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15120099CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15120099 19770 STEVENS CRK BLVD CUPERTINO CA 95014 VR MASON INC HUNTINGTON BEACH, CA 92647 OWNER'S NAME: LP EVERSHINE VI DATE ISSUED: 95/03/2016 OWNER'S PHONE: 314-965-1555 PHONE NO: (714) 843-0707 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class DRYWALL Lic. #455149 Contractor VR MASON INC Date 05/31/2018 BLDG —ELECT _ PLUMB I hereby affirm that I am licensedunder the provisions of Chapter 9 (commencing MECH — — RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: TENANT IMPROVEMENT FOR SCOTTRADE (2533 SFJ 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. % I have 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 permit is issued. Sq. Ft Floor Area: Valuation: $131599.00 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 and state laws relating to building construction, and hereby authorize "N Number: 6q o 6' Occupancy Type: 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. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source re tions per the u e ' unicipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 5/3/2016 Issued by: AbbyAyende o Date: 05/03/2016 A 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) 2. 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: 5/3/2016 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance 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 Worker's Compensation laws of California. If, after making this certificate of au' contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with a Cupertino Municipal Co , apter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety ode, Sections 25505 255:113, and 534. be deemed revoked. - Ownerbr authorized agent: APPLICANT CERTIFICATION - -Date: 5/3/2016 certify that I have read this application and state that the above information is LE correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a cotr ctionlending g ncy 1, r the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is �ssyaed (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name l/ 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. Signature Date 5/3/2016 Licensed - Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building0cupertino org /T1 PROJECT ADDRESS I C1 -1 -IV s4e\ VIS R Jd APN # V q 0 ®1 - OWNER NAME 7MHrqd-e_ PHONE 51 q W5_155-:. E- a STREET ADDRESS t' ID 1 % / po 3 I /✓ 9 CITY, STA ,ZIP A FAX CONTACT NAME �,t@, V j�-7 y� `� J /.�'PHONE m� �' V. 1 ,/ I EAi rMAIL .K1u� eVr. MU—Q U11de1r. `. STREET ADDRESS ' �3"I , `3 V U Y LOQ S I CITY, STATE; ZIP FAX ❑ OWNER ❑ OWNER -BUILDER El OWNERAGENT CONTRACTOR ❑ CONTRACTOR RAAGGE `NT` ❑ ARCHITECT ❑ENGGRMFR ❑ T)PVFTnPPP ❑ �ivehi�{m aC�ONTRACT R AME \/ C t, A t -t / ` ^ LIC EN E E LICENSE TYPE BUS. LIC # ��� PROPOSED USE . CONSTR TYPE / COMPANY NAME �V AVIJ ` E-MAIL -_11`4-%L42)-9q9 (_ [/ �y q 1 FAX `11`4'%`I *� _I_l 6 lQ 6-"9 STREET ADDRESS.. TTY, STATE,. ZIP C. M 2W-1 W. PHONE N _ry q 0.7 „r-, ARCHITECT/ENG ERN e a s�ibs _ LICENSE NUMBER BUS. LIC # COMPANY NAME,( 1 L^ v STREET ADDRESS 30 N `til �..L' /000 D® E-MAII A'OLk2k 14INre2r�c>Z CITY, STATE, ZIP s_, LDU/S,HV &,310 2. FAX 3/(1®23/-08/0 PHONE3/q 2 31, 57 DESCRIPTION OF WORK U►/ pL l C.lr C r ,/ �Yl l�ltc� �N C(,/ Its WUNI NU USE PROPOSED USE . CONSTR TYPE # STORIES - - - Of, / /a,533 USE TYPE OCC. SQ.FT. VALUATION ($) `� P�� �j, AMAEXISTJ✓3 NEW J �f, DAREA �EMO( 1/J INET AREA //_18 5 l0 A2153 /31, 9.2 - BATHROOM - KITCHEN _ }�' OTHER -... REMODEL AREA REMODEL AREA X REMODEL AREA ATTACH # DWELLEV UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑.YES BEING ADDED? �91NO ADDITION? RNO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN❑YES O B� �-� TOTAL VALUATION• PLANNINGAPPL# [ NO PLANNING APPROVAL LETTER EICHLERHOME? RNO ' '; �� '� /� j ��y/� %C - ., ,,,,. ... ... ...... .. . mom... a By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on roperty owner's behalf. I have read this application