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B-2016-1362Philz Coffee will allow the employees of Capezio and Howard's Shoes for Children to use their restroom during the period of restroom construction at M within 30-45 days. ain St., Cupertino. The restroom should be constructed �cCIjam' LIFIL" CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1362 19449 STEVENS CREEK BLVD STE 110 CUPERTINO, CA 95014 (316 20 112) BOAZ RENOVATIONS INC SAN JOSE, CA 95117 OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC DATE ISSUED: 04/21/2016 OWNER'S PHONE: PHONE NO: (408) 279-0300 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B. C-10 Lic. #943011 Contractor BOAZ RENOVATIONS INC Date 03/31/2017 X BLDG _ELECT _PLUMB MECH RESIDENTIAL X_ 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: CAPEZIO (STE #110) - T.I. TO BUILD OUT SHELL FOR (N) M I hereby affirm under penalty of perjury one of the following two declarations: OCCUPANCY (741 S.F.) 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 erformancc of the work for which this permit is issued. _,13I have and will maintain Worker's Compensation Insurance, as provided for by lf Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $50000.00 permit is issued. APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 31620 112 A (Tenant Improvements),M (Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the �plieagt.4jnderstancls and will comply with all non -point source regulations per t ertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. i Signa{ re Date 4/20/2016 Issued by: ABBY AYENDE �f Date: 04/21/2016 OWNER-BUILDE DECL ATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/20/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 perfonnance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the unicipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety ode, Sections 25 2$533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked,ner or authorized agent: gate: APPLICANT CERTIFICATION 4/20/2016 I certify that I have read this application and state that the above information is Ti E i A Y correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construe on lendin ency for the performance s relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued 97, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally; the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 4/20/2016 Professional COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 `- I (408) 777-3228 •FAX (408) 777-3333 • buildin cu ertino.or 2v t Ct�6'f FtT1N4� 1 ❑ NEW CONSTRUCTION ❑ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS �s c�v fl Su � i o T74 3( - OWNER NAME �v tu.L Coy PAot PHONE 4ob --7-?-7�- 3o EMAIL AA rc0 xde cc 5keo .coves STREET ADDRESS i oil23 CITY, STATE, ZIP Capip-lnWO C& e7S� l FAX CONTACT NAME J ib1'P ' cK'L E 1.43A6foeG A �iiC�G • PHONE �Z� -2 a-��i© E-MAIL � 1'�cte�.ee((eCcDc �tlxcack- STREET ADDRESS a5co l AAT, ►PWZL. �OW i7, . S t)11le 2 CITY, STATE, ZIP "PA Eta CA FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT! ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME .—t,,-,,,, LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME t4V 1 FA5CO K LICENSE NUMBERG'�� P (o BUS. LIC # COMPANY NAME DG. E-MAIL 1,tt �i C-0^ FAX A- d fr �K - STREET ADDRESS 3S°1( .0-17- '01AP-.o Thr'0 st? ot1E ��a5 CITY, STATE, ZIP LAE: E_=0 �1 4549 PHONE _ (q2's-263-5b-7 DESCRIPTION OF WORK 74k 5 1 iW- Foe lt-N7A�%— rV l PP we-4,(qy4`T Cit Ksip -- e r . L! -Ta EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES r& fi ?,Vr l L_ --r. 1 •� �JTOTAL i USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA 1 P �.'� 1 NEW FLOOR AREA —f/+I DEMO AREA q( /lam ' /TOTHER NET AREA i BATHROOM KITCHEN REMODELAREA REMODELAREA 4 REMODELAREA 141A PORCH AREA DECK AT14EG TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: COND UNIT ❑ YES SECOND STORY [:]YES ADDED? ❑ NO ADDITION? ❑ NO I PRE -APPLICATION YES IF YES, PROVIDE COPY OF IS THE BLDG AN _ TQTAL VALILIJ61(�: PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? O !✓� O /V) (J By my signature below, I certify to each of t e�Uvm I am the property owner orau onze agent to act on the property owner's behalf. I have read this application and the information v' I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rel ing to build! nstructi I authorize representatives of Cupertino to enter the above -id ' of d property for inspection purposes. Signature of Applicant/Agen . Date: ��� SUPPLEMENTAL INF RMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD El PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ NAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp 2011.doc revised 06/21/11 A NW-M-1 ---�-- CITY OF CUPERTINO FF.F ESTIMATOR - BUILDING DIVISION im,ADDRESS: 19449 STEVENS CREEK BLVD DATE: 02/16/2016 REVIEWED BY: MELISSA APN: 316 20 112 BP#: B-2016-1362 *VALUATION: 1$50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRE%1ARy USE: Commercial Building 741 PENTAMATION PERMTYPE: 1 M T� IT WORK CAPEZIO STE #110 - T.I. TO BUILD OUT SHELL FOR N M OCCUPANCY 741 S.F. SCOPE Permit Fee: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f. PC FEES PC FEE ID BP FEES BP FEE ID M (Tenant Improvements) II-B,III-B,IV,V-B 741 $2,914.15 IMTIPLNCK $908.95 IMTHNSP Permit Fee: $908.95 Suppl. Insp. Fee -(D Reg. 0 OTF0,01hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 t..'on'Struc:tion T(xcl G Work Without Permit? 0 Yes 0 No $0.00 TOTALS: 741 $2,914.15 Ti-aveIl �oczaa.ewarion IFees. $908.95 Strong Motion Fee: 1BSEISMICO NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, mire, sanitary sel ver District, school of, 1 Th—, Ir- m•o hacod All MO nl•o%inlilfal•V illf(PI-MOflall OVOilahlB OBd OPP an1v all OwimatP_ CantaCt thr. DP.nt fol• addn'L info. FEE ITEMS (Fee Resolution I1-053 Eff. 711113) FEE QTY/FEE7 MISC ITEMS Plan Check Fee: $2,914.15 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $908.95 Suppl. Insp. Fee -(D Reg. 0 OTF0,01hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 t..'on'Struc:tion T(xcl G Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential 0 Building or Structure 0 i Ti-aveIl �oczaa.ewarion IFees. Strong Motion Fee: 1BSEISMICO $14.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 SUBTOTALS:, $3,839.10 $0.00 TOTAL FEE: $3,839.10 Revised: 01/01/2016 A