Description of work and veri accurate. I agree to comply with all applicable local ordinances and state laws relatin to buil ' I Ehorize representatives of Cupertino to enter the a ve -i ntified property for inspection purposes. ie W Signature of Applicant/Agent: Date: V 15 SUPPLEMENTAL qKIFOT —TION REQUIRED PLANCHEZ If TYPE BorrlNsLIP ,�vElt -axE CaurYix ❑ I3uuDrN�PAivREVrEw . New SFD or Multifamily dwell g Apply for demolition permit for existing building(s). Demolition pe " is required prior to issuance of building permit for new building. C3, EXPRESg' ❑ pr:�NNnvOpl ANkEV7Ew _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTANDAFD ©. rusLlewoxics form if any Hazardous Materials are being used as part of this project. CI.. LARGE _ � FI12E "I}EPT — Copy of Planning Approval Letter or Meeting with Planning prior to �., MASOR - $34ITARY SERbI5TRTCr submittal of Building Permit application. . T . I=1 IIVVIRZINAIENTAT e1LTH B1dgApp_2011.doc revised 06121111 YAe � CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 19409 STEVENS CREEK #200 DATE: 0810512015 REVIEWED BY: MELISSA — APN: 316 20 112 BP #: *VALUATION: 1$249,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE:: Tenant Improvement -T USE: ARY Commercial Building PENTAMATION PERMIT TYPE: 1 B TI WORK CINARRA STE 200 T.I. TO BUILD OUT SHELL FOR N B OCCUPANCY (5,939 S.F. (MAIN SCOPE I STREET - FLEX 2) - OCCUPANCY TYPE: TYPE 4F CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II- 8,111- B,IV,V -B 5,939 $2,485.60 IBTIPLNCK $5,072.40 IBTIINSP Permit Fee: >.. ... si. ,f -3 .v. l'Im ;:13. itp, Tee hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 const'-wfion RV;: Work Without Permit? 0 Yes No $0.00 TOTALS: 5,939 $2,485.60 s $5,072.40 Strong Motion Fee: IBSEISMICO rsts VNurnute uoes not inctuae fees aue to other vepartments (i e. Planning, Public Works, Fire, Sanitary Sewer District, School District_ Pfr'_ )_ Thoco foot nrn --I.. FEE ITEMS (Fee Resolution 11 -053 E . 711113) FEE 05 MISC ITEMS R` 9f1 :S't`t:Lli. i t_. E,..,e• >..fy 1 i.f -f. ;. M,mt :,cL :. ....c.c.. iv: n .. .., .,t 7 it'.J £ - ._ L. 3 E f f7< t 1J -ts p, Permit Fee: >.. ... si. ,f -3 .v. l'Im ;:13. itp, Tee hrs $0.00 rsts VNurnute uoes not inctuae fees aue to other vepartments (i e. Planning, Public Works, Fire, Sanitary Sewer District, School District_ Pfr'_ )_ Thoco foot nrn --I.. FEE ITEMS (Fee Resolution 11 -053 E . 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: $2,485.60 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $5,072.40 Suppl. Insp. Fee :@ Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 const'-wfion RV;: Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure °rr -<l.l r r. ri re zt€ir 3n 1'Ces. Strong Motion Fee: IBSEISMICO $69.86 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $10.00 SUET ©TALS =. $7 637:86 $0.00 rE r.. r .. $7,637.86 Revised: 07/02/2015 1931, lk, W 111W Of''IEW 'WX Building Department 119 City Of Cupel'thio 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408- 777 -3228 Fax! 408-777-3333 JOB ADDRESS: 19409 Stevens Creek Blvd. #200 PERK TT # 15080040 OWNER'S NAME: Main Street Cupertino Aggregator PHONE #(650)948-6930 GENERAL CONTRACTOR. Cartmell/Tarn Construction, Inc. BUSINESS LICENSE # 36752 ADDRESS:4001 Page Mill Road CITY/Z,1.PCODE: Los Altos Hills, 94022 V SUBCONTRACTOR BUSINESS NANIE BUSINESS LICENSE # . .. . .......... Cabinets & Millwork Bayside Commercial Casework, Inc Cernent Finishing Electrical TDN Electric, Inc. 28386 Excavation Fencing Flooring / Carpeting Commercial Design Services Linoleum / Wood ... . ..... . .... Glass / Glazing Crediford Enterprises 55210 Heating The Trillo Companies, Inc. 29816 Insulation South Bay Interiors, Inc. 25499 Landscaping Lathing Masonry Painting / Wallpaper Joel Favela Painting 55191 01-6 Paving Plastering Plumbing Fresno Plumbing & Heating, Inc. 32000 Roofing Statewide Roofing 23509 Septic Tank Sheet Metal Sheet Rock South Bay Interiors 25499 Tile JNL Marble & Granite ...... . .... 55201 Contractor Signature 11 Date