and the information I have 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 relating to building conss�truction. I authorize representatives of Cupertino to enter the above -identified ro�e for inspection purposes. Signature of Applicant/Ag /tib Q A Date: SUPPLEMENTAL INFORMATION REQUIRED _ 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. B1dgApp_201 Ldoc revised 06/21/11 a CITY OF CUPERTINO FM --7, FEE ESTIMATOR — BUILDING DIVISION ialADDRESS: 19770 Stevens Creek Blvd DATE: 12/10/2015 REVIEWED BY: Phuong APN: 369-06-012 BP#. EVALUATION: JW1,599 71;PERMIT TYPE: Building Permit PLAN CHECKTYPE: Tenant Improvement PRIMARY USE: Commercial Building hrs PENTAMATION PERMIT TYPE: 1 B TI WORK Tenant improvement for Scottrade 2533 SF SCOPE Permit Fee: - TYPE OF FLR AREA OCCUPANCY TYPE: PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. (s.f.) B (Tenant Improvements) II-B,111-B,IV,V-B 2,533 j $2,320.06 IBTIPLNCK 1 $2,292.41 1 IBTIINSP TOTALS: 1 2,533 1� $2,320 06 . $2,292,41 Plan f ,...e FEE QTY/FEE MISC ITEMS 'Fzt3 I'a.<a. ChecA, $2,320.06 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: •° Reg. 0 OT O.Q hrs $0.00 PME Plan Check: $0.00 _ Permit Fee: $2,292.41 Suppl. Insp. Fee:Q Reg.. Q OT 0 0 hrs $0.00 P£r;?€h ec ' PME Unit Fee: E17-�{. PME Permit Fee: $0.00 «4 t. YS, �' S' e r S q... Work Without Permit? 0 Yes Q No $0.00 Advanced Plann n I~'ee:$0.00 cc:hfi?SI `. /'`�G'i.". Select a Non -Residential E) Building or Structure 0 11{j3fi� I��..i, `z: Strong-++ Motion Feb: IBSEISMICO hep" NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These ees are based on the prelimina information available and are only an estimate. Contact the Det for addn'l in o.. FEE ITEMS (Fee Resolution 11-053 F,f: 7/7/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,320.06 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: •° Reg. 0 OT O.Q hrs $0.00 PME Plan Check: $0.00 _ Permit Fee: $2,292.41 Suppl. Insp. Fee:Q Reg.. Q OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Plann n I~'ee:$0.00 Select a Non -Residential E) Building or Structure 0 _ av Strong-++ Motion Feb: IBSEISMICO $36.85 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC ' $6.00 .. SUBTOTALS:: $4,655.32 $0.00. =TOTAL FEE: $4,655.32 Revised: 10/01/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15120099 19770 STEVENS CRK BLVD CUPERTINO CA 95014 VR MASON INC HUNTINGTON BEACH, CA 92647 OWNER'S NAME: LP EVERSHINE VI I I DATE ISSUED: 05/03/2016 I OWNER'S PHONE: 408-343-1088 I I PHONE NO: (714) 843-0707 I LICENSED CONTRACTOR'S DECLARATION License Class DRYWALL tic. #455149 Contractor VR MASON INC Date 05/31/2018 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: 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 1 rr performance of the work for which this permit is issued. 1 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 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 Municip I Code, Section 9.18. Signature ? y!�_ c� r^ _ ' Date 07/29/2016 a BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: TENANT IMPROVEMENT FOR SCOTTRADE (2533 SF) ## 1: LEGALIZE 200 AMP ELECTRICAL PANEL AT REAR - ED 7/29/16 Sq. Ft Floor Area: Valuation: $131599.00 Number: I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. sued by:,p,Pnrlr Awl 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: x. 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 07/29/2016 Signature of Applicant: Date: 07/29/2016 "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_255133r, __ 3y.,—_' Owner or authorized agen Date: 07/29/2016 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.orq ❑ PLUMBING ❑ MECHANICAL L/1xLECTRICAL ❑ MISCELLANEOUS MEP misc PRQJ CT ADDRESS APNY. OWNERNA. P N - 4- -11) E-MAIL r r T,J��EEET ADDRESS N LP CI ,STATE, ZIP / 5-0 I r- uo 7 FAX EiCS–e M� I { ` VC i KJ" f E-MAIL -ull,Q ST EET ADDRES 6 u CI STATE, IP u C1 FAX WNER OWNER—BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME V (-J LICENSE-NUM§ER, 15COMPANY LICENSE TYPE BUS. LIC 0 NAME E—MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E—MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD Or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ NO PROJECT IN FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK 12� 2fl�hyo, Lj TOTAL VALUATION: RECEIVED BY: e 1 By my signature below, 1 certify�eache following: application and the information 1ve provid 3 is c ect. ordinances and state laws relating bui ding const ctio Signature of ApplicanVAgent: I am the property owner or authorized went to act on the property owner's behalf. I have read this I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local I authorize representatives of Cupertino to enter the ab-o7ve-'dfi entie property for inspection purposes. _ Date: Z l / SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER a F' Y ❑ EXPRESS U x ❑ STANDARD v z J ❑ LARGE ❑ MAJOR MEPMiscApp_2011.doc revised 03/16/11 key.. CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: 15120099 19770 STEVENS CRK BLVD CUPERTINO CA 95014 VR MASON INC HUNTINGTON s _....-... ....... -__.._.— -------- BEACH, CA 92647 ........ _....._._._ _ OWNER'S NAME. LP EVERSHINE VI DATE ISSUED: 05/03/2016 _ _- — --- - OWNER'S PHONE. 314-965-1555 __,..- -.... — - — PHONE NO: (714) 843-0707 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class DRYWALL Lic. #455149 Contractor VR MASON INC Date 05/31/2018 — BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL I hereby affirm that [ 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: TENANT IMPROVEMENT FOR SCOTTRADE (2533 SF) 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 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 Sq. Ft Floor Area: Valuation: $131599.00 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 APN Number: 0 Occupancy Type: and state laws relating to building construction, and hereby authorize Q 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. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source re tions per the u7eunicipal) Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Date 5/3/2016 Issued by: Abby Ayende k�m YSignature JER DECL " Date: 05/03/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RFrROOFS- following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. 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 (Scc.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 Codc). Date: 5/3/2016 I hereby affirm under penalty of perjury one of the following three declarations: t. 1 have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance 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 Lhe 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 Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with a Cupertino Municipal Co apter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety de, Sections 25505 255:0, and 534. be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 5/3/2016 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 I hereby affirm that there is a co tr ction lending g nc r the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is s ed (Sec. 3097, 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. Signature Date 5/3/2016 Licensed Professional - ------------ ------- -- ------ —...... ...... ....... . CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION/DEFERRED 151)_0()gq ORIGINAL PERMIT tt PROJECT ADDRESS me, APNNskVeyls 1 OWNER NAME PHONE / E-MAIL/ MAI STREET ADDRESSX/ �l 15 /`�\J CITY, STATT, ZIP A FAX ( I CONTACT NAME (� 11� ^,p ,v W ` V PHONE �k -�43-0�0� E-MAIL .KIu�eVYmo�o�nbul�der STREET ADDRESS 1��2^'11 /�,iS,�0.� S-� 'Q-. vV❑\YOW�NERAGENF CITY, STATE, ZIP�( QIko�j 3•�NARCHITECT `❑ENGINEER FAX I _r6g5� 11 OWNER ❑ OWNER--BUIIILDERIvT ACONT�RAJCTOR 1:1 CONTRACTOR CONTRACTOR AGENT ❑ DEVELOPER ❑ TENANT CQNTRACT AME �O, n I LICEN'E N� E LICENSE TYPE 2, BUS. LIC N COMPANY NAME ()LS 0" EE-MAILQ` FAX Iq_% I J,_9C( ee AmkSTREET ADDRESS TTY, STATE, ZIP PHONE ARCHITECT/ENGIN ER NA I Amami& LICENSE NUMBER �� BUS. LIC H COMPANY NAME E-MAIL lawrenaL FAAX I/ (Y - z3 / - On / STREET ADDRESS :3/ 9 N, 41-th /'Sk /()(),)CITY, STATE, ZIP St LDI /A / � JJ PHONE 3/4 Z 3/-57 DESCRIPTION OF WORK T -T. ._ // I kY ('O%— tA) EXISTING USE Dn ce,EXISTG PROPOSED USE CONSTR. n TYPE k STORIES / USE TYPE OCC. SQ.FT. VALUATION (S) AREA . �/ 533 AREA NEW FLOOR .i J( DEMO OTAL TNETAREA a/5 33 O l .253 /3/ 5W..2 / 5 - BATHROOM REMODEL AREA KITCHEN ` / REMODEL AREA X `RCH OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PO/ AREA GA� AREA: DETACH ❑ ATTACH x X b DWELLIN: IS A SECOND UNIT [:]YES SECOND STORY []YES NF BEING ADDED! mo -` ADDITION! �NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNINGAPPLM gNO PLANNING APPROVAL LETTER IS THE BLDG AN❑ YES EICHLERHOME! RNO REQ: ED BY; O/V%/ T TAL VALUATION- 599. �25- By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on t roperty owner's behalf. I have read this application and the information I have 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 relating to building construction. I authorize representatives of Cupertino to enter the above-identifiedpro a for inspection purposes. Signature of Applicant/Age Date: SUPPLEMENTAL INFORMATION REQUIRED PIaNHKTYPE RgUlI3GSLAF?, ❑`' OVEWTHE-COUNTER ❑ su�ILUING PIAN PFVIICW _ 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 ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. El LARGE ❑ FIRE DJ*PT Copy of Planning Approval Letter or Meeting with Planning prior to ❑' mmoR ❑ SA141TARV SEWER DISTRICT submittal of Building Permit application. _ ❑ ENVIRONMENTAL HEALTH BldgApp_20/ Woc revised 06/21111 M N FM_R7, CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 19770 Stevens Creek Blvd DATE: 12/10/2015 REVIEWED BY: Phuong PC FEE ID APN: 369-06-012 BP#: 'VALUATION: 1$131,599 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IBTIPLNCK PENTAIVIATION 1B TI PERMIT TYPE: WORK Tenant improvement for Scottrade 2533 SF SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 2,533 $2,320.06 IBTIPLNCK $2,292.41 IBTIINSP $0.00 PME Plan Check: $0.00 Permit Fee: $2,292.41 Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 2,533 $2,320.06 $2,292.41 MECH, HOURLY 0 Yes E) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No Lj NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These_fees are based on the preliminary information available and are only an estimate. Contact the Dept. for addn'l info. FEE ITEMS 0,ee. Resolulion 11-053 E_ . 7%1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,320.06 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. () OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,292.41 Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 _FT 0 G Work Without Permit? ® Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Q 0 Strong Motion Fee: /BSEM1,11Co $36.85 Select an Administrative Item Bldg Stds Commission Fee: 113CBSC $6.00 SUBTOTALS: $4,655.32 $0.00 TOTAL FEE: $4,655.32 Revised: 10/01/2015 GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE. CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.otg XMBING F IMECHANICAL T.RC.TRIC'AI. F ITOT.gC :~TI ANTPOT APN # MEP MISC vvviv_nni� ,I h 4N2 - EE ---MAIL �,9EE ADDRESS ((� CI ,STATE, ZIP r i `1. FAX ACT NAM��yig{pp� 65 VCE-MAILo �,SCTJATE, V� . ST ETG RESP S u C P t� ^` `7 FAX WNER OWNER -BUILDER ❑ OWNERAGENT❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME VIZ I V1 cd LICENSE NUMBE ;V 55 LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi 'Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK M 1 ZC_._ ftme e� it TOTAL VALUATION: By my signature below, I certify to each he 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 ve provid is c ect. 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 to building cons ctio I authorize representatives of Cupertino to enter the aboveerty for inspection purposes. Signature of Applicant/Agent: Date: -7-MM i SUPPLEMENTAL INFORMATION REQUIRED AFF, I V V. tCR (iNr.V; MEPMiscApp 2011.doc revised 03/16